Death by Zr

[disturbed]

Let me try to help you all to understand something. by providing and promoting full contour zirconia crowns we are doing a disservice to patients. Think about it like this: take a rock grinder, place a few opal stones in it, tumble, they simply get shined more; now though in a diamond, in a few hundred cycles you will have nothing but dust, and a slightly smoothed diamond...The same thing will happen in the mouth with full contour zirconia: contacts will open after tooth gnathalogical processes (tooth movement from attrition) opposing teeth will wear often changing function and slowly one tooth can destroy the entire mouth. NEXT... we are all trying to layer to zirconium, zirconium has NO chemical bond only mechanical retention, it can't... ever.. zirconium has no oxidation to bond to. slight wetting of surface is not an adequate bonding layer..E'max is doing the best with there bonder layer for layering zirconium, as it is designed to fire at a higher temp, but, as I have personally seen, even some of the best labs in the country are foregoing it "cuz its a pain to use". The silly idea to just turn up your oven temp for a "bonder" layer is stupidity.. learn your materials! More lucite crystals form when you over cook your porcelain, lucite crystals are weak and the more you have the more likely you will have breakage in the future.It takes a while sometimes but wear is a long process, just because it leaves the lab does not mean its ok later.... thats why we try to cool our pressings guys..to PREVENT over growth of lucite crystals that form. Doctors are seeing chipping more and more..get off the zirconium band wagon and come back to reality. zircon grows with advertising but can die with knowledge..

 

[DMC]

Zirconia is very slippery when polished.

It is used in ball-bearings and other load bearing applications.

Bruxzir is around the same hardness as a good Noble Alloy, or around 800mPa (+/_)

I agree with some of your concerns, but they are not as bad you may think.

Don't offer this stuff if you loose sleep at night worrying about teeth exploding.

Close you eyes and it will all be over soon enough.

Believe it or not, us Dental Techs do not run the world. We are at the bottom of the ladder. Go to the top if you have a complaint. (Doctors, Insurance companys, and Manufactures)

Good Luck!

 

[disturbed]

Zirconia is very slippery when polished.

It is used in ball-bearings and other load bearing applications.

Bruxzir is around the same hardness as a good Noble Alloy, or around 800mPa (+/_)

I agree with some of your concerns, but they are not as bad you may think.

Don't offer this stuff if you loose sleep at night worrying about teeth exploding.

Close you eyes and it will all be over soon enough.

Believe it or not, us Dental Techs do not run the world. We are at the bottom of the ladder. Go to the top if you have a complaint. (Doctors, Insurance companys, and Manufactures)

Good Luck!

told my doctors, they quit using the stuff, all of them, once they understood the facts and admitted to seeing more and more chipping lately, I am making noise NOW because the time has come when the million's of Zr layered crowns made 5-7 years ago are starting to break from fatigue. insurance companies. LOL, they just barely stopped paying for amalgam's. manufactures agree with me but after such a hefty investment they can't stop at the risk of losing to much $$.. it just saddens me to see sooo much greed and disregard for the patients. If we as technicians are educated enough to the point we can explain the reasons for not using a product to our clients it WILL disappear. this is my goal, not for me, for the patients. I could care less what we use as long as it is a sound and science backed material. pressed to Zr has my attention, but it's still a eggshell theory.

full contour crowns are slippery, yes, but in a mouth with functional issues (50%+ of mouths) they become the antagonist, and when built by a untrained tech can be very destructive. abrasion and wear.. Any way you look at it you are throwing a hard rock into a bag of chaulk.:heeeelllllooooo:

 

[NicelyMKV]

I quit doing layered Zr a few years ago. Not because of failures but due to all the attacks on the material from reputable sources. I am not saying it does not work I would just rather hold off and make sure before I send anymore to my accounts. They trust me to do what is best for them and the patient as far as materials go. The only problem now is Bruxzir. I am not excited about it and have voiced the same concerns regarding opposing dentition etc but a few of my accounts are absolutely demanding it( I know contridicting myself about the trust thing). the problem is I get some posterior cases where they literally prepped 6 tenths off the tooth. Ridiculous I know but
13,000 per month account and I have had similar and growing
Issues across the boards. Bruxzir seems to be the quick and easy fix. Not saying it's the right thing to do but..... I have some pics of a posterior crown where the ceramic is already under manufacturers recommendations and still opaque and over contoured compared to a Bruxzir on the same case. Completely different
End result. Bruxzir wins hands down. I do not sell them cheap either. Pain to make them look decent. I have seen older maxillary anterior work with smooth linguals that had totally wiped out the mandibular anteriors. That was slick? So is it because the older ceramic was more hard? Like Zr? Just curious.

