The International Journal of Periodontics & Restorative Dentistry

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 315

Consecutive Case Series of Monolithic and

Minimally Veneered Zirconia Restorations on
Teeth and Implants: Up to 68 Months

Michael Moscovitch, DDS, CAGS1 The basic indications for the use of
an advanced high-strength ceramic
is to avoid damage and wear and in-
crease the esthetic and performance
outcomes of dental restorations. The
variability of function and support,
The aim of this study was to evaluate the performance of monolithic zirconia ie, teeth and/or implants, underpins
in function and minimally veneered zirconia (feldspathic ceramic, not in the use of the technical ceramic zir-
function, on the facial surface to enhance tooth esthetics or replace gingival conia to circumvent the performance
structures) on both teeth and implants. This open-ended consecutive case
issues of weaker ceramics.
series involved 238 patients between the ages of 16 and 92 years, 1,022
restoration units, and 365 cases in all categories of tooth and implant Zirconia is a well-documented
restorations in a private practice clinical environment for up to 68 months. material of high strength and ex-
The restoration parameters monitored in the patient base were fracture, cellent biocompatibility in the sci-
cracking, or chipping of the zirconia structure and/or the minimally veneered entific literature in both the dental
feldspathic ceramic. There were no observed complications with respect to and medical disciplines.1–4 Zirconia
these parameters associated with any of the restorations included in this study.
ceramics have been used in den-
(Int J Periodontics Restorative Dent 2015;35:315–323. doi: 10.11607/prd.2270)
tistry for implants, implant abut-
ments, posts and cores, orthodontic
brackets, as well as copings and
frameworks for bilayered dental res-
torations with feldspathic ceramic.5–7
During the past decade, there
has been a dramatic increase in the
use of all-ceramic non-zirconia-based
and zirconia-based restorations in
fixed prosthodontics. Wang et al8
reported an overall 5-year fracture
rate of 4.4% of teeth supported by
single all-ceramic crowns (bilayered),
irrespective of the materials used.
1Assistant Clinical Professor, Department of Restorative Sciences/Biomaterials, Goldman Posterior segments showed higher
School of Dental Medicine, Boston University, Boston, Massachusetts, USA; Lecturer, veneer fracture incidences than an-
Faculty of Dentistry, Dental Residency Program, Jewish General Hospital, McGill University,
Montreal, Québec, Canada.
terior segments. Molars showed sig-
nificantly higher crown fracture rates
Correspondence to: Dr Michael Moscovitch, 4150 St Catherine St West, Suite 210, Montreal, than premolars. This study did not
Quebec, Canada H3Z 2Y5; fax: 514-935-5261;
include glass-ceramics because this
email: [email protected].
material is no longer recommend-
©2015 by Quintessence Publishing Co Inc. ed for full crown use.3 The strength

