J Interdiscip Dentistry
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Table of Contents
CASE REPORT
Year : 2012  |  Volume : 2  |  Issue : 1  |  Page : 35-37

Restoration of anterior missing teeth using computer-aided manufacturing CAD/CAM zirconia restoration: A multidisciplinary report


Department of Prosthodontics, Vokkaligara Sangha Dental College and Hospital, Bangalore, India

Date of Web Publication22-Mar-2012

Correspondence Address:
Varun Pitti
Department of Prosthodontics, Vokkaligara Sangha Dental College and Hospital, Bangalore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5194.94190

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   Abstract 

Recent advances in all ceramic restorative materials have made it possible to restore a patient with high esthetics and comfort. This article brings about the case report in which a young male patient lost his maxillary anterior teeth in a road side accident; and, because of combined efforts of endodontics, periodontics and prosthodontics' departments, the patient's dentition was restored achieving high levels of esthetics and comfort.

Keywords: Anterior, computer-aided design, computer-aided manufacturing, zirconia


How to cite this article:
Shetty S, Pitti V, Satish Babu C L, Priya M. Restoration of anterior missing teeth using computer-aided manufacturing CAD/CAM zirconia restoration: A multidisciplinary report. J Interdiscip Dentistry 2012;2:35-7

How to cite this URL:
Shetty S, Pitti V, Satish Babu C L, Priya M. Restoration of anterior missing teeth using computer-aided manufacturing CAD/CAM zirconia restoration: A multidisciplinary report. J Interdiscip Dentistry [serial online] 2012 [cited 2019 Jun 24];2:35-7. Available from: http://www.jidonline.com/text.asp?2012/2/1/35/94190


   Introduction Top


All ceramic restorations are the most esthetically pleasing restorations currently available. Though metal ceramic restorations are most commonly used, they sometimes fail to satisfy esthetic demands of the patient. The metal copings used in metal ceramic restorations block the light transmission Through the tooth structure, darkening the root. and causing discoloration of the gingiva. [1] It has also been hypothesized that the metal copings in the metal ceramic restorations scatter the light resulting in dark shadow apical to the margins of the restoration. Since the time Alexis D first used ceramics for fabricating denture teeth, the ceramics have undergone intensive research, which has led to the development of high strength materials that can be used for the restoration of the missing posterior teeth as well.

All ceramic restorations can be classified microstructurally into four categories. [2]

  • Category 1- Glass based systems (mainly silica with sodium and potassium aluminosilicates)
  • Category 2- Glass based systems with crystalline fillers (leucite or lithium disilicate like IPS Empress II, IPS E-max)
  • Category 3- Crystalline based systems with glass fillers (glass infiltrated, partially sintered alumina like In-Ceram)
  • Category 4- Polycrystalline solids (solid sintered aluminous oxide like Nobel Biocare-Procera and sintered zirconia oxide like 3M ESPE- LAVA)
Zirconia based ceramics are the newly developed ceramic system. [3],[4] Zirconia restoration consists of Zirconia oxide substructure or coping, which is veneered with Zirconia veneering feldspathic ceramic, having a coefficient of thermal expansion similar to Zirconia oxide coping. Zirconia oxide has high flexural strength and toughness of 1.0-1.12 GPa and 7-8 MPa, respectively. 5


   Case Report Top


A 25 year old male patient, reported to the department of Prosthodontics, Vokkaligara Sangha Dental College and Hospital, Bangalore with the chief complaint of missing upper front teeth and Superaerupted lower teeth [Figure 1]. Intraoral examination. revealed that the patient had missing maxillary left and right central incisors and left lateral incisors. On further examination, it was found that the patient had over retained left maxillary canine, and supraerupted mandibular left and right central incisors and left lateral incisor almost touching the opposing ridge. Patient had a history of road side trauma 1 year back, due to which the maxillary left and right central incisors and left lateral incisors were extracted, and endodontic treatment of maxillary right lateral incisor was done and the tooth was saved. Supraeruption of the mandibular teeth because of absence of teeth in the opposing arch was noted. Depending on the age and the requirements, patient was explained about both implant supported fixed prosthesis and all ceramic Zirconia based Computer-aided Design and Computer-aided Manufacturing (CAD CAM) restorations. Finally Zirconia based CAD CAM restorations (Lava, 3M-ESPE) were planned for the patient with maxillary right lateral incisor and maxillary left deciduous canine to be used as abutments.
Figure 1: Pre operative photograph showing missing maxillary teeth and supraerupted mandibular teeth of the patient in the case report. Note that the mandibular teeth are almost touching the maxillary ridge

