Would Zirconia be the right way to go?

[tonightwetaco]

Thank you for taking a look at my issue.

Recently I suffered an accident to both of my incisors. One was broken in half and will require a crown while the other has a chip on the bottom side of the tooth next to the other incisor. 2 dentists recommended crowns and do not feel a filling will solve the problem for either tooth.

One dentist offered PFM while the other recommended Zirconia. After researching both I believe Zirconia would be best if I develop gum recession. I do not want to see exposed metal.

Question:
1. is this a sound decisions?
2. which type or Zirconia is recommended for the two front teeth?

Thank you!

 

[honestdoc]

Great questions! I would go for Full Contour Zirconia (fake diamond). PFMs tend to look too opaque and the Porcelain layer over the metal tends to fracture. There are many grades of Zirconia ranging from the most durable (less esthetic) to the most esthetic (less durable). The dentist needs to evaluate your bite and assess the risks of fracture. If you have high risks of fracture, you may need to opt for the most durable. Emax crowns are very Hollywood esthetic, but they are not durable and will likely fracture.

 

[tonightwetaco]

Thank you for your input, honestdoc. My bite has been evaluated as low risk for fracture. The dentist is currently inquiring as to the grades of Zirconia produced by his lab. Hopefully, they offer the most advanced options presently available.

What is the best aesthetic grade of Zirconia? What are the top 3 best aesthetic grades HAHA.

Thank you for your continued help

 

[honestdoc]

There are many grades. Keep in mind the more esthetic grade Zirconia, the less strong and more likely to fracture.

 

[tonightwetaco]

is it correct that even the most esthetic grade of Zirconia is stronger than Emax, PFM or a real tooth?

Can you tell me what the most esthetic grades are called?

 

[honestdoc]

I've included a link about zirconia. https://www.ddslab.com/zirconia-in-dentistry/

Keep in mind that different dental labs have their proprietary products or vendors.

 

[brushandfloss]

Yes, you're correct. Even the most esthetic zirconia is much stronger than e.Max and the real tooth. These are measured in megapascal for strength and generally the more esthetic and translucent will have a lower MPa. You'd be looking for the more esthetic zir. since it's an anterior restoration. Ideally, you might want to look for a multi-layer which has up to 1,200 MPa and less translucent toward the margin and layers down to 500-700 MPa and much more translucent. The majority of labs will use zirconia since it's very esthetic and stronger than e.Max. You'll find e.Max mostly in office that offer crowns made in the dental office due to the machines their using and no need for a long "sinter." Zirconia is "sintered" at high heats over long duration to keep the esthetics but get the strength.
e.Max for refence now offers 500 MPa with a new version, up from the 260-300 previously. Higher=stronger.

Right now, there's more zirconia brands and companies to keep track. I wouldn't get caught up asking the Dr. or lab the brand of zir. but maybe ask to see some previous cases and pictures. Also, you can ask to visit the lab for a shade. The lab should be able to have you visit and match the shade of you existing teeth though a VITA shade guide.

 

[tonightwetaco]

thank you brushandfloss, wouldn't the dental office be able to decide the shade? I like the idea of visting the lab but I have a feeling the dentist will look at me like im nuts. thoughts?

 

[tonightwetaco]

spoke with my dentist and they recomended something like EMax as it is the most aesthetic. I asked them about strength and she told me not to bite anything harder than a raw carrot. Does that sound about right?

i am considering asking her about the most aesthetic zirconia her lab offers

 

[tonightwetaco]

my understanding is that the dentist not only thinks emax will be the most aesthetic but she also thinks Zirconia might damage my teeth, I assume this is do to bite.

i am scared to get Emax because I have chewed the way I chew for my entire life on this planet and now I am going to spend $3,000 for 2 crowns that could break that afternoon if I don't change my lifestyle immediately....

 

[honestdoc]

I would get an esthetic grade Full Contour Zirconia. I would strongly consider custom bite guard. If your dentist disagrees, see a different dentist. Zirconia does not damage the opposing teeth to the degree conventional porcelain does. You can protect them with the custom guard.

 

[tonightwetaco]

than you, honestdoc. The dentist told me that her concern is the tooth beneath the crown breaking if i go with something as sturdy as zirconia. She said the Emax will be very strong and I should be able to eat normally but I shouldnt bite silverware. she remarked that using our front teeth isn't really necessary and most people should be chewing with the backteeth.