:t.

14
Tesl87.1
Use of Zirconia in Restorative Dentistry
RichardM.
Parker; DDS
T
hough zirconia has been available for
use in restorati ve dentistry for several
years, t here has been an increased
interest recent ly in these materials. Zirconia
based res t orati ons are qui te versatile and can
be used for crowns, bri dges, and implant abut
ments in a vari ety of clin ical situations if th e
approp ri a te gui delines a re followed.
The typ e of zirconia used in denti stry is
yt t ria tetragona l zirconia polycrystal (Y-TZP)
ma terial , which is a zirconia oxid e. Yttria
(Y
2
0
a
) is a n oxide of th e metal lic element
yttrium (at omic No. 39) .
Y-TZP is a monophase ceramic mater ial
that is formed by directly sintering crystal s
together wit hout any intervening matrix to
form a dense, ai r-free, polycrystalline struc
ture. The yttri a is added to the zirconia to sta
bilize the st ructure and main ta in the materi
al 's desirab le properties.
Many denti st s are not familia r with zirco
nia, its di ffer ences compared t o other ma t er i-
Both fully sintered (HIP) and partially sin
tered (non-HIP) zirconia products appear to
be clinically acceptable... Caution is urged,
however, in regard to the clinical application
of this material. Long-term, multicenter stud
ies are needed.
als, th e diffe rent types that are available, an d
clinical in di ca ti ons an d usage. After reading
this art icle, th e read er will have an under
st a nding of zirconia's prope rties and t he
knowl edge to make a ppropriate t reatment
decisi ons regardi ng its use.
PROPERTI ES OF ZI RCONIA
The flexu ral strength of zirconi a oxid e mate
rials has been re ported to be in th e ra nge of
900 to 1,100 MPa.
l
This is approxi ma tel y
twice as st ron g as alumina oxide cera mi cs
currently on th e market and 5 times gre ater
than st an dard glass ceramics.
Even more impor tant is the fr actur e
toughness of t he material. Fracture t ough
ness measu res th e ability of a mate ri a ] to
resi st prop agation of an inte rnal cr ack (frac
t ure ). This is a n important indication of a
ma te ri al 's cli nical re liab ility.f Cli nically, non-
DENTISTRY TODAY ' MARCH1007
FIgure1...Preparations for single-unit anterior Zirconia figure 2. Zirconia copings tor anterior crowns.
crowns.
FIgure 3. Zirconia copings seated on laboratory model. Rg we 4. Anterior zirconia-based crowns cemented in
pface .
fatal cracks (cracks that devel op in th e zirco
nia bu t do not result in complete fr acture or
failure of the restoration) for m fr om cyclic
fat igu e, wh ich can lead t o fa il ure of th e
res tora t ion if the cr ac ks propagst e.
a
Zir
con ia's fra cture t oughness is be tween 8 a nd
10 MPa m
ll2
,4 whi ch is almost t wice as high
all tha t of al uminum oxide ceramics. This is
due to transformat ional tou gh ening, whi ch
gives zirconia it s unique mecha nical pr oper
ti es . Beca use of its tetragonal polycrystall ine
struct ure, when a crack devel ops th e ma te rial
t ra nsforms to a thermodynami call y more
favorable monoclinic form. Thi s t rans forma
tion is associate d with a 4% local in crease in
volume , wh ich produces a "cl amping effect " on
th e cra ck a nd halts its furth er expa nsi on. f
I n additi on, without any glass ma trix, zir
coni a oxi de mat er ials a re generally s tronger
a nd offer more res istance to cr ackin g t han
oth er ceramice.f Furthe r, che mical cor rosion
occurs on glass s ubstrates, which can lead to
clinical failure. The aqueo us component in
saliva can react with glass in ceramic materi
al, cau sing cor ros ion . This can increase th e
rate of crack propagation and lea d to failure
of th e material,
TYPES OF ZIRCONIA
Three main type s of zirconia are avai lab le for
use in clinical dentis try. Th ough th ey are
chemically ident ical , t hey have slight ly differ
en t phys ical pr ope r t ies (eg, porosi ty, den sity,
purity, strength), which may (or ma y not ) be
clinically r elevant.
