Dentaltown October 2017 - 44

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E.max Bridge Fractured After 1 Year
Townies discuss the best ways to shore up a bridge

cbee926
Member Since: 02/29/16
Posts: 1, 3 and 6 of 68

A 6x8 e.max bridge fractured on a patient after one year. Crowns were etched and silane
applied. Nexus 3 used for cement. There was enough occlusal clearance and all margins were
1.25mm 360 shoulder. What would cause #6 portion of the bridge to fracture after only one
year? Anyone use a different bonding cement for e.max?
Do you think it was an occlusal issue? Occlusion was adjusted on it twice. Suggestions for
the future so I can avoid this? What material do you suggest? Zirconia? Thanks! ■
6/20/2017

bhk208
Member Since: 08/15/14
Post: 8 of 68

It's all about connector size with e.max and zirconia. It's sometimes hard to get big enough
connectors and not compromise aesthetics. For that reason, I still like PFM for bridges. ■
6/20/2017

Richy
Member Since: 03/30/10
Post: 9 of 68

I haven't been out long. But I have worked several jobs, and in my office now seeing work
from 7-10 years+ on recalls: Stick to PFM for bridges. Zirconia fractures at the connectors.
E.max is not strong enough for multiple units. PFZ debonds at porcelain and zirconia interface.
The above also agrees with everything I have read on Dentaltown. As of now I use zirconia and
e.max for single units and PFM for bridges. If I start to see zirconia and e.max failing in my own
work I will go back to PFM for everything. ■
6/20/2017

cbee926
Member Since: 02/29/16
Post: 11 of 68

Thanks, Richy. What about the aesthetic obsessed patient? They don't want to see metal on
an anterior case. If they insist no metal, warn them about the potential to fracture? Do you have
the patient sign something stating you suggest PFM, and the risks of e.max/zirconia so when
they come back with an issue you do not have to pay to replace? ■
6/20/2017

Richy
Member Since: 03/30/10
Posts: 12 and 16 of 68

I don't. I just have a come to Jesus conversation with them. But honestly, I try to avoid
dealing with people like that to begin with lol. If you prep a heavy shoulder on the facial you
can hide all of the metal. One of Lanes posts on here showed the prep design and the crown.
Maybe he can post it again. It's hard for anyone to give a definitive answer in a vacuum without
knowing more about the patient. Example: Did they have posterior support? Perio? How was
posterior occlusion? Anterior occlusion? Parafunction? ■
6/20/2017

mike k
Member Since: 05/01/01
Post: 18 of 68

Where did the bridge fracture? Was it the connector or the actual crown? Depending on
where it broke will indicate what the reasons for the fracture were. All about the material,
respecting the limits. If you can't get the proper thickness or connector size, things will break.
Personally, I've had good luck with e.max for bridges, no breakage, but I'm careful with how
and where I use it.
If I need something stronger I will go with a zirconia frame with e.max pressed to the frame.
This gives a good esthetic and seems the pressed e.max solves the issue of the layering porcelain
coming off the zirconia. Also, your layered porcelain is now a much stronger material. I've done

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