So, what should you do about it? Following is our guide for handling patient’s dental opinions downloaded directly from the internet.

Where patients get dental information

Patients get dental information in a few ways. Googling sometimes pushes them to health sites like WebMD or one of its cousins, Cleveland or Mayo Clinic. Some might hear it through word-of-mouth, which could be secondhand relays of content from the above. Others find information on social media through scrolling or targeted paid ads.

Harmful dental information that has gained popularity on the Internet

The harmful information patients encounter might surprise you. Influencers on various platforms have videos on everything from whitening your teeth using an abrasive melamine foam sponge meant for cleaning sinks to filing chipped incisal edges with a nail file. 

Delta Dental identified a few additional trends from a popular social media site a few years ago, which include:

• DIY Ortho: A woman uses elastic hair ties wrapped around her teeth to close a diastema. 
• Art-Supply Prosthetics: Another woman demonstrates how to make a prosthetic tooth from polyester thermoplastic beads used for art projects. 
• Tooth Filing Prep for Prosthetics:  Several posts show people filing their teeth into pegs for crown placement or veneers. 
• Super Gluing Vampire Fangs to Teeth: Some users use cyanoacrylate adhesive (super glue or nail adhesive) to fasten vampire fangs to their natural teeth. 
• Whitening with Hydrogen Peroxide: These videos show people directly applying three percent hydrogen peroxide to their teeth.
• Flossing with human hair: Yes, you read that right.

Unfortunately, that isn’t all. Newsweek recently covered a few other troubling social media trends. One platform showed people doing DIY fillings using at-home kits or non-dental supplies without sterilization or application experience. It also had videos of people oil pulling or swishing oil to reduce bacteria and improve saliva production, misleading viewers into thinking it substitutes for routine home hygiene. Savannah Magazine describes one showing a mom self-applying veneers and using an electric sanding tool to straighten the edges.

Sometimes, the problem with patient dental opinions isn’t misinformation; it’s having no information. For example, many patients don’t ask their dentist for sports mouthguards because they don’t know that the dentist offers them. Instead, patients use the boil-and-bite generics that neither fit nor protect, as well as a mouthguard from a dental professional. 

This situation also occurs with clear aligners. Patients might choose an online or remote option for correcting their smile because they didn’t know clear aligners were available at their dental home. 

How to handle false dental information

When patients ask about something they saw online, we have a few suggestions for handling it. 

First, view it as a positive thing. Searching for solutions online signals patients are interested in learning more about treatments to improve their smiles or oral health. 

Second, establish rapport to replace their online searching with conversations with you. Start by listening to what they were searching or watching. Rather than criticizing the content, lead with empathy. Harvard Medical School says research shows empathy enhances patient satisfaction, boosts treatment adherence, and leads to better clinical outcomes. Patients who feel understood are more likely to follow their treatment plans and practice self-care. Additionally, empathetic relationships can reduce disputes and improve patient experience scores, ultimately leading to better reimbursement. Most importantly, empathy allows healthcare providers to connect with patients on a deeper, more human level.

Sharing science-backed evidence to counter misinformation can help, too. The team can assemble information sheets based on the reasoning behind your opinion. Also, photos can help show what happens if patients follow your advice—or when they don’t. 

What you don’t want to do is talk down to patients or use too much medical jargon. Per Cleveland Clinic, using simple, clear language in healthcare communication helps patients make better decisions and avoid misunderstandings. Additionally, be sure to take your time; rushed communication can frustrate patients, erode trust, and make them feel disrespected. What’s worse, confused patients may turn to unreliable information sources, potentially harming their health.

Building trust for the future with patients

Becoming a trusted resource is essential to combating misinformation in your patient base. When you have a relationship, patients will come to you with their questions and concerns. Making yourself more available for these types of questions is critical to building trust for the future. Having an open-door policy on patient questions and having time in your schedule for free consults goes a long way to building rapport with patients. It would also be great if patients have a way to forward you content they see online or can email you questions. 

Additionally, you have to know what is out there. So, monitor online content and coach staff on the new harmful trends your patients might encounter. Your team and you can then agree on a consistent message about it as a practice. A proactive, myth-busting approach on your social media will also help.

How you position the information you post is essential. Fondation Descartes published a literature review that gave excellent recommendations on how to frame that content:

• State the correct information to replace the false information
• Avoid repeating the false information at all
• Keep the correct information short and simple, and, in particular, shorter and simpler than the misinformation. 
•  Create content that reflects the patient’s ideals and values whenever possible 

Publish this reframed content and messaging on your patient portal so patients can access it whenever they need or want it. Per the journal JAMIA Open, patient portals are emerging as a valuable tool for patient education and engagement. 

Another proactive strategy to combat misinformation could be to email your patients about new harmful trends as they emerge with a catchy subject line like, “Don’t Fall for Slick Content: Why Oil Pulling is Dangerous to Your Oral Health.” Additionally, explain why skepticism is critical when encountering unusual oral health information online; the motivations of the content creator might not be the same as those of a healthcare professional.

Affordable Clear Aligners for your patients with Dandy

Your patients are online more than ever before and the demand for straighter smiles increases with every scroll. So, why not serve your patients with affordable Clear Aligner options supplied by Dandy? Dandy helps general dentists offer Clear Aligners that are more effective than direct-to-consumer brands on TikTok and Instagram and more affordable than other leading brands. Book a demo with Dandy to see how we can help your patients today. 

Sources

7 dangerous dental trends from TikTok (2021) Delta Dental. Available at: https://www1.deltadentalins.com/dentists/fyi-online/2021/dental-tiktok-trends.html (Accessed: 14 August 2024).

Dewan, P. Dentist warns of six ‘dangerous’ TikTok trends you should never try at home (2024), Newsweek. Available at: https://www.newsweek.com/dentist-warns-dangerous-tiktok-trends-teeth-1921268 (Accessed: 15 August 2024).

Sanders, A. A. (2024) When Teeth Become Trendy, Savannah Magazine. Available at: https://savannahmagazine.com/health/when-teeth-become-trendy/ (Accessed: 15 August 2024).

James, T. A. (2023) Building Empathy into the Structure of Health Care, Building Empathy into the Structure of Health Care | HMS Postgraduate Education. Available at: https://postgraduateeducation.hms.harvard.edu/trends-medicine/building-empathy-structure-health-care (Accessed: 16 August 2024).

Avoiding Medical Jargon to Improve Communication, Reduce Ambiguity (2024). Cleveland Clinic. Cleveland Clinic. Available at: https://consultqd.clevelandclinic.org/avoiding-medical-jargon-to-improve-communication-reduce-ambiguity (Accessed: 16 August 2024).

Lewandowski, S. et al. Correcting a misinformation (2020) Fondation Descartes. Available at: https://www.fondationdescartes.org/en/2020/07/how-to-effectively-correct-misinformation/ (Accessed: 19 August 2024).

Johnson AM, Brimhall AS, Johnson ET, et al. A systematic review of the effectiveness of patient education through patient portals. JAMIA Open. 2023;6(1):ooac085. Published 2023 Jan 18. doi:10.1093/jamiaopen/ooac085

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Digital dentistry = modern dentistry

Do you remember the first time you used a smartphone? For some of us, it was mind-blowing, and some of us grew up with the technology already implanted in society. That’s how doctors and patients look at digital dentistry today. For some older dentists and patients it is a new novelty; for younger people it is what all dentistry should be

Most everybody has a smartphone today, but many practices have already out-of-date technology or aren’t taking advantage of all digital dentistry can make more efficient—the equivalent of still using an iPhone 7 or having the current model but not using any app other than email. The ability to leverage digital dentistry solutions to improve your diagnosis, treatment planning, and procedures with computer-aided design and manufacturing (CAD/CAM) can shift what is possible in your dental practice.

However, many clinicians don’t realize all the ways a digital workflow in dentistry can transform their general dentistry practice and patient experience. They do not harness all these utilities, opting to continue using the traditional workflow with many treatments and leaving these improvements and enhancements—and the revenue they generate—on the operatory table.  

To avoid this fate, let’s take a closer look at what digital dentistry does and the digital dentistry solutions available.

What are all the digital dental treatments?  

Digital dentistry advances the delivery of dental care with the help of technology to elevate the patient experience. Precise imaging, efficient treatment planning, and personalized restorations have revolutionized the delivery of oral health and improved dental education and communication between patient and clinician. Digital dentistry enhances diagnostic accuracy, streamlines workflows, and improves treatment outcomes, increasing patient satisfaction.  

By contrast, traditional dentistry relies on manual techniques and analog tools. While proven and more familiar than digital dentistry to many dentists, traditional dentistry also takes longer and doesn’t offer the same accuracy and precision that digital dentistry does.

In other words, digital dentistry enhances virtually every treatment you do in your daily dental practice—and a few things you probably haven’t tried. Here are ways general dentists can leverage digital dentistry workflows to transform their dental practices.

Crowns and bridges 

Digital dentistry enhances crown and bridge delivery. Digital workflows provide the information necessary to receive restorations that fit consistently, meaning fewer adjustments and less chair time for patients. Digital workflows also allow your lab to deliver crowns faster than traditional workflows. Additionally, a wide range of materials are available for digital crown and bridge restorations, like eMax and Zirconia so that you can treat any case. 

Dentures: Full and partial

One of the greatest enhancements digital dentistry provides over a traditional workflow is for full and partial dentures. Digital technology streamlines the denture delivery process, reducing the usual number of appointments to as little as two in some cases. Additionally, digitally-produced full and partial digital dentures have a range of materials available, providing both a superior fit and excellent esthetics, even in complex or challenging cases. 

Implants 

Dental implants are much more accessible for the general dentist to add to their practice when leveraging the benefits of the digital workflow. Not only does the digital workflow enhance the planning of implant cases, but it also allows for continuous case collaboration and support, including surgical guides that streamline and simplify implant placement.

Surgical guides

For any dentist, especially those new to dental implants, surgical guides take the guesswork out of drilling. They promote a better understanding of the diagnosis, ensuring the most efficient use of the patient’s available bone. Surgical guides facilitate more predictable placement, improved case outcomes, and reduced unexpected issues and remakes. 

Ortho – Clear Aligners 

Digital dentistry also makes it easier for the general dentist to offer Clear Aligner therapy. The ability to deliver this treatment modality—that patients often ask about—significantly impacts the patient experience. Adding one new clear aligner case per week can result in as much as $200,000 of additional annual revenue for the general practice. 

Night guards and splints 

When adding new treatments to a general dentistry practice, a digital workflow makes adding night guards and splints easy and convenient. These appliances are valuable to dentists and patients, from treating the rising number of Bruxism and TMJ cases in your patient base to providing an insurance policy on the new crown or implant you just placed. 