There is th e ful ly sin tered or HIP type of
zirconia. HIP sta nds for "hot isostatic press
ing," and is a sint e ri ng technique used in th e
cerami c industry that utihzea high tempera
tures a nd pr essures t o increase density of th e
materi al . Examples of t his type of full y sin-
conti nued on page 11 6
Use of Zirconia...
continued from page 11 4
FIgure 5. Preoperat ive view of teeth
for fixed bridge.
Rgure 6. LBboratory model at
preparati ons for zirconia bridge.
FIgur e 7. Zirconia t ramework for
bridge for Nos. 12 to 14.
FIgure 8. Zirconia bridge framework
after veneeri ng wlth porcelain.
FIgUre 9. Zirco nia-based bri dge
sea ted on laborat ory model.
Rgure 10. Post oper at ive vi ew of
bridge for Nos. 12 to 1 4 cemented
in place.
OEl'Ii Tl\ fRY m OAY. MARCB z007
te red zirco nia are DC-Zirkon
(DCS Dental AG) and Ever
est -ZH (KaVo).
The second t ype is a par
tiall y si nt ered zir conia, an d
th e th ird type is nonsintered
or "green state" zirconia. Due
to th e simi la r ma nufact uri ng
a nd fabr ica ting processes,
bot h of these types will be
considered together (partially
sintered or non -HIP zi rconia).
Blocks of these typ es of mate
ri al s are manufa ct u red by
utilizi ng a spray-dri ed zirco
nia powde r th at is th en iso
stat ically pr essed and incom
plete ly sinte red. These mate
rials rema in softer than the
HIP zirconia and are easi er to
mill. After milling, the zirco
nia is then sintered complete
ly in a furnace a t l ,350C to
1,500 C to achiev e its final
s hape, st rengt h, an d phys ical
properties. Examples of thi s
type are Lava (3M ESPE), Cer- .
con (DENTSPLY Ceramco),
and Vita YZ (Vident).
Another t ype of zirconia
product is that employed by
Nobel Biocare's Procera sys
tem. Thi s process uti lizes a
slurry of zirconia oxide that is
applied to an oversized die
and then sintered.
FABRICATION
The most common method to
fabricate a zirconia substruc
t ure is by CAD/CAM mi lling
from a solid block. The fully
sintered zirconia is mil led at
a 1:1 ratio, while t he partially
si ntered zirconia is mi lled
20% to 25% larger than t he
des i re d final size du e to
shrinkage ca use d by the si n
teri ng process." For bot h t he
pa rtially si n tered a nd th e
fully sintered tech niq ues, the
die is scanned, and then the
compute r progra m des igns
the framework or the coping.
After the milli ng and any
necessary si ntering, t he por
celai n is then han d-applied
over th e zi rco nia for th e
restorati on's fina l shape and
shade. For cli nical success,
the layeri ng por celain ideally
should have the same coeffi
cient of thermal expansio n
as t he zir conia substructure,
and t he refore only s pecifical
ly engineered porcelains can
be used. Porce lain t hat is
use d in por cela in-fused- to
meta l restorations can not be
used wi t h a zirconia su b
str uctur e, since delamina
tion wi ll occur. Further, prop
er firing of a bonding layer of
porcelain to the zirconia core
is essential to create a sta
bl e in t er fa ce be tween the
2 material a.s
On average, manufactur
ers recommend that the min
imal thickness for a zirconia
coping should be 0.3 mm for
a nterior teeth and 0.5 mm for
posteri or teeth. For a fixed
prosth esis fab ri ca te d with
zirconia, the cross -sectional
dimens ion for a connect or
should be 9 m m-', This is
much smaller t han the 16
mm
2
connector recommended
for conve ntional glass ceram
ics. This decrease in coun ce
tor di mension is du e to zirco
nia's greater st rength, allow
ing for a small er connector
and thus resulting in a mor e
aesthet ic appearance.
It is iro portant to note
t ha t the labora tory tech ni
cia n plays a very important
role in the fabri cation proc
ess . Identical cas es sent to
differ ent la boratories pro
duced different results .
s
Cli nicia n's shou ld use a labo
ratory that has good knowl
edge of zirconia's prope rties
and a t horou gh und ers tand
ing of th e enti re fabrica tion
process to ens ure a successful
clinic al res ult .