Volume 35, Number 3, 2015

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
316

between the ages of 16 and 92 years

Table 1 Restorative materials used in the case series (mean age, 61.9 years; Table 2 and
Restorative material Number of restorative units Fig 1). The inclusion criteria of this
Monolithic zirconia 745 study were all patients who were
Monolithic zirconia with facial feldspathic veneer 277 planned for restorative treatment
Pink feldspathic ceramic (not in function)* 193 involving fixed restorations on teeth
and/or implants in a private practice
Total 1,022
clinical environment. These resto-
*Not included in total; used in conjunction with the monolithic zirconia or
monolithic zirconia + feldspathic ceramic veneer units. rations ranged from single crowns
to multi-unit fixed partial dentures
(Table 3). The selection process was
of zirconia allowed its use in the ising results with respect to the sequential, except for patients re-
fabrication of frameworks for fixed performance of these restoration quiring only custom esthetics with
partial dentures. Breakage of the designs.20–22 In addition, several fully veneered zirconia restorations
veneering feldspathic ceramic con- studies have indicated that mono- in the anterior maxilla.
tinued to plague this approach, es- lithic or minimally veneered (ie,
pecially in posterior segments.9–11 no feldspathic in function) zirconia
Conrad et al3 reported typical sur- would be the current choice for reli- Clinical approach
vival rates of 88% to 100% after 2 to able ceramic dental restorations.5,7,23
5 years in service and 84% to 97% The aim of this study was to eval- Patient histories were taken, fol-
after 5 to 14 years in service for all- uate the performance of monolithic lowed by complete diagnosis and
ceramic restorations (bilayered), in- zirconia in function (no feldspathic treatment planning procedures.
cluding fixed partial dentures. ceramic veneer) and minimally ve- Supportive implant, periodontal,
The frequent occurrence of neered zirconia (feldspathic ceramic endodontic, and orthodontic treat-
breakage of the veneering feld- on the facial surface, not in function, ment was provided by the appro-
spathic ceramic and substrate be- used to enhance tooth esthetics or priate dental specialists in a team
came a clinically unacceptable to replace gingival structures with approach.25 Informed consent was
problem compared to bilayered pink feldspathic ceramic; Table 1) obtained with respect to procedures,
metal restorations.12–14 These com- on both teeth and implants, regard- choice of materials, and outcomes.
plications were generally the result less of parafunctional occlusal activ- Each patient in the study entered
of the greater forces of occlusion ity. Klasser et al24 reported that this into the normal clinical workflow of
in posterior areas, varying para- condition is a continuously variable the author’s private practice.
functional occlusal activity, and the event, and it would be challenging
rigid nature of dental implants.15–17 to determine the severity of bruxism
Historically, restoring patients with activity at any given time. Restorative workflow
advanced wear or function with bi-
layered ceramics on both teeth and Initially, the workflow to produce the
implants has been challenging with- Method and materials provisional restorations, prototypes,
out the prescription of a protective and definitive zirconia restorations
acrylic appliance or full-metal occlu- Patient selection was managed with analog technol-
sion to prevent damage.18,19 ogy. Subsequently, digital technolo-
In recent years, various short- This consecutive case series includ- gies were included in the workflow
term clinical reports involving the ed 1,022 restorative units (all cat- (Fig 2). These technologies com-
use of monolithic and minimally ve- egories) in 365 cases involving 238 prised in-laboratory scanning of the
neered zirconia have shown prom- patients (38% male, 62% female) master casts and computer-aided

The International Journal of Periodontics & Restorative Dentistry

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 317

140
Table 2 Number of patients, cases, and
restorative units included in 120
case series

Number of patients
100
Parameter Number
80
Total patients 238
Total cases* (tooth- and implant-supported) 365 60

Tooth-supported restorations (units) 422 40

Implant-supported restorations (units) 600
20
Total restorations (units) 1,022
*A case refers to a restored segment; there may be more than one case 0
per patient. 10s 20s 30s 40s 50s 60s 70s 80s 90s
Age range of patients (y)

Fig 1 Age distribution of patients.

design/computer-assisted manufac-
turing (CAD/CAM) software, along Table 3 Case categories
with computer numerical controlled Location and type of unit Tooth-supported Implant-supported
(CNC) machinery. The zirconia res- Single anterior and posterior (units) 236 91
torations were equally precise irre- Multi-unit splinted anterior, posterior, 61 98
spective of the technique.26 and full-arch (units)
All intraoral impressions were Multi-unit anterior, posterior, and 125 411
taken with traditional materials: al- full-arch (at least one pontic; units)
ginate (Jeltrate, Dentsply) for study Total 422 600
casts and opposing casts and poly-
vinyl siloxane (Aquasil, Dentsply) for
Phase 1 Phase 2 Phase 3
all master casts. These impressions Scanned Scanned Scanned
diagnostic Digital provisional Digital prototype Digital
were poured with high-quality die setup milled and cast milled milled
stone (Fujirock EP, GC) and scanned. data data data
Data input input Data input input Data input input
Diagnostic mock-ups were accom- merged merged merged

plished for each patient situation.