Sleep Apnea appliances 

A new dental treatment category with high revenue potential is mandibular advancement devices, which treat sleep apnea cases. For patients with mild-to-moderate obstructive sleep apnea, sleep apnea appliances are a preferable alternative to CPAP devices. Digital dentistry allows general dentists to provide sleep apnea appliances for these patients.

Wellness Scans 

Digital dentistry enables general dental practices to offer wellness scans, a new diagnostic tool that establishes a comprehensive patient record. Leveraging the imaging capabilities of the intraoral scanner, general dentistry practices can create detailed 3D images of the patient’s teeth, gums, and bite. A wellness scan helps clinicians plan treatment, visualize outcomes, and establish a baseline to monitor patient oral health changes over time.  

Do all digital dental treatments with Dandy

Dandy is there for general dentists ready to dive deeper into all that digital dentistry offers. Not only do we provide a free scanner, but we are also a 100% digital lab, and can be your all-in-one lab as we manufacture all the above. Plus, all our practices get to experience the Dandy Difference, which includes the following:  

• Five-day turnaround on zirconia crowns 
• Free training on digital workflows 
• Real-time clinical support
• Free wellness scans 
• 2-Appointment Dentures 
• Straight-to-finish partials 

With all of these opportunities available to you, it is time to embrace the future of dentistry with digital dentistry solutions.  Taking advantage of digital dentistry’s benefits to your clinical outcomes and patient experience can make the difference you have been looking for in your day-to-day care. 

Book a consultation with us to learn more about how digital dentistry solutions can help your practice increase its services and improve the patient experience. 

The post What does it mean to go fully digital as a dentist? All digital dentistry treatments for general dentists  appeared first on Dandy.

How do we define AI in dentistry?

AI is a term that is often used broadly. However, it’s important to understand that AI encompasses various technologies. For instance, science-fiction writers and movies influence us to think of AI as machines with human-like intelligence and self-awareness (that go on to imprison humanity or, worse, destroy it). However, that scenario is (still) fictional. While such machines represent a “final stage” type of AI, this is not the AI used in dentistry. Instead, most AI in dentistry falls under Reactive Machines and Limited Memory. Forbes describes these two categories as:

• Reactive Machines: The oldest form of AI that imitates our ability to respond to stimuli. These machines do not use past experience to “learn,” but instead have automatic responses. 
• Limited Memory: These machines have the automatic reaction to stimuli but with the additional ability to learn from past experiences to influence future decisions. These systems need large amounts of historical data to increase their accuracy and usability.

How is AI used in dentistry?

Dentistry AI and technology systems can provide numerous benefits, such as improved diagnosis accuracy and increased administrative task efficiency. We hope that by presenting AI dentistry options, we give you an idea of what is possible, and then you can decide whether to pursue AI technology in your dental practice.

That said, some dentistry AI applications already being used in today’s dental practices include the following:

• Imaging and diagnosis
• Treatment planning
• Robotics and automation
• Augmented and virtual reality
• Data analysis and predictive analytics
• Administrative support

Let’s take a closer look at each area and how it can help clinicians deliver patient care. 

AI in radiograph and intraoral scan analysis

AI-powered imaging systems are transforming the way clinicians diagnose dental conditions. These advanced systems use machine learning algorithms to analyze radiographs, intraoral scans, and 3D images with incredible accuracy and speed. These AI systems can automatically detect issues like cavities, fractures, and tumors, allowing dentists to make more precise diagnoses and intervene earlier on developing conditions, ultimately improving patient outcomes.

It is important to mention that AI systems do not diagnose oral health conditions. Rather, the AI indicates that an area of anomaly on the imaging might need further scrutiny by the dentist. Some clinicians describe it as having an impartial second opinion in the operatory with you and an eagle-eyed assistant who ensures you don’t miss anything.

Also, AI can help dental professionals master their scanning techniques. Using AI, the scanning software for many systems can guide the dental professional’s scanning showing which areas were missed or need to be rescanned. AI systems for dental scanners can also aid clinicians with taking a proper digital impression, eliminating unnecessary frames to optimize the final scan, detecting margins automatically, and developing a restoration design that restores the anatomy of the natural tooth.

Treatment planning with AI

In addition to enhancing diagnostic capabilities, AI-powered imaging systems enable the creation of detailed 3D models of patients’ teeth and jaws. These models can be incredibly useful for planning complex restorative procedures before treatment begins. Furthermore, the automated measurement and recording of tooth dimensions streamline record-keeping and facilitate easy sharing of digital records with other healthcare professionals.

Robotics and automation

The future of robotics and automation in Dentistry AI is to program repetitive dental tasks, like tooth preparation, implant placements, and orthodontic adjustments. However, some companies have already been exploring using robotics in the operator. 

For example, Neocis has the FDA-cleared robotic surgery platform Yomi, which helps clinicians with dental implant planning and placement. Yomi allows dentists to plan everything prior to placement using a digital image and a CT scan. Then, clinicians can “drag and drop” the implant where they want it. During placement, the robot keeps the dentist on track, correcting their placement with haptics and visuals on the screen that ensure they stick with the correct angle, depth, and position from the plan. In many ways, Yomi helps dentists with implant placement like lane-assist features do when you are driving a car.

Is AI going to replace dentists?

No. Forget the mechanics of dental procedures, AI can not provide the empathy or clinical judgment needed for the treatment of human care (and if it ever becomes capable we have bigger issues). AI will not take jobs away from dentists, but dentists who utilize AI will take patients away from those who don’t eventually harness its efficiencies.

Augmented and virtual reality

Augmented Reality (AR) enhances patient experiences. AR overlays computer-generated images onto the user’s real-world perspective, creating a combined view. In dentistry, AR technology allows patients to see how they would look in different prosthetics, which AI algorithms help customize, ensuring that the final prosthesis aligns with the patient’s specifications. 

Virtual Reality (VR) creates a computer-generated 3D simulation interacting with the real world. When combined with AI systems, VR becomes a potent tool for addressing dental concerns and managing pain that may not respond to traditional medications.

AR and VR have also revolutionized how students learn and practice in dental education. These technologies create realistic scenarios simulating clinical work on patients without the associated risks of live-patient interaction. Intelligent teaching systems, such as the Unified Medical Language System (UMLS) powered by AI, contribute to developing preclinical virtual patients. Through interactive interfaces, students can assess their work, compare it to the ideal standards, and engage in high-quality training settings. Recent studies indicate that students using AR and VR achieve competency-based skill levels faster than those relying on traditional simulator modules.

Data analysis and predictive treatment

AI algorithms process patient data, from medical records to oral health histories to treatment outcomes. AI can then identify patterns, which it uses to predict future oral health outcomes. Based on this information, dentists create personalized treatment plans and preventive care strategies for patients.   

The future of predictive treatment has numerous dental applications. For example, AI algorithms could use patient data regarding diet, oral hygiene habits, and personal medical histories to predict the risk of tooth decay. Using smoking, medical, and genetic history, AI could also indicate the risk of gum disease or oral cancer. These algorithms could also look at patient bone density and medical and lifestyle data to foresee the risk of implant failures. Additionally, a 2022 study indicates that it can accurately predict the need for tooth extractions for orthodontic cases nearly 94% of the time.

AI for administrative support

AI virtual assistants can streamline administrative tasks in dental practices. From appointment scheduling to using Google Gemini or ChatGPT to draft patient communication to billing processes, AI reduces the workload on the front office team and increases practice efficiency.

For example, virtual assistants can offer patients convenient appointment times that optimize the schedule for the office as well. It can also inform dentists when a patient’s genetic history of lifestyle factors makes them at higher risk for an oral health condition, as well as any allergy information in the patient record or associated medical background to help with diagnosis and treatment planning. Virtual assistants can also process paperwork and insurance.

Should you harness the advantages of AI in dentistry?

If you told a dentist in the ’90s that in their lifetime they would witness every other dental practice use an intraoral digital scanner to make impressions, they would have laughed and asked if it would be delivered via hoverboard. Right now AI is helping dental professionals do their job by serving as an extra pair of eyes or brain in the operatory and front desk.

As AI’s capabilities grow in our industry—and become time-tested—we see an era in which every practice will utilize some function of AI. The question is: When will your practice be ready? Are you an early adopter or a wait-and-see-er?

Continue to check back with this article as we update it for current AI technology.

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The popularity of zirconia crowns led to development of different types of the materials, including layered and monolithic zirconia, each of which have different clinical benefits. Also, zirconia provides a metal-free crown material alternative to porcelain fused to metal (PFM) materials.

The zirconia crown cementation technique differs from a PFM and other crown materials. Understanding these differences and mastering the zirconia cementation steps for zirconia crowns can help you deliver these restorations with maximum efficiency and improved patient outcomes.

Explore Dandy Zirconia Crowns

Dandy offers a variety of different dental zirconia crowns with various strengths, durability, and aesthetics.

Explore Dandy Zirconia

Steps for zirconia crown cementation

There are a few steps for zirconia crown cementation. Many of these are similar to how you cement other types of crown materials. However, there are nuances that are particular for cementing zirconia crowns. 

For example, zirconia adhesion benefits from surface abrasion. Therefore, the best cementation for zirconia crowns includes air abrasion of the zirconia surface with alumina particles. Zirconia adhesion is also enhanced by employing primers and cements that contain methacryloyloxydecyl dihydrogen phosphate (MDP). 

Preparing the restoration

Zirconia restorations require preparation before you adhere them to the tooth. In particular, they need decontamination after the try in. Contamination will create a chemical reaction that interferes with adhesion. 

So, before you attempt to place the restoration, you should remove anything that got on the restoration during the try in, like saliva. We recommend first sandblasting the intaglio surface of the restoration with aluminum oxide and then steam cleaning the restoration and allowing it to fully dry before attempting to affix it to the tooth. Other options for saliva decontamination can be airborne particle abrasion, zirconia cleaning solutions and hydrofluoric acid.

Pretreating the tooth

Once you have removed the temporary, it is essential to pretreat the tooth to remove all the residue from astringents, desensitizers, disinfectants, and temporary cement to provide the best possible conditions for adhesion. Mechanical cleaning with a pumice paste will work here.

Apply cement and seat the crown

Now you are ready to break out the cement. Studies show that the best cements for zirconia are those that contain MDP.

First, you want to get rid of the first bit of the cement to ensure there is a good mix for seating. Then dispense the cement into the prepared and decontaminated crown. Next, seat the crown using firm finger pressure.

Remove excess cement and clean up area

Once seated and after the tack cure, clean up any extra cement around the crown. Use your finger to continue to hold the crown in place when using the scaler. 

It is essential only to give the cement the tack cure time indicated in the manufacturer’s instructions. Otherwise, it can take a lot longer to remove the excess cement.

