:t.

14
Tesl87.1
UseofZirconiain RestorativeDentistry
RichardM.
Parker; DDS
T
hough zirconia has been available for
use in restorati ve dentistry for several
years, t here has been an increased
interest recent ly in these materials. Zirconia-
based res t orati ons are qui te versatile and can
be used for crowns, bri dges, and implant abut-
ments in a vari ety of clin ical situations if th e
approp ri a te gui delines a re followed.
The typ e of zirconia used in denti stry is
yt t ria tetragona l zirconia polycrystal (Y-TZP)
ma terial , which is a zirconia oxid e. Yttria
(Y
2
0
a
) is a n oxide of th e metal lic element
yttrium (at omic No. 39) .
Y-TZP is a monophase ceramic mater ial
that is formed by directly sintering crystal s
together wit hout any intervening matrix to
form a dense, ai r-free, polycrystalline struc-
ture. The yttri a is added to the zirconia to sta-
bilize the st ructure and main ta in the materi-
al 's desirab le properties.
Many denti st s are not familia r with zirco-
nia, its di ffer ences compared t o other ma t er i-
Both fully sintered (HIP) and partially sin-
tered (non-HIP) zirconia products appear to
be clinically acceptable... Caution is urged,
however, in regard to the clinical application
of this material. Long-term, multicenter stud-
ies are needed.
als, th e diffe rent types that are available, an d
clinical in di ca ti ons an d usage. After reading
this art icle, th e read er will have an under-
st a nding of zirconia's prope rties and t he
knowl edge to make a ppropriate t reatment
decisi ons regardi ng its use.
PROPERTI ES OF ZI RCONIA
The flexu ral strength of zirconi a oxid e mate-
rials has been re ported to be in th e ra nge of
900 to 1,100 MPa.
l
This is approxi ma tel y
twice as st ron g as alumina oxide cera mi cs
currently on th e market and 5 times gre ater
than st an dard glass ceramics.
Even more impor tant is the fr actur e
toughness of t he material. Fracture t ough-
ness measu res th e ability of a mate ri a ] to
resi st prop agation of an inte rnal cr ack (frac -
t ure ). This is a n important indication of a
ma te ri al 's cli nical re liab ility.f Cli nically, non-
DENTISTRY TODAY'MARCH1007
FIgure1...Preparations for single-unit anterior Zirconia figure 2.Zirconia copings tor anterior crowns.
crowns.
FIgure 3. Zirconia copings seated on laboratory model. Rg we 4. Anterior zirconia-based crowns cemented in
pface .
fatal cracks (cracks that devel op in th e zirco-
nia bu t do not result in complete fr acture or
failure of the restoration) for m fr om cyclic
fat igu e, wh ich can lead t o fa il ure of th e
res tora t ion if the cr ac ks propagst e.
a
Zir-
con ia's fra cture t oughness is be tween 8 a nd
10 MPa m
ll2
,4 whi ch is almost t wice as high
all tha t of al uminum oxide ceramics. This is
due to transformat ional tou gh ening, whi ch
gives zirconia it s unique mecha nical pr oper-
ti es . Beca use of its tetragonal polycrystall ine
struct ure, when a crack devel ops th e ma te rial
t ra nsforms to a thermodynami call y more
favorable monoclinic form. Thi s t rans forma-
tion is associate d with a 4% local in crease in
volume , wh ich produces a "cl amping effect " on
th e cra ck a nd halts its furth er expa nsi on. f
I n additi on, without any glass ma trix, zir-
coni a oxi de mat er ials a re generally s tronger
a nd offer more res istance to cr ackin g t han
oth er ceramice.f Furthe r, che mical cor rosion
occurs on glass s ubstrates, which can lead to
clinical failure. The aqueo us component in
saliva can react with glass in ceramic materi-
al, cau sing cor ros ion . This can increase th e
rate of crack propagation and lea d to failure
of th e material,
TYPES OF ZIRCONIA
Three main type s of zirconia are avai lab le for
use in clinical dentis try. Th ough th ey are
chemically ident ical , t hey have slight ly differ-
en t phys ical pr ope r t ies (eg, porosi ty, den sity,
purity, strength), which may (or ma y not ) be
clinically r elevant.
