FIXED

Balmoral Dental will work together with the dentist to offer the best possible solution that meets the requirements of the individual situation and the esthetic expectations.

We offer many types of fixed restorations in various materials.

Veneers
Crowns
Dental Bridges
Implants

We mill all our zirconia in-house. Having complete control of the process from end to end means we can set the standard and provide the highest quality zirconia restorations while maintaining the customization of design desired by our dentists. With esthetics that mimic natural teeth you can provide your patients with a monolithic metal free restoration economically.

Full Contour Zirconia

Milled in our laboratory to full contour and stained to your specifications

Indications

Full-contour zirconia is so versatile, it can be used in almost any situation from singles, bridges with any combination of abutments and pontics, inlay bridges and screw-retained implants. Also an esthetic alternative to a PFM with metal occlusion due to limited space.

Contraindications

When esthetic expectations are high and it is important that the restorations match surrounding natural dentition or other existing restorations. If bonding is necessary to retain the restoration, bond strength is weaker and less predictable than other ceramics.

Preparation

Shoulder preparation not needed. A mild chamfer or a feather-edge margin is good. 1mm buccal, lingual, and occlusal reduction is ideal, but can go to .5mm in some areas when reduction is limited. Minimum occlusal reduction of 0.5 mm; 1 mm is ideal. Adjustments and polishing: Adjust full-contour zirconia crowns and bridges using water and air spray to keep the restoration cool and to avoid microfractures with a fine grit diamond. If using air only, use the lightest touch possible when making adjustments. A football-shaped bur is the most effective for occlusal and lingual surfaces (on anterior teeth); a tapered bur is the ideal choice for buccal and lingual surfaces. Polish full-contour zirconia restorations with the porcelain polishing system of your choice.

Cementation

It is recommended that full-contour zirconia be cemented using a zirconia primer like Z-Prime from Bisco or Clearfil Ceramic Primer from Kuraray. Alternatively, a resin reinforced glass ionomer such as RelyX Luting cement can also be used. When a greater bond is needed due to the lack of a retentive preparation, use a resin cement like RelyX Unicam or RelyX Ultimate. Before cementing all full-contour zirconia crowns, the interior surface of the crown needs to be cleaned with Ivoclean (Ivoclar Vivadent – Amherst, NY). This is critical in assuring maximum bond strength.

Porcelain Fused to Zirconia

Veneered porcelain over our in lab milled zirconia substructure for the most translucent effect and highest aesthetic results.

Indications

A CAD/CAM substitute for traditional PFM, our porcelain-fused-to-zirconia can be used for anterior and posterior crowns, crowns over implants, and bridges of up to fourteen units.

Contraindications

Attachment cases
Cases with less than 1 mm clearance
Bruxism
Patients who have broken a PFM crown
Cases that require bonding

Preparation

The ideal preparation for PFZs is a chamfer margin preparation. If a porcelain labial margin is prescribed, then a shoulder margin preparation is required.

Cementation

Resin Ionomer cement (RelyX or RelyX Unicem, 3M ESPE)
Maxcem Elite (Kerr)
Panavia F 2.0 (Kuraray) – ideal for short, tapered preparations
Glass ionomer cement (GC Fuji, GC America)

Highlights

Unparalleled Translucency
High Strength and Durability
Suitable for anterior or posterior bridges Up to 3 Units
100% Digitally manufactured in lab
Conventional cementation Zirconia

e.max® Press is best suited for high esthetics in the Anterior with properties that mimic natural enamel in translucency.
Available by either the stained or cutback technique to meet your patients specific esthetic desires.

Our layering technique displays a highly esthetic three dimensional effect for a natural looking restorations while our stain technique offers an economical option and a minimally invasive restoration.

Highlights

Highly esthetic
Precision fit, form & function
Layered or Stained
Higher aesthetics for conservative preparations

Advantages

Proven, high-strength material for long-lasting clinical results; flexible cementation options
Lifelike esthetics, regardless of the shade of the prepared tooth
Polychromatic Multi ingots for utmost efficiency
Five levels of translucency and additional Impulse ingots for maximum flexibility
Minimally invasive, accurately fitting restorations
Adhesive, self-adhesive, or conventional cementation options depending on the indication

Indications

IPS e.max is the premium lithium disilicate, glass-ceramic restoration. Combining lifelike materials and fracture resistant properties, IPS e.max is as durable as it is lifelike. The flexibility of IPS e.max makes it an excellent restorative method for anterior esthetics or posterior function.

Contraindications

Bridges which include molars, Maryland style bridges, and bridges which have a short vertical height that does not allow for adequate connector height.

