“Zirconia on Zirconia” case study

Implant-retained zirconia dentures are playing an increasingly important role in implant rehabilitation.
This is happening for two main reasons: the first is due to patients’ requests to stabilize their prostheses through implant therapy.
This is happening for two main reasons: the first can be traced back to the requests of patients who want to stabilize their prostheses through implant therapy;
The second relates to the fact that this therapy has become increasingly effective, personalized, and minimally invasive.
The number of implants inserted, the type of anchorage required, whether screwed or cemented, the availability of patients determines the choice of rehabilitation.
CAD-CAM technology, combined with new materials, has made it possible to produce precise and stress-free screw-retained restorations.
precise and stress-free.
This rehabilitation option, long-neglected and relegated exclusively to the use of acrylics, is now the preferred choice.
This choice of rehabilitation, long-neglected and relegated exclusively to the use of acrylics, is now preferred by clinicians who recognize, in addition to a number of obvious clinical aspects, as well as ease of installation and removal when an inspection is required. need for inspection.
Cemented prostheses, on the other hand, are increasingly losing acceptance, and even at a time when and even when it seems to be the only possible solution, knowledge, technology, and associated materials still favor screw-retained restorations.
In this extract, the author will show a clinical case in which the above-mentioned is highlighted.

Clinical case

Rehabilitation request:
Zirconia denture-skeletal prosthesis retained through screws.
Patient of about seventy years of age from whom the clinician removed an old work on implants in the maxillary.
The rehabilitation therapy foresees keeping four old implants – positioned one posteriorly on the left and three posteriorly on the right with very inclined emergence – and the insertion of four new implants in the anterior region, different both in terms of the type of connection and manufacturer from the existing ones.
This choice is able to create a suitable architecture to support the new prosthesis.

Photo 1

The unfavorable emergence of the three pre-existing implants, together with the difference in the connection between the implants present and not properly indicated for a screwed prosthesis, has led the clinician to consider, through the indication of the temporary, a definitive rehabilitation of cemented type on custom titanium abutments. (Photo 2)

Photo2

The long experience gained on this type of prosthetic restoration, the knowledge of technological systems associated with that of the materials has allowed the author to indicate to the clinician an alternative prosthetic solution, able to satisfy the rehabilitative retention through screws.
Consequently, a titanium bar with a continuous design is designed, fractionated however into three segments with the following purpose: to eliminate the tensions due to the different types of connection and different inclination of the implants present.
Photo 3

Photo3

On the head of the bar, the author decides to make three threaded holes; each of them is placed on a segment of the bar itself, so as to constitute a tripod geometric design.
Photo 4

Photo 4

Titanium bonding links are screwed onto these threaded holes, enabling the design of a zirconia restoration intercalated with the bar and retained by the three screws. Design a zirconia restoration interlocked with the bar and retained by the three screws through the
bonding links. The reference technique is called “zirconia on zirconia”

 

The “zirconia on zirconia” fabrication technique allows a highly tough Katana HT ML zirconia to be combined with less tough multilayer zirconia. Katana HT ML by sintering 1200 MPa with a less tough, highly aesthetic Katana ST ML 750 MPa multilayer.
aesthetic Katana ST ML 750 MPa.
The use of the full-zirconia anatomical part enables the anatomy of the installed temporarily to be perfectly replicated.
the anatomy of the previously installed temporarily.

The beauty of Katana ST ML 750 MPa, coupled with its chemical and physical properties, makes it an excellent
this material an excellent reference for this choice of material.

The integration of the prosthetic restoration on the patient.
Photos 8,9

Photo 8,9

Conclusions
The prosthetic case treated, despite the objective difficulties encountered, has allowed evaluating how it is possible to give an innovative and unexpected vision through the use of new technologies and materials associated with them, together with the specific knowledge of the operators.

