Implant-supported Monolithic Zirconia

GIVING BACK A SMILE

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At Burbank Dental Lab, we understand that each restoration we create has one final purpose, and that purpose is, ultimately, to help patients.

Whether we help get someone out of pain, improve function, straighten malalignments, or make a smile more esthetic, we are changing lives. And sometimes, we get the privilege of working on a patient that leaves a lasting impact on us.

We recently had the privilege of working on such a patient. Dr. Vivian Roknian contacted us about her patient Mr. Craig Coley and explained that he had spent 39 years in prison for a crime that was later determined he did not commit. His heartbreaking circumstance motivated our team to provide our best to help give him back his smile.

In cases such as these, it is essential that we achieve and help manage the patient's esthetic expectations and provide proper form and function.

Edentulous patients can suffer from pain, discomfort, and low self-esteem. Also, edentulism has been linked to bone loss, coronary issues, cancers, and diabetes.

Taking care of tooth loss then is paramount to a patient's physical and mental wellbeing. One of the best restorations available to combat edentulism is an implant-supported fixed prosthesis. These prosthesis support tissue, maintain bone, help with chewing, and provide excellent esthetics.

Case Preparation

This patient presented with multiple dental issues. His number one concern was to improve esthetics and mastication. Dr. Roknian provided a full dental exam and put together a treatment plan. She prescribed implant-supported monolithic zirconia restorations on both the mandibular and maxillary arches.

Study models were sent to Burbank Dental Lab. A denture set up was fabricated and sent to the doctor for try-in. Slight modifications were made, and a bite registration was taken. This step was used to determine the bite and establish the vertical dimension.

The implants used in this case were Nobel multi-unit abutments. The doctor took traditional impressions using Nobel multi-unit impression copings. These were poured in stone, and the bite registration, taken from the converted denture set-up, was used to mount the models. The models were mounted on an adjustable Panadent Articulator.

Case Fabrication
PMMA - Temporary Models

The models were scanned, and a polymethyl methacrylate (PMMA) temporary was fabricated (fig.1, shown above). The temporaries were checked and adjusted to ensure the correct horizontal (fig.2, shown above).

The patient wore the temporaries for approximately three weeks. During this time, the doctor made adjustments to balance the occlusion and noted any esthetic issues the patient had. This step is a prototype of the final restorations. It is crucial to evaluate the occlusal relationship between the upper and lower, the vertical, the esthetics, including teeth position, and evaluate the speech. After the esthetics and function were established and accepted by the patient, the case was ready for final fabrication.

The case was then moved to the scanning process. The mandibular model was scanned along with the soft tissue (fig.3, shown below).

Mandibular Model - Soft tissue scanned

Next, the multi-unit scan bodies were recorded to mark the implant placement (fig.4, shown below).

Multi-unit scan bodies

Finally, the approved prototype was scanned, and the final design was saved (fig.5, shown below).

Approved scanned prototype

The same was done for the maxillary arch (fig.6 and 7, shown below).

Maxillary arch - figure 6
Maxillary arch - figure 6
Maxillary Arch - Figure 7
Maxillary Arch - Figure 7
Zir-Max.M

The doctor prescribed Burbank Dental Lab's Zir-Max.M for this case.

Zir-Max.M is a high strength monolithic zirconia with a flexural strength of 1000 MPa. It is indicated for long-span bridges, including full-arch implant-supported prosthesis. While the material is extremely strong, it also has a high level of translucency, helping make the prosthesis look natural and meet the patient's esthetic demands.

With the doctor's material choice noted, the designed case was finalized and moved on to be milled.

The case was then adjusted to add surface texture and to ensure the restorations looked like individual teeth. The proper shading was done, and stains were used to add characterization to help ensure the case looked natural. In the final step of fabrication, the case was glazed.

Zir-MAX Zirconia from Burbank Dental Lab
Success Guides of Burbank Dental Lab
In Lab Case Placement

Burbank Dental Lab, among its state-of-the-art laboratory facilities, has a fully functioning operatory where the final case was tried, and the necessary changes were made on site.

The final restorations were then prepared for insertion (fig.8, shown below).

Implant-Supported Monolithic Zirconia

The doctor inserted the prosthesis (fig.9, shown below).

Implant-Supported Monolithic Zirconia - Inserted prosthesis

Minor adjustments were made using a diamond bur and later polished with a silicone wheel (fig.10, shown below).

Minor adjustments using a diamond bur

Once the case was fully adjusted, the patient was asked to approve the esthetics (fig.11, shown below).

Patient approves the esthetics

The case was approved and finalized.

The final step was to seal the access holes first with Teflon tape and then the appropriate composite shade. (fig.12, shown below).

Final step - seal the access holes - composite shade

The key to case success in complex cases such as this one is proper planning.

The proper plan and creating a prototype that the patient can evaluate allows for ease on insertion day.

Through our digital design workflow, this case was milled with precision to ensure excellent results.

While adjustments were still necessary, they were minor for a case of this size.

See the results below!

By listening and taking down accurate notes, the patient's concerns concerning esthetics were noted and made an important part of the fabrication process.

Dr. Roknian, Mr. Coley, and Andrew Sedler, COO of Burbank Dental Lab

Once this case was completed, the patient was thrilled, and his gratitude was felt by everyone involved. There is no way for us to fully understand what this man has gone through, but being able to participate in giving him back his smile reminds us of why we are in this business in the first place.

For more information on Burbank Dental Lab's implant-supported fixed prosthesis, please call or chat today with one of our implant planning specialists.

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