Lab Tribune Middle East & Africa No. 2, 2015
Firsthand Experience With Polychromatic LS2 ingot... IPS e.max Multi… because it works / Team players: efficiency and esthetics / inLab MC X5: Open 5-axis production unit for dental laboratories
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lab tribune 1C
Dental Tribune Middle East & Africa Edition | March-April 2015
Firsthand Experience With Polychromatic LS2 ingot...
IPS e.max Multi… because it works
Fig. 2
Fig. 1
By Aiham Farah
P
olychromatic lithium disilicate pressing ingot—IPS
e.max Press Multi. The
400MPa ingots feature a graduated level of shade and translucency, with chroma and opacity
higher in the cervical and dentin
regions, and more translucency
in the incisal areas.
Here under I am sharing with
you my firsthand experience on
this ingot, from a material and
technology point of view, before
deciding whether it’s your material of choice to use in a real
clinical case or not, you need to
experiment the optical properties, and learn how to handle the
masking, shade matching and
color dimensions, and how to
get the best esthetic results out
of it.
Here I decided to choose a
unique feminine smile of hollowed celebrity (Imogen poots),
and try to mimic it using a combination of our new IPS e.max
press Multi ingot BL2 (for centrals & Laterals) AND the traditional IPS e.max press ingot LT
BL2 (for Canines and 1st premolars).
Horizontal sprueing technique
- From a (Mesial-Distal) angle of
view.
We align the more narrow side
Fig. 3a
Fig. 3b
Fig. 4
Fig. 5
of the Wax Pattern Sprue with
the occlusal or incisal area of the
waxup. For the labial surface
of our wax restoration to be always parallel to the Wax pattern
Sprue surface, so the ceramic
flow path is not directed toward
the die. This eliminates lateral
pressure on the investment die.
more incisal portion from the
ingot to the pressed restoration.
(Fig 4.)
From the natural teeth in the
picture we notice high level of
translucency in the incisal third
of the two centrals which do not
exists in the two laterals, what
required lowering the position
of the centrals so more incisal
layer will reach the pressed restoration from the Multi ingot,
however the positioning for the
two laterals kept the same according to the instruction for
use for pressing IPS e.max Multi
from Ivoclar Vivadent. (Fig 6.)
Canines and 1st premolars were
sprued vertically in the traditional way of spruing the IPS
emax press and prepared in
another ring base to be pressed
later. (Fig 7.)
LT ingot, maybe the masking capability is even a little better, especially after testing the centrals
on ND1 & ND2, they maintained
the same shade brightness they
have in BL2 shade tap with no
ND influence. (Fig 11.)
2. The thickness played an im-
portant role in boosting the
brightness level and positioning
the final shade in between the
BL2 & BL1. (Fig.11.)
3. The Incisal layer exists in the
- From a (Labial) angle of view.
We Align our wax restoration
vertically with the center of the
Wax Pattern Sprue. The long
axis of the Wax Pattern Sprue to
be parallal to the long axis of the
restoration; this way, the material layers (Dentin-Incisal) maintain their horizontal relationship
during pressing. (Fig 3a.)
Controlling translucency ratio
The ability to manipulate the
sprued restoration on the sprue
base is a fabulous option to control translucency level, If more
translucency is desired, the restoration and Wax Pattern may be
lowered by up to 2mm Max, by
cutting a small notch from the
wax pattern, in order to reach
> Page 2C
LIFELIKE ESTHETICS –
EFFICIENTLY PRESSED
In a close comparison between
the conventional IPS e.max
Press (low translucency) ingot
and IPS e.max Press Multi, I noticed the following remarks:
1. The dentine layer exists in the
Multi is equivalent to the one in
Fig. 8
IPS e.max PRESS MULTI
®
THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT
Fig. 6
Fig. 7
Fig. 9
amic
all cer need
u
all yo
• Monolithic LS2 restorations showing a lifelike shade progression
• Exceptional combination of strength, esthetics and efficiency
• For crowns, veneers and hybrid abutment crowns
• Coordinated with high-precision Programat press furnaces
• Maximum cost effectiveness in the press technique
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstrasse 2 | 9494 Schaan | Liechtenstein
Tel.: +423 235 35 35 | Fax: +423 235 33 60
Fig. 10
Fig. 11
[2] =>
2C lab tribune
Dental Tribune Middle East & Africa Edition | March-April 2015
< Page 1C
Fig. 12a
Fig. 12b
Fig. 12c
face with the HT bleach colors.
(Fig 10.)