Provisional Prototype Definitive
This information was scanned into Design restoration Design restoration Design restoration
modifications PMMA modifications PMMA modifications Zirconia
the design software and further
modified as necessary. The com- Fig 2 Digital restorative workflow.
pleted design was then used to
generate a polymethyl methacry-
late (PMMA; Vipi Block PMMA, Vipi) fied intraorally with either the fixed ics in the nonfunctioning anterior
provisional and/or prototype resto- provisional or prototype restoration. facial surfaces or gingival areas (to
ration to be used as a blueprint for The prototype was adjusted in- meet patient-specific esthetic re-
the zirconia design.27,28 Master casts traorally, then scanned and merged quirements). The completed file
for multi-unit tooth-supported res- with the master cast. Further minor was then used with the CAD/CAM
torations were verified intraorally virtual modifications were carried software to mill the definitive zirco-
with the prototype restoration. out as necessary, eg, contour, oc- nia restoration29 according to the
Master casts for multi-unit implant- clusal form, and facial cutbacks for manufacturer’s specifications (Pret-
supported restorations were veri- white or pink feldspathic ceram- tau, Zirkonzahn).

Volume 35, Number 3, 2015

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
318

Fig 3 Case presentation: Maxillary implant-

supported screw-retained restoration
(Astra Tech Implant System, Dentsply).
(a) Virtual design for the provisional (PMMA),
prototype (PMMA), and definitive (zirconia
with pink gingival feldspathic ceramics)
restorations. (b) Pretreatment intraoral frontal
view with eight implants. (c) Completed
a b definitive restoration. (d) Posttreatment
intraoral frontal view with definitive
restoration in place. (e) Occlusal view of
the virtual design. (f and g) Posttreatment
occlusal view of zirconia restoration with
open (f) and sealed (g) screw access
channels. (h) Posttreatment full smile view.
(i) Posttreatment radiograph of the maxillary
restoration.

c d

e f g

The zirconia restoration was white and pink ceramics (VITA VM9, with fine high-speed diamonds (ET
colored with water-based (Colour VITA Zahnfabrik) were added to Series Fine, Brasseler) and copious
Liquid Aquarell, Zirkonzahn) or the nonfunctioning facial surfaces water spray. In all cases, the glaze
acid-based (Colour Liquid Prettau, where required for esthetics (Figs was polished from the functional
Zirkonzhan) stains before the sinter- 3 and 4). Post-delivery minor oc- surfaces to minimize wear of op-
ing and glazing cycles. Feldspathic clusal adjustments were performed posing structures.30 The adjusted

The International Journal of Periodontics & Restorative Dentistry

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 319

Fig 4 Case presentation: Four maxillary

anterior tooth–supported single crowns.
(a) Pretreatment maxillary anterior view.
(b to d) Definitive tooth preparations.
(e to g) Posttreatment radiographs.
(h to j) Posttreatment facial views of defini-
tive zirconia crowns (minimally veneered;
no feldspathic ceramic in function). Note
that the maxillary canines were restored with
direct composite. (k and l) Virtual design of
definitive zirconia restorations with facial
cutbacks. (m) Posttreatment full smile.
a

b c d

e f g h i j

l m

surfaces were finished with a zir- and luted with resin ionomer (RelyX, tial denture screws to allow for fu-
conia polishing system (Dialite, 3M). Screw-cement-retained im- ture retrievability. Screw access
Brasseler). All tooth- and implant- plant-supported restorations were channels were sealed with poly-
supported cement-retained res- secured with a combination of tetrafluoroethylene tape (white) and
torations were sandblasted with temporary cement (TempBond, a suitable composite shade (Filtek
aluminum oxide (50 μm) at 2 bars Kerr) and titanium-alloy fixed par- Supreme Ultra, 3M; Fig 3).31

