Lab Tribune Middle East & Africa No. 4, 2018
Making a perfect ceramic crown on a titanium abutment in the esthetic zone / Celtra® Press – All Ceramic Power
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Published in Dubai
July-August 2018 | No. 4, Vol. 8
www.dental-tribune.me
Making a perfect ceramic crown
on a titanium abutment in
the esthetic zone
SUBSCRIBE NOW
https://me.dental-tribune.com/e-paper
Vol. 8 • Issue 4/2017
issn 1616-7390
CAD/CAM
international magazine of
digital dentistry
4
2017
Overcoming a challenging situation step by step
interview
“Dentistry has finally arrived in the digital age”
case report
Screw-retained implant-supported restoration
in the edentulous maxilla
By MDT Patrick Rutten, Belgium
For reasons of strength, a titanium
abutment may be required in the
esthetic zone. However, masking the
dark metal to achieve a natural-looking outcome will present a challenge.
A ceramic crown with a zirconia coping should be used to mask the metal
abutment. A layering protocol is used
to create natural light and color and
avoid a greyish-looking gingival tissue in the cervical area. In the following clinical report, MDT Patrick Rutten (Tessenderlo, Belgium) presents
how to handle such a challenging situation and obtain predictable white
and pink esthetics.
Clinical situation
More than 40 years after a sports in-
jury, extensive caries was detected radiographically under a post crown on
a maxillary right central incisor (Fig. 1
and 2). The tooth was determined to
be nonrestorable and was extracted.
After a healing period of eight weeks,
an implant was placed (Fig. 3) together with allogenic bone augmentation
and soft tissue regeneration with a
free connective tissue graft harvested
from the palate. A healing abutment
was screwed onto the implant and a
removable provisional denture provided. For strength reasons, a custom
CAD/CAM-fabricated titanium abutment was chosen (Fig. 4). “I do not
prefer using titanium in the front if
possible, but in this case, function is
more important than esthetics,” Rutten explains.
The challenge was now to veneer a
Fig. 1 and 2: Initial situation, clinically and radiographically, before extraction of right maxillary central incisor.
zirconia coping with the fine-structure feldspar ceramic VITA VM 9 to
reproduce the natural appearance
of the adjacent teeth and to support
and sculpt the soft tissue for optimal
gingival management. “Working
with a titanium abutment is very difficult. The gingiva can look greyish.
We have to mask the greyish cervical
part,” Rutten warns. Precise shade determination was the first essential for
success.
To guarantee a perfect shade match,
the VITA Linearguide 3D-MASTER
was used (Fig. 5) to cover the whole
three-dimensional tooth shade spectrum and to allow shade determination in three defined steps. In the first
step, the shade value was verified, followed systematically by chroma and
hue. The basic shade of the adjacent
Fig. 3: Radiograph
after implant
placement.
teeth was measured digitally with the
VITA Easyshade V spectrophotometer. Independently of one another,
the expert and the digital device both
determined the tooth shade to be
3M2. For Rutten to achieve a shade
match between the natural teeth
and the restorations, the correct basic
shade is highly important.
Layering procedure
The zirconia coping was virtually designed, milled, sintered, and fitted.
An initial wash firing with VITA VM 9
EFFECT LINER was a crucial step in
adding a fluorescent layer to the nonfluorescent zirconia coping. The liner
also provided reliable bonding to the
framework. The firing temperature
should be 50 degrees higher than
that of normal dentine firing.
Fig. 4: Titanium abutment screwed onto implant.
cone beam supplement
Dynamic navigation for reliable
and predictable flapless implant placement
VITA VM 9 BASE DENTINE 3M3 with a
higher chroma was used in the cervical area to mask this critical area and
to mask the lifeless and greyish appearance of the titanium abutment.
Yellow EFFECT CHROMA 4 (EC4) was
then applied with a deeper orange in
the interdental areas with a mixture
of EFFECT CHROMA 5 (golden rod)
and 6 (sunflower) to enhance the
masking effect. For the incisal third
area, a higher value was selected with
3M2. To create the ridges, the bluish
ÿPage B2
Fig. 5: Determination of basic shade with VITA
Linearguide 3D-MASTER.
