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 Implant-Supported Zirconia
Full-Mouth Rehabilitations:
Key Factors

Alvaro Blasi, DDS, CDT1

Aram D. Torosian, MDC, CDT2
Somkiat Aimplee, DDS, MSc, FACP3
Sung Bin Im, MDC, CDT, BS2
Amy M. Camba, DMD4
Gerard J. Chiche, DDS5

Adjunct Assistant Professor, Department of Oral Rehabilitation,

1

Augusta University, Dental College of Georgia, Augusta, Georgia, USA;

private practice in Barcelona, Spain.
Master Dental Ceramist, Ronald Goldstein Center for Esthetic and
2

Implant Dentistry, Augusta University, Dental College of Georgia,

Augusta, Georgia, USA.
Adjunct Assistant Professor, Oral Rehabilitation Department, Augusta
3

University, Dental College of Georgia, Augusta, Georgia, USA; private

practice in Bangkok, Thailand.
Adjunct Assistant Professor, Oral Rehabilitation Department, Augusta
4

University, Dental College of Georgia, Augusta, Georgia, USA; private

practice in Alpharetta, Georgia, USA.
Director, Ronald Goldstein Center for Esthetic and Implant Dentistry,
5

Augusta University, Dental College of Georgia, Augusta, Georgia, USA.

Correspondence to: Dr Alvaro Blasi, Blasi Clinic, Muntaner 341 3-3,

Barcelona 08021, Spain. Email: [email protected]

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 BLASI ET AL

Fig 1  Component space requirements for full-arch implant-

supported restoration.
2 mm

2–3 mm

10–11 mm

14–16 mm

I
mplant-supported zirconia full-mouth rehabilitations etiology should be combined with differential diagnosis to
have become a common treatment option for patients determine if the patient’s dentition has been worn due to
with failing dentitions or edentulism.1–7 Although zirco- attrition, abrasion, erosion, or a combination of these. In cir-
nia is a material with good properties, practitioners and den- cumstances of abrasion and erosion, it is important to focus
tal technicians have been designing zirconia restorations on changing the patient’s habits or treating gastrointestinal
applying the same principles that were used when fabri- issues to avoid further loss of tooth structure prior to any
cating metal-ceramic or metal-acrylic restorations.7–13 Some restorative treatment.15–20 After the cause of the wear has
of the adverse outcomes have been failure due to chipping been eradicated, these patients have a low to medium risk
and fractures.9,14 Success and long-term stability of implant- of restoration failure. Patients with attrition have the high-
supported zirconia full-mouth restorations can be achieved est risk for restoration failure, and diagnosis of the cause
when important parameters are followed in detail: of the attrition should be made (brain-mediated bruxism,
breathing disorders, occlusal disharmony, etc). The main
1.  Treatment plan (etiology and differential diagnosis; space focus should be to treat the cause rather than just the
and dimensional requirements; number and position of symptoms. However, even after treating the cause of attri-
implants; guided surgery and immediate loading protocol) tion, high-strength all-ceramic restorations must be utilized
2.  Framework design (thickness requirement and esthetics) due to these patients’ high functional-risk prognosis. When
3.  Material selection for opposing arch patients present with existing restorations, they should be
4.  Occlusal considerations analyzed for signs of attrition, with special attention to the
location of wear patterns to determine their pathway. Pa-
Appropriately addressing these four factors will allow tients who have worn prostheses for many years with no
the clinician to deliver long-lasting implant-supported zir- signs of attrition would be at low risk for fracture, whereas
conia full-mouth restorations with reduced risk of chipping patients with broken or worn prostheses would be consid-
and fractures, especially in patients with heavy occlusal ered to have a high functional-risk prognosis.
function.

Space and Dimension Requirements

TREATMENT PLAN Treatment planning for a full-arch implant-supported res-
toration can be an arduous process.20,21 The starting point
Etiology and Differential Diagnosis is usually to determine the desired incisal edge position in
relation to the upper lip at rest.22,23 The amount of display
The etiologic factors that produce a failing dentition or would be based on the patient’s gender and age and the
edentulism have a major impact on decisions in treat- necessity to hide the transition zone between the restora-
ment design. In patients with worn dentition, diagnosis of tion and the gingiva.24,25

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

Implant number and position

1 2
1. AP Spread + Cantilever 3
3
2. Safety zone implant X

3. Fill the gaps 2 2

1 1
Y

Fig 2  Illustration of eight well-distributed implants in the maxillary arch.

