Presentation at the congress of Korean Association of Pediatric Dentistry(KAPD) held in Seoul, Korea.

1. Pediatric Zirconia Crowns:
up-to-date
CDC해운대어린이치과
Qualified instructor of NuSmile crowns
김 성 기

4. Contents
• Current researches
• Biocompatibility and gloss
• Preparation : state-of-the-art
• Cementation
• Zirconia crowns for primary posterior teeth
• Crowns for primary canine: lateral force

15. In the late 1960’s, the development of
Zirconia as a biomaterial was refined.
The first recommended use of Zirconia
as a ceramic biomaterial was in the
form of the ball portion of the femur
head in total hip replacement.

16. Tissue Attachment
to Zirconia
Numerous studies have
confirmed the high
biocompatibility of Zirconia.
Place subgingivally

17. Subgingival placement
• Biocompatibility
• Retention
• Coronal sealing

18. Depending on the smoothness, zirconia prevents the buildup of plaque, creating a favor
able surface for gingival tissues. Zirconia based ceramics are chemically inert
allowing good cell adhesion with no adverse systemic reactions reported.
Reference: Ichikawa, et. Al. 1992
Tissue Attachment
to Zirconia

19. What is the Relevance of Gloss on
Zirconia Surfaces?
• Most glazes are hand brushed onto the surface producing inconsistencies.
• The value of a glossy crown usually equates to a smoother surface.
A smoother surface leads to less plaque buildup and a surface that is
easier to clean.
• Gloss can effect esthetics, often a tooth that has more gloss can be
more esthetic.
• Wear on the opposing tooth

20. PREPARATION!

21. Ready-made crown
Fit your preparation to the crown

25. 0.12~0.14mm

26. Ready-made crown
Prep to the crown
Cement thickness?
Filling material?
Gap filling?

27. Cementation Options to Zirconia
Types of Cement
• Glass Ionomer – not recommended
• RMGI
• Resin Cement
• Ceramir
(Bioactive Calcium Aluminate/GI
luting cement)
• BioCem Universal BioActive Cement

28. Retention Values to Zirconia
Types of Cement
- Glass Ionomer - approx 10 kg or less
- RMGI - approx 15 kg
- Resin Cement - approx 20 kg
- Ceramir & BioCem - approx 20 kg
When using eugenol based pulp material,
cover with GI before using RMGI & resin cements

30. Contamination!
(blood, saliva)
Tooth structure!
(preparation, taper)

32. Zirconia-cement interface?
Cement-tooth interface!

34. Zirconia crowns for primary
anterior teeth
 Bilateral symmetry(esp. primary central incisors)
 Bleeding
 Passive fit : hard to hold the crown in the proper position
Recommendation : Light-cured cement
(resin cement or RMGI)

35. Zirconia crowns for primary
posterior teeth
Recommendation : Any kind of cement
(resin cement or RMGI or conventional GIC)

37. Try-In Features and Benefits
• Quick and easy to use
• Eliminates extra steps
• Autoclavable for repeated use
• Ensures successful results

39. Fracture load value of ZR Crowns according to the repeated heat sterilization
0 5 10 15 20 25
0
100
200
300
400
500
600
700
800
- Model of crowns: D5R
- Already reannealed at 1350
o
C
FractureLoad(N)
Number of Repetition
Heat sterilized at 121
o
C for 20min
(according to Lava Zirconia Sterilization Guidelines)
Repetition number increased, it was irregularly deviated from the straight line but it was not affected by the 25-
repeated sterilization.

40. Bleeding control
Time & Pressure
Hemostatic agents

43. Case 1
One week
Post-op

45. Case 4
Prof. Anne O’Connell
Dentinogenesis
Imperfecta

54. 2Y10M later

55. 3Y6M later

60. 2016.04.08 (5 months later)

68. Primary canine
occlusion

70. 3 weeks later

71. 4 months later

76. Posterior primary
crowns

77. 2013.04.16

80. Use a football or coarse tapered diamond to reduce the occlusal
surface of the tooth 1-2mm following occlusal contours.
Tooth Preparation

81. Carefully prep tooth supragingivally to avoid tissue
maceration. Reduce the tooth 20-30% overall or 0.5-1.25mm
on all planes of the tooth.
Black stripe – 5855

82. Use a fine thin tapered diamond –
create a feather-edge margin 1-2mm subgingiva
lly
Green Stripe - 6852
Make sure no subgingival
shoulders or ledges remain

83. Round line angles.
Overall tooth reduction = approximately 20-30%

84. Trial fit with pink Try-In Crown
Finger Pressure Only

85. Hemorrhage and Saliva Control is Important

86. Load Crown with BioCem Ce
ment, Ceramir,
Resin Cement,
or RMGI and passively
seat crown

87. Tack cure when applicable and begin final clean-up

88. Check occlusion and
perform final clean-up
after cement is set.
If occlusal adjustment
is needed, adjust
the opposing tooth as neces
sary.

96. 7 months later

98. Inadequate reduction of buccal bulge resulting in horizontal extension and MB Rotation

101. HT shade
• More transparent
• Enough strength
• For anterior teeth only

102. HT Shade Light Shade
0
10
20
30
40
- Sample Size : 15 x 1.0 mm
- Light Source : Standard Illuminant D65
- Polish : 1m Diamonds until Scratches Disappear
Transmittance(%)
HT shade

103. More smiles for your patients
and your practice.