Fig. 6a: MDT Patrick Rutten at work.
Fig. 6b: Layering dentine core.
Fig. 6c: Creation of mamelons.
Fig. 6d: Layering of enamel.
Fig. 6e: Characterization with INTERNO.
Fig. 6f: Result after first dentine firing.
[2] =>
B2
lab tribune
Dental Tribune Middle East & Africa Edition | 4/2018
◊Page B1
Fig. 7: Shade assessment after first dentine firing.
Fig. 8: Final layering and contouring.
Fig. 9: Clinical evaluation.
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Vol. 8 • Issue 4/2017
issn 1616-7390
CAD/CAM
international magazine of
digital dentistry
4
2017
Fig. 11 and 12: Cemented maxillary right central incisor crown
intraorally and periapical radiograph.
Fig. 10: Evaluation before glaze firing.
EFFECT ENAMEL 9 (EE9) mixed with
ENAMEL LIGHT (ENL) was chosen
(Fig. 6 a-f). The synergy of these three
basic components is essential for the
incisal edge:
- Color
- Enamel
- Translucency
VITA VM 9 ENAMEL LIGHT and EFFECT ENAMEL 9 (EE9) were layered
to create a bluish accentuation and
replicate natural esthetics. In addition, VITA INTERNO 2 (sand) and
4 (orange) were added to replicate
the characteristics found in the
contralateral tooth. VITA INTERNO
ceramics played an important role
in increasing fluorescence and natural warm color effects with internal
characterization. These characterizations should always be arranged
irregularly for a natural appearance.
Fig. 13: Natural and esthetic smile.
interview
To achieve a contrast, BASE DENTINE
was layered onto the palatal side of
the incisal edge. During contouring
the ceramic mixture must remain
creamy and stable to achieve an efficient and successful layering procedure. This layer was increased slightly
to allow for intraoral adjustment. An
implant crown should be adjusted so
that functional loading is minimized.
“Dentistry has finally arrived in the digital age”
case report
Screw-retained implant-supported restoration
in the edentulous maxilla
cone beam supplement
Dynamic navigation for reliable
and predictable flapless implant placement
Fig. 14: Close-up lateral view of maxillary incisors
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Be careful with translucency!
If the crown contour needs to be increased, translucent porcelain should
never be added since the addition
will always reduce value and chroma.
Using too much translucent enamel
is a common mistake, which will automatically lead to a greyish-looking
tooth. BASE DENTINE should be used
again to correct the deficient contour
(Fig. 7 and 8). If the value has to be
changed, the technician should go
back two steps and correct the basic
value. “The basic value is the most
important thing for me. You should
play around with it,” is Rutten’s strategy. The palatal side was layered with
EFFECT CHROMA 4 (lemon drop) and
BASE DENTINE to mask the transition
between coping and layering in these
areas. This is Rutten’s general advice
for finding the correct ceramic shade
combination: “Getting the right mixture will sometimes take more time
than the layering itself. Don’t start
mixing thousands of powders.”
Finishing the restoration
Maintaining adequate healthy pinkcolored gingiva is challenging for the
dentist, especially around implant
restorations. To accomplish optimal
gingival architecture, the shape of
the neighboring lateral incisor was
replicated and the gingival papilla
supported to avoid creating black
triangles. The distal and mesial marginal ridges were created with a fine
diamond instrument to produce a
fluent curvature toward the apex. After the fine-structure feldspathic ceramic was fired, the subgingival areas
were contoured and polished with
a rubber wheel to create a smooth
and compatible environment for the
surrounding soft tissue. The chipped
adjacent tooth was matched in the
restoration, although in a different
location for a more natural outcome.
A vertical crack line was accom-
plished with a fine tungsten carbide
bur. As Rutten says: “You can place
your cracks two or three millimeters
away from the position on the corresponding neighboring tooth. We
need an irregular crack line.” Final
characterization was achieved with
VITA AKZENT Plus EFFECT STAINS
and then fired. “I try to create something soft without overdoing it,” says
Rutten in describing this final step.
“Make the best,
but keep it simple!”