4. Grinding off the sprues attachment in the Multi press is a
little tricky to bring back the distal contact aspect contour to the
way you finished it in the wax,
what I still like in the IPS e.max
press, the vertical spruning and
the fact of (pointed sprue attachment not Lined) that grinding off
the sprue will not affect the surface contour. (Fig 9.)
Characterizing & layering
Referring back to our case photo
and the detailed centrals’ incisal
and mamelon effect, cutting
backing was necessary if we
want to mimic the centrals in the
picture, so work flow was set as
the following:
- Cutting back on Multi pressed
centrals to proceed with Cutback technique, then layering
just the incisal third with IPS
emax Ceram powder. (Fig 12.)
Fig. 13
Multi is close to the one in the
HT ingot, but with a little more
brightness and opalcent radiation phenomenon, what literally
solved the very difficult lack of
brightness scenario we could
- Final contouring of the Multi
pressed laterals to proceed with
staining technique then using
IPS e.max Ceram Shades and
Essence; glaze with IPS e.max
Ceram Glaze Flu.
- Final contour of the emax
press canine and premolars to
proceed with staining technique
then using IPS e.max Ceram
Shades and Essence; glaze with
IPS e.max Ceram Glaze Flu.
Conclusion
Ivoclar Vivadent’s new IPS
e.max Press Multi is a real innovation in the pressing technology pyramid, for fabricating
esthetic and multi-dimensional
monolithic restorations without cutback or layering in most
of the cases; because esthetic
results are achieved in a single
press sequence with subsequent
glazing. The ingots feature a
graduated level of shade and
translucency similar to that of
natural teeth, With a strength
of 400MPa, the material is indicated for anterior and posterior crowns, veneers and hybrid
abutment crowns. The ingots
are available in one size and in
the following shades: A1, A2, A3,
A3.5, B1, B2, C1, C2, D3 and BL2.
I advice using this solution for
upper and lower centrals and
laterals, where translucency
level and esthetic is high, but
strictly when the labial preparation thickness is 1 mm and up,
for the graduated level of shade
and translucency in the ingot to
be visible. I was intuitive to try
the bleach shade out of the full
shade range intentionally, because I believed this ingot will
solve the grayish problem generated by layering enamel powder on any bleach color. And it
really worked.
Contact Information
Aiham Farah. CDT
Technical Training
Consultant
Near East & Orient
Ivoclar Vivadent
Email:
aiham.farah@ivoclarvivadent.com
Team players: efficiency and esthetics
Modern zirconium oxides fulfil three major requirements of contemporary dental technology: high strength,
esthetics and efficiency. The author describes the fabrication of monolithic posterior tooth restorations with
the translucent zirconium oxide Zenostar Zr Translucent.
By Dieter Knappe
T
his article is written in celebration of zirconium oxide, a material which has
firmly established itself in the
dental laboratory over the past
15 years or so. If appropriately
used, zirconium oxide restorations produce very strong and
durable results. They also satisfy demanding esthetic requirements due to their translucent
properties. The following case
study shows how monolithic
zirconium oxide is effectively
incorporated into the digital
manufacturing chain to produce
highly cost-effective dental restorations without having to compromise on esthetics. In the case
presented, a wax-up was crafted
which served as a basis for fabricating a provisional restoration
(Telio® CAD for Zenotec, Wieland Dental) and a permanent
restoration (Zenostar Zr Translucent, Wieland Dental) with
one digital data set and CAD/
CAM milling equipment.
Preoperative situation
The patient presented to the
dental practice with a fractured
ceramic inlay restoration in
tooth 26 which she wished to
have replaced. The tooth had
been restored many years previously. Since tooth 25 and tooth 35
were discoloured as a result of
root canal treatment, they were
included in the treatment plan.
The existing tooth structure of
tooth 26, which had been prepared to accommodate the inlay
in the past, was preserved to the
best possible extent. The patient
had very high esthetic expectations and wanted the explicit assurance that the crowns would
look completely natural. Nonetheless, we decided to use a very
efficient fabrication method in
which monolithic restorations
are produced with translucent
zirconium oxide (Zenostar Zr
Translucent). Three options are
available for fabricating monolithic restorations with this approach:
1. milling, sintering, glazing (efficient, cost-effective);
2. milling, sintering, individualization with ceramic characterization materials, glazing;
3. milling, individualization with
infiltration liquids, sintering,
glazing (highly esthetic).
We chose to pursue the third
method, which would be very
cost-effective as a result of the
benefits offered by the digital
workflow.