FULLY SINTERED VERSUS
PARTIALLY SINTERED
MATERIAL
Th e question often arises as
to which type of zirconia (HIP
or non-HI P) is bes t to use. It
appears that t hey both have
their a dva nta ges and disad
vantages. Fully sint ered HIP
zirconi a has a denser poly
crystalline structure wi th less
porosity th an non-HIP mate
ri al ," and this should trans
la te clinically into increased
resistance to frac ture. On the
other hand, SOme investiga
tors have questioned whether
th e grinding nee ded to mill
th e fully sint ered zir conia ,
an d the heat t hat is generat
ed, ca use su rface an d struc
tural defect s that can have
adver se clin ical implicat ions. P
The margi nal fit of either
type of mat erial is associated
with very acceptable clinical
resul ts . The mi lled margi ns
are t he equa l of, or are s upe
rior to, t he fit of a restoration
fabricated of a high noble
all oyf Studies have measured
the marginal gap of CADI
CAM-mil led zirconia of both
var ieties and found that to be
40 to 70 ]llIl,l O
The manu factu ri ng proc
ess for HIP zirconi a is more
expe nsive, involves more ma
chining time, and is more
labor -intensive t o fi t the
coping than non -HIP sy s
t oms." As a r es ul t , n on-HIP
systems cu rren tly dominate
t he market place.
CLI NICAL IMPLICATIONS
Considering zi rcon ia' s high
str ength, this mater ial en
ables the clinici an t o place a
ceramic restorati on almost
anywhere in the mouth. Sin
gle crow ns, imp la n t abut
ments, and bridges can be fab
ricated fr om zirconia.
11
, 12
Manufactur er s suggest that 2
ab utment bridges can have a
38-mm span, and mul tiple
abutment bridges can have a
span of 47 mm.f
Zirconia is a semitrans
lucent s ubstance tha t is only
slightly more opaque t h an
denti n.3 By varyi ng th e th ick
ness of the coping, t he
amo unt of opacity can be con
tro lled. In addition, Lava (3M
ESPE) and inVizion (Vident)
allow t he lab to shade the
s ubst r uct ure in t he "green
state ."Th is a llows th e color to
pene t r ate th e material, as
opposed to surface stain, giv
ing the final restorati on a
nat ura l appearance ("chroma
from wit hin").
Zirconia is radi opaqu e, en
ab ling the clini cian to detect
more easi ly improper fit an d
marginal caries. Addi tio nally,
it has been show n to be bio
compati ble, without any re
ported cases of toxicity, pa
tient allergy, or sensitivity,l3
TOOTH PREPARATION
The tooth preparation needed
t o accommodate a zirconia
rest orati on is essentially t hat
of a porcelain-fused-to-metal
crown with a few modifica
tions . The 3M ESPE recom
mendations for its Lava zirco
nia is 1.5 to 2.0 mm of
incisaVocclusal reductio n and
1.0 to 2.0 mm of axial r educ
ti on. The r ange of red uction is
related to the aesthet ic needs.
The mor e tooth reduct ion, the
more available space for the
lab t echnician to appropriate
ly layer various porcelai ns to
achieve better aest hetic s.
Some clinicians and t ech ni
cians advocate 2.0 to 2.5 mm
of incisal/ occlusal reduction
for opti mal appear an ce and
anatomical form.3 The axia l
continued on page 118
figure 11 Preoperative view of tooth
No. 11 and of implant No. 12 (with
transf er coping in place). Note that
the pati ent is mi ssing toot h No. 10.
Rgure 12. Preparation of too th No.
11 for zirconia crown.
FIgUre 13. Laboratory mode l at
preparation No. 11 and implant
No. 12.
Rguro 14. Zirconia copi ngs for
crown Nos. 11 and 12 and zirconi a
imp lant abutment No. 12.
figure 15. Zirconia coping and zirco
nia implant abutme nt on laborat or y
model.
Rgure 16. Zirconia Implant abut
ment seat ed clinically.
Useof Zirconia...
conti nued from page 116
ta per s houl d be gre ater th an
or equ al to 4
0
, a nd the hori
zontal angle of th e margin
should be greate r th an or
equal to 5".
Du e to the limitations of
the die-scanning process and
the s ubsequent machine mil
ling , sharp an gl es in the
preparati on must be avoid ed.
A circumferential deep cha m
fer or rounded s houlder at
t he gingival margin is recom
mended. Ninety-degree shoul
ders, tr onghing at t he mar
gi ns, feather edge margins,
undercuts , or sh arp line an
gles are not accep table.
