Lab Tribune Middle East & Africa No. 5, 2015
Natural-looking imitation of pink esthetics / Accurately colour zirconia using the Amann Girrbach colouring concept / The Fascination of Simplicity
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lab tribune 1C
Dental Tribune Middle East & Africa Edition | September-October 2015
Discovering the world of
dental ceramics
A blog delivers answers to questions about dental ceramics
which concern dental laboratories today.
By Ivoclar Vivadent
I
voclar Vivadent has established a new interactive online platform, whose contents
address the challenges currently
facing dental laboratories.
In our fast-paced world, dental
laboratories are confronted by
many questions. They look for
enhanced efficiency and costeffectiveness; for solutions that
provide reliable support in their
everyday work. Many are unable
to keep track of the continuously
increasing variety of products,
product systems and processes
that are entering the market and
thus seek direction.
Increasing productivity and efficiency
The new online platform www.
worldofceramics.com provides
useful tips on the issues that
concern laboratory owners. For
Natural-looking imitation
of pink esthetics
Completing a denture base using the IvoBase System
Fig. 1: Esthetic try-in of the wax-up
Figs 2 and 3: Wax-up after successive contouring of the s 20
Fig. 4: The teeth are conditioned and the
stone parts isolated.
Fig. 5: The inhibited opaquer layer is removed and the framework repositioned on
the framework.
By Carsten Fischer, Germany
E
ven in the case of complex
prosthetic
reconstructions, patients want their
dentures to look natural in addition to having the basic functions
(speaking, chewing, tasting) returned to their stomatognathic
system. Dentures should by no
means have an adverse effect
on the patient’s esthetic appearance. Esthetic soft tissue design
reflects this philosophy.
The IvoBase® denture base system offers an efficient method
to create custom-made esthetic
soft tissue reconstructions. The
patients’ expectations can be
ideally met with a flair for esthetic design and a combination
of three materials – IvoBase denture base material, SR Nexco®
light-curing lab composite (customization) and ideally designed
denture teeth.
Discovering the World of Ceramics from Ivoclar Vivadent
example, they will learn how to
increase the productivity of their
lab, what they should pay attention to when selecting a ceramic
material or equipment and what
the current trends in the field of
dental ceramics are. Moreover,
they will be given the opportunity to participate in the discussion
and contribute their experience
as well as provide further tips.
vadent and how these will provide answers to today’s pressing
questions for dental laboratories.
New products in October
But that’s not all. During October, dental technicians will be
informed about the new products developed by Ivoclar Vi-
Contact Information
Ivoclar Vivadent AG
Bendererstrasse 2
9494 Schaan/Liechtenstein
Tel.: +423 235 35 35
Fax: +423 235 33 60
E-mail:
info@ivoclarvivadent.com
www.ivoclarvivadent.com
LIFELIKE ESTHETICS –
EFFICIENTLY PRESSED
Fig. 6: The flask and IvoBase mixture are
placed in the injector and the program is
started.
IvoBase System
The IvoBase System is based
on a fully automated injection
and polymerization process. All
the components (flasks, capsules, injector, etc.) are coordinated with each other. Chemical
shrinkage of the resin is compensated during the polymerization process due to thermal
management in the flask. As a
result, volumetric shrinkage is
prevented by the continued supply of additional material during the polymerization process
to provide a denture base that
demonstrates a high accuracy
of fit and an excellent surface
finish. Chemically, the IvoBase
denture base materials fall into
the category of self-curing polymers but offer the qualitative
advantages of heat-curing polymers. As the self-cure process of
IvoBase commences at a starting temperature of 40°C, thermal shrinkage is reduced com-
pared with that of conventional
heat-curing polymers. Monomer
and polymer are supplied in predosed capsules to ensure an optimal mixing ratio and to eliminate direct skin contact with the
monomer.
The IvoBase System results in
denture bases that demonstrate
lifelike pink esthetics and closely
resemble the light-optical properties of the natural gingiva.
