A BruxZir solid zirconia veneer case
Glidewell Laboratories’ weekly web series “Chairside Live” has given us a great opportunity to communicate with clinicians across the nation and educate them on topics that they’re actually interested in learning. If you haven’t yet had the opportunity, episodes can be viewed on-demand at www.chairsidelive.com or on YouTube and iTunes.
In the Case of the Week from Episode 105, I wanted to try something that I really hadn’t done before. I’ve done some anterior BruxZir restorations, and they turned out well, but I had yet to do an anterior crown case in conjunction with a BruxZir veneer. This is going to be a straightforward case on teeth #8 and #9 with a BruxZir crown and a BruxZir veneer adjacent to it.
This patient had a pre-existing PFM on tooth #8 that was a poor esthetic match (Fig. 1). Because of the patient’s deep overbite, I liked the idea of using a BruxZir crown for tooth #8 because I could keep it almost as thin as that PFM was on the lingual. I also planned to have the lab fabricate a BruxZir no-prep veneer for tooth #9, which happened to be facially deficient anyway.
I anesthetized the patient and took off the crown. The prep had been endodontically treated, and it looked like a gold post was placed in the incisal edge.
We placed the first cord (size 00) and then prepared the gingival third of the tooth. Because the tooth already had a PFM, I didn’t have to do a ton of reduction; it was more about where I did the reduction.
While reducing, I exposed a little bit of gold, so I covered it up with a self-adhering composite resin, and then I finished smoothing off the prep (Fig. 2). Then I placed the top cord (size 2), which upon removal left us a wide open sulcus that would be simple to impress. That’s the benefit of using the two-cord technique.
Six days later, we took off the temporary and tried in the final restorations, which the patient approved. We cemented the crown with Ceramir Crown & Bridge cement (Doxa Dental; Newport Beach, Calif.). The thing I love about Ceramir cement is the fact that it bonds on its own to zirconia without requiring you to decontaminate the internal surface of the BruxZir crown or use a zirconia primer. Plus, the cement will typically clean up in just one piece (Fig. 3).
With the crown placed, I then turned to the veneer. After try-in, I decontaminated the internal portion of the BruxZir veneer by sandblasting it for 15 seconds. I then placed a layer of Z-Prime Plus and air thinned it, and then placed a layer of bonding agent and air thinned it. I isolated the two adjacent teeth with mylar strips and then etched with phosphoric acid, rinsed, placed the bonding agent, air thinned it, placed the veneer with the light-cured resin cement inside and cured it. You can definitely light-cure through solid zirconia. Try it yourself when you receive the case.
Here’s the patient with the crown and veneer in place (Fig. 4). It looks pretty good, considering those are BruxZir solid zirconia restorations with no ceramic on the facial. BruxZir continues to look better because of the increased translucency of the material. I’m now feeling more confident that if I’m placing a crown on a single anterior tooth that I can place a BruxZir veneer on the tooth next to it. As long as #8 and #9 match, we have a chance of having a nice smile.
Note: This article was published in Today, CDA Presents edition, San Francisco, Calif., Friday, Sept. 5, 2014, Vol. 6, No. 2.