CASE REPORT pyrig

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A Multi-faceted Treatment Approach sse nc e fo r

for Anterior Reconstructions Using

Current Ceramics, Implants, and
Adhesive Systems
Jan Hajtó, Dr Med Dent
Specialist in esthetic dentistry (DGÄZ), Munich, Germany

Uwe Gehringer, CDT

Private practice, Munich, Germany

Mutlu Özcan, Prof Dr Med Dent, PhD

University of Zurich Dental Materials Unit, Switzerland

Correspondence to: Jan Hajtó

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Abstract
Of all developments in dental technol
ogy, fulfilling the esthetic and functional
demands of the patient, especially re
garding anterior reconstructions, is still
a challenge for both dentists and dental
technicians. This becomes more diffi
cult for patients with a previous treat
ment history that is not ideal. This case
presentation demonstrates reconstruc
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(Eur J Esthet Dent 2010;5:242–259)
n
ss e n c e
fo r
mandible with a combined treatment ap
proach utilizing veneers for harmonized
space distribution on the abutment teeth
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dental prosthesis in the anterior seg
ment of the maxilla. Adhesive cementa
tion of the restorations is also presented
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the current state of the art.

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 CASE REPORT
Introduction
Today, prosthetic and operative treat
ment concepts could be categorized as
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sive (partially reversible), and (more) in
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or zirconia copings. However, the pres
various materials. Dentistry, perhaps,
has the unique distinction of using the
widest variety of materials, ranging from
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composites and ceramics. Develop
ments, especially in the field of polymers

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and ceramics, have largely eliminated
the use of metals in the mouth. In spite of
all the advances, clinicians should real
ize the drawbacks before selecting the
most appropriate material for a particu
lar situation. Concentrating only on the
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nicians should be mindful of the best ap
plication method. As the esthetic aspect
of dental care becomes increasingly im
portant to patients, the dental practitioner
should be aware of the applications and
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restorative materials or systems and bal
ance these with the ethical aspects of
the invasive applications.
Fortunately, the dental profession has
profited from remarkable technological
advances in the substitution of missing
dental tissues and teeth. However, we
are still faced with the challenge of rep
licating the tooth tissues, mechanically,
physically, biologically, and optically.

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With the increased options, the choice of

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material is also becoming more difficult.
When a qualified ceramist is engaged,
pressed ceramics provide outstanding
results for a single anterior fixed dental
prosthesis (FDP), more so than almost
all other restorative options, with suitable
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marginal fit, minimal abrasion, and ss e n c e
fo r
servative tooth preparation. Yet they are
not as effective as reinforced ceramics
in preventing premature failure. On the
can be achieved using milled aluminous
ence of the relatively opaque internal
ceramic core may provide an impedi
ment to matching some tooth colors.
Although minimally invasive applica
tions are possible using direct compos
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the drawbacks of composites involve the
loss of surface lustre. This may require
repolishing, refinishing, or relayering.
This is commonly found to be the case
after several years of clinical function,
and therefore the maintenance of the
surface characteristics of composites,
even after finishing and polishing, is an
ongoing issue.
Minimally invasive applications are
also possible using ceramic veneers.
According to the majority of studies, it
is clear that from the mechanical point
of view, retention of laminates is not
seen to be problematic.4 Clinical stud
ies rarely report debonding, indicating
that the adhesion of the luting cement,
not only to dental tissues but also to the
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ic, is very reliable. Therefore the choice
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mechanical retention reasons cannot be
justified.
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preferable to metal ceramics due to be
ing minimally invasive, and also for es
thetic reasons. Nevertheless, teeth sur
rounded by healthy periodontal tissues
generally have a very high longevity, up
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utmost care should be taken to preserve
the cementoenamel junction. This may
not always be achieved, however, due to
required tissue sacrifice for esthetic rea
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will continue to dominate when choosing
one restoration type over another, or the
most suitable restorative materials for
the patient.
The situation becomes even more
complex when the patient has a history
of several treatment concepts that have

