FCZ look terrible in the mouth

[DarrenS]

Cool Hand, I wont attack or defend FCZ. It is a commodity crown. Cheap and fast. Has its place in todays market.
Drs don't care how they look only how cheap they are.

I do few posterior PFMs anymore but they are easy to make look decent.

Most the crappy ones you see are just poorly made, same as with any material.
Less about material but more the technician.

Interesting I work with prosthodontics departments at 2 different universities. They are still old school and prescribe PFMs for the posterior and emax for Bicuspid forward.
I tell them mono emax is stronger than pfm but......

All pfms below. 12 units Old cases.

If pfms look bad its the tech or no room.

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I like how you barreled in your furcations. Much more cleansable.

 

[DarrenS]

Racist jokes?

You mean like Nascar?

That is one bada** photo!

 

[rkm rdt]

"I spend a lot of my time learning from docs more so than techs these days."

Then You at the wrong place then Bubba!

 

[prosthotech]

Tissue is more likely to be more compatable to e.Max than it is to metal or Zr, just had that conversation with our perio surgeon and my doc. Bone will integrate well with Ti more so than to Zr. Dr. Branemark proved that with rabbits in the early years. Gold is the most biocompatible alloy for the human body than anything. Just to soft to handle heavy loads. we all know that though.

Poor dental hygiene is absolutely correct. Most hygienists out there are only tooth polishers in reality.

Soft tissue looks amazing around zirconia, far better than most alloys, equivalent with high content gold castings. The gingiva even looks decent when violating biologic width, which I was not expecting, in special cases.

Also, zirconia implants have been shown to be as biocompatible as titanium. While I like e.max, it is too weak in posterior areas when opposing restorations are on implants.

 

[prosthotech]

gladly....but honestly its more fun watching you guys squirm as the **** wears craters in enamel,the fatigue failures, and chips. looks like crap in the mouth 90% of the time, no chemical bond, but yea,looking through a invoice they probably look great...

We are having phenomenal results using Bisco's z-prime or all bond universal. There seems to be an incredible bond on my bench tests and in my patients' mouths. We started experimenting with z-prime after several hybrid abutments debonded, with the resing sticking to the titanium, and not to the zirconia. Haven't had that problem in over a year.

 

[prosthotech]

Here's an easy solution to failed PFM implant. Just my way of making a EBM(e.Max Bonded to Metal).

Failed PFM clearly seen

Reduce metal to even smaller than I did on this one, my first one of these.

Re wax to full contour.

Press in e.Max and bond with opaque Panavia 2.0 and you have a EBM screw retained with a ton of strength. Not trying to ruffle feathers of the guys who are making a living in something they believe in. I just believe there are easier and more esthetic ways of looking at things.

Everyone keep up with what you believe, just make it the best for the patient.


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Looks great. We have been using np-metal or zirconia to support the non-working cusps using a tall metal/zirconia lingual band on these lower posteriors, as they tend to fracture when they are opposing implant restorations, even with pressed e.max bonded to a np or zirconia substructure, and zirpress directly on a zirconia substructure. It can even happen when opposing natural dentition, but at a much lower rate.

 

[prosthotech]

The patient had limited funds and this case was out of warranty. Doc gave them a good and fair price to repair than to replace. As for it being splinted together, my best guess knowing the doc I work directly under has a good reason. Strupp has a lot of work in patients mouths that have lasted a long time. Also this is one of the first ones we did a trial on. I am now making multiple unit cases like this with no metal showing. We have made them look natural and cleanable. If that answers your question. They are like a hybrid denture, but with e.Max instead of denture teeth.
This one came out nice. Posted in case presentation thread. No metal anywhere except in the functional anterior guidance. Would never do with denture teeth.
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It is not difficult to repair these, especially using e.max. In the future, just have the dr prep the fractured portion for a saddle crown. Doing a trial prep on a die stone model is helpful to anticipate proper bevel angulation on the facial surface. The facial margin is often near knife edge, and the lingual margin can be placed where convenient. I purposely have my frameworks designed to accommodate the possibility of needing to make a single saddle crown in the future. Make sure a good chunk of the facial restoration is preserved to facilitate shade matching, and it is a good idea to keep precise records of ingot, powders, stain and glaze brands, as well as, framework opaque shade, for these full arch cases.

By the way, having a splinted restoration, screw retained or cemented, is a great way to compensate for bruxing or other parafunctional issues, as well as, allow the surgeon to avoid having to graft or all the use of shorter fixtures, since the entire load is being shared cross arch through a rigid connection. We try to use splinted restorations in all of my cases, with the exception being in about 5% of my lower full arch cases, where mandibular flexure is an issue.

 

[prosthotech]

Why do people think working with Strupp is hard? He is demanding, but then so am I. Look at what we are doing with Dr. Brumm. Come by sometime, we have an open door policy with docs and techs.


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Bill Strupp is a clinician's clinician. If it is hard to work for/with him, it is because you are learning something.

 

[DarrenS]

Bill Strupp is a clinician's clinician. If it is hard to work for/with him, it is because you are learning something.

I've learned a lot from him over the years. Before I came here, I was already reading his articles and seeing him lecture. Phenomenal wealth of knowledge, not only clinically but technically as well. Heck, I once worked with Carl Rousseau. He was in the same realm. Never found him difficult to work for either. Thank you for your input!


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[NicelyMKV]

Here is an example of what I have to do to get FCZ in the right hue and value range.....

To the right is my "mix" for C3/4 and to the left is the actual C3/C4 shade out of the empress tube.

 

[NicelyMKV]

The middle of the tray has my B1 mix and the lower left is my A1 mix. Just basic shade color doesn't cut it you still have to mimic that enamel overlay effect and or try to create the illusion of translucency. Very difficult.

 

[AltreX]

Tissue is more likely to be more compatable to e.Max than it is to metal or Zr, just had that conversation with our perio surgeon and my doc. Bone will integrate well with Ti more so than to Zr. Dr. Branemark proved that with rabbits in the early years. Gold is the most biocompatible alloy for the human body than anything. Just to soft to handle heavy loads. we all know that though.

Poor dental hygiene is absolutely correct. Most hygienists out there are only tooth polishers in reality.

Hello Darren,
Is it really proven scientificaly that Lithium disilicate use with soft tissue is better? I am in doubt because it is still porous ceramic. Thank you for your time.

 

[grantoz]

THATS WHY IN THE EMPRESS 2 DAYS THEY FOUND LITHIUM DISCILICATE TO BE TOXIC TO THE GINGIVA POUROSE CERAMIC IS NOT GOOD AT ALL FOR THE GINGIVA.