E.max vs Zirconia toxicity question

[Freedom180]

Hi,

Anyone have experience here with adverse reactions to monolithic Lithium Disilicate crowns? I understand there’s some research showing cytotoxicity rates in LS2 crowns, mitochondrial suppression, and that they are not biologically inert.
Between the two materials - monolithic Lithium D. And monolithic Zirconia, which would be most biocompatible for a patient who is allergic to metals (gold, silver, etc)?

Would appreciate learning from your experiences with these materials.

 

[JMN]

Hi,

Anyone have experience here with adverse reactions to monolithic Lithium Disilicate crowns? I understand there’s some research showing cytotoxicity rates in LS2 crowns, mitochondrial suppression, and that they are not biologically inert.
Between the two materials - monolithic Lithium D. And monolithic Zirconia, which would be most biocompatible for a patient who is allergic to metals (gold, silver, etc)?

Would appreciate learning from your experiences with these materials.

People can be allergic to anything, but that doesn't mean it needs to be toxic for that to occur.

Do you know where you saw this or have a link or pdf of the claim?

I have never heard of anyone allergic to gold, but I guess that is a possibility.

 

[user name]

Gold is inert in the chemical sense because it does not react with any other substances. This is attributed to the stable and balanced configuration its electrons. You arent allergic to gold. Period. You may have a reaction to high gold alloys though. There are many other metals and fluxes that are present.

Bio inert Materials | List of High Impact Articles | PPts | Journals | Videos

Bio inert Materials High Impact List of Articles PPts Journals

www.omicsonline.org

Ivoclar changed its prep guidelines many years ago with LD products. They wanteed Drs to keep the margin .5mm above the gingiva to avoid reactions. I dont know if thats changed.

Regardless what your restorations are made of, they will have some stains and glaze applied. Stains are oxides, and microscopically dont usually 'glaze', so they must be sealed under an additional layer of glaze.

There are other LD products than just e.Max. I like working with GC Americas LiSi.
What about all the differences in different zirconias?

I dont believe anyone when they start telling me about everything theyre allergic to. Nickle allergy? Then how are you able to wear denim jeans? What exotic cook ware do you use to prepare food for someone so delicate?

 

[Jason D]

Anyone with an “allergic” reaction to zirconia or lithium disilicate is either misinformed or mischaracterizing inflamation from a variety of other sources (unsealed margins, residual cement etc)

Allergies so extreme would mean the person would have to live in a class 10 clean room

 

[Freedom180]

Anyone with an “allergic” reaction to zirconia or lithium disilicate is either misinformed or mischaracterizing inflamation from a variety of other sources (unsealed margins, residual cement etc)

Allergies so extreme would mean the person would have to live in a class 10 clean room

I’m referring specifically to these studies. Concluding that Lithium Disilicate is not bio inert. And causes mitochondrial suppression.

In vitro cytotoxic response to lithium disilicate dental ceramics - PubMed

Our results suggest that lithium disilicates are not biologically inert, and that many have a similar cytotoxicity dynamic regardless of small differences in composition or processing.

www.ncbi.nlm.nih.gov

In vitro cytotoxicity of all-ceramic substructural materials after aging

Several all-ceramic materials have been developed to meet the most challenging requirements in restorative dentistry. However, only limited reports ha…

www.sciencedirect.com

 

[grantoz]

in the early days of empress 2 there was a paper saying that it was cytotoxic if you went thru the glaze and exposed the crystal structure of the lithium discilicate if you look at it under a scope its very needle like. the problem is that when you polish the crown margins after cementing you almost certainly go thru the glaze layer. they also stated that you must add glaze to any exposed lithium discilicate ceramic.Is everyone dying of cancer? no but if you look at any crown thats subgingival you will see the zi crowns have a much happier gingiva than emax crowns.

 

[CoolHandLuke]

I feel like we have been through this before... was a patient a while ago with a similar concern... will dig up the thread.

 

[CoolHandLuke]

Fully Informed Dentists and Patients

I have been searching this thread and trying to find out more about the subject of labs that outsource, and the Dentists that use them. Some Dentists may choose to use international outsourcing labs wittingly and others may not know that their work is being done overseas. When you buy a car or a...

dentallabnetwork.com

Theres your one.