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failed. This case presentation could be


considered an example of the most mini

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mally invasive and durable approach
being practiced, according to the cur
rent state of the art and considering the
patient’s demands.
Materials and methods
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with an implant placed alio loco at tooth

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rarily rehabilitated situation in the max
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augmentation, the implant shoulder was
a permanent rehabilitation in both the

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maxilla and the mandible as quickly as

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possible. Since she had already been
through extensive therapy, her explicit
wish was to limit therapy as much as
possible, but at the same time accom
plish the best possible result. Among
others, the previous treatments involved
implantation and explantation in the re
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tissue augmentation in the region of teeth

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as very sensible, nervous, critical, and
unsure about the treatment outcome.
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Fig 1

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in the maxilla
In the maxilla, both bone loss and soft tis
sue loss were observed. The implant was
positioned correctly. However, despite
the previously accomplished soft tissue
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an individualized zirconium oxide (ZrO)
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and a short external hex connector of
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ance against loading of the connection.
During cyclic loading, vibrations and
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the two participating materials occurs
with the consequence of material loss at
the surface. For the wear process, not
only the roughness but also the hard
ness of the material plays a role. ZrO

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Fig 2

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der is hardly covered with gingiva. abutment with traces of worn titanium and food de
bris at the inner side.

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mm, being relatively harder than that of

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pontic showed a correct contact surface
loose fit between the implant body and
various tested abutments were deter
mined.7,8
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terface can never be avoided. Also in
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the ZrO
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a titanium base, and to thin the titanium
debris and biofilm on the inner surface
of the abutment were indicators of the
presence of an insufficient connection.
The high rotational forces of the can
tilever pontic are another unfavorable
factor in such a material combination.
Changing the implant geometry by
grinding must be considered a major
complication since, in the case of a re
pair, the new restoration would require
a direct impression followed by manu
facturing and inserting an individually
cast abutment. In the described case,
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beyond (cervically) the finishing line of
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to the gingiva.
The therapy concept
tion, it was decided to construct a new
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base on the labial side to the minimum
thickness possible. In such difficult cas
es, the crown margin should be posi
tioned labially and cervically, as much
as possible, in order to avoid any expo
sure of the zirconium abutment. If fur
ther recession occurs, the finishing line
between crown and abutment would be
visible.
Accomplishing a perfect harmony
from an esthetic standpoint is more diffi
cult when fewer teeth are subject to treat
ment in a given segment of the dental
arch. In the presented case, the baseline
situation exhibited asymmetric positions

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Fig 4 The digital modeling of the new ZrO abut Fig 5 The new finished individual ZrO abutment
ment. Note that due to the low implant depth, the MVUFE
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shoulder of the titanium adhesive base had to be #BEFO
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designed short. With this approach the metal mar
gins were achieved almost invisibly.

of the lateral incisors due to soft tissue

loss and the rotation of the lateral inci
sors. In order to fulfill the high esthetic
demands of the patient, it was decided
to involve these two teeth in the recon
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as an abutment tooth was planned (Figs
4–8). This relatively invasive treatment
option was chosen for two reasons: (1) Fig 6

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;S0 framework.
With ZrO fixed dental prostheses, it is important
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sion bridge seemed questionable, and CVU
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(2) a harmonious optimal closure of the a rounded cervical transition shape from abutment
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to the pontic.

possible. In such a case, with several

extracted neighboring teeth, the papilla
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preservation of the pulp. In the anterior
area, it is considered an appropriate
clinical practice to reduce the zirconium
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Fig 7 The labial position of the connector requires
ing, it is possible to achieve a good es
precise planning. In this case, the waxup yielded a
thetic outcome even with minimal space palatal position of the connectors to obtain a maxi
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mum thickness strength also at the proximal areas.

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a b

Fig 8 The labial surface of the ZrO
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maximum thickness of the veneering ceramic.