AESTHETIC QUALITIES
The metal-free nature of a
zirconia restorati on is an
advantage wit h regard to aes
thetics, but if th e preparation
is inadequate or the laborato
ry design is flawed, then th e
fini sh ed crown Or bridge can
be un appealing'. The most
common inadequacy is teeth
that are not r educed suffi
ciently. This can result in a
restora ti on that is too opaque
and ha s a mono chromati c
appearan ce. Likewis e, if the
laboratory designs a restora
tion wi th a copin g that is too
thick, or the connectors are
too large, th e r esul t will be
a n aesthe t ica lly unappeal
ing cro wn or br idge th at
looks too bulky.
Du e to the inh erent opa c
ity of the zir coni a , the clini
cia n must be s ure that the
tooth is prepare d adequa t ely
to all ow enough room for the
substructure an d the porce
la in layer. If thi s is not the
cas e, t hen the opaque coping
can show through. In addi
ti on, if the lab oratory techni
cian creates a restoration in
which the zir conia is t oo
thi ck, then th er e may not be
enou gh space for veneering
porcel ain . Furthermore, the
technician needs to consid er
the final shade and sele ct an
appropriately colored zirconia
that a llows layering of vari
ous translucencies of porce
lain to develop a restoration
th at demonstrates "color from
within."
To enhan ce a nte ri or aes
th eti cs, the clini cian ca n use
a r ounded sh oulder pr epara
tion, then cut back the zir co
nia copi ng sligh tl y to pla ce a
more translucent por celain
at the margin. This allows
light to pass through the
tooth structure and better
bl end the r estoration/root
junct ion, resul ting in a natu
ral ap pearance.
PLACEMENT TECHNIQUES
Pl acement of zirconi a restora
ti ons ca n be via standard
cemen tation or by bonding.
Thi s can simplify the place
Code:DTO:J07
FREEinfo, circle 77 on card
Agure 17. Zirconia-based crowns
on laboratory model.
Flgure 18. Postoperati ve view of zlr
conia Implant abutment and crown
Nos. 11 and 12 .
ment pr ocess and gives th e
dentist a number of options.
Due t o zirconia's inherent
strength, convent ional ce
ments like zinc phosphate or
polycarboxylate ca n be used,
These cements may not be
the first choi ce, however, due
to their physical pr operties as
well as their opaque nature.
Opaque cements may show
t h rough t he zirc onia and
affect th e final appearan ce of
th e restora tion. Glass iono
mer, resin- modifi ed glass
ionomer , and self- etching
resin cements have a ll been
used with succes s,14,15 and
th ese have the potential to
enhan ce aesthet ics. Further,
with these cemen ts the clean
up of the excess cement at the
margin is eas y, and elimina
tion of exces s ce me nt is
a lways clini cally beneficia l.
In th e case of short or ex
t re mely ta pere d preparati ons,
a bond ed resin cement may
be best. The probl em is how to
achieve adherence to the zir
conia. Zirconia does not etch
with hydr ofluori c aci d due to
lack of a glass ma t rix , nor
does it conta in sili ca to allow
silane coupli ng to occur. By
sandblas ti ng t he intaglio s ur
face with a l umi num oxide
particles, a relatively weak
bond can occur bet>veen t he
z:i reonia and th e resin .l '' The
bond to z:i rconia can be fur
th er improved by using a
che mical s urface treatment
wi th th e Rocatec system (3M
ESPEl prior to bcnding.l?
The choice of placement
technique ultimately depends
upon th e clinical situat ion.
Th e dentist needs to deter
mine how much ret ention the
References
preparation provi des , t h e a es
1. SN. Miklus VG, McLa", n EA, at at
thetic dem ands, the type of
Rexur at strergth of a layered arccota
restoration bei ng placed , and
end porcelaindental en-cerarrec system.
J Proslhe l Dent 2005:94: 125131. Continuing Education
the location in the mout h.
2, Evans AG. Perspective on the devel - ,..
opment 01high -toughness ceramics. J
Am Gerem Soc. 1990;73:187206. ' :c..
POTENTIAL PROBLEMS
3. McUl"'n EA. Hyo L CAD/CAM l4ldala:
Fai lure of de ntal materials techmloqtes and materi als am ctinical
Test No. 87.1
-
can and does occur in clinica l
dental practice. All failures
cannot be prevented, b ut th e
majori ty can be prevente d if
both proper material selection
guidelines a nd usage r ecom
menda t ions a re followed in re
ga r d to preparation, fabrica
tion, and cementation.
