Using ZIRMAX M for Full Mouth Rehabilitation

Teeth experience gradual wear on the occlusal surfaces throughout a person’s life. This can be from erosion, abrasion, or attrition. Serious cases can result in worn, cracked, broken dentition that can result in compromised esthetics and poor function. Ultimately this can have a significant impact on a person’s quality of life and self-esteem. Full mouth rehabilitation offers a solution to people who want to improve their esthetics and restore their oral function.

It is important to identify the factors that contribute to the wear and trauma found in the mouth. Once a proper diagnosis is achieved, a comprehensive treatment plan can be established. These types of cases can be a significant challenge but are manageable with proper planning.

Patient Examination

We recently helped with the full mouth rehabilitation of this patient who was having issues chewing and wanted to correct the poor esthetics that his dysfunction had created. Upon examination, the teeth were worn, chipped, and broken down. There were missing teeth and an old amalgam restoration that needed to be replaced. The patient had lost vertical dimension, indicating the need for full mouth rehabilitation.

Diagnostics

The first step in completing a full mouth rehabilitation case is to complete a diagnostic wax-up. Impressions and bite records are needed to capture the patient’s existing situation. This information is used to properly mount and articulate the models.

One of the most critical steps in ensuring the case is mounted accurately is to include a record of the horizontal plane and facial midline. One great and simple way to record this is by using a Kois Dento-Facial Analyzer.

This device is simple to use, and the necessary information is captured in registration material that is adhered to an index tray. This small tray is sent to the lab and used to mount the case. Using this tool, the chance for errors concerning the horizontal and finding the facial midline is greatly reduced. It essentially acts as a face-bow and stick-bite in one.

Next, photos should be sent as they provide crucial information to the laboratory that is vital to the overall success of the case. Photos will show the patient’s existing situation, including tooth position, periodontal issues, and occlusion. The photos needed are as follows:

• A photo showing the patient’s full face
• A photo of the full smile (close-up)
• A photo of the lips at rest

For this patient’s case, all of the gathered data was then sent to the laboratory to begin the diagnostic wax-up. At this stage, the patient’s initial requests, the preliminary treatment discoveries, and the determination of whether or not to change the vertical dimension of occlusion were evaluated and built into the wax-up.

The completed wax-up was then sent back to the doctor, and then shared with the patient along with the treatment plan details. At this stage in a case, changes can be made to the wax-up if needed.

Preparation

The case was then prepared in stages, with the maxillary teeth getting prepared first.

Final impressions were taken, along with bite records.

DuraTemp provisionals were created from the approved wax-up and examined to ensure a passive fit.

The occlusion and VDO were checked for accuracy.

The temporaries were worn for several days so that the patient could evaluate the shape, contours, shade, and length. During this stage is the patient’s opportunity to provide any changes that they want in the final restorations.

ZIRMAX M

The fabrication of the final restorations could then begin. It was determined that this case would be done with both layered zirconia and monolithic zirconia. The anterior restorations were fabricated using Burbank Dental Lab’s proprietary ZIRMAX layered material, and the posterior teeth would be restored using ZIRMAX M (monolithic restorations).

First, the anterior units were fabricated using ZIRMAX zirconia to fabricate an anatomical coping used as a substructure that then was layered to mimic the internal structures of natural teeth. This was used on the patient’s maxillary and mandibular anterior teeth. Layered zirconia offers exceptional esthetic results. Layering offers a more natural translucent result that works well when restoring the smile zone.

The rest of the restorations were fabricated using monolithic ZIRMAX M zirconia. Zirconia is the strongest material option on the market. ZIRMAX M has a flexural strength of 1200 MPA. In addition, it offers 25% more translucency than other types of zirconia materials. The translucency creates a more natural result and blends nicely with the layered zirconia restorations.

The ZIRMAX M brand of zirconia is a high-quality material that works well for crowns and bridges, including long-span bridges.

Also, this material can be used as high-strength substructures when layering is the best option for a specific case. One of the critical factors in choosing a zirconia material is to consider its flexural strength. With over 1000 MPa, ZIRMAX M is one of the most durable monolithic zirconia options on the market. This strength helps to create long-lasting restorations that resist fracture and breakage.

Also, ZIRMAX M offers 25% more translucency than other comparable high-strength materials. This translucency helps to create more natural and lifelike restorations. The benefits of using ZIRMAX M is as follows:

• Resists fractures and chipping
• It is easy to customize to achieve desired results
• An extremely long-lasting restorative option
• Very strong all-ceramic material (1200 MPa)
• Restorations can be cemented, making cases less complicated to seat.

This case was completed using a combination of 12 ZIRMAX layered restorations and 18 ZIRMAX M Monolithic restorations.

Full mouth rehabilitation can be challenging. Often, wear is present in these cases, and opening the vertical is necessary to achieve both esthetic and functional expectations. The treatment plan is the key to ensuring the case is successful. Using the right material is also essential in meeting the necessary needs of the patient.

Burbank Dental Lab has restored countless of these complex cases and has created a workflow that ensures these cases successfully meet the patient’s needs. Call today to find out more about how Burbank Dental Lab can help you with your next case.