Monolithic Restorations

MONOLITHIC RESTORATIONS
The New Gold Standard

In Dentistry
Bruxzir Zirconia Crown

IPS eMax
Eugene L. Antenucci, DDS, FAGD, DICOI

Esthetic Restoration of Posterior
Teeth
“Extension
for
Prevention”
Esthetic Restoration of Posterior
Teeth
Extension for Prevention
Restorative Dentistry
2016
We have witnessed
and have participated in
the decline of the AMA
LGA
age of amalgam and M
metallic materials RIP
in restorative dentistry.
2016
• Pit and Fissure Sealants
• Preventive Resin Restorations
• Direct Adhesive Composite Restorations
• CAD CAM Chairside and Lab Produced
• Ceramic and Hybrid Ceramic Restorations
- Lithium Disilicate Restorations
- Zirconium Restorations
- Empress Ceramics
• Ceramic Bridges
This is a New Age in restorative dentistry.
The Metal-age served basic needs - freedom from pain and the
restoration of function. Our patients had limited value for the
services that dentistry provided. We used available technologies,
which today are old and dated, and offered non-esthetic materials.
The New Age is an Adhesive Age. It is an age that requires

routine restoration with esthetic materials, and of elective dental
care that enhances our patient’s appearance. It brings with it a
high degree of cosmetic consciousness. It is an age of brighter
smiles and higher patient demands. It requires relationships,
advanced technology, and the promotion of value in all aspects of
practice.
We were all taught
In dental school
That GOLD was the
Standard when it came
to dental restorations
Glidewell Dental Lab

Benefits of Gold
Bio-compatibility: Gold will wear similarly to enamel, and will not abrade enamel as
traditional porcelains do. The human body tolerates gold exceptionally well, with
insignificant adverse reactions.
Excellent Strength and physical properties: Gold will not fracture or break
Longevity: While all restorations are prone to fail over time, the success rates for gold
restorations is high
Contour and gingival harmony: Gold restorations can be intimately adapted to tooth
structure, with margins that are thin and well-contoured to the restored tooth as well
as to gingival tissues.
Disadvantages of Gold
ESTHETICS: The majority of patients consider gold and metal to be unesthetic, and do
not desire gold or metallic restorations
COST: Although Gold prices fluctuate, the laboratory cost of a gold restoration in high,
and that cost will be passed on to the patient
TIME and convenience: Gold restorations require at least 2 patient visits and do not
give the dentist or patient the option of a single visit CAD CAM restoration
PREPARATIONS: Metal-based ceramic restorations require sufficient reduction for
both the metal coping and overlying ceramic.
CERAMIC TO METAL FAILURE: Excess stress and/or insufficient amount of ceramic
veneering materials, coupled with laboratory errors cause a consistent rate of
ceramic to metal fusion problems and debonding.
Disadvantages of Gold
However the main

disadvantage is
ESTHETICS.
What would your

patients prefer?
JADA June 2011
Gordon Christiansen wrote:
“In my experience, most

patients want tooth-colored
indirect restorations,
regardless of whether such
restorations are in their best
interest.”
PFM Restorations
Dr. Charles Land introduced the

first all-ceramic crown in 1903
after having attained a patent
in the late 1800’s.
The “Porcelain Jacket Crown”
was made of feldspathic
porcelain. They were very
esthetic, but exhibited
relatively high failure rates.
PFM Restorations
PFM’s became available in the

late 1950’s, and by the mid
60’s they had become a
popular alternative to the
porcelain jacket crown that
was developed and made
popular in the early 1900’s by
Dr. Charles Land.
Trends in Dentistry
So Lets Explore and Make Sense of What Is
Going On In The World Of Restorative Dentistry
In a Way That Is Clinically Practical To You
Revolutionary Changes in
Dr Mike DiTolla and Glidewell Laboratory

Revolutionary Changes in
Add to this the number of in-office CAD CAM restorations
being performed annually. At last count, there were over
12,000 in-office scanning and milling machines in active use
in the United States – counting both Cerec and PlanmecaFit
(formerly E4D).
Monolithic Crowns as Compared to
Traditional Bi-Layered Crowns
Ceramo-Metal Restorations (PFM Crowns)