 

 

Written and performed by Marco Stoppaccioli DGSHAPE Expert

Marco Stoppaccioli DGSHAPE

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BIBLIOGRAPHY of case study

Scarano A, Lorusso F, Orsini T, Morra M, Iviglia G, Valbonetti L. Biomimetic
surfaces coated with covalently immobilized collagen type I: an X-ray
photoelectron spectroscopy, atomic force microscopy, micro-CT and
histomorphometrical study in rabbits. Int J Mol Sci. 2019;20(3):724–40.
PubMed Central Article PubMed Google Scholar2.
Scarano A, Carinci F, Lorusso F, Festa F, Bevilacqua L, Santos de Oliveira P, et
al. Ultrasonic vs drill implant site preparation: post-operative pain measurement
through VAS, swelling and crestal bone remodeling: a randomized clinical study.
Materials. 2018;11(12):2516–29.
1. PubMed Central Article PubMed Google Scholar 3.
Mangano C, Piattelli A, Scarano A, Raspanti M, Shibli JA, Mangano FG, et
al. A light and scanning electron microscopy study of human direct laser
metal forming dental implants. Int J Periodontics Restorative Dent.
2014;34:e9–17.
PubMed Article Google Scholar
2. 4.
Nissan J, Narobai D, Gross O, Ghelfan O, Chaushu G. Long-term outcome
of cemented versus screw-retained implant-supported partial restorations.
Int J Oral Maxillofac Implants. 2011;26:1102–7.
PubMed Google Scholar
3. 5.
Chee W, Felton DA, Johnson PF, Sullivan DY. Cemented versus screwretained
implant prostheses: which is better? Int J Oral Maxillofac
Implants. 1999;14:137–41.
PubMed Google Scholar
4. 6.
Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant
restorations: achieving optimal occlusion and esthetics in implant
dentistry. J Prosthet Dent. 1997;77:28–35.
PubMed Article Google Scholar
5. 7.
Lewis S, Beumer J, Hornburg W, Moy P. The “UCLA” abutment. Int J Oral
Maxillofac Implants. 1988;3:183–9.
PubMed Google Scholar
6. 8.
Michalakis KX, Hirayama H, Garefis PD. Cement-retained versus screwretained
implant restorations: a critical review. Int J Oral Maxillofac
Implants. 2003;18:719–28.
PubMed Google Scholar
7. 9.
Karl M, Taylor TD, Wichmann MG, Heckmann SM. In vivo stress behavior
in cemented and screw-retained five-unit implant FPDs. J Prosthodont.
2006;15:20–4.
PubMed Article Google Scholar
8. 10.
Korsch M, Obst U, Walther W. Cement-associated peri-implantitis: a
retrospective clinical observational study of fixed implant-supported
restorations using a methacrylate cement. Clin Oral Implants Res.
2014;25:797–802.
PubMed Article Google Scholar
9. 11.
Montero J, Macedo de Paula C, Albaladejo A. The “Toronto prosthesis”, an
appealing method for restoring patients candidates for hybrid
overdentures: a case report. J Clin Exp Dent. 2012;4:e309–12.
PubMed PubMed Central Article Google Scholar
10. 12.
Zarb GA, Bolender CL. Prosthodontic treatment of edentulous patients:
complete dentures and implant-supported prostheses. 12th ed. St. Louis:
Mosby; 2004.
Google Scholar
11. 13.
Maló P, de Araujo Nobre M, Petersson U, Wigren S. A pilot study of
complete edentulous rehabilitation with immediate function using a new
implant design: case series. Clin Implant Dent Relat Res. 2006;8:223–32.
PubMed Article Google Scholar
12. 14.
Maló P, de Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M. “Allon4” immediate-function concept for completely edentulous maxillae: a
clinical report on the medium (3 years) and long-term (5 years) outcomes.
Clin Implant Dent Relat Res. 2012;14(Suppl 1):e139–50.
PubMed Article Google Scholar
13. 15.
Maló P, Rangert B, Nobre M. “All-on-four” immediate-function concept
with Brånemark system implants for completely edentulous mandibles: a
retrospective clinical study. Clin Implant Dent Relat Res. 2003;5(Suppl
1):2–9.
PubMed Article Google Scholar
14. 16.
Cappare P, Sannino G, Minoli M, Montemezzi P, Ferrini F. Conventional
versus digital impressions for full arch screw-retained maxillary
rehabilitations: a randomized clinical trial. Int J Environ Res Public
Health. 2019;16(5):829–44.
