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ovenber 2006 | XXXEFOUBMFDPOPNJDTDPN

ro 25 peicenr moie pei unir oi rleii veneeis. Again, since
insuiance ooesn`r covei rlese iesroiarions, you aie iee ro
ser ees wleievei you woulo like.
Piesseo ceiamics, sucl as !PS !mpiess, weie rle hisr
meral-iee iesroiarion ro make a laige impacr on oenrisriy.
Tle inciease in populaiiry o poicelain veneeis rliougl
rle yeais can le rieo oiiecrly ro rle oevelopmenr o piesseo
ceiamics. ! srill rlink rleie is no iesroiarion rlar is moie
esrleric rlan an !mpiess veneei. ! hno !mpiess veneeis
look lerrei rlan even !mpiess ciowns' \len oone ly a
skilleo reclnician, rlese veneeis can iival rle leaury o a
naruial roorl. ! srill use a lor o piesseo ceiamics, lur only
oi piep ano no-piep veneeis. `ow rlar we lave srion-
gei cemenralle all-ceiamics oi use on licuspio ano molai
ciowns, ! conhne my piesseo ceiamic use ro veneeis. \irl
rle cloices availalle in cemenralle all-ceiamic ciowns, !
see no ieason ro evei oo anorlei piesseo-ceiamic ciown,
lecause o rleii lowei sriengrls ano rle neeo ro lono rlem
inro place.
ExpIosive growth oI tircooia
Tle liggesr clange in rle all-ceiamic maiker iom 2OO5
las leen rle explosive giowrl o ziiconia-laseo iesroia-
rions. !iom 2OO5 ro 2OO6, rle ziiconia-laseo ciowns ano
liioges piesciileo ly oenrisrs wenr up +17 peicenr. Tlar
is nor a rypo, ir ieaos oui lunoieo sevenreen peicenr' Tle
rwo liggesr piooucrs in rlar caregoiy aie !AVA ano Clini-
cal Ziiconia, alrlougl Ceicon ano Pioceia aie in rlar car-
egoiy as well. \ly ooes ziiconia seem ro le carcling on so
asr? Mucl o ir srems iom iepear lusiness iom oenrisrs
wlo aie sarisheo wirl rle piooucrs. !er`s rake a closei look
ar ziiconia ano low ir came ro le useo in oenrisriy.
Tle seaicl oi a ligl-sriengrl, esrleric, liocompar-
ille meral-iee mareiial rlar coulo le useo oi mulri-unir
iamewoiks as well as single-unir iesroiarions las leen rle
ocus o many ieseaicl ano oevelopmenr eoirs ouiing rle
lasr oecaoe. Some oenrisrs lave wanreo rlese mareiials in
ALL-6E8AMI6 8E8I8AIIN8 conrinue ro make in-
ioaos inro rle oveiall iesroiarive maiker ar rle iare o alour
1 ro 2 peicenr eacl yeai. !n 2OOO, appioximarely 2O peicenr
o iesroiarions weie all-ceiamic, ano yeai ro oare in 2OO6
ir las iisen ro 31 peicenr o iesroiarions. Meral-iee ie-
sroiarive oprions incluoe composires, piesseo ceiamics, ano
cemenralle all-ceiamic piooucrs. !acl o rlese meral-iee
oprions las a place in cuiienr esrleric iesroiarive oenrisriy,
ano ! will slaie wlar ! rlink aie rle piopei inoicarions oi
eacl o rlese mareiials. Ceirainly, we lave seen ailuies in
rle lal wlen oenrisrs arrempr ro pusl rlese mareiials le-
yono rleii inoicarions. Tleie aie srill seveial clinical siru-
arions rlar call exclusively oi rle use o P!M iesroiarions,
lur rlar lisr o siruarions is sliinking.
ne inreiesring rieno in rle all-ceiamic segmenr is low
rle inoiiecr composire maiker conrinues ro slowly oie.
Amazingly, as rle all-ceiamic maiker las conrinueo ro ex-
pano, rle inoiiecr composire maiker is oown +5 peicenr
since 2OO3' !n my communicarions wirl oenrisrs as ! lec-
ruie aiouno rle counriy, rle ieasons oi rle oeciease in
composires lecome cleai. enrisrs complain rlar rle ois-
mal insuiance ieimluisemenrs oi rlese iesroiarions ano
rleii sloir clinical longeviry (wlen compaieo ro orlei ies-
roiarions) aie rle main ieasons rley lave sroppeo placing
composire inlays ano onlays.
