Dr. Larry Grillo’s take on Prime Zirconia

Patient demand for the use of all-ceramic materials to restore decayed or failing dentition has increased exponentially over the past two decades. Fortunately, advancements in all-ceramic material science have provided dentists with metal-free options to meet these demands whether restoring a single tooth or full arch. For indirect restorations, two of the most popular all-ceramic materials used by clinicians today are lithium disilicate and zirconia. What was once a choice between restorative beauty for the esthetic zone and restorative strength for the posterior arches has been nullified by the latest developments in zirconia materials that are both strong and esthetic.

 

As dentists, our goal when dealing with indirect cases, especially in the esthetic zone, is to create a highly esthetic restoration that blends seamlessly in the mouth, replicating the shape, form and shade of the patient’s natural dentition. While the original generation of high-strength zirconia materials were lauded by clinicians for their strength and durability, the opaque nature of the monolithic restoration lacked the optical properties desired for the anterior arch unless overlaid extensively with ceramics. This feature relegated use of the material primarily to posterior restorations where esthetics was less of a concern.

In response, manufacturers reformulated the material to increase its translucency, hoping this second generation would produce a more esthetic natural-looking monolithic restoration and lessen or eliminate the need for ceramic layering to achieve the desired esthetics. While the translucent appearance of this second generation of zirconia was increased slightly, it suffered from a significant loss in flexural strength. In addition, this second generation, like the first, required ceramic layering to bring the restoration to life and achieve the high-quality anterior esthetics demanded by patients. Soon thereafter, gradient zirconia pucks were introduced to the market. These multilayered zirconia pucks transitioned in shade from a darker dentin layer to a more translucent enamel layer in order to replicate incisal translucency, but the transition from one layer to the next was not seamless and the resulting restoration was again of a lower strength value.

The introduction of IPS e.max® ZirCAD® Prime (Prime Zirconia) has been a game changer for general dentists with practices like mine that emphasize cosmetics and comprehensive care. This newest generation of zirconia material has finally achieved the once elusive goal of melding strength and esthetics in a single monolithic material that does not require ceramic overlay to achieve natural-looking results. The addition of a higher cubic phase into the seamless gradient puck not only results in layer-free restorations that exhibit life-like esthetics but also is a single material suitable for a broad range of indications from single crowns to 14-unt bridges, all the while maintaining a flexural strength of 1200 MPa

The introduction of IPS e.max ZirCAD Prime finally offered a monolithic solution for this patient that offered the high-end esthetics for the anterior arch without the need for ceramic overlay and the overall strength to endure long-term stress.  When it was proposed that the patient undergo a full mouth reconstruction using this material, he agreed. Today, the patient is thankful for the long-term solution and smiles with confidence.

Dr. Grillo
Dr. Larry Grillo is the senior partner of Aventura Dental Arts LLC, and has been practicing comprehensive esthetic dentistry in South Florida since 1986. He graduated from the University of Texas at San Antonio Dental School and went on to complete the Advanced Implant Dentistry residency at the University of Miami.
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