Lab Tribune Middle East & Africa No. 5, 2017
Processing of NPM sintering metal with inLab MC X5. User Case / Restorations at 35 minute intervals
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[1] =>
DTMEA_No.6. Vol.7_LT.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
November-December 2017 | No. 6, Vol. 7
Processing of NPM sintering metal
with inLab MC X5. User Case
Base-metal bridges from small to large
By Dentsply Sirona
The CAD/CAM-based in-house production of crown and bridge frameworks made of non-precious metals
(NPM) has opened up new possibilities in the dental laboratory for some
time now, as it presents a faster,
more economical, and more reliable
alternative to conventional casting
methods. The scope of this option
is now further extended by the new
inCoris CCB disc (Dentsply Sirona
CAD/CAM) that allows the fabrica-
tion of wide-span NPM restorations
using the inLab MC X5 5-axis milling
unit. These two concrete cases document the digital process.
Case report 1: 4-unit bridge
The patient presented at the dental practitioner’s office has a failing
bridge in her upper left quadrant
(tooth 22 to 26). Due to agenesis of
the canine, a four-unit bridge with
one pontic at site 25 was required. As
the patient wished to bring the cost
down as low as possible, the dentist
agreed to provide a veneered bridge
with an NPM framework.
ÿPage B2
Fig. 1, 2: The bridge restoration was first defined in the software inLab CAD SW 16.0
(Fig. 1), choosing the new inCoris CCB disc for the framework (Fig. 2). The digital impression of the intraoral situation was taken at the dental office using the CEREC Bluecam
intraoral camera and transferred to the dental laboratory’s inLab CAD SW 16.0 online
via the Sirona Connect portal.
LIFELIKE ESTHETICS –
EFFICIENTLY PRESSED
Fig. 3, 4: A virtual version of the master model, including segmentation and pinning, was created for subsequent mounting on the
perforated plate.
Fig. 5: The model data were exported in STL format by way of
the interface module of the inLab CAD software and used for inhouse production of the physical model with a 3D printer.
Fig. 6: The model axis, the jaw ridge line, and the insertion axis
were defined in the inLab CAD 16.0 software (Fig. 6).
IPS e.max PRESS MULTI
®
THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT
• Monolithic LS2 restorations showing a lifelike shade progression
amic
all cer need
u
all yo
• 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
Fig. 7-10: Thanks to its integrated biogeneric function, the CAD software supplied a design proposal. Only minor modifications were
made: the contact points were individually adjusted and the thickness of the framework was reduced somewhat.
Bendererstrasse 2 | 9494 Schaan | Liechtenstein
Tel.: +423 235 35 35 | Fax: +423 235 33 60
[2] =>
DTMEA_No.6. Vol.7_LT.indd
B2
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 6/2017
◊Page B1
Fig. 11-12: At the end of the design process, the connector lines were adjusted
Fig. 13: The final check was performed on the preview
screen, from where the data was exported to the inLab CAM 16.0 software.
Fig. 15: As this case shows, the restoration to be
milled could be positioned within the blank quickly
and without any complications
Fig. 16: In the production preview, the sprue connections were reduced and the milling job passed on to
the laboratory’s own inLab MC X5 5-axis milling unit
Fig. 17, 18: The software presents a reminder screen at this point (Fig. 17) to ensure that both the correct workpiece and the corresponding tool magazine are loaded into the unit (Fig. 18).
Fig. 19: After 20 minutes of wet milling, the workpiece with the milled bridge framework is removed
from the inLab MC X5. The blank was allowed to dry
overnight and the framework separated the next day.
Fig. 20: Since the inCoris CCB blank is made of a sintering metal, the next step was the sintering step that
brought the framework to its final size and strength. This step was performed in the inFire HTC speed sintering
furnace (Dentsply Sirona CAD/CAM). For NPM sintering, the furnace is fitted with an argon gas connection and
a separate sintering platform.