Cure

Light cure the cement per the manufacturer’s instructions. Be sure to pay attention to the details regarding surfaces and distances involved with the curing light position. Once the cement has achieved the timing and curing required, finish and polish the restoration as desired.

What to avoid in zirconia crown cementation

As you cement the zirconia crown, here are things to not do:

• Do not use common surface treatments for zirconia crowns. Treatments like silanization and acid etching don’t work on zirconia’s inert surface. 
• Avoid non-MDP cement formulations. Research also indicates that zinc-phosphate-and Bis-GMA-based cements and glass ionomer cements do not perform as well as those with MDP.
• Keep the phosphoric acid away from the zirconia during cementation. There should be no contact because the phosphate ion in the acid causes problems with zirconia’s potential adhesion.
• Avoid using prophy paste during cleaning to the prepared tooth. There are cleaning ingredients in the paste that contribute to crowns coming off. 
• Do not use too much force during sandblasting during pretreatment. Experts recommend 30 t0 50 micrometers and a blast pressure of approximately 20-30 psi from two to three centimeters back for high strength zirconia and the lower end of those ranges for translucent ones.
• Do not rely on self-adhesives to retain the restoration in cases with limited mechanical retention. It may not be sufficient. Same goes for restorations that necessitate resin bonding. Studies show that a combination of micromechanical and chemical pretreatment is better for long-term bond performance.
• Stay away from luting cements with translucent zirconia. The opaque nature can interfere with the shade matching. Resin cements might be better here to enhance fracture resistance and optimize the strength of the restoration.

Can zirconia crowns be bonded? 

Yes, you can bond a zirconia crown with a resin cement, but it is essential to use the correct protocol. Most bonding protocols are designed for bonding with glass, and zirconia is a ceramic. Therefore, bonding with zirconia requires different technique, one that creates a chemical and mechanical pretreatment. 

When attempting to chemical bond with a silane coupling agent, ceramic primer, self-adhesive or adhesive cement, pretreat the zirconia crown to increase mechanical retention. You can achieve pretreatment with air-particle abrasion and tribochemical silica coating. The same goes when using a ceramic primer, self-adhesive or adhesive cement containing an acidic adhesive monomer, but with the caveat that you should follow up with a silane coupling agent to achieve chemical bonding with the surface now coated in silica.  

Depending upon the zirconia you are using, a resin-modified glass ionomer (RMGI) cement works, too. For example, higher-strength zirconia formulations can bond using RMGI. However, zirconia that is optimized for aesthetics, like y5 zirconia, benefits from the strength of the resin cements.

Using zirconia-specific primers that can chemically bond to zirconia enhance the bond strength, too, particularly those that have 10-MDP in them. Primers that contain 10-MDP leverage phosphate-based bonding to chemically bond to zirconia.

However you decide to bond, please ensure that you follow the manufacturer’s instructions for the system you choose. These instructions ensure that you get the strong bond and the working time you need. 

Zirconia Crowns with Dandy

Whether you’re new to zirconia crown cementation and assessing the advantages and disadvantages of zirconia crowns in your practice or have lots of experience with it, making Dandy your zirconia dental lab partner can help your practice and patient experience. Our clinical support team can help with material selection for your crown and bridge cases, case planning, digital dentistry, zirconia cementation steps, and more.

Ready to learn more about Dandy as your dental lab? Get in touch with us today!

Sources

Kongkiatkamon S, Rokaya D, Kengtanyakich S, Peampring C. Current classification of zirconia in dentistry: an updated review. PeerJ. 2023;11:e15669. Published 2023 Jul 14. doi:10.7717/peerj.15669

Sulaiman TA, Altak A, Abdulmajeed A, Rodgers B, Lawson N. Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions. J Prosthodont. 2022;31(3):239-244. doi:10.1111/jopr.13389

Zirconia Crown Cementation. (2015)  Available at: https://multimedia.3m.com/mws/media/1133847O/relyx-simple-steps-cement-guide-for-labs-no-logo.pdf (Accessed: 12 October 2023).

Gargari M, Gloria F, Napoli E, Pujia AM. Zirconia: cementation of prosthetic restorations. Literature review. Oral Implantol (Rome). 2010;3(4):25-29.

Cementing zirconia restorations. (2022). Available at: https://www.dentaleconomics.com/science-tech/article/16388075/cementing-zirconia-restorations (Accessed: 13 October 2023).

The Dos and Don’ts of Bonding Zirconia. (No date). Available at: https://www.bisco.com/assets/1/7/Dos_and_Donts_of_Bonding_Zirconia.pdf (Accessed: 13 October 2023).

Guide to Zirconia Bonding Essentials. Available at: https://kuraraydental.com/wp-content/uploads/2018/05/zirconia_bond_guide-1.pdf (Accessed: 13 October 2023).

Best practices for bonding with zirconia (no date) Dental Products Report. Available at: https://www.dentalproductsreport.com/view/best-practices-bonding-zirconia (Accessed: 13 October 2023).

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So, with these other options available, the question becomes, should you move on from the Maryland bridge in dental treatment plans? In other words, are Maryland bridge problems more significant than their solutions?

Maybe, or maybe not. Let’s look at what a Maryland bridge is good for, what it isn’t, and what might be a better option for your patient outcomes.

What is a Maryland bridge?

Faculty from the University of Maryland introduced Maryland bridge dentistry in the 1980s. The Maryland bridge is an adhesive-retained, fixed partial denture with an artificial tooth between one or two wings bonded to abutments. They are made from porcelain-fused-to-metal (PFM) materials or ceramics.

What are Maryland bridges generally used for?

The reduced impact on adjacent teeth is a significant benefit of the Maryland bridge. A Maryland bridge doesn’t require crowns on the teeth adjacent to the missing tooth. The dentist adheres the wings to the back of the surrounding teeth to hold them in place. 

There are other critical benefits, too. For example, they are affordable, minimize the patient’s chair time, and do not require anesthesia, recovery time, or a temporary. 

A Maryland bridge has patient-specific benefits, too. The Maryland bridge is low maintenance and allows patients to talk, eat, and clean their teeth like always.

When should you prescribe a Maryland bridge?

Maryland bridges are best for temporarily replacing single anterior teeth, preferably in adolescent patients. Research shows that the overall survival rate was 77% after ten years. However, the survival rate increased to 87% after eight years if the appliance is rebonded or reconstructed after debonding.

There are multiple keys to success with the Maryland bridge. These include careful case selection, sound design and treatment planning, proper preparation, and excellent cementation technique. 

When should you use an alternative to a Maryland bridge?

Of course, there are also Maryland bridge problems, including a few situations where a Maryland bridge isn’t the best option. First, they can’t hold up to occlusal forces in the posterior. Also, they aren’t great when the patient’s edentulous span is more than two teeth, nor are they recommended when the patient has poor home care habits or poses a high caries risk.

In addition, the aesthetics aren’t always optimal especially if you are using one with metal wings that can be visible at certain angles. Plus, if you aren’t using one of the new all-ceramic options, adhering metal to the back can make supporting teeth appear darker. 

Alternatives to Maryland bridges

There are alternatives for the Maryland bridge. For example, dental implants, partial dentures, or fixed- or implant-supported bridges can all restore function and aesthetics for patients with missing teeth.

Dental implants

Dental implants that osseointegrate into the jaw and support a crown have many patient benefits. Implants provide a restoration that looks and feels natural and has a success rate of nearly 97% at 10 years and 94% at 15. Implants also allow patients to chew and talk like they always have. Additionally, the implant helps slow bone resorption in the alveolar ridge. Plus, they keep the surrounding dentition in place, preventing a change in the patient’s bite.

The biggest drawback of dental implants is that they are expensive, and few dental insurance policies cover much of the cost. There is also a significant recovery time involved, and the patient must have a clean bill of health before surgery, which might mean additional treatments like bone or gum grafting, which add to the costs.

Dental implants aren’t for every patient, either. If the jaw bone has experienced deterioration to a point where it can no longer support an implant, the patient would benefit from another restoration. Patients with thinning gums might not like how the implant shows at the gumline.

Partial dentures

Partial dentures replace one or multiple teeth using a plastic or metal base. The partial denture often uses clasps around surrounding teeth to hold them into place. There are also flexible partial dentures with a non-rigid base that is more comfortable for some patients.  

Partial dentures provide an aesthetic and affordable option for tooth replacement that enhances the patient’s ability to smile, eat, and talk. However, patients cannot wear them all the time, and they require much maintenance. Also, they are considered temporary replacements, with many needing replacements at around five years.

Partial dentures are an option for patients who have three or missing teeth next to each other. Sometimes, they replace teeth after extractions from trauma or disease until a more permanent option is delivered. They can also be an option for patients who need a more affordable option than dental implants.

Fixed- or implant-supported bridge

Fixed- or implant-supported bridges are a popular way to replace missing teeth. The traditional fixed-bridge uses crowns on the adjacent teeth to hold a replacement tooth in place. Sometimes, in the case of a cantilever bridge, it only has one crown supporting it. They are usually made of porcelain-fused-to-metal or ceramics. Sometimes, you can also use a dental implant to support the replacement tooth, called an implant-supported bridge. Proper oral care helps a bridge last five to seven years and, in some cases, more than ten years. 

Dental bridges have several benefits. They are a natural-looking solution that can restore the patient’s ability to chew and speak as usual. Plus, they keep the neighboring teeth from shifting into the open space. However, success with a bridge requires good oral health care, including preventing decay or damage to the abutment teeth. And sometimes, despite one’s best effort, the bridge can break, requiring a replacement, which can be expensive and inconvenient.

Dental bridges are best for patients with solid teeth with good support surrounding the edentulous space. Those with poor oral health or high-risk risk might not be the best candidates for this restorative procedure, as the supporting teeth and bone need to be able to take on the load of the missing tooth. As a more affordable option than implants and a type of restoration that enjoys a longer restorative life, a dental bridge might be an excellent choice for patients who would otherwise be in a Maryland bridge or partial denture.

Crown and bridge restorations that last with Dandy

Whether you’re a practitioner who is steadfast on providing Maryland bridges as a prosthesis or are ready to look into alternatives for your patients, Dandy is here as your crown and bridge lab. From zirconia crowns, inlays, onlays, and yes—even Maryland bridges—we can help you provide best-in-class care for your patients. Ready to get started?

Join us today!

Source:

What Are the Different Types of Partial Dentures? (2021) Available at: https://www.dentureliving.com/en-us/advice-tips/types-of-dentures/partials/types-of-partial-dentures  (Accessed: 22 September 2023). 

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Dental flippers have pros and cons. On the pro side, they’re affordable, natural looking, and easy for patients to remove, while keeping surrounding teeth from shifting into the open space. However, the cons are they don’t stimulate the bone, the clasps used to hold them in place are sometimes visible and can loosen with use. Plus, the lightweight material they are made from means they can break easily.  