 

[Freedom180]

in the early days of empress 2 there was a paper saying that it was cytotoxic if you went thru the glaze and exposed the crystal structure of the lithium discilicate if you look at it under a scope its very needle like. the problem is that when you polish the crown margins after cementing you almost certainly go thru the glaze layer. they also stated that you must add glaze to any exposed lithium discilicate ceramic.Is everyone dying of cancer? no but if you look at any crown thats subgingival you will see the zi crowns have a much happier gingiva than emax crowns.

So what is the reason for many dentists claiming that there is no difference bicompatibally between LD and Zirconia?
If the gingiva reacts badly when in contact with Lithium Disilicate isn’t that a strong enough case against its usage?

 

[JMN]

So what is the reason for many dentists claiming that there is no difference bicompatibally between LD and Zirconia?
If the gingiva reacts badly when in contact with Lithium Disilicate isn’t that a strong enough case against its usage?

If you read the study, it's not really that toxic at all.
This isn't massive and sustained tissue necrosis. It's a few days worth of reduced tissue health.

Less than what you'd expect from a crown on implant that overblanches the tissue and causes tissue death from lack of blood flow.


If we're gonna get in a twist over L/D then we ought to be lighting torches and lifting pitchforks over Amalgam. The only material known to man that has to be treated as a highly toxic Federally listed substance before it's in the body, as it's removed from the body, and after it's removed from the body. So bad it was decreed that Mercury thermometors cannot be made as they just might break and the mercury just might come in contact with something that's alive.

But it's "Perfectly Safe"(according to the ADA) while it's in the human body.

Edit: Uh, anyone need a slightly used soapbox?

 

[CoolHandLuke]

Great points JMN.

 

[grantoz]

i would be more worried what dental acrylic does in the mouth when screwed in on say an all on 4 case for years without removal.

 

[JMN]

i would be more worried what dental acrylic does in the mouth when screwed in on say an all on 4 case for years without removal.

Easy. It breaks.

 

[Dave Hall]

Gold is inert in the chemical sense because it does not react with any other substances. This is attributed to the stable and balanced configuration its electrons. You arent allergic to gold. Period. You may have a reaction to high gold alloys though. There are many other metals and fluxes that are present.

Bio inert Materials | List of High Impact Articles | PPts | Journals | Videos

Bio inert Materials High Impact List of Articles PPts Journals

www.omicsonline.org

Ivoclar changed its prep guidelines many years ago with LD products. They wanteed Drs to keep the margin .5mm above the gingiva to avoid reactions. I dont know if thats changed.

Regardless what your restorations are made of, they will have some stains and glaze applied. Stains are oxides, and microscopically dont usually 'glaze', so they must be sealed under an additional layer of glaze.

There are other LD products than just e.Max. I like working with GC Americas LiSi.
What about all the differences in different zirconias?

I dont believe anyone when they start telling me about everything theyre allergic to. Nickle allergy? Then how are you able to wear denim jeans? What exotic cook ware do you use to prepare food for someone so delicate?

Nickel allergy is fairly well documented. About 20% of women and 10% are allergic to nickel, which is why there is a market for hypoallergenic earrings. You can be allergic to nickel and still carry nickels in your pocket or have a nickel buckle on your clothes without a reaction, because it isn't in constant contact with the skin. But it has even been shown that patients can get a systemic allergic reaction to a stainless steel post (which contains nickel) because nickel ions will leach through the dentin and cementum, which is why smart dentists have all shifted to titanium posts.
If you place a non-precious crown containing nickel in a patient with a documented nickel allergy because you failed to ask that question on your medical history form, I hope you are current with your malpractice insurance payments!

 

[JMN]

Nickel allergy is fairly well documented. About 20% of women and 10% are allergic to nickel, which is why there is a market for hypoallergenic earrings. You can be allergic to nickel and still carry nickels in your pocket or have a nickel buckle on your clothes without a reaction, because it isn't in constant contact with the skin. But it has even been shown that patients can get a systemic allergic reaction to a stainless steel post (which contains nickel) because nickel ions will leach through the dentin and cementum, which is why smart dentists have all shifted to titanium posts.
If you place a non-precious crown containing nickel in a patient with a documented nickel allergy because you failed to ask that question on your medical history form, I hope you are current with your malpractice insurance payments!

Greetings Earthling and welcome!

Username went to live forever in health and peace with the Lord last year. But he left us a lot of help.