There is th e ful ly sin tered or HIP type of
zirconia. HIP sta nds for "hot isostatic press-
ing," and is a sint e ri ng technique used in th e
cerami c industry that utihzea high tempera-
tures a nd pr essures t o increase density of th e
materi al . Examples of t his type of full y sin-
conti nued on page 11 6
Useof Zirconia...
continued from page 11 4
FIgure 5. Preoperat ive view of teeth
for fixed bridge.
Rgure 6. LBboratorymodel at
preparati onsforzirconia bridge.
FIgur e 7. Zirconia t rameworkfor
bridge for Nos. 12 to 14.
FIgure 8. Zirconia bridge framework
afterveneeri ng wlth porcelain.
FIgUre 9. Zirco nia-basedbri dge
sea ted on laborat ory model.
Rgure10. Post oper at ive vi ew of
bridge for Nos. 12 to 1 4 cemented
in place.
OEl'Ii Tl\ fRY m OAY. MARCB z007
te red zirco nia are DC-Zirkon
(DCS Dental AG) and Ever-
est -ZH (KaVo).
The second t ype is a par-
tiall y si nt ered zir conia, an d
th e th ird type is nonsintered
or "green state" zirconia. Due
to th e simi la r ma nufact uri ng
a nd fabr ica ting processes,
bot h of these types will be
considered together (partially
sintered or non -HIP zi rconia).
Blocks of these typ es of mate-
ri al s are manufa ct u red by
utilizi ng a spray-dri ed zirco-
nia powde r th at is th en iso-
stat ically pr essed and incom-
plete ly sinte red. These mate-
rials rema in softer than the
HIP zirconia and are easi er to
mill. After milling, the zirco-
nia is then sintered complete-
ly in a furnace a t l ,350C to
1,500 C to achiev e its final
s hape, st rengt h, an d phys ical
properties. Examples of thi s
typeare Lava (3M ESPE), Cer- .
con (DENTSPLY Ceramco),
and Vita YZ (Vident).
Another t ype of zirconia
product is that employed by
Nobel Biocare's Procera sys-
tem. Thi s process uti lizes a
slurry of zirconia oxide that is
applied to an oversized die
and then sintered.
FABRICATION
The most common method to
fabricate a zirconia substruc-
t ure is by CAD/CAM mi lling
from a solid block. The fully
sintered zirconia is mil led at
a 1:1 ratio, while t he partially
si ntered zirconia is mi lled
20% to 25% larger than t he
des i re d final size du e to
shrinkage ca use d by the si n-
teri ng process." For bot h t he
pa rtially si n tered a nd th e
fully sintered tech niq ues, the
die is scanned, and then the
compute r progra m des igns
the framework or the coping.
After the milli ng and any
necessary si ntering, t he por-
celai n is then han d-applied
over th e zi rco nia for th e
restorati on's fina l shape and
shade. For cli nical success,
the layeri ng por celain ideally
should have the same coeffi-
cient of thermal expansio n
as t he zir conia substructure,
and t he refore only s pecifical-
ly engineered porcelains can
be used. Porce lain t hat is
use d in por cela in-fused- to-
meta l restorations can not be
used wi t h a zirconia su b-
str uctur e, since delamina-
tion wi ll occur. Further, prop-
er firing of a bonding layer of
porcelain to the zirconia core
is essential to create a sta-
bl e in t er fa ce be tween the
2 material a.s
On average, manufactur-
ers recommend that the min-
imal thickness for a zirconia
coping should be 0.3 mm for
a nterior teeth and 0.5 mm for
posteri or teeth. For a fixed
prosth esis fab ri ca te d with
zirconia, the cross -sectional
dimens ion for a connect or
should be 9 m m-', This is
much smaller t han the 16-
mm
2
connector recommended
for conve ntional glass ceram-
ics. This decrease in coun ce-
tor di mension is du e to zirco-
nia's greater st rength, allow-
ing for a small er connector
and thus resulting in a mor e
aesthet ic appearance.
It is iroportant to note
t ha t the labora tory tech ni-
cia n plays a very important
role in the fabri cation proc-
ess . Identical cas es sent to
differ ent la boratories pro-
duced different results .
s
Cli nicia n's shou ld use a labo-
ratory that has good knowl-
edge of zirconia's prope rties
and a t horou gh und ers tand-
ing of th e enti re fabrica tion
process to ens ure a successful
clinic al res ult .
