Zir Monolithic Bridges

[Brett Hansen CDT]

I have a relatively new doctor to our lab that restores almost all her posterior crowns with Zir Monolithic. I have about 2 years experience designing monolithic crowns on our Dental Wings 3 Series scanner. She recently sent me 2, 4 unit, monolithic posterior bridges. My first question is, do you guys charge more for monolithic bridges per unit than you do for single unit cases? The second question is, what kind of results are you getting on your monolithic bridges. I am either not good enough, or my scanner software isn't good enough, or both. I am not happy at all with the way these bridges look after I finish designing them. Trying to close the cervical embrasures ends up stretching the teeth and makes them look unnatural. I guess I want to know if it is me that needs more training with this scanner/software, or maybe I am asking more out of the DW software than it can actually do. Thanks in advance for any input.

 

[dentalcreators]

https://www.facebook.com/photo.php?fbid=10200214544386389&set=pcb.10200214549826525&type=1&theater

 

[Sevan P]

No extra charge for mono bridges, do you charge extra on your PFM bridges? Mono bridges can look a bit funky, maybe you might need to dial in you infiltrating on the pontics, more ZR and can cause a darker color outcome if not careful. There are a lot of variables that come into play on bridges. As for the cervical embrasures You can add pink porcelain if needed but it all varies from design to design. I sometimes will fill the embrasures up if my connections between the teeth are not adequate enough just to make them a bit more beefy.

Can you post some screen shots or images?

Sevan

 

[ParkwayDental]

This is a photo of a Bruxzir Bridge we have done. We have done full round house bridges and we get a consistent result all the time. We charge a normal FCZ fee plus a bridge connection fee that is just us. The photo on the bottom is FCZ all the way around except for we layered our pink porcelain!

 

[Brett Hansen CDT]

I haven't sent the file to be milled. Here are a couple of pictures of what I have designed so far. I can make it look a bit better, but I could do a much better job if this was a conventional pfc bridge. Tyler, what scanner and software are you using?

 

[Drizzt]

I haven't sent the file to be milled. Here are a couple of pictures of what I have designed so far. I can make it look a bit better, but I could do a much better job if this was a conventional pfc bridge. Tyler, what scanner and software are you using?

Brett , you should change the libray you're using . Try the Merz artegal BM . It is so musch better .The library you used for that bridge is the DW standard right ? I also have DW and I am using the Merz BM library almost in every case where I don't copy the anatomy of the natural tooth . Dental Wings sucks , but if you try another library you'll get much better results .

https://www.facebook.com/photo.php?...906500.-2207520000.1374081323.&type=3&theater

For this I used the BM as a base and after that the add/remove function .

 

[PDC]

Brett, as you look down on the occlusal, use your green transformer dots and move the distal & mesial in until you get the correct width. Get a little gap between them and then recompute your connectors. Now edit the connectors to fill in the embrasures as you like.

 

[ParkwayDental]

Tyler, what scanner and software are you using?

We are using 3Shape with a D800 and D700 Scanner

 

[charles007]

Yes I charge more for a bridge unit compared to a single unit.. but I don't charge extra for connectors like I do in metal ceramic fees.
Brett, design as though you designing single unit crowns that almost connect, then add connectors last.. This way your designs are more rounded looking rather than square and block looking.. The lower lingual area is where I add to beef up my connectors,, and usually way thicker than the minimum 9mm..

 

[shane williams]

Looking great Tyler!! I like the full arch case. Doing my first one. Well I've milled it out a few times, changed the design too. Now I'm being told that there is a small crack. After pink was being fired a crack appeared!! Looks like I'm milling it again.

 

[Marcusthegladiator CDT]

Brett, as you look down on the occlusal, use your green transformer dots and move the distal & mesial in until you get the correct width. Get a little gap between them and then recompute your connectors. Now edit the connectors to fill in the embrasures as you like.

When building full contours with 3 shape I would minimize and almost ignore the connectors and just overlap the contact circles between the crowns/pontics.
Then adjust them slightly in green to make them perfect...

