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Among the latest generation of prosthetic materials, zirconia represents one of the most versatile ceramic materials offering options for rehabilitation of both anterior and posterior sectors. In the last two decades, zirconia frameworks have become increasingly popular in the implant prosthesis and the introduction of CAD/CAM technology has made it possible to approach full-arch restorations in a different way and with promising success rates. In this case report we present Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs) using digital technology to fabricate advanced monolithic zirconia solutions. We report a brief examination of the advantages of the two solutions in comparison.
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Annali di stomatologia
Implant-supported fixed complete dental prostheses
Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia solutions
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Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia (UNIMORE), Via del Pozzo 71, 41125 Modena, Italy.
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Implant-supported fixed complete dental prostheses
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Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia solutions
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Double Full-Arch Implant-Supported
Fixed Complete Dental Prostheses
(IFCDPs): advanced monolithic
zirconia solutions


Andrea Berzaghi1 DDS, MSc, PhD                                                                  Authors
Sergio Bortolini1 DDS, Associate Professor                                                      Andrea Berzaghi, DDS, MSc, PhD
                                                                                                - Department of Surgery, Medicine,
                                                                                                Dentistry and Morphological Sciences
Department of Surgery, Medicine, Dentistry and Morphological
1
                                                                                                with Interest in Transplant, Oncology and
Sciences with Interest in Transplant, Oncology and Regenerative Medicine,                       Regenerative Medicine, University of
University of Modena and Reggio Emilia (UNIMORE),                                               Modena and Reggio Emilia (UNIMORE),
Via del Pozzo 71, 41125 Modena, Italy.                                                          Via del Pozzo 71, 41125 Modena, Italy.
                                                                                                Sergio Bortolini, DDS, Associate
Corresponding author: Andrea Berzaghi                                                           Professor - Department of Surgery,
andrea.berzaghi@unimore.it                                                                      Medicine, Dentistry and Morphological
                                                                                                Sciences with Interest in Transplant,
                                                                                                Oncology and Regenerative Medicine,
Abstract                                                                                        University of Modena and Reggio Emilia
Among the latest generation of prosthetic materials, zirconia represents one of the             (UNIMORE), Via del Pozzo 71, 41125
                                                                                                Modena, Italy.
most versatile ceramic materials offering options for rehabilitation of both anterior
and posterior sectors. In the last two decades, zirconia frameworks have become
increasingly popular in the implant prosthesis and the introduction of CAD/CAM
technology has made it possible to approach full-arch restorations in a different
way and with promising success rates. In this case report we present Double Full-
Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs) using digital                  License
technology to fabricate advanced monolithic zirconia solutions. We report a brief               This work is licensed under a Creative
examination of the advantages of the two solutions in comparison.                               Commons Attribution-NonCommercial-
                                                                                                NoDerivatives 4.0 International License.

Key words: Zirconia, monolithic zirconia, metal bar, Implant-supported fixed com-               Authors contributing to Annali di
plete dental prostheses.                                                                        Stomatologia agree to publish
                                                                                                their articles under the Creative
                                                                                                Commons Attribution-NonCommercial-
Introduction                                                                                    NoDerivatives 4.0 International License,
                                                                                                which allows third parties to copy and
The recent evolution of ceramic materials in prosthetic dentistry is aimed at increas-          redistribute the material providing
ing the mechanical and aesthetic properties and simplifying the manufacturing and               appropriate credit and a link to the
decision-making processes for clinicians and technicians. Until a few years ago it was          license but does not allow to use the
universally recognized in the literature that the most mechanically resistant ceramics of-      material for commercial purposes and to
                                                                                                use the material if it has been remixed,
fered less advanced aesthetic characteristics, most of the time resulting more opaque,          transformed or built upon.
therefore less translucent and attractive1. In the panorama of the latest generation of
prosthetic materials, zirconia represents one of the most versatile ceramic materials of-       How to Cite
fering options for rehabilitation of both anterior and posterior sectors. The 3mol% Y-TZP       A. Berzaghi, S Bortolini.
and the recent 4/5mol% Y-TZP are heterogeneous materials in composition, structure,             Double Full-Arch Implant-Supported
mechanical and optical properties and offer dentists and laboratories solutions that            Fixed Complete Dental Prostheses
                                                                                                (IFCDPs): advanced monolithic zirconia
can be layered or monolithic with a different compromise between strength and aes-              solutions
thetics1-6. In particular, the introduction of monolithic zirconia for its characteristics of   Annali Di Stomatologia, 15(1), 17-20.
reliability and practicality has led to a downsizing in prosthetic design with indisputable     https://doi.org/10.59987/ads/2024.1.17-20
advantages for clinicians and technicians7-9. In the last two decades, zirconia frame-
works have become increasingly popular in the implant prosthesis and the introduction
of CAD/CAM technology has made it possible to approach full-arch restorations in a
different way and with promising success rates10-13.
The aim of this clinical report is to describe the prosthodontic management of a female
patient with Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses
(IFCDPs) using digital technology to fabricate advanced monolithic zirconia solutions:
monolithic screw-retained zirconia design in the upper jaw compared to the innovative
design which features monolithic zirconia supported by a metal bar made of cobalt
chromium (Co-Cr) in inferior arch. We report a brief examination of the advantages of
the two solutions in comparison.




