All-on-4® hybrid with a titanium frame and zirconia teeth

Zirconia Complications Will Inevitably Present

As with any full arch restoration, the question we feel we are ethically obligated to ask as a lab that specializes in removable and implant supported prosthetics is, how do we manage a complication down the road? As a clinician, it is also critical to ask this question as you are the one managing the patient’s expectations and long-term care. We’ve learned through years of experience that almost every restoration eventually has some sort of complication, a chip or fractured tooth etc. There are a multitude of things that can cause a complication, many outside of our control.

The real question is, is it repairable? If the answer is no, that can often lead to a full remake for you and your patient. An example of this is when a full one-piece zirconia hybrid fractures, it typically needs to be remade. If a tooth chips or if a space under the prosthesis develops, porcelain must be added and it must be refired. The refiring of porcelain that has been in the mouth for a long period of time is a very high-risk procedure that is rarely successful. It will most likely combust under the pressure of refiring. We are always thinking long-term and to begin with the end in mind. Things like fractures will come. We have to be thinking ahead about what is going to best for the patient both durability and investment wise for the duration of their life. We believe in always giving yourself an escape hatch.

While many are still opting for full Zirconia restorations, we have moved to what we have seen to be a superior design with so many more benefits. An alternative solution without sacrificing aesthetics is a CAD/CAM titanium bar with Zirconia teeth. In most cases, a titanium bar lasts a lifetime. Should it fracture, it can easily be repaired through laser welding. Should a tooth chip or fracture, a single unit can easily be replaced. Additionally, a titanium bar is not as rigid as Zirconia and allows for flexure of the mandible. Further, less interocclusal space is required for this design (9mm), something we as a lab rarely get enough of, pink gingiva can be added if needed, an implant site can be added if one fails and lasty, it can be cantilevered up to 15 mm.

Our IC Zirconia Hybrid (individual crowns) would be our recommendation over full Zirconia so complications down the road do not require a complete redo on the investment your patient already made in their mouth. This is one of many examples of why it is critical to think ahead. Managing your patient’s expectations upfront when you are armed with all the information will prevent you from ever having to make excuses for complications down the road.