Anterior Implant

Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
te
Approach sse nc e
n
for Anterior Reconstructions Using

Current Ceramics, Implants, and
Adhesive Systems
Jan Hajt, Dr Med Dent
Specialist in esthetic dentistry (DGZ), Munich, Germany
Uwe Gehringer, CDT

Private practice, Munich, Germany
Mutlu zcan, Prof Dr Med Dent, PhD

University of Zurich Dental Materials Unit, Switzerland
Correspondence to: Jan Hajt

(FNFJOTDIBGUTQSBYJT)BKU$BDBDJ 8FJOTUS .VOJDI (FSNBOZUFMFNBJMESKBOIBKUP!UPOMJOFEF
242
THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY
70-6.&t/6.#&3t"656./
fo r
A Multi-faceted Treatment
ot
CASE REPORT
HAJT ET ALopyrig
Abstract
fo r
Of all developments in dental technol
mandible with a combined treatment ap
ogy, fullling the esthetic and functional
proach utilizing veneers for harmonized
demands of the patient, especially re
space distribution on the abutment teeth
garding anterior reconstructions, is still
BOEBOJNQMBOUTVQQPSUFE[JSDPOJBmYFE
a challenge for both dentists and dental
dental prosthesis in the anterior seg
technicians. This becomes more dif
ment of the maxilla. Adhesive cementa
cult for patients with a previous treat
tion of the restorations is also presented
ment history that is not ideal. This case
JO B TUFQCZTUFQ BQQSPBDI CBTFE PO
presentation demonstrates reconstruc
the current state of the art.
ot
Q ui
by N
ht
No C
t fo
rP
ub
lica
tio
n
te
ss e n c e
UJPOPGBOBOUFSJPS[JSDPOJBSFTJOCPOEFE
mYFEEFOUBMQSPTUIFTJT 3#'%1
GPSUIF
(Eur J Esthet Dent 2010;5:242259)
243
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
ti
te con on
marginal t, minimal abrasion, and
ss e n c e
ot
Introduction
fo r
servative tooth preparation. Yet they are

Today, prosthetic and operative treat
not as effective as reinforced ceramics
ment concepts could be categorized as
in preventing premature failure. On the
OPOJOWBTJWF SFWFSTJCMF
NJOJNBMMZJOWB
PUIFSIBOE BSFJOGPSDFEBMMDFSBNJD'%1
sive (partially reversible), and (more) in
can be achieved using milled aluminous
WBTJWFTUSBUFHJFT OPOSFWFSTJCMF
VTJOH
or zirconia copings. However, the pres
various
materials.
Dentistry, perhaps,
ence of the relatively opaque internal
has the unique distinction of using the
ceramic core may provide an impedi
widest variety of materials, ranging from
ment to matching some tooth colors.
NFUBMT BOE NFUBM BMMPZT UP SFTJOCBTFE
Although minimally invasive applica
composites and ceramics. Develop
tions are possible using direct compos
ments, especially in the eld of polymers
JUFT TFOTJUJWJUZPGUFDIOJRVFJTBOJTTVF
and ceramics, have largely eliminated
the drawbacks of composites involve the
the use of metals in the mouth. In spite of
loss of surface lustre. This may require
all the advances, clinicians should real
repolishing,
ize the drawbacks before selecting the
This is commonly found to be the case
most appropriate material for a particu
after several years of clinical function,
lar situation. Concentrating only on the
and therefore the maintenance of the
NBUFSJBMTQSPQFSUJFTJTOPUTVGmDJFOUDMJ
surface characteristics of composites,
nicians should be mindful of the best ap
even after nishing and polishing, is an
plication method. As the esthetic aspect
ongoing issue.
renishing, or relayering.
of dental care becomes increasingly im
Minimally invasive applications are
portant to patients, the dental practitioner
also possible using ceramic veneers.
should be aware of the applications and
According to the majority of studies, it
MJNJUBUJPOT PG UIF WBSJPVT UPPUIDPMPSFE
is clear that from the mechanical point
restorative materials or systems and bal
of view, retention of laminates is not
ance these with the ethical aspects of
seen to be problematic.4 Clinical stud
the invasive applications.
ies rarely report debonding, indicating
Fortunately, the dental profession has
that the adhesion of the luting cement,
proted from remarkable technological
not only to dental tissues but also to the
advances in the substitution of missing
IZESPnVPSJDFUDIFEBOETJMBOJ[FEDFSBN
dental tissues and teeth. However, we
ic, is very reliable. Therefore the choice
are still faced with the challenge of rep
PGGVMMDPWFSBHF'%1TPWFSMBNJOBUFTGPS
licating the tooth tissues, mechanically,
mechanical retention reasons cannot be
physically, biologically, and optically.
justied. 4JNJMBSMZ SFTJOCPOEFE '%1T
With the increased options, the choice of
3#'%1T
XIJDI BSF BMMDFSBNJD BSF
material is also becoming more difcult.
preferable to metal ceramics due to be
When a qualied ceramist is engaged,
ing minimally invasive, and also for es
pressed ceramics provide outstanding
thetic reasons. Nevertheless, teeth sur
results for a single anterior xed dental
rounded by healthy periodontal tissues
prosthesis (FDP), more so than almost
generally have a very high longevity, up
all other restorative options, with suitable
UPPWFSZFBST5 Therefore, the
244
70-6.&t/6.#&3t"656./
HAJT ET ALopyrig
utmost care should be taken to preserve
fo r
the cementoenamel junction. This may
ot
Q ui
by N
ht
No C
t fo
rP
ub
lica
tio
n
te
ss e n c e
not always be achieved, however, due to

required tissue sacrice for esthetic rea
TPOT*OBEEJUJPO QBUJFOUSFMBUFEGBDUPST
will continue to dominate when choosing
one restoration type over another, or the
most suitable restorative materials for
the patient.
The situation becomes even more
complex when the patient has a history
of several treatment concepts that have
failed. This case presentation could be
Fig 1 #BTFMJOFTJUVBUJPOXJUIBOJNQMBOUBU SF

