full contour zirconia in the anterior

[UCan'tHandleTheTooth!]

Hi all! We were having a patient come in around 11 this am, with one or two chipped full-contour Emax veneers that were just done in march.This patient had lived with some chipped Esthetic veneers for sometime; and i thought Emax may work out, but that already is not the case. I wanted to recommend to have the Dr. prep for full contour zirconia 3/4 crowns. This gentleman is in his early 20's ; and this is a bite problem. The patient is abusing his anterior edges, but he is not looking to address this issue for the time being. Any thoughts or suggestions on my planned direction of this case would be appreciated.

And just one catch! The patient is leaving the country for 1 yr. sometime early next week. Does anyone hav a recommendation on where i could overnight this case for full contour anterior zirconia, and get it back ASAP. I know early next week is a big push, just wanted to see if anyone had any suggestions! Thanks All!

 

[DMC]

I'll be glad to make some beautiful Bruxzir anteriors for ya.
I think we are one day away with UPS ground.
We are having good luck so far with anterior shading.

I think we are at $49 a tooth from your model, or $39 from your scan.
If you don't like them.... We will accpet for full refund.

Scott

 

[paulg100]

Interesting, so there are issues with the bite that are cracking a monlithic 400mpa restoration on an anterior tooth... thats some going right there!

so you put a 1200mpa restoration on.. MORE STRENGTH they scream

So what gives next..the root!?!

Occlusion always wins, obsctructing the bite with a stronger and stronger crown is just gonna end up with the patient loosing the whole tooth

Bruxzir's new slogan: "brawn over brains"

I can just hear the doc now" Well we told you the crown wouldnt break!" as his extracting the tooth..

Maybe it would be better to make up a composite crown as a long term temp untill the pt can get the occlusual issue sorted. At least this should wear rather than busting everything up..

 

[rkm rdt]

Extract the 2 teeth and make a flipper!

That way he can leave his teeth for the annual repair at your lab.

Vita Physiodens..the original monolithic restoration.

 

[UCan'tHandleTheTooth!]

thanks for the input and replies. i was preparing a course of action based on the patients explanation of a "broken veneer", but am pleased to report that this is not exactly the case.
The whole veneer came off of the prep, just losing a small chip at the gingival. so I am assuming this is a bonding issue for the Dr.. I just advised him to double check all protrusive and lateral movements to make sure that one tooth is not taking more force than necessary, and to make sure patient has a nightguard.
Thanks Again!
Brandon

 

[UCan'tHandleTheTooth!]

P.S. Not a surprise, because the dr. isnt exactly a perfectionist. I have an interesting contrast in our office. It takes one dr 2 1/2 hrs. to insert 6 veneers, and the other dr. will do it in a half-hour. And you should see some of his preps!

 

[paulg100]

well thats good to hear.

they dont even publish the elastic modulus for zirconia (at least not zircad),im guessing its a million miles away from natural enamel.

Using FC zirconia for posteriors that are taking a verticle chomping load only is one thing, but for anteriors that are subject to excursive and horizontal forces, thats something else.

Using something this hard and stable for anterior teeth just dosent sound very clever to me...

Ive seen some published bonding protocols that talk about 45minutes per tooth! so 6 veeners in 30 minutes err yeah right! I hope you are charging again when they crack or debond..

 

[charles007]

My choice would be emax monolithic, no layering, and new bonding protocal...plus a nightguard, or no more free veneers.
If this is a good account, it would be a free-bee.

 

[Hary]

from what i see this person has a major bite problem, when some one brakes 400 mpa on a front tooth that means that lower jaw wants to come forward on a relax position by puting that patient a full zirconia bridge he will start getting some symptoms. The best thing is to have well ajusted ortothic and again lithium disilicate.

 

[Mike2]

Insurance Codes

I have a question about the insurance side of Bruxzir. Are the dentist able to get insurance recovery for these units or are they elective like Empress and therefore not covered. Not sure if that is a dumb question, but I was told by a Nobel rep. that full cntr Ti can be coded the same as high noble fcc.http://dentallabnetwork.com/forums/images/icons/icon5.gif

 

[Mark Jackson]

Bruxzir's new slogan: "brawn over brains"

I can just hear the doc now" Well we told you the crown wouldnt break!" as his extracting the tooth..

Maybe it would be better to make up a composite crown as a long term temp untill the pt can get the occlusual issue sorted. At least this should wear rather than busting everything up..

If the crown is so strong the tooth breaks, then there was something wrong with Gods tooth. You don't build in a fail safe mechanism. Parafunction rarely occurs overnight.

 

[disturbed]

So what gives next..the root!?!

Occlusion always wins, obsctructing the bite with a stronger and stronger crown is just gonna end up with the patient loosing the whole tooth

Bruxzir's new slogan: "brawn over brains"

I can just hear the doc now" Well we told you the crown wouldnt break!" as his extracting the tooth..
..

:congrats:

 

[disturbed]

If the crown is so strong the tooth breaks, then there was something wrong with Gods tooth.

......./facepalm

 

[nellynoo]

Interesting comments about this case and using zirconia for a bruxist patient, so FYI
modulus of elasticity of zirconia is around 270 gpa this is one of the reasons it is not recommended for post etc

 

[rkm rdt]

Think I'll trust this guy's opinion,

Ask Dr. Christensen - Dental Economics

"My summary is to go for it in moderation! These restorations look like something we will be looking at for a long time. However, as I said, don't throw away PFM just yet."