Zirconia vs. Metal - Ceramics: Dollars & Sense
At $1700 per ounce, precious metal has become one big downer for fixed dentistry. We are now half-heartedly giving zirconia a second look, but we still suffer PTSD from old memories of failed cases.
Remember back when it came in one stone white material that killed esthetics and the layering porcelain chipped away from itself. Poor design, loose fits and open margins didn’t matter so much because the porcelain was likely to shear off anyway! Dark dental days indeed and our leaders were right to sound the clarion call to cease and desist!
I am talking about Reinforced Porcelain System (RPS), a little known nearly bulletproof system for metal ceramics. We used it for over 20 years because it was just too logical to ignore, so take a look at the link. When zirconia came on line, we lost our design niche because we were completely dependent on the milling centers. Our special design went MIA. Also, early zirconia layering porcelains were predisposed to chipping and under fired porcelain made things worse.
By now you sense that I believe in design first, so fast forward to lab owned scanners. For the record, we use the 3Shape CAD Design for our digital workflow and then outsource the case to high tech mills. Make no mistake about it, real design and doing it digitally is a real skill set.Technicians and milling centers are not created equal, so education needs to be involved. A more recent study that labs and dentist should read is Modified Veneered Zirconia vs. Metal Ceramic. This study lends credence to the importance of design in zirconia vs. metal ceramics and can help us understand design fundamentals. When designing zirconia, my lab uses a strategy we call monolithic layering combined with RPS strategy.
Going Forward Today most dentists quietly deliver fixed zirconia work while awaiting some magical endorsement of perfect. We didn’t let “perfect” get in the way of “really good” in metal ceramics, but it is no longer a viable option due to extreme metal cost. Financially and esthetically, we need to use zirconia today and it should be all about design!
Doctors or Lab feedback welcome!
- Dene LeBeau