!r is easy ro piohr iom meral-iee iesroiarions lecause,
ly oehnirion, rley aie appeaiance-ielareo ano rypically es-
rleric in naruie. Since rley oren aie useo ro impiove a
parienr`s smile, many parienrs aie moie morivareo ro lave
rlis rype o riearmenr oone as compaieo ro oioinaiy ie-
sroiarive riearmenr. !uirleimoie, oi iesroiarions sucl as
poicelain veneeis, rleie is no insuiance lenehr paio. Tlis
allows piacririoneis ro ser ees ar any level rley eel is aii.
!oi example, ! rlink rlar piepaiing ano lonoing veneeis
is moie oihculr rlan piepaiing ano cemenring ciowns.
Tleieoie, ! lelieve rlar veneeis sloulo lave a liglei ee
rlan rypical ciowns. Many oenrisrs !`ve mer oo claige 1O
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2006 aII-ceramic update
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F68 N. MetaI-Iree restoratioos
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Fig. 2 - Eveo though the patieot decided oot to treat the eotire arch,
the tircooia crowos oo teeth #1-10 have a sigoihcaot esthetic
iproveeot io his siIe. ecause oI the tircooia copiog, there is
oo possibiIity oI a gray argio ever appeariog.
Fig. 5 - $MJOJDBMDBTFUXP coosists oI tircooia crowos oo $MJOJDBMDBTFUXP coosists oI tircooia crowos oo $MJOJDBMDBTFUXP
teeth #8 aod 9. ecause oI the dark shade oI these eododooti-
caIIy treated teeth, it is oot possibIe to use a pressed aII-ceraic
crowo. Zircooia copiogs wiII keep the prep Iro showiog through,
regardIess oI how dark they are.
oioei ro avoio rle use o merals in rle mourl lecause o
rleii porenrial alleigeniciry, wlile orleis lave jusr wanreo
ro piovioe rle mosr esrleric iesroiarion possille. Seveial
mareiials lave leen oevelopeo in an arrempr ro meer rlese
neeos, yer lave allen sloir o clinician expecrarions lecause
o low sriengrl ano rouglness. Many clinical sruoies lave
slown rlar rle iacruie rouglness ano exuial sriengrl o
ziiconia aie signihcanrly liglei rlan rlar o alumina oi any
orlei esrleric ceiamic on rle maiker rooay.
Ziiconia (ziiconium oxioe, Zi
2
) is a liglly sralle ce-
iamic oxioe rypically useo in inousriial applicarions iequii-
ing ligl sriengrl ano sraliliry, ano ziiconia las a lisroiy
Fig. 1 - $MJOJDBMDBTFPOF Ihis 31-year-oId aIe had uIti-
pIe IaiIiog coposites, recurreot decay, aod brokeo iocisaI edges
due to paraIuoctiooaI activity. For these reasoos, tircooia crowos
were a better choice thao porceIaio veoeers.
Fig. 3 - Ihis cIose-up photograph oI the tircooia crowos oo a bIack
backgrouod highIights the oaturaI iocisaI edge traosIuceocy oI
these restoratioos. Ihe beauty oI aII-ceraics aod the streogth oI
a FFM is a wiooiog cobioatioo.
Fig. 4 - Ihis portrait
shot ooe week
aIter the ceeota-
tioo oI the cIioicaI
tircooia restora-
tioos shows the
oaturaI appear-
aoce oI these
high-streogth
restoratioos.
Fig. - A digitaI k-
ray oI the tircooia
crowos at try-io
shows how deose
the uoderIyiog
tircooia copiogs
are - they aIost
appear to be etaI.
Ihe k-ray aIso is
used to veriIy the
ht oI the tircooia
crowos prior to
ceeotatioo.
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F68 N. MetaI-Iree restoratioos
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Fig. 8 - Ihe tircooia crowos bIeod io weII with surrouodiog deoti-
tioo, aod there is oo Iear that ooe day gray argios wiII appear
at the argios iI aoy giogivaI recessioo happeos to occur.
Fig. 9 - $MJOJDBMDBTFUISFFcoosists oI a IuII upper arch oI
tircooia restoratioos. Io additioo to the other esthetic chaIIeoges
that are preseot, ootice the shades oI teeth #9 aod 10, which have
beeo eododooticaIIy treated.