Volume 35, Number 3, 2015

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
320

Results
350

300 Within the patient population of

Number of restorations

250
the study, 1,022 restorative units
were completed over a period of 68
200 months (Fig 5). A total of 755 units
150 of restoration have been in func-
tion between 1 day and 36 months.
100
A total of 267 units of restoration
50 have been in function between 36
0
and 68 months. All patients in the
0–12 12–24 24–36 36–48 48–60 60–68 study were followed by the author in
Time in function (mo)
his private practice continuing care
program. The distribution of resto-
Fig 5 Distribution of restorations in function over time.
rations lost to follow-up is shown in
Table 4. One cement-retained im-
Table 4 Distribution of restorations lost to follow-up plant-supported restoration was lost
Number of restorations to zirconia abutment fracture (not
Replacement
Tooth- Implant- Months in months in a failure of the zirconia restorative
Cause of loss supported supported function function material) and replaced with a single
Abutment fracture* 0 1 1.9 49.1 screw-retained implant-supported
Root fracture†,‡ 1 0 10.5 44.8 zirconia restoration with a titanium
Root fracture †,‡
1 0 1.5 10.3 base. Six tooth-supported restora-
Root fracture ‡ 1 0 9.4 N/A tions were lost as a result of root
fracture (not a failure of the zirconia
Root fracture ‡
1 0 14.0 N/A
restorative material); two of these
Root fracture ‡ 1 0 31.4 N/A
were replaced with single-crown
Root fracture‡ 1 0 20.3 N/A
restorations each supported by
Deceased 0 4 10.6 N/A
two implants.32 Four patients with
Deceased 0 9 13.4 N/A 22 implant-supported and 3 tooth-
Deceased 0 4 45.4 N/A supported restorations passed away
Deceased 3 5 45.4 N/A during the follow-up period.
Total (11 patients) 9 23 N/A N/A There were no observed com-
N/A = not applicable. plications with respect to fracture,
*Zirconia abutment fracture; replaced with screw-retained crown with titanium base.
†Replaced with an implant-supported restoration. cracking, or chipping of the zirconia
‡All root fractures were associated with endodontically treated teeth.
structure and/or the minimally ve-
neered feldspathic ceramic to date
Table 5 Number of restorative units with clinical (Table 5). This is in agreement with
complications at 68 months case reports by Rojas-Vizcaya,21
Complication Zirconia structure* Feldspathic veneer† Thalji and Cooper,22 and Marchack et
Fracture 0 0
al.33 However, these results vary from
previous studies using zirconia with
Chipping 0 0
feldspathic ceramic in function9–11 as
Cracking 0 0
well as all other bilayered ceramic or
*All units have zirconia in occlusal function.
†No feldspathic ceramic in function. metal-based restorations.12–14

