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RESTORATIVE DENTISTRY
Range of indications for translucent zirconia
modications: Clinical and technical aspects
Sven Rinke, Dr med dent, MSc, MSc
1
/Carsten Fischer
2
Translucent zirconia modications offer esthetic improvement for manually veneered zirco-
nia structures, as they do not lead to a shining through of the substructure material, even
in cases with a pronounced anatomic core design for maximum support of the veneering
ceramics. Moreover, these zirconia modications allow the production of fully anatomic zir-
conia crowns and xed dental prostheses in the posterior region. The clinical advantage of
these restorations is dened by a signicantly reduced material thickness in comparison
with veneered restorations or other monolithic materials. As the restoration can be colored
individually prior to sintering, followed by characterization by staining, good esthetic
results in the posterior region are achieved, even in cases with substantially reduced
space. The results of laboratory studies performed so far seem to justify the clinical appli-
cation of fully anatomic restorations. However, additional clinical studies are required to
support these new material modications. (Quintessence Int 2013;44:557566;
doi:10.3290/j.qi.a29937, id=29937 ; originally published (in German) in
Quintessenz;63(7):895-905)
Key words: abrasion, all-ceramic, chipping, monolithic ceramics, zirconia
1
Clinician, Geleitstr. 68, 63456 Hanau, Germany.
2
Dental Technician, Lyoner Str. 44-48, 60528 Frankfurt/Main,
Germany.
Correspondence: Dr Sven Rinke, Geleitstr. 68, 63456 Hanau,
Germany. Email: rinke@ihr-laecheln.com
All-ceramic restorations made from a variety
of materials have become widely accepted,
especially since the introduction of yttrium
partially stabilized zirconia structures. After
more than 10 years of clinical application,
zirconia is known as a material with good
long-term stability for the production of
crown and xed dental prosthesis (FDP)
structures. However, systematic reviews
show an increased incidence of technical
complications, such as fractures of the
ceramic veneer.
1,2
These complications do
not necessarily lead to replacement of the
restoration, but in some cases intervention
is required to keep the restoration in func-
tion. Fractures of the ceramic veneer are
seen most often in the molar region.
1
Sev-
eral strategies for reducing the chipping
risk in molar restorations are available:
fully anatomic monolithic crowns and
three-unit FDPs made of lithium-silicate
ceramics
computer-aided design/computer-
assisted manufacture (CAD/CAM)-com-
pound technology: a zirconia structure
is fused with a lithium disilicate veneer-
ing ceramic by using a low-melting
ceramic material (connector compound)
fully anatomic monolithic restorations
made of zirconium-silicate or zirconia
veneered zirconia restorations with a
modied cooling process and a pro-
nounced anatomic structure design.
Ten-year results are available for monolithic
three-unit FDPs made of lithium-disilicate
ceramics, and show a survival rate of
87.9%.
3
It is worth mentioning that these
restorations were fabricated with a minimum
wall thickness of 1.5 mm and a minimum
connector area of 16 mm
2
. Adhering to the
design parameters seems essential for the
clinical long-term success of monolithic
FDPs made of IPS e.max (Ivoclar Vivadent).
The results of this study showed that mono-
lithic lithium-disilicate FDPs have a better
survival rate than veneered FDP structures
made of lithium-disilicate ceramics.
4
CAD/CAM-produced monolithic restor-
ations have been applied clinically for sev-
eral years. Clinical data are available for
lithium disilicate crowns produced with the
Cerec system (Sirona Dental Systems). Two
studies reported a survival rate of more
than 97% and initially good clinical perfor-
mance.
5,6
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For the CAD/CAM compound technol-
ogy, as yet only data from short-term stud-
ies with observational periods of 12 months
are available. However, in vitro studies
show that for this technique the mechanical
strength is twice as high as for manually
layered veneers.
7
The fabrication of fully anatomic zirconia
restorations has so far been limited by
translucency, which is signicantly lower
than that of lithium disilicate ceramics. Con-
ventional standard zirconia materials
achieve at most 70% of the translucency of
lithium disilicate ceramics.
