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    How to use GC Fuji PLUS for seating an anterior full-coverage zirconia crown restoration

    How one clinician uses this resin-reinforced glass ionomer cement to ensure an optimal marginal seal.

    When faced with providing patients with an indirect restoration, dentists take many factors into consideration when evaluating and selecting from today’s available cementation options. Depending on the restorative material used, underlying substrate (e.g., natural tooth, composite, or cast post and core) and characteristics of the preparation (e.g., subgingival margins, difficult to isolate margins), the selected cement can affect treatment longevity and oral health.

    Considering the multiple challenges that could influence cementation success, resin-reinforced glass ionomer cements can provide reliability and predictable bond strengths when seating a variety of indirect restorations (e.g., zirconia, metal-ceramic, lithium disilicate, or full cast metal crowns). Not only are resin-reinforced glass ionomer cements easy to use, but they also demonstrate ideal handling characteristics that facilitate restoration placement and excess cement cleanup.

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    One resin-reinforced glass ionomer cement in particular, GC Fuji PLUS® (GC America), provides dentists with significantly higher bond strengths compared to conventional glass ionomer cements because it bonds both chemically and mechanically to tooth structure and core materials. However, it still maintains the favorable characteristics of glass ionomers, like fluoride release, low coefficient of thermal expansion, and biocompatibility with tooth structure and soft tissues.

    Indicated for the cementation of metal-based and resin inlays, onlays, crowns and bridges, this resin-reinforced glass ionomer cement can also be used to cement all-ceramic inlays and high-strength, zirconia-based, all-ceramic crowns and bridges. The following case presentation describes the use of GC Fuji PLUS resin-reinforced glass ionomer cement in the treatment of a patient who required an anterior full-coverage porcelain-fused-to-zirconia restoration. Among the benefits realized by using this cementation option were ease of use and placement, extended working time, and predictable bond strengths to the underlying cast post and core.

    Case presentation

    A 60-year-old female presented upon referral from her general dentist for prosthodontic treatment when she requested a new full-coverage crown restoration for tooth #9. She fractured the tooth participating in gymnastics as a child. The tooth was initially restored with composite resin, but when it became discolored, endodontic therapy followed by placement of a cast post, core and crown was performed. The ceramic on the mesial-incisal portion of the crown had fractured (Fig. 1), so the patient reported that it was finally time to replace it.

    Fig. 1Fig. 2

                         Fig. 1                                                                                              Fig. 2

    The patient also reported that she was never happy with the restoration, and she also was unhappy with the incisal chipping on tooth #8. Since she was about to embark on a new career, she wanted a smile she felt confident about.

    A multitude of treatment options were discussed, including tooth whitening and placing a conservative veneer on tooth #8. The patient opted for the most minimally invasive approach, which included placing direct composite bonding on the incisal edge of tooth #8 and a new full-coverage crown restoration on tooth #9.

    Read more: How to use a universal nano-hybrid composite to restore a reattached tooth fragment

    The comprehensive oral examination, which included radiographs, revealed nothing that would contraindicate this treatment plan (Fig. 2). In fact, the previous endodontic treatment was acceptable, and the post was well-adapted to the tooth. The risks and benefits of removing the post were discussed with an endodontist and ultimately the patient, and it was decided to leave the existing cast post and core in place. However, doing so would create prosthetic challenges, including identifying a material that offered an esthetic outcome while blocking out the dark-colored post and core. For this reason, a full-coverage crown fabricated from zirconia was recommended and accepted by the patient.

    Clinical protocol

    A preoperative impression was taken and a wax-up was made, after which a silicone matrix (Sil-Tech, Ivoclar Vivadent) was made from the wax-up for use in creating a direct provisional restoration. The old crown restoration was sectioned off, and the preparation was refined using a series of preparation burs (Dr. Robert Winter Restorative Design Bur Block, Brasseler USA). Final impressions were then taken using a vinyl polyether silicone (VPS) impression material that demonstrates intrinsic hydrophilicity and optimal flow and tear strength (EXAl’ence™, GC America) (Fig. 3). Stumpf shades were taken using a stumpf shade guide (Ivoclar Vivadent) (Fig. 4), and the tooth shade for fabricating the restoration was determined using a standard VITA shade guide and VITA 3D-Master Shade Guide against the adjacent natural tooth #8 (Figs. 5 and 6).

    Fig. 3Fig. 4

    Fig. 3                                                                                                     Fig. 4

     

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