FULLYSINTERED VERSUS
PARTIALLYSINTERED
MATERIAL
Th e question often arises as
to which type of zirconia (HIP
or non-HI P) is bes t to use. It
appears that t hey both have
their a dva nta ges and disad-
vantages. Fully sint ered HIP
zirconi a has a denser poly-
crystalline structure wi th less
porosity th an non-HIP mate-
ri al ," and this should trans-
la te clinically into increased
resistance to frac ture. On the
other hand, SOme investiga-
tors have questioned whether
th e grinding nee ded to mill
th e fully sint ered zir conia ,
an d the heat t hat is generat-
ed, ca use su rface an d struc-
tural defect s that can have
adver se clin ical implicat ions. P
The margi nal fit of either
type of mat erial is associated
with very acceptable clinical
resul ts . The mi lled margi ns
are t he equa l of, or are s upe-
rior to, t he fit of a restoration
fabricated of a high noble
all oyf Studies have measured
the marginal gap of CADI
CAM-mil led zirconia of both
var ieties and found that to be
40 to 70 ]llIl,l O
The manu factu ri ng proc-
ess for HIP zirconi a is more
expe nsive, involves more ma-
chining time, and is more
labor -intensive t o fi t the
coping than non -HIP sy s-
t oms." As a r es ul t , n on-HIP
systems cu rren tly dominate
t he market place.
CLI NICAL IMPLICATIONS
Considering zi rcon ia' s high
str ength, this mater ial en-
ables the clinici an t o place a
ceramic restorati on almost
anywhere in the mouth. Sin-
gle crow ns, imp la n t abut-
ments, and bridges can be fab-
ricated fr om zirconia.
11
, 12
Manufactur er s suggest that 2
ab utment bridges can have a
38-mm span, and mul tiple
abutment bridges can have a
span of 47 mm.f
Zirconia is a semitrans-
lucent s ubstance tha t is only
slightly more opaque t h an
denti n.3 By varyi ng th e th ick-
ness of the coping, t he
amo unt of opacity can be con-
tro lled. In addition, Lava (3M
ESPE) and inVizion (Vident)
allow t he lab to shade the
s ubst r uct ure in t he "green
state ."Th is a llows th e color to
pene t r ate th e material, as
opposed to surface stain, giv-
ing the final restorati on a
nat ura l appearance ("chroma
from wit hin").
Zirconia is radi opaqu e, en-
ab ling the clini cian to detect
more easi ly improper fit an d
marginal caries. Addi tio nally,
it has been show n to be bio-
compati ble, without any re-
ported cases of toxicity, pa-
tient allergy, or sensitivity,l3
TOOTH PREPARATION
The tooth preparation needed
t o accommodate a zirconia
rest orati on is essentially t hat
of a porcelain-fused-to-metal
crown with a few modifica-
tions . The 3M ESPE recom-
mendations for its Lava zirco-
nia is 1.5 to 2.0 mm of
incisaVocclusal reductio n and
1.0 to 2.0 mm of axial r educ-
ti on. The r ange of red uction is
related to the aesthet ic needs.
The mor e tooth reduct ion, the
more available space for the
lab t echnician to appropriate-
ly layer various porcelai ns to
achieve better aest hetic s.
Some clinicians and t ech ni-
cians advocate 2.0 to 2.5 mm
of incisal/ occlusal reduction
for opti mal appear an ce and
anatomical form.3 The axial
continued on page 118
figure 11Preoperative view of tooth
No. 11 and of implant No. 12 (with
transf ercoping in place). Note that
the pati ent is mi ssing toot h No. 10.
Rgure12.Preparationof tooth No.
11forzirconia crown.
FIgUre13. Laboratory mode l at
preparation No. 11 and implant
No. 12.
Rguro 14. Zirconia copi ngs for
crown Nos. 11 and 12 and zirconi a
implant abutment No.12.
figure15. Zirconia coping and zirco-
nia implant abutme nt on laborat or y
model.
Rgure16.Zirconia Implantabut-
ment seat ed clinically.
Useof Zirconia...
conti nued from page 116
ta per s houl d be gre ater th an
or equ al to 4
0
, a nd the hori-
zontal angle of th e margin
should be greate r th an or
equal to 5".
Du e to the limitations of
the die-scanning process and
the s ubsequent machine mil-
ling , sharp an gl es in the
preparati on must be avoid ed.
A circumferential deep cha m-
fer or rounded s houlder at
t he gingival margin is recom-
mended. Ninety-degree shoul-
ders, tr onghing at t he mar-
gi ns, feather edge margins,
undercuts , or sh arp line an -
gles are not accep table.