8
Moreover, the
limited translucency of conventional zirco-
nia materials often leads to compromised
esthetics in restorations with a pronounced
anatomic core structure, as a reduction of
the veneering layers may lead to shining
through of the core material.
The introduction of modied translucent
zirconia materials results in two ranges of
application:
esthetic optimization of veneered restor-
ations with pronounced anatomic struc-
ture design
monolithic crowns and FDPs in the pos-
terior region.
The present study demonstrates the differ-
ent possibilities for the application of trans-
lucent modications of zirconia on the basis
of clinical case studies. Moreover, the spe-
cial technical aspects of the application in
the dental practice and laboratory are dis-
cussed.
ANATOMIC STRUCTURE
DESIGN WITH
TRANSLUCENT ZIRCONIA
MODIFICATIONS
In the initial phase, a pronounced core
structure of zirconia restorations was limited
by the design and software features of the
rst CAD programs. This allowed only an
insufcient anatomic structure model from
todays point of view one possible factor for
the high fracture rates of the veneering
ceramics (Fig 1). However, based on cur-
rent ndings, an even more pronounced
anatomic framework design than for metal-
ceramic restorations is required (Fig 2). La-
boratory studies
9
and the rst results of
clinical studies demonstrate that a pro-
nounced anatomic structure design and a
prolonged cooling period lead to a signi-
cant reduction of the fracture rate of the
veneering ceramics in manually layered
molar zirconia restorations.
10
Adequate ana-
tomic structure design is best achieved by
a subtractive approach.
11,12
The shape of
the structure is calculated back from the
outer contour of the restoration in the CAD
software, and then reinforced in the proxi-
mal region. Thus, the thickness of the
veneering ceramics in the proximal region
is signicantly reduced: this procedure is
intended to provide maximum support of
the veneering ceramics.
However, this means that color charac-
teristics cannot merely be achieved with
veneering. In fact, it is important to deter-
mine the basics of the tooth color in the
structure. Industrially monocolored zirconia
structures meet these requirements only to
a limited degree. By a separate colorization
and characterization in the marginal region
and in the area of the later dentin body, the
color composition can be effected in the
structure, and it will then support and sim-
plify the ceramic layering (Figs 3 and 4).
The build-up of the nal anatomic shape
and color characterization is then carried
out by manual veneering (Fig 5). This is
suitable for restorations that require a high
degree of individual coloring. Preparation
and cementation are performed according
to the known recommendations for zirconia
restorations in the posterior region.
ESTHETIC OPTIMIZATION
OF ANTERIOR
RESTORATIONS
Framework materials with increased translu-
cency are favorable for treatments that do
not require the covering or masking of a
discolored prepared tooth or a metallic post
and core restoration. Due to their higher
opacity, restorations made of zirconia are
inferior to glass-ceramic restorations. The
increased light transmission of translucent
zirconia modications improves the esthetic
results in these areas (Figs 6 and 7).
According to the manufacturers informa-
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Fig 1 Structure design in the early stage of zirconia
processing. The anatomic structure design is insu-
cient and favors a premature failure of the inade-
quately supported veneering ceramics.
Fig 4 The individual staining of the structures
(Multi-Coloring technique according to C Fischer)
with dierent color intensities in the cervical, dentin,
and incisal regions allows the ceramic veneering
with signicantly reduced layering thickness without
compromising the esthetic result.
Fig 2 Pronounced anatomic struc-
ture design with additional reinforce-
ment in the proximal region. This
structure design allows good sup-
port of the veneering ceramics.
Fig 3 Anatomic framework design
for crowns in the posterior region
with a translucent zirconia modica-
tion (Cercon HT). For optimum sup-
port of the veneering ceramics, a
small-area contact is planned in the
proximal region.
Fig 5 Manually veneered zirconia crowns.