Characterizations can be easily
applied to the denture bases to
accommodate the specific expectations of the patient.
Case presentation
A partially edentulous upper jaw
was to be restored with a palate-free denture retained with
telescopic crowns. The inner
(primary) zirconia copings for
IPS e.max PRESS MULTI
®
THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT
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
> Page 2C
[2] =>
2C lab tribune
Dental Tribune Middle East & Africa Edition | September-October 2015
< Page 1C
Fig. 7: Careful divesting after the fully automated polymerization process
Fig. 9: Light-curing SR Nexco composite can be optimally combined with the
IvoBase System to characterize the denture
base.
Fig. 8: Finishing requires only a few steps as the wax-up is
processed into the acrylic without loss of accuracy.
Fig. 10: A thin coating of bonding agent is
applied to the gingiva-coloured parts,...
Fig. 12: Characterization: subtle stippling and fine red
blood vessels enhance the natural appearance of the prosthetic gingiva parts.
Fig. 11: ... allowed to react and then cured
with light.
Abb. 13: The individual SR Nexco materials can be adapted using a disposable sponge.
teeth no. 13, 14, 15 and 23, 24, 25
were sheathed with electroformed copings (secondary parts)
attached to a tertiary structure
made of base alloy. The electroformed copings were cemented
to the base alloy structure in
the oral cavity to ensure a tension-free fit. Tooth setup was
performed according to conventional prosthetic principles
while the static and functional
requirements as well as the patient’s individual expectations
were taken into account. Tooth
position, smile line, lip volume,
phonetics and other criteria
were checked in the course of
an esthetic try-in (Fig. 1) before
fabricating the final denture.
Natural-looking artificial gingiva parts were already achieved
in the wax-up and the soft tissue
areas were individualized with
subtle but effective touches (Figs
2 and 3).
mer half and filter wax component in one of the flask halves.
After applying a thin coating
of petroleum jelly to the inner
surfaces of the prepared flasks,
I soaked the model with the
mounted waxed-up denture
with water and isolated it with
stone-to-stone separating fluid.
The model was now ready for
being invested in plaster; a Class
III dental stone is recommended
for this purpose. I took care to
place the model at the centre of
the flask and to ensure a space
between the anterior margin of
the model and flask of approx.
10 mm. To create a flush surface
between the edge of the model
and the flask housing, I removed all surplus plaster whilst
it was still soft. The stone surface
should be flush with the access
former to prevent the plaster
from spalling during the subsequent working procedure.
Lab procedure
After both the dentist and patient
had approved the wax-up, the
denture was ready to be processed into acrylic. To perform
this task, I used the IvoBase denture base system, which allowed
me to transfer the wax-up to the
final restoration without loss of
detail.
After the stone had hardened, I
replaced the access former half
with the access former full and
positioned the prefabricated
injection wax component. As a
palate-free denture base was
fabricated in the present case,
the sprues were pressed onto
the maxillary tuberosity. I made
sure that the sprue was contiguous in all areas of the denture
base. Then, I attached what are
known as aeriation channels at
the anterior region to vent the
flask cavity during the injec-
Investing and boiling out
Both flask halves were identical.
Prior to investing the model, I
placed the flask lid, access for-
Fig. 14: The tooth replacement harmoniously integrates into the patient’s face
and satisfies his esthetic expectations.
tion process. These components
were also prefabricated and
were easy to connect to the denture base. Important: the aeriation channels must not come
into contact with the flask housing. Next, I coated the teeth and
gingival areas with a mediumbody addition curing silicone (Asilicone of a shore hardness of
65) and then applied some stippling to the silicone before it had
set to create a retentive pattern
and secure the silicone in the
stone. No silicone was applied to
the occlusal surfaces and access
former. After isolating the stone
surface, I positioned the upper
flask half and locked the flask
halves using the locking clasp.