 

[Mark Jackson]

BruxZir came in the midst of the perfect storm:

1) Gold prices have reached unreasonably high levels
2) Zirconia chipping reports
3) Constantly revised and ammended handling instructions for zirconia
4) Failures of cheap generic zirconia frameworks
5) emax marketing blitz capitalizing on zirconia failures
6) Too many milling centers and not enough demand for frames. People are digging for new uses.
7) Off shore competition has driven down PFM pricing to 1980's levels
8) Doctors and patients seeking low cost, fixed price crowns that are biocompatible and reasonably esthetic

Quit fighting monolithic restorations, find ways to improve them. Capitaize on the automation and consistency of CAD CAM restorations, and stop crying about wear. That argument has been put to sleep. Ceramco is worse and you will never make the PFM go away with that argument either.

Look to next generation resins my friends.

 

[disturbed]

BruxZir came in the midst of the perfect storm:

1) Gold prices have reached unreasonably high levels
2) Zirconia chipping reports
3) Constantly revised and ammended handling instructions for zirconia
4) Failures of cheap generic zirconia frameworks
5) emax marketing blitz capitalizing on zirconia failures
6) Too many milling centers and not enough demand for frames. People are digging for new uses.
7) Off shore competition has driven down PFM pricing to 1980's levels
8) Doctors and patients seeking low cost, fixed price crowns that are biocompatible and reasonably esthetic

Quit fighting monolithic restorations, find ways to improve them. Capitaize on the automation and consistency of CAD CAM restorations, and stop crying about wear. That argument has been put to sleep. Ceramco is worse and you will never make the PFM go away with that argument either.

Look to next generation resins my friends.

good old percision dental...mark, I LOVE monolithics! the ones that dont destroy natural dentition, namely E'max.. Yes, ceramco is bad as well for a lot of the same reasons as Zr, Wear. this is why I choose D'sign, a flouralapatite porc. NOT a feldspathic. It will NOT wear out the surrounding dentition, either will E'max, these are the ONLY two I know of that will not beat the crap out of the mouth, I have seen a 20 Y/O single central made out of feldspathic wear a grove in the lowers, destroying protrusive, which in turn put the potrusive forces on the posteriors, which in turn destroyed those. the really funny part is where you say the argument for wear has been put to sleep....It may keep getting hit on the head by crown and bridge salesmen such as yourself trying to ignore and it, but in higher circles, especially perio, it is and will remain forever a major concern. don cornell and bob winters did a lot of work to make sure d'sign is as close to natural dention as possible from wear to crystalain structure to mimic how light plays in it. got a thin crown that will break with a pressable or milled? don't switch to a destructive material, recommend a gold crown, do a reduction coping, or ask the doctor to re-prep. guys like mark are pushing this because they invested in it, that does not make it right or a quality material.My panties are in a wod ("crying about wear") because after 10 years of training I come out to see whats around me and I see people like mark ignoring simple material science because a salemen is taking him golfing...and than pushing this crap on others.should we just mill everything out of the hardest material we can find so it NEVER breaks? again.. put a rock in one hand and a piece of fruit in the other, rub them together for a while and let me know what happens..

 

[disturbed]

I quit doing layered Zr a few years ago. Not because of failures but due to all the attacks on the material from reputable sources. I am not saying it does not work I would just rather hold off and make sure before I send anymore to my accounts. They trust me to do what is best for them and the patient as far as materials go. The only problem now is Bruxzir. I am not excited about it and have voiced the same concerns regarding opposing dentition etc but a few of my accounts are absolutely demanding it( I know contridicting myself about the trust thing). the problem is I get some posterior cases where they literally prepped 6 tenths off the tooth. Ridiculous I know but
13,000 per month account and I have had similar and growing
Issues across the boards. Bruxzir seems to be the quick and easy fix. Not saying it's the right thing to do but..... I have some pics of a posterior crown where the ceramic is already under manufacturers recommendations and still opaque and over contoured compared to a Bruxzir on the same case. Completely different
End result. Bruxzir wins hands down. I do not sell them cheap either. Pain to make them look decent. I have seen older maxillary anterior work with smooth linguals that had totally wiped out the mandibular anteriors. That was slick? So is it because the older ceramic was more hard? Like Zr? Just curious.

