Leaving the subginival zirconia of a screw retained restoration unglazed

[Brett Hansen CDT]

I had a discussion with a client about a technique he was taught for promoting tissue adherence to implant restorations. Apparently, polished, unglazed, zirconia is a great surface for the gingiva to adhere to. I like to use custom abutments for my screw retained restorations, but I also place the margins much closer to the implant than I would if it was a cemented restoration. We are going to try and do this on his future restorations. I am just going to polish the sub g zirconia and glaze the supra g zirconia. He was asking about not using glaze at all, but I told him that unglazed zirc has a different look. It may be acceptable in the posterior region to not glaze the zirc so i am gong to send him an unglazed and a glazed zirc crown on his next case so he can compare. Here's and article with more detail about the science behind this technique.

https://www.thejpd.org/article/S0022-3913(20)30589-8/fulltext

 

[Contraluz]

He was asking about not using glaze at all, but I told him that unglazed zirc has a different look.

This and unglazed Zr is not fluorescent!

So, in a blacklight situation may look awkward ... (See image from one of my presentations I do on the subject)

But yes, unpolished Zr seem to best material for the tissue.

 

[Sda36]

I had a discussion with a client about a technique he was taught for promoting tissue adherence to implant restorations. Apparently, polished, unglazed, zirconia is a great surface for the gingiva to adhere to. I like to use custom abutments for my screw retained restorations, but I also place the margins much closer to the implant than I would if it was a cemented restoration. We are going to try and do this on his future restorations. I am just going to polish the sub g zirconia and glaze the supra g zirconia. He was asking about not using glaze at all, but I told him that unglazed zirc has a different look. It may be acceptable in the posterior region to not glaze the zirc so i am gong to send him an unglazed and a glazed zirc crown on his next case so he can compare. Here's and article with more detail about the science behind this technique.

https://www.thejpd.org/article/S0022-3913(20)30589-8/fulltext

I believe Labman related a study on this a while back and was impressed. Not sure if it was Danish or Norwegian. From what I've read, on the subject, it really can't hurt and not an esthetic issue in any way.

 

[filippos]

I can tell you what i learned from dentists and seminars about zirconia implant restorations and soft tissue.

we need to leave subgingival parts of zirconia restorations, unglazed. Only handpolished, and actually, in a seminar with Nondas Vlachopoulos about implants that i attended, he told us that we should not finish the polishing with diamond paste. Only polish with 2 rubbers, rough and medium one, not the super fine. This is to create a smooth surface of zirconia but in microscopic view it should be slightly rough to motivate the epithelium cells to adapt to the zirconia surface. I think there is a study that proves this theory also, i will look if i can find this.

We at the lab, also handpolish the areas beneath the pontics of full zirconia bridges that are in touch with the soft tissue, not only implant based restorations.

I attach you a study of Dr Pelekanos and Vergoulis about the shape and design of the subgingival areas of zirconia restorations. Design is also super important and there are so many factors, dentists, surgeons and technician should consider. I still not finished reading this study but im impressed.

 

[LarryRDC]

Brett, you can glaze the supragingival and get the look you prefer and just polish the tissue profile portion. I design all SR’s using tibases with the tissue emergence profile’s in polished ZI. ( the Tibase vs custom milled abutments is a whole other discussion ; ). IMHO, If you design them properly, the tissue profile can be just as ‘custom’ as a milled custom abutment. The feedback I’ve gotten in the past 7 years of doing this has been extremely positive on how healthy the tissue is!

 

[Sda36]

I believe Labman related a study on this a while back and was impressed. Not sure if it was Danish or Norwegian. From what I've read, on the subject, it really can't hurt and not an esthetic issue in any way.

Sorry, meant LabGuy

 

[rkm rdt]

I think you may want to consult a hygienist about plaque adherence before bowing to the lecture gods.

 

[Car 54]

I can tell you what i learned from dentists and seminars about zirconia implant restorations and soft tissue.

we need to leave subgingival parts of zirconia restorations, unglazed. Only handpolished, and actually, in a seminar with Nondas Vlachopoulos about implants that i attended, he told us that we should not finish the polishing with diamond paste. Only polish with 2 rubbers, rough and medium one, not the super fine. This is to create a smooth surface of zirconia but in microscopic view it should be slightly rough to motivate the epithelium cells to adapt to the zirconia surface. I think there is a study that proves this theory also, i will look if i can find this.

We at the lab, also handpolish the areas beneath the pontics of full zirconia bridges that are in touch with the soft tissue, not only implant based restorations.

I attach you a study of Dr Pelekanos and Vergoulis about the shape and design of the subgingival areas of zirconia restorations. Design is also super important and there are so many factors, dentists, surgeons and technician should consider. I still not finished reading this study but im impressed.

Thank you for the bonus PDF, very nice

 

[Sda36]

I think you may want to consult a hygienist about plaque adherence before bowing to the lecture gods.

Hygienists don't ever see the mucosal interface, not sure what you mean here? Unless, of course the implant is removed at a recall appt. I have a Panther rubber wheel that was developed to provide the "Best" surface topography at ~ 40 um roughness, definitely not highest shine but really not rough at all. Relates to this topic for being Optimum grit.

 

[rkm rdt]

Hygienists don't ever see the mucosal interface, not sure what you mean here? Unless, of course the implant is removed at a recall appt. I have a Panther rubber wheel that was developed to provide the "Best" surface topography at ~ 40 um roughness, definitely not highest shine but really not rough at all. Relates to this topic for being Optimum grit.

How deep are the margins? Are we talking about ti bases here?

 

[Andrew Priddy]

You can see ZBLConcept cases on my web site under training




you are talking about Zero Bone Loss Concepts

https://education.tomaslinkevicius.com/

 

[Sda36]

How deep are the margins? Are we talking about ti bases here?

Yes but like Congratultz said, predominately most of the emergence profile is Zirconia.

 

[Sda36]

Sorry, meant LabGuy

Getting there... TheLabGuy

 

[Sda36]

Yes but like Congratultz said, predominately most of the emergence profile is Zirconia.

Sorry, Contraluz, new update giving me fits with auto Non AI.

 

[rkm rdt]

Yes but like Congratultz said, predominately most of the emergence profile is Zirconia.

I usually make custom abutments where the margins are 1mm sub g. Ti bases are a whole new ball game for what we are discussing here.

 

[Toothman19]

We have been doing this for awhile with great results

 

[DIMADEL]

It’s make a lot of sense, the subgingival zone always has to be polish it by the dentist, because resuidual cement, also Part of the abutment to make the a nice interface.

 

[TheLabGuy]

Shared this awhile ago, zero bone loss concept by Dr. Tomas Lincivicus. All labs should be doing this, especially on those ti-bases cases where the zirconia goes all the way to the interface.

 

[DIMADEL]

Shared this awhile ago, zero bone loss concept by Dr. Tomas Lincivicus. All labs should be doing this, especially on those ti-bases cases where the zirconia goes all the way to the interface.

 

[Sda36]

I usually make custom abutments where the margins are 1mm sub g. Ti bases are a whole new ball game for what we are discussing here.

Absolutely