Fig 9

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unchanged, which is too narrow and tilted distally, (FSNBOZ

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is an esthetic compromise. With the consent of the TJCMF
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patient, a labial veneer was placed to improve the
esthetics.

is one of the most important steps of the

treatment and should be practiced sev
eral times if necessary. During bisque
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taken into consideration:
n fit of the abutments
n proximal contacts
n basal shape and contact of the pon
tics with the gingiva
Fig 11 Temporarily cemented fixed dental pros n occlusion
thesis (bridge) for several days with the veneer on n perception of the reconstruction with
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the tongue
mandible.
n phonetics
n esthetics.

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The control of the position of the pon
tics in relation to the gingiva is especially
important. Corrections can be made by
removing ceramic or by adding material,

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and the correct relationship should be
communicated to the dental technician.
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The veneers had to be made twice since
the form did not suit the clinical require
ment at the first attempt and the color

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was too light. (With veneers, the color
of the ceramic should be correct right
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composite gives only very limited scope
for change. For this reason, it is pre
ferred to remake a veneer if the color is in
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n enlarge the abutment teeth with
sure about the final treatment outcome,
despite great care and individual adjust
ments, the finished work was cemented
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is rarely performed due to possible dam
age occurring during the temporarization
period or during removal of the restora
tion. It is, however, sometimes necessary
if the patient specifically requests it.

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in the mandible
The missing tooth could be replaced
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The question was which design would be
best. Extension of the wings over more
than one abutment tooth has yielded
clinically unfavorable outcomes, the dis
tally connected tooth showing delamina
tion over time. The question of whether
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ss e n c e
fo r
by Kern. Clinical data have clearly
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However, it is the present authors’ expe
design functions very well. For this rea
the mandible, the gap was significantly
larger than the usual width of the man
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the best esthetics are achieved when
the width is distributed equally to each
tooth. As to how this can be realized, the
theoretical possibilities are as follows:
n enlarge the abutment teeth with
composite
ceramic as an integrated part of the
bridge
n make separate additional veneers.
The therapy concept
In order to close the proximal gap as
much as possible towards the cervical,
the authors’ preference was the last op
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would have required firing on veneer
ing ceramic without an adequate sup
porting substructure, which seemed
questionable from a technical point of
view. Furthermore, the required inser
tion path would have created problems
cervically. The possible aging of the
composite was the reason for rejecting
the first option. The contact points of the
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determined using a laboratory paralel
lometer. Additional veneers are virtually
invisible on teeth as long as the finishing
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Fig 12 The wax setup on the prepared tooth Fig 13 Waxup of the required enlargement of the
serves as a quick impression of the width discrep neighboring teeth.
ancy and the gap between the abutment teeth (set
up system: Anteriores Set, Wichnalek, Augsburg,
Germany).

Fig 14 For a better visualization of the width distri Fig 15 Additional ceramic veneers (Creation
bution, gold powder was used on the waxup. Classic) on the plaster model.

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to the tooth’s long axis may be visible in
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some cases. After adhesive cementa
tion of the veneers, a new impression
 Of all possible alternatives,
was made. The construction of the ZrO
framework was achieved using an es
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is not etchable, a clean and rough sur
The surface treatment of the ZrO for
adhesive cementation can be achieved
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ing primer and the corresponding ce
ment.
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ing effect.
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face is obtained that ensures wetting of
the surface, which is a prerequisite for
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Fig 16 The already accomplished lingual prep Fig 17 Proximal veneers.

aration is completed with additional veneers. The
sharp finishing line is placed backwards behind
the middle in order to enable a smooth adaptation
between the etched feldspathic ceramic and the
ZrO framework. Central positioning grooves in the
preparation make cementation easier.

Fig 18

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dental prosthesis.
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coat the cementation surfaces with Co In the case presented, the whole lin
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gual surfaces of the teeth and the proxi
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clinical study available on the effect of ,
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ceramics on clinical behavior. Aging 'JOBMMZ
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was reported to have a detrimental ef QIPTQIPSJD
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Fig 20

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Fig 21

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dental prosthesis on the model. two wings (two bonded retainers). ZrO framework
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retainers were not veneered.