Advanced zirconium oxide
Zirconium oxide is more than
twice as strong as other dental
ceramics, and it exhibits excellent mechanical properties. Due
to its translucent characteristics,
the material has been fulfilling
highly esthetic requirements for
quite some time now. The material is used to fabricate full-contour (monolithic) restorations
and frameworks that provide a
base for individualized veneers.
The zirconium oxide material
Zenostar Zr Translucent shows
excellent light transmission. In
this system, efficiency teams up
with esthetics to offer impressive results. The wide range of
discs, the matching stains and
the brush infiltration technique
allow lifelike effects to be imparted to restorations in a relatively short time.
Preparation
The following aspects were paramount in preparing teeth 25, 35
Figs 1 and 2: Manual waxing up of
the crowns
Figs 3 and 4: CAD/CAM images of the scanned wax-up and the PMMA-based
long-term temporaries (Telio CAD for Zenotec)
Fig.5: The milled crowns before they
were trimmed from the PMMA disc
and 26 for the ceramic restorations: avoidance of sharp edges
and observation of a minimum
wall thickness. The benefits of
using zirconium oxide include
the material’s high strength and
as a consequence, the fact that
very little tooth structure needs
to be removed. The cavity in
tooth 26 already showed extensive preparation. However, in order to properly anchor the new
restoration, re-preparation was
shown to be inevitable. The cavity had to be extended towards
the buccal aspect. Despite being
very thin, the buccal cusp walls
were in an acceptable condition.
The main objective was to maintain the tooth by restoring it with
Fig.6a: The completed long-term
temporaries made of PMMA on the
model and ...
Fig.6b: ... in the mouth
a crown. Following the preparation phase, impressions were
taken of the upper and lower
jaws and the occlusal relationship was established. Then, the
clinician fabricated the provisional restoration chairside with
the help of a customized tray.
According to the treatment plan,
the patient would have to wear
long-term temporaries for a period of several months. In order
to fabricate these restorations, a
Fabrication of long-term temporaries
> Page 3C
[3] =>
Dental Tribune Middle East & Africa Edition | March-April 2015
Microcracks are
prevented by reducing
the grinding work to a
minimum.
< Page 2C
wax-up was created (Figs 1 and
2). In this type of situation we
prefer to use the manual waxup technique, because we have
found this method to be faster.
Alternatively, the restorations
could have been virtually designed. Irrespective of the method used, a lasting result can only
be achieved if the technician has
an in-depth knowledge of the
principles of functional occlusion.
The waxed up crowns were
transformed into long-term temporaries with CAD/CAM equipment. First, the physical models and wax-ups were digitally
scanned (Zenotec D500, Wieland Dental) and the STL file
was imported into a corresponding design software (Dental
DesignerTM, 3Shape) (Fig. 3).
Then, all the parameters were
suitably adjusted and the construction data was transferred
to the milling machine (Zenotec
select, Wieland Dental), where
the restoration was cut from a
PMMA-based disc (Telio CAD
for Zenotec) (Figs 4 and 5). The
milled crowns were re-worked
only minimally and then placed
on the model. In order to impart
the PMMA restorations with a
natural-looking
appearance,
their surface texture was finished in such a way that a natural play of light was achieved.
The crowns were subsequently
polished with a special polishing
medium and goat’s hair brushes
(Fig.6a). Next, the clinician removed the chairside provisional
restorations and cemented the
long-term temporaries with a
suitable luting composite (Telio® CS Link) (Fig. 6b).
Fabrication of the permanent
restorations
Three months later, it was time
to focus on the permanent restorations. In an effort to keep
the treatment with monolithic
restorations as straightforward
as possible, the existing data set,
which had been validated by
means of the longterm temporaries, was used (Fig.7). We selected the translucent zirconium
oxide Zenostar Zr Translucent
for the restorations. This material comes in disc form and in
six different shades. We decided
to use the ”sun” variant, which
would give the restorations a
warm, reddish foundation. Various possibilities of finishing the
restoration were available after the milling process (Zenotec select) (Fig. 8). In this case,
the unsintered structures were
characterized with the colour
infiltration method.
Finishing: brush infiltration
In the brush technique, the
milled structures (crowns) are
infiltrated with a colouring liquid (Zenostar Color Zr, Wieland
Dental). In this process, the restorations acquire a lifelike appearance, showing a tooth-like
progression of shade, already
before the sintering procedure.
