Lab Tribune Middle East & Africa No. 3, 2019
Metal-free aesthetics in everyday lab work / Dental Technician Int’l Meeting Highlights
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DTMEA_No.3. Vol.9_LT.indd
NL
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Published in Dubai
www.dental-tribune.me
May-June | No. 3, Vol. 9
Metal-free aesthetics in everyday lab work
By Mario Pace, Germany
Z-ART’s venture began in August
2010, from an offshoot of the Kimmel Zahntechnik laboratory in Koblenz. The idea was to establish a small
laboratory to manufacture individual metal-free workpieces, designed to
meet the aesthetic requirements of
the patient. Despite some initial difficulties, our work philosophy has now
been a reality for eight years.
Our usual approach is to involve
the patient and to focus the plan on
him or her until it is complete. We
are defined by the service our team
provides, which begins with an informal interview with the patient. We
collaborate with the patient by discussing and sharing our opinions. We
examine dental problems together
and this helps us to establish a working relationship with the patient that
includes psychological aspects (Fig. 1).
Once we have had our meeting to explore the patient’s case, I consult with
the professional and we discuss the
case and the approaches to be taken
(Fig. 2).
In many cases, the intervention of
specialists from other dentistry sectors will be needed. When the waxup for the project is ready and the
resulting mock-ups have been made,
with the involvement of the patient,
the dentist will contact me for shade
matching and then we will create a
photographic record that provides us
with detailed information (Fig. 3).
us to produce a very aesthetic result
using the Press-Technique, which
with optimal use guarantees highprecision results and is superior to
lithium disilicate as the dispersion
layer, which is formed during pressing and is vastly inferior to lithium
disilicate and can be easily removed
at the sandblasting stage, without the
need to repeat this step a second time
following acid treatment, as is the
case with disilicate (Figs. 11-12).
The phosphate phase generates opalescence within the structure that we
will later stratify individually (Fig. 13).
Once the materials have been selected, the issue of aesthetics is carefully
addressed using an analog method,
based on the requirements of the
case.
Fig. 1: Initial interview with the patient
Fig. 2-3: Sample of a mock-up
This first clinical case illustrates the
difficulty of providing prosthetic restorations on partially reconstructed
teeth using metal parts (Fig. 14).
While the abutment on the 12 is a natural tooth, on 21-22 reconstructions
of the abutments made with metal
alloys can be seen. From our experience, it is very useful to vary the opacity of the single lithium silicate blank.
The case was resolved by providing
some alterations to the pressed and
layered ceramic, as can be seen in
Figs. 15-16. Also in this case, an assess-
ÿPage B2
For this purpose we use a digital
reflex camera (Fig. 4) with a ringshaped flash and polarising filter
with the Smile Lite (Figure 5) and the
color scale that we as dental technicians are all familiar with (Fig. 6). My
team, Giuseppe Dimaggio and Antje
Überholz, assist with this.
Fig. 5: Smile lite
Fig. 4: Status photos with digital reflex camera with ring flash
Fig. 6: Colour shade matching
After we have gathered this information, it is the professional’s turn.
In addition to making the impression, the prosthetic dentist also provides the color for the abutments
remaining in the patient’s mouth
(Figs. 7-9).
Fig. 7-9: Impression and colour shade matching
In our daily practice, we have found
it particularly important to be provided with the color of the remaining
abutments in the patient’s mouth.
Experience has shown how vital this
information is for an optimal aesthetic result. The colour of the abutment helps us to choose the best
pellets to use. When we started in
2010, the materials we selected were
lithium disilicate and zirconium dioxide to construct extended bridges.
For the last two years, we have had
the option of a new material -- Celtra,
a zirconia-reinforced lithium silicate
which contains about 10% ZrO2 (Fig.
10).
Why did we choose this material?
What are the benefits? Celtra allows
Fig. 10: Range of Celtra ingots
Fig. 11-12: Dispersion layers after sandblasting and deflasking
Fig. 13: Effect of light on Celtra
Fig. 14: Initial situation with different colour abutments
Fig. 15: Frontal view of the case
[2] =>
DTMEA_No.3. Vol.9_LT.indd
B2
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 3/2019
◊Page B1
Fig. 17: Opacity and translucency check with polarising
filter
Fig. 16: Left lateral view of the finished work
Fig. 20: Initial situation with metal ceramics and showing gingival recession
Fig. 18: Frontal view with work in situ
Fig. 19: Cotton wheel with pumice for
final polishing
crowns and a buccal veneer, which
due to their nature have significantly different thicknesses. As can be
clearly seen in the initial photograph
taken with a polarised filter, on elements 11-21 there are very worn and
infiltrated composite reconstructions, while on element 12 the worn
composite material is mainly on the
proximal palatal surface (Fig. 32).