Depending on the material selected for the restoration, full-mouth implant-supported prosthesis. The dimensions
there is more or less need of interarch space. When using also change depending on the location within the mouth,
zirconia, there must be sufficient space based on interarch as there are greater forces in the posterior and less in the
position in the mouth, distance between supporting im- anterior.26–29 Zirconia around the screw access hole should
plants, presence of cantilever, and likely occlusal loading. be at least 2 mm thick to ensure strength. Dimensions for
The component-based space requirement for the tita- connectors should be at least 7.0 mm2 in the anterior area
nium interface is 2 mm. The interface will prevent any dam- while 9.0 mm2 in the posterior area. Dimensions for two
age to the implant head due to contact with the zirconia. pontics in the anterior and posterior should be 12.5 mm2. A
A minimum of 2 to 3 mm of space is needed for pink por- cantilever should be 6.0 mm2 in the anterior area, while 36
celain for a natural-looking restoration, with 10 to 11 mm mm2 would be required in the posterior.26–29 The authors
of space for tooth length to achieve esthetic proportions. recommend limiting posterior cantilevers to two premolars
In total, these components require 14 to 16 mm of space or one molar.
in the anterior region between the implant head and the
desired final incisal edge location (Fig 1).
Because the prosthesis design is initially based on in- Implants: Number and Position
cisal edge position, it will also be influenced by lip mobil-
ity. The interface between the prosthesis and the gingiva The number of implants needed for a full-arch fixed pros-
should be located 3 to 5 mm above the highest position thesis is a controversial topic. The prescribed numbers vary
of the lip during maximum smile.21 Vertical bone reduction from 4 to 12 implants depending on the authors.30–32
would be planned according to these numbers. A zirco- The present authors’ preference for implant number
nia prosthesis should always be considered as an option and position is to have eight implants well distributed
when there is more than 12 mm from the desired incisal within the maxillary arch, especially when opposing natural
edge to the bone crest. If there is 12 mm or less, an im- dentition (Fig 2). The approach goes as follows: (1) One
plant-supported fixed prosthesis with no pink should be implant is placed in the most anterior position of the arch
fabricated instead of performing aggressive vertical bone and two implants in the most posterior area; these implants
reduction.4,24 Interarch space can also be increased by in- will provide the most ideal anterior-posterior spread for
creasing the patient’s vertical dimension of occlusion.15 the mechanical behavior of the prosthesis, and they will
Every material has a different behavior in function, and also reduce cantilever length. (2) One implant is placed as
it is important to fabricate prostheses with the dimen- close as possible to each of the three implants already in
sions each material requires to have adequate fracture place; these safety implants would be used if any of the
strength. The thickness requirements of zirconia change initial implants failed over time, in which case there would
when it is used on natural dentition, a single implant, or a be no need to place another implant or reduce the pros-

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 BLASI ET AL

3a 3b 3c

Figs 3a to 3c  Surgical guide is used to optimize implant position, angulation, and depth in guided implant surgery.

thesis length.33 (3) One implant is added per side between FRAMEWORK DESIGN
the two anterior implants and the four posterior implants
if there is enough space; these would reduce pontic num- Thickness Requirements
bers and stress during function.
The framework design depends on a combination of risk
factors, opposing dentition, and material. The framework
Guided Surgery and Immediate Loading should always meet the minimum thickness requirements
Protocol for zirconia fixed partial dentures. The preparation design
for an all-ceramic crown typically provides more than ad-
Flapless guided surgery is the treatment of choice if there equate space for layering feldspathic porcelain on a full-
is no need for bone grafting or bone reduction during im- arch zirconia implant-supported prosthesis. However, in
plant placement. The surgical guide should be fabricated high-risk cases it is better to be conservative when cut-
from a diagnostic wax-up, not based on an existing func- ting back the framework. A general rule for a conservative
tionally inadequate or esthetically unpleasing prosthesis. design/cutback is 0.7 mm on the gingival aspect and 0.7
The guided surgery approach optimizes implant position, to 1.0 mm on the buccal aspect of teeth, while the occlu-
angulation, and depth (Figs 3a to 3c). Consequently, there sion on the posterior and lingual of the anterior are kept in
is less discrepancy between the planned and the final po- zirconia extended to the incisal edge for full support of the
sition of the implants and less time in surgery.34,35 layered ceramics. This is similar to the preparation design
An immediate loading approach, in which the implants of a laminate veneer based on the principle that all func-
and prosthesis are placed the same day, has been favor- tional contacts should be in zirconia.
ably reported in the literature with high success rates.35 It The authors combined the preparation principles of
can be performed in medium- and low-risk patients when porcelain-fused-to-metal and porcelain-fused-to-zirconia
implants have good primary stability of at least 35 Ncm. restorations with clinical experience and classified frame-
Favorable loading conditions can be achieved by splinting work design into three categories. The framework design
the implants together immediately after placement. Ac- is individualized based on each patient’s function and risk
cording to Jivrav and Chee,21 the prosthesis should sat- assessment. The more evidence there is of bruxism, the
isfy the following requirements: (1) cross-arch stabilization higher the risk. Also factored in is how much translucency
with a screw-retained rigid prosthesis with no cantilevers; and depth are indicated in the prosthetic teeth, and finally,
(2) no premature occlusal contacts; (3) no interferences in the type of opposing dentition.
lateral excursion with canine guidance; 
(4) minimal verti- The categories are as follows (Fig 4):
cal and horizontal overlap; and (5) adequate esthetics.
•  Type A: HIGH RISK (full lingual supported)—0.7- to 0.9-
mm maximum reduction, facial only