Fig 6 Try-in of an individually stained crown struc-
ture made of a translucent zirconia modication
(Cercon HT with Multi-Coloring technique).
Fig 7 Palatal illumination shows the signicantly
increased translucency in comparison with classic
zirconia structures.
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tion, the modications do not inuence the
mechanical properties of the restoration. In
cases with limited space available, it is pos-
sible to fabricate the restorations with ves-
tibular veneering only, thus according to the
manufacturers recommendations the nec-
essary substance reduction in the palatal
region can be limited to 0.5 to 0.7 mm. With
regard to a modication of the structure,
this procedure offers possibilities equal to
metal-ceramic restorations.
MONOLITHIC ZIRCONIA
RESTORATIONS
The use of fully anatomic zirconia crowns
and FDPs in the posterior region is a new
option for the fabrication of restorations. On
one hand, the elimination of chipping is a
clear advantage of monolithic zirconia res-
torations; on the other hand, economic
advantages are also important, as these
restorations can be produced with CAD/
CAM procedures at reasonable prices. Of
course the ability of the design software to
generate a fully anatomic occlusal surface
is a precondition. However, with regard to
clinical aspects, a reduced space require-
ment and thus a reduced preparation depth
are important in comparison with veneered
restorations. According to the manufactur-
ers instructions, when compared with
monolithic restorations made of lithium dis-
ilicate ceramics, the required substance
reduction can be reduced to 0.5 to 0.7 mm
in the occlusal area and to 0.5 mm at the
preparation limit. However, these recom-
mendations are based on the manufactur-
ers results of chewing simulation tests; they
have not yet been veried by respective
clinical studies. Nevertheless, it should be
considered that this process for the rst
time offers the possibility of fabricating con-
ventionally cemented all-ceramic crowns
and FDPs with substance reductions that
could previously only be achieved in metal-
lic full-cast restorations. Considering that
coloring of the presintered structure, fol-
lowed by painting, allows individual color-
ing, interesting areas of application for an
all-ceramic restoration concept develop
(Figs 8 and 9).
However, as the fabrication of fully ana-
tomic zirconia restorations is a relatively
new application, the available scientic
ndings with regard to potential risks have
to be evaluated prior to a general recom-
mendation for clinical use.
SCIENTIFIC EVALUATION
At present, no data from systematic clinical
studies on fully anatomic zirconia restor-
ations exist. The application of fully ana-
tomic restorations is only documented in
single case studies with a maximum obser-
vation period of 2 years.
11-13
However,
potential risks of their clinical application
and possible advantages have been evalu-
ated comprehensively in in vitro studies.
Beuer et al
14
evaluated the translucency
and fracture strength of fully anatomic and
veneered zirconia crowns. The fully ana-
tomic crowns showed both a higher translu-
cency and a higher fracture strength than
the veneered zirconia crowns.
Fig 8 Example of a restoration with fully anatomic
crowns in the posterior region. Color characteriza-
tion was achieved by surface painting only.
Fig 9 Signicantly improved color adaptation to
adjacent teeth after coloring of the fully anatomic
structures, followed by individual color characteriza-
tion.
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The abrasion behavior of zirconia sur-
faces is also essential for clinical applica-
tion. In the initial phase of using zirconia,
full coverage of the zirconia structure with
veneering ceramics was required, as expo-
sition of the structure was suspected to
increase abrasion at the antagonistic tooth.
This was based on the assumption that zir-
conia, due to its hardness, showed high
antagonistic abrasion. However, a study of
Jung et al
15
demonstrated that polished as
well as glazed zirconia surfaces show lower
antagonistic abrasion than classic veneer-
ing ceramics.
These results have since been con-
firmed by studies by Preis et al
16
and
Rosentritt et al.
17
Both studies show that the
antagonistic abrasion of zirconia is lower
than that of veneering ceramics or lithium
disilicate ceramics. Later studies invariably
conrm that zirconia surfaces show a lower
antagonistic abrasion than feldspathic por-
celain veneers.