The goal should be to keep the technique straightforward and to know
when a restoration is finished so that
time is not wasted and economic
goals are met. Consequently, every
veneering procedure should be consistently ended at some point. The
crown was clinically evaluated before
the final glaze firing (Fig. 9 - 10). After
evaluating the esthetics, function
and occlusion, the restoration was
finalized in the dental laboratory and
definitively cemented (Fig. 11 - 14).
The restoration looked exceptionally natural and integrated harmoniously in the esthetic zone. Texture
and ceramic layering created a highly
esthetic combination of contour and
color. The crown supported the gingival architecture and was thereby able
to accomplish pink esthetics. The
patient was delighted with his new
restoration and appreciated the outcome. Thanks to know-how, technical skills, interdisciplinary teamwork,
and outstanding ceramics, a challenging clinical case was solved in a
highly esthetic manner.
Source
This case has been previously published in dental dialogue 5/16, teamwork media GmbH, Germany
[3] =>
[4] =>
B4
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 4/2018
Celtra® Press – All Ceramic Power
By Dentsply Sirona
Life’s getting easier! In today’s dental laboratory, selecting the right
material has become a complex issue. Dental technicians are continually confronted with new materials
whose development often paves
the way for more advanced forms
of dental rehabilitations. Celtra®
Press Zirconia-Reinforced Lithium
Silicate, is a new material on the market that makes life for dental technicians easier. Its excellent optical
properties open up new and better
options in the area of high-strength
glass ceramic restorations. Master
dental technician Hans-Jürgen Joit
discusses the ideal optical properties
required from a material and illustrates how Celtra® Press meets the
high aesthetic demands from both
dentists and technicians today.
Conclusion
The material properties of Celtra®
Press allow the dental technician to
concentrate more on the morphology. The opalescent effect looks just
great in the mouth, and the crown
becomes simply – a tooth.
For more information please contact your
local Dentsply Sirona representative.
www.dentsplysirona.com
SUBSCRIBE NOW
https://me.dental-tribune.com/e-paper
Vol. 8 • Issue 4/2017
issn 1616-7390
CAD/CAM
international magazine of
digital dentistry
4
2017
interview
“Dentistry has finally arrived in the digital age”
case report
Screw-retained implant-supported restoration
Fig. 1: This image shows two rows of samples of polished opals for use in
jewellery. The top row has been photographed with a flash from above;
the opals appear as radiantly blue in the incident light. The lower row
has been photographed with a flash from below; the samples appear
to be made of a completely different material. This interaction is a basic
prerequisite for the optical intraoral acceptability of a dental material.
Fig. 2: Ultimately, our goal as dental technicians is to produce copies of
natural teeth with exactly the same characteristics. One of the main aspects of the optical effect is the opalescence of the material. With Celtra®
Press, in transillumination the teeth appear more orange, while in direct
incident light they appear bluish.
in the edentulous
Fig. 3: This image shows six Celtra®
Press maxilla
veneers, about 0.6 to 0.8mm
cone
beam
supplement
thick, placed on the window sill in
the
laboratory
and transilluminated
Dynamic navigation for reliable
and predictable flapless implant placement
by sunlight. The special microstructure, with its particularly fine crystalline structure and high glass-content, provides the material with outstanding light-optical properties. Thanks to this combination of high
translucency and opalescence Celtra® Press exhibits an amazingly natural chameleon effect to surrounding teeth in the mouth. Restorations
fabricated with it blend into the natural dentition extremely well and
assure users maximum aesthetics for mimicking natural teeth.
Fig. 4: The same jewellery opaque as previously photographed in transillumination and in incident light, now in cross-polarised light. An orangeblue flicker and a lively, playfully changing colour can be seen.
Fig. 5: Shows previously transilluminated Celtra® Press veneers in polarised light. Celtra® Press possesses the same characteristics as the polished
opals, meaning it has an optimised balance of translucency and natural opalescence resulting in a game-changing chameleon effect (in-vivo
blending) that makes the restoration indistinguishable from the natural
tooth.
Fig. 6: This image shows an extracted natural tooth with a Celtra® Press
MT coping in A2. The coping was merely fitted on the tooth and manually polished. Note the conspicuous transition from the unprepared root
to the Celtra® Press crown. The crown practically becomes a part of the
tooth.
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