Perhaps most importantly, patients dislike flipper teeth. When treating edentulism, you need dental flipper alternatives that won’t damage your patient experience. 

What is a dental flipper?

A dental flipper is a removable partial denture with an artificial tooth or teeth that fills an edentulous space in the arch. They use clasps or stay plates attached to surrounding dentition to keep them in place.  Unlike a flexible partial denture, flipper teeth are usually made of hard acrylic of metal. Dental flippers in the maxilla cover the roof of the patient’s mouth, but in the mandible sit on the jaw. 

Why are dental flippers used?

A dental flipper can be a permanent solution. Usually, for patients with a condition precluding them from other tooth replacement options.

For example, heavy smokers, patients with chronic conditions like diabetes, or cancer patients undergoing radiation treatment for areas in their head or neck often use a flipper tooth. Others wear a flipper when there is not enough bone to support an implant.  Sometimes, it’s the only tooth replacement option the patient can afford.  Children can get a flipper tooth when their anatomy is too underdeveloped for an implant or bridge.

However, dental flippers are also used temporarily. Some clinicians use flippers while a patient heals after an extraction, gum surgery, or dental implant surgery, like a bone or tissue graft. These healing times can be as long as six months, so a flipper tooth is an affordable and esthetic solution.

A dental implant is an alternative for replacing missing teeth, but not the only one. Here are other dental flipper alternatives.

Dental flipper alternative: Maryland bridge

The Maryland bridge, named after the University of Maryland faculty who introduced it, is an adhesive-retained, fixed bridge. This alternative has one or two wings, bonded to abutments, with an artificial tooth in between.  They are usually porcelain-fused-to-metal (PFM), although sometimes employ ceramic teeth.  

A Maryland bridge doesn’t require crowns on the teeth adjacent to the missing tooth. The dentist adheres the wings to the back of the surrounding teeth to hold them in place.

Pros of Maryland bridges

Maryland bridges have advantages. They are non-invasive, require minimal preparation, and do not require anesthesia. They are not painful, nor do they require downtime for recovery. Plus, they are easy to replace if there is a problem.  

Cons of Maryland bridges

There are drawbacks, too. They can’t hold up to bite force in the posterior. They also don’t work for patients missing more than two teeth or those with poor oral hygiene or high caries risk. Plus, they can break and don’t always match the natural teeth as well as everyone hoped.  

How Maryland bridges compare to dental flippers

A Maryland Bridge has some hard-to-beat features. For example, the Maryland Bridge requires less maintenance and allows patients to eat, talk, and clean their teeth like always. By contrast, a flipper tooth is more invasive than a Maryland Bridge and requires careful cleaning and maintenance.  

Dental flipper alternative: Essix retainer

Another alternative is an Essix retainer, a clear plastic removable appliance that fits over patient’s teeth. Created from the patient’s impression, they fit over patients’ teeth.

Many clinicians use Essix retainers after orthodontic treatment.  However, they also hide missing teeth by filling the spaces with prosthetics inside the plastic.  

Pros of the Essix retainer

Essix retainers have some excellent advantages. They are removable, which makes home care and retainer cleaning easier. Plus, people don’t notice Essix retainers when patients wear them. In addition, they are easy to fabricate and require no mouth preparation, which makes them a simple solution for a transitional replacement of missing teeth, particularly in the anterior where tooth loss can be traumatic to patients. In addition, the appliance can protect the healing site below from food particle irritations.  

Cons of the Essix retainer

Not everything is perfect, though. Essix retainers do not adjust, so what you have is what you get and if you need a new one, you need a new retainer. If it breaks, you can’t fix it either. Also, plastic can warp if it gets too hot. Additionally, patients sometimes have challenges adjusting their speech with them.  Plus, some patients have a higher risk for increased plaque levels and more gingival bleeding from wearing them.

How Essix retainers compare to dental flippers

An Essix retainers’ transparent nature means they’re invisible. A flipper tooth’s clasps or wires are not.  Also, an Essix retainer is less bulky, so it might be more comfortable than a flipper for the patient. Flipper teeth might feel uncomfortable in the patient’s mouth, especially at first. Like a flipper tooth, an Essix retainer is also affordable, so patients don’t have to compromise on their budget with them either.

Dental flipper alternative: Temporary crown

Temporary crowns, or temporaries cap what remains of a damaged natural tooth to restore function and esthetics while protecting what is left of it underneath. Once the permanent crown is complete, the dentist removes the temporary crown to place the final restoration.  Temporary crowns are usually made of acrylic, composite resin, or stainless steel.

A temporary crown serves many of the same functions as a permanent crown. A temporary can prevent bacterial infection. Temporaries also hold the space open for the permanent restoration. Sometimes, they keep a dental bridge in place or cover a dental implant. They can also mask an unattractive tooth or protect a tooth that has had a root canal from further damage.  

Pros of the temporary crown

Temporary crowns play an essential role in the optimal outcomes of dental crowns. They protect the pulp and prevent infection, preserving the gum tissue. They also enhance the health of the abutments and periodontium. They also preview the esthetics of the future prosthesis.  

Cons of the temporary crown

A temporary crown is not perfect. It won’t shade match as well because the materials used are different. The fit won’t be exact either, which means food and bacteria can get underneath and cause decay. Also, patients have to modify their diets since the cement can’t hold up to the rigors of hard, sugary, or sticky foods. In addition, patients have to brush and floss gentler than with a permanent crown.  

How temporary crowns compare to dental flippers

Temporary crowns are better than a flipper tooth in some areas. For example, temporaries fill the space quickly while waiting for the bone to heal around an implant and prevent shifting of the surrounding teeth. Plus, they improve esthetics over the metal clasps often visible with flippers.  

Alternatives to dental flippers to impact the patient experience

You want your patients to have the best possible experience. However, providing that experience requires knowing what matters most to them. Then, you can ensure they get that from your treatment planning and options. 

Many options might be better for the patient experience than a dental flipper tooth. From a Maryland bridge to an Essix retainer with a prosthetic tooth or a temporary crown, you have several options that can affordably treat edentulism—and keep patients returning to you for care year after year. 

If you’re serious about creating a better patient experience, not just in your clinical operations, but in your business operations, check out the Dandy Dental Study: Patient Experience to learn more about what patients expect from their dentist experiences.  

Sources

Flipper Tooth (Partial Denture) Benefits, Drawbacks, Costs, and Care (2019). Available at: https://www.healthline.com/health/what-you-need-to-know-about-maintaining-a-partial-denture-also-known-as-a-flipper-tooth (Accessed: 5 September 2023).

Is A Flipper Denture Right For You? | Colgate (2023). Available at: https://www.colgate.com/en-us/oral-health/dentures/is-a-flipper-denture-right-for-you (Accessed: 5 September 2023).

Flipper Tooth | Dental Flipper Partials For Front Teeth (2023). Available at: https://www.guardiandirect.com/dental-care/dental-flipper-tooth (Accessed: 5 September 2023).

Gutmann JL. The Origin of the Maryland Bridge. J Hist Dent. 2019;67(2):110.

Dental Bridge vs. Partial: Which One is Right for You | Polident. Available at: https://www.polident.com/en-us/partials/getting-partials/dental-bridge-vs-partial/ (Accessed: 5 September 2023).

Why You Might Need a Dental Bridge (2023). Available at: https://my.clevelandclinic.org/health/treatments/10921-dental-bridges (Accessed: 28 August 2023).

What is a Maryland Bridge? – Cost, Procedure, Pros, & Cons (2020). Available at: https://www.newmouth.com/dentistry/restorative/maryland-bridge/#:~:text=Maryland%20bridges%20are%20a%20cost,options%2C%20such%20as%20dental%20implants (Accessed: 5 September 2023).

 Dental Bridge vs. Partial: Which One is Right for You | Polident. Available at: https://www.polident.com/en-us/partials/getting-partials/dental-bridge-vs-partial/ (Accessed: 5 September 2023).Essix Retainer: Cost, Cleaning, Care and Pros and Cons – Dentaly.org (2023). Available at: https://www.dentaly.org/us/adult-braces/teeth-retainers/essix-retainer/ (Accessed: 28 August 2023).

Patel A, Prajapati P, Sethuraman R, Patel JR. Essix restoration: a novel approach for transitional teeth replacement. BMJ Case Rep. 2014;2014:bcr2013200422. Published 2014 Apr 23. doi:10.1136/bcr-2013-200422

Retainer Types: Bonded, Hawley, Essix, and Clear Retainers (2018). Available at: https://www.healthline.com/health/retainer-types#clear-plastic-retainer-pros-and-cons (Accessed: 5 September 2023).

Essix Retainer (Uses, Costs, & Alternatives) (2023). Available at: https://www.newmouth.com/orthodontics/treatment/essix-retainer/ (Accessed: 5 September 2023).

What to Know About a Temporary Dental Crown (2023). Available at: https://www.webmd.com/oral-health/what-to-know-about-temporary-dental-crown (Accessed: 28 August 2023).

Comparison between direct chairside and digitally fabricated temporary Crowns. (2023) Jstage.jst.go.jp. Available at: https://www.jstage.jst.go.jp/article/dmj/37/6/37_2017-315/_pdf/-char/en (Accessed: 5 September 2023).

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The starting point of a digital workflow is capturing the patient’s dentition with the intraoral scanner (IOS), a remarkable technology. The small camera takes intraoral photos in a half-inch by half-inch field, delivering a high level of precision while managing the humid and wet oral environment where soft tissues move and change shape constantly. 

Today’s scanners have improved technology from the first ones to hit the market. Features exist like Smart Filtering that recognizes the difference between hard dentition elements, teeth, and soft tissue in dental pictures, removing unnecessary tissue from the scan data based on movement. 

However, none of the available software features do you any good without proper dental photography techniques. Also, nuances exist regarding setup in the operatory and sensor handling during image capture. Plus, it is critical to isolate soft tissue properly to keep the area clear from contaminants that would interfere in data capture.

The ability to capture adequate intraoral photos requires some training and attention to detail. We look at IOS scanning techniques and share tips and tricks to leverage this advanced digital dental technology to improve the quality of your dental photography. 

Preparing to scan

Your IOS technique fundamentals start with how you prepare to take scans. For example, the operatory layout is essential. The room should accommodate the scanner cart and computer and allow for a setup angle enabling you to see both the patient and the live HD images on the scan box. If the scan box is behind you, you will have to turn around to see the scan, which interferes with ergonomics and efficiency.

Also, prepare to do a full arch scan for every case, especially for complex restorations, because the more information you give the lab, the better. Full arch scans allow the lab to provide greater bite accuracy by having information on how all the teeth come together. A four-to-six-tooth quadrant scan doesn’t let the lab know what’s happening on the other side. Plus, the whole arch data gives you a complete digital patient record.