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

Fig 4  Framework design

categories based on Type A Type B Type C
patient’s risk factors. High risk Medium risk Low risk
Full lingual Linqual Conventional
supported supported reduction

•  Type B: MEDIUM RISK (lingual supported)—0.7- to 0.9- Esthetics

mm facial, 0.5-mm incisal reduction
•  Type C: LOW RISK (conventional reduction)—0- to 1.2- A seven-step esthetic analysis is a good guideline to fol-
mm facial, 1.0-mm incisal reduction low for evaluating a patient’s esthetic requirements and
designing the final prosthesis. It consists of evaluating the
The key is to achieve a uniform cutback and a frame- (1) smile line, (2) incisal profile, (3) length, (4) proportion,
work design that allows a uniform thickness of ceramic (5) tooth-to-tooth proportion, (6) gingival outline, and (7)
while maintaining maximum ceramic support. A two-step desired fullness. The information from the analysis is used
cutback procedure of a duplicated prototype, which will to refine the esthetic design and fabricate the surgical
eventually be copy milled into the definitive framework, is guide, provisional, and final prosthesis.22
recommended. The cementoenamel junctions and gingival The final prosthesis will be a combination of zirconia
areas are marked with a thin Sharpie pen to provide an framework and layered feldspathic porcelain.8 The color
outline for a controlled cutback. With a set of lingual and and value of the framework can greatly influence the final
facial matrices, diamond burs can be used to achieve the esthetic outcome of the restoration. Use of a white zirco-
final framework design. The gingival area should be pre- nia framework will have a significant effect on the target
pared with 0.5-mm depth-cutting burs to achieve a uniform shade, even if the ceramic of the target shade is used in
reduction. Following the cutback of the gingival area, the the build-up. The solution is to use internal stains during
facial tooth surface is then marked with a thin Sharpie pen, application of the feldspathic porcelain to achieve a chro-
and similar to the gingival area, reduced in three planes to ma and value similar to that of the target shade. Internal
a depth of 0.5 mm. stains add minimal bulk while giving the ceramist the ability
To complete the definitive framework design, a silicone to reproduce chroma, value, and internal characterization.
matrix is used to verify if adequate reduction of the acrylic This technique is particularly indicated for “high-risk” cases
has been achieved. At this stage, the framework must be with minimal layering space.
finished to exact specifications because it will be scanned In the first build-up, the main goal is to fill the facial as-
and used to copy mill the definitive framework. The design pects with ceramic mass, creating tooth morphology, and
phase can be performed using Nobel Procera or compa- start the process of creating depth and color gradation. A
rable software, and CAD-CAM frameworks are milled and brighter dentin mix is applied in an “L” shape in the middle
prepared for ceramic application. After the milling is com- of the tooth, and some “bright islands” are added in a non-
pleted, the silicone matrices can be used to verify the ac- symmetric pattern to create a high-value area. Following
curacy of the milling. the dentin/enamel and bright area build-up, a ceramic tool
Typically after milling there will be lines on the restora- is used to cut back the incisal one-third to make room for
tions. In order to apply stain in a uniform manner, these incisal effects. After the cutback in the incisal areas, more
lines should be removed with a Dura-Green stone (Shofu) translucent powders are added to the corners and mam-
and a smooth surface achieved. elon powders are layered for internal effects.