yes NICELY, like Zr.. but think more in terms of abrasive and less in terms on hardness.. Zr can be a little more gentle in ideal situations because it has a MUCH tighter grain structure, so it is smoother and will slide more easily causing less abrasion, but again..WILL harm natural dentition. giving the material time won't help..it will never oxidize, a chemical bonding layer, for layering and it will always be a destructive force in the mouth. Are quick and easy fixes ever the "right thing to do"? glad to find someone using their head, just don't let the ease and availability corrupt you. Never stop doing whats right and soon when this blows over you will be highlighted in the doctors mind. tell them why and most the time they will also strive to do whats right for their patients. the ones that don't can send to mark.. He's more about turning a profit than helping people it seems..I am not trying to make the PFM go away....just trying to make a better one. why does this guy attack me at every turn? hmm.. It's almost like he's trying to protect a bad investment, trying to sell because he got sold. wish he would provide something besides economic reasons for his deliberation, the other reasons he has listed are a good sell on why NOT to use the stuff..oye...big labs.... ..I am not competing on his level, don't want to.. keep fighting the good fight nicely. If/when enough people share this info it will change things.

when someone has a broken leg but no insurance do they use any less of a quality material if they need a rod in there bone? how about the heart? cheaper parts cause of patients financial status? we are making body parts here, never forget that doing a bad job on ONE crown can really make someones life miserable down the road.

 

[araucaria]

put a rock in one hand and a piece of fruit in the other, rub them together for a while and let me know what happens..

Thanks for the tip, just discovered a great new exfoliating hand cleanser. Don't you just love how the world evolves eh. BTW, it's not practical to try changing the world from a soapbox, the only changeable part is generally your own little part of it. There's pro's and con's for most of the systems applied in modern dentistry, we usually end up using what is deemed best at the time of the treatment - and 'best knowledge' changes over time. I've seen a lot of cases where damage is done simply through neglect over the years, the types of treatment offered to some of these patients wouldn't alter how their mouth changed one bit. Maybe Zirconia is a vital stepping stone in the quest for knowlege, and will ultimately lead us to superior products and technology in the future that might not have been discovered if not for the zirconia experiences.

 

[charles007]

distured, your 32 yrs young with only 10 yrs of training. Give me a break... Wait till you 60, then try listening to someone with 10 years of training with all the answers...
Have you heard the names of Dr.Rella Christiensen, she spoke highly of Noritake and zirconia in her study last year to me. What say you about Dr. Ed. McLaren in his zirconia study. Do you think he will stop using zirconia ...

Inceram was and is a great material, but doctors jumped on Empress since it was more translucent, and now we have Emax and Empress is dying a slow death. Now BruxZir is blazing a trail with monolithic zirconia, and who knows how this material will improve or be replaced with the next monolithic material..
To think Dsign and Emax are the best materials on the market and BruxZir is the devil, is thinking with a very closed mind in my experience. Everyone knows unpolished/nonglazed opaque/porcelain and zirconia is very abrasive.
Do you actually think all dentist repolish gold and porcelain to a high glaze when they adjust. BruxZir on the other hand is extremely easy to polish and much less chance of being seated unpolished.
I don't think Jim G. would sell BruxZir all over the world with a chance of being sued by thousands of labs and doctors......Hope I'm right !
Did you see the Zirconia study that Noritake has, very impressive.
If you have studies showing glazed/highly polished zirconia is abrasive, please share with us. popcorn
I want to see the meat and potatoes(facts) if your going to preach to the choir.
Charles

 

[Bobby Orr ceramics]

BruxZir came in the midst of the perfect storm:

1) Gold prices have reached unreasonably high levels
2) Zirconia chipping reports
3) Constantly revised and ammended handling instructions for zirconia
4) Failures of cheap generic zirconia frameworks
5) emax marketing blitz capitalizing on zirconia failures
6) Too many milling centers and not enough demand for frames. People are digging for new uses.
7) Off shore competition has driven down PFM pricing to 1980's levels
8) Doctors and patients seeking low cost, fixed price crowns that are biocompatible and reasonably esthetic

Quit fighting monolithic restorations, find ways to improve them. Capitaize on the automation and consistency of CAD CAM restorations, and stop crying about wear. That argument has been put to sleep. Ceramco is worse and you will never make the PFM go away with that argument either.

Look to next generation resins my friends.

Touche' Mark !!

Disturbed....... where is your data to support your claims?? I have personally invested $20,000 into my own research that proves properly fabricated Zr restorations have similar strength longevity(veneered ceramic) to the almighty PFM. Also, The fact is that abrasiveness is due to a lack of material density of whatever product, not just the hardness factor....Zr, eMax, feldspathic, fluorappetite , etc. If you believe all the fluorappetite BS from Ivoclar's cooked up research, I have some oceanfront property to sell ya in Oklahoma.

 

[charles007]

Distured, your to young to know this, when Vita porcelain came to the US, many labs couldn't use it because of checking... duh CTE issues, thick under supported porcelain....Hmmm ...sounds familar doesn't it
Same issues among other problems when NP was being used years ago.
Still think Vita is the best porcelain on the market.
For me and many others, it didn't take a book or lecture to know that porcelain must be supported no matter what substructure is used, metal or zirconia ! Now its been several years since labs learned that zirconia must be cooled very slowly with properly supported substructures, and higher fired wash bakes... Now we have proper techniques so that zirconia crowns are equal to pfms with better fits and no black lines

OK, had a bad week....shoot me down if you have more knowledge than me.....