14,18,19
The reasons for increased antagonistic
abrasion of veneering ceramics are mainly
functional surface modications which lead
to surface wrinkling of the veneering ceram-
ics. A functional antagonistic contact leads
to increased ssures and chips in the sur-
face of the veneering ceramics, which lead
to destruction of the initially smooth sur-
faces. These changes of the surface are
also reported in clinical studies with
veneered all-ceramic restorations.
20,21

These studies prove that the abrasion
behavior of veneering ceramics observed
under laboratory conditions also occurs
under clinical conditions. Abrasion at the
natural enamel increases with increasing
roughness. The studies show that this sur-
face destruction does not occur at zirconia
surfaces. Even with repeated exposure to
the antagonistic tooth, zirconia maintains its
smooth surface and thus cannot have an
abrasive effect on natural enamel.
The majority of studies show that pol-
ished zirconia surfaces have lower antago-
nistic abrasion than glazed surfaces.
14-19

This can be explained by the composition
of the glaze material, which mainly consists
of a nely ground ceramic frit, thus being
similar to a veneering ceramic material.
Therefore, the glaze layer is liable to the
same destruction process as a veneering
ceramic. The surface roughening caused
by this process also increases the abrasion
of natural enamel. However, it has to be
considered that the difference between pol-
ished and glazed zirconia surfaces is sig-
nicantly less than the difference between
zirconia and classic veneering ceramics.
Summarizing the scientific findings
available so far, the clinical application of
polished or glazed fully anatomic restor-
ations does not bear an increased risk of
antagonistic abrasion. However, as during
clinical application a grinding of monolithic
zirconia restorations has to be anticipated,
it is interesting to evaluate the effects of this
procedure on the antagonistic abrasion.
Earlier studies showed that the abrasion of
zirconia increases with increasing surface
roughness.
22
However, recent studies have
demonstrated that increased abrasion is
reduced after polishing with diamond-
impregnated silicone polishing instruments
and diamond polishing paste.
23
These
results show that every intraoral adjustment
of monolithic zirconia restorations inevitably
requires several polishing steps in order to
compensate the increased risk of antago-
nistic abrasion.
An increased accumulation of biolm is
another potential risk in the clinical applica-
tion of fully anatomic restorations. However,
Bremer et al
24
reported that zirconia sur-
faces that were not veneered do not show
increased biolm formation in comparison
with other ceramic materials.
Thus, considering the scientic aspects
of the materials, the in vitro studies avail-
able show general applicability of fully ana-
tomic zirconia restorations.
TECHNICAL ASPECTS
From a dental technicians point of view, the
combination of translucent zirconia and an
individual coloring technique with different
shading areas matching the tooth structure
makes sense. A selective application of col-
oring liquids allows seamless color
changes of varying intensities.
Considering esthetic challenges, indi-
vidual coloring of the presintered structures
in fully anatomic as well as in veneered res-
torations is reasonable. In fully anatomic
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restorations, this leads to a signicantly
more natural result than surface painting. C
Fischer developed the Multi-Coloring con-
cept, especially designed for the translu-
cent zirconia Cercon ht (DeguDent). Owing
to a guided color application, it offers an
even color intensity in all areas (Fig 10).
Selective application of coloring liquids
leads to several coloring areas, with smooth
transitions and varying intensities mimicking
the natural tooth. Color application starts in
the cervical region, followed by character-
ization of the dentin and the incisal edge.
Further individualization is possible by
ceramic veneering or, in fully anatomic res-
torations, by painting (Figs 11 and 12).