PubMed Central Article Google Scholar
15. 17.
Mangano F, Gandolfi A, Luongo G, Logozzo S. Intraoral scanners in
dentistry: a review of the current literature. BMC Oral Health. 2017;17:149.
PubMed PubMed Central Article Google Scholar
16. 18.
Ferrini F, Sannino G, Chiola C, Capparé P, Gastaldi G, Gherlone EF.
Influence of Intra-Oral Scanner (I.O.S.) on The Marginal Accuracy of
CAD/CAM Single Crowns. Int J Environ Res Public Health.
2019;16(4):544–53.
PubMed Central Article Google Scholar
17. 19.
Mangano F, Margiani B, Admakin O. A novel full-digital protocol (SCANPLANMAKE-DONE®) for the design and fabrication of implantsupported
monolithic translucent zirconia crowns cemented on
customized hybrid abutments: a retrospective clinical study on 25
patients. Int J Environ Res Public Health. 2019;16(3):317–37.
PubMed Central Article Google Scholar
18. 20.
Attard NJ, Zarb GA. Long-term treatment outcomes in edentulous
patients with implant-fixed prostheses: the Toronto study. Int J
Prosthodont. 2004;17:417–24.
PubMed Google Scholar
19. 21.
Scarano A, Noumbissi S, Gupta S, Inchingolo F, Stilla P, Lorusso F.
Scanning electron microscopy analysis and energy dispersion X-ray
microanalysis to evaluate the effects of decontamination chemicals and
heat sterilization on implant surgical drills: zirconia vs. steel. Appl Sci.
2019;9:2837.
Article Google Scholar
20. 22.
Candotto V, Lauritano D, Carinci F, Bignozzi CA, Pazzi D, Cura F, et al.
Silver-based chemical device as an adjunct of domestic oral hygiene: a
study on periodontal patients. Materials. 2018;11(8):1483–90.
PubMed Central Article PubMed Google Scholar
21. 23.
Noumbissi S, Scarano A, Gupta S. A literature review study on atomic ions
dissolution of titanium and its alloys in implant dentistry. Materials.
2019;12(3):368–383.
PubMed Central Article PubMed Google Scholar
22. 24.
Sarıkaya I, Hayran Y. Effects of dynamic aging on the wear and fracture
strength of monolithic zirconia restorations. BMC Oral Health.
2018;18:146.
PubMed PubMed Central Article Google Scholar
23. 25.
Dauti R, Cvikl B, Franz A, Schwarze UY, Lilaj B, Rybaczek T, et al.
Comparison of marginal fit of cemented zirconia copings manufactured
after digital impression with lava™ C.O.S and conventional impression
technique. BMC Oral Health. 2016;16:129.
PubMed PubMed Central Article Google Scholar
24. 26.
Meirowitz A, Bitterman Y, Levy S, Mijiritsky E, Dolev E. An in vitro
evaluation of marginal fit zirconia crowns fabricated by a CAD-CAM dental
laboratory and a milling center. BMC Oral Health. 2019;19:103.
PubMed PubMed Central Article Google Scholar
25. 27.
Papadiochou S, Pissiotis AL. Marginal adaptation and CAD-CAM
technology: a systematic review of restorative material and fabrication
techniques. J Prosthet Dent. 2018;119:545–51.
PubMed Article Google Scholar
26. 28.
Faeghinejad M, Proussaefs P, AlHelal A, Lozada J. The CAD/CAM
compound prosthesis: digital workflow for fabricating cement-retained
zirconia prosthesis over screw-retained milled titanium bars. Int J
Periodontics Restorative Dent. 2019;39:39–47.
PubMed Article Google Scholar
27. 29.
Abduo J, Bennani V, Waddell N, Lyons K, Swain M. Assessing the fit of
implant fixed prostheses: a critical review. Int J Oral Maxillofac Implants.
2010;25:506–15.
PubMed Google Scholar
28. 30.
Jemt T. Failures and complications in 391 consecutively inserted fixed
prostheses supported by Brånemark implants in edentulous jaws: a study
of treatment from the time of prosthesis placement to the first annual
checkup. Int J Oral Maxillofac Implants. 1991;6:270–6.
PubMed Google Scholar
29. 31.
Mangano F, Veronesi G. Digital versus analog procedures for the
prosthetic restoration of single implants: a randomized controlled trial
with 1 year of follow-up. Biomed Res Int. 2018;2018:5325032.
PubMed PubMed Central Google Scholar
30. 32.
Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of
osseointegrated implants in the treatment of the edentulous jaw. Int J Oral