The potential probl ems
t hat ca n occur with zirconia
can be divided into 3 ca t
egories :
s ubstruc ture failure;
failure of th e bond at the
interface between the zir coni a
and th e layeri ng porce lain; a nd
bre ak age a n d chip
ping of the porcel ai n veneer.
Du e to t h e lack of long
te r m cl inical st udi es , it is dif
ficul t to rep ort on the fail ur e
ra te of zirconi a An ecdotal ev
idence a nd limit ed , s hort
term clinical studies s uggest
tha t the mater ial is cli nically
acce pta ble.Jf Some fr a ct ures
of the por cel a in layer h a ve
occurred.If but th e ca use ha s
not been de te r mined. Lon gi
tudi nal studies are n eeded.
One property of zirconi
um oxide tha t h as not bee n
well studied is th e ph enome
non of low- temper a ture de
gradation or "agin g." Wa ter and
nonaqueou s solvent s a r e in
volved in forma tion of zirconia
hydroxides alo ng a crack. This
process accele r a tes expansion
of th e fr acture and can result
in reduced strength, tough
ness, and density, leading to
failur e of the restorati on.P
CONCLUSION
Both fully sintered (HIP) and
partially sinte r ed (non-H IP)
zirconi a pro ducts a ppear to
be cli nical ly accep table. Th e
pr eparati on and cementation
pr otocols are similar to what
is used for conventional por
celain-fus ed-to- metal restora
tions . Ca uti on is urged, h ow
ever, i n regar d to th e cli nica l
applica tio n of thi s material.
Long -term, m ulticenter stud
ies are n eeded. Currently, zir
con ia appears appropri a te for
single crowns, a nterio r im
pl a nt ab utm ents, and an teri
or/posterior bridges with one
ponti c a nd a span less t han or
equal to 38 mm (Figures 1 to
18).
perspectives. Inside D8fJtfstry. 2006 ;
Nov/Dec :l02.
4. Mclaren EA, Glordanc RA II. Zirconia
based ceramics: material properties.
esthetics, and l ayering of a
new veneering porcelain, VM9.
Quintessence Dental tecnna. 2005;
28:99-111.
5. Guazz ato M. AIbaJ<ryM. Ringer SP, et
al. Strength, fractur e toughness and
micr ostructure at a selecti on of 5.11
cerami c materi al s. Part II. Zirconia
based dental ceramics, Dent Mater.
2004 :20:449456.
6. Guazzato M, AlbakJy M. Ri ngerSP. at
al. Strength, fractur e toughness and
mi crostructure 01 a selecti on of all
ceramic materi al s. Part I. Pressa ble
and alumina glass -infilt rated ceramics.
Dent Mat er. 2004;20:441-448.
7. Keough BE. Kay HB. Sag ar RD. A ten
unlt all-ceramic anterior fixed parti al
dent ure usin g YTZP zirconi a. Pract
ProceaAe sthet Dent. 2006 ;18:37'43
8. Impor tant changes in fixed pr ostho
dontics. e RA NewsJeffer. Sep 2005;
29:1-4.
9. Lu1I1ardt RG, Holzhutar MS. Rudolph
H, et aI. CACWCAM-machining effects
on Y-TZP zi rconia. Dent Mater.
2004 ;20:655662.
10. Hertl ein G, Hoscheler S, Frank S, et
al. Marginal fit of CA D/CA M manufac
tured all ceramic zi rconi a prosthese s.
J Dent Res. 2001:80: _tract 49 .
11. Sadan A, Blatz M, lBnO B. Clinical
conside rations tor densely si ntered
alumina and zirconi a restor ati ons: Part
1. Int J Pen'odonticsRBstoratwe Den t.
20 05:25;213 21 9.
12. So rense n JA The Lava system for
CAD/CA M producti on of rogh-stTength
pr ecision fixed prostnooonncs. Quin
tessen ce Denttl l Techno l. 2003;
28:5767.
13. Zirca'lia SURJOrted ceranic fued pros
11188es, CRA NewsJeaer. Nov2004:28:2
4.
14. PalaciosRp'Jot'nsa1 GH. KM. at
al. Reten1ionof zircoriun oxide ceramic
crowns with three types of CEment J
Prosthet Dent 2006 ;96:104-114.
