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<strong>Dental</strong>; Coppell, Texas), and have the<br />
technician use it to place depth cuts.<br />
I let the technician know that is the<br />
most I want removed from the teeth to<br />
ensure that I stay in enamel.<br />
– Mike<br />
Dear Dr. DiTolla,<br />
I really enjoy watching the educational<br />
videos you provide through the <strong>Glidewell</strong><br />
website. Recently I have noticed an<br />
increased incidence of porcelain fracturing<br />
from the zirconia (Prismatik CZ and some<br />
NobelProcera [Nobel Biocare; Yorba Linda,<br />
Calif.]). I have started to use more BruxZir ®<br />
restorations in the posterior, but its limited<br />
esthetics are sometimes a problem. I<br />
fear I may have to return to PFMs. Any<br />
recommendations?<br />
– Dr. Fred Curcio<br />
Ridgefield Park, N.J.<br />
Dear Fred,<br />
Like you, I noticed a good deal of fracturing<br />
of porcelain-fused-to-zirconia<br />
restorations and have drifted to monolithic<br />
BruxZir Solid Zirconia. I find<br />
BruxZir restorations to be esthetically<br />
acceptable on first and second molars,<br />
especially when the patient’s other<br />
choice is cast gold! I am also very<br />
happy with the results I am getting<br />
with IPS e.max. So, basically, I usually<br />
go for IPS e.max in the anterior and<br />
BruxZir restorations in the posterior.<br />
I haven’t done a single-unit PFM in<br />
two years, but I still use porcelainfused-to-metal<br />
for many bridge cases<br />
where I don’t trust BruxZir as much —<br />
it’s still an all-ceramic product. Also,<br />
as you may have noticed, I am starting<br />
to put more anterior BruxZir cases on<br />
our website, but keep in mind these<br />
cases are being accomplished with the<br />
help of an in-office technician.<br />
If you aren’t happy with the esthetics<br />
of BruxZir restorations, you may have<br />
to return to PFMs, unless you are<br />
convinced that IPS e.max is strong<br />
enough for the posterior. My personal<br />
feeling is that with 1.5 mm of occlusal<br />
reduction, IPS e.max is strong enough,<br />
but many dentists don’t give us that<br />
much reduction.<br />
Hope that helps!<br />
– Mike<br />
Dear Dr. DiTolla,<br />
I recently watched a video from <strong>Glidewell</strong><br />
Laboratories where you were discussing the<br />
“cleaning” process for the internal surface<br />
of a zirconia crown (BruxZir ® crown, etc.)<br />
prior to cementation. You mentioned using<br />
Ivoclean (Ivoclar Vivadent; Amherst, N.Y.)<br />
and a zirconia primer. I will typically cement<br />
my zirconia crowns with the RMGI RelyX <br />
Luting Plus (3M ESPE; St. Paul, Minn.).<br />
Would you recommend using Ivoclean and<br />
the zirconia primer prior to cementing with<br />
RelyX Luting Plus or only with resin-type<br />
cements (RelyX Unicem or RelyX Ultimate)?<br />
Thanks so much for your help. I really enjoy<br />
your videos through the lab and find them<br />
all very helpful.<br />
– Kevin G. Jones, DDS<br />
Little Rock, Ark.<br />
Dear Kevin,<br />
It comes down to how retentive your<br />
prep is. If the prep is, say, 4 mm in<br />
vertical height and has no more than<br />
10 degrees of taper, then cementing<br />
with a RMGI without the zirconia<br />
primer will work fine. As the prep<br />
gets shorter or more tapered, that<br />
is when you should consider using<br />
Ivoclean and Z-PRIME Plus (BISCO;<br />
Schaumburg, Ill.) in conjunction with<br />
an RMGI such as RelyX Luting Plus.<br />
When you need maximum retention,<br />
such as on a short mandibular<br />
second molar, you should probably<br />
go with Ivoclean, Z-PRIME Plus and<br />
a self-etching resin cement like RelyX<br />
Unicem. I now use Ceramir ® (Doxa<br />
<strong>Dental</strong> Inc.; Newport Beach, Calif.) as<br />
my everyday cement. One of its chief<br />
benefits is that it has a natural bond<br />
to BruxZir crowns, once the inside<br />
of the crown has been cleaned with<br />
Ivoclean. I also really like the way<br />
Ceramir cleans up, making it a very<br />
enjoyable cement to use.<br />
Hope that helps!<br />
– Mike<br />
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