Fig 22 Silica coating of the cementation surfac Fig 23 Application of the silane coupling agent
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.
&41&
(Monobond S, Ivoclar Vivadent, Schaan, Liechten
Seefeld, Germany). TUFJO

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UP
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Fig 24

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DPN Fig 25

$MFBOJOH
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,

posite (Variolink II, Ivoclar Vivadent, Schaan, Liech Max, EMS).
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PO
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PG
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bonded fixed dental prosthesis.

252
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Fig 26 Cementation of the ZrO
SFTJOCPOEFE
Fig 27

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mYFE
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BG

fixed dental prosthesis and photopolymerization. ter the adhesive cementation in situ.

Fig 28 The final treatment result.

253
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 CASE REPORT
conditioned, followed by the application
PG
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DMBTTJD
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TZT
tem (Syntac, Ivoclar Vivadent, Schaan,
Liechtenstein). The cementation was
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cement (Variolink® II, Ivoclar Vivadent)
'JHT

UP


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final treatment result.
Discussion
Unfortunately, there is rarely a single so
lution for all problems in dentistry and
dental technology. In most cases, den
tists find solutions for individual situa
tions and individual complications. The
presented case involved several such
challenges and indicates that esthetics
in reconstructive dentistry is an extremely
demanding discipline requiring experi
ence and knowledge, and the poten
tial to apply both. The esthetic aspect
of treatment always adds an additional
requirement to the medical basics, and
sometimes competes with them, mak
ing the whole treatment more difficult.
Good esthetics do not happen neces
sarily as a consequence of correct den
tal and medical treatment. Often there
is a need to do more. Furthermore, the
individual patient’s wishes need to be
taken into consideration. Patients with
high esthetic demands require good
management, which can create chal
lenging situations.
The present case illustrates, from dif
ferent angles, the demanding daily task
of the practicing dentist to apply modern
and advanced methods and at the same
time assess their benefits and risks. With
the increasing complexity of cases, the
responsibility of the clinician is increas
254
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lica
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ing. The solutions demonstratedt eshould
n
ot
n
ss e n c e
fo r
not be considered the most correct
USFBUNFOU

JOTUFBE
UIFZ
JMMVTUSBUF
UIF

thought process during the planning of
such complex cases. Whilst almost two
decades ago the missing teeth in such
FDPs, with the preparation of at least four
abutment teeth, today there is the pos
sibility of using implants and zirconium
oxide frameworks, but these also require
NPSF
FYQFSJFODF
BOE
LOPXIPX
*O
DPO
sidering hard and soft tissue augmen
tation and the indications for implants,
their number, position, system, design,
and the dental material itself need to be
considered in the treatment planning, as
well as time management on the part of
the dental professional.
5IF
TUBUFNFOU
i)JHIUFDI
EFOUJTUSZ

JT
IJHISJTL
EFOUJTUSZw
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BDDFQUFE

saying a decade ago but it is not true
BOZNPSF
$"%$".
NJMMFE
;S0 frame
works and glass ceramic restorations
(eg, lithium disilicate) are more reliable
GVMMDFSBNJD
NBUFSJBMT
UIBO
NBOVBMMZ

produced ceramics. Today, the follow
ing statement is more valid: “High es
UIFUJDT
EFOUJTUSZ
JT
IJHISJTL
EFOUJTUSZw

The more esthetic the material is, or the
more translucent the ceramic, the weak
er it is. Moreover, the higher the esthetic
demands, the more difficult it is to es
tablish static and mechanically strong
restorations. Today, ZrO implants and
ZrO abutments that are screwed direct
ly onto the titanium implants are still an
experimental solution.
The pressure from the market is trig
gering sales of such untested medical
products, and every practitioner needs
UP
EFDJEF
GPS
IJNIFSTFMG
IPX
BOE
XIFO

such progressive alternatives should be

applied in their own practice. With the
presented adhesive abutment solution
in the maxilla, it is clearly shown that
even in such challenging situations it is