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     Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia solutions




                                                                   Figure 4. Zirconia superstructure coupled to the metal bar.
                                                                   Zirconia Ceramotion Z Hybrid 1300/1020 Mpa (Dentaurum
                                                                   s.p.a) was chosen for the superstructure.


                                                                   man), both arches were loaded immediately using stan-
                                                                   dardized prosthodontic techniques to produce an interim
                                                                   resin prosthesis. The definitive prosthodontic treatment
                                                                   was initiated after 10 weeks of loading the maxillary
                                                                   and mandibular implants. Appropriate abutments were
                                                                   placed on the implants to obtain parallelism and path of
                                                                   draw. Final impression of the implants were made us-
                                                                   ing polyether impression material after rigidly splinting all
                                                                   impression copings. Using standard prosthodontic pro-
                                                                   tocols, maxillomandibular relationships and trial denture
                                                                   procedures were accomplished to fabricate prototype
                                                                   prosthesis (interim acrylic resin prosthesis) using CAD/
                                                                   CAM technology. In maxilla a screw-retained interim
                                                                   acrylic resin prosthesis while in the mandible an interim
                                                                   acrylic resin prosthesis supported by a Co-Cr metal bar
                                                                   were made. Minor adjustments were made to prosthetic
                                                                   contours, occlusion and esthetics. The bar was milled
                                                                   from a solid block of Co-Cr. The bar was planned on
                                                                   incorporating a zirconia overlay prosthesis (Fig. 4) only
                                                                   up to the last tooth on either side. After confirmation of
                                                                   the aesthetic and functional result, patient’s written ap-
                                                                   proval was obtained in order to use this for copy milling
                                                                   the definitive zirconia prosthesis (Zirconia Ceramotion
     Figure 1-3. Panoramic radiograph and photos of the initial    Z Hybrid 1300/1020 Mpa, Dentaurum s.p.a). The over-
     case. Patient comes to our observation with incongruous       lay mandibular prosthesis and the maxillary monolithic
     complete dentures.                                            screw-retained zirconia was milled from a solid blank
                                                                   of pre-sintered zirconia, which was then infiltrated with
     Case Report                                                   stains and veneered with feldspathic porcelain at aes-
                                                                   thetic and gingival region (Figg. 5-7). Passive fit of both
     An 80-year-old female patient, an edentulous patient          prostheses was confirmed. A post-treatment panoramic
     with Complete Dental Prostheses, comes to our obser-          radiograph was taken to confirm seating of the prosthe-
     vation requesting a fixed Double Full-Arch prosthodontic      ses (Fig.8).
     solution. Patient’s existing complete dentures made by        monolithic zirconia: zirconia on a metal bar in lower arch,
     his general dentist was deemed unsatisfactory to the          screw-retained zirconia in upper arch. Gingival and den-
     patient and the clinician (Figg.1-3). Patient’s medical       tal aesthetic ceramization with Ceramotion One Touch
     history revealed that she had a history of multiple im-       ceramic pastes (Dentaurum s.p.a). Dental technician
     plant failures. Patient also had a history of smoking for     Mdt Germano Rossi.
     several decades and was aware of his bruxism. Based
     on patient’s history, clinical and radiographic findings,
                                                                   Discussion
     the patient was diagnosed with a Class C Classifica-
     tion System ABC14. 8 implants were planned for being          The advantages of the monolithic screw-retained
     restored with a maxillary screw-retained monolithic zir-      prosthesis are many. The screw-retained prosthesis
     conia IFCDP. 6 mandibular implants were planned on            traditionally represents the first choice in full-arch im-
     being restored with Metal-Zirconia Implant Fixed Hybrid       plant-prosthetic rehabilitation for fewer biological com-
     Full-Arch Prosthesis: restoration that provides monolith-     plications and easier management of complications15,16.
     ic zirconia supported by cobalt chromium bar. After the       Zirconia guarantees advanced mechanical properties
     surgical implant placement (implants Even Mech & Hu-          with a low complication rate; excellent biocompatibility;



18                                                                                                     10.59987/ads/2024.1.17-20
A. Berzaghi et al.