The International Journal of Periodontics & Restorative Dentistry

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 321

Discussion the restoration substructure with Hisbergues et al2 have indi-

fully veneered feldspathic ceram- cated that soft tissue response
In the present study, the zirconia ic.1–6 This bilayered approach led to and plaque adhesion to zirconia is
restorations exhibited a 100% suc- a high percentage of chip-off frac- as good as or better than natural
cess rate at 68 months. No frac- tures of the veneering ceramic.9–11 tooth structure. At this time, the
tures, cracks, or chipping of the Some of these studies surmised that high cost of gold alloys is influenc-
monolithic zirconia structure with or the use of monolithic zirconia would ing the restorative community to
without a minimally veneered feld- be likely to produce the results that consider alternative metal alloys
spathic ceramic component (not in are reported in this clinical study.5,6 such as titanium for substructures,
function) have been observed to The restorative community combined with various veneering
date (see Table 5). Acrylic occlusal continues to seek solutions to the materials. Ko et al37 have shown that
guards were not used to protect clinical challenges using bilayered titanium has been implicated in in-
any of the restorations in the study zirconia restorations. In an effort to ducing localized hypersensitivities
because of the strength of zirconia solve the chip-off fracture problem, as well as severe systemic allergic
and the fact that all function was Fabbri et al34 suggested the use reactions. Gökçen-Röhlig et al38 in-
only on this material.23 However, it of reinforced feldspathic ceramic dicated that dental zirconia has no
should be noted this practice has (lithium disilicate) cemented over reported allergic reactions and has
been routinely used with traditional a zirconia substructure, and some proven to be nontoxic and nonirri-
bilayered ceramic restorations.18 have suggested various modifica- tating, enhancing the desirability of
This is of particular importance go- tions to the technical management using zirconia as a substrate for res-
ing forward in terms of being able of applying feldspathic ceramic to torations. Finally, recent studies by
to create esthetic restorations with the zirconia substrate.35,36 How- Alghazzawi et al39 and Flinn et al40
a time-efficient workflow that re- ever, limited data are available for have indicated that previous con-
sults in outcomes with a level of these techniques. Realistically, all cerns regarding low-temperature
success not previously reported in bilayered designs of zirconia res- degradation of zirconia at oral tem-
the literature.9–11,15,16 torations with material other than peratures is not a long-term con-
The use of zirconia to produce the zirconia in function continue cern for the residual strength of
dental restorations as described re- to create complications that affect zirconia restorations.
quires a milling protocol. Previous- outcomes.9–11 The results of this study indicate
ly, milling with analog machinery All restorations in this study, that there is a new paradigm pos-
made this a tedious and time-con- whether supported by teeth and/ sible in fixed prosthodontics that
suming process. As CNC machinery or implants, have only zirconia in allows for the use of an advanced
and associated software became function against opposing restora- high-strength ceramic (zirconia)
available, it allowed for an increase tions or natural teeth. The oppos- to enhance the overall esthetics,
in the time efficiency of producing ing restorative materials included biocompatibility, performance, ef-
zirconia restorations. These new precious alloys, nonprecious alloys, ficiency, and cost-benefits41 to the
digital protocols for milling zirconia feldspathic ceramics, reinforced restorative community and patients
also provided a collateral benefit in feldspathic ceramics, amalgams, in a manner not previously possible.
the ability to create surgical guides, and composites. As reported by
provisional restorations, and proto- Park et al,30 zirconia is minimally
type restorations with PMMA. abrasive to opposing structures, Conclusions
Studies supporting the biologic and this property is maximized by
and strength characteristics of zir- leaving the occlusal surfaces pol- After an observation time of 68
conia over other ceramic materials ished after definitive intraoral occlu- months, monolithic and minimally
resulted in zirconia being used as sal adjustments. veneered zirconia in the restoration