TUPSFEXJUIBUFNQPSBSJMZDFNFOUFEMPOHUJNFUFN
QPSBSZ SFTJOCBTFE mYFE EFOUBM QSPTUIFTJT '%1
considered an example of the most mini
DSPXO
.FUBMCBTFESFTJOCPOEFE'%1POBOE
mally invasive and durable approach
XJUICFJOHUIFQPOUJD
being practiced, according to the cur

rent state of the art and considering the
patients demands.
Materials and methods
#BTFMJOFTJUVBUJPO
in the maxilla
"ZFBSPMEGFNBMFQBUJFOUQSFTFOUFE
In the maxilla, both bone loss and soft tis
with an implant placed alio loco at tooth
sue loss were observed. The implant was
CZIFSQSFWJPVTEFOUJTUBOEBUFNQP
positioned correctly. However, despite
rarily rehabilitated situation in the max
the previously accomplished soft tissue
JMMBBOENBOEJCMF 'JH
4IFBTLFEGPS
augmentation, the implant shoulder was
a permanent rehabilitation in both the
MPDBUFE MBCJBMMZ BQQSPYJNBUFMZ NN
maxilla and the mandible as quickly as
CFMPXUIFHJOHJWB 'JH
'PSUIJTSFBTPO
possible. Since she had already been
an individualized zirconium oxide (ZrO)
through extensive therapy, her explicit
DFSBNJDBCVUNFOUXJUImSFEPODFSBNJD
wish was to limit therapy as much as
and a short external hex connector of
possible, but at the same time accom
TNBMM EJBNFUFS #SOFNBSL 4ZTUFN
plish the best possible result.
Among
NP) was made. The problem with this
others, the previous treatments involved
BQQSPBDIJTVODFSUBJOMPOHUFSNSFTJTU
implantation and explantation in the re
ance against loading of the connection.
HJPOPGUPPUIBTXFMMBTSFQFBUFETPGU
During cyclic loading, vibrations and
tissue augmentation in the region of teeth
PTDJMMBUJOHNJDSPNPWFNFOUTPSXFBSPG
BOE5IFQBUJFOUEFTDSJCFEIFSTFMG
the two participating materials occurs
as very sensible, nervous, critical, and
with the consequence of material loss at
unsure about the treatment outcome.
the surface. For the wear process, not

only the roughness but also the hard
ness of the material plays a role. ZrO
245
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
te
ss e n c e
ot
fo r
Fig 2 #BTFMJOFTJUVBUJPOXIFSFUIFJNQMBOUTIPVM
Fig 3
der is hardly covered with gingiva.
abutment with traces of worn titanium and food de
The already existing individualized ZrO
bris at the inner side.
IBTB,OPPQIBSEOFTTWBMVFPGLH
UIFUFNQPSBSZDSPXO 'JH
.PSFPWFS
mm,
being relatively harder than that of
UIFMPOHUFSN UFNQPSBSZ'%1FYIJCJUFE
UJUBOJVN LHNN).6 For external hex
BOBEFRVBUFGPSN BOEUIFFHHTIBQFE
DPOOFDUPST UPEFHSFFTPGSPUBUJPOBM
pontic showed a correct contact surface
loose t between the implant body and
to the gingiva.
various tested abutments were deter

mined.7,8
The therapy concept
8JUI OPODPOJDBM TFMGCMPDLJOH DPO

OFDUJPOT B NJDSPNPWFNFOU BU UIF JO
terface can never be
avoided.
#BTFE PO UIF BCPWFNFOUJPOFE TJUVB
Also in
tion, it was decided to construct a new
this case, wear of the titanium surface on
BMMDFSBNJD;S0 abutment bonded onto
the ZrOXBTOPUJDFE 'JH

5IFGPPE
a titanium base, and to thin the titanium
debris and biolm on the inner surface
base on the labial side to the minimum
of the abutment were indicators of the
thickness possible. In such difcult cas
presence of an insufcient connection.
es, the crown margin should be posi
The high rotational forces of the can
tioned labially and cervically, as much
tilever pontic are another unfavorable
as possible, in order to avoid any expo
factor in such a material combination.
sure of the zirconium abutment. If fur
Changing
by
ther recession occurs, the nishing line
grinding must be considered a major
between crown and abutment would be
complication since, in the case of a re
visible.
the
implant
geometry
pair, the new restoration would require
Accomplishing a perfect harmony
a direct impression followed by manu
from an esthetic standpoint is more dif
facturing and inserting an individually
cult when fewer teeth are subject to treat
cast abutment. In the described case,
ment in a given segment of the dental
UIFmSFEPODFSBNJDXBTDMFBSMZWJTJCMF
arch. In the presented case, the baseline
beyond (cervically) the nishing line of
situation exhibited asymmetric positions
246
70-6.&t/6.#&3t"656./
HAJT ET ALopyrig
fo r
Fig 4
The digital modeling of the new ZrO abut
Fig 5
ot
Q ui
by N
ht
No C
t fo
rP
ub
lica
tio
n
te
ss e n c e
The new nished individual ZrO abutment
ment. Note that due to the low implant depth, the
MVUFE PO UIF UJUBOJVN CBTF .FEFOUJLB #BEFO
shoulder of the titanium adhesive base had to be
#BEFO (FSNBOZ
.JOJNBMQSFQBSBUJPOPGUPPUI
designed short. With this approach the metal mar

gins were achieved almost invisibly.
of the lateral incisors due to soft tissue

loss and the rotation of the lateral inci
sors. In order to fulll the high esthetic
demands of the patient, it was decided
to involve these two teeth in the recon
TUSVDUJPO 0O UPPUI B DMBTTJD MBCJBM
WFOFFSXBTNBEF'PSUPPUI BDSPXO
as an abutment tooth was planned (Figs
48). This relatively invasive treatment
option was chosen for two reasons: (1)
Fig 6 5IF WJFX PG $"%$". ;S0 framework.
UIFMPOHUFSNTUBCJMJ[BUJPOPGUIFFYUFO
With ZrO xed dental prostheses, it is important