Preparation

Anterior full-coverage crowns require a chamfer or shoulder margin. A circular shoulder is prepared with rounded inner edges or a chamfer at an angle of 10-30°: the width of the shoulder/chamfer is approx. 1 mm. Facial reduction is 1.5 – 2 mm; 1 – 1.5 mm lingual contact clearance. Incisal reduction is 1.5 – 2 mm with rounded internal line angles, and an incisal edge at least 1mm wide to permit optimum milling of the incisal edge during CAD/CAM processing.

Posterior full-coverage crown requires a chamfer or shoulder margin. A circular shoulder is prepared with rounded inner edges or a chamfer at an angle of 10-30°: the width of the shoulder/chamfer is approx. 1 mm. Occlusal reduction is 1.5 – 2 mm: axial reduction (buccal, lingual, and interproximal) is 1.5 mm with rounded internal line angles.

Cementation

IPS e.max layered – can be cemented using a resin reinforced glass ionimer such as RelyX Luting cement. Or bonded using a resin cement when extra strength is needed due to lack of retention on the prep, use a resin cement such as RelyX Unicem or RelyX Ultimate.

This full contour Monolithic Solution is CAD designed and demonstrates high strength, durability and proven clinical properties.
Suitable for Veneers to 3 unit bridges and are available in different levels of translucency of the A-D shades.

Indications

Thin veneers (0.4 mm)
Veneers
Occlusal veneers
Inlays/Onlays
Crowns
Three-unit bridges (up to the second premolar as the terminal abutment)
Minimally invasive crown preparation; adhesive cementation
Milled in-house

Highlights

High-strength lithium disilicate glass-ceramic (LS2) featuring a flexural strength of 360 MPa
Excellent esthetics and optional customization
Comprehensive indication range
Extensive clinical evidence from long-term scientific studies
Fast and efficient processing
Clinically proven and versatile cementation options

Amazing chameleon effect provides in-vivo blending for perfect balance of translucency and natural opalescence (natural vitality). Natural-like opalescence reduces graying effect in the patient mouth giving an excellent VITA shade matching.
Fascinating esthetics unmatched.

Indications

Single-tooth restorations (Inlays, onlays, veneers, anterior and posterior crowns and up to 3-unit anterior bridges)

Highlights

Highly esthetic pressed restorations
Excellent margin quality increase confidence in complex case designs
Exceptional flexural strength >500 MPa

Situation to avoid:

Insufficient wall thickness.
Direct insertion without polishing or glazing.

Cutting blocks using non-compatible CAD/CAM system.

Use of stains and veneering materials by third-party manufacturers.

Use of auxiliary firing pastes by third-party manufacturers.

Use of tungsten carbide cutters.

The metal provides stability and strength, which makes it a strong contender against crowns made from alternative materials. The porcelain provides the restored tooth with a lifelike appearance. These crowns are still a popular option due to their high rate of clinical success and their biocompatibility that helps ensure continued periodontal health. PFMs are also gentle on opposing dentition. The use of CAD/CAM technology allows our clinicians to fabricate this traditional solution with extreme precision.

Indications

Our PFMs can be used for crowns and bridges (up to fourteen units). PFMs can be manufactured to nonprecious, semiprecious, and yellow high noble copings and can be used in conjunction with cast partials and implants.

Contraindications

Contraindicated when the patient has a metal allergy or when the size of the tooth pulp is negligibly smaller, thus compromising the tooth preparation process. It is also contraindicated when the clinical tooth crown is very short and lacks the required stability including retention that is enough to provide the space for porcelain and metal.

Preparation

The ideal preparation for PFMs is a chamfer margin preparation. If a porcelain labial margin is prescribed, then a shoulder margin preparation is required.

Cementation

Panavia 21 – tin plated
Glass ionomer cement (GC Fuji, GC America)
Zinc Phosphate Polycarboxylate
Resin Ionomer cement (RelyX, 3M ESPE)

Our all metal crowns are a good choice where minimal tooth reduction and superior strength is required.

Types of restoration design

Inlays
Onlays
Full Crowns
3/4 Crowns
Surveyed Crowns
Bridges
Retainers for FPD

Indications

Full-cast gold crowns are indicated for crowns, veneers, inlays, onlays, and bridges.

Contraindications

Full-cast gold crowns are contraindicated for partials and implants.

Preparation

Inlays and onlays can also be fabricated as a full-cast restoration. Feather-edge margin preparations are indicated for full-cast restorations, but any margin preparation may be used.