- weakest point is the ceramo-metal interface
- fusion is a combination of mechanical retention, charged
particle attraction and chemical bonding
- tensile strength is approximately 4% of its compressive
strength – layering porcelain on metal gives support
- studies have shown the mean de-bond strength of
feldspathic porcelain to gold-palladium alloy to be 42 Mpa
Venkatachalam B, Goldstein GR, Pines MS, et al. Ceramic pressed to metal versus feldspathic porcelain fused to metal: a comparative study of bond strength. Int J Prosthodont. 2009;22(1):94-100. -
See more at: http://www.dentalaegis.com/special-issues/Dawson/2010/08/monolithic-versus-bilayered-restorations-a-closer-look#sthash.NwV9ovM3.dpuf
Monolithic Restorations – Lithium Disilicate
- iPS eMax Press and iPS eMax Cad
- produced either from an ingot that is “pressed” to form, and
as a precrystallized block that is milled in CAD CAM systems
and then sintered in an oven. Both allow for cutback,
porcelain addition, staining and glazing.
- fracture toughness studies show it to be 3 Mpa-m1/2 or
greater.
- studies have shown that veneering ceramics on lithium
disilicate show no difference in the restoration’s longevity
- conventional or adhesive cementation.
Monolithic Restorations – Zirconium

- Flexural strength of 1000+ MPa
- Adequate esthetics
- Low wear of opposing tooth structure
- Conservative tooth preparation
- Indicated for 3+ unit anterior bridges and 3 unit posterior
bridges, as well as single unit posterior crowns
- Conventional or adhesive cementation
IPS e.max
IPS e.max
IPS e.max
IPS e.max
New York University
Mouth Motion Fatigue Study
New York University
New York University
Of An IPS e.max Crown
New York University
Of A Zirconium Crown
New York University
New York University
IPS e.max and Translucency
IPS e.max Refractive Index Demonstration
IPS e.max Esthetic Superiority
Our Goal at All Times Should Be To Provide
The Most Conservative Approach To
Treatment
Establish defined protocols

for each restorative situation:
Esthetic Restoration of
Posterior Teeth
How do we approach the treatment
of defective existing restorations?
What parameters do we follow in order
to restore posterior teeth having more
than a moderate amount of tooth
structure requiring replacement?
Decisions in Treatment Planning
Composite Crown
What do you do here???

Composite Ceramic Onlay Crown

What do you do here???

Esthetic Restoration of
Posterior Teeth
Indications and options for
determining types of restorations:
•Size of the lesion

•Size and number of restorations
•Location of restoration margins
•Location of the tooth in the arch
•Tooth anatomy
Tooth Preparation for IPS e.max
1.5mm Occlusal Reduction Bur
Minimum Material Thickness – Inlay/Onlay
Full Crown Preparation
Onlay Preparations
Veneer Preparations
IPS e.max Adjusting and Finishing
Cementation of IPS e.max Restorations
Cementation of IPS e.max Restorations
20 seconds
60 seconds
15 seconds on dentin or
30 seconds on enamel
Light cure
Cementation of IPS e.max Restorations with
Relyx UniCem
60 seconds
20 seconds
Everyday Dentistry with IPS e.max
and Planmeca Fit
42 year old male
patient presents
with pain #6. He not
seen a dentist for
years, is traveling
to Greece in 4 days,
is very concerned
about his pain and
has high esthetic
demands.
And he wants a
discount!
Endodontic treatment was performed on an emergency basis
and temporized with composite until later in the day when time
was available to complete the treatment
When the patient returned at 6pm a direct post and composite
core was placed. The diode laser was used at 2W for 30
seconds to perform a soft tissue crown lengthening beyond the
level of decay.
PLANMECA FIT
Fully Integrated Technology
Rapid Scanning with
Planmeca Fit
A direct post and core was placed and a digital impression was
taken with the PlanScan image of the preparation, the opposing
arch and the bite which was recording by having the patient
close.
Digital impression of the opposing occlusion
Digital impression of the bite registration
Powerful and Simple Design
Tools With Planmeca FIT
Design Basics
The design was completed, including morphology,
occlusion, and proper contacts within 5 minutes
of time.
An LT e.max A2 Block
was milled chairside in the
PlanMill Unit
An eMax LT shade A2 crown was milled by the PlanMill 40
and the crown was prepared for crystallization, staining and glazing in the Ivoclar
oven after an intial tryin for contacts, form and occlusion. After adjsutments are
made the crown is placed in the oven. The cycle is approximately 20 minutes and
the crown is ready to try in.
Ivoclar Programat P 310 Furnace
The crown was seated with MultiLink Clear Cement after a ten
minute 5% HF acid etch and 60 second of silane. This photo was
taken 3 days post-op prior to the patient leaving for Greece
Understanding the benefits
of single-day dentistry from this case
Understanding the benefits
of single-day dentistry from this case
Case Fee:
Root Canal treatment $1150