All the A-D shades can be reproduced with these colouring
solutions. Five additional characterization stains are available. In the case at hand, the bar
joints were removed from the
milled crowns 26, 25 and 35 by
grinding, and the surfaces were
smoothed (Figs 9a and b). Sub-
lab tribune 3C
At this stage – before the staining materials were applied – the
zirconium oxide crowns were
polished and the surfaces were
smoothed (Fig. 12). This effectively counteracted the common
concern of abrasion.
Fig.7: Same digital data set: preparation for the fabrication of the zirconium
oxide crowns (Zenostar Zr Translucent) with CAD/CAM equipment
Fig.8: The milled crowns before they were trimmed from the zirconium oxide
disc
Figs 9a and b: The unsintered structure is carefully ground and smoothed.
Figs 10a and b: Brush infiltration before sintering: The colouring liquid is
applied in the cervical areas.
Figs 11a and b: Brush infiltration:
The colouring liquid is applied on the
cusp tips and in the fissures.
Fig. 12: The occlusal surfaces are polished before the stains are applied.
sequently, the colouring liquid
was selectively brushed on the
cusp tips, around the margins
and in deep fissures (Figs 10a to
11b).
The charm of this colourless liquid lies in the fact that it can be
made visible. For this purpose
a drop of colour concentrate
(Zenostar VisualiZr, Wieland
Dental) is added to the solution.
As a result, the individual liq-
Before the crowns were fired,
a glaze (Zenostar Magic Glaze,
Wieland Dental) was sprayed on
their surfaces in order to establish an even base for the application of the staining materials.
Stains in paste form (Zenostar
Art Module Pastes, Wieland
Dental) were used to characterize the restorations. The pastes
had to be mixed to a soft, smooth
consistency before they could
be applied. The cervical and
incisal areas of the restorations
were individualized with the
stains (Fig. 13). A film of glaze
was sprayed on the restorations
(Fig. 14) before they were fired.
The combination of the stains
and the lightly fluorescent spray
glaze produced a three-dimensional effect.
After the final firing, the crowns
did not appear any different
from layered restorations. On
the contrary, they looked very
lifelike and showed a natural
internal play of colour. In the
next step, the occlusal contacts
were checked in the articulator and the proximal contacts
on the model. Then the crowns
were sent to the dental practice
for placement.
Seating of the restorations
Teeth 25, 35 and 26 were suitably prepared for the permanent
restorations. Unfortunately, the
attempt to save tooth 26 failed.
The buccal crown wall fractured
when the long-term temporary
was removed. Right from the
beginning, we were aware of
the fact that the remaining part
of this tooth might not be strong
enough to withstand the treatment. At this stage, therefore, it
became quite clear that the tooth
could not be preserved. Conse-
quently, the long-term temporaries were re-seated and a new
treatment plan was presented
to the patient for tooth 26 on the
basis of a detailed analysis. A few
weeks later, the permanent allceramic crowns were cemented
(SpeedCEM®) on tooth 25 and
tooth 35. The plan was to replace
tooth 26 with an implant-supported restoration at a later date.
Conclusion
The monolithic zirconium oxide
crowns on tooth 25 and tooth 35
were indiscernible from the other teeth (Figs 15 and 16). The patient reported that she was able
to chew comfortably and naturally. The CAD/CAM fabrication
protocol allowed the crowns to
be cost-effectively produced.
The translucent material (Zenostar Zr Translucent) that
was used in this case showed a
high level of light transmission.
Therefore, it offered the ideal
basis for reproducing the optical
properties of the natural teeth.
The described approach will
help to satisfy the rising number
of cost-conscious and esthetically discerning patients, since
it offers an attractive alternative
to individually layered ceramic
crowns and cast crowns made of
precious or non-precious metal.
Contact Information
Dieter Knappe, CDT
Knappe Zahntechnik GmbH
Weinstrasse 14
67889 Schweigen-Rechtenbach
Germany
dieter.knappe@orange.fr
Figs 13 and 14: The stains were
applied and sprayed with another
coating of glaze.
uids can be easily distinguished
from each other when they are
brushed on the restoration. The
colouring material is composed
of organic pigments which fire
without leaving any significant
residue. Next, the restorations
were sintered at 1450°C (Zenotec Fire P1, Wieland Dental).
After the sintering process, the
crowns appeared lifelike and
showed a warm and natural
glow due to the reddish zirconium oxide used. Only a few minor adjustments had to be made
on the basis of the inspection on
the model. As a result, this approach not only ensures savings
in terms of time and money, but
it also heightens quality assurance.