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 BLASI ET AL

The internal stain bake is an integral part of creating a mers, to allow for progressive wear and stress breaking.
natural structure and color of the zirconia framework. In Opposing esthetic restorations are acceptable in patients
this technique, developed by Mr Hitoshi Aoshima,36 stains with a low functional risk and high esthetic expectations.
are “painted” on to achieve the lifelike characteristics of There are two main scenarios to be considered for the op-
natural teeth. The internal live stain paint-on protocol has posing dentition: whether it is edentulous or dentate.
three stages: (1) providing the desired chroma and value,
(2) painting a white band and any horizontal characteris-
tics, and (3) applying vertical characterizations. Edentulous
An understanding of natural gingival anatomy is key to
achieving natural and harmonious gingival esthetics. To The material for restoration of the mandibular arch of pa-
that effect, the gingival levels of the lateral incisors should tients with a maxillary full-arch implant-supported zirconia
be 1 to 1.5 mm lower than those of the central incisors, prosthesis is a controversial topic.1,4,6,14,38–40 In patients
which can be the same as the canine gingival levels. The with mandibular implants there are two materials of choice
papilla should fill 40% of the space from the cervical to the based on functional assessment. In high-risk patients, the
incisal edge. The gingival zeniths of central incisors should authors recommend using prefabricated denture teeth,
be placed 1 mm distal from the mid-axis of the tooth; those or polymethyl methacrylate or composite material as the
of the lateral incisors should be placed 0.3 to 0.5 mm dis- weak link. Patients should be informed that the mandibular
tal from the mid-axis. The zeniths of the canines can be restorations will need to be replaced periodically due to
placed right along the mid-axis of the tooth. loss of structural material during function. This approach is
After morphologic adjustments are completed on the the most conservative and most retrievable option.
teeth, the gingival area is layered using gingival powders For restoring medium- to low-risk patients, the authors
from the same ceramic kit. recommend monolithic zirconia or a zirconia framework
Burs are used to create texture that mimics nature. with layered feldspathic porcelain. Extreme precision in oc-
After texturing, the ridges are softened with gray silicone clusal refinement is required when using zirconia against
wheels and then a finer pink silicone wheel. A diamond zirconia or ceramic against ceramic. There would be more
dresser is used to alter the shape of the silicone wheels. stress transmitted to the implants and a clicking sound
The next step of the surface treatment involves the use of would be heard during function.
a pearl surface bur and a felt wheel to provide a fine finish
on the surface. In the last step, a gray fine silicone is used
on the line angles and high spots of the morphology to Dentate
create highly reflective surfaces. The advantage of using
these polishers in different grits and shapes is to create a High-strength ceramics are always recommended for res-
surface with differential lusters, high-shine areas, matte- torations in patients with opposing natural dentition. The
finish areas, and different groove depths. The reflection authors recommend lithium disilicate for onlays and zirco-
of these different surface treatments will mimic a natural nia for crowns. It is not recommended to use feldspathic
tooth surface. porcelain for restorations with a dentate opposing arch.20

MATERIAL SELECTION FOR OCCLUSAL CONSIDERATIONS

OPPOSING ARCH
There is no consensus as to tooth form or occlusal scheme
The patient’s functional risk assessment and esthetic de- for patient comfort or chewing efficiency. The authors
mands should be taken into consideration when deciding recommend sufficient anterior guidance to disclude the
the material to be used in the opposing arch.37,38 It is impor- posterior teeth while accommodating habit patterns. This
tant not to prioritize esthetics over function. In patients with guidance should be correlated with the envelope of func-
high functional risk, the authors recommend monolithic tion and should always be tried during the 4- to 6-month
restorations unlikely to wear, or densely cross-linked poly- provisional phase. The functional steps that should be

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

CASE 1

5a 5b 5c

5d 5e 5f

Figs 5a to 5f  Initial presentation of fully edentulous patient with unsatisfactory removable complete dentures.