Fig. 14: In the current version of the CAM software,
the inCoris CCB blank can easily be identified by QR
code detected by a webcam — a convenient feature
that can also be used for all other inCoris blanks. The
QR code provides all of the necessary information on
the current blank without the inconvenience of manual data entry; the software even recognizes already
partially milled blanks.
Fig. 21: After the framework, in its final dimension,
could now be tried on the model (Fig. 21). A tensionfree fit was noted, meaning that the framework was
now ready to be veneered.
Case report 2: 11-unit bridge
The second case involved a much more extensive restoration. Due to the extraction of a tooth that had previously served as an abutment tooth, several bridges had to be replaced by a large 11-unit
bridge. The workflow and approach were similar to that described for case #1. Again, the impression was taken digitally by a CEREC Bluecam and transmitted to the laboratory‘s own inLab CAD SW 16.0
unit via Sirona Connect.
Fig. 22-24: The virtual design of the master model (Figs. 23 to 24) was followed by its physical production using an STL data export and a 3D printer.
Fig. 25-27: For the production, the resulting job was transferred to the inLab CAM SW 16.0 (Fig. 25), where the restoration, the sprues, and the sinter support, required for the subsequent sintering process (Fig. 26) were positioned
and the milling job initiated (Fig. 27).
[3] =>
DTMEA_No.6. Vol.7_LT.indd
Dental Tribune Middle East & Africa Edition | 6/2017
B3
LAB TRIBUNE
◊Page B2
Conclusion
described here have shown. Thus, the
laboratory can resort to this simple
and economic process in almost all
situations where economic aspects
play a significant role for patients.
Moreover, the profits generated by
the CAD/CAM-based process accrue
to the laboratory itself.
The CAD/CAM-based processing of
NPM provides various advantages
over the traditional casting process.
A quick and clean procedure reliably
produces high-quality results. Complex workflows have become a thing
of the past, as have porosities and
inLab MC X5
voids, distortion, impurities or other
problems associated with the casting
process. With the new inCoris CCB
disc, an even greater number of cases Jens Richter
can Disks
benefi
t from these advantages. Dental
Technician
Kerstin Straßburger
& blocks. Milling & grinding. Wet & dry. The 5-axis laboratory
production
unit
X5 is combination
your universal CAD/CAM
partner the
for a wide range of indications –
AfterinLab
all,MC in
with
Noßwitzer Weg 1
with complete freedom to use any material and flexible STL integration into existing
CAD
systems.
own CAM
module andunit,
functional
a highRochlitz,
degree
inLab
MC
X5Its5-axis
milling
it design
is guarantee
D-09306
Germany
of user-friendliness and effective production processes.
suitable for smaller objects as well as Email: post@sofg.de
New: Clean and safe milling of NPM sintering metal blanks inCoris CCB with the
large-span
bridges, as the two cases Tel: +49 (0) 37 37 / 4 25 87
inLab MC X5 based on digital restoration data.
Dental lab freedom
of choice
Fig: 28-29: The milling job executed by the inLab MC X5 took 64 minutes to complete.
Fig. 30, 31: The bridge framework is then removed from the milling unit (Fig. 30) and separated for overnight drying (Fig. 31).
Fig. 32, 33: The final dimensions of the bridge framework were once again obtained
by sintering in the inFire HTC speed (Figs. 32-33). Due to the large dimensions of the
framework, sintering was performed with the aid of a sinter support – a procedure generally recommended for 6-unit and larger frameworks. The sintered framework was
then veneered and finished.
Dental
Technician
Int’l Meeting
05 May 2018
By Dental Tribune MEA/CAPPmea
The Dental Technician International
Meeting (DTIM) is the continuation
and growth of CAPP’s Dental Technician Sessions during the last 10 years.
These Dental Technician Sessions
were accomplishments not only for
dental laboratory owners and dental
technicians but for the entire dental
technology profession.
Who Should Attend and Why?
- Dental technicians
- Clinical Dental Technicians (CDTs)
- Dental lab owners
Join the DTIM 2018 to ensure that
you are at the very forefront of the
industry!