Then, I filled the flask with dental stone (Class III) with the help
of a vibration device to avoid
air bubbles. Excess stone was
skimmed off so that a flush surface resulted between the stone
and flask lid. Once the stone
had set, the flask was heated in
a water bath at 90°C and then
the two flask halves were separated. The wax was now soft
and could be easily removed in
large pieces. After the full access
former had been taken out, the
model and teeth were boiled out
with clean boiling water to thoroughly remove all wax residue.
Transfer to acrylic
The basal surfaces of the cleaned
teeth were roughened with jet
medium and mechanical reten-
Fig. 15: Successful interplay between
light, shadow and shade. The surface
texture modelled in wax has been
processed into acrylic without loss of
detail using the IvoBase System. The
resulting light dynamic properties
convey a natural appearance to the
artificial gingiva.
tions applied with a small round
bur. After that, I returned the
teeth to the silicone key. Next, I
applied a thin coating of Separating Fluid to the stone surfaces of the cooled flask halves
(Fig. 4). Prior to joining the flask
halves, I masked the base metal
alloy framework with opaquer.
For this purpose, I used a pink
opaquer for the gingival areas
and a tooth-coloured shade for
the areas under the telescope
teeth. These materials were first
applied as a foundation layer
and then in a covering layer.
Once the framework had been
thus prepared, it was placed
on the model and secured with
wax (Fig. 5). The aeriation filter,
centring insert and funnel were
inserted and the flask halves assembled.
The denture base materials are
available in seven shades. For
the case presented here, I selected IvoBase High Impact in
shade 34-V. I removed the monomer container from the predosed capsule, joined the fluid
and powder and mixed the two
components to a homogenous
mixture. With a few easy manipulations I attached the centring
insert and flask to the capsule
and then placed them into the
injector according to the manufacturer’s instructions. Next, I
selected the relevant injection
program and then started the injection process (Fig. 6). The process was fully automated and,
with the RMR function added,
took approx. 65 minutes to complete. The RMR function further
reduces the already very low
content of residual monomer to
below one per cent. As the injection and polymerization process
were exactly matched to the material, chemical shrinkage was
completely compensated. Once
the program had been complete,
I removed the flask and cooled
with water. Divesting was performed under a dental press.
The IvoBase System includes
a divesting aid to facilitate this
process. Having detached the
flask halves, I carefully removed
the denture from the stone core
and separated the capsule using a separating disc (Fig. 7). All
waxed-up areas were faithfully
reproduced in the acrylic.
Completing the denture
Now, I directed my full attention
to finishing the denture. The
advantage of using this system
became most apparent at this
stage, as hardly any reworking was necessary. The finely
modelled surface structures
and textures of the wax pattern
were replicated in the acrylic
without loss of detail. In a few
quick steps the denture base
was ready for final customization (Fig. 8). With SR Nexco, the
artificial gingiva can be given
an individual touch and naturallooking characterizations to suit
the patient’s expectations. SR
Nexco ideally complements the
IvoBase denture base material
(shade 34 V) (Fig. 9).
I applied a light-curing conditioner (SR Connect) to the
acrylic surface to create an adhesive interface that would allow the application of individual
shade characterizations (Figs
10 and 11). After that, I focused
on creating subtle details to reproduce a natural depth effect. I
customized the vestibular areas
and applied fine capillaries on
the facial side using a variety of
different shades. Key anatomical features should be borne in
mind when characterizing soft
tissue parts to achieve a lifelike reproduction. For instance,
keratinized gingiva has a light
pink colour because less blood
normally flows through it. By
contrast, the mucogingival areas receive a far larger supply of
blood and are interspersed with
fine blood vessels. These details
were easy to reproduce with the
SR Nexco range of materials.
Aspects of three dimensionality
including alveoli and festooning
were already created in detail in
the wax-up and transferred to
the acryclic without loss of detail
using the IvoBase System. The
SR Nexco gingiva materials and
my technical skills enabled me
to individualize the prosthetic
gingiva by applying materials
in different shades in a targeted
fashion to attain a natural-looking final result (Figs 12 and 13).