15. .. p. NothdJr1lF, ftlspoch P.1n
vitr o Investi gations on the fracture
strengtt1 of all-ceramic posterior bridges
of zroz-ceremc. J 0Frl Res. 2001;80:
Abstract 173.
16. Kinzer GA. Cementati on 01lava reeera
tiCYl s. AcNanced Esthetics sraInterdi.9
dplinary DenIisJIy. 2006:2(3) 026-32.
17. Atsu SS, Kilicarman MA. KuaJ<esrren
He , at al. Effect of zi rconiurn-mdde
ceramic swace treatmen1B m the bcrd
strengU1 to adhesive resin. J Prr::5thet
Dent 2006 ;950430 -436 .
18. Zircona vs, porcel ain-fused-to -metal
(PFM); di rical pel10rmance at 1 year.
eRA Newslener: Nov 2006:30;1,4 .
19. Chevalier J.\Nhat futur e for zirconia as a
biomaterfal? Bi omaterials. 2006;27:535
543
Acknowledgment
La boratory pr ocedure s were
performed by Rol and B.
Tasker, CDT.
Dr. Parker Is in private practice in
Lemont, III. He Is a graduate of the
University of Illinois, has completed
the EstheticDentistry Program at the
Unive rsity of Minnesota , and is a Fel
lowInthe AGO. Dr. Parker practices
general dentistry with an emphasis
on restorative aesthetics and can be
reached at ParkerDenlal1@aol.com.
T
o submit Continuing Education answers , use the answer s hee t on pag e 112. O n the
an swer s heet , identify the arti cle (this one is Test 87.1), pla ce an X in the box corre
s ponding to the answer you be lieve is correc t, de tac h the answe r s heet from the
magazi ne , and mail to DentistryToda y Dep artment of Cont inuing Edu cation.
The following 8 quest ions were de rived from the art icle Useof:Orconia in RestoratiVe
DentBlJyby Richar d M. Pa rker, DDS, on pages 114 through 119.
'!i"ii,ji!1!l!@lfU-
After reading this article, the individual will learn:
the phys ical prope rties of zirco nia oxide materials, a nd
clinica l appli cations and techniques for zirconia materials.
1. The type of zirconia oxide used in den 5. Preparations for zircon ia restorat ions
tistry is composed Df __' must not have
a. a matrix-free , den se polycrysralline a 1.5 mm 102.5 mm of incisaVocciusal
mate rial reduction
b. ce ra mic crystals e mbedded in a glassy b. 1.0 mm to 2.0 mm of axial reduction
matrix c. an axial tape r of at least 4"
c. a reucite-rei nforced pressed ceramic d. s harp, 900 shoulder preparations
d. a metal a nd glass heterogen eous
mixt ure Bondinq of zlrconia restoratlons can be
problematic because _ _ "
2. Transformational tDughening refers to a. there is nota glass matrix to acid-etchand
zirconia's ability to __. they do not contain silica for silanating
a. produce a "clamping effect' on cracks to b. hydroftuoric acid denatures the tetragonal
stop their continued growth crystalline structure
b. change its physicalstate when repeatedly c. dental adhesives willnot set under zirconia
heated and Cooled due to chemical inhibition
c. exhibit properties such as d. resin cements will expand and fracture
ductibility and burnishability the coping
d. transform the vereering porcelain irtto a
zirconia-like ceramic 7 . The main clinical concern with zirconia
restoratiDns is
3. The most common way to fabr icate a a. they are too unaesthetic foruse in the
zirconia substructure Is by _ _ . ante rior region
a. CAD/CAM technology b. they are cost prohi bitive to use in daily
b. the "lost waX'technique practice
c. electrophoresis c. they have been shown to be highly
d. the plasma-spray metl10d allergenic
d. long-term clinicalstudies are not yet
4 . Zirconia restorations demonstrate available
a. highftexu ralstrength and highfracture
toughness 8. At present, recommended usage of zir
b. se mitranslucency and ability to be conia is restricted to
cemented a. single crowns
c. radiopacity and good marginalfit b. anterior implantabutments
d. allof the above c. short-span bridges
d. all ofthe above
tinui J fEll "
Conmumg our " ourney 0 xce ence -0 TftD..,y
MARC)) ZD07 ' DENl'&IRY TODAY