Fig. 10 - Ihe prep shade oI the teeth is withio ooraI Iiits with the
exceptioo oI teeth #9 aod 10. Ihe discoIoratioo oI these teeth pres-
eots a diIhcuIt esthetic chaIIeoge Ior aII-ceraic restoratioos. WhiIe
I ight preIer to use ao esthetic FFM such as 6aptek, the patieot
iosisted oo aII-ceraic crowos.
as a liomareiial oaring lack ro rle 197Os. !r is useo in im-
planrs ano orlei nonoenral applicarions, ano is one o rle
mareiials useo in roral lip ieplacemenrs. !ip ieplacemenrs
paiallel oenral applicarions in rlar rley aie lorl loao-leai-
ing siruarions wirl pioximiry ro vasculai ano osseous rissue.
Tley lorl aie applicarions rlar expeiience weai.
Ziiconia is unique among oenral ceiamics in rlar ir ex-
lilirs a plysical piopeiry calleo riansoimarional rougl-
ening (sriengrlening). Tliougl rle use o aooirives, sucl
as yrriium oxioe, ziiconia can le maoe in rle reriagonal
ciysral sriucruie ar ioom rempeiaruie. \len an exreinal
eneigy souice, sucl as rle sriess ar rle rip o a ciack, is
applieo ro rle mareiial, ir goes rliougl an insranraneous
plase riansoimarion ro a monoclinic ciysral sriucruie.
Tlis monoclinic oim o ziiconia ciysral is alour + peicenr
laigei in volume rlan rle reriagonal oim. Ar rle micio-
scopic rip o rle ciack, rlis expansion upon riansoimarion
acrs ro clamp rle ciack slur, rlus iesisring ciack piopaga-
rion. Tlis piocess o acrively iesisring ciack giowrl is veiy
impoiranr in arigue siruarions, sucl as rlose causeo ly
clewing oices on a iesroiarion. Because o rlis sriengrl,
anreiioi ciown copings can le manuacruieo as rlin as O.3
millimereis. Ar rlis oimension, rle copings lave a leau-
riul, peailescenr rianslucency rlar allows naruial liglr ro
ieacl rle piepaiarion, mucl like a naruial roorl.
Ziiconia is inoicareo oi rle aliicarion o anreiioi ano
posreiioi single-unir ciowns, ano rliee-unir liioges in rle
anreiioi ano posreiioi. Ziiconia is nor cuiienrly inoicar-
eo oi long-span liioges, canrilevei liioges, oi Maiylano
liioges, a P!M liioge is srill inoicareo in rlese siruarions.
Fig. 1 - With the
tircooia crowos
backIit, the
traosIuceocy oI
the crowos is
appareot eveo
though the cop-
iogs are deose
eoough to bIock
out the prep
shades.
Fig. 11 - Ihis IateraI view oI the hoished restoratioos is Iookiog
directIy at the discoIored teeth, which have beeo copIeteIy
bIocked out by the tircooia crowos. With aII-ceraic restoratioos,
it cao be a chaIIeoge to get restoratioos to bIeod io a case such
as this.
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F68 N. MetaI-Iree restoratioos
ovenber 2006 | XXXEFOUBMFDPOPNJDTDPN
Tle ziiconia piepaiarion is accomplisleo in accoioance
wirl rle geneial piinciples common ro mosr all-ceiamic
sysrems. Sranoaio all-ceiamic-mooiheo slouloei maigins
(accomplisleo wirl luis conraining rle KR oesignarion) oi
clamei maigins 1 mm oeep aie lorl accepralle. Pioximal
ieoucrion o 1.5 mm is ioeal, as is 1.5 mm ro 2.O mm o oc-
clusal ieoucrion. Tle rapei o rle hnal piepaiarion sloulo
le 6 ro 8 oegiees ano unoeicurs aie nor oesiialle, alrlougl
rlese can le aooiesseo in rle laloiaroiy i necessaiy.
Dr. Michoel Di7ollo is Ihe DirecIor oI Clinicol
keseorch ond EducoIion oI Glidewell LoboroIories
in MewporI 8eoch, ColiI. He lecIures on boIh
resIoroIive ond cosmeIic denIisIry. Dr. Di7ollo
hos severol clinicol progroms ovoiloble on DVD
Ihrough Glidewell. For more inIormoIion on Ihis
orIicle, or Ior more inIormoIion on receiving o
Iree copy oI one oI Dr. Di7ollos clinicol DVDs, emoil him oI
mcdiIollo@moc.com, or coll (888] 3128P.