Aesthetic Restorations on the NHS

Patients want a natural-looking smile – so why not offer them a highly aesthetic restorative option? Even though zirconia has traditionally only been widely available to private patients, with Monolith Full-Contour Zirconia from CosTech Dental Laboratory a strong, aesthetic option is now viable on the NHS.

The CosTech team has always believed that every patient deserves the best restoration. PFM crowns have long been considered one of the more aesthetic options for NHS patients. However, they do have some limitations, meaning the only alternative is a full metal crown. So why not offer your NHS patients a solution that is truly natural looking?

Specifically designed for your NHS patients, Monolith Full-Contour Zirconia has been made possible as zirconia is fast becoming the material of choice for dental restorations, helping to drive the cost of the material down. The use of CAD/CAM technology – now introduced into all aspects of the crown and bridge department – the need for labour intensive processes has been further reduced. With all this and working directly with zirconia manufacturers, CosTech can produce Monolith zirconia for less than £30 per unit.

Finding A Zirconia You Can Trust

While zirconia has evolved to become more translucent and aesthetic with each generation, the earlier generations are still viable. Monolith Full-Contour Zirconia can be used on any crown prep design and is versatile enough for use in single and multiple units as well as dental bridges (maximum 3 units). With a conservative prep where only a full metal restoration would suffice, you can now offer an alternative. So while the shade range is limited to only the A to D shades and may not be as aesthetic as the latest generations, it is still a more favourable choice compared to full metal restorations.

At just £29.95 per unit, including delivery to and from the laboratory, Monolith Full-Contour Zirconia is available on the NHS and an option that every patient will love.

Indications and Tooth Preparations

Monolith can be thought of as a direct replacement for both PFM and full metal restorations, for single units and bridges up to 3 units. Inlay and onlays are possible, however, there are cases where marginal fits are compromised by material thicknesses that are not uniform.

Monolith Zirconia will work with any style of preparation. Shoulder prep is not required, and a feather edge margin is adequate with a minimum of 1mm occlusal clearance. Much research has gone into this, and it is generally agreed among clinicians that tooth preparations should be at least 4mm in height from the gingival margin to the occlusal table. The preparation walls should also be up to, but not more than, 20 degrees from the long axis of the tooth being prepped for crown placement. As with all all-ceramic restorations any sharp edges should be rounded as this fulcrum point can cause micro fractures over time and ultimately lead the restoration to fail.

Cementing Zirconia Restorations: A Guide to Longevity

Full zirconia restorations have all but revolutionised aesthetics in modern dentistry. Echoing the translucency and appearance of natural dentition, the material also offers good strength and biocompatibility, making it easy to see why zirconia is fast becoming the restorative material of choice for many patients and professionals alike.

However, due to its unique properties, extra care needs to be taken when cementing and fitting zirconia, especially as this can have a direct impact on the longevity of the restoration.

Choose Your Cement Wisely

Zirconia will readily bond with any phosphate molecules, thus clogging the binding surface. With this in mind, phosphoric acid must never be used to etch zirconia. Saliva also contains phospholipids which will bind to zirconia. The best way to prime your zirconia is with Ivoclean by Ivoclar Vivadent. Prior to using the Ivoclean, and after trying in the restoration sand blast the fitting surface with Aluminium Oxide at 2.5 bars. This will greatly increase adhesion.

A good primer is then required, most of which contain phosphate to make use of the zirconia’s natural affinity for it. Suggested primers are Monobond Plus (Ivoclar) or Z-Prime Plus (Bisco). Be sure to air dry before continuing.

Once your Monolith is primed, use a good resin-modified glass ionomer cement. Suggested cements include RelyX Luting Plus (3M ESPE) or Fuji-CEM (GC America). Use as per manufacturer’s guidelines.

Adjusting Monolith

If you have to adjust the occlusal surface of a full contour zirconia, time must be taken to polish the crown. Raw zirconia is highly abrasive and will wear opposing dentition rapidly.

If you must adjust always be sure to use lots of water and air spray. This will reduce the build-up of heat that is generated. A fine grit diamond should always be used on a low speed. This sounds counterproductive as zirconia is such a hard material, but with light even pressure on and off, the material can easily be removed. This method also reduces the risk of micro fractures in the zirconia which could compromise the longevity of the restoration.

In the laboratory, we finish with a fired glaze – the same used as on PFM or eMax – so when adjusting this glaze is removed. Any adjusted surfaces must therefore be re-polished. Work through from a pre polish to a fine polish. This fine finish will reduce the abrasiveness of the zirconia and will prevent any damage to the opposing dentition.

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Discover how Monolith Full-Contour Zirconia can help you enhance the patient experience by contacting CosTech Dental Laboratory today.

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Posted on 07.04.19