Volume 35, Number 3, 2015

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
322

of teeth and implants shows prom- 8. Wang X, Fan D, Swain MV, Zhao K. A 19. Moshaverinia A, Kar K, Aalam AA,
ising results as a reliable material systematic review of all-ceramic crowns: Takanashi K, Kim JW, Chee WW. A
Clinical fracture rates in relation to re- multidisciplinary approach for the reha-
for the wide variety of clinical ap- stored tooth type. Int J Prosthodont bilitation of a patient with an excessively
plications described in this study. 2012;25:441–450. worn dentition: A clinical report. J Pros-
9. Schmitter M, Mussotter K, Rammels- thet Dent 2014;111:259–263.
More studies of this category of berg P, Gabbert O, Ohlmann B. Clini- 20. Keren H, Caro S. Das beste material.
restoration will be helpful in estab- cal performance of long-span zirconia Dental Labor 2009;57:1056.
lishing this treatment modality as a frameworks for fixed dental prosthe- 21. Rojas-Vizcaya F. Full zirconia fixed de-
ses: 5-year results. J Oral Rehabil 2012; tachable implant-retained restorations
possible new benchmark in restor- 39:552–557. manufactured from monolithic zirconia:
ative dentistry. 10. Roediger M, Gersdorff N, Huels A, Rinke Clinical report after two years in service.
S. Prospective evaluation of zirconia pos- J Prosthodont 2011;20:570–576.
terior fixed partial dentures: Four-year 22. Thalji GN, Cooper LF. Implant-
clinical results. Int J Prosthodont 2010; supported fixed dental rehabilitation
Acknowledgments 23:141–148. with monolithic zirconia: A clinical case
11. Larsson C, Wennerberg A. The clinical report. J Esthet Restor Dent 2014;26:
success of zirconia-based crowns: A sys- 88–96.
The author would like to thank Hiam Keren, tematic review. Int J Prosthodont 2014; 23. White SN, Miklus VG, McLaren EA, Lang
MDT, for the laboratory support in the pro- 27:33–43 LA, Caputo AA. Flexural strength of
12. Augstin-Panadero R, Fons-Font A, Ro- a layered zirconia and porcelain den-
duction of all restorations in this study and
man-Rodriguez JL, Granell-Ruiz M, del tal all-ceramic system. J Prosthet Dent
Jacques Geleyn and Danae Sandoval for Rio-Highsmith J, Sola-Ruiz MF. Zirconia 2005;94:125–131.
their technical assistance in the preparation versus metal: A preliminary comparative 24. Klasser GD, Greene CS, Lavigne GJ.
of this manuscript. The author reported no analysis of ceramic veneer behavior. Int Oral appliances and the management
conflicts of interest related to this study. J Prosthodont 2012;25:294–300. of sleep bruxism in adults: A century
13. Zarone F, Russo S, Sorrentino R. From of clinical applications and search for
porcelain-fused-to-metal to zirconia: mechanisms. Int J Prosthodont 2010;23:
Clinical and experimental consider- 453–462.
References ations. Dent Mater 2011;27:83–96. 25. Cohen M (ed). Interdisciplinary Treat-
14. Esquivel-Upshaw JF, Clark AE, Shuster ment Planning: Principles, Design,
JJ, Anusavice KJ. Randomized clinical Implementation, vol 1. Chicago: Quin-
1. Chevalier J, Gremillard L, Virkar AV, w trial of implant-supported ceramic-ce- tessence, 2008.
DR. The tetragonal-monoclinic trans- ramic and metal-ceramic fixed dental 26. Kapos T, Evans C. CAD/CAM technol-
formation in zirconia: Lessons learned prostheses: Preliminary results. J Prosth- ogy for implant abutments, crowns, and
and futureww trends. J Am Ceram Soc odont 2014;23:73–82. superstructures. Int J Oral Maxillofac
2009;92:1901–1920. 15. Sagirkaya E, Arikan S, Sadik B, Kara C, Implants 2014;29(suppl 1):117–136.
2. Hisbergues M, Vendeville S, Vendeville Karasoy D, Cehreli M. A randomized, 27. Güth JF, Almeida E Silva JS, Beuer FF,
P. Zirconia: Established facts and per- prospective, open-ended clinical trial Edelhoff D. Enhancing the predictability
spectives for a biomaterial in dental im- of zirconia fixed partial dentures on of complex rehabilitation with a remov-
plantology. J Biomed Mater Res B Appl teeth and implants: Interim results. Int J able CAD/CAM-fabricated long-term
Biomater 2009;88:519–529. Prosthodont 2012;25:221–231. provisional prosthesis: A clinical report.
3. Conrad HJ, Seong WJ, Pesun IJ. Current 16. Larsson C, Vult von Steyern P. Five-year J Prosthet Dent 2012;107:1–6.
ceramic materials and systems with clini- follow-up of implant-supported Y-TZP 28. Moscovitch MS, Saba S. The use of a
cal recommendations: A systematic re- and ZTA fixed dental prostheses. A ran- provisional restoration in implant den-
view. J Prosthet Dent 2007;98:389–404. domized, prospective clinical trial com- tistry: A clinical report. Int J Oral Maxil-
4. Kelly JR, Denry I. Stabilized zirconia as paring two different material systems. lofac Implants 1996;11:395–399.
a structural ceramic: An overview. Dent Int J Prosthodont 2010;23:555–561. 29. Jing Z, Ke Z, Yihong L, Zhijian S. Effect
Mater 2008;24:289–298. 17. Schmitter M, Boemicke W, Stober T. of multistep processing technique on
5. Christensen GJ. Indirect restoration use: Bruxism in prospective studies of ve- the formation of micro-defects and re-
A changing paradigm. J Am Dent Assoc neered zirconia restorations—A system- sidual stresses in zirconia dental restora-
2012;143:398–400. atic review. Int J Prosthodont 2014;27: tions. J Prosthodont 2014;23:206–212.
6. Guess PC, Att W, Strub JR. Zirconia in 127–133. 30. Park JH, Park S, Lee K, Yun KD, Lim HP.
fixed implant prosthodontics. Clin Im- 18. Alqahtani F. Full-mouth rehabilitation Antagonist wear of three CAD/CAM
plant Dent Relat Res 2012;14:633–645. of severely worn dentition due to soda anatomic contour zirconia ceramics.
7. Ozkurt Z, Kazazoğlu E. Clinical suc- swishing: A clinical report. J Prostho- J Prosthet Dent 2014;111:20–29.
cess of zirconia in dental applications. dont 2013;23:50–57.
J Prosthodont 2010;19:64–68.