This shading technique is especially
useful when occlusal adjustments of fully
anatomic restorations are necessary. In
crowns that have only been individualized
by painting, the original color of the struc-
ture will immediately shine through after
occlusal adjustments or polishing. The Multi-
Coloring technique reduces this effect sig-
nificantly and prevents esthetic distur-
bances. From a dental technical point of
view, the combination of fully anatomic zir-
conia structures and individual coloring
offers the possibility to combine veneered
and fully anatomic restorations, even in
cases with high esthetic standards. There-
fore, anterior teeth, canines, and premolars
can be restored with individually veneered
structures made of translucent zirconia res-
torations. In cases with terminal abutments,
ie, in indications with the highest chipping
risk, non-veneered fully anatomic restor-
ations are used (Figs 13 and 14). In com-
parison with fully anatomic restorations
made of lithium disilicate, this fabrication
technique offers the advantage of produc-
ing posterior FDPs with a reduced connec-
tor area (9 mm
2
instead of 16 mm
2
for lithium
disilicate ceramics) and a reduced occlusal
material thickness (0.5 to 0.7 mm in com-
parison with lithium disilicate ceramics).
CLINICAL ASPECTS
Apart from material preconditions, special
clinical processing parameters have to be
considered. The recommendations for
preparation and the production steps for
occlusal adjustment and polishing are
Fig 10 The coloring liquids with dierent color
intensities are applied with a paintbrush prior to
sintering.
Fig 11 Milled translucent zirconia structure prior to
individual staining.
Fig 12 After sintering of the structure, the dierent
colorings in the cervical, dentin, and incisal regions
are clearly visible.
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important. The advantage of fully anatomic
zirconia restorations lies in their minimally
invasive preparation: the required sub-
stance reduction is similar to that of a clas-
sic full-cast crown. The minimum occlusal
thickness is 0.5 to 0.7 mm, while the mini-
mum substance reduction in the area of the
preparation limit should at least be 0.5 mm
(Figs 15 to 17). The preparation limit should
be designed as a chamfer or shoulder with
rounded inner edge (Fig 18). All other prep-
aration parameters (preparation angle,
design of occlusal preparation relief) are in
accordance with the known recommenda-
tions for the preparation of zirconia restor-
ations.
Fig 13 Clinical example of a possible combination
of a fully anatomic zirconia restoration at the termi-
nal abutment and veneered restorations for the pre-
molar and rst molar tooth.
Fig 14 After veneering and staining of the fully
anatomic restoration, only minor color discrepancy
is visible between the two types of restorations.
Fig 15 Diagram of the space required for a
veneered restoration.
Fig 16 Diagram of the required minimum material
thicknesses for a fully anatomic zirconia restoration.
Fig 17 Clinical example of the diering occlusal
reduction for a veneered restoration (premolar, rst
molar) and a fully anatomic restoration (second
molar).
Fig 18 In fully anatomic restorations, the prepar-
ation limit should be designed as a chamfer or a
shoulder with rounded inner angle. The required
cervical cutting depth is 0.5 mm.
chamfer
0.5 mm
max. 0.5 mm
min. 0.5 mm
min. 0.4 mm
Shoulder with
rounded inner angle
0.5 mm
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The preparation design is supposed to
reduce the rate of biologic complications
(endodontic treatments). Moreover, due to
an increased height of the preparation,
especially the reduced occlusal reduction
leads to a better retention of crowns and
FDPs in comparison with a veneered restor-
ation (Fig 19). Accordingly, conventional
cementation can be applied more fre-
quently. This aspect is especially advanta-
geous for restorations with an increased
risk of loss of retention (three- to four-unit
posterior FDPs in the mandible).
For the occlusal adjustment as well as for
intra- and extraoral polishing of fully ana-
tomic zirconia restorations, adequate instru-
ments are necessary. Considering practical
aspects, occlusal adjustment should rst be
performed intraorally, eg, the contacts in
static and dynamic occlusion are checked
and marked while the restoration is not
cemented. For intraoral occlusal adjust-
ments of zirconia restorations, the use of
special diamond instruments with a particu-
lar binding of the diamond grit (eg, ZR
grinder, Komet, Gebr. Brasseler; or K-Dia-
monds, Edenta) is recommended (Fig 20).
