CAD CAM laboratory work for Zirconia substructures

Laboratory work for Zirconia substructures is more technique and product sensitive than some of the other options. We must take great care must in product selection and fabrication of zirconia substructures.

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Laboratory work for zirconia substructures

The main two fabricators are Prettau and Izir.

Component Prosthesis design – framework with individual crowns Salinas

If doing Zir framework with cut back for ceramic then a PMMA (polymethyl methacrylate) model is made for try-in and/or just for the lab to cut back on before the zir is milled.  Patient can wear this for awhile too, especially if using something like Primotec’s Premiotemp multi-layered PMMA

Can take old acrylic and Ti and duplicate to zir K-Art dental lab

Labs for zirconia substructures

Zirconia substructure CAD/CAM with pressed emax crowns on multi-unit transmucosal abutments and pressed gingival ceramic by Stan Lott. In the case he uses emax crowns on the zirconia substructure and does final hand waxing of gingival architecture using berry and rose IPS emax gingival stains. He removes the crowns, the case is sprued, invested, and pressed with IPS emax Zirpress gingiva 3. Finally, he bonds on the emax crowns, except those that are covering screw holes which the dentist must cement in after he/she attaches the substructure. The zirconia substructure has CAL cylinders luted inside. Same case presented in Inside Dentistry. Stan Lott’s lab is Precision Elite.

Bob Cohen PMMA CAD verification bridge (CVD) looks nice

Another lab Prettau Zirkonzahn

 

Research on zirconia substructures

Multiple firings are beneficial – Study shows 3-5 firings are ideal. Vichi JPD 2016

3D printing still needs some work before being viable.  Silva JPros 2011

Tischler has shown excellent results with their Prettau, however there is a heavy bias since this is his company. Tischler JPD 2018

Barootchi JOMI 2020 found zirconia have higher initial costs than metal but better satisfactory outcomes, less complications, and higher survival rates.

Best resin cement for the ti-base to the zirconia frame is multilink hybrid abutment according to Lang JPD 2022.