UP IBWF OPU POMZ NN DPOOFDUPS DSPTTTFDUJPOT
sion bridge seemed questionable, and

(2) a harmonious optimal closure of the
JOUFSEFOUBMHBQTCFUXFFOBOEXBT
CVUBMTPBDPOOFDUPSIFJHIUPGNJOJNVNNNBOE
a rounded cervical transition shape from abutment
to the pontic.
possible. In such a case, with several

extracted neighboring teeth, the papilla
MPTT CFUXFFO BOE BT XFMM BT
BOEQSFTFOUFEBNBKPSFTUIFUJDQSPC
MFN#FDBVTFXBTBTPVOEUPPUI UIF
DSPXO SFEVDUJPO XBT LFQU UP NN GPS
preservation of the pulp. In the anterior
area, it is considered an appropriate
clinical practice to reduce the zirconium
PYJEFGSBNFXPSLUPNN In so do
ing, it is possible to achieve a good es
Fig 7
The labial position of the connector requires
precise planning. In this case, the waxup yielded a
thetic outcome even with minimal space
palatal position of the connectors to obtain a maxi
BWBJMBCMF 8JUI '%1T UIF CJTRVF USZJO
mum thickness strength also at the proximal areas.
247
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
te
ss e n c e
fo r
Fig 8
ot
b
The labial surface of the ZrODPQJOHPGXBTSFEVDFEUPNNJOPSEFSUPBDIJFWFSPPNGPSUIF
maximum thickness of the veneering ceramic.
Fig 9 %VSJOHCJTRVFUSZJOPGUIFVOJUmYFEEFO
Fig 10
UBM QSPTUIFTJT JU XBT OPUJDFE UIBU MFBWJOH UPPUI
MVUFEPOBUJUBOJVNCBTF .FEFOUJLB #BEFO#BEFO
unchanged, which is too narrow and tilted distally,
(FSNBOZ
1SFQBSBUJPOPG BTNJOJNBMMZBTQPT
is an esthetic compromise. With the consent of the
TJCMF BOEWFOFFSPOUPPUI
The nished individualized ZrO abutment
patient, a labial veneer was placed to improve the

esthetics.
is one of the most important steps of the

treatment and should be practiced sev
eral times if necessary. During bisque
USZJO UIF GPMMPXJOH BTQFDUT TIPVME CF
taken into consideration:
n t of the abutments
n proximal contacts
n basal shape and contact of the pon
tics with the gingiva
Fig 11
Temporarily cemented xed dental pros
thesis (bridge) for several days with the veneer on

UPPUI 7JFX PG UIF UFNQPSBSZ SFTUPSBUJPO JO UIF
mandible.
n occlusion
n perception of the reconstruction with
the tongue
n phonetics
n esthetics.
248
70-6.&t/6.#&3t"656./
HAJT ET ALopyrig
important. Corrections can be made by
TIPXO UIF TVQFSJPS MPOHFWJUZ PG POF
removing ceramic or by adding material,
XJOHFE3#'%1T*OUIFNBYJMMB POFVOJU
and the correct relationship should be
FYUFOTJPO3#'%1TBSFDMFBSMZQSFGFSSFE
communicated to the dental technician.
However, it is the present authors expe
*OUIJTDBTF UIFUSZJOTIPXFEUIBUUIFWF
SJFODFUIBUJOUIFNBOEJCMF UIFUXPXJOH
OFFSPQUJPOGPSTJHOJmDBOUMZJNQSPWFE
design functions very well. For this rea
UIF HFOFSBM FTUIFUJDT 'JHT BOE

TPO B UXPXJOH EFTJHO XBT DIPTFO *O
The veneers had to be made twice since
the mandible, the gap was signicantly
the form did not suit the clinical require
larger than the usual width of the man
ment at the rst attempt and the color
EJCVMBSJODJTPST 'JH
*OTVDIDBTFT
was too light. (With veneers, the color
the best esthetics are achieved when
of the ceramic should be correct right
the width is distributed equally to each
BXBZ B MBUFS DPSSFDUJPO XJUI UIF MVUJOH
tooth. As to how this can be realized, the
fo r
The control of the position of the pon
composite gives only very limited scope
theoretical possibilities are as follows:
for change. For this reason, it is pre
n enlarge the abutment teeth with
ferred to remake a veneer if the color is in

EPVCU
#FDBVTFUIFQBUJFOUEJEOPUGFFM
composite
n enlarge the abutment teeth with
sure about the nal treatment outcome,
ceramic as an integrated part of the
despite great care and individual adjust
bridge
ments, the nished work was cemented
ot
Q ui
by N
ht
tics in relation to the gingiva is especially
No C
t fo
rP
ub
lica
tio
n
te
BPOFXJOHEFTJHOIBTCFFOBOTXFSFE
ss e n c e
by Kern. Clinical data have clearly
n make separate additional veneers.
UFNQPSBSJMZ 'JH
4VDI B QSPDFEVSF
is rarely performed due to possible dam
The therapy concept
age occurring during the temporarization

period or during removal of the restora
In order to close the proximal gap as
tion. It is, however, sometimes necessary
much as possible towards the cervical,
if the patient specically requests it.
the authors preference was the last op

UJPO 'JHT o
5IF TFDPOE PQUJPO
would have required ring on veneer
#BTFMJOFTJUVBUJPO
in the mandible
ing ceramic without an adequate sup

porting substructure, which seemed
questionable from a technical point of
The missing tooth could be replaced
view. Furthermore, the required inser
XJUI BO BMMDFSBNJD 3#'%1 XJUI MJOHVBM
tion path would have created problems
XJOHT VTJOH B UJTTVFTBWJOH BQQSPBDI
cervically. The possible aging of the
The question was which design would be
composite was the reason for rejecting
best. Extension of the wings over more
the rst option. The contact points of the
than one abutment tooth has yielded
WFOFFST UP UIF 3#'%1 XFSF QSFDJTFMZ
clinically unfavorable outcomes, the dis
determined using a laboratory paralel
tally connected tooth showing delamina
lometer. Additional veneers are virtually
tion over time. The question of whether
invisible on teeth as long as the nishing
BUXPXJOHEFTJHOXPVMECFCFUUFSUIBO
MJOFJTPSJFOUFEDFSWJDPJODJTBMMZ 'JH

249
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
te
ss e n c e
fo r
The wax setup on the prepared tooth
serves as a quick impression of the width discrep
Fig 13
ot
Fig 12
Waxup of the required enlargement of the
neighboring teeth.
ancy and the gap between the abutment teeth (set

up system: Anteriores Set, Wichnalek, Augsburg,
Germany).
Fig 14
For a better visualization of the width distri
Fig
15
Additional ceramic veneers (Creation
bution, gold powder was used on the waxup.
Classic) on the plaster model.
However, nishing lines perpendicular
QBSUJDMFTBUCBSGPSTUPHFUIFSXJUI
to the tooths long axis may be visible in
B QIPTQIBUF NPOPNFS .%1