The International Journal of Periodontics & Restorative Dentistry

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
 323

31. Moráguez OD, Belser UC. The use of 35. Canullo L, Micarelli C, Bettazzoni L, 39. Alghazzawi TF, Lemons J, Liu PR, Essig
polytetrafluoroethylene tape for the Magnelli A, Baldissara P. Shear bond ME, Bartolucci AA, Janowski GM. Influ-
management of screw access chan- strength of veneering porcelain to zirco- ence of low-temperature environmental
nels in implant-supported prostheses. nia after argon plasma treatment. Int J exposure on the mechanical properties
J Prosthet Dent 2010;103:189–191. Prosthodont 2014;27:137–139. and structural stability of dental zirco-
32. Moscovitch, M. Molar restorations sup- 36. Tan JP,  Sederstrom D,  Polansky nia. J Prosthodont 2012;21:363–369.
ported by two Implants: An alternative JR,  McLaren EA,  White SN. The use of 40. Flinn BD, deGroot DA, Mancl LA,
to wide implants. J Can Dent Assoc slow heating and slow cooling regimens Raigrodski AJ. Accelerated aging char-
2001;67:535–539. to strengthen porcelain fused to zirco- acteristics of three yttria-stabilized te-
33. Marchack BW, Sato S, Marchack CB, nia. J Prosthet Dent 2012;107:163–169. tragonal zirconia polycrystalline dental
White SN. Complete and partial contour 37. Ko N, Mine A, Egusa H, et al. Allergic materials. J Prosthet Dent 2012;108:
zirconia designs for crowns and fixed reaction to titanium-made fixed dental 223–230.
dental prostheses: A clinical report. restorations: A clinical report. J Prostho- 41. Walton TR. Making sense of complica-
J Prosthet Dent 2011;106:145–152. dont 2014;23:501–503. tion reporting associated with fixed den-
34. Fabbri G, Zarone F, Dellificorelli G, et 38. Gökçen-Röhlig B, Saruhanoglu A, Cifter tal prostheses. Int J Prosthodont 2014;
al. Clinical evaluation of 860 anterior ED, Evlioglu G. Applicability of zirco- 27:114–118.
and posterior lithium disilicate restora- nia dental prostheses for metal allergy
tions: Retrospective study with a mean patients. Int J Prosthodont 2010;23:
follow-up of 3 years and a maximum 562–565.
observational period of 6 years. Int J
Periodontics Restorative Dent 2014;34:
165–177.

Volume 35, Number 3, 2015

© 2015 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.