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For the supraerupted mandibular incisors, endodontic therapy was undertaken followed by crown lengthening surgery and final restorations with lithium disilicate based all ceramic crowns (IPS E-max) were planned. After the endodontic therapy was completed, crown lengthening Procedure was undertaken [Figure 2]. Gingivectomy and about 2 mm of the gingiva was excised along with bone recountouring and sutures were placed. After one week, sutures were removed and all ceramic tooth preparation was done for maxillary right lateral incisor and maxillary left deciduous canine with shoulder margins. Shade selection was done before starting the teeth preparation. Mandibular right and left central incisors and left lateral incisors were also prepared in the same appointment for all ceramic crowns with shoulder margins. After attainting proper hemostasis using ferric sulphate, gingival retraction was done using '000' retraction cord, single cord technique, and final impression was made using 2-stage putty light body impression technique with vinyl polysiloxane impression material (Affinis, Coltene Waldent). This was followed by temporization using tooth colored self cure acrylic resin. Impressions were casted using Type IV gypsum product (Pearl stone, India), and maxillary and mandibular master cast with removable dies were obtained. In the next appointment, Face bow record (Hanau Spring Bow) and bite registration records were made using polyvinylsiloxale bite registration material (Bitrex, Equinox). Maxillary and mandibular master cast with the removable dies were then articulated using the facebow and the bite registration record on a semiadjustible articulator (Hanau Wide View articulator).
Figure 2: Post operative photograph of the crown lengthening procedure

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Master cast was then sent to the laboratory for fabrication of prosthesis. Zirconia copings (LAVA, 3M-ESPE) and lithium disilicate copings (IPS E.max) were evaluated in the patient's mouth and were checked for the fit of the margins and occlusal clearance. After layering of veneering material, the prosthesis was again evaluated for marginal fit and occlusal adjustments were done in maximum intercuspation position (heavy contacts on the posterior teeth and light contacts on the anterior teeth) and eccentric movements (disocclusion of posterior teeth by the anterior teeth). Final cementation of the prosthesis was done using dual cured resin cement as the inner surface of zirconia prosthesis was sandblasted. Light curing of the resin cement was done after removing excess cement around the Prosthesis [Figure 3] and [Figure 4]. Patient was educated and motivated regarding the maintenance of oral hygiene. Patient was asked to clean the gingival surface of the pontic using Super Floss (Oral B) and interdentally using proxa brush after every meal and was recalled after 1 week. On recall appointment, patient's gingiva was found to be healthy with no signs of inflammation and the patient was extremely happy with the prosthesis without any discomfort.
Figure 3: Photograph showing cementation of restorations

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Figure 4: Photograph showing mandibular incisors cemented with E-Max crowns

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   Discussion Top


With recent advances in all ceramic restorations it is now possible to restore patients with long span fixed partial denture prosthesis with high esthetics and comfort. Implant supported fixed prosthesis was another good treatment option; however, depending on the limitation of time, additional surgical trauma of implant placement (patient had roadside trauma) and required restoration of maxillary left deciduous canine, it was finally decided to restore the patient with tooth supported fixed prosthesis. Zirconia based LAVA all ceramic restorations can be used to restore patients with multiple missing teeth and long span edentulous arches up to 48 mm.


   Conclusion Top


Advancement in all ceramic fixed prosthesis has helped to bring about quick rehabilitation of the patient, causing lesser surgical trauma and resulting in high esthetics. Further, it is more comfortable as compared to implant supported fixed prosthesis. The greatest disadvantage with all ceramic fixed prosthesis is that it is a less conservative approach and results in more amount of tooth reduction as compared to implant supported fixed prosthesis. Decision between the two treatment modalities should be made only after proper diagnosis and looking after the demands of the patient.

 
   References Top

1.Beuer F, Schweiger J, Eichberger M, Kappert HF, Gernet W, Edelhoff D. High-strength CAD/CAM-fabricated veneering material sintered to zirconia copings - A new fabrication mode for all-ceramicrestorations. Dent Mater 2009;25:121-8.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Shenoy A, Shenoy N. Dental Ceramics: An update. J Conserv Dent 2010;13:195-203.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Swain VL, Pesun IJ, Hodges JS. The Effect of metal ceramic restoration design on tooth colour. J Prosthet Dent 2008;99:468-76.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Rosenstial, Land, Fujimoto. Contemporary Fixed Prosthodontics: 4 th Ed, ST Louis: Mosby Publications; 2008 Shillinburg, Hobo. Fundamentals of fixed prosthodontics: 3 rd Ed, Carol Stream: Quintessence Publishing; 2007  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
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