Prior to final light-curing, I covered the entire surface with an
oxygen-tight
glycerine-based
gel (SR Gel) to prevent the formation of an inhibition layer.
After completing the final polymerization process, I polished
the surface. The use of goat’s
hair brushes, a high-gloss buff
and Universal Polishing Paste
effectively resulted in a superbly smooth and glossy surface,
without loss of surface texture
or shade characteristics.
Result
Pink esthetics that very closely
resembles healthy soft tissue is
the result of this approach. Fine
details of texture – such as subtle stippling, slightly accentuated
alveoli or free gingiva margins –
give artificial gingiva a natural
appearance. The IvoBase denture base material beautifully
harmonizes with the SR Nexco
composite and together, these
two materials create natural
light reflections and a dynamic
interplay of colours. The compact and smooth surface is not
only esthetically pleasing but
also provides optimum conditions for denture hygiene (Figs
14 and 15).
Conclusion
The IvoBase injection process
provides
a
straightforward
method to process waxed up
denture bases into high-quality
PMMA. Waxed-up setups can be
transferred 1:1. Polymerization
shrinkage is mostly compensated, thus minimizing the effort
required by the dental technician. The soft tissue parts can be
customized to meet the individual expectations of the patient
and to provide dentures with
natural-looking pink esthetics.
I would like to thank Dr. Rafaela
Jenatschke and OA Dr. Tobias
Locher/Frankfurt on the Main
for the dentistry-related work.
Contact Information
Carsten Fischer
sirius ceramics
Lyoner Strasse 44-48
60528 Frankfurt on the Main
Germany
info@sirius-ceramics.com
[3] =>
Dental Tribune Middle East & Africa Edition | September-October 2015
lab tribune 3C
Accurately colour
zirconia using the
Amann Girrbach
colouring concept
By Amann Girrbach
C
olour zirconia restorations
accurately and reproducibly – this is performed
successfully using the Ceramill
Colouring Liquids from Amann
Girrbach. The colouring liquids
were developed and adapted according to the specific material
characteristics of the respective
zirconia group (LT, HT, SHT)
to ensure consistently exact
and reliable results based on
the VITA classical shade guide.
All shades of the VITA classical
shade guide can only be reliably
matched right away using this
optimal harmonisation of material and colouring solution.
Ceramill Liquid FX Set including colouring guide
Three material-specific Ceramill Liquid sets have been created that are used for easily and
precisely customising the milled
restorations.
A compact liquid set with 4 basic
shades and 2 shade modifiers
was therefore developed specifically for the slightly translucent
zirconia Ceramill ZI (LT), which
only requires an aesthetic basis
for the porcelain veneer due its
use as an anatomically reduced
framework material.
A clearly designed set of colouring solutions in the 16 VITA
classical tooth shades and shade
modifiers for the incisal/occlusal surfaces and gingival region is
also available for each of the (super-) highly translucent zirconia
materials Ceramill Zolid and
Ceramill Zolid FX (HT/SHT),
which are also used for monolithic restorations. The shades
can be applied directly to the
restoration without mixing and
optimise the reliability and efficiency of the workflow. Both liquid sets provide the maximum
degree of aesthetics, customisation and cost-effectiveness as
they are coordinated with one
another as well as with the specific working and material parameters for Ceramill Zolid and
Ceramill Zolid FX.
The Amann Girrbach colouring concept is completed by the
Ceramill Stain&Glaze set, which
can especially be used to enhance the light dynamics and indepth shade effect of monolithic
restorations.
Contact Information
The STRONG alternative to lithium disilicate.
Highly aesthetic and reliably stable –
Ceramill Zolid FX anterior restorations with precise staining
concept according to the VITA classical shade guide.
