In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers. If you would like to submit a question to Dr. Christensen, please send an email to [email protected].
Gordon J. Christensen, DDS, MSD, PhD
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Q I see zirconia-based, full-zirconia, and IPS e.max restorations advertised in many magazines and journals. They seem to be serving relatively well in my practice. However, I am worried about the future with them. I recently had to remove a zirconia-based bridge, and the task required major effort and destruction of several burs. Additionally, I was worried about the trauma to the teeth as I removed the restorations with difficulty. It is obvious that the profession will be facing a dilemma as more of these types of restorations begin to fail clinically and have to be removed. What is the best way to take off these very strong restorations when necessary?
AYour question is very important, since both zirconia and lithium disilicate restorations are becoming very popular. Currently, many practices are using these restorations more than porcelain-fused-to-metal (PFM). The increasing price of metal and the rapid growth of laboratory digital dentistry and in-office CAD/CAM milling of restorations prompt me to predict that all-ceramic crowns will soon not only be more popular than PFM, but will eventually replace PFM.
However, there are looming problems with these all-ceramic restorations. When removing PFM or full-metal crowns, dentists have been accustomed to the simple task of making a slot in the restoration with a bur, placing a screwdriver-like instrument in the slot, and popping the crown off with little or no difficulty.
Such is not the case with zirconia or lithium disilicate restorations. The arduous task of making slots in the restoration and slowly chipping the material from the tooth, piece by piece, is well known to dentists (Figs. 1-5).
There are several important separate points that relate to your question. They include the following:
- ◆ The adequacy of the tooth preparation at the time of cementation
- ◆ The physical characteristics of the ceramic used
- ◆ Whether the restoration is bonded or luted
- ◆ The instrument used to remove the restoration
I will discuss each point individually to answer your question.
Tooth preparation adequacy
It is a well-known fact that many crown tooth preparations have excessive taper on them. Such tooth preparations are not retentive, and removing the restorations is much easier than removing crowns from conventional tooth preparations with near parallel walls. Also, some tooth preparations are too short from the gingival margins to the occlusal table.