All-ceramic surveyed crowns for removable partial denture abutments

Sergio Kancyper, DDS, MS,a Marianella Sierraalta, DDS, MS,b and Michael E. Razzoog, DDS, MS, MPHc
University of Michigan, Ann Arbor, Mich.
All-ceramic restorations may have limitations when used in combinations with other treatment
modalities. Removable partial denture (RPD) abutment crowns are typically shaped to provide
guide planes, rest seats, and retentive areas. Porcelain-to-metal crowns are routinely fabricated with
retentive contours in the veneering porcelain, but until recently, the contours of the other portions
of the restoration were developed in metal. This article describes the fabrication of all-ceramic
crowns for RPDs with rest seats and guide planes in densely sintered aluminum oxide and retentive
areas in veneering porcelain. Within the limitations outlined, this procedure allows the practitioner
to use all-ceramic crowns in situations previously reserved for metal or metal-ceramic restorations.
(J Prosthet Dent 2000;84:400-2.)

esearchers and clinicians are constantly seeking

new ways to fabricate all-ceramic restorations that possess the required qualities of strength, color stability,
favorable wear characteristics, and precision of fit so
that they may be placed in all intraoral regions. The
Procera AllCeram System (Nobel Biocare, AB,
Gteborg, Sweden) is a system that embraces the
concept of computer-assisted dental design and
computer-assisted machining (CADD/CAM) to fabricate a Procera AllCeram crown. In the fabrication
process, manufacturing techniques for a densely sintered aluminum oxide coping are combined with
local dental laboratory porcelain veneering.
Traditional approaches to optimizing abutments for
removable partial dentures (RPDs) call for the fabrication of guide planes and occlusal (cingulum) rest seats.
Rudd et al1 have described providing these preparations on natural teeth, in metal, or in composite. In
the quest for alternative options, the data on the
strength of aluminum oxide copings2-4 supports the
premise that, in specific situations, a Procera AllCeram
crown might be used to restore RPD abutments. The
purpose of this article is to present an overview of a
method used to fabricate all-ceramic crowns to be used
in conjunction with RPDs.

PROCEDURE
1. Select the teeth that are going to serve as abutments for the RPD, and survey the cast to determine the path of insertion.
2. Design the RPD on the cast and resolve the anticipated positioning of the occlusal rest seats, clasps,

aGraduate,

Prosthodontics.
Assistant Professor, Department of Biological and Material
Sciences.
cProfessor, Department of Biological and Material Sciences.
bClinical

400 THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 1. Die is digitized with touch probe under minimal

pressure. Approximately 35,000 data points are gathered
during scanning process.

and amount of tooth reduction needed to accomplish treatment goals.

3. Prepare the tooth for an all-ceramic crown
according to the manufacturers guidelines of a
moderate chamfer, along with rounded internal
line angles. Attention must be paid to provide
adequate occlusal clearance to accommodate the
occlusal rest seat.

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THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 2. Wax-up of RPD abutment crown after cut back for

veneering porcelain is placed onto die and digitized to capture contours that will be used in conjunction with RPD.

Fig. 4. Completed all-ceramic crown after addition of

veneering porcelain. All critical areas used in RPD construction are left in aluminum oxide and polished to provide equivalent surface to veneer porcelain.

Fig. 3. Finished aluminum oxide coping placed back onto

die to illustrate how guide plane and occlusal rest seats
were incorporated into coping.

Fig. 5. Mirror photograph after fabrication of RPD framework casting and crowns are evaluated to determine intimate contact before addition of base and replacement teeth.

4. Make a full arch impression of the relevant anatomic landmarks, along with the tooth preparations.

shape of the aluminum oxide coping with the

information obtained in the second digitizing
procedure (Fig. 2).
4. Merge the computer files that contain the die and
wax-up data. Send the resultant information by
modem to the manufacturing facility (Procera
Sandvik, Fair Lawn, N.J.) where the aluminum
oxide copings are fabricated (Fig. 3).
5. Apply the veneering porcelain to complete the
esthetic and retentive portion of the restoration
after the custom-designed copings are returned
to the dental laboratory. Polish the exposed aluminum oxide with a sequence of increasingly fine
diamond-impregnated porcelain polishing wheels
(Dialite Ultra Porcelain Resurfacing Kit, Brasseler
USA, Savannah, Ga.) to obtain a smooth,
nonabrasive surface5 (Fig. 4).