GSFRVFOU
DPN
possible to offer, in borderline cases, a

XFSF
SFQPSUFE
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relatively safe and clinically proven so
lution. The most probable risk here is
the debonding of the ZrO restorations.
*O
TVDI
B
TJUVBUJPO

B
OPOQSPCMFNBUJD
DFTTw
JT
VTFE
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'%1
SFNBJOFE


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PS
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CF

an easy solution. Adhesion of ZrO abut
ments to titanium bases is successful
in vitro and has become successful
clinical practice for years in the authors’
office as well as in many others.
Regarding the mechanical stability of
the components, the alternative titanium
abutment in combination with metal
frameworks is considered the most reli
able option with the longest track record.
The chosen material combination in the
presented case must still prove its lon
gevity in the clinic. However, experience

SFTQFDUJWFMZ

with several such cases is promising.
The most difficult decision in this case
XBT
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PO
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UZQF

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issue was discussed intensively with the
patient. A series of review articles tried to
BOTXFS
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supported FDPs or combined implant–
UPPUITVQQPSUFE
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restorations.
5IF
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studies that met the inclusion criteria
indicated an estimated survival rate for
JNQMBOUTVQQPSUFE
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PG

BGUFS


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tion. The survival rates for the implants
UIFNTFMWFT
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supported cantilever FDPs show lower
to Pröbster a prosthetic restoration sys
tem can be regarded as successful if it
HAJTÓ ET ALopyrig
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tio
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TIPXT
B
DMJOJDBM
TVSWJWBM
SBUF
PG

BGUFS

ss e n c e
fo r

ZFBST
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tion. Against the high survival rates for
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the first 5 years in the same study.
These included chippings and loosen
ing or fracture of screws. The term “suc
unchanged and free of all complications
over the entire observation period. The
reported complication rates indicate that
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ally carry a high risk of retreatment and
require maintenance services. In a
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that met the inclusion criteria, combined
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a significantly lower estimated survival
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However, the complication rates related
to the implants alone ranged between

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that presented a figure considerably low
FS
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restorations.
In the present case, the issue in ques
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have a higher survival and lower com
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FDP supported by a single implant.
Thus the decision made for this case
deviates from the situations analyzed
in the dental literature. Although trends
can be observed, the literature does not
QSPWJEF
BO
BOTXFS
/POFUIFMFTT
survival rates and higher complication
rates than those of conventional FDPs
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 CASE REPORT
supported by at least two abutments.
This indicates that the leverage forces
created by a cantilever should, in gen
eral, be regarded as mechanically prob

,OPXJOH
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UIF
POFXJOH

lematic.
Due to the fact that the diameter of
the implant and of the external hex was
small and that the vertical dimension of
the prosthesis was high, and that there
fore strong leverage forces were to be
expected, the conventional bridge solu
UJPO
XBT
DPOTJEFSFE
TBGFS
UIBO
B
GSFFFOE

pontic. This assessment was confirmed
by the fact that the temporary restora
tions showed multiple debondings. The
implant situation was given and, accord
ing to today’s possibilities, correct as
well. The presence of two neighboring
implants in the anterior region is a de
manding esthetic challenge for the pros

EVSJOH
NPSF
UIBO

ZFBST

thodontist, due to the soft tissue (ie, pa
pillae) problems. In fact, an implant can
POMZ
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the abutment tooth and at the same time

UIFTF
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replace the missing tooth. Therefore the
decision to incorporate a crown on tooth

