Alternative metal

We in the dental community have all been concerned for some time about the high price of gold in the London market. We are directly affected by these prices because of the uncertain economy and the metal supplies necessary to fabricate our crown and bridge work.

Fortunately, in using the newest technology possible to fabricate titanium copings, there is an exciting and cost-effective solution to the high cost of metal. Titanium is ADA approved and has been assigned code number 2794 for insurance purposes as a porcelain to titanium crown. 

Case study

This article will deal with the technical aspects of creating a single porcelain to titanium crown, beautifully layered to mimic the same esthetics as a porcelain to metal restoration.

01 With the Nobel Biocare NobelProcera CAD/CAM scanning system (Fig. A), the lab first scans the model. The titanium coping is then milled by Nobel Biocare and returned to us two days later. In the laboratory, the technician can then design the restoration as it was prescribed by the clinician. 

02 The titanium coping from Nobel Biocare is ready to be ground with a KOMET carbide bur (Fig. B) to ensure that its lines are smooth. When grinding a titanium coping, the technician should use the carbide bur and move in only one direction to create a flat line, as demonstrated on the right side of Fig. C.

03 The next step is to sandblast the coping, done here using a Renfert Sandblaster at 2-4 bar speed (Fig. D). Please note: sandblasting is very important between steps for this type of restoration.

04 After sandblasting the coping, it is placed in an ultrasonic with distilled water (Fig. E), cleaning the coping for 5 minutes.

05 By carefully following the GC Initial Titanium (GC Initial Ti™) low fusing porcelain system chart guidelines (Fig. F), I was able to ensure my final results. First, the instructions indicate that a titanium bonder must be applied in a thin coat, appearing like that of the right view in Fig. G.

06 Following normal opaque procedures, GC Ti Opaque is applied onto the coping, as seen here with shade A-4 (Fig. H). After baking twice, it will have this appearance. GC Initial Ti™ porcelain is offered in a full range of colors (Fig. I).

07 Several applications of porcelain build-up were layered onto the coping, using this particular range of nine different colors (Fig. J).

08 In the final restoration, note the beautiful effects and the natural tooth morphology (Fig. K). The mirrored image in Fig. L gives an occlusal view as well as a side-by-side image in Fig. M.

Conclusion

It is exciting to be able to announce this groundbreaking material option to our colleagues. Lately, when we purchase high noble metal for the lab, the cost is very expensive. In turn, we have to pass this on to the clinician, which drives up the price of our restorations.

The good news is now we can all offer our clients this titanium option, which has the advantages of a very light weight, excellent biocompatibility and an easier process for fabrication because the waxing, investing, casting and divesting steps are all eliminated.

After testing a single unit in the laboratory, we found the results to be fantastic. However, with a long-span bridge, we noticed that we have to control cooling times and temperatures to get the best results. Please stay tuned for a product report on that type of restoration in an upcoming issue, after further research and experimentation.