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Photo Essay ® Anterior BruxZir Solid Zirconia Crown – ARTICLE by Michael C. DiTolla, DDS, FAGD BruxZir ® Solid Zirconia crowns & bridges were originally designed by <strong>Glidewell</strong> Laboratories as a replacement for posterior cast gold or metal occlusals, when the patient did not want any metal showing in his or her mouth. As dentists began placing BruxZir restorations and were repeatedly satisfied with the results, they started to prescribe BruxZir for bicuspids, as well. The lab realized that if dentists wanted to prescribe BruxZir in the anterior, the translucency of this material needed to increase. Our R&D team worked on this quietly and finally told me when they were ready to test it. They asked me for an esthetic challenge, so I decided to give them the tough one we all face: the single-unit central incisor crown adjacent to a natural tooth. This photo essay shows the clinical steps for placing an anterior BruxZir crown. For a crown that is 100 percent zirconia with no ceramic facing, the lab pretty much nailed it. 14 www.chairsidemagazine.com
Figure 1: Tooth #9 is going to be prepped for a BruxZir crown. I chose this case for a couple of reasons. First, tooth #8 is a natural tooth, and it will be a good test of how the light interacts with the BruxZir restoration versus the natural tooth. Second, tooth #7 is an all-ceramic crown, which will be replaced later, and tooth #10 and #11 are a PFM cantilever bridge. So, we will be able to compare the BruxZir crown to those two restorations, as well. Figure 2: I place PFG topical anesthetic gel (Steven’s Pharmacy; Costa Mesa, Calif.) into the sulcus using an Ultradent syringe. I used to use a cotton-tipped applicator, but this made it difficult to get PFG into the sulcus. Because I am using single-tooth anesthesia for this case, the needle is going into the sulcus, so that’s where the topical needs to go. The tufted tip on the syringe makes it easy to place the topical subgingivally. Figure 3: The 30-gauge extra short needle of the STA System (Milestone Scientific; Livingston, N.J.) is placed in the sulcus. I prefer using the Rapid Anesthesia Technique for injections, and a few drops of anesthetic are given as I penetrate the base of the sulcus and contact bone. (An in-depth look at this technique is available at www.glidewelldental.com.) I started using this technique for single mandibular molars to avoid blocks, until I realized patients hate anterior infiltrations just as much. So I began using single-tooth anesthesia here, as well. Figure 4: I use the Reverse Preparation Technique to prep the tooth. (View a step-by-step clinical technique video online.) The first step of this technique is to break the proximal contacts. Because we are only preparing tooth #9, we are going to do this with a thin 56 carbide bur on both the mesial and distal. The goal is to break contact with the adjacent teeth just enough to place our first retraction cord. Photo Essay: Anterior BruxZir Solid Zirconia Crown15
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Contents 38 CEREC ® Connect: A Wel
Page 6 and 7: Letters to the Editor Dear Dr. DiTo
Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 10 and 11: Numbers by the An elephant’s mola
Page 12 and 13: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 14: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 19 and 20: Figure 7: Crowns often look fake in
Page 21 and 22: Figure 15: The prep is essentially
Page 23: Depth cuts ensure that we get enoug
Page 27 and 28: Interview with Stephen Thorne - INT
Page 29 and 30: ST: No, it was definitely the forme
Page 31 and 32: can share a blog. There are many ti
Page 33 and 34: After those steps, Owner Dentists t
Page 35 and 36: dental schools, and I thought that
Page 37 and 38: all the way through retirement. And
Page 40 and 41: CEREC ® Connect: A Welcomed Upgrad
Page 42 and 43: Many CEREC ® dentists find making
Page 44 and 45: Figure 1 Figure 2 CEREC Connect Pro
Page 46: Figure 5 Figure 6 Conclusion CEREC
Page 50 and 51: working stone model of the single p
Page 52 and 53: detailed occlusal anatomy picked up
Page 54 and 55: high occlusion in the final prosthe
Page 56: use a high-flow, stiff (no bounce)
Page 60 and 61: most overlooked esthetic zone 3,4 (
Page 62 and 63: and floss. The facial and lingual p
Page 64: metal designs like the Wynne Hybrid
Page 67:
The Chairside® PHOT Hunt Eleven ye
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