DPOUBJO
some cases. After adhesive cementa
ing primer and the corresponding ce
tion of the veneers, a new impression
ment. Of all possible alternatives,
was made. The construction of the ZrO
HSJUCMBTUJOHIBTUIFCFTUTVSGBDFDMFBO
framework was achieved using an es
ing effect.#FDBVTF[JSDPOJVNPYJEF
UBCMJTIFE$"%$".TZTUFN 'JH

is not etchable, a clean and rough sur
The surface treatment of the ZrO for
face is obtained that ensures wetting of
adhesive cementation can be achieved
the surface, which is a prerequisite for
VTJOH BJS BCSBTJPO XJUI N BMVNJOB
BEIFTJPO"OPUIFSQPTTJCJMJUZJTUPTJMJDB
250
70-6.&t/6.#&3t"656./
HAJT ET ALopyrig
fo r
Fig 16
The already accomplished lingual prep
Fig 17
ot
Q ui
by N
ht
No C
t fo
rP
ub
lica
tio
n
te
ss e n c e
Proximal veneers.
aration is completed with additional veneers. The

sharp nishing line is placed backwards behind
the middle in order to enable a smooth adaptation
between the etched feldspathic ceramic and the
ZrO framework. Central positioning grooves in the
preparation make cementation easier.
Fig 18 "EIFTJWFMZDFNFOUFEWFOFFSTPOBOE
Fig 19 %JHJUBM EFTJHO PG UIF SFTJOCPOEFE mYFE
"T B SVMF WFSUJDBM USBOTJUJPOT BSF JODPSQPSBUFE
dental prosthesis.
quite invisibly.
coat the cementation surfaces with Co
In the case presented, the whole lin
+FUPS3PDBUFD .&41& 4FFGFME
gual surfaces of the teeth and the proxi
Germany) silanization and then use
mal cementation surfaces of the veneers
B #JT(."CBTFE DFNFOU 'JHT
XFSFDMFBOFEVTJOHNJDSPBCSBTJPOXJUI
UP
$VSSFOUMZ UIFSF JT OP MPOHUFSN
NBMVNJOBTMVSSZVOEFSXBUFS 1SFQ
clinical study available on the effect of
, .BY &.4 /ZPO 4XJU[FSMBOE

BOE
TVSGBDF DPOEJUJPOJOH PG OPOFUDIBCMF
UIF TVSGBDFT XFSF SPVHIFOFE 'JH

ceramics on clinical behavior. Aging
'JOBMMZ UIFUFFUIXFSFFUDIFEXJUI
was reported to have a detrimental ef
QIPTQIPSJDBDJE 6MUSB&UDI, Ultradent
GFDUPOMPOHUFSNBEIFTJPO
Products, South Jordan, UT, USA) and
251
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
te
ss e n c e
fo r
dental prosthesis on the model.
ot
Fig 20 'JOJTIFE BMMDFSBNJD SFTJOCPOEFE mYFE
Fig 21 3FTJOCPOEFEmYFEEFOUBMQSPTUIFTJTXJUI

two wings (two bonded retainers). ZrO framework
XBT WFOFFSFE XJUI $SFBUJPO ;*' DFSBNJD CVU UIF
retainers were not veneered.
Fig 22
Silica coating of the cementation surfac
Fig 23
Application of the silane coupling agent
FT PG UIF XJOHT XJUI UIF $P+FU TZTUFN . &41&
(Monobond S, Ivoclar Vivadent, Schaan, Liechten
Seefeld, Germany).
TUFJO
*UUBLFTNJOVUFUPFWBQPSBUFUIFTPMWFOU
Fig 24 "QQMJDBUJPO PG UIF EVBMDVSFE MVUJOH DPN
Fig 25 $MFBOJOHUIFTVSGBDFXJUIBJSnPX 1SFQ,
posite (Variolink II, Ivoclar Vivadent, Schaan, Liech
Max, EMS).
UFOTUFJO
PO UIF DFNFOUBUJPO TVSGBDFT PG UIF SFTJO
bonded xed dental prosthesis.
252
70-6.&t/6.#&3t"656./
HAJT ET ALopyrig
fo r
Fig 26
Cementation of the ZrO SFTJOCPOEFE
xed dental prosthesis and photopolymerization.
Fig 28
ot
Q ui
by N
ht
No C
t fo
rP
ub
lica
tio
n
te
ss e n c e
Fig 27 3FTJOCPOEFEmYFEEFOUBMQSPTUIFTJTBG

ter the adhesive cementation in situ.
The nal treatment result.
253
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
ing. The solutions demonstratedt eshould
ss e n c e
ot
fo r
PGBDMBTTJDFUDIBOESJOTFBEIFTJWFTZT
conditioned, followed by the application
not be considered the most correct
tem (Syntac, Ivoclar Vivadent, Schaan,
USFBUNFOU JOTUFBE UIFZ JMMVTUSBUF UIF
Liechtenstein). The cementation was
thought process during the planning of
BDIJFWFE VTJOH EVBMDVSFE BEIFTJWF
such complex cases. Whilst almost two
cement
(Variolink
II, Ivoclar Vivadent)
decades ago the missing teeth in such
'JHTUP
'JHTBOETIPXUIF
DBTFTXFSFSFTUPSFEXJUINFUBMDFSBNJD
nal treatment result.
FDPs, with the preparation of at least four

abutment teeth, today there is the pos
sibility of using implants and zirconium
Discussion
oxide frameworks, but these also require

NPSFFYQFSJFODFBOELOPXIPX*ODPO
Unfortunately, there is rarely a single so
sidering hard and soft tissue augmen
lution for all problems in dentistry and
tation and the indications for implants,
dental technology. In most cases, den
their number, position, system, design,
tists nd solutions for individual situa
and the dental material itself need to be
tions and individual complications. The
considered in the treatment planning, as
presented case involved several such
well as time management on the part of
challenges and indicates that esthetics
the dental professional.
in reconstructive dentistry is an extremely
5IF TUBUFNFOU i)JHIUFDI EFOUJTUSZ
demanding discipline requiring experi
JTIJHISJTLEFOUJTUSZwXBTBOBDDFQUFE
ence and knowledge, and the poten
saying a decade ago but it is not true
tial to apply both. The esthetic aspect
BOZNPSF$"%$".NJMMFE;S0 frame
of treatment always adds an additional
works and glass ceramic restorations
requirement to the medical basics, and
(eg, lithium disilicate) are more reliable
sometimes competes with them, mak
GVMMDFSBNJD NBUFSJBMT UIBO NBOVBMMZ
ing the whole treatment more difcult.
produced ceramics. Today, the follow
Good esthetics do not happen neces
ing statement is more valid: High es
sarily as a consequence of correct den
UIFUJDT EFOUJTUSZ JT IJHISJTL EFOUJTUSZw
tal and medical treatment. Often there
The more esthetic the material is, or the
is a need to do more. Furthermore, the
more translucent the ceramic, the weak
individual patients wishes need to be
er it is. Moreover, the higher the esthetic
taken into consideration. Patients with
demands, the more difcult it is to es
high esthetic demands require good
tablish static and mechanically strong
management, which can create chal
restorations. Today, ZrO implants and
lenging situations.
ZrO abutments that are screwed direct
The present case illustrates, from dif