 

[NicelyMKV]

Are you The Bobby Orr?!

 

[DMC]

I don't think he is, but I need a story behind the obsession with him.

Tell us....

 

[rkm rdt]

Hockey is our religion.

 

[DMC]

ok...

I guess that's enough?

Not for me. I really like extreme sports and stuff...but soccer and hockey are so damn boring. Throw Golf in there while you're at it!

I just don't get it. Gliding around on skates? Punching each other at random while slapping an almost invisible tiny black disk of teeth shattering fun into a tiny net!

 

[TheLabGuy]

Hockey is our religion.

Too bad we have to teach you how to play it every year...*oh snap*

 

[Bobby Orr ceramics]

I don't think he is, but I need a story behind the obsession with him.

Tell us....

Bobby Orr was the greatest defenceman to ever play hockey. He always innovated the game, was tough against huge odds, played with grace and grit to the highest level he could. He pitched in and played goal when the goalie was down and out in a game as any great team player without thinking if his pads were adequate. He'd play on 1 leg when necessary for the better of his team. He always focussed on trying to make his teammates better. He achieved NHL records never to be conquered again. On top of all that, he never show-boated when he scored a goal......even when he won the Stanley Cup......He's in the Hockey Hall of Fame on first ballot.

I try to model my journey in dentistry with those same attributes. It's good for our profession .

Any questions ?? Just let me know, I'm happy to help in any way possible.

, James (aka Orr4)

 

[user name]

Bobby Orr was the greatest defenceman to ever play a game nobody really cares about. Aye?

 

[disturbed]

distured, your 32 yrs young with only 10 yrs of training. Give me a break... Wait till you 60, then try listening to someone with 10 years of training with all the answers...
Have you heard the names of Dr.Rella Christiensen, she spoke highly of Noritake and zirconia in her study last year to me. What say you about Dr. Ed. McLaren in his zirconia study. Do you think he will stop using zirconia ...

Inceram was and is a great material, but doctors jumped on Empress since it was more translucent, and now we have Emax and Empress is dying a slow death. Now BruxZir is blazing a trail with monolithic zirconia, and who knows how this material will improve or be replaced with the next monolithic material..
To think Dsign and Emax are the best materials on the market and BruxZir is the devil, is thinking with a very closed mind in my experience. Everyone knows unpolished/nonglazed opaque/porcelain and zirconia is very abrasive.
Do you actually think all dentist repolish gold and porcelain to a high glaze when they adjust. BruxZir on the other hand is extremely easy to polish and much less chance of being seated unpolished.
I don't think Jim G. would sell BruxZir all over the world with a chance of being sued by thousands of labs and doctors......Hope I'm right !
Did you see the Zirconia study that Noritake has, very impressive.
If you have studies showing glazed/highly polished zirconia is abrasive, please share with us. popcorn
I want to see the meat and potatoes(facts) if your going to preach to the choir.
Charles

ok.. I will prove myself if that is what it takes.. please research Ask Dr. Christensen - Dental Economics , skip down to the part where he discusses occlusal wear..TIME WILL TELL.. but come on.. AGAIN.. put a very smooth rock in a bag of chaulk and shake it for a while.. let me know what happens... I will see if I can find the NYU layered to lava Zr attrition and fatigue studies for you.. unless you think you are capable of doing your own research.. let me know I have is stored somewhere..

 

[disturbed]

Distured, your to young to know this, when Vita porcelain came to the US, many labs couldn't use it because of checking... duh CTE issues, thick under supported porcelain....Hmmm ...sounds familar doesn't it
Same issues among other problems when NP was being used years ago.
Still think Vita is the best porcelain on the market.
For me and many others, it didn't take a book or lecture to know that porcelain must be supported no matter what substructure is used, metal or zirconia ! Now its been several years since labs learned that zirconia must be cooled very slowly with properly supported substructures, and higher fired wash bakes... Now we have proper techniques so that zirconia crowns are equal to pfms with better fits and no black lines

OK, had a bad week....shoot me down if you have more knowledge than me.....

Charles..Do you know what happens to the crystalain structure of porcelain when we fire it the 100 degrees above manufactures recommendation? research lucite crystals.. they are bad news, a LOT more form when you fire your porcelain at those temps.. they may go out the door looking fine, they may last 5-8 years because you did a good job supporting them, but I am fairly certain they will never last as long as they should because there IS NO BOND...

also regarding D'sign.. Ivoclar had nothing to do with its creation, they just knew a good thing when they saw it, so they bought the rights.. research don cornell..the inventor...