Case Presentation: Fabrication of a 3-Unit Zirconia Bridge Using Digital Technologies

Published Date 01/10/2019
 
NuCalm
Figure 1—Preop photograph
The patient was a 64-year-old woman who presented for a routine new patient examination with the primary complaint being, “I have a lot of problems.” One of those problems was a failing 3-unit porcelain-fused-to-metal bridge from the maxillary right canine to central incisor (Figure 1). The patient was scheduled to have knee-replacement surgery in a month and requested that she undergo dental treatment as quickly as possible so it would be completed prior to the surgery. Radiographs were obtained using a NOMAD Pro 2 handheld x-ray unit (KaVo Imaging) and a Sopix2 sensor (ACTEON). The treatment was discussed and the patient was scheduled.

All procedures were done under magnifi cation using the EyeZoom with XV1 frames (Orascoptic). The endodontic treatment was done under 5x magnification and the restorative treatment under 4x magnification. The patient was anesthetized with 4% Septocaine 1:200K epinephrine (Septodont) using The Wand STA machine (Milestone Scientific). The bridge was then removed. Endodontic therapy was performed on the maxillary right canine using TF Adaptive files (Kerr Endodontics). The root canal procedure was completed, and Visalys Core buildup material (Kettenbach) was bonded to the remaining tooth structure using the Optibond XTR bonding agent (Kerr Restoratives). The material was cured with a Demi Ultra curing light (Kerr Restoratives). The teeth were prepared using an iOptima electric handpiece (Bien Air) (Figure 2).
Figure 2—Visalys Core buildup bonded and the teeth prepped
Figure 3A and 3B—Intraoral scans taken using a Carestream CS 3600
An intraoral scan of the preparations was taken using a CS 3600 intraoral scanner (Carestream Dental) (Figures 3A and 3B). The margins of the crowns were marked. In the interest of masking the darkness of the central incisor, the material of choice for the restoration was BruxZir Anterior solid zirconia (Glidewell Dental). A temporary bridge was fabricated from a preoperative impression of the failing bridge using Silginat (Kettenbach), a medium-viscosity, addition-curing impression material with alginate-like consistency. The temporary bridge was fabricated using TempSpan (Pentron) (Figure 4). We cemented the bridge using ZONEfree temporary cement (Pentron) (Figure 5).
Figure 4—Preop Silginat impression to fabricate temporary bridge
Figure 5—Temporary bridge cemented
Figure 6A—Shade-matching photograph to be sent to the dental laboratory
Photographs were taken with the EyeSpecial C-III digital camera (Shofu Dental) to help the laboratory technician match the existing PFM crowns. The images were taken in both regular and shade-matching modes (Figures 6A and 6B). The bridge was sent to the laboratory and then tried in; no adjustments were necessary. The bridge was cemented using Ceramir Crown & Bridge (Doxa Dental), and the excess cement was removed. The patient was very happy with the result (Figures 7 and 8).
Figure 6B—Shade-matching photograph to be sent to the dental laboratory
Figure 7 and 8—The patient was pleased with the final result
GO-TO PRODUCTS USED IN THIS CASE
EYEZOOM
EyeZoom offers 3 magnifi cation levels ranging from 3x to 5x. Developed to assist clinicians view an operating site from multiple perspectives, the loupe conforms to fit each user’s individual preference.
EYESPECIAL C-III
Designed exclusively for dentistry, the EyeSpecial C-III camera offers 8 shooting modes, fast autofocusing capabilities, exceptional depth of field range, and a large LCD touchscreen for ease of use.
MARTY JABLOW, DMD
Dr. Jablow is America’s Dental Technology Coach. He received his dental degree from Rutgers School of Dental Medicine in 1986 and practices in Woodbridge, NJ. He is a member of the Cellerant Best of Class selection committee, charged with the annual selection of industry awards, and is Chief Development Officer of Cellerant Consulting. Dr. Jablow has achieved Fellowships from the Academy of General Dentistry and the International Association of Dental-Facial Esthetics. He has been selected multiple times as one of Dentistry Today’s Top Lecturers. Dr. Jablow holds memberships in the American Dental Association and NJ Dental Association. He is a longtime member of his county’s Peer Review Committee. Dr. Jablow has written articles for many dental journals and has had his own column and video series.
EyeZoom (3x-5x) Loupe
Orascoptic
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