Michele Bolognesi, DT
Laboratorio Bonfiglioli-CCD, Bologna, Italy
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a b
Fig 4 Details of the retainer preparation on the a) premolar, and b) molar on the master model.
Fig 5 Wax-up of the inlay-retained FDP. Fig 6 Master model powdered for scanning be-
fore computer aided design (CAD).
Fig 7 Sintered zirconia framework for deep re- Fig 8 Ceramic liner application.
tainers.
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Fig 9 Framework stabilization with wax and VPS Fig 10 Framework junction to VPS positioning
positioning template. template.
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Fig 11 Wax-up of the retainer obtained by frame- Fig 12 Inlay-retained FDP with full contour wax-
work repositioning on the model by means of the up ready for the ceramic press-on.
template.
- A soft wax was placed between pontic (Fig 12). The press-on technique
the pontic and the edentulous follows a lost-wax technique. After this
area of the master model, and the stage, the ceramic (ZirPress, Ivoclar
framework was moved until the oc- Vivadent) was heated at 900°C for 15
clusal clearance from the template minutes after an increase of 60°C/min.
is uniform. Then, the same wax is It was then injected by the same device
placed under the retentions. A new (Programat EP 5000, Ivoclar Vivadent).
occlusal template that contacts the When ceramic cooling was complete,
framework was prepared (Fig 9); the ceramic channels were removed
- The wax under the pontic and the with a tungsten carbide bur and the FDP
retention was removed, and the adapted to the master model (Fig 13). For
liner was layered and fired in this the correct color matching, shade and
portion; stain can be used (1 or 2 firings). Other-
- The FDP was locked to the new wise, the FDP can be ceramic stratified
template with an adhesive wax (IPS e.max Ceram, Ivoclar Vivadent).
(Fig 10) while the technician holds
it in the hand, putting fluid wax Try-in
under the inlays and the pontic,
and obtaining the right modeling The fit of the structure in the oral cav-
repositioning on the master model, ity was controlled using a low-viscosity
starting from the inlays (Fig 11); silicone material (Fit Checker Black 1-1
- Occlusal waxing was performed PKG, GC, Tokyo, Japan), which showed
using the first template, generated no friction and demonstrated marginal
from the wax up analysis. integrity of the retainers.
The occlusion was controlled with
In both cases, the wax cylinders that will 35 μm occlusal paper, both in maxi-
drive the pressed ceramic to the frame- mum intercuspidation position and dur-
work are placed on every cusp of the ing the eccentric movements, correct-
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ing the FDP with fine diamond burs and surface for 5 minutes at 60°C. A single
reshaping opposing fillings, if existing. layer of bonding agent from the 3-step
The interproximal contact areas with the adhesive system chosen was applied
adjacent teeth were also checked if they on the surfaces, and luted with a micro-
were involved in the restoration. brush. The FDP was then placed under
The FDP was then glazed (e.max® a dark cover, preventing polymerization
Ceram Glaze Fast, Ivoclar Vivadent) of the adhesive.
and then ready for the luting procedures
(Figs 14a, b). Cavity conditioning
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a b
Fig 14 a) Cementation surface and b) occlusal surface of the final restoration ready for luting procedure.
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Procter & Gamble, Cincinnati, USA). Fol- only minimum tooth structure removal
lowing removal of excess composite, it beyond the filling extension.
was polymerized from mesio-buccal, Complete coverage FDPs may present
mesio-lingual, disto-buccal, disto-lin- long-term survival rate due to macro-
gual, and occlusal directions. Addition- mechanical retention but biological
al polymerization was performed for 20 complications such as caries around the
seconds at each side with glycerine gel restorations, loss of vitality or periodon-
that was placed to prevent oxygen from tal problems are commonly reported.2
inhibiting the polymerization. Excess lut- When abutment teeth contain restora-
ing material was removed with a scaler. tive fillings adjacent to the missing tooth,
The tooth-restoration interface was inlay-retained FDPs are very minimally
then finished using composite polish- invasive options because they require
ing points (Astropol, Ivoclar Vivadent, only minimum tooth structure removal
Schaan, Liechtenstein) at average RPMs beyond the filling extension. Wolfart et al
and then with an occlubrush (Occlu- reported 89% survival rate after 4 years
brush, Kerr, Orange, CA, USA) at 6,000 for lithium disilicate, with failures due to
RPM. Proximal areas that are difficult to debonding or a combination of debond-
reach can be finished with narrow finish- ing and fracture.11
ing strips (Soft-Lex 1954N, 3M ESPE, St. The technique described here could
Paul, MN, USA) (Fig 15). reduce these phenomena due to the ri-
gidity of the zirconia and the possibility
of adhesive cementation given by the
Discussion pressed ceramic.30 Ceramics materi-
als, moreover, have some basic advan-
Inlay-retained FDPs could be consid- tages in polishing and color matching,
ered when implants are not indicated or as well as the possibility of intraoral re-
cannot be afforded by the patients. Fur- pair.31 On the other hand, zirconia has
thermore, peri-implantitis issue or mar- the potential to age due to hydrotermal
ginal bone loss around implants have degradation that could possibly occur
not been thoroughly solved in implant when it is exposed to oral fluids, which
dentistry.29 Such restorations could be is a phenomena that has not been clari-
considered as conservative options, fied yet in dentistry.32 With the use of
compared to complete coverage FDPs. a full-contour veneering or at least the
Complete coverage FDPs may present use of a ceramic marginal closure at the
long-term survival rate due to macro- margins of the retainers, this problem
mechanical retention, but biological could be avoided.
complications such as caries around the
restorations, loss of vitality or periodon-
tal problems are commonly reported.2 Conclusions
When abutment teeth contain restora-
tive fillings adjacent to the missing tooth, Within the limits of a preliminary clinical
inlay-retained FDPs are very minimally application, the technique described
invasive options because they require here allows for single-tooth substitution
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