Bridge Replacement with BruxZir Solid Zirconia
The patient received facial trauma at age 14 when she was hit by a golf club in the maxillary pre-molar region. In 1998 the patient lost several maxillary teeth due to external root resorption. During that time a PFM Nobel Bridge was placed using metal linguals on teeth Nos. 8 and 9 and a metal occlusal on No. 14. In 2011, the patient fractured the porcelain off No. 8 and desired a more cosmetic material to replace the entire bridge.
I chose BruxZir Solid Zirconia because of its strength, fracture toughness, and esthetics. When fabricating the bridge I asked the lab to perform a cutback in the CAD software to provide adequate room for porcelain application to the buccal and labial surfaces of the framework. BruxZir material can be milled to full contour or with a labial or buccal cutback. I chose the cutback feature to maximize the esthetic outcome.
An IPS e.max veneer (Ivoclar Vivadent) was also chosen for tooth No. 7 to enhance labial contours and esthetics. IPS e.max ceramic powder was layered onto the bridge framework to provide a closer shade match with the accompanying bridge. The bridge preparations were refined, leaving a moderate chamfer margin. Tooth No. 7 was reduced 0.5 mm on the facial and incisal aspects, providing adequate thickness of the IPS e.max material. Asymmetry of the gingival contours of teeth Nos. 8 and 9 were addressed by performing an electrocautery gingivectomy.
I cemented the bridge using CLEARFIL SA Cement (Kuraray) in a universal shade. I applied Ceramic Primer (Kuraray) to the internal aspects of the zirconia to improve bond strength. The e.max veneer was cemented using CLEARFIL ESTHETIC CEMENT EX (Kuraray) in a clear shade. CLEARFIL ESTHETIC CEMENT EX is a high-performance, esthetic, dual-cure composite cement system that includes a self-etch, single-step, dual-cure adhesive. The veneer was initially checked for shade match using a clear try in paste to accurately replicate the final cement outcome.
Esthetic metal-free restorations are becoming more and more popular. The benefits of IPS e.max and BruxZir restorations include tissue adaptation, gingival color, and improved esthetics without sacrificing strength or longevity. In addition, the restorations were made at less cost to me than the previous porcelain-fused-to-noble alloy bridge.
The patient was pleased with the final outcome of the case. The morphology, shade and tissue adapation were significantly improved.