AESTHETIC QUALITIES
The metal-free nature of a
zirconia restorati on is an
advantage wit h regard to aes -
thetics, but if th e preparation
is inadequate or the laborato-
ry design is flawed, then th e
fini sh ed crown Or bridge can
be un appealing'. The most
common inadequacy is teeth
that are not r educed suffi-
ciently. This can result in a
restora ti on that is too opaque
and ha s a mono chromati c
appearan ce. Likewis e, if the
laboratory designs a restora-
tion wi th a copin g that is too
thick, or the connectors are
too large, th e r esul t will be
a n aesthe t ica lly unappeal-
ing cro wn or br idge th at
looks too bulky.
Du e to the inh erent opa c-
ity of the zir coni a , the clini-
cia n must be s ure that the
tooth is prepare d adequa t ely
to all ow enough room for the
substructure an d the porce-
la in layer. If thi s is not the
cas e, t hen the opaque coping
can show through. In addi-
ti on, if the lab oratory techni-
cian creates a restoration in
which the zir conia is t oo
thi ck, then th er e may not be
enou gh space for veneering
porcel ain . Furthermore, the
technician needs to consid er
the final shade and sele ct an
appropriately colored zirconia
that a llows layering of vari -
ous translucencies of porce-
lain to develop a restoration
th at demonstrates "color from
within."
To enhan ce a nte ri or aes-
th eti cs, the clini cian ca n use
a r ounded sh oulder pr epara-
tion, then cut back the zir co-
nia copi ng sligh tl y to pla ce a
more translucent por celain
at the margin. This allows
light to pass through the
tooth structure and better
bl end the r estoration/root
junct ion, resul ting in a natu-
ral ap pearance.
PLACEMENT TECHNIQUES
Pl acement of zirconi a restora-
ti ons ca n be via standard
cemen tation or by bonding.
Thi s can simplify the place-
Code:DTO:J07
FREEinfo, circle 77 on card
Agure 17. Zirconia-based crowns
on laboratory model.
Flgure 18. Postoperati ve view of zlr
conia Implant abutment and crown
Nos. 11 and 12 .
ment pr ocess and gives th e
dentist a number of options.
Due t o zirconia's inherent
strength, convent ional ce-
ments like zinc phosphate or
polycarboxylate ca n be used,
These cements may not be
the first choi ce, however, due
to their physical pr operties as
well as their opaque nature.
Opaque cements may show
t h rough t he zirc onia and
affect th e final appearan ce of
th e restora tion. Glass iono-
mer, resin- modifi ed glass
ionomer , and self- etching
resin cements have a ll been
used with succes s,14,15 and
th ese have the potential to
enhan ce aesthet ics. Further,
with these cemen ts the clean-
up of the excess cement at the
margin is eas y, and elimina-
tion of exces s ce me nt is
a lways clini cally beneficia l.
In th e case of short or ex-
t re mely ta pere d preparati ons,
a bond ed resin cement may
be best. The probl em is how to
achieve adherence to the zir-
conia. Zirconia does not etch
with hydr ofluori c aci d due to
lack of a glass ma t rix , nor
does it conta in sili ca to allow
silane coupli ng to occur. By
sandblas ti ng t he intaglio s ur -
face with a l umi num oxide
particles, a relatively weak
bond can occur bet>veen t he
z:i reonia and th e resin .l '' The
bond to z:i rconia can be fur-
th er improved by using a
che mical s urface treatment
wi th th e Rocatec system (3M
ESPEl prior to bcnding.l?
The choice of placement
technique ultimately depends
upon th e clinical situat ion.
Th e dentist needs to deter-
mine how much ret ention the
References
preparation provi des , t h e a es-
1. SN. Miklus VG, McLa", nEA, atat
thetic demands, the type of
Rexur at strergth ofa layeredarccota
restoration bei ng placed, and
endporcelaindental en-cerarrecsystem.
J ProslhelDent 2005:94: 125131. Continuing Education
the location in the mout h.
2, Evans AG. Perspective on the devel- - ,..
opment 01high -toughnessceramics.J
Am Gerem Soc. 1990;73:187206. ':c..
POTENTIALPROBLEMS
3. McUl"'n EA. Hyo L CAD/CAM l4ldala:
Failure of dental materials techmloqtesand materials amctinical
TestNo. 87.1
-
can anddoes occurin clinica l
dental practice. All failures
cannot be prevented, b ut th e
majority can be prevente d if
both proper material selection
guidelines a nd usage r ecom-
menda t ions a re followed in re-
ga r d to preparation, fabrica-
tion, and cementation.