There are a couple more essential considerations for preparing to scan, including lighting, and moisture control. Let’s take a closer look at each.

Lighting

Great scans, like any great photography, require excellent lighting. Therefore, turning off any external light sources, like loupe lights and overhead chair lights, is essential. The scanner has an internal light that will be best for capturing the dental pictures needed for the scan. Any excess light can interfere with this process, creating a glare on the intraoral photos that makes images unclear.

Moisture control

It is also crucial to control moisture before attempting to capture dental photography. Moisture also creates glare and distortions in the scan. Use the air-water syringe and suction before and during the scan to dry the teeth and gums. 

Holding the scanner and scanning techniques

Holding the scanner

How you grip the sensor matters, too. When scanning an upper and lower arch, you don’t want to change how you hold the sensor too much. So, after removing the scanner’s protective tip and replacing it with the mirror tip, we recommend holding the sensor like a pencil, letting it rest in the pocket of your thumb and index finger, with the power button accessible easily on the top. Then, you can switch the mirror tip to facing up or down from this position, depending upon which arch you are scanning.

The Twist Technique

To capture interproximal areas and contact points around your prep, try incorporating an alternative scanning approach called the Twist Technique.

Capturing interproximal areas:

• Place the scan on the occlusal surface of the prep. 
• Roll the scanner over to either the buccal or lingual sides.
• Position the scanner at a 45-degree angle. 
• Twist the scanner back and forth to fill in missing areas around the prep; it is crucial to twist and hold, pause, then twist and hold in the other direction, pause.
• Ensure the light hits the hard-to-reach areas; if the light touches it, the camera is, too.

Capturing contact points:

• Place the scanner on the occlusal surface. 
• Rotate the scanner out 90 degrees.
• Twist the scanner back and forth to fill in missing areas around the prep; again, it is crucial to twist and hold, pause, then twist and hold in the other direction, pause.
• Ensure the light hits the hard-to-reach areas.

Tips for intraoral scanning

Following are a few dental photography techniques to help you capture the intraoral photos you need for successful patient outcomes:

• Tip 1: Use anchors and landmarks. In soft tissue scans, where there is not natural landmark, applying biocompatible materials as reference points that can “fast set” on tissue walls allows the scanner to distinguish between soft tissue zones in dental pictures, particularly the cheek and gums. 
• Tip 2: Do the math. Integrating math and software facilitates practical rough approximations of what you scanned. Repeatedly measuring and scanning makes the software more tolerant of shiny pink surfaces. 
• Tip 3: Employ wax rims. When scanning a fully edentulous patient, remember the scan is a preliminary impression used to make the wax rims. Once fabricated, take a functional wash impression inside those wax frames. That final impression will provide the necessary information to create a master cast and, ultimately, the finished dentures. 
• Tip 3: Keep the tissue dry. The best intraoral scans follow the mantra, “drier is better.” Be sure to isolate appropriately, which is easier said than done. However, pay attention to the method you use to control moisture, as some can interfere with data capture. For example, using cotton rolls in the buccal vestibule will not leave enough space for a proper scan. Additionally, consider sponges instead of fibrous material; the fiber shows up in a scan. 
• Tip 4: Slow and steady wins the race. Make the movement slow and steady when using the IOS, and remember your scan patterns to ensure you capture all the data necessary.
• Tip 5: Study gum tissue scanning techniques. Capturing the necessary data from gum tissues is enhanced by using a few tweaks in your approach. For example, tilt the scanner on both sides of the patient’s arch. Also, try different angles over the occlusal surface rather than hovering directly over it. In addition, slow down while scanning the posterior teeth; scanning too quickly creates voids. 
• Tip 6: Remember tooth preparation matters. Your preparation significantly affects the quality of your scans, particularly regarding margins. Try a Shoulder Prep for a clean margin finish and a robust platform underneath a crown or bridge to minimize margin issues. Chamfer and Shoulder Bevel are also acceptable, but Knife and Feather Edge are not due to a lack of clear margins. Also, double cord retraction is best, but if you have one adequately sized cord, that works, too. Paste and Laser retraction can also work and helps avoid washed margins. 
• Tip 7: Learn bite scan techniques. Quality bite scans are essential to producing the best product for your patient. Start by setting the therapeutic bite position to get one, leaving roughly three mm vertical clearance between arches and five mm between the opposing anterior teeth. Use a gauge, gig, or firm makeshift device to ensure a stable jaw position. Remember that the bite scan should cover at least three or four teeth to get the proper alignment and scan the bite on both sides. 

Practice makes perfect

Recognize every new technology has a learning curve. The more you practice, the more intuitive it becomes to use the proper technique for dental photography. Plus, investing in time to practice appropriate dental photography techniques now saves time you might have spent recasting later. 

In other words, the benefits of investing time and energy in scanning techniques outweigh the challenges of learning something new. Plus, high-resolution scans performed in minutes save time for patients in the chair and you working chairside. 

However, not every intraoral scanner is the same. Some manufacturers require various scan path strategies, suggesting a particular direction to operate the wand to acquire better scan visibility. 

Also, not all scanners are equal. Some devices involve significant calculations and software usage to achieve scan accuracy. Others are excellent scanners but challenging to use with less sophisticated software. Finding the product with the optimal cross-functional device and software ensures intraoral photos have the best resolution and data. 

Practicing your scanning technique improves your transition to digital dentistry. Perfecting your intraoral scans increases your confidence and elevates the patient experience while enhancing the workflows at your dental practice. 

Which intraoral scanner is best for you?

Here are the criteria we used to determine which intraoral scanner is the best. We think this criterion is the best way to find the all-around winner, but it might help to weigh these facets against your needs to see what suits you.

View comparison

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We look at what implant overdentures are, the types of overdentures available, when to prescribe them and what to consider when you do, and the complete overdenture process using digital workflow for the overdenture steps. 

What are overdentures?

Overdentures are similar to regular dentures in that they replace several missing teeth, are removable, and patients can eat with them. However, unlike conventional dentures that rest on the patient’s gums, an implant overdenture is secured with dental implants into the jawbone.  

Patients with implant overdentures enjoy improved oral function and esthetics over traditional dentures, while also restoring the natural form and function of their teeth and supporting structures.  For example, research indicates that the chewing efficiency of individuals with natural dentition is 90%. Patients with overdentures came in at 79%, while complete denture wearers only enjoyed 59%.  Moreover, patients with implant overdentures are associated with reduced alveolar bone resorption and have demonstrated long-term success, maintaining effectiveness for five to ten years.  

Types of overdentures

There are a few different kinds of overdentures, which vary by how one puts on the overdenture. These include:

• Removable implant-supported dentures: These are designed to securely attach to dental implants in the patient’s jawbone using a snap-on mechanism. They stay in place until patients remove them. This option allows for easy daily removal, making cleaning a hassle-free process.
• Fixed implant-supported dentures: Also known as hybrid dentures, fixed implant-supported dentures attach permanently to implants in the jawbone. Patients cannot remove them at home, but their dentist can remove them when needed. This type requires regular brushing and flossing underneath using floss threaders, interproximal brushes, and other specialized cleaning tools.  
• Bar-Retained Implant-Supported Overdentures: The bar-retained implant-supported overdenture attaches a bar to the implants, allowing the denture to clip securely in place. This design allows easy removal and insertion, usually for cleaning or sleeping. 
• Ball-Retained Implant-Supported Overdentures: These overdentures use ball-shaped supports that connect the implants to the denture. These ball attachments simplify cleaning and allow for easy replacement of parts if necessary.   
• Implant-Retained Removable Partial Denture: Using implants and remaining natural teeth, these overdentures lessen the inconveniences of conventional removable partial dentures without requiring ugly clasps in the esthetic zone. With a flange added, clinicians can replace facial esthetics and extraoral soft tissue support lost from advanced ridge resorption. These appliances need minimal modification when adding prosthetic teeth and can serve as a transitional appliance that allows for additional surgical procedures.   

When to prescribe overdentures

Overdentures are an alternative for patients who struggle with conventional dentures. They also benefit patients with altered oral anatomy, neuromuscular disorders, pronounced gag reflexes, or significant ridge resorption.  

An appropriate attachment system selection depends on several factors, categorized into patient-related and dentist-related considerations. Patient factors include the amount of available bone in each jaw, the patient’s expectations regarding the prosthetic outcome, and whether they can afford it. Dentist factors are personal preferences and clinical expertise. Additional factors include the experience and technical knowledge of the lab technicians involved. 

There are other considerations, too. For example, minimizing the attachment height is also important to reduce the space required inside the denture, which reduces the risk of fractures from inadequate acrylic thickness. Whether to use housings with replaceable matrices is another essential concern.  

Moreover, implant-related factors affect in the patient selection process. These include the location of the implants, the number of implants placed, their length, and the percentage of surface area surrounded by bone. These elements also collectively influence the attachment system choice to ensure the most suitable and successful outcome.  

Implant overdenture steps 

Producing overdentures using conventional methods can require from four to 10 appointments, with as many as 14 days between them to coordinate with the lab for each step. It can take two to three hours of clinical time and run up a significant lab bill for hundreds of dollars. By contrast, using a digital workflow for your overdenture steps saves time and money and improves the patient experience. Experts agree a digital workflow simplifies the fabrication process and the number of clinical appointments required to deliver the prosthesis. Moreover, the data captured by a digital workflow produces an equal or, in some cases, superior prosthesis.

Following are the digital workflow implant overdenture steps. 

Appointment 1: Take impressions

Capturing the arches is a critical part of the overdenture scanning process. Before scanning, ensure the healing caps or abutments are clean and dry, and the field is clear of debris. 

If you are replacing an overdenture or converting an immediate denture, adjust the existing denture (if needed) before scanning. Then, using light body wash, seat the denture while having the patient move their lips and tongue from side to side and apply gentle pressure to it, then wait for the impression material to set. If there is significant wear to the existing denture, use blue mousse to fill the bite onto the occlusal. 

After removing and cleaning any excess material from the existing prosthesis, get a 360 scan of the reference denture or dentures. In single-arch cases, get a scan of the opposing, too. 

Appointment 2: Register bite 

For cases where the patient does not have an existing overdenture to ascertain the vertical dimension of occlusion (VDO), use a Wax Bite Rim to capture the bite. Light body wash on the wax rim helps capture the border molding and improves accuracy. Be sure to mark the wax bite rim with the smile lines, canine lines, and midlines. The added blue mousse will get the bite. Then, get a 360 extraoral scan of the wax bite rim. 

When taking a bite digitally in single arch overdenture or immediate denture replacement cases, register the bite using the intraoral bite scan (from molar to the midline) with blue mousse. For dual arch cases, record the bite by scanning both arches in occlusion extraorally (from molar to molar) with blue mousse.