Surg. 1981;10:387–416.
PubMed Article Google Scholar
31. 33.
Brånemark PI, Engstrand P, Ohrnell LO, Gröndahl K, Nilsson P, Hagberg
K, et al. Brånemark Novum: a new treatment concept for rehabilitation of
the edentulous mandible. Preliminary results from a prospective clinical
follow-up study. Clin Implant Dent Relat Res. 1999;1:2–16.
PubMed Article Google Scholar
32. 34.
Maló P, Araújo Nobre MD, Lopes A, Rodrigues R. Double full-arch versus
single full-arch, four implant-supported rehabilitations: a retrospective, 5-
year cohort study. J Prosthodont. 2015;24:263–70.
PubMed Article Google Scholar
33. 35.
Scarano A, Di Carlo F, Quaranta M, Piattelli A. Bone response to zirconia
ceramic implants: an experimental study in rabbits. J Oral Implantol.
2003;29:8–12.
PubMed Article Google Scholar
34. 36.
Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A. Bacterial adhesion
on commercially pure titanium and zirconium oxide disks: an in vivo
human study. J Periodontol. 2004;75:292–6.
PubMed Article Google Scholar
35. 37.
Souza ROA, Özcan M, Pavanelli CA, Buso L, Lombardo GHL, Michida
SMA, et al. Marginal and internal discrepancies related to margin design
of ceramic crowns fabricated by a CAD/CAM system. J Prosthodont.
2012;21:94–100.
PubMed Article Google Scholar
36. 38.
Renne W, McGill ST, Forshee KV, DeFee MR, Mennito AS. Predicting
marginal fit of CAD/CAM crowns based on the presence or absence of
common preparation errors. J Prosthet Dent. 2012;108:310–5.
PubMed Article PubMed Central Google Scholar
37. 39.
Martins LM, Lorenzoni FC, de Melo AO, de Silva LM, de Oliveira JLG, de
Oliveira PCG, et al. Internal fit of two all-ceramic systems and metalceramic
crowns. J Appl Oral Sci. 2012;20:235–40.
PubMed PubMed Central Article Google Scholar
38. 40.
Tezulas E, Yildiz C, Kucuk C, Kahramanoglu E. Current status of zirconiabased
all-ceramic restorations fabricated by the digital veneering
technique: a comprehensive review. Int J Comput Dent. 2019;22:217–30.
PubMed Google Scholar
39. 41.
Gehrke P, Bleuel K, Fischer C, Sader R. Influence of margin location and
luting material on the amount of undetected cement excess on CAD/CAM
implant abutments and cement-retained zirconia crowns: an in-vitro
study. BMC Oral Health. 2019;19:111.
PubMed PubMed Central Article Google Scholar
40. 42.
Woelber JP, Ratka-Krueger P, Vach K, Frisch E. Decementation rates and
the peri-implant tissue status of implant-supported fixed restorations
retained via zinc oxide cement: a retrospective 10-23-year study. Clin
Implant Dent Relat Res. 2016;18:917–25.
PubMed Article Google Scholar
41. 43.
Pjetursson BE, Asgeirsson AG, Zwahlen M, Sailer I. Improvements in
implant dentistry over the last decade: comparison of survival and
complication rates in older and newer publications. Int J Oral Maxillofac
Implants. 2014;29(Suppl):308–24.
PubMed Article Google Scholar
42. 44.
Schwarz S, Schröder C, Corcodel N, Hassel AJ, Rammelsberg P.
Retrospective comparison of semipermanent and permanent cementation
of implant-supported single crowns and FDPs with regard to the incidence
of survival and complications. Clin Implant Dent Relat Res. 2012;14(Suppl
1):e151–8.
PubMed Article Google Scholar
43. 45.
Testori T, Del Fabbro M, Capelli M, Zuffetti F, Francetti L, Weinstein RL.
Immediate occlusal loading and tilted implants for the rehabilitation of the
atrophic edentulous maxilla: 1-year interim results of a multicenter
prospective study. Clin Oral Implants Res. 2008;19:227–32.
PubMed Article Google Scholar
44. 46.
Agliardi E, Panigatti S, Clericò M, Villa C, Malò P. Immediate
rehabilitation of the edentulous jaws with full fixed prostheses supported
by four implants: interim results of a single cohort prospective study. Clin
Oral Implants Res. 2010;21:459–65.
PubMed Article Google Scholar
45. 47.
Di P, Lin Y, Li J, Qiu L, Chen B, Cui H. Clinical study of “All-on-4” implant

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