used in developing the occlusal scheme include providing As in all the case scenarios presented in this article, it is
a mutually protected occlusion with moderate guidance always recommended to provide patients with an occlusal
and determining if the provisional prosthesis produces an guard for wear prevention and protection.
acceptable vertical dimension of occlusion.
Different occlusal principles exist for the provisional
immediate-load prosthesis and the final prosthesis. Occlu­
sion in the provisional phase is designed to protect the im- CASE SCENARIOS
plants in the weakest quality bone. In static occlusion there
should be
no premature contacts, minimal vertical and hori- Case 1: Edentulous, Low Risk
zontal overlap, harmonious centric contacts in centric relation (Figs 5 to 13)
verified with Shim stock, and no contacts on the posterior
teeth. The objective is to reduce the occlusal load on the The patient was unhappy with the esthetics and function
posterior implants, which are submitted to the highest oc- of her old complete dentures. She had high esthetic de-
clusal forces with the least quality of bone, while osseointe- mands. The existing dentures were analyzed with no sign
gration is taking place. The occlusion in the final prosthesis of attrition, so she was classified as low functional risk.
should incorporate the same contact intensity in anterior The teeth were set up at increased vertical dimension
and posterior teeth. Vertical overlap should be enough to to improve esthetics, function, and zirconia space require-
disclude the posterior teeth. Lateral guidance should be ment. Implants were placed using guided surgery and were
progressive group function: in lateral movement with ca- loaded following the immediate loading protocol.
nine guidance, the posterior teeth are predesigned to be The framework was designed as type C. Because of
in group function occlusion should canines undergo wear. the patient’s high esthetic expectations and low functional
Group function is defined as “multiple contacts between risk, zirconia was used in the mandibular arch. The final
the maxillary and mandibular teeth in lateral movements on occlusion was anterior guidance and progressive group
the working side, whereby simultaneous contact of several function.
teeth acts as a group to distribute occlusal forces.”15,21

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 BLASI ET AL

Fig 6  Denture teeth set-up following

facial integration design to create a
blueprint for guided surgery.

Fig 7  Virtual representation of implant

placement plan to support a full-arch
zirconia rehabilitation (Nobel Clinician
software, Nobel Biocare).

8a 8b

9a 9b 9c

Figs 8a and 8b  Full-arch implants were placed through a guided surgical stent, and full-mouth prefabricated immediate
loaded fixed provisional prostheses were seated.
Fig 9a  Conventional framework design with 1.0- to1.2-mm facial reduction and 1.0-mm incisal reduction was used for this
low-risk patient.
Figs 9b and 9c  Maxillary framework prototype with and without silicone matrices to control reduction space for layering
porcelain.

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

9d 9e 9f

9g

10a 10b 10c

10d 10e

Figs 9d to 9g  Maxillary framework prototype with 1.0- to1.2-mm facial reduction and 1-mm artificial gingival area reduction.
Fig 10a  Maxillary full-arch zirconia framework with silicone matrices illustrate the space for layering porcelain.
Figs 10b to 10e  Preparation sequence of the full-arch zirconia framework surface before application of feldspathic layering
porcelain.

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 BLASI ET AL

11a 11b 11c

11d 11e 11f

11g 11h 11i

11j 11k 11l

Figs 11a to11f  Layering sequence of feldspathic porcelain on maxillary full-arch zirconia framework.
Figs 11g and 11h  Internal staining technique to create a natural effect.
Figs 11i to 11l  Addition of translucent feldspathic porcelain layering and natural effects with final glaze.

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

12a 12b 12c

12d 12e 12f

12g 12h 12i

12j 12k 12l

12m 12n 12o

Figs 12a to 12g  Layering sequence of feldspathic porcelain on mandibular full-arch zirconia framework.
Figs 12h to 12j  Incisal cutback to create space for additional feldspathic porcelain layering.
Figs 12k to 12o  Addition of translucent feldspathic porcelain layering and natural effect with final glaze.

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 BLASI ET AL

13a

13b

Figs 13a and 13b  Final result of full-mouth implant rehabilitation using full-arch zirconia restoration.

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

CASE 2

14a 14b 14c

14d 14e 14f

15

Figs 14a to 14f  Patient presented with bruxism habit, failing restoration, supraeruption, and a compromised occlusal plane.
Fig 15  Denture teeth set-up following facial integration design to create a blueprint for the surgical guide.

Case 2: Edentulous, High Risk The framework was designed as type A. The oppos-
ing dentition was fabricated with a metal framework and
(Figs 14 to 22)
acrylic resin teeth. The final occlusion had minimal verti-
The patient presented with failing dentition and signs of cal overlap with anterior guidance and progressive group
attrition. He was classified as high functional risk. function.
Vertical dimension was increased to improve space and
dimension requirements. Guided surgery and immediate
loading protocol were used for implant placement.