ferent angles, the demanding daily task
ly onto the titanium implants are still an

experimental solution.
of the practicing dentist to apply modern
The pressure from the market is trig
and advanced methods and at the same
gering sales of such untested medical
time assess their benets and risks. With
products, and every practitioner needs
the increasing complexity of cases, the
UPEFDJEFGPSIJNIFSTFMGIPXBOEXIFO
responsibility of the clinician is increas
such progressive alternatives should be
254
70-6.&t/6.#&3t"656./
HAJT ET ALopyrig
in the maxilla, it is clearly shown that
tion. Against the high survival rates for
even in such challenging situations it is
JNQMBOUTVQQPSUFE'%1T GSFRVFOUDPN
possible to offer, in borderline cases, a
QMJDBUJPOT
XFSFSFQPSUFEXJUIJO
relatively safe and clinically proven so
the rst 5 years in the same study.
lution. The most probable risk here is
These included chippings and loosen
fo r
applied in their own practice. With the
the debonding of the ZrO restorations.
ing or fracture of screws. The term suc
*O TVDI B TJUVBUJPO B OPOQSPCMFNBUJD
DFTTw JT VTFE XIFO BO '%1 SFNBJOFE
JOUSB PS FYUSBPSBM SFCPOEJOH XPVME CF
unchanged and free of all complications
an easy solution. Adhesion of ZrO abut
over the entire observation period. The
ments to titanium bases is successful
reported complication rates indicate that
in vitro and has become successful
JNQMBOUTVQQPSUFE SFTUPSBUJPOT HFOFS
clinical practice for years in the authors
ally carry a high risk of retreatment and
ofce as well as in many others.
require maintenance services. In a
Regarding the mechanical stability of
DPNQBSBCMFNFUBBOBMZTJTPGTUVEJFT
the components, the alternative titanium
that met the inclusion criteria, combined
abutment in combination with metal
UPPUIoJNQMBOUTVQQPSUFE '%1T TIPXFE
frameworks is considered the most reli
a signicantly lower estimated survival
able option with the longest track record.
SBUF PG BGUFS ZFBST BOE
The chosen material combination in the
BGUFSZFBST5IFTVDDFTTSBUFTGPSUIF
presented case must still prove its lon
JNQMBOUTXFSFBMTPMPXFSXJUIBOE
gevity in the clinic. However, experience
BGUFSBOEZFBST SFTQFDUJWFMZ
with several such cases is promising.
However, the complication rates related
The most difcult decision in this case
to the implants alone ranged between
XBTXIFUIFSUPDPOTJEFSBGVMMDPWFSBHF
BOE EFQFOEJOHPOUIFUZQF
TJOHMFVOJU'%1POUPPUIPSOPU5IJT
that presented a gure considerably low
issue was discussed intensively with the
FS UIBO UIPTF PG UIF JNQMBOUTVQQPSUFE
patient. A series of review articles tried to
restorations.
BOTXFSUIFRVFTUJPOPGXIFUIFSJNQMBOU
In the present case, the issue in ques
supported FDPs or combined implant
UJPOXBTXIFUIFSBUISFFVOJUDPNCJOFE
UPPUITVQQPSUFE'%1TBSFQSPHOPTUJDBMMZ
UPPUIoJNQMBOUTVQQPSUFE '%1 XPVME
JOGBWPSPGUIFTPMFMZJNQMBOUTVQQPSUFE
have a higher survival and lower com
restorations.
QMJDBUJPO SBUF UIBO B UXPVOJU DBOUJMFWFS
5IF BOBMZTJT PG
ot
Q ui
by N
ht
presented adhesive abutment solution
No C
t fo
rP
ub
lica
tio
n
te
TIPXTBDMJOJDBMTVSWJWBMSBUFPGBGUFS
ss e n c e
ZFBSTBOEBGUFSZFBSTPGGVOD
studies that met the inclusion criteria
FDP supported by a single implant.
indicated an estimated survival rate for
Thus the decision made for this case
JNQMBOUTVQQPSUFE'%1TPGBGUFS
deviates from the situations analyzed
ZFBSTBOEBGUFSZFBSTPGGVOD
in the dental literature. Although trends
tion. The survival rates for the implants
can be observed, the literature does not
UIFNTFMWFTXFSFBOEBGUFS
QSPWJEFBOBOTXFS/POFUIFMFTT UPPUI
BOEZFBST SFTQFDUJWFMZ"DDPSEJOH
supported cantilever FDPs show lower
to Prbster a prosthetic restoration sys
survival rates and higher complication
tem can be regarded as successful if it
rates than those of conventional FDPs
255
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
te
fracture, debond
ss e n c e
ot
supported by at least two abutments.
where an unnoticed
This indicates that the leverage forces
ing, or delamination occurs, second
created by a cantilever should, in gen
ary caries on the abutment tooth could
eral, be regarded as mechanically prob
occur. ,OPXJOH UIBU UIF POFXJOH
lematic.
3#'%1IBTBOFYDFMMFOUDMJOJDBMMPOHFW
fo r
Due to the fact that the diameter of
ity record, other options are not justi
the implant and of the external hex was
ed in such a situation. The most com
small and that the vertical dimension of
NPO JOEJDBUJPO GPS 3#'%1T JT NJTTJOH
the prosthesis was high, and that there
lateral incisors in the maxilla. Splinting
fore strong leverage forces were to be
the central incisor with the canine of the
expected, the conventional bridge solu
TBNFTJEFVTJOHBO3#'%1IBTQSPWFO
UJPOXBTDPOTJEFSFETBGFSUIBOBGSFFFOE
to be not physiologic. The experience of
pontic. This assessment was conrmed
UIF BVUIPST SFHBSEJOH TVDI 3#'%1T JO
by the fact that the temporary restora
the maxilla has shown unilateral debond
tions showed multiple debondings. The
ings in many cases. A possible reason
implant situation was given and, accord
for these debondings could be stress at
ing to todays possibilities, correct as
the adhesive interfaces due to uneven
well. The presence of two neighboring
tooth mobility of the anterior maxillary
implants in the anterior region is a de
teeth under physiologic functional load.
manding esthetic challenge for the pros
*O DPOUSBTU EVSJOH NPSF UIBO ZFBST
thodontist, due to the soft tissue (ie, pa
of observation, no unilateral debonding
pillae) problems. In fact, an implant can
XBT PCTFSWFE JO UIF NBOEJCMF XJUI BMM
POMZ QSFWFOU B GVMMDPWFSBHF DSPXO PO
DFSBNJD3#'%1TNBEFPGMJUIJVNEJTJMJ
the abutment tooth and at the same time
cate.'VSUIFSNPSF UIFTF3#'%1TXFSF
replace the missing tooth. Therefore the
made specially with proximal grooves
decision to incorporate a crown on tooth
but no wings. This indicates that in the
JOUIFQSFTFOUDBTFDPVMECFKVTUJmFE
mandible, the load is directed axially
from an ethical standpoint as well.
rather than lingually, which may explain
The situation in the mandible is a clas
XIZUXPXJOH3#'%1TXFSFNPSFTVD
TJDJOEJDBUJPOGPSBO3#'%15IJTJTFTQF
cessful. Similarly, Kern et al found all
cially true after an already failed implant
POFTJEFEEFCPOEJOHTFYDMVTJWFMZJOUIF
BUUFNQU " DPOWFOUJPOBM GVMM DPWFSBHF
maxilla. The question remains whether,
FDP would require much hard tissue
under the assumption that in the mandi
loss. In cases where there are soft tissue
ble both options could function clinically,
recessions in combination with small root
a second wing is necessary. Even if the
diameters at the gingival level, a correct
potential danger of a connector fracture
crown preparation is almost impossible.
is present, in the present authors opinion
4VDI3#'%1TDPVMECFNBEFXJUIPOFPS
UIFUXPXJOHEFTJHOJTGBWPSFE CFDBVTF
UXPXJOHTPOPOFPSUXPBCVUNFOUT0OF
it allows for thinner connectors.
XJOH 3#'%1T NBEF FOUJSFMZ PG DFSBN
The discussion above clearly un
ics have been shown to be a successful
derlines the difculty of the practicing
treatment option. The disadvantage
dentist to make the right decisions to
PG UIF UXPXJOH UZQF JT UIBU JO B DBTF
HVBSBOUFF MPOHUFSN DMJOJDBM TVDDFTT
256
70-6.&t/6.#&3t"656./
HAJT ET ALopyrig
OPOFUDIBCMF DFSBNJD [JSDPOJVN PY
ics do not contain silica, as an alternative
ide ceramic remains unanswered. The
UPUIFBEIFTJWFDFNFOUBUJPOXJUI.%1
longest clinical experience exists with
containing
HMBTTJOmMUSBUFEBMVNJOVNPYJEFDFSBN
coating and silanization could be con
ics. The results with this material indi
sidered in combination with dual polym
DBUF UIBU TVSGBDF DPOEJUJPOJOH XJUI BJS
FSJ[FE #JT(." DFNFOU Which
abrasion using alumina, and the use of
method for the cementation of zirconium
a primer and adhesive with bifunctional
oxide would be clinically more success
(MDP) monomers, yields a good clinical
ful needs to be determined. Therefore,
However, in vitro micro
such cases are currently under review
tensile tests showed unfavorable results
fo r
survival
rate.
Also, the question regarding durabil
cements,
chairside
ot
Q ui
by N
ht
ity of the adhesive cementation with a
No C
t fo
rP
ub
lica
tio
n
te
cementation surfaces is best achieved
ss e n c e
with air abrasion. Since oxide ceram
silica
in the present authors practice.
GPSUIFBEIFTJPOPGSFTJODFNFOUTUP*O
Ceram"MVNJOBBOE*O$FSBN;JSDPOJB
after articial aging conditions. For
Conclusions
pure zirconium oxide, such information

