Limited Space Calls for Multiple Monolithic Zirconia Bridges Over Titanium Subframe

The patient had an eight-unit PFM bridge on teeth #21-28 and complained about bulky incisal edges and chipped ceramics. Due to a medical issue, implants weren’t an option so we went with a removable solution: a milled titanium substructure with bi-lateral ball attachments and monolithic zirconia restorations.

Once I received the intraoral scans, I designed the full-contour restorations using Zirkonzahn’s Modellier software and included cutbacks for the framework. There was only .9mm of space from the prep to the occlusion, so I designed the framework to be as thin as possible. Also, because of the unique prep designs and path of insertions over the framework, I had to design three separate zirconia bridges.

I sent the framework out for milling; once I received it, I fitted the frame to a printed model and scanned it in order to finish designing the zirconia bridges, then milled them in house using my Zirkonzahn M5 milling machine and Zirkonzahn Prettau Zirconia.

For the pink ceramic, I used a variety of stains and ceramic powders from IPS e.max Ceram Gingiva by Ivoclar and, to characterize the teeth, I used the MiYO® Esthetic System from Jensen Dental. To help mask the framework, I anodized it to a nice yellow hue and cemented the bridges to the frame using Panavia V5 Opaque from Kuraray Noritake.