These instruments have an increased reduc-
tion performance and greater durability than
conventionally bound instruments, and they
are always used under water cooling.
Adjustment of static and dynamic occlu-
sion is followed by a multi-step polishing
procedure, which should be performed
extraorally. First, diamond-impregnated sili-
cone polishing instruments are used
(Fig 21); various manufacturers offer two- or
three-step polishing systems. This step is
followed by a nal polishing stage with a
diamond polishing paste. Applicable pol-
ishing pastes contain up to 20% diamond
particles in a grain size of 2 to 4 m, thus
Fig 19 Instruments suitable for the preparation of
fully anatomic zirconia crowns: 881 ISO010/8847KR
ISO 014/881 ISO 010 (all instruments by Komet, Gebr.
Brasseler).
Fig 21 Diamond instruments (ZR-Diamant, Komet,
Gebr. Brasseler) developed especially for the surface
treatment of densely sintered zirconia. Their special
binding increases the removal rate and protracts the
durability.
Fig 20 Example of a three-stage diamond-inter-
spersed silicone polisher for intraoral application
(StarGloss).
Fig 22 After pre-polishing with diamond-inter-
spersed silicone polishers, the restoration should be
treated with a diamond polishing paste (eg, Direct-
Dia Paste, Shofu Dental).
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leading to an optimum high gloss nish of
the zirconia.
If occlusal adjustment is necessary after
cementation of a fully anatomic zirconia res-
toration, the authors recommend the follow-
ing instruments for intraoral use:
Occlusal adjustment: ZR diamonds
(Komet), and K-Diamonds (Edenta)
Pre-polishing (silicone polishing instru-
ments): StarGloss (Edenta), OptraFine
(Ivoclar-Vivadent), EVE DiaCera (Ernst
Vetter), 94000 C/M/F (Komet)
High gloss polishing: OptraFine HP Pol-
ishing Paste (Ivoclar-Vivadent), Direct-
Dia Paste (Shofu Dental).
Occlusal adjustment with diamond instru-
ments as well the pre-polishing with silicone
polishing instruments must be performed
under water cooling. The silicone polishing
instruments should be applied with a maxi-
mum rotation speed of 15,000 rpm. The
nal high gloss polishing is done with a dia-
mond polishing paste without water spray-
ing. The polishing paste is rst applied to
the brush and then distributed on the sur-
face to be polished with the non-rotating
instrument. Polishing is performed at 5,000
to 10,000 rpm (Fig 22).
CONCLUSION
Translucent zirconia modications in combi-
nation with an individual coloring of presin-
tered structures offer an esthetic
optimization of veneered and fully anatomic
zirconia restorations. Due to their reduced
minimum material thickness and their low
antagonistic abrasion after polishing, fully
anatomic zirconia restorations are a reason-
able addition to the range of indications.
However, prior to a general recommenda-
tion, the expanded clinical application has
to be supported by clinical data.
REFERENCES
1. Al-Amleh B, Lyons K, Swain M. Clinical trials in zirco-
nia: a systematic review. J Oral Rehabil 2010;37:
641652.
2. Bachhav VC, Aras MA. Zirconia-based xed partial
dentures: a clinical review. Quintessence Int 2011;42:
173182.
3. Kern M, Sasse M, Wolfart S. Ten-year outcome of
three-unit xed dental prostheses made from
monolithic lithium disilicate ceramic. J Am Dent
Assoc 2012;143:234240.
4. Makarouna M, Ullmann K, Lazarek K, Boening KW.
Six-year clinical performance of lithium disilicate
xed partial dentures. Int J Prosthodont 2011;3:
204206.
5. Fasbinder DJ, Dennison JB, Heys D, Neiva G. A clin-
ical evaluation of chairside lithium disilicate CAD/
CAM crowns: a two-year report. J Am Dent Assoc
2010;141(Suppl 2):10S14S.
