Crown & Bridge

IPS e.max®

The doctors’ choice for esthetic restorations for two decades, IPS e.max® delivers translucency and shading so lifelike it’s perfect even for anterior restorations. Fabricated from fully biocompatible lithium disilicate, we press our IPS e.max restorations for ideal esthetics and 400 MPa strength that are superior to CAD/CAM produced e.max crowns. We use Ivoclar e.max porcelain on all our layered e.max restorations.

 

Indications

IPS e.max CAD is indicated for full anterior or posterior crowns. IPS e.max press is indicated for full anterior or posterior crowns and three-unit bridges having only one pontic with the second bicuspid as the most distal abutment. Veneers can also be indicated and are recommended when combining with adjacent IPS e.max crowns or bridges, provided ample reduction is achieved. Otherwise, original IPS Empress or IPS e.max CAD would be indicated for veneers, inlays and onlays.

 

 

Contraindications

IPS e.max should not be used on patients with malfunctional occlusion such as bruxers or clenchers. IPS e.max should not be used as abutments for cast partials. IPS e.max should not be used in situations when preparation requirements cannot be achieved. IPS e.max is not indicated for Maryland-type bridges.

Preparation
Anterior full-coverage crowns require a chamfer or shoulder margin. A circular shoulder is prepared with rounded inner edges or a chamfer at an angle of 10-30°: the width of the shoulder/chamfer is approx. 1 mm. Facial reduction is 1.5 – 2 mm; 1 – 1.5 mm lingual contact clearance. Incisal reduction is 1.5 – 2 mm with rounded internal line angles, and an incisal edge at least 1mm wide to permit optimum milling of the incisal edge during CAD/CAM processing.

Posterior full-coverage crown requires a chamfer or shoulder margin. A circular shoulder is prepared with rounded inner edges or a chamfer at an angle of 10-30°: the width of the shoulder/chamfer is approx. 1 mm. Occlusal reduction is 1.5 – 2 mm: axial reduction (buccal, lingual and interproximal) is 1.5 mm with rounded internal line angles.

 

Cementation
For greatest strength, and where preparation allows for dry field (supra-gingiva margins), it is recommended to use adhesive bonding, such as VarioLink II (Ivoclar Vivadent) or similar dual cure materials (Insure, Cosmedent; Nexus, Kerr; Choice, Bisco, Inc.; Lute-It, Pentron).

 

For areas subgingival, or when a dry field cannot be achieved, Ivoclar Vivadent recommends a hybrid glass ionomer cement system with less than 0.5 percent expansion. (NOTE: Resin-reinforced glass ionomers (Advance, Vitremer) are not indicated for any all-ceramic restoration.)

 

Some recommended resin cements:

  • Vivaglass (Ivoclar Vivadent)
  • GC Fuji (GC America)
  • Ketec Cem (3M ESPE)
  • Panavia F (J. Morita)
  • C&B Metabond
  • Variolink (Ivoclar Vivadent)

 

Insurance

  • D2740 Crown
  • D2610 Inlay for 1 surface
  • D2620 Inlay for 2 surfaces
  • D2630 Inlay for 3 surfaces
  • D2962 Labial Veneer
  • D2783 Crown 3/4 Porcelain Ceramic (does not include veneers)

 

Porcelain Fused to Metal

Many doctors still favor traditional restorative techniques, and we leverage our decades of experience on every PFM case. Hand-layered feldspathic porcelain offers the reliability of traditional esthetics and the strength of an all-metal coping. We offer a range of alloys, from nonprecious to high noble, to best suit your patients’ needs. We use Ceramco 3 porcelain as well as Ivoclar Design porcelain for the PFM restorations.

 

Indications

PFM restorations are suitable for posterior and anterior restorations when natural teeth have been compromised or have previously been restored, and are ideal for restorations with limited clearance.

 

Contraindications

Any crown in which less than 2 mm of occlusal clearance is available or for patients with a demonstrated metal sensitifity.

 

Preparation
The ideal preparation for PFMs is a chamfer margin preparation. If a porcelain labial margin is prescribed, then a shoulder margin preparation is required.
Feather-edge margin preparations are indicated for full-cast restorations.

