My good long term patient wanted to look better and we were thinking of taking off old opaque PFM and chipped composites (the PFMs were deep subgingival and hard as a car bumper). Underlying shade was not good. I warned him we may have to opaque and he seems okay with it but he picks an OM3 shade. I have done some emax and it has covered pretty well in posterior, but the lab wants to do prismatic which is their zirconium overlaid with feldspathic. I have held the case for three days trying to decide what to do.
I have been wanting to try the esthetic zirconium’s that you showed at the seminar and I saw at the 3M booth. I take it that this is not a good case for it. If I do go along with zirconium and overlaid porcelain, are there some materials that are better esthetically than others depending on the lab? Ie lava vs glidewell vs???
Depending upon the thickness of the crowns, the new HT ZrO2, like lava Esthetic, can be a very good option. This material can either be monolithic with staining or cutback and layered, like the Prismatic you described. In the anterior, due to esthetic demands, I would use Lava Esthetic and have it overlaid on the facial with Noritake powder-liquid ceramic. They can choose a brighter shade as a base, which will neutralize the underlying dark color, and overlay with some beautiful enamel porcelains.
You could also use E.Max as a core (they make opaque E.Max) but it is not as strong as the Lava Esthetic. Utah Valley Dental Lab has done some really beautiful ZrO2 layered Crowns, using Lava Esthetic, to cover dark preps in cases very similar to your patient. As far as ZrO2, I am not a fan of Glidewell’s Bruxzir material. The original is just too opaque and their new Buxzir Anterior is not as translucent and vital as the Lava Esthetic. As a second choice, I like Katana ZrO2 which is available in multiple opacities.