is limited in the literature. In general,
Missing teeth can be restored both func
JUDBOCFBOUJDJQBUFEUIBUBMMLJOETPGOPO
tionally and esthetically utilizing treat
etchable ceramics would behave simi
ment modalities such as veneers and
MBSMZ #BTFE PO UIF JOGPSNBUJPO EFSJWFE
TVSGBDFSFUBJOFE 3#'%1T DPVQMFE XJUI
from in vitro studies, the aging effect on
implants and zirconia suprastructures.
the adhesive interfaces and thereby the
The durability of such restorations can
durability of the adhesion is the Achilles
be achieved through adhesive cementa
heel of such therapies.
tion, based on the current state of the art
A possible structural change through
derived from both clinical and laboratory
air abrasion in the stabilized zirconium
studies. This clinical example illustrates
oxide could be a concern. Limited in
the particular challenge for any clini
formation is available on the possible
cian when confronted with exceptional
negative effects of air abrasion on zir
situations, where former experience or
conium oxide. The opinions on this
scientic evidence may not followed. It
controversial.
Neverthe
is important to learn from previous unfa
less, chairside application of silicatiza
vorable applications and inappropriate
tion was claimed to be less hazardous
assessments or decisions affecting the
on the material properties of zirconium
individual and to keep an open mind re
oxide than laboratory air abrasion utiliz
garding treatment concepts in the light
ing alumina.
of new ndings and experiences.
aspect are
Air abrasion could be expected to

create damage in the form of delamina
tion or total fracture according to cur
rent knowledge. However, it depends
on several other parameters. It was,
however, claimed that the cleaning of
257
70-6.&t/6.#&3t"656./
CASE REPORT
Q ui
by N
ht
pyrig
No Co
t fo
rP
ub
lica
tio
n
te
ss e n c e
fo r
[DBO."OUFSJPSEFOUBM
restorations: direct compos
ites, veneers or crowns? In:
3PVMFU+'BOE,BQQFSU)'
Statements: Diagnostics and
Therapy in Dental Medicine
5PEBZBOEJOUIF'VUVSF#FS
MJO2VJOUFTTFODF1VCMJTIJOH

