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Special Issues
July/August 2016
Volume 37, Issue 3

Enhanced Esthetic Outcome With Zirconia-Based Resin-Bonded Fixed Partial Denture

Preserving the natural appearance of teeth

Congenitally missing laterals pose esthetic challenges. A problem inherent to traditional Maryland bridges is that the retainers do not allow for incisal translucency, and show-through of metal occurs in the interproximal space if retainers are extended. Another restorative challenge for this type of prosthesis is that the wings of the bridge are limited to the cingulum of the abutment teeth and rely solely on the strength of the cement for retention. With advances in high-strength tooth-colored materials and the development of more translucent zirconia, clinicians can anticipate an improved esthetic outcome with this restoration. Furthermore, enhanced primers containing organophosphate enable predictable longevity. Newer color-stable luting resin also contributes to superior esthetic outcomes by allowing the transmission of light, thus preserving the natural esthetics of the teeth without obstructing the natural tooth substructure. This case report describes the use of zirconia-based resin-bonded fixed dental prostheses (FDP), bonded using a series of products from Bisco Inc. (www.bisco.com) to replace failed metal-bonded FDP for teeth Nos. 7 and 10.

Key Takeaways

• Historically, replacement of congenitally missing lateral teeth has been done via a cement-retained, metal-based FDP, referred to as a Maryland bridge.

• Improvements in high-strength tooth-colored materials and primers along with the development of translucent zirconia have enabled improved esthetics.

• Color-stable luting resin allows transmission of light to preserve natural-looking restorations.

About the Authors

Shannon D. Roberts, DDS
Assistant Clinical Professor
Department of Comprehensive Dentistry
University of Texas Health Science Center at San Antonio School of Dentistry
San Antonio, Texas

Nasser Barghi, DDS
Professor, Department of Comprehensive Dentistry
University of Texas Health Science Center at San Antonio School of Dentistry
San Antonio, Texas

Fig 1. Preoperative frontal and sagittal views. A 27-year-old male fourth-year dental student with frequently failed metal-bonded FDP replacing teeth Nos. 7 and 10 was referred to the outpatient facility of the University of Texas Health Science Center student clinic. Both bridges had been bonded several times but failed to remain bonded. Clinical examination revealed that the amount of tooth preparation was limited to only the cingulum areas of both abutment teeth. Occlusal contacts on both contacts were light in maximum intercuspation (MI), with no excursive contacts on pontics.

Figure 1

Fig 2. Preoperative frontal and sagittal views. A 27-year-old male fourth-year dental student with frequently failed metal-bonded FDP replacing teeth Nos. 7 and 10 was referred to the outpatient facility of the University of Texas Health Science Center student clinic. Both bridges had been bonded several times but failed to remain bonded. Clinical examination revealed that the amount of tooth preparation was limited to only the cingulum areas of both abutment teeth. Occlusal contacts on both contacts were light in maximum intercuspation (MI), with no excursive contacts on pontics.

Figure 2

Fig 3. Preoperative frontal and sagittal views. A 27-year-old male fourth-year dental student with frequently failed metal-bonded FDP replacing teeth Nos. 7 and 10 was referred to the outpatient facility of the University of Texas Health Science Center student clinic. Both bridges had been bonded several times but failed to remain bonded. Clinical examination revealed that the amount of tooth preparation was limited to only the cingulum areas of both abutment teeth. Occlusal contacts on both contacts were light in maximum intercuspation (MI), with no excursive contacts on pontics.

Figure 3

Fig 4. Preoperative frontal and sagittal views. A 27-year-old male fourth-year dental student with frequently failed metal-bonded FDP replacing teeth Nos. 7 and 10 was referred to the outpatient facility of the University of Texas Health Science Center student clinic. Both bridges had been bonded several times but failed to remain bonded. Clinical examination revealed that the amount of tooth preparation was limited to only the cingulum areas of both abutment teeth. Occlusal contacts on both contacts were light in maximum intercuspation (MI), with no excursive contacts on pontics.

Figure 4

Fig 5. Palatal view of tooth preparation performed for metal-based FDP.

Figure 5

Fig 6. The patient requested zirconia-based resin-bonded FDP because the teeth were previously prepared for such restorations. Tooth preparation for retainers was extended incisally, gingivally, and interproximally to include the entire lingual surface of the abutment teeth. The depth of the preparation on the cingulum was kept at 0.75 mm with light gingival and interproximal chamfer. Laboratory instructions included layered zirconia restorations on the pontics, monolithic zirconia for the retainers, and light occlusal contacts in MI with functional occlusal contacts on the canines. As shown here, the patient was provided a Hawley retainer with prosthetic teeth replacing Nos. 7 and 10.

Figure 6

Fig 7. Lingual views of zirconia-based restorations. Intaglio surfaces of restorations were lightly sanded with 50-μm alumina at 5-mm distance from the restorations and at a pressure of 2.8 bars for 20 seconds. Z-Prime™ Plus (Bisco Inc.) was applied to the retainers 5 minutes in advance of clinical try-in. Prostheses were tried in for proper fit and occlusal contact. Try-in was performed with eCement® (Bisco Inc.) light-cured translucent luting resin. Restorations were cleaned using acetone for 5 minutes removing excess with a gentle flow of air. Preparations were pumiced using fine flour pumice, briefly etched using 37% phosphoric acid gel, and primed using All-Bond Universal® (Bisco Inc.). Excessive primer was removed using a gentle flow of air, and light-curing was done following the manufacturer’s instructions.

Figure 7

Fig 8. Frontal sagittal views of resin-bonded zirconia-based restorations. Restorations were permanently bonded with light-cured translucent luting resin (eCement, Bisco Inc.).

Figure 8

Fig 9. Frontal sagittal views of resin-bonded zirconia-based restorations. Restorations were permanently bonded with light-cured translucent luting resin (eCement, Bisco Inc.). restorations.

Figure 9

Fig 10. Palatal view of resin-bonded zirconia-based restorations

Figure 10

Fig 11. Postoperative smile.

Figure 11

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