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 BLASI ET AL

Figs 16a to 16c  Total space require-

ment and that for each component of
the maxillary full-arch zirconia restora-
tion.
Fig 16d  Total space requirement and
that for each component of the mandib-
ular full-arch metal-acrylic restoration.

16a 16b

2.0 mm
8–10 mm
2–3 mm

4 mm

10–11 mm 2 mm
2 mm

16–18 mm
14–16 mm

16c 16d

17

18a 18b 18c

Fig 17  Virtual representation of implant placements to support the full-arch zirconia restoration (Nobel Clinician software,
Nobel Biocare).
Figs 18a and 18b  Full-arch implants were placed through a guided surgical stent, and full-mouth prefabricated immediate
loading fixed provisional prostheses were seated.
Fig 18c  Second set of maxillary and mandibular fixed provisional restorations improve esthetics and function and will be used
as a blueprint for final restorations.

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

19a 19b 19c

20a 20b 20c

20d 20e 20f

20g 20h

Fig 19a  Maxillary zirconia framework with 0.7- to 0.9-mm facial reduction and no reduction at the incisal edge or lingual/
occlusal surface for maximum strength.
Figs 19b and 19c  Maxillary zirconia framework and mandibular titanium framework try-in process to verify passive fit.
Figs 20a to 20h  Blueprint and layering sequence of feldspathic porcelain on maxillary full-arch zirconia framework for maxi-
mum strength.

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 BLASI ET AL

21

22a

22b

Fig 21  Maxillary full-arch zirconia reconstruction.

Figs 22a and 22b  Final result of full-mouth rehabilitation using hybrid restorative material.

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

CASE 3

23a 23b

Implant number and position

1 2
1. AP Spread + Cantilever 3
X
3
2. Safety zone implant 2
2
3. Fill the gaps
1
1
Y

24

Figs 23a and 23b  Patient presented with maxillary fully edentulous and mandibular partially edentulous situation.
Fig 24  Illustration of relationship between implant number, position, and AP spread to reduce the cantilever effect.

Case 3: Edentulous/Dentate, Medium The framework was designed as type B. Mandibular

teeth were restored utilizing monolithic high-strength ce-
Risk (Figs 23 to 31)
ramics. The final occlusion was anterior guidance and pro-
The patient’s existing denture had mild signs of attrition. gressive group function.
He was classified as medium functional risk.
Eight implants were strategically placed. A provisional
was used to test esthetics and occlusion.

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 BLASI ET AL

25a 25b 25c

25d 25e 25f

25g 25h 25i

26a 26b 26c

26d 26e 26f

Figs 25a to 25i  Facially driven integration of diagnostic wax-up blueprint converted into full-arch
fixed provisional.
Figs 26a to 26f  Type B framework design and CAD/CAM zirconia framework.

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

27a 27b 27c

28a 28b 28c

28d 28e 28f

28g 28h 28i

29 30
Figs 27a to 27c  Type B framework (lingual supported) design with 0.7- to 0.9-mm facial and 0.5-mm incisal reduction for this
medium-risk patient.
Figs 28a to 28i  Layering sequence of feldspathic porcelain on maxillary full-arch zirconia framework.
Fig 29  Gold coating for texture evaluation/modification.
Fig 30  CAD/CAM design.

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 BLASI ET AL

31a

31b

Figs 31a and 31b  Final result of maxillary full-arch zirconia restoration and mandibular individual zirconia restorations.

CONCLUSION ACKNOWLEDGMENTS
Four main recommendations have been described for the The authors would like to thank Nobel Biocare and the Augusta Univer-
sity Center for Excellence for their support in these cases, Dr Jae Seon
successful fabrication of full-mouth implant-suppported
Kim and Dr Jimmy Londono for their support during the treatment of
zirconia rehabilitations: detailed treatment planning, frame- these patients, and Dr Henry Ferguson and Dr Jacob Stern for the sur-
work design, material selection for the opposing arch, and geries. They would also like to thank Dr William Brackett for manuscript
editing.
occlusal considerations. Diagnosing a patient’s occlusal
level and correlating it to the framework design and the re-
storative material for the opposing arch is critical for main-
taining stability and long-term success.

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 Implant-Supported Zirconia Full-Mouth Rehabilitations: Key Factors

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