DENTAL LABORATORY PROCEDURE

1. Wax abutments to full contour in the same
manner that a metal substructure for a porcelainfused-to-metal crown for a similar situation would
be configured. Once the appropriate partial denture components are developed in wax, cut back
the crown to allow for the 1 mm of veneering
porcelain.
2. Digitize the die for the aluminum oxide coping
using the Procera scanner, Model 40 (Nobel
Biocare, AB, Gteborg, Sweden) without the
wax-up in place (Fig. 1).
3. Secure the wax-up onto the die, and complete a
new scanning procedure. Determine the exterior
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401

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6. Verify the occlusal contacts and marginal adaptation of the crown. Cement these all-ceramic
crowns using any accepted luting agent, then
make a new impression for an RPD using conventional methods to complete the fabrication of the
prostheses (Fig. 5).

DISCUSSION
Although traditional approaches have and will continue to function for the majority of dental patients
requiring RPDs, the proposed technique offers alternatives for both the dental patient and practitioner. The
outlined technique customizes aluminum oxide copings to provide a strong and smooth substructure that
incorporates guide planes, cingulum, and occlusal
rest seats while the retentive areas are developed with
veneering porcelain. By using this approach, practitioners who are familiar and comfortable with allceramic crowns may continue to use them in
conjunction with RPDs. Although not illustrated in
this article, dental laboratories are offering RPD clasps
with tooth-colored surfaces to mask out the metal
color, and the described technique for abutment
crown fabrication may be of benefit for that specific
patient situation. In addition, veneered aluminum
oxide partial denture abutment crowns may be of use
for patients who claim metal sensitivities and for whom
titanium RPD frameworks are prescribed. What is
missing from the published dental literature is longterm clinical studies of the soft tissue response to the
specific described type of restoration. The question
remains whether soft tissue response to polished aluminum oxide is the same or better than polished metal
or veneer porcelain.
The radius of 1.25 mm for the sapphire-tipped
probe constitutes the limits of the scanner to reproduce rest seats in the abutment. If the rest seat is smaller than 1.25 mm in any dimension, the probe tip will
not be able to record the surface topography, and the
resulting coping will not contain the area for the
occlusal rest seats. Therefore, it is important to follow
accepted formats for the development of rest seats.1

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KANCYPER, SIERRAALTA, AND RAZZOOG

SUMMARY
Issues of esthetics, biocompatibility, and the
increasing cost of dental alloys have caused the practitioner to look for alternatives to the traditional cast
alloy or porcelain-fused-to-metal restorations. Until
recently, all-ceramic crowns could not be used for
RPD abutments because they lacked the strength to
withstand forces generated by the framework. The
procedure described in this article should be useful for
practitioners who wish to replace traditional materials
used for crowns supporting RPDs with all-ceramic
crowns. With the use of CADD/CAM technology, it
is possible to fabricate crowns for partial denture abutments with conventional support mechanisms for
proper guide plane, rest seat design, and rest seat
preparation.
REFERENCES
1. Rudd RW, Bange AA, Rudd KD, Montalvo R. Preparing teeth to receive
a removable partial denture. J Prosthet Dent 1998;82:536-49.
2. Andersson M, Oden A. A new all-ceramic crown. A dense-sintered,
high-purity alumina coping with porcelain. Acta Odontol Scand
1993;51:59-64.
3. Wagner WC, Chu TM. Biaxial flexural strength and indentation fracture
toughness of three new dental core ceramics. J Prosthet Dent
1996;76:140-4.
4. White SN, Caputo AA, Li ZC, Zhao XY. Modulus of rupture of the
Procera all-ceramic system. J Esthet Dent 1996;8:120-6.
5. Andersson M, Razzoog ME, Oden A, Hegenbarth EA, Lang BR. Procera:
a new way to achieve an all-ceramic crown. Quintessence Int
1998;29:285-96.
Reprint requests to:
DR MICHAEL E. RAZZOOG
DEPARTMENT OF BIOLOGICAL AND MATERIAL SCIENCES
DIVISION OF PROSTHODONTICS
THE UNIVERSITY OF MICHIGAN
SCHOOL OF DENTISTRY
1011 N UNIVERSITY AVE
ANN ARBOR, MI 48109-1078
FAX: (734)763-3453
E-MAIL: merim@umich.edu
Copyright 2000 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/2000/$12.00 + 0 10/1/110253
doi:10.1067/mpr.2000.110253

VOLUME 84 NUMBER 4