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Dental Tribune U.S. Edition

Photo essay: BruxZir Solid Zirconia meets an anterior esthetic challenge This article illustrates recent advance- ments by Glidewell Laboratories to im- prove the esthetic properties of BruxZir® Solid Zirconia restorations. As the lab’s R&D department refines its processes, improving the material’s translucency, the esthetics continue to improve. First appointment Our goal is to replace the PFM crowns on teeth #8 and #9 (Fig. 1) with BruxZir Solid Zirconia crowns (Glidewell Labora- tories; Newport Beach, Calif.). First, we take the shade before the teeth become dehydrated. I use the VITA Easyshade® Compact (Vident; Brea, Calif.), which displays the shade in both VITA Classical and VITA 3D-Master® shades. After taking the shade, I hold the select- ed 2M1 3D-Master shade tab to the tooth, along with the 1M1 3D-Master shade tab for contrast. Next, we photograph the shade tabs in the mouth. This is probably the most im- portant part of communicating shade to the technician. I use an Ultradent syringe to place PFG gel (Steven’s Pharmacy; Costa Mesa, Ca- lif.) into the sulcus of teeth #8 and #9. Next, I use a STA Single Tooth Anesthe- sia System® device (Milestone Scientific; Livingston, N.J.) to anesthetize teeth #8 and #9. Desensitizer [Clinician’s Choice; New Milford, Conn.]). I use a Warm Air Tooth Dryer (A-dec; Newberg, Ore.) after applying both coats of the G5, while my assistant places Z- PRIME™ Plus (Bisco; Schaumburg, Ill.) inside the crowns. We then load the crowns with a resin-modified glass ion- omer cement (RelyX™ Luting Plus Auto- mix [3M/ESPE]) and seat them, using a pinewood stick (Almore International; Portland) to ensure they are fully seated and the same length. In this “after” picture (Fig. 4), the amazing thing is there isn’t any por- celain on these BruxZir crowns; they are solid zirconia. This is why they are stronger than all other restorative mate- rials, except cast gold. Also, the facial anatomy on the crowns makes them look like real teeth. Because that anatomy is built into the CAD/CAM database, Glidewell Laboratories can de- liver it every time — provided the clini- cian gives the lab enough reduction. While I’m not suggesting you sud- denly switch all of your anterior res- torations to BruxZir crowns, you may want to consider using it for patients with parafunctional habits or old PFMs, where an esthetic improvement is es- sentially guaranteed. Source: Glidewell Laboratories The Razor® Carbide bur (Axis Dental; Coppell, Texas) easily cuts through por- celain and metal substructures, and when used in combination with my KaVo ELECTROtorque handpiece (KaVo Den- tal; Charlotte, N.C.), it is simple to cut through the existing PFM. I torque the crown with a Christensen Crown Remover (Hu-Friedy; Chicago). After using a periodontal probe to sound to bone to ensure I have enough bio- logic width to safely remove some tis- sue (Fig. 2), I use my NV MicroLaser™ (Discus Dental) to remove 1.5 mm of tis- sue. With the margins exposed, I use an 856-025 bur (Axis Dental) and KaVo ELECTROtorque handpiece to drop the margins to the new gingival level. My as- sistant then relines BioTemps® Provision- als (Glidewell Laboratories) on teeth #8 and #9 with Luxatemp provisional mate- rial (DMG America; Englewood, N.J.). Using a thin, perforated diamond disc (Axis Dental), we open the gingival em- brasures to avoid blunting the interprox- imal papilla, and we make sure the gingi- val margins aren’t overextended and the emergence profile is flat. We use TempBond® Clear™ (Kerr Corp.; Orange, Calif.) to cement the BioTemps, and we use loupes to inspect around the temporaries and gingival embrasures for excess cement. Second appointment After two weeks, we remove the temps and clean the preps with a KaVo SONIC- flex scaler. After trimming the gingival margin with the diode laser, I place an Ultrapak® cord #00 (Ultradent; South Jordan, Utah), cutting the cord intraoral- ly on the lingual to avoid any overlap. To make the margin visually obvious, I place a second cord (Ultrapak cord #2E) before refining the preparation. As I pack the top #2E cord on tooth #8, you can see how the top cord on tooth #9 exposes the margin (Fig. 3). Now we can begin finishing the preps using a fine grit 856-025 bur. Two moistened ROEKO Comprecap Anatomic compression caps (Coltène/ Whaledent; Cuyahoga Falls, Ohio) are placed on the preps, and the patient is asked to bite with medium pressure for eight to 10 minutes. The Comprecaps are then removed and the top cords pulled. We syringe me- dium body impression material around the preparations for the impression and then take a bite registration. The tempo- raries are then replaced. Third appointment After two weeks, the temporary crowns are off, the BruxZir crowns are ap- proved, and we place a layer of desen- sitizer on the teeth (G5™ All-Purpose Fig. 1 Photos/Glidewell Laboratories Fig. 2 Fig. 3 Fig. 4 By Michael C. DiTolla, DDS, FAGD Dental Tribune U.S. Edition | February 2012A18 iNdustry News CMWM BOOTH NO. 4411