The potential probl ems
t hat ca n occur with zirconia
can be divided into 3 ca t-
egories:
s ubstruc ture failure;
failureofthebond at the
interface between the zir coni a
and the layeringporcelain;and
bre akage a n d chip-
ping of the porcel ai n veneer.
Du e to t h e lack of long-
te r m clinical st udi es ,it is dif-
ficul t to report on the fail ur e
ra te of zirconi a An ecdotal ev-
idence a nd limit ed , s hort-
term clinical studies suggest
tha t the mater ial is cli nically
acce pta ble.Jf Some fr a ctures
of the por cel a in layer h a ve
occurred.Ifbut th ecauseha s
not been de te r mined. Lon gi-
tudi nal studiesare n eeded.
One property of zirconi-
um oxide tha t h as not bee n
well studied is th e ph enome-
non of low- temper ature de-
gradationor"agin g." Waterand
nonaqueou s solvent s a r e in -
volved in formation ofzirconia-
hydroxides alo ng a crack.This
process acceler atesexpansion
of th e fr acture and can result
in reduced strength, tough-
ness, and density, leading to
failureofthe restoration.P
CONCLUSION
Bothfully sintered(HIP)and
partially sinte r ed (non-HIP)
zirconi a pro ducts a ppear to
be cli nical ly acceptable. Th e
pr eparati on and cementation
pr otocols are similarto what
is used for conventional por-
celain-fus ed-to- metalrestora-
tions . Ca uti on is urged, h ow-
ever, i n regar d to th e cli nica l
application of this material.
Long-term, multicenter stud-
ies aren eeded. Currently,zir-
con ia appears appropri a te for
single crowns, a nterio r im-
pl ant ab utments, and an teri-
or/posterior bridges with one
ponti ca nd a spanless thanor
equal to 38 mm (Figures 1 to
18).
perspectives. Inside D8fJtfstry. 2006 ;
Nov/Dec:l02.
4. MclarenEA,Glordanc RAII.Zirconia-
based ceramics: material properties.
esthetics,andl ayering of a
new veneering porcelain, VM9.
Quintessence Dental tecnna. 2005;
28:99-111.
5. Guazz ato M.AIbaJ<ryM. Ringer SP,et
al. Strength, fractur e toughness and
micr ostructure at a selecti on of 5.11-
cerami c material s. Part II. Zirconia-
based dental ceramics, Dent Mater.
2004:20:449456.
6. Guazzato M,AlbakJy M.Ri ngerSP. at
al. Strength, fractur e toughness and
mi crostructure 01a selection of all-
ceramic materi al s. Part I. Pressa ble
andalumina glass -infilt ratedceramics.
Dent Mat er.2004;20:441-448.
7. Keough BE. KayHB.Sagar RD. Aten-
unlt all-ceramic anterior fixed parti al
dent ure usin g YTZP zirconi a. Pract
ProceaAesthetDent.2006;18:37'43
8. Impor tant changes in fixed pr ostho-
dontics. eRA NewsJeffer. Sep 2005;
29:1-4.
9. Lu1I1ardt RG, Holzhutar MS. Rudolph
H, et aI.CACWCAM-machining effects
on Y-TZP zi rconia. Dent Mater.
2004;20:655662.
10.Hertl ein G, Hoscheler S, Frank S, et
al. Marginal fitof CAD/CAM manufac-
tured all ceramic zi rconi a prostheses.
J Dent Res.2001:80: _tract49 .
11. Sadan A, Blatz M, lBnO B. Clinical
considerations tor densely si ntered
alumina and zirconi a restor ati ons: Part
1.Int J Pen'odonticsRBstoratweDent.
2005:25;213219.
12.Sorensen JA The Lava system for
CAD/CA M producti on ofrogh-stTength
precision fixed prostnooonncs. Quin-
tessen ce Denttl l Techno l. 2003;
28:5767.
13.Zirca'lia SURJOrtedceranic fued pros-
11188es,CRANewsJeaer. Nov2004:28:2
4.
14.PalaciosRp'Jot'nsa1GH. KM.at
al.Reten1ionof zircoriunoxideceramic
crowns with three types of CEment J
Prosthet Dent 2006 ;96:104-114.