5JOTDIFSU+ ;XF[% .BSY3
Anusavice KJ. Structural reli
BCJMJUZPGBMVNJOB GFMETQBS
MFVDJUF NJDBBOE[JSDPOJB
based ceramics. J Dent

.PODBEB( 'FSOOEF[&
Martn J, Arancibia C, Mjr
IA, Gordan VV. Increasing
the longevity of restorations
by minimal intervention: a
UXPZFBSDMJOJDBMUSJBM0QFS
%FOU
4. Peumans M, van Meerbeek
# -BNCSFDIUT1 7BOIFSMF(
Porcelain veneers: a review
of the literature. J Dent

)PMN1FEFSTFO1 -BOH
NP, Mller F. What are the
longevities of teeth and oral
implants? Clin Oral Implants
3FT 4VQQM

#SPECFDL65IF;J3FBM
post: a new ceramic implant
abutment. J Esthet Restor
%FOU
7. Garine WN, Funkenbusch
PD, Ercoli C, Wodenscheck
J, Murphy WC. Measure
ment of the rotational mist
BOEJNQMBOUBCVUNFOUHBQ
PGBMMDFSBNJDBCVUNFOUT*OU
J Oral Maxillofac Implants

,BOP4$ #JOPO11 #POGBOUF
G, Curtis DA. The effect of
casting procedures on rota
tional mist in castable abut
ments. Int J Oral Maxillofac
*NQMBOUT
;JQQSJDI) 8FJHM1 -BOHF
# -BVFS)$&SGBTTVOH
Ursachen und Folgen
von Mikrobewegungen
BN*NQMBOUBU"CVUNFOU
Interface. Implantologie

&EFMIPGG %FUBM7PMMLFSB
mische Restaurationen.
Interdiszipl J Restaurat Zahn
IFJMLE
)BKU+ 4DIFOL)-JDI
tdurchutete Frontzahnkro
nen, Teil I. Das Dental Labor,
-7 )FGU
)BKU+7FOFFST.BUFSJBMJFO
und Methoden im Vergleich.
Interdiszipl J Restaurat Zahn
IFJMLE
,FSO.$MJOJDBMMPOHUFSN
TVSWJWBMPGUXPSFUBJOFSBOE
TJOHMFSFUBJOFSBMMDFSBNJD
SFTJOCPOEFEmYFEQBSUJBM
EFOUVSFT2VJOUFTTFODF*OU

#MBU[.# 4BEBO" .BSUJO
+ -BOH#In vitro evalua
tion of shear bond strengths
PGSFTJOUPEFOTFMZTJOUFSFE
IJHIQVSJUZ[JSDPOJVN
PYJEFDFSBNJDBGUFSMPOH
term storage and thermal
cycling. J Prosthet Dent

8PMGBSU. -FINBOO' 8PM
fart S, Kern M. Durability of
the resin bond strength to
zirconia ceramic after using
different surface condition
ing methods. Dent Mater

:BOH# -BOHF+BOTFO
HC, Scharnberg M, Wolfart
S, Ludwig K, Adelung R,
Kern M. Inuence of saliva
contamination on zirconia
ceramic bonding. Dent Mater

:BOH# 8PMGBSU4 4DIBSO
berg M, Ludwig K, Adelung
R, Kern M. Inuence of
contamination on zirconia
ceramic bonding. J Dent Res

2VBBT"$ :BOH# ,FSO
.1BOBWJB'CPOEJOH
to contaminated zirconia
ceramic after different clean
ing procedures. Dent Mater

[DBO. 7BMMJUUV1,&GGFDU
of surface conditioning meth
ods on the bond strength of
luting cement to ceramics.
%FOU.BUFS
258
70-6.&t/6.#&3t46..&3
ot
References
"NBSBM3 [DBO. 7BMBO

ESP-' #BMEVDDJ* #PUUJOP
MA. Effect of conditioning
methods on the microtensile
bond strength of phosphate
NPOPNFSCBTFEDFNFOUPO
zirconia ceramic in dry and
BHFEDPOEJUJPOT+#JPNFE
.BUFS3FT#"QQM#JPNBUFS

&CFSU" )FEEFSJDI+ ,FSO
M. Retention of zirconia
ceramic copings bonded
to titanium abutments. Int
J Oral Maxillofac Implants

-BOH/1 1KFUVSTTPO#&
5BO, #SBHHFS6 &HHFS.
Zwahlen M. A systematic
review of the survival and
complication rates of xed
partial dentures (FPDs) after
an observation period of at
least 5 years. II: Combined
UPPUIoJNQMBOUTVQQPSUFE
FPDs. Clin Oral Implants Res

1KFUVSTTPO#& 5BO, -BOH
/1 #SBHHFS6 &HHFS.
Zwahlen M. A system
atic review of the survival
and complication rates
of xed partial dentures
(FPDs) after an observation
period of at least 5 years.
**NQMBOUTVQQPSUFE'1%T
Clin Oral Implants Res

1KFUVSTTPO#& #SHHFS
U, Lang NP, Zwahlen M.
Comparison of survival
and complication rates of
UPPUITVQQPSUFEmYFEEFOUBM
prostheses (FDPs) and
JNQMBOUTVQQPSUFE'%1T
and single crowns (SCs).
Clin Oral Implants Res

5BO, 1KFUVSTTPO#& -BOH
NP, Chan ESY. A systematic
review of the survival and
complication rates of xed
partial dentures (FPDs) after
an observation period of at
least 5 years. III: Convention
al FPDs. Clin Oral Implants
3FT
HAJT ET ALopyrig
fo r
1SCTUFS-,MJOJTDIF
Erfahrung mit vollkera
mischem Zahnersatz Ein
Rckblick. In: Kappert HF
(ed). Vollkeramik: Werk
TUPGGLVOEF;BIOUFDIOJL
,MJOJTDIF&SGBISVOH#FSMJO
2VJOUFTTFO[
,FSO. (MTFS3$BOUJMFW
FSFEBMMDFSBNJD SFTJOCPOE
ed xed partial dentures: a
new treatment modality. J
&TUIFU%FOU
.FIM$ 4PNNFS5 ,FSO.
Eingelige vollkeramische
"EITJWCSDLFOoNJOJNBMJO
vasive sthetik. sthetische
;BIONFEJ[JO
,FSTDICBVN5 ,FSO .
Stellungnahme der DGZMK.
"EITJWCSDLFO(FNFJO
same Stellungnahme der
Deutschen Gesellschaft fr
;BIOS[UMJDIF1SPUIFUJLVOE
Werkstoffkunde (DGZPW)
und der Deutschen Gesells
DIBGUGS;BIO .VOEVOE
Kieferheilkunde (DGZMK)