Fig. 15: The zirconium oxide crown on tooth 25 immediately after it was
placed. Tooth 26 was provisionally restored with a PMMA crown.
Fig. 16: A suitable alternative to a veneered crown and a cast crown – the
full-contour zirconium oxide crown on tooth 35. It smoothly blends into the
surrounding dentition.
[4] =>
4C lab tribune
Dental Tribune Middle East & Africa Edition | March-April 2015
inLab MC X5: Open 5-axis production
unit for dental laboratories
By Sirona
i
nLab MC X5, the five-axis
milling and grinding unit
newly developed especially
for the demands of dental laboratories, completes Sirona’s inLab system. Dental technicians
benefit from the greatest flexibility for the entire production
process of esthetically pleasing
restorations and the largest selection of materials available on
the market.
Bensheim/Salzburg, Austria: An independent choice of
production processes and materials and complete control of
the work process – these are the
primary demands dental technicians make of in-house production with modern CAD/CAM
systems. Sirona’s new five-axis
laboratory unit inLab MC X5 fulfills these demands and gives users new freedom – with wet and
dry pro-cessing, a wide range of
indications, and the free choice
of materi-als.
Developed especially for dental laboratories
“The new laboratory unit sends
a clear signal from Sirona to
dental technicians,” says Reinhard Pieper, Director of inLab
Product Management at Sirona.
Users benefit from 30 years of
experience with CAD/CAM in
wet processing of various materials combined with new dry
processing techniques – in one
machine. “We imple-mented
all of our know-how as a pioneer and innovation leader of
inLab MC X5, Sirona’s new five-axis
laboratory unit, enables wet and dry
processing of many materials
inLab MC X5:
DENTAL LAB
FREEDOM OF CHOICE.
Experience new freedom in your lab processes breaking the chains of
former dependencies with inLab and the new 5 axis milling and grinding
unit inLab MC X5. Open for all restoration data, combining the largest
material range and the possibility to machine both wet and dry disks
and blocks – for no limitations to your production. Enjoy every day.
With Sirona.
INLABMCX5.COM
dental CAD/CAM technology to
develop a CAD/CAM laboratory
machine tailored specifically
to meet existing and future demands,” added Pieper. “This ensures that inLab MC X5 will be
a good in-vestment in the long
term.”
inLab MC X5 is Sirona’s first
open production unit and is suitable for use with various existing CAD/CAM equipment in
dental labora-tories – for users
with a Sirona scanner and inLab
software or for laboratories with
scanners and CAD components
from other manufacturers. STL
restoration data can be imported
easily and quickly to the CAM
software module developed for
inLab MC X5 and processed
with inLab MC X5. In combination with the inEos X5 scanner
and inLab software, the new
laboratory machine is the optimal complete solution for new
users of Sirona CAD/CAM production.
Productive laboratory unit for
all common processing jobs
Depending on the indication
and material, the five-axis inLab MC X5 can be used for wet
or dry processing. In addition,
for the first time it is possible to
switch automatically from dry to
wet pro-cessing when working
on one part. Tools used include
carbide cutters and diamond
grinders as well as standardized disks with a diameter of
98.5 millimeters and a height of
up to 30 millimeters. Users can
ensure efficient utilization of
material by using the disk management function and extensive
nesting functions. The spe-cially
developed multi-block holder
uses CAD/CAM materials in
block form. It can be loaded
with up to six blocks of different mate-rials at the same time.
inLab MC X5 is thus designed to
be a uni-versal laboratory unit
for a number of indications and
for pro-cessing zirconium oxide, polymers, composites, wax,
glass ceramics, hybrid ceramics,
and prepared for metals. The
machine allows the dental laboratory a free choice of all material suppliers and it benefits
additionally from the material
competence of Sirona’s material partners VITA Zahnfabrik,
Ivoclar Vivadent, Dentsply, Merz
Dental, 3M ESPE, and GC.
Open, user friendly, and cost
effective
Thanks to the combination of the
wide range of indications, free
choice of materials, and open interfaces for external restoration
data, dental technicians can use
the machine flexibly from the
start. The high-quality, functional design of the chamber of the
la-boratory unit ensures easy
maintenance and makes it fast
and easy to clean with the specially developed “easy-clean”
concept. It can quickly switch
among various materials and
between wet and dry processing. This flexibility combined
with the reasonable cost and the
fact that there are no additional
dongle fees makes inLab MC
X5 very cost effective. The unit
is delivered with its own inLab
CAM software module and can
be ordered from dental dealers
immediately.
)
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