Effective collaboration between the dentist and dental technician is a key success factor for dental implant treatment, argues Stephen Lusty.
Effective collaboration between the dentist and dental technician has never been more important – even in the era of digital prostheses.
The Association of Dental Implantology (ADI) understands and appreciates the importance of fostering strong dentist-technician relationships. The ADI has developed the ADI Team Congress 2021 to include a dedicated Technicians’ Programme. Here, the delegates are able to share ideas, get up-to-date on industry developments and explore the latest concepts pertaining to dental implantology.
The Technicians’ Programme also provides the platform for delegates to find out more about the cutting-edge dental materials that can effectively enhance treatment outcomes.
I will be sharing insights at the event, focusing on the multiple uses of zirconia as both a dental implant and tooth-borne restoration material. In particular, I will demonstrate how the combination of a digital and an ‘old school’ manual approach to processing zirconia is necessary to achieve optimal function and aesthetics.
My lecture will focus on the use of scaled models in the processing of un-sintered zirconia. I will also look at staining and glazing techniques, layering of ceramics and methods for dealing with vertical and sub-gingival preparations, as well as the use of zirconia on everyday implant cases.
Examples from my own laboratory
I can only speak for my own dental laboratory, but I use both full contour, reduced and layered techniques.
When working with full contour, I primarily use an ultra-high translucent zirconia. This is rated at 600MPA.
For partial cut back techniques, I use a 1100MPA zirconia with a high translucency and for large span bridges or fully layered dental crowns, I use a 1400MPA zirconia. In the anterior region, I always layer ceramics at least on the buccal face for enhanced aesthetics.
I believe the first element to consider when deciding what zirconia to use for a case is the strength of the material. For example, as we know, the higher the strength of the zirconia, the lower its translucency.
Unless it is a large case, the translucency level is usually the key factor in determining which zirconia to use, so we need to assess the colour of the prep, as well as the space available.
Issues with zirconia
Another issue is the ability, or lack thereof, to bond zirconia. It puts some clinicians off using it for restorations such as Maryland bridges.
Zirconia is also a material you must use with care, once sintered. You shouldn’t grind the surface too heavily. If zirconia is ground to adjust the bite or for any other reason, you need to treat it correctly in order to prevent the restoration from weakening.
If a dark prep is present and a high translucency zirconia is desired, I would regularly use Illusion white block-out liquid on the internal aspect of the restoration prior to sintering. This can mask even very dark preps or titanium abutments.
I have recently been using the zirconia etch from Illusion to treat the surfaces of restorations. This enables you to bond them into place. This is an etch that’s applied to un-sintered zirconia in order to provide a more retentive surface once the zirconia has been sintered. I check the bite, contacts and contours of the restoration in its pre-sintered state using scaled models. This alleviates the need to grind the zirconia, once sintered.
Getting it wrong
The consequences of getting it wrong are the same for zirconia as for other types of restoration.
It means an unwanted remake for the dental technician and a waste of valuable surgery time for the dentist. It is also a waste of the patient’s time.
Worse still, the restoration is at risk of failing over time. You could potentially cause more damage to the patient’s teeth. As with every restoration, getting it right first time ensures everyone is happy and that treatment is ultimately profitable.
Details of the ADI Team Congress event
Titled The Great Debate: Current Dilemmas in Dental Implantology. The ADI Team Congress is the place to be if you are looking to learn from experts in the field.
The whole team engages in thought-provoking discussions. They also present the opportunity to get hands-on with ground-breaking dental technology.
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