                                                                favorable wear characteristics; reduced accumulation
                                                                of plaque and biofilm; satisfactory gingival and dental
                                                                aesthetics associated with minimal ceramization of
                                                                non-functional areas; reduced pigmentation compared
                                                                to acrylic resin. The CAD-CAM design and production
                                                                of zirconia has led to further advantages: better preci-
                                                                sion of the prosthesis thanks to modern manufacturing
                                                                systems; availability of a permanent digital file with the
                                                                possibility of duplicating the prosthetic restoration; pos-
                                                                sibility of making temporary posts in PMMA. However,
                                                                the monolithic zirconia screw-retained design remains
                                                                a complex prosthetic solution, in which clinical suc-
                                                                cess is linked to the knowledge of the materials and
                                                                the high precision required by 3Y-TZP17,18,19. The need
                                                                to guarantee the framework suitable dimensions in ar-
                                                                eas at risk of fracture, the impossibility of recovery of
                                                                the structure in the event of failure, the low tolerance
                                                                to imprecision imprecisions and the opacity of the high-
                                                                strength material represent the current limits of this
                                                                prosthesis17,20. Metal-Zirconia Implant Fixed Hybrid
                                                                Full-Arch Prosthesis currently represents the most ad-
                                                                vanced implant-prosthetic design in the field of implant-
                                                                supported restorations and represents the evolution of
                                                                screw-retained monolithic solutions, potentially able to
                                                                solve some critical issues21,22. The metal bar gives stiff-
                                                                ness, excellent tensile strength, high fracture strength,
                                                                passive fit and allows you to manage long spans be-
                                                                tween adjacent implants and extend cantilevers. It also
                                                                allows versatile use on different implant platforms, com-
                                                                pensates for problems of unfavorable angles and of-
                                                                fers the possibility, if necessary, to be segmented. The
                                                                metal frameworks obtained by laser sintering/melting
                                                                procedures have improved the “fit”, the “bonding” and
                                                                the corrosion resistance compared to the bars obtained
                                                                by casting23. The monolithic zirconia in this prosthetic
                                                                design represents the first choice solution for reasons
                                                                related to the intrinsic characteristics of the material
                                                                and to the prosthetic technologies. From an aesthetic
                                                                point of view, the metal framework gives the possibility
                                                                to take full advantage of the new generations of trans-
Figure 5-7 Case concluded. Double Full-Arch Implant-Sup-        lucent zirconia without risk of structural failure. Starting
ported Fixed Complete Dental Prostheses in monolithic zir-      from the CAD design information on the bar, we can
conia: zirconia on a metal bar in lower arch, screw-retained    create PMMA provisionals that act as prototype pros-
zirconia in upper arch. Gingival and dental aesthetic cerami-
                                                                theses useful in the preliminary evaluation and approv-
zation with Ceramotion One Touch ceramic pastes (Dentau-
rum s.p.a). Dental technician Mdt Germano Rossi.                al phase17,20.




      Figure 8 End of case panoramic radiograph.



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     Double Full-Arch Implant-Supported Fixed Complete Dental Prostheses (IFCDPs): advanced monolithic zirconia solutions

     Conclusion                                                         9.    Candido LM, Miotto LN, Fais L, Cesar PF, Pinelli L. Me-
                                                                              chanical and Surface Properties of Monolithic Zirconia.
     The innovative design of the implant-supported re-                       Oper Dent. 2018 May/Jun;43(3):E119-E128.
     habilitation of the lower arch that uses a monolithic              10.   Al‐Amleh B, Lyons K, & Swain M. Clinical trials in zirco-
     structure in zirconia on a metal bar was born to ex-                     nia: A systematic review. Journal of Oral Rehabilitation
                                                                              2010;37:641-652.
     ploit the aesthetic potential of the latest generation zir-
                                                                        11.   Raigrodski A J, Hillstead MB, Meng, GK, Chung K H.
     conia even in the presence of extensive cantilevers.                     Survival and complications of zirconia‐based fixed den-
     The diffusion of CAD/CAM technology together with                        tal prostheses: A systematic review. Journal of Prosthetic
     the promising characteristics of aesthetics, reliability                 Dentistry 2012;107:170-177.
     and versatility of this advanced solution make mono-               12.   Mendez Caramês JM, Sola Pereira da Mata AD, da Silva
     lithic zirconia on bar a successful and widespread re-                   Marques D N, de Oliveira Francisco H C. Ceramic‐Ve-
                                                                              neered Zirconia frameworks in full‐arch implant rehabili-
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                                                                              tations: A 6‐month to 5‐year retrospective cohort study.
     generation multilayered zirconia for the construction of                 International Journal of Oral and Maxillofacial Implants
     monolithic structures allows to overcome the limits of                   2016;31:1407-1414.
     the traditional 3Y-TZP. The incorporation of 4Y-TZP in             13.   Abdulmajeed AA, Lim KG, Närhi TO, Cooper LF. Complete‐
     multi-translucent implant-prosthetic structures allows                   arch implant‐supported monolithic zirconia fixed dental
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                                                                              tistry 2016;115(6):672-677.
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                                                                        14.   Bortolini S, Berzaghi A et al. Classification system for par-
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     translucent monolithic zirconia materials, incorporating                 2022; XIII (1-4): 21-26
     3Y, 4Y and 5Y-TZP with varying translucency levels,                15.   Sailer I, Muhlemann S, Zwahlen M, Hammerle CHF,
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     particular, some types of 4Y-TZP with high mechanical                    con- structions: a systematic review of the survival and
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                                                                              23:163–201.
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     Acknowledgments                                                          retained implant-supported fixed restorations. Journal of
                                                                              Prosthodontics 2014;23(1):1-9.
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