Direct post and core $ 350
Laser crown lengthening $ 350
eMax crown $1495
TOTAL: $3345.00
Total Time required:

Emergency assessment
and root canal treatment 1.25 hours
Direct post and core and
customized eMax crown 2 hours
TOTAL: 3.25 hours
Productivity per hour: $1029.23 / hour

MONOLITHIC ZIRCONIA RESTORATIONS
Indications:
- Crowns
- Bridges
- Veneers
- Inlays and onlays
- Screw-retained implant crowns
Preparation Requirements
for Monolithic Zirconium
Cementing Monolithic Zirconium
Restorations
Adjusting, Polishing, Finishing
and Removing Monolithic
Zirconium Restorations
Removing a Monolithic Zirconium Crown
One of the biggest issues with Monolithic Zirconium

to date is its opacity, or lack of translucency, resulting in
a compromise in esthetics.
Bruxzir Anterior was developed to remedy the esthetic

compromises in using Zirconium. It exhibits a reported flexural
strength of 650 Mpa with color and translucency similar to dentin.
They are indicated only in areas of lesser stress since they are
weaker, and they can be conventionally cemented or adhesively
bonded.
Tooth #10 restored

With Bruxzir Anterior
Bruxzir screw-retained
implant crowns #14, 15
Bruxzir crowns #18, 19

Sample Lab Fees for Crowns
The Dental Practice
Paradigm has
dramatically
changed
“A paradigm is like a pair of

glasses, affecting everything you
see in your life.
Your paradigms are the source
from which your attitudes and
behaviors flow.”
- Steven Covey
Success in dentistry isn’t the result of
luck. It isn’t something reserved for
somebody else. With a sound foundation of
concrete goals, technical skills,
communication skills, business savvy, and
the proper use of technology, your practice
will rise to the highest achievable levels.
There is nothing more difficult to take in hand,
more perilous to conduct, or more uncertain
in its success, than to take the lead
in a new order of things.
- Niccolo Macchiavelli
The proper use of Advanced
Technology in Dentistry will help to get
you where you want to go.
And you’ll have fun getting there!!!!
QUESTIONS???
Questions?
Eugene L. Antenucci, DDS, FAGD, DICOI

1579 Brentwood Road
BayShore, NY11706
Phone: 631 665-8484
Email: laserdocc@gmail.com
Web: www.baydentalhealth.com

Monolithic Restorations

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MONOLITHIC RESTORATIONS

The New Gold Standard

Bruxzir Zirconia Crown

Eugene L. Antenucci, DDS, FAGD, DICOI

The New Age is an Adhesive Age. It is an age that requires

Glidewell Dental Lab

However the main

What would your

Gordon Christiansen wrote:

“In my experience, most

Dr. Charles Land introduced the

PFM’s became available in the

Dr Mike DiTolla and Glidewell Laboratory

Ceramo-Metal Restorations (PFM Crowns)

Monolithic Restorations – Zirconium

Establish defined protocols

What do you do here???

Composite Ceramic Onlay Crown

What do you do here???

•Size of the lesion

Root Canal treatment $1150

Total Time required:

Productivity per hour: $1029.23 / hour

One of the biggest issues with Monolithic Zirconium

Bruxzir Anterior was developed to remedy the esthetic

Tooth #10 restored

Bruxzir crowns #18, 19

“A paradigm is like a pair of

Eugene L. Antenucci, DDS, FAGD, DICOI

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