In addition, take photos. First, take a head-on photo with the patient smiling naturally with the wax bite rim in place, followed by a second version of the head-on photo plus cheek retractors. Lastly, take a profile dental picture from each side with the patient smiling naturally and the wax rim in place. 

Appointment 3: Placement and adjustment

Careful evaluation of base fit, extensions, and occlusion is critical in this step. Clinicians should also pay attention to patient comfort, invest time in post-insertion instructions, and set proper patient expectations.  

Regarding denture fit and base extensions, determine if any areas of contact need relief. Then, verify that the stress-bearing area of the maxilla is the crest of the alveolar ridge with pressure distributed evenly bilaterally, that the mandible has the primary stress distributed to the buccal shelf, and that adjustment to the bilateral contacts here does not need adjustment.  

Also, ensure no overextensions exist in the denture base by using the material to identify them while patients move the overdenture in functional movements. Check the base thickness for whether it needs adjusting to support tissues appropriately.  

Once adjustments are complete, check esthetics and occlusion. In particular, occlusion should have stable, bilateral contact in the centric position.  

Then, to place overdenture, put auto-polymerizing material inside denture reliefs and then seat, having the patient close into the bite. After polymerization is complete (use a timer or put a bit of the material on the glove to help you gauge completion), check for voids around the abutments and place additional material as needed, not getting it inside them. Then, clean up excess with a carbide bur on the inside or lingual areas and polish as required. Regarding excess material, consider drilling lingual exhaust vents for it to connect into relief holes. 

Post placement considerations

For follow-up, continue monitoring all the metrics for fit, function, and comfort, and evaluate the healing process for the patient’s soft and hard tissue. Adjust any areas causing problems for the oral cavity or the patient’s function. In some cases, a resilient relining material might need replacing (if used at the placement and adjustment appointment) as the soft tissues might shrink as they heal. Check these areas at each subsequent appointment.  

Also, checking in with the patient regarding their handling of the prosthetic is essential. Additionally, check in about the patient experience, particularly their satisfaction with the restorations. It’s not uncommon for patients to determine they would instead switch to a fixed appliance after experiencing a removable one. 

Final notes on implant overdentures

Overdentures provide edentulous patients with an improved experience over conventional dentures that provides a better approximation to the efficiency and function of their natural teeth. Getting patients prepped for successful implant overdentures starts with a proper case selection and attachment type. 

The traditional overdenture steps can be time-consuming and expensive. By following these digital workflow overdenture steps, you can set the overdenture process up for its best possible outcome, which can deliver an excellent prosthetic in fewer appointments—giving you and the patient plenty to smile about.

Please contact the team at Dandy with questions about the overdenture process or overdenture steps, or click here to learn about our many restorative services.

Sources:

Implant Supported Dentures: Process, Benefits & Care (2022). Available at: https://my.clevelandclinic.org/health/treatments/24303-implant-supported-dentures (Accessed: 20 July 2023).

Implant Overdentures, Introduction, Placement, and Post-Placement. Available at: https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-options/implant-prosthetics-removable/implant-overdenture-overview/implant-overdentures-introduction (Accessed: 20 July 2023).

Implant Overdenture – A Review to Highlight the Concept (2020). Available at: https://www.heraldopenaccess.us/openaccess/implant-overdenture-a-review-to-highlight-the-concept (Accessed: 20 July 2023).

An, X. et al. (2020) “Digital workflow for fabricating an overdenture by using an implant surgical template and intraoral scanner”, The Journal of Prosthetic Dentistry, 123(5), pp. 675-679. doi: 10.1016/j.prosdent.2019.04.022.

5 Types of Overdentures – Procedure, Pros, Cons, & Costs (2021). Available at: https://www.newmouth.com/dentistry/restorative/dentures/overdenture/ (Accessed: 20 July 2023).

AEGIS Communications, D. (2008) Expanding the Benefits of Implant Therapy: Implant-Retained Removable Partial Dentures, Aegisdentalnetwork.com. Available at: https://www.aegisdentalnetwork.com/special-issues/2008/07/implant-retained-removable-partial-dentures (Accessed: 20 July 2023).

Implant CE Article – Implant-supported overdentures (2023). Available at: https://implantpracticeus.com/ce-articles/implant-supported-overdentures/ (Accessed: 20 July 2023).

Sherer, DMD, MS, M. Intraoral Scanning, 3D Printing and Milling Workflows for Overdentures (2019) Available at: https://www.michaelschererdmd.com/wp-content/uploads/2020/12/SchererMD-Digital-Implant-Overdentures-Compendium-eBook.pdf (Accessed: 25 July 2023).

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What is an open tray impression?

An open tray impression is a technique that employs impression copings attached to implants with a retaining screw extending past the tray and embedded in the impression. Before removing the impression, the clinician unscrews the coping through an opening in the tray.

Open tray impression technique

To take an open tray impression:

• Coat the impression tray with adhesives to retain impression material.
• Load the tray with heavy-body impression material and place light-body impression material around the copings to capture the soft tissue.
• Place the custom tray in the patient’s mouth, and expose the coping for easy access later by wiping away the material from the occlusal opening. 
• After polymerization, loosen the screws in the temporary copings and remove the impression.

What is a closed tray impression?

In the closed tray impression technique, the clinician captures the post within the impression and after curing and impression removal, unscrews the post from the implant and reinserts it in the impression.

Closed tray impression technique

To take a closed tray impression:

• Affix closed tray impression copings on the implants (or multi-unit abutments)
• Load the tray with impression material and seat in the patients’ mouth
• Dislodge and remove the closed tray impression copings after polymerization
• Attach the implant or abutment analogs to the copings
• Insert the coping-analog assembly into the definitive impression

Open vs. closed tray impression

Research suggests that open tray implant impressions are more accurate for capturing multiple implants with different angulations. However, they are time-consuming and stressful for all involved.

By contrast, the closed-tray impression technique captures the implant and natural teeth in a single impression. It is ideal for single or multiple parallel implant impressions or when there is limited mouth opening or a sensitive gag reflex. However, transfers are less secure in the impression material, perhaps causing positions to vary when casting the model. Also, it can tear when you remove it from the patient’s mouth.

How digital dentistry changes an implant impression

However, a third option exists: digital implant impressions. Studies and experience show that using an intraoral scanner for a dental implant scan captures high-quality implant impressions. 

Scan bodies enhanced the digital scanning data capture. After securing the scan body into the implant, like with an impression coping in a conventional impression, it captures important 3D data that labs use to produce the crown and stock or custom abutment. 

Also, patients prefer digital impressions and clinicians like the accuracy scanners produce without the degradation that occurs with each step of a conventional impression technique. Both like that it takes less time without uncomfortable (and expensive) impression materials involved.

Open or closed tray, or digital can all produce high-quality implant impressions. However, patients and clinicians both prefer the comfort, cost, and time savings of digital implant impressions. 

With accuracy so essential to case success, can you afford not to take digital implant impressions? Contact Dandy today to explore our digital solutions.

Sources

Impressions – Overview. Available at: https://www.for.org/en/treat/treatment-guidelines/edentulous-treatments/treatment-procedures/fixed-prosthetics/impressions/impressions-overview?active_tid=403 (Accessed: 6 July 2023).

Open or Closed? by Dr. Gary Radz (2023). Available at: https://www.dentaltown.com/magazine/article/7057/open-or-closed (Accessed: 6 July 2023).

Impressions of implants: pick-up and closed tray impressions (2023). Available at: https://magazine.zhermack.com/en/studio-en/pick-up-and-closed-tray-impressions/ (Accessed: 8 July 2023).

Imen, D., et al. Open Tray Impression Technique Using The Direct Pick-Up Coping: A Case Report (2023) Juniperpublishers.com. Available at: https://juniperpublishers.com/adoh/pdf/ADOH.MS.ID.555771.pdf (Accessed: 8 July 2023).

Deogade SC, Dube G. A sectional-splinting technique for impressing multiple implant units by eliminating the use of an open tray. Contemp Clin Dent. 2014;5(2):221-226. doi:10.4103/0976-237X.132347

Closed Tray Impression. Available at: https://www.icoi.org/glossary/closed-tray-impression/# (Accessed: 6 July 2023).

Marques S, Ribeiro P, Falcão C, et al. Digital Impressions in Implant Dentistry: A Literature Review. Int J Environ Res Public Health. 2021;18(3):1020. Published 2021 Jan 24. doi:10.3390/ijerph18031020

Wilk, DMD, B. (2015) Intraoral Digital Impressioning for Dental Implant Restorations Versus Traditional Implant Impression Techniques, Aegisdentalnetwork.com. Available at: https://www.aegisdentalnetwork.com/cced/2015/07/intraoral-digital-impressioning-for-dental-implant-restorations-versus-traditional-implant-impression-techniques (Accessed: 8 July 2023).

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However, the precision required in a prep for zirconia crown—as well as the zirconia crown prep dimensions—make getting it right trickier than with other restorative materials. So, we developed this comprehensive guide to zirconia crown preparation that can deliver the best possible patient outcomes and experience with your crown and bridge restorations.

The importance of tooth preparation for zirconia crowns

In addition to design, crown preparation for a zirconia crown is critical to enjoy the advantages of zirconia crowns, like durability, biocompatibility, chemical and dimensional stability, and fracture resistance. Zirconia crowns have preparations similar to other materials’ prep, but need extra care because of the complexity of the entire procedure.

Knowing the proper steps for zirconia restoration design and crown preparation optimizes the longevity of the restoration. Also, using the appropriate tools and technology for prep and seating is essential. Therefore, training, technology, and experience in these areas will improve procedural accuracy and extend the life of the zirconia crown. 

Explore Dandy Zirconia Crowns

Dandy offers a variety of different dental zirconia crowns with various strengths, durability, and aesthetics.

Explore Dandy Zirconia

Zirconia crown prep dimensions & guidelines

The zirconia crown prep dimensions depend on the natural tooth’s location. Visibility and continuity are essential for zirconia crown prep, whether anterior or posterior crowns. The guidelines and specific incisal edge reduction and clearance measurements are altered according to the crown’s location.

Tooth prep can be a complex process. However, using intraoral scanners and digital modeling facilitate a comparative evaluation and the prep process. Prosthetic restoration margins are essential factors in clinical success. Industry literature indicates a preference for supragingival preparation.

Preparing a tooth for a zirconia crown needs impeccable marginal finishing lines. There are two types: a vertical finishing line without a defined margin, known as feather edge preparation, or a sharp horizontal line with a clear finishing line, also known as a chamfer.

Zirconia crown prep for anterior crowns

Anterior zirconia crown prep requires closer attention to the following elements. 