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from an ethical standpoint as well.
The situation in the mandible is a clas
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cially true after an already failed implant
BUUFNQU
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FDP would require much hard tissue
loss. In cases where there are soft tissue
recessions in combination with small root
diameters at the gingival level, a correct
crown preparation is almost impossible.
4VDI
3#'%1T
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CF
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ics have been shown to be a successful
treatment option.
 The disadvantage dentist to make the right decisions to
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JO
B
DBTF
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256
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te ot n
n
where an unnoticed fracture, debond
ss e n c e
fo r
ing, or delamination occurs, second
ary caries on the abutment tooth could
occur.
3#'%1
IBT
BO
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ity record, other options are not justi
fied in such a situation. The most com
NPO
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GPS
3#'%1T
JT
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lateral incisors in the maxilla. Splinting
the central incisor with the canine of the
TBNF
TJEF
VTJOH
BO
3#'%1
IBT
QSPWFO

to be not physiologic. The experience of
UIF
BVUIPST
SFHBSEJOH
TVDI
3#'%1T
JO

the maxilla has shown unilateral debond
ings in many cases. A possible reason
for these debondings could be stress at
the adhesive interfaces due to uneven
tooth mobility of the anterior maxillary
teeth under physiologic functional load.
*O
DPOUSBTU
of observation, no unilateral debonding
XBT
PCTFSWFE
JO
UIF
NBOEJCMF
XJUI
BMM
DFSBNJD
3#'%1T
NBEF
PG
MJUIJVN
EJTJMJ
cate.
'VSUIFSNPSF
made specially with proximal grooves
but no wings. This indicates that in the
mandible, the load is directed axially
rather than lingually, which may explain
XIZ
UXPXJOH
3#'%1T
XFSF
NPSF
TVD
cessful. Similarly, Kern et al found all
POFTJEFE
EFCPOEJOHT
FYDMVTJWFMZ
JO
UIF

maxilla. The question remains whether,
under the assumption that in the mandi
ble both options could function clinically,
a second wing is necessary. Even if the
potential danger of a connector fracture
is present, in the present authors’ opinion
UIF
UXPXJOH
EFTJHO
JT
GBWPSFE
it allows for thinner connectors.
The discussion above clearly un
derlines the difficulty of the practicing

Also, the question regarding durabil
ity of the adhesive cementation with a
OPOFUDIBCMF
DFSBNJD
[JSDPOJVN
PY
ide ceramic remains unanswered. The
longest clinical experience exists with
HMBTTJOmMUSBUFE
BMVNJOVN
PYJEF
DFSBN
ics. The results with this material indi
DBUF
UIBU
TVSGBDF
DPOEJUJPOJOH
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BJS

 Which
abrasion using alumina, and the use of
a primer and adhesive with bifunctional
(MDP) monomers, yields a good clinical
survival rate. However, in vitro micro
tensile tests showed unfavorable results
GPS
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PG
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UP
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Ceram®
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after artificial aging conditions.
 For Conclusions
pure zirconium oxide, such information
is limited in the literature. In general,
JU
DBO
CF
BOUJDJQBUFE
UIBU
BMM
LJOET
PG
OPO
etchable ceramics would behave simi
MBSMZ
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UIF
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from in vitro studies, the aging effect on
the adhesive interfaces and thereby the
durability of the adhesion is the Achilles’
heel of such therapies.
 tion, based on the current state of the art
A possible structural change through
air abrasion in the stabilized zirconium
oxide could be a concern. Limited in
formation is available on the possible
negative effects of air abrasion on zir
conium oxide. The opinions on this
aspect are controversial.
 Neverthe is important to learn from previous unfa
less, chairside application of silicatiza
tion was claimed to be less hazardous
on the material properties of zirconium
oxide than laboratory air abrasion utiliz
ing alumina.
Air abrasion could be expected to
create damage in the form of delamina
tion or total fracture according to cur
rent knowledge. However, it depends
on several other parameters. It was,
however, claimed that the cleaning of
HAJTÓ ET ALopyrig
No C
ht
t fo
rP
by N
ub
Q ui
lica
tio
te n
ot
n
cementation surfaces is best achieved ss e n c e
fo r
with air abrasion. Since oxide ceram
ics do not contain silica, as an alternative
UP
UIF
BEIFTJWF
DFNFOUBUJPO
XJUI
.%1
containing cements, chairside silica
coating and silanization could be con
sidered in combination with dual polym
FSJ[FE
#JT(."
DFNFOU
method for the cementation of zirconium
oxide would be clinically more success
ful needs to be determined. Therefore,
such cases are currently under review
in the present authors’ practice.
Missing teeth can be restored both func
tionally and esthetically utilizing treat
ment modalities such as veneers and
TVSGBDFSFUBJOFE
3#'%1T
DPVQMFE
XJUI