7BO%BMFO" 'FJM[FS"+
Kleverlaan J. A literature
SFWJFXPGUXPVOJUDBOUJMFW
ered FPDs. Int J Prosthodont

1PTQJFDI1 3BNNFMTCFSH
P, Unsld F. A new design
GPSBMMDFSBNJDSFTJO
bonded xed partial den
UVSFT2VJOUFTTFODF*OU

[DBO. "MLVNSV) (FNBM
maz D. The effect of surface
treatment on the shear bond
strength of luting cement to
a glass inltrated alumina
ceramic. Int J Prosthodont

[DBO. /JKIVJT) 7BMBOESP
LF. Effect of various surface
conditioning methods on the
BEIFTJPOPGEVBMDVSFSFTJO
cement with MDP functional
monomer to zirconia after
thermal aging. Dent Mater J

ot
Q ui
by N
ht
No C
t fo
rP
ub
lica
tio
n
te
ss e n c e
[DBO. ,FSLEJKL,4
Valandro LF. Comparison
of resin cement adhesion
UP:5;1DFSBNJDGPMMPXJOH
manufacturers instructions
of the cements only. Clin Oral
*OWFTUJH
7BMBOESP-' [DBO. "NB
SBM3 7BOEFSMFJ" #PUUJOP
MA. Effect of testing meth
ods on the bond strength
PGSFTJOUP[JSDPOJBBMVNJOB
ceramic: microtensile versus
shear test. Dent Mater J

;IBOH: -BXO#3 3FLPX
ED, Thompson VP. Effect
of sandblasting on the
MPOHUFSNQFSGPSNBODFPG
EFOUBMDFSBNJDT+#JPNFE
.BUFS3FT#"QQM#JPNBUFS

[DBO. -BTTJMB-7- 3BBE
schelders J, Matinlinna JP,
Vallittu PK. Effect of some
QBSBNFUFSTPOTJMJDBEFQP
sition on a zirconia ceramic.
+%FOU3FT 4QFDJBM
*TTVF""CTUSBDU

259
70-6.&t/6.#&3t"656./

Anterior Implant

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Anterior Implant

Transféré par

Droits d'auteur :

Formats disponibles

Q ui

for Anterior Reconstructions Using

Uwe Gehringer, CDT

Mutlu zcan, Prof Dr Med Dent, PhD

Correspondence to: Jan Hajt

Of all developments in dental technol

mandible with a combined treatment ap

ogy, fullling the esthetic and functional

proach utilizing veneers for harmonized

demands of the patient, especially re

space distribution on the abutment teeth

garding anterior reconstructions, is still

a challenge for both dentists and dental

dental prosthesis in the anterior seg

technicians. This becomes more dif

ment of the maxilla. Adhesive cementa

cult for patients with a previous treat

tion of the restorations is also presented

ment history that is not ideal. This case

JO B TUFQCZTUFQ BQQSPBDI CBTFE PO

presentation demonstrates reconstruc

the current state of the art.

(Eur J Esthet Dent 2010;5:242259)

servative tooth preparation. Yet they are

not as effective as reinforced ceramics

ment concepts could be categorized as

in preventing premature failure. On the

sive (partially reversible), and (more) in

can be achieved using milled aluminous

or zirconia copings. However, the pres

ence of the relatively opaque internal

has the unique distinction of using the

ceramic core may provide an impedi

widest variety of materials, ranging from

ment to matching some tooth colors.

NFUBMT BOE NFUBM BMMPZT UP SFTJOCBTFE

Although minimally invasive applica

composites and ceramics. Develop

tions are possible using direct compos

ments, especially in the eld of polymers

and ceramics, have largely eliminated

the drawbacks of composites involve the

the use of metals in the mouth. In spite of

loss of surface lustre. This may require

all the advances, clinicians should real

ize the drawbacks before selecting the

This is commonly found to be the case

most appropriate material for a particu

after several years of clinical function,

lar situation. Concentrating only on the

and therefore the maintenance of the

surface characteristics of composites,

nicians should be mindful of the best ap

even after nishing and polishing, is an

plication method. As the esthetic aspect

of dental care becomes increasingly im

Minimally invasive applications are

portant to patients, the dental practitioner

also possible using ceramic veneers.

should be aware of the applications and

According to the majority of studies, it

MJNJUBUJPOT PG UIF WBSJPVT UPPUIDPMPSFE

is clear that from the mechanical point

restorative materials or systems and bal

Of all developments in dental technol

mandible with a combined treatment ap

demands of the patient, especially re

dental prosthesis in the anterior seg

technicians. This becomes more dif

ment of the maxilla. Adhesive cementa

cult for patients with a previous treat

JO B TUFQCZTUFQ BQQSPBDI CBTFE PO

presentation demonstrates reconstruc

sive (partially reversible), and (more) in

or zirconia copings. However, the pres

ceramic core may provide an impedi

NFUBMT BOE NFUBM BMMPZT UP SFTJOCBTFE

Although minimally invasive applica

composites and ceramics. Develop

tions are possible using direct compos

all the advances, clinicians should real

most appropriate material for a particu

nicians should be mindful of the best ap

of dental care becomes increasingly im

MJNJUBUJPOT PG UIF WBSJPVT UPPUIDPMPSFE

restorative materials or systems and bal

seen to be problematic.4 Clinical stud

the invasive applications.

are still faced with the challenge of rep

justied. 4JNJMBSMZ SFTJOCPOEFE '%1T

preferable to metal ceramics due to be

ing minimally invasive, and also for es

thetic reasons. Nevertheless, teeth sur

UPPWFSZFBST5 Therefore, the

Fig 1 #BTFMJOFTJUVBUJPOXJUIBOJNQMBOUBU SF

considered an example of the most mini

being practiced, according to the cur

In the maxilla, both bone loss and soft tis

rarily rehabilitated situation in the max

MPDBUFE MBCJBMMZ BQQSPYJNBUFMZ NN

an individualized zirconium oxide (ZrO)

possible, but at the same time accom

implantation and explantation in the re

abutment with traces of worn titanium and food de

The already existing individualized ZrO