Case Presentation: Fabrication of a 3-Unit Zirconia Bridge Using Digital Technologies

CASE PRESENTATION

Fabrication of a 3-Unit Zirconia Bridge Using Digital Technologies

The patient was a 64-year-old woman who presented for a routine new patient examination with the primary complaint being, “I have a lot of problems.” One of those problems was a failing 3-unit porcelain-fused-to-metal bridge from the maxillary right canine to central incisor (Figure 1). The patient was scheduled to have knee-replacement surgery in a month and requested that she undergo dental treatment as quickly as possible so it would be completed prior to the surgery. Radiographs were obtained using a NOMAD Pro 2 handheld x-ray unit (KaVo Imaging) and a Sopix2 sensor (ACTEON). The treatment was discussed and the patient was scheduled.

All procedures were done under magnifi cation using the EyeZoom with XV1 frames (Orascoptic). The endodontic treatment was done under 5x magnification and the restorative treatment under 4x magnification. The patient was anesthetized with 4% Septocaine 1:200K epinephrine (Septodont) using The Wand STA machine (Milestone Scientific). The bridge was then removed. Endodontic therapy was performed on the maxillary right canine using TF Adaptive files (Kerr Endodontics). The root canal procedure was completed, and Visalys Core buildup material (Kettenbach) was bonded to the remaining tooth structure using the Optibond XTR bonding agent (Kerr Restoratives). The material was cured with a Demi Ultra curing light (Kerr Restoratives). The teeth were prepared using an iOptima electric handpiece (Bien Air) (Figure 2). An intraoral scan of the preparations was taken using a CS 3600 intraoral scanner (Carestream Dental) (Figures 3A and 3B). The margins of the crowns were marked. In the interest of masking the darkness of the central incisor, the material of choice for the restoration was BruxZir Anterior solid zirconia (Glidewell Dental). A temporary bridge was fabricated from a preoperative impression of the failing bridge using Silginat (Kettenbach), a medium-viscosity, addition-curing impression material with alginate-like consistency. The temporary bridge was fabricated using TempSpan (Pentron) (Figure 4). We cemented the bridge using ZONEfree temporary cement (Pentron) (Figure 5). Photographs were taken with the EyeSpecial C-III digital camera (Shofu Dental) to help the laboratory technician match the existing PFM crowns. The images were taken in both regular and shade-matching modes (Figures 6A and 6B). The bridge was sent to the laboratory and then tried in; no adjustments were necessary. The bridge was cemented using Ceramir Crown & Bridge (Doxa Dental), and the excess cement was removed. The patient was very happy with the result (Figures 7 and 8).