implants and zirconia suprastructures.
The durability of such restorations can
be achieved through adhesive cementa
derived from both clinical and laboratory
studies. This clinical example illustrates
the particular challenge for any clini
cian when confronted with exceptional
situations, where former experience or
scientific evidence may not followed. It
vorable applications and inappropriate
assessments or decisions affecting the
individual and to keep an open mind re
garding treatment concepts in the light
of new findings and experiences.
257
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 CASE REPORT pyrig
No Co

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ub

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lica
tio
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n
References ss e n c e
fo r

½[DBO
.
"OUFSJPS
EFOUBM

&EFMIPGG
%
FU
BM
7PMMLFSB 
"NBSBM
3
½[DBO
.
7BMBO
restorations: direct compos mische Restaurationen. ESP
-'
#BMEVDDJ
*
#PUUJOP

ites, veneers or crowns? In: Interdiszipl J Restaurat Zahn MA. Effect of conditioning
3PVMFU
+'
BOE
,BQQFSU
)'
IFJMLE
 methods on the microtensile
Statements: Diagnostics and 
)BKUØ
+
4DIFOL
)
-JDI bond strength of phosphate
Therapy in Dental Medicine tdurchflutete Frontzahnkro NPOPNFSCBTFE
DFNFOU
PO

5PEBZ
BOE
JO
UIF
'VUVSF
#FS nen, Teil I. Das Dental Labor, zirconia ceramic in dry and
MJO
2VJOUFTTFODF
1VCMJTIJOH

-7
)FGU
 BHFE
DPOEJUJPOT
+
#JPNFE


 
)BKUØ
+
7FOFFST.BUFSJBMJFO
.BUFS
3FT
#
"QQM
#JPNBUFS



5JOTDIFSU
+
;XF[
%
.BSY
3
und Methoden im Vergleich. 
Anusavice KJ. Structural reli Interdiszipl J Restaurat Zahn 
&CFSU
"
)FEEFSJDI
+
,FSO

BCJMJUZ
PG
BMVNJOB
GFMETQBS
IFJMLE
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MFVDJUF
NJDB
BOE
[JSDPOJB 
,FSO
.
$MJOJDBM
MPOHUFSN
ceramic copings bonded
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PG
UXPSFUBJOFS
BOE
to titanium abutments. Int
 TJOHMFSFUBJOFS
BMMDFSBNJD
J Oral Maxillofac Implants


.PODBEB
(
'FSOÈOEF[
&
SFTJOCPOEFE
mYFE
QBSUJBM

Martín J, Arancibia C, Mjör EFOUVSFT
2VJOUFTTFODF
*OU

-BOH
/1
1KFUVSTTPO
#&

IA, Gordan VV. Increasing  5BO
,
#SBHHFS
6
&HHFS
.