Amann Girrbach AG
Herrschaftswiesen 1
6842 Koblach | Austria
Web: www.amanngirrbach.com
Beirut | Lebanon I Fon +961 3133911
mea@amanngirrbach.com
www.amanngirrbach.com
Dental Tribune_ET1507_Ceramill Zolid FX_A4_4c_AG4990_EN_v01.indd 1
20.07.15 14:27
[4] =>
4C lab tribune
Dental Tribune Middle East & Africa Edition | September-October 2015
The Fascination of Simplicity
By Dr. Patrice Lalet, France
A
fter 30 years of research
and development, CEREC
is so highly user-friendly
that tasks can be handled quicker,
more easily and more successfully. Using dental CAD/CAM
technology for the first time is
easier than you would think and
is worthwhile for all dentists. New
software features, which further
enhance user comfort and offer
additional treatment safety, make
the system especially interesting
to newcomers of all ages. Starting
out in the world of CAD/CAM production is not normally a cause for
concern for younger dentists who
have grown up using PCs, mobile
phones and tablets. And experience has shown that even less
technology savvy dentists quickly
get used to the computer support making treatments extremely safe
thanks to its intuitive operation.
Nevertheless, during this initial
period, CEREC training is highly
recommended to allow users to
learn how to use the system as
quickly and safely as possible.
Intuitive user guidance leads to
impressive results
CAD/CAM technology is appealing thanks to its impressive
results. Its usability means that
even dentists who have not grown
up as “digital natives” can use
CEREC easily. An easy-to-operate
camera replaces the conventional
impression technique using a tray
and impression material. Quick,
digital, extremely precise – and no
prior powdering is required. The
various restorations are then designed with the intuitive CEREC
software with user guidance and
active feedback. The subsequent
in-house production of the restoration ensures precise results
and enthusiastic responses from
patients. It also increases the value added in the practice. And the
Fig. 1: Initial situation
Fig. 2: Anterior teeth after preparation
Fig. 3: Virtual tooth model with initial
proposals in the CEREC software
Fig. 4: Check of the contact points
Fig. 5: Insertion of the finished crowns
Fig. 6: Satisfied patient after completion of the treatment
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
possibility of single visit dentistry
which leads to more comfort for
the patient and the dentist.
Brief case report
A very typical example for CEREC
treatment is presented in the following case: A 42-year-old patient
came to my practice to improve
the look of her anterior teeth.
Since the teeth emerged at the age
of 6 or 7 years she suffered from a
lack of enamel. So we decided to
make crowns on lively teeth. With
the aid of the CEREC Bluecam we
captured the preparation, the antagonist and the bite situation and
the 3D preview appeared on the
monitor in the CEREC software.
On the basis of these intraoral impressions the software generated
a virtual 3D model. When generating the initial proposal for the
four crowns, the software used the
Biogeneric modelling function.
We sent the design of the restorations to the CEREC milling unit
and clamped a bloc made of zirconia-reinforced Lithium-Silicate.
The translucency of the ceramic
assured very natural looking
teeth. We added stain and glaze to
obtain this result. After characterization, we placed the crowns and
the patient could leave the practice with a new nice smile.
Quo vadis, cerec?
Powder-free impressions in natural colors, designing in an intuitive
software and the grinding of a wide
range of innovative materials - all
these treatment steps are possible
in every practice with CEREC. It is
the only professional CAD/CAM
system worldwide, which allows
you to offer all-ceramic restorations in a single visit with a clear
conscience. Using the latest digital
technology there are no limits to
construct fully anatomical bridges
as well as implant restorations.
With the patient specific surgical
guides CEREC GUIDE 2 for a safe
placement of implants and the
CEREC ORTHO software for orthodontic treatments CEREC enables an incomparably broad range
of applications to the practitioner
and the patient to ensure optimal
treatment result.
About the Author
Dr. Patrice Lalet has been a
CEREC user for 13 years and
received his certification as a
CEREC trainer from ISCD in
2004. Dr. Lalet is member and
co-founder of the French CEREC
training team e-dentisterie.
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