15. ..p. NothdJr1lF,ftlspochP.1n-
vitr o Investi gations on the fracture
strengtt1 of all-ceramic posterior bridges
of zroz-ceremc.J 0Frl Res. 2001;80:
Abstract173.
16. KinzerGA. Cementati on 01lava reeera-
tiCYl s.AcNanced Esthetics sraInterdi.9-
dplinary DenIisJIy. 2006:2(3) 026-32.
17.Atsu SS, Kilicarman MA. KuaJ<esrren
He, at al. Effect of zi rconiurn-mdde
ceramic swacetreatmen1B mthe bcrd
strengU1 to adhesive resin. J Prr::5thet
Dent 2006 ;950430 -436 .
18.Zircona vs, porcel ain-fused-to-metal
(PFM); di rical pel10rmance at 1 year.
eRA Newslener:Nov2006:30;1,4.
19. ChevalierJ.\Nhatfutur e forzirconiaas a
biomaterfal?Bi omaterials.2006;27:535-
543
Acknowledgment
Laboratory pr ocedure s were
performed by Rol and B.
Tasker,CDT.
Dr. Parker Is in private practice in
Lemont, III. HeIsa graduate ofthe
UniversityofIllinois, has completed
theEstheticDentistry Programat the
Unive rsity of Minnesota ,andis a Fel -
lowIntheAGO. Dr. Parker practices
generaldentistrywith an emphasis
on restorative aesthetics and canbe
reachedat ParkerDenlal1@aol.com.
T
o submitContinuing Education answers , usethe answers hee t on pag e 112.On the
an swers heet ,identify thearti cle (this one isTest87.1), place an X inthe box corre-
s ponding to the answer you be lieve is correc t, de tac h the answe r sheet from the
magazi ne ,and mail to DentistryToda y Department of Cont inuing Edu cation.
The following8 quest ions were de rivedfromthe art icle Useof:OrconiainRestoratiVe
DentBlJybyRichar d M.Pa rker, DDS,on pages 114 through 119.
'!i"ii,ji!1!l!@lfU-
Afterreadingthisarticle,the individualwilllearn:
the phys ical prope rties of zirco nia oxide materials, a nd
clinica lappli cations andtechniquesfor zirconia materials.
1. Thetypeof zirconiaoxideusedin den- 5. Preparationsfor zirconia restorat ions
tistryis composedDf __' mustnothave
a.a matrix-free,dense polycrysralline a 1.5mm102.5 mmofincisaVocciusal
material reduction
b. ceramiccrystals embedded ina glassy b.1.0 mmto2.0 mmofaxialreduction
matrix c.anaxialtaperofatleast4"
c. a reucite-rei nforced pressed ceramic d.sharp,900shoulderpreparations
d.a metal andglass heterogeneous
mixture Bondinqof zlrconiarestoratlonscan be
problematicbecause_ _"
2. TransformationaltDughening refersto a. thereis notaglassmatrixtoacid-etchand
zirconia'sabilityto __. theydonotcontainsilicaforsilanating
a. producea"clampingeffect'oncracksto b. hydroftuoricaciddenaturesthetetragonal
stoptheircontinuedgrowth crystallinestructure
b. changeitsphysicalstatewhenrepeatedly c.dental adhesiveswillnotsetunderzirconia
heatedandCooled duetochemicalinhibition
c. exhibit propertiessuchas d.resincementswill expandandfracture
ductibilityandburnishability thecoping
d. transform thevereeringporcelain irtto a
zirconia-likeceramic 7. Themain clinicalconcernwith zirconia
restoratiDns is
3. The most common way to fabricate a a.theyaretoo unaestheticforuse inthe
zirconiasubstructureIs by _ _. anteriorregion
a.CAD/CAM technology b. theyarecostprohibitive touse indaily
b.the"lostwaX'technique practice
c.electrophoresis c. theyhave beenshowntobehighly
d.the plasma-spraymetl10d allergenic
d.long-termclinicalstudiesarenotyet
4. Zirconiarestorationsdemonstrate available
a. highftexuralstrengthandhighfracture
toughness 8. At present, recommended usageof zir-
b. semitranslucencyandability tobe coniais restrictedto
cemented a.singlecrowns
c. radiopacityandgoodmarginalfit b.anteriorimplantabutments
d. alloftheabove c.short-spanbridges
d.all oftheabove
tinui J fEll "
Conmumg our " ourney 0 xce ence -0TftD..,y
MARC)) ZD07 ' DENl'&IRYTODAY