6. Reich S, Fischer S, Sobotta B, Klapper HU, Gozdows-
ki S. A preliminary study on the short-term ecacy
of chairside computer-aided design/computer-
assisted manufacturing-generated posterior lithi-
um disilicate crowns. Int J Prosthodont 2010;23:
214216.
7. Schmitter M, Mueller D, Rues S. Chipping behaviour
of all-ceramic crowns with zirconia framework and
CAD/CAM manufactured veneer. J Dent 2012;40:
154162.
8. Baldissara P, Llukacej A, Ciocca L, Valandro FL,
Scotti R. Translucency of zirconia copings made
with dierent CAD/CAM systems. J Prosthet Dent
2010;104:612.
9. Rues S, Krger E, Mller D, Schmitter M. Eect of
ring protocols on cohesive failure of all-ceramic
crowns. J Dent 2010;38:987994.
10. Rinke S, Schfer S, Roediger M. Complication rate of
molar crowns: a practice-based clinical evaluation.
Int J Comput Dent 2011;14:203218.
11. Marchack BW, Futatsuki Y, Marchack CB, White SN.
Customization of milled zirconia copings for all-
ceramic crowns: a clinical report. J Prosthet Dent
2008;99:169173.
12. Marchack BW, Sato S, Marchack CB, White SN. Com-
plete and partial contour zirconia designs for
crowns and xed dental prostheses: a clinical
report. J Prosthet Dent 2011;106:145152.
13. Rojas-Vizcaya F. Full zirconia xed detachable
implant-retained restorations manufactured from
monolithic zirconia: clinical report after two years in
service. J Prosthodont 2011;20:570576.
14. Beuer F, Stimmelmayr M, Gueth JF, Edelho D, Nau-
mann M. In vitro performance of full-contour zirco-
nia single crowns. Dent Mater 2012;28:449456.
15. Jung YS, Lee JW, Choi YJ, Ahn JS, Shin SW, Huh JB. A
study on the in-vitro wear of the natural tooth struc-
ture by opposing zirconia or dental porcelain. J Adv
Prosthodont 2010;2:111115.
16. Preis V, Behr M, Kolbeck C, Hahnel S, Handel G,
Rosentritt M. Wear performance of substructure
ceramics and veneering porcelains. Dent Mater
2011;27:796804.
17. Rosentritt M, Preis V, Behr M, Hahnel S, Handel G,
Kolbeck C. Two-body wear of dental porcelain and
substructure oxide ceramics. Clin Oral Investig
2012;16:935943.
QUI NTESSENCE I NTERNATI ONAL
Ri nke/ Fi scher
18. Gehrt M, Wolfart S, Rafai N, Reich S, Edelho D. Clin-
ical results of lithium-disilicate crowns after up to 9
years of service. Clin Oral Investig 2013;17:275284.
19. Kontos L, Schille C, Geis-Gerstorfer J. Inuence of
surface treatment on wear of solid zirconia. J Dent
Res 2011;90(Spec Iss B):Abstr 303.
20. Ghazal M, Kern M. The inuence of antagonistic
surface roughness on the wear of human enamel
and nanolled composite resin articial teeth. J
Prosthet Dent 2009;101:342349.
21. Schmitt J, Wichmann M, Karl M, Gllner M, Lohbau-
er U, Holst S. Surface characteristics of zirconia-
based posterior restorations: clinical and scanning
electron microscopic analysis. J Can Dent Assoc
2011;77:b31.
22. Geis-Gerstorfer J, Schille C. Inuence of surface
treatment on wear of solid zirconia (Lava). J Dent
Res 2011;90(Spec Iss A):Abstr 3056.
23. Sabrah AH, Cook NB, Luangruangrong P, Hara A,
Bottino MC. Full-contour Y-TZP surface roughness
eect on wear of hydroxyapatite. J Dent Res
2012;91(Spec Iss A):Abstr 156571.
24. Bremer F, Grade S, Kohorst P, Stiesch M. In vivo
biolm formation on dierent dental ceramics.
Quintessence Int 2011;42:565574.