All-on-4, acrylic or or zirconia porcelain?
Doctor Answers 10
Zirconia versus Acrylic Hybrid WILL ANSWER A LOT OF QUESTIONS YOU MAY HAVE
Prosthodontic care for missing teeth should be thought of in a “chronic condition” context. You must recognize that long-term outcome monitoring is necessary.Think of a prosthetic arm or leg: As with any other body part that needs to be replaced as a result of an amputation, there is maintenance!
The overall goal of the All-on-4 (Fixed bridge implant bridge) protocol is to restore a terminal or missing dentition. The dentist/dental specialist restoring the case is giving you a tooth substitute (not replacement). Since we cannot implant natural teeth, the two most common substitutes are: 1. Acrylic or 2. Zirconia.
A combination that is used more and more is an upper zirconia bridge opposing a lower acrylic bridge.
I've seen some patients that come in for second opinions that have very PRETTY Acrylic bridges, but also some with very UGLY Acrylic bridges. Zirconia bridges are the same, some are very esthetic, others are VERY OPAQUE, dead looking, and can look "Less-natural" than an Acrylic bridge. Ask your dentist to show you some ORIGINAL work, not stock photos.
Each have its pros and cons:
Description: Typically a titanium milled (CAD/CAM) bar connects the four implants. Acrylic denture teeth are set on the bar, tried in for approval of esthetics, and the teeth are processed (connected to the bar) with a pink acrylic. So in essence, there is 3 layers: the bar, the teeth, and the pink acrylic that connects everything.
There needs to be necessary room for all layers (14-16mm), otherwise the bridge will not fit in the space provided. Many times repairs/breaks on the acrylic hybrid All-on-4 bridge are a result of the minimized space; either the teeth or the acrylic has to be thinned out, weakening the strength.
Cost is Less (denture teeth come "stock," mass-fabricated)
Easier to repair
Acrylic is softer, so there is a "give" to the bite, for grinders they will slowly wear away the acrylic, similar to natural teeth. However, if the material is more stiff (Ceramic) a grinder can chip the restoration (too brittle).
Staining more frequent
Delamination (Debonding) of tooth from acrylic
Wear is faster
Higher repair; in a study in the Journal of Prosthodontics, 255 patients were followed up for an average of 13 years, and approximately 58% had one or more prosthetic events (i.e, chipped/broken tooth, loose implants screw) during that recall period. Overall survival rates at 20 years were 86% for prostheses (bridge), 15% survived free of any event, and 92% experienced survival free of biological implant failure.
Description: A monolithic, high-strength material that is directly fitted to the 4 implants (without a titanium bar).
Zirconia is Harder than Acrylic (for grinders they will slowly wear away the zirconia compared to acrylic)
Can layer porcelain for more esthetic, natural look (should be as minimal layering as possible)
No chance for tooth delamination/debonding (All one piece)
Can be used in limited space situations (12-16 mm of space)
Cost is Higher (requires expensive milling/sintering machinery, custom hand finishing/detailing)
Very Opaque (porcelain can be layered, or added to improve esthetics, but the porcelain can chip)
Harder to repair (since the material is all one piece, if a "chip" occurs, the entire bridge needs to be replaced, OR a ceramic veneer can be glued to the front surface of the bridge as an alternative)
Too Stiff (because of the incredibly stiff nature of the zirconia there is a potential for catastrophic failure from fracture of the entire zirconia bridge)
As with all comments, ask a professional Prosthodontist in your area what treatment best suites your needs.
Zirconia or Acrylic titanium
Zirconia - This is the ultimate option where there is a combination of strength and cosmetics. Most patients feel that this is the option that is the closest to the feel of their natural teeth. The material is very rigid and if upper and lower jaw is being done it is recommended to use a material that is not so rigid in the lower jaw.It has been around for approximately 10 years or so. This means the follow up is not as long as other options.
Acrylic Titanium - This option does have long term follow up, the advantage of this option is that it is easily repaired should you sustain trauma to the teeth. It has some resiliency meaning that with impact the force is not at easily transferred to the implants. It does stain over a period of time but this can be cleaned and polished readily
For a full mouth solution a combination of materials is recommended to have the esthetics of zirconia and the resiliency of acrylic titanium .
Longevity and Aesthetics Make The Decision
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Zirconium or Acrylic: All on 4?
Porcelain zirconium provides the durability and longevity, and also the aesthetics. This is becoming the more popular material used in fabricating this prosthesis. Labs are becoming more innovative with processing this material too make it more life-like. This could be the ideal choice for someone looking for aesthetics as well as longevity for the All on 4 Hybrid Denture.
All on 4 acrylic or zirconia
As far as durability zirconia will be more durable and will last and not chip.
if you do chose acrylic teeth they have the longest trac record they will wear and will chip but they are easily repaired . The teeth can be replaced easily in a few days .
Remember this technique is relatively new less 11 years in the US.
some doctors have concerns about zirconia against zirconia and are not recommending it this product is very new (a few years )so the jury is still out
Material for the All-on-4 teeth.
Materials do break and need maintenance. Acrylic does wear and the teeth may break off. If using Zirconia ceramic monolithic teeth, there is no fear of wear or breakage. If you choose to use any porcelain (glass) there may be more fractures over time.
A list of Pros & Cons for Arcylic and Zirconium
There are two basic options: acrylic and zirconium.
Pros: This material looks great, it is the "tried & true" method, it can be repaired easily.
Cons: Teeth wear down over time (7-10 years) and have to be replaced, Sometimes the teeth break completely in cases where the patient is a teeth grinder.
Pros: Very strong material and does not generally break or chip if made properly. This material can last you longer than 10 years if properly maintained.
Cons: If it is made incorrectly, the whole appliance can break and it is impossible to repair it. Any small inaccuracies in the fabrication of the prosthesis can be problematic. Also, this material can look a little bit too white. (Porcelain can be added to it to give it a better cosmetic appearance but this increases the cost)
Acrylic versus zirconia teeth for the All on 4 procedure
One of the biggest factors in determining which type of teeth would be best for you is to know what the opposing arch has.
If you're All on 4 prosthesis will be opposing acrylic denture teeth, then you should go with acrylic teeth.
If however you're posing arch has porcelain or zirconia, then you should go with a zirconia All on 4 prosthesis because it will wear much better.
I hope you found this information to be helpful,
Zirconia dental bridges are more durable than acrylic
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.