Clearance: Leave at least 0.3 mm of space to accommodate the crown’s wall thickness. Additionally, you’ll need to account for an incisal reduction of 1 to 1.5 mm or 1.8 to 2.0 mm.

Circumferential chamfer: The continuous circumferential chamfer should be visible and continuous. The gingival margin needs a reduction of at least 0.5mm.

With more visibility, the anterior crown necessitates prepping the tooth structure with an angle of approximately 5°, with no beveling. The incisal edge should be rounded using a football diamond bur to reduce the incisal edges of the crown facing the tongue, making it slightly concave.

Zirconia crown prep for posterior crowns

In the posterior of the mouth, zirconia crown prep involves many of the same considerations that apply to anterior crowns, plus a few aspects that are specific to the back of the mouth. This is because the posterior section of the mouth is a startlingly different environment than the front of the mouth, as it shoulders more mastication responsibility and can be more vulnerable to cavities.

When prepping for posterior zirconia crowns, pay close attention to the below.

Clearance: Posterior crowns are slightly thicker than anterior crowns and thus need more room to accommodate their size. Approximately 0.5mm of space is recommended. The proper occlusal reduction is between 1 and 1.5mm or 1.5 to 2mm. 

Circumferential chamfer: Visibility and continuity are key when it comes to zirconia crown prep. For posterior crowns, provide for a 0.5m reduction at the gingival margin. Additionally, posterior crowns should be slightly tapered between 4° and 8°.  

Like their anterior counterparts, it’s recommended that you avoid beveling posterior crowns. The edges of the crown surfaces that come into contact with food should be slightly rounded. 

Patient assessment for zirconia crown preparation

For optimal success of a zirconia crown restoration, there are needed assessments. Answer the following:

What type of crown is necessary?

What is the location of the crown?

What kind of crown is required?

What is the health of existing abutment teeth?

What are the patient’s aesthetic goals?

The last assessment depends on whether it is for an anterior or posterior crown. We shall give more detail on this later.

Secondly, there are impressions of the patient’s teeth. The usual method of capturing impressions was trays and impression material, such as putty. While they did capture the patient’s teeth contours, PVS lacked exactness and speed of use.  Consider all the necessary steps:

• Taking impressions with PVS molds
• Creating stone models
• Shipping the models to a lab

When models arrive at a traditional dental laboratory, additional time is needed for the following:

• Scanning the models
• Designing the crown
• Printing or milling new models for fit
• Sending the crown back to your practice 

This process may take 12 to 15 days for most labs to complete. However, some labs may take more than three weeks. That does not include adjustment time or reorders.

Digital impressions for zirconia crowns

Improved technology, like digital scanners, makes dentistry easier, cost-effective, and more efficient. Even complex procedures like the denture process and the zirconia prep process have these advantages when digital versus traditional impressions. 

There are advantages to digital dental crown prep. Digital intraoral scanners provide scans of both the original and prepped tooth quickly. Lab software can copy the preexisting anatomy of the original tooth. 

The advantages to digital impressions, besides time and money, are providing patients with a dental crown prep process that is faster and more accurate. Additionally, there is an average five to eight-day turnaround time. But envision the patient experience. There is less time in the chair and no gooey gag-worthy impression material. That is an experience the patient will remember and talk about.

A typical process includes: 

1. The patient gets an intraoral scan.
2. The clinician sends the digital scan electronically to the dental lab.
3. The lab designs the patient’s restoration using the digital impression and design software.
4. The lab sends the restoration to the practice, where it fits the patient the first time the clinician seats it.

The other benefit of intraoral scanners is they are multi-use. They can cover the denture process, orthodontic appointments, and dental implants optimizing all workflows.

Limiting factors for zirconia crown preparation suitability

Knowing what to do is an excellent start to producing appropriate preps for zirconia crowns. Next, it’s a good idea to know what not to do when prepping for a zirconia crown. These include:

• Do not include undercuts or gutter preparations. Be sure to look for undercuts in the gingival third; this area has undercuts most often, especially in long preparations. 
• Avoid parallel wall preparations. Instead, the prep walls should be angled the appropriate amount depending up on where they are in the patient’s mouth.
• Skip sharp incisal edges. Use a football diamond to round the incisal edge of the crown on the lingual, making it concave. Occlusal edges should also be rounded, too.

Monolithic restorations

Solid or monolithic zirconia is favored for posterior crowns. The difference will be the zirconia state. Non-sintered zirconia, or green state, is soft, fragile, and moist. Pre-sintered is the process most manufacturers use. The pressed zirconia blocks are “sintered” at about 65% of the final sintering temperature. At this stage, the zirconia is still soft for milling and dry for easy shrinkage factor calculation. The pre-sintered zirconia state is more robust and has a predictable uptake of the coloring solution.

Recently, layering techniques have advanced creating zirconia crowns that are stronger due to the substructure. A layered crown does not chip or crack on the incisal surface of the tooth or the occlusal  biting edge or the top of molars. The increased structural durability from pre-sintered or layered zirconia helps patients with a heavy bite, grind their teeth, or present a limited occlusal clearance.

Crowns using solid zirconia need an occlusal anatomy depth of 1.0 to 1.5 mm with functional cusp tips reduced by 1 to 1.5 mm and a 6° to 8° along the axial wall.

Layered restorations

In some cases, clinicians want to use layered zirconia to improve aesthetics. This type of zirconia uses ceramic layering to increase translucency and opalescence, which makes the patient’s smile look more realistic.

Layered zirconia can be made from layers of other types of zirconia that produce improved aesthetics, or with other materials, like porcelain. However, on the biting surface where durability is essential, the material is still full zirconia.

Porcelain Fused to Zirconia (PFZ) Crowns have the best of both materials. PFZ crowns have the aesthetics of porcelain on the outside with the strength of zirconia on the inside. We consider it the go-to alternative material for Porcelain Fused to Metal (PFM) crowns.

Some things you might not realize about PFZ include:

• It enjoys higher aesthetics than lithium disilicate (eMax). 
• It is stronger than a PFM.
• It uses the same prep margins as monolithic zirconia, although with slightly less flexural strength. 

Chairside adjustments for zirconia crowns

Any roughness of the surface can be polished to an exceptionally smooth surface with a fine diamond bur. Do not use a heavy hand in the reduction or excessive heat. This can lead to micro-factures.

Crown preparation avoidances

The factors that make tooth prep suboptimal for zirconia restorations. 

• Undercuts
• Gutter preparation 
• Parallel wall preparations
• Sharp incisal  

Be attentive to these situations, know the rules of zirconia crown prep, and follow them closely to avoid errors.

Why is tooth preparation for crowns important?

Proper zirconia crown preparation is crucial to a comfortable and correct prosthodontic fit. Precision fitting restorations, e.g., a zirconia dental crown, can impact how your patient’s mouth feels and operates, influencing their experience. It also affects the patient’s oral health. If an improper fit and excess cement are used, it can lead to issues. The wrong fit risks can include: 

• Cavities and tooth decay
• Gum disease
• Core teeth fracture
• Tooth sensitivity
• Jaw pain 

A zirconia crown prep done well will create a resilient crown and prevent complications. With modern technology and tools, there is no guesswork and fewer errors. Digital scanners aid in workflows providing a streamlined, user-friendly process that reduces the number of translations from impression to design. 

There are definite advantages to digital dentistry.

How Dandy supports zirconia crown preparation

Crown and bridge restorations have had significant advancements in quality and efficiency in the last decade. As one of its newest materials, zirconia requires taking the proper steps during preparation to seat crowns and bridges to deliver more beautiful smiles than ever. 

Beautiful smiles also need a good dental lab partner. We invite you to try Dandy as your next crown and bridge lab. Our process improves patient experience, bolsters your practice output, and streamlines every aspect of how you practice oral healthcare. 

We make it easier than ever to go digital with your dentistry and dental restorations. Our platform is the first of its kind and serves as a complete, fully-digital dental lab that makes digital dentistry easy, convenient, and powered by the speed of the internet. 

Ready to find out how you can save time and money by going digital? Meet Dandy today and learn more.

Sources: 

International Journal of Oral Science. Surface roughness of zirconia for full-contour crowns after clinically simulated grinding and polishing. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153586/

AVF Dental Group. Zirconia Crowns: Advantages and Disadvantages of Zirconia Crown. https://www.avfdentalgroup.com/zirconia-crown-advantages-and-disadvantages-of-zirconia-crown/#

International Journal of Dentistry. Three-Dimensional Accuracy of Digital Impression versus Conventional Method: Effect of Implant Angulation and Connection Type. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008832/

Journal of Materials Research and Technology. Zirconia in dental prosthetics: A literature review. https://www.sciencedirect.com/science/article/pii/S2238785419300419#sec0040

Acero Crowns. How Many Times Can Posterior Crowns Be Replaced? https://www.acerocrowns.com/posterior-crowns

Science Direct. Influence of Preparation Design On the Quality of Tooth Preparation in Preclinical Dental Education. https://www.sciencedirect.com/science/article/pii/S1991790216300526#

Dentistry 33. Chamfer vs. Feather Edge for a Single Zirconia Crown https://www.dentistry33.com/clinical-cases/prosthodontics/318/chamfer-vs-feather-edge-for-a-single-zirconia-crowns.html#:~:text=To%20prepare%20a%20tooth%20for,finishing%20line%20(knows%20aschamfer).

European Journal of Oral Sciences. Effect of margin design on fracture load of zirconia crowns https://onlinelibrary.wiley.com/doi/full/10.1111/eos.12593

City Smiles of St. Louis. Does Your Crown Fit Right? https://www.citysmilesstlouis.com/blog/does-your-crown-fit-right/#

DiTolla, DDS, FAGD, M. “Common Preparation mistakes that cost you money (2015).” Available at: https://www.dentaleconomics.com/science-tech/article/16391662/common-preparation-mistakes-that-cost-you-money (Accessed: 11 October 2023).

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Zirconia was around for a long time before it became a material in dentistry. A German chemist Martin Heinrich Klapropse first introduced the idea of zirconium dioxide as a bioceramic in the 18^th century. However, it didn’t start serving dentists as a restorative material until the late 20^th century (1995). 

Today, zirconia is a popular crown material in today’s dental operatories, often replacing materials like porcelain-fused-to-metal or even gold crowns. However, like any material, zirconia crowns have problems sometimes. In this article, we look at the advantages and disadvantages of zirconia crowns.

The three types of zirconia crowns

There are several types of zirconia materials. Each of them has different features and benefits that contribute to patient outcomes, which can affect what you want to choose for your case. 

Zirconia has varying structures at different temperatures. It is monoclinic (i.e., the crystals have three axes of uneven length, and two of them are perpendicular to each other) at room temperature. However, mixing it with elements like yttrium, calcium, magnesium, or cerium, changes the structure as it stabilizes at room temperature.

