Figure 1: Clinical case A is a 37-year-old male with multiple failing composites, recurrent decay and broken incisal edges due to parafunctional activity. For these reasons, CZ crowns were a better choice than porcelain veneers.

Figure 2: Even though the patient decided not to treat the entire arch, the CZ crowns on teeth #7–10 have made a significant esthetic improvement in his smile. Because of the zirconia coping, there is no possibility of a gray margin ever appearing.

Figure 3: The close-up photograph of the CZ crowns on a black background highlights the natural incisal edge translucency of these restorations. The beauty of all-ceramics and the strength of a PFM is a winning combination.

Figure 1: Clinical case B consists of a full upper arch of CZ restorations. In addition to the other esthetic challenges that are present here, notice the shades of teeth #9 and #10, which have both been endodontically treated.

Figure 2: The prep shade of the teeth are within normal limits, with the exception of teeth #9 and #10. The discoloration of these teeth presents a difficult esthetic challenge for all-ceramic restorations. While I might prefer to use an esthetic PFM such as Captek™ (Argen; San Diego, Calif.), the patient insisted on all-ceramic crowns.

Figure 3: This lateral view of the finished restorations focuses on the discolored teeth, which have been completely blocked out by the CZ crowns. With all-ceramic restorations, it can be a challenge to get restorations to blend on a case like this.

Figure 1: Clinical case C consists of CZ crowns on teeth #8 and #9. Due to the dark shade of these endodontically treated teeth, it is not possible to use a pressed all-ceramic crown. Zirconia copings will keep the prep from showing through regardless of how dark they are.

Figure 2: A digital X-ray of the CZ crowns at try-in shows how dense the underlying zirconia copings are; they almost appear to be metal. The X-ray is also used to verify the fit of the CZ crowns prior to cementation.

Figure 3: With the CZ crowns backlit, the translucency of the crowns is apparent even though the copings are dense enough to block out the prep shades.

Figure 4: The CZ crowns blend in well with surrounding dentition, and there is no fear that one day gray margins will appear if any gingival recession happens to occur.

Figure 1: Clinical case D is a 31-year-old male who was born without his left maxillary central incisor. Because there is no room to place an implant to replace this missing tooth, CZ crowns and Vivaneers™ no-prep veneers were used to correct the smile.

Figure 2: The CZ crown placed on tooth #10 was shaped to look like tooth #9. The CZ crown placed on tooth #11 was shaped to look like tooth #10. The CZ crown on tooth #8 was reduced heavily on the mesial to move the midline back to the right. Vivaneers no-prep veneers were utilized to complete the smile.

Figure 1: Clinical case E is a 47-year-old female who has chewed through two cast gold crowns on teeth #2 and #3. Additionally, tooth #4 has a vertical fracture through the mesial marginal ridge and requires a full-coverage restoration as well.

Figure 2: CZ crowns were placed on teeth #2–4 with no fear of fracture, due to its proven clinical record of high strength and longevity. As a result, all CZ restorations can be cemented with conventional cements such as 3M ESPE’s RelyX™ Luting Cement Plus (St. Paul, Minn.).

Figure 1: Clinical case F is a 29-year-old male with multiple failing interproximal incisors and recurrent decay on teeth #7–9. Tooth #10 had a failing PFM crown with a gray margin starting to appear on the facial.

Figure 2: CZ crowns were placed on teeth #7–10 to accommodate the patient’s wish for “no more metal margins.” Vivaneers no-prep veneers were used on teeth #4–6 and #11–13 to finish the smile.

Figure 1: Clinical case G is a 25-year-old female who had endodontic treatment on teeth #7–9 due to accidental trauma. Because of concerns about the preps turning darker with time, it was decided to do CZ crowns on these teeth rather than veneers.

Figure 2: CZ crowns were placed on teeth #7–9 and individual Vivaneers no-prep veneers were placed on teeth #4–6 and #10–13. The combination of all-ceramic crowns and no-prep veneers is an excellent way to enhance a smile.

Figure 1: Clinical case H is a 37-year-old female with an existing PFM on tooth #8 with recurrent decay. She also doesn’t like how tooth #7 is severely rotated.

Figure 2: CZ crowns were used on teeth #7 and #8 to improve the alignment and esthetics. We used Vivaneers no-prep veneers on teeth #4–6 and #9–12 to complete the smile makeover.

Figure 1: Clinical case I is a 47-year-old female who was unhappy with several aspects of her smile. Her chief complaint was a PFM bridge from teeth #5–7 that had exposed metal margins on both abutments.

Figure 2: An all-ceramic CZ bridge was placed on teeth #5–7 and single-unit CZ crowns were placed on #8 through #12. The patient no longer covers her mouth with her hand when smiling.

Figure 1: Clinical case J is a 43-year-old male with multiple failing PFM crowns. Also, tooth #7 needs to be removed due to a failed endodontic re-treatment. Due to the patient’s dislike of exposed metal margins, we decided to use all-ceramic CZ restorations.

Figure 2: We placed a three-unit CZ bridge from teeth #6–8 and single-unit CZ crowns on teeth #5 and #9–11. A laser was used to create an ovate pontic receptor site for the pontic on tooth #7. We were able to eliminate the metal margins and the open gingival embrasures with the new CZ restorations.