Cementation

  • Panavia 21 – tin plated
  • Glass ionomer cement (GC Fuji, GC America)
  • Zinc Phosphate Polycarboxylate
  • Resin Ionomer cement (RelyX, 3M ESPE)


Insurance

  • D2750 Crown Porcelain fused to high noble
  • D2751 Crown Porcelain fused to non-precious
  • D2752 Crown Porcelain fused to semi-precious
  • D6750 Crown Porcelain fused to high noble (bridge units)
  • D6751 Crown Porcelain fused to non-precious (bridge units)
  • D6752 Crown Porcelain fused to semi-precious (bridge units).

 

Full Cast Crown

When esthetic concerns aren’t a factor, full gold crowns are still a favored restorative option by many doctors. More durable than any ceramic and highly resistant to plaque and bacteria, full cast crowns offer the least wear on opposing enamel of any restorative option. Full gold crowns are an ideal option for bruxers or cases with limited clearance.

Indications
Full-cast crowns are suitable for posterior restorations and long-span bridges. It’s an ideal option for restorations with minimal occlusal clearance or sort occluso-gingival height

Contraindications
Crowns when caries extend gingivally, anterior restorations or in patients with uncontrolled caries

Preparation
Inlays and onlays can also be fabricated as a full-cast restoration.

 

Feather-edge margin preparations are indicated for full-cast restorations, but any margin preparation may be used

Cementation

  • Panavia 21 (Must be tinplated if precious metal is used)
  • Glass ionomer cement (GC Fuji, GC America)
  • Zinc Phosphate Polycarboxylate Resin Ionomer cement (RelyX, 3M ESPE)


Insurance

  • D2790 Crown Full-Cast Hi-Noble Metal
  • D2791 Crown Full-Cast Predominantly Base Metal
  • D2792 Crown Full-Cast Noble Metal

 

BruxZir® 

The industry leader in full-contour zirconia, BruxZir® offers flexural strengths up to 1,460 MPa, more than 15 times that of feldspathic porcelain. Available in all 16 Vita® Classical shades, its monolithic composition eliminates gray areas at the margin and oxidation associated with alloys. More gentle on opposing dentition than porcelain, it’s the leading choice for bruxing patients.

Indications
Indicated for posterior crowns, bridges, inlays and onlays. An esthetic solution for bruxers and grinders when PFM metal occlusal/lingual or full-cast restorations are not desired or when patient lacks the preparation space for a PFM or has broken a PFM in the past. Zirconia can also be used for anterior teeth with a facial veneer of porcelain for improved esthetics

Contraindications
Indicated for posterior crowns, bridges, inlays and onlays. An esthetic solution for bruxers and grinders when PFM metal occlusal/lingual or full-cast restorations are not desired or when patient lacks the preparation space for a PFM or has broken a PFM in the past. Zirconia can also be used for anterior teeth with a facial veneer of porcelain for improved esthetics

 


Preparation
Shoulder preparation not needed, feather edge is okay. It is a conservative preparation similar to full-cast gold, so any preparation with at least 0.5 mm of occlusal space is accepted.

 

Minimum occlusal reduction of 0.5 mm; 1 mm is ideal.

 

Adjustments and polishing:

Adjust BruxZir® zirconia crowns and bridges using water and air spray to keep the restoration cool and to avoid micro-fractures with a fine grit diamond. If using air only, use the lightest touch possible when making adjustments. A football shaped bur is the most effective for occlusal and lingual surfaces (on anterior teeth); a tapered bur is the ideal choice for buccal and lingual surfaces.

 

Polish BruxZir® restorations with the porcelain polishing system of your choice.

Cementation

  • Resin Ionomer cement (RelyX or RelyX Unicem, 3M ESPE)
  • Maxcem Elite (Kerr)
  • Panavia F 2.0 (Kuraray) -ideal for short, tapered preparations
  • Glass ionomer cement (GC Fuji, GC America)


Insurance

  • D2740 Crown – Porcelain/Ceramic Substrate
  • D6245 Pontic Porcelain/Ceramic
  • D6740 Abutment Crown Porcelain/Ceramic