Once your one step away from completion and you may edit the bridge as a whole, the wire mesh that made up the connectors disappears and the only wire mesh's are the internal and external, so with full contours, I never bothered with connector design.

 

[Brett Hansen CDT]

I outsource my milling, so I have to get the design as close to perfect as possible.

I really appreciate the input everyone. I am gonna take another crack at that bridge in the morning and incorporate your suggestions. I will post pics of the new bridge design in the morning.

 

[JohnWilson]

Here is my take on mono bridge design,

1) I charge more per Bridge unit than single
2) In 3shape using the NONE feature for joint validation works great on most cases.

With that being said I am however liking the silhouette joint feature that allows me to keep my facial embrasures WIDE open and then blend the ling. CAP has a great video showing their technique.

Lots of guys use the add on morph with good luck but I feel using the joint tool I can get a better looking smoother unit with out wiping out all the ling anatomy. Works really good with you have long thin lower ant pontics and you don't want to make blocky tall rentangular looking teeth.

 

[Sevan P]

Yes ace the bridge connectors and in the final stage apply more material between the lingual interproximal areas and beef them up a bit. But you will still need to refine the interproximal areas after sintering so you can eliminate the fake bridge look, open them up a bit more by hand.

Link to the CAP video.

CAP ACADEMY

this is for 3Shape, but I think DW is capable of the same thing hopefully.

 

[Drizzt]

this is for 3Shape, but I think DW is capable of the same thing hopefully.[/QUOTE]

Don't be that sure ....

 

[paulg100]

i dont see why people dont charge more for bridges, when nesting a bridge uses more space than you can get with just singles, so your using more ZR no?

Also people not charging more for PFM bridges, to do contacts/seperation properly you need at least 1 or more extra firing cycles so again.. how are you not charging for this?... unless your just separating units with a disc which always looks like crap.. at least when i do it that way.

 

[Brett Hansen CDT]

Here is my new bridge design. Not perfect, but much better than the first one.

 

[jthacke3]

i dont see why people dont charge more for bridges, when nesting a bridge uses more space than you can get with just singles, so your using more ZR no?

Also people not charging more for PFM bridges, to do contacts/seperation properly you need at least 1 or more extra firing cycles so again.. how are you not charging for this?... unless your just separating units with a disc which always looks like crap.. at least when i do it that way.

We don't charge more for small zirconia bridges. Yes, there's more zirconia material but we're talking about pennies here. The fact we get the efficiency of doing model work for a 3 unit case rather than 1 unit more than offsets the cost. Plus, we don't want to do anything to discourage dentists from using full zirconia at this point. However, we charge more for long span zirconia bridges not because raw materials cost but for the higher remake factor--longer spans take much longer to design, require a higher skill level for the designer, and frequently need to be milled more than once. Those costs need to be factored in.

Our lab definitely charges more for PFM bridges units than for crowns. Pontics and connectors mean more alloy. We generally charge $15 more per unit on average for high noble, more for 7+ unit bridges depending on the amount of endentulous space.

 

[JohnWilson]

This case was done yesterday, 8 unit bridge milled on my mini in 72 mins. The joint design as you can see it so the pontics look narrow but strong. The pictures are of the unit straight out of the sintering oven, you can see the pontics are slightly holding the bridge up but when we adjust the stone its going to seal and be bang on perfect.

 

[Sevan P]

i dont see why people dont charge more for bridges, when nesting a bridge uses more space than you can get with just singles, so your using more ZR no?
.

No, when nesting a three unit bridge you will be using less Zr. Try to nest three units with in the same space as a bridge. You have to keep some space between then single units as where a bridge is already connected to each other using less space. Only thing is with a bridge you may need to use a large puck due to insertion angles and what not as where a single units has a better chance at fitting into a smaller puck. The use of a large puck is why most would charge more for a bridge.

We charge a certain amount up to a 3-4 unit bridge, a 5-8 unit is more and 9+ is more, Frame anf FCZr.