Fig. 21-22: Modeling in wax on master with copings
After the proper removal of the composite, the clinician prepares the
abutments leaving the best quantity
of residual dental tissue possible, in
particular in the area of the veneer
on 22 where it is necessary to maintain the maximum availability of
natural enamel in order to optimise
the adhesive cementing, which the
clinician will use for the fitting of 22
(Fig. 33).
Fig. 23-25: Prepared abutments and crown try-in 21-22
ment of the stratification quality can
be performed during the try-in by
obtaining photographic documentation using polarised light (Fig. 17).
For our procedure the degree of final
glossiness is particularly important
(Fig. 18). In our laboratory we perform
this procedure by hand with a special
cotton brush (Fig. 19).
The second case that we present here
is particularly interesting because in
the oral cavity of the patient there
was a gap in position 12 due to a missing dental element (Fig. 20).
necessary preparations in order to
restore the dental esthetics and, once
the model was made with removable
plaster abutments, we proceeded
to the wax modeling and the consequent lithium silicate pressing (Figs.
21-22).
The third case illustrated in this presentation concerns the prosthetisation of four upper anterior elements
that, in addition to being significantly short, also had the peculiarity
of being an antagonist with severely
overlapped teeth.
The stratification with the appropriate ceramic is performed according
to the manufacturer’s instructions
but naturally we made some modifications in the stratification technique, based on our own experience.
The product is then fitted into the
oral cavity and ready for cementing
(Figs. 23-25).
The patient visited the clinic with a
metal-resin prosthetic rehabilitation
in which there were large infiltrated
areas at the gingival level (Fig. 26).
The professional carried out the
We also used lithium silicate for
this prosthetic situation, as we consider it sufficiently resistant, despite
the reduced vertical dimensions of
the abutments on which to fit our
crowns. Due to the strength of the
material, it is possible to obtain a
very fine thickness, as is clearly visible in the photographs of the palatal
surfaces of the prosthetic reconstructions we created (Figs. 27-28).
The quality of the stratification material is quite good, as is evidenced
in the anterior view of these crowns,
where the nuances introduced by
the materials inserted with different
translucencies can be seen both with
polarised and direct light (Figs. 29-31).
The fourth and last case is particularly interesting because it presents
a set of prosthetic solutions, two full
Once the model has been developed,
we work on the wax morphologies
of the individual elements, paying
particular attention to the incisal
and proximal support areas of our
lithium silicate core. We try to keep
a slightly reduced shape with respect
to the final elements for the modeling, as we want our silicate dentin
core to give a “full-bodied colour” to
the element we are making (Figs. 3437).
For the final stratification we use specific powders, but taking particular
care with the curing and cooling stages. In fact, this type of ceramic material achieves the best colour result if
it undergoes fully controlled thermal
treatments. This is a characteristic
of all low-melting-point ceramics,
but according to our experience it
applies mostly to lithium silicate
ceramics, in which the post-firing
lithium reagglomeration must have
a so-called ordered disorder for the
best wear resistance.
After the usual polishing, the work
is delivered to the dentist for testing
and bonding (Figs. 38-39).
Fig. 26: Initial situation and poor gingival conditions
Fig. 29: Anterior morphological and chromatic features
Fig. 27: Lingual view of the manufactured product on
the model
Fig. 28: Lingual view of the stratified product in the
mouth
It may seem natural to question
whether it is anachronistic to work
analogically in the digital era.
We are certain that digital means are
absolutely necessary both today and
in the future. However, the individual manual skills of a professional like
the dental technician will always be
decisive for the final aesthetic result
and for the quality of the workpiece.
Fig. 30: Finished case photographed with polarized filter
Fig. 31: Work in-situ with healthy gingiva
Fig. 32: Initial situation and color shade matching with
polarised filter
Fig. 36: Barbed caps on the nipple (it is necessary to
avoid narrowing around the melting rods)
Fig. 33: Prepared abutments
Fig. 37: Fitted structures
Fig. 34: Molded copings with fusion pins
Fig. 38: Finished work in situ.
Fig. 35: Lingual view of wax model
Fig. 39: Close-up of the centrals
[3] =>
DTMEA_No.3. Vol.9_LT.indd
Dental Tribune Middle East & Africa Edition | 3/2019
LAB TRIBUNE
B3
Dental Technician Int’l Meeting Highlights
Impressions from the Dental Technician Int’l Meeting which took place in
Dubai on 12 April 2019 at Madinat Jumeirah Conference & Events Centre
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