For example, adding 8% yttrium (Y2O3) transforms the structure to cubic at room temperature, referred to as cubic-stabilized zirconia (CSZ). With 3-to-8% yttrium, it’s a mix of tetragonal and cubic phases at room temperature, called partially stabilized zirconia (PSZ). When it’s around 3% yttrium, it’s mostly tetragonal at room temperature and is called tetragonal zirconia polycrystal (TZP) or toughened zirconia. This TZP material was one of the early types of zirconia used in dentistry. Similarly, cerium-stabilized zirconia (Ce-TZP) also has a tetragonal structure when cerium is added.

To clarify the significance of  the amount of yttrium in zirconia, it affects how strong and clear it is. It’s usually given as a percentage, like 3%, 4%, or 5%. However, it is critical to note that these percentages are actually in tenths, so a small change can make a big difference in the properties of the material.

For example, zirconia with about 3% yttrium is very strong, with mostly a tetragonal structure. On the other hand, zirconia with about 5% yttrium is more translucent, with about half of its structure being cubic. So, the amount of yttrium makes zirconia stronger or clearer. 

The three types of zirconia used in dental crowns are:

• Solid or monolithic zirconia 
• Layered zirconia
• High translucent zirconia 

The type of zirconia crown most appropriate for your patient depends on a range of factors, from the quality of the material itself to other patient-specific details. Let’s take a closer look at each type. 

Solid or monolithic zirconia 

Solid or monolithic zirconia, also called Full-Contour, is the most opaque of zirconia styles. Solid zirconia crowns are a popular choice because of their durability and because they require less occlusal clearance than other crown materials. 

As a single material, monolithic zirconia has several advantages. First, it has flexural strength like its metal counterparts. It is also multichromatic. Since it is one single material, it has a manufactured consistency. Plus, it has great aesthetics with multi-layered color.

However, it also has a disadvantage. If you use it below the minimum thickness, it doesn’t perform. 

Generally, monolithic zirconia is recommended for posterior crowns. There are two primary reasons for this: 

• Monolithic zirconia is opaque. Monolithic zirconia lacks the translucency of other zirconia types, and the opaque color can be difficult to match teeth that are situated at visible points of the mouth.  
• Monolithic zirconia contains many stabilizers. Oxide additives are used in zirconia to add strength and durability. Solid zirconia contains more of these stabilizers than other kinds of zirconia, making them perfect for the primary job of the molars at the back of the mouth—aka, chewing. Patients who tend to grind their teeth may also be better served by the durability of monolithic zirconia. 

So, how long do zirconia crowns last? It depends on many things, but when you have a monolithic zirconia crown, chances are they will hold up for a long time. Also, in addition to their durability, monolithic zirconia crowns cause less wear to neighboring teeth.

Layered zirconia

The idea behind using multi-layered zirconia in dental work is to make artificial teeth look more like real ones. Natural teeth have a gradient in color, with the outer being more see-through and getting darker and less translucent towards the gumline. Various types of this layered zirconia are recommended for different dental procedures based on how they look and work.

Layered zirconia is coated with a special ceramic where the teeth are visible. However, only the visible surfaces are layered; the occlusal surfaces remain full zirconia to ensure durability.

With this modification, the answer to the question, “How long will this type of zirconia crown last?” will still be a satisfying answer. 

The ceramic layering is why layered zirconia a popular choice for anterior crowns. There are a couple of reasons for this, which include:

• Layered zirconia creates a more realistic-looking smile. Compared to full zirconia, layered zirconia is more translucent and opalescent.
• Layered zirconia allows you to skip the extra layer if you want. The improved aesthetics mean you can use it in the visible zone with or without porcelain layering.  

Another significant advantage of layered zirconia is that the color variation you see in the finished tooth is part of the zirconia itself. With older types of zirconia, the coloring was added to the outside of the restoration with special stains. However, if the patient brushed their teeth vigorously or had an acidic oral environment, those added colors could wear off, and the tooth would look the same color all over. With layered zirconia, even if the added color on the surface wears off, the tooth keeps its color variation because it’s built into the material.

Although layered zirconia is perfect for anterior crowns, it can also be used for posterior crowns, provided there’s room for the amount of clearance layered zirconia crowns require. However, when you are using it in the posterior, recognize that layered zirconia is weaker than monolithic zirconia, if only slightly. 

High translucent zirconia 

High translucent zirconia is considered the most natural-looking of all zirconia types. Its heightened translucency allows it to reflect the color of the teeth surrounding it, leading to crowns that blend in more with the rest of the teeth in the mouth. 

The further individual benefits of high translucent zirconia may include:

• Enhanced durability – High translucent zirconia is sturdier than other kinds and far stronger than traditional porcelain crowns.
• A quicker implant procedure – High translucent zirconia doesn’t require any of the fine-tuning that other crowns need, like color shadings or glazes. This can also cut back on the time it takes for those kinds of additions to dry.

Explore Dandy Zirconia Crowns

Dandy offers a variety of different dental zirconia crowns with various strengths, durability, and aesthetics.

Explore Dandy Zirconia

Zirconia crowns advantages

No matter what type of zirconia you and your patient decide on for their crowns, there are many ways this dental option can elevate their smile. Here are the three top advantages of zirconia crowns:

• Zirconia crowns are biocompatible. Biocompatibility means your patients don’t have to worry about their zirconia crowns negatively interacting with the living tissue in their mouth. Zirconia is non-toxic and naturally hypoallergenic.
• Zirconia crowns are customizable. Zirconia is an incredibly customizable material, thanks to its chemical composition and the range of technologies that have been developed to work with the material. When it comes to zirconia crowns, that means designing for the needs of specific patients is more feasible than ever. For your patients, this helps ensure a perfect fit and long-lasting comfort.
• Zirconia crowns are metal-free. Zirconia crowns contain zero metal, which makes them the obvious choice for people with nickel allergies or other metal sensitivities.
• Zirconia crowns are digital friendly. Due to new dental technology, zirconia crowns can be fabricated 100% digitally. You can start by taking a digital impression. The crowns are then digitally designed with CAD/CAM technology and are precisely milled so that seating requires fewer chairside adjustments. 
• Zirconia crown cementation is easy. Zirconia crowns are cemented differently; however, the process can be simpler and more efficient than their other ceramic counterparts.

Zirconia crowns disadvantages

The disadvantages of zirconia crowns are essential to understand, also. For example, the opaque appearance of some zirconia types can make the restoration look less natural than other crown materials. Also, they can be pricier than crowns of other materials, which makes them less accessible for patients.

Furthermore, it is essential to remember that while zirconia crowns can be an excellent option for many patients, a few potential challenges associated with zirconia crowns could present.  Let’s examine a couple of possible zirconia crown problems—and how innovative technology can help to mitigate them:

• Discoloration – In the past, it could be difficult and time-consuming to match zirconia crowns to the color of neighboring teeth. However, digital options like Dandy’s intraoral scanning technology nullify this problem with zirconia crowns; shade matching workflows help to ensure that digitally produced zirconia teeth are the perfect shade, creating a seamless aesthetic.
• Potential damage to neighboring teeth – Some members of the dental community have raised concerns that a hard, durable material like zirconia might wear away the comparatively soft texture of natural enamel in the neighboring teeth. To address this common issue, Dandy’s dedicated CAD design team places a special emphasis on proper spacing and alignment of zirconia teeth. Such digital workflows help to prevent any deterioration caused by wear and tear.

In addition, some contraindications for zirconia crowns can also occur. A zirconia crown is not recommended when the:

• Preparations have very little reduction (less than 0.6 mm) and thin walls.
• Strong biting forces occur where the opposing contact is zirconia also (as microscopic breakdown can occur)
• Opposing contact is made of cast gold or polymer (to prevent excessive wear)
• Case requires precision attachments
• Aesthetics are paramount (unless the dental lab can apply the right stains, fire it correctly, and polish it without making it look gray or shiny and without using a glaze)

Zirconia crowns with Dandy

The type of dental crown material that’s right for your patient will depend on a variety of factors, from aesthetics to individual needs and crown location. But when it comes to improving patient experience, increasing production, and optimizing your practice’s efficiency, there’s only one logical choice: going digital.

That’s where Dandy comes in. Our digital dental lab provides quality prosthetics based on custom scans that can only be achieved in an intraoral scanner. Get started with Dandy as your next crown and bridge lab. We start you off with a free intraoral scanner, then provide you with training and guidance every step of the way.

Ready to get started with digital dentistry? Get in touch!

Sources:

Journal of Materials Research and Technology. Zirconia in dental prosthetics: A literature review: https://www.sciencedirect.com/science/article/pii/S2238785419300419

Materials. Optical and Mechanical Properties of Highly Translucent Dental Zirconia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435650/

Advanced Dental Arts NYC. Your Guide to Zirconia Dental Implants. https://advanceddentalartsnyc.com/everything-about-zirconia-implants/

AVF Dental Group. Zirconia Crown: Advantages and Disadvantages of Zirconia Crown. https://www.avfdentalgroup.com/blog/zirconia-crown-advantages-and-disadvantages-of-zirconia-crown/

Britannica, T. Editors of Encyclopaedia (2018, February 2). monoclinic system. Encyclopedia Britannica. https://www.britannica.com/science/monoclinic-system

Ban S. (2021). Classification and Properties of Dental Zirconia as Implant Fixtures and Superstructures. Materials (Basel, Switzerland), 14(17), 4879. https://doi.org/10.3390/ma14174879

Zirconia: The Material, Its Evolution, and Composition AEGIS Communications, B. J. O. B. (2018). Available at: https://www.aegisdentalnetwork.com/cced/special-issues/2018/10/zirconia-the-material-its-evolution-and-composition (Accessed: 26 October 2023).

Kolakarnprasert, N., Kaizer, M. R., Kim, D. K., & Zhang, Y. (2019). New multi-layered zirconias: Composition, microstructure and translucency. Dental materials : official publication of the Academy of Dental Materials, 35(5), 797–806. https://doi.org/10.1016/j.dental.2019.02.017

Arce, DDS, MD, FACP, Celin, et al. (2018). Multilayered Translucent Zirconia Crowns: Inside Dentistry. Retrieved from: https://www.aegisdentalnetwork.com/id/2018/04/multilayered-translucent-zirconia-crowns

Larson, J. (2020). Zirconia Crown Benefits, Disadvantages, Costs, Other Options. Retrieved from https://www.healthline.com/health/what-you-need-to-know-about-dental-crowns-made-from-zirconia

Zirconia Crowns: What Dentists and Labs Need to Know 2020! Retrieved from: https://www.cliniciansreport.org/products/single-topic-articles/single-topic-1-from-september-2020-volume-13-issue-9.php

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