the longevity of restorations 
#MBU[
.#
4BEBO
"
.BSUJO
Zwahlen M. A systematic
by minimal intervention: a +
-BOH
#
In vitro evalua review of the survival and
UXPZFBS
DMJOJDBM
USJBM
0QFS
tion of shear bond strengths complication rates of fixed
%FOU
 PG
SFTJO
UP
EFOTFMZTJOUFSFE
partial dentures (FPDs) after
4. Peumans M, van Meerbeek IJHI
QVSJUZ
[JSDPOJVN an observation period of at
#
-BNCSFDIUT
1
7BOIFSMF
(
PYJEF
DFSBNJD
BGUFS
MPOH least 5 years. II: Combined
Porcelain veneers: a review term storage and thermal UPPUIoJNQMBOUTVQQPSUFE

of the literature. J Dent cycling. J Prosthet Dent FPDs. Clin Oral Implants Res
  


)PMN1FEFSTFO
1
-BOH

8PMGBSU
.
-FINBOO
'
8PM 
1KFUVSTTPO
#&
5BO
,
-BOH

NP, Müller F. What are the fart S, Kern M. Durability of /1
#SBHHFS
6
&HHFS
.

longevities of teeth and oral the resin bond strength to Zwahlen M. A system
implants? Clin Oral Implants zirconia ceramic after using atic review of the survival
3FT
 4VQQM


different surface condition and complication rates


#SPECFDL
6
5IF
;J3FBM
ing methods. Dent Mater of fixed partial dentures
post: a new ceramic implant  (FPDs) after an observation
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:BOH
#
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period of at least 5 years.
%FOU

HC, Scharnberg M, Wolfart *
*NQMBOUTVQQPSUFE
'1%T

7. Garine WN, Funkenbusch S, Ludwig K, Adelung R, Clin Oral Implants Res
PD, Ercoli C, Wodenscheck Kern M. Influence of saliva 
J, Murphy WC. Measure contamination on zirconia 
1KFUVSTTPO
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#SÊHHFS

ment of the rotational misfit ceramic bonding. Dent Mater U, Lang NP, Zwahlen M.
BOE
JNQMBOUBCVUNFOU
HBQ
 Comparison of survival
PG
BMMDFSBNJD
BCVUNFOUT
*OU

:BOH
#
8PMGBSU
4
4DIBSO and complication rates of
J Oral Maxillofac Implants berg M, Ludwig K, Adelung UPPUITVQQPSUFE
mYFE
EFOUBM

 R, Kern M. Influence of prostheses (FDPs) and


,BOP
4$
#JOPO
11
#POGBOUF
contamination on zirconia JNQMBOUTVQQPSUFE
'%1T

G, Curtis DA. The effect of ceramic bonding. J Dent Res and single crowns (SCs).
casting procedures on rota  Clin Oral Implants Res
tional misfit in castable abut 
2VBBT
"$
:BOH
#
,FSO

ments. Int J Oral Maxillofac .
1BOBWJB
'

CPOEJOH

5BO
,
1KFUVSTTPO
#&
-BOH

*NQMBOUT
 to contaminated zirconia NP, Chan ESY. A systematic


;JQQSJDI
)
8FJHM
1
-BOHF
ceramic after different clean review of the survival and
#
-BVFS
)$
&SGBTTVOH
ing procedures. Dent Mater complication rates of fixed
Ursachen und Folgen 
partial dentures (FPDs) after
von Mikrobewegungen 
½[DBO
.
7BMMJUUV
1,
&GGFDU
an observation period of at
BN
*NQMBOUBU"CVUNFOU of surface conditioning meth least 5 years. III: Convention
Interface. Implantologie ods on the bond strength of al FPDs. Clin Oral Implants
 luting cement to ceramics. 3FT

%FOU
.BUFS


258
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 HAJTÓ ET ALopyrig
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ss e n c e
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1SÚCTUFS
-
,MJOJTDIF

7BO
%BMFO
"
'FJM[FS
"+

½[DBO
.
,FSLEJKL
,4

Erfahrung mit vollkera Kleverlaan J. A literature Valandro LF. Comparison
mischem Zahnersatz – Ein SFWJFX
PG
UXPVOJU
DBOUJMFW of resin cement adhesion
Rückblick. In: Kappert HF ered FPDs. Int J Prosthodont UP
:5;1
DFSBNJD
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(ed). Vollkeramik: Werk  manufacturers’ instructions
TUPGGLVOEF;BIOUFDIOJL 
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