The DTIM will be held on the 5 May
2018 at the Madinat Jumierah Conference Centre. Over 200 dental technicians, clinical dental technicians
(CDTs), lab owners, trade visitors and
more are expected to attend.
The DTIM takes place in conjunctions with the 13th CAD/CAM &
Digital Dentistry Conference which
will be attended by over 2000 dental
professionals.
For more information contact:
CAPP Events
Tel: +971 4 347 6747
Fax: +971 4 347 6867
Mob: +971 50 2793711
E-mail: events@cappmea.com
[4] =>
DTMEA_No.6. Vol.7_LT.indd
B4
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 6/2017
Restorations at 35 minute intervals
Photo: COLTENE
By COLTENE
Whereas production times with
zirconium of up to 14 hours are no
exception, aesthetically appealing
composite crowns can today be created within 35 minutes and only require minimal post-polishing. The
CAD/CAM experts of the renowned
laboratory partner DT&Shop know
all about the benefits of fast, high
quality production and how to keep
dental laboratories competitive in
the long run. In this interview, Dr.
Nicolas Rohde, Head of Digital &
International Division, and dental
technician Manfred Bildhäuser explain what is possible in the field of
CAD/CAM with state-of-the-art materials research.
Dr. Nicolas Rohde is well acquainted
with the notion of speedy deliveries. The fast implementation of
demanding customer orders is the
daily agenda of the leading mail order company for dental laboratory
equipment. Eight dental technicians
produce highly aesthetic prosthetics for the company‘s numerous
customers in the in-house milling
centre. No wonder the enthusiasm
for the novel CAD/CAM composite
blocs, for example the BRILLIANT
Crios submicron hybrid composite
from Swiss dental specialist COLTENE, knew no bounds. The flexible
all-rounders make life considerably
easier for CAD/CAM production and
are notable for their rapid polishability, among other things.
Dr. Rohde, it is difficult for dentists to bypass composites in
classical filling therapy. Now
this versatile material is also
entering the arena of CAD/
CAM technology. Is composite
the new ceramic?
Dr. Rohde: This depends entirely
on the indication! Indeed, the CAD/
CAM composite blocs currently
available on the market bring with
them a number of excellent material properties. In many cases it is
possible to create visually attractive
results from this flexible material in
virtually no time. Long sintering or
crystallising of other dental materials can be eliminated completely.
After oughly 35 minutes, the milling
machine produces virtually finished
crowns, partial crowns, inlays, onlays
or veneers. Due to the high intrinsic
gloss of high performance composites such as BRILLIANT Crios, brief
polishing is all that is required. This
allows fabrication of a top quality
restoration within one hour.
How did you find out about the
reinforced composite blocs?
Dr. Rohde: Based on our long-standing experience in milling, COLTENE
asked us to grind a number of restorations from the material for their
acrylic models. Amazingly, of the
700 units which we produced in
record time, there was not a single
restoration which did not leave the
CNC machine in perfect condition.
After this convincing result we immediately included BRILLIANT Crios
in our portfolio and are already handling first enquiries for the novel
material.
What can composite do which
traditional CAD/CAM materials can‘t?
M. Bildhäuser: Above all, the marginal stability of BRILLIANT Crios
is extremely high. Compared with
glass ceramics, the high performance composite is ideally suited
for inlays or onlays requiring extremely thin walls. We also use the
flexible material in all cases where
preparation was not so good. Dr.
Rohde: From my days in implant
dentistry, I know that removing
part of the dental fibres for dentures
with implants often leads to a lack
of the natural damping effect of the
ligament in the jaw. This makes it
extremely pleasant for patients, if
the crown itself has a slight damping
effect. Many users have reported on
the high wear comfort of composite
based restorations. The dentine-like
modulus of elasticity provides for a
natural chewing feeling and is gentle
on the opposite tooth at the same
time.
Where exactly is the specific
advantage in processing,Mr
Bildhäuser?
M. Bildhäuser: I was amazed at how
easy the novel material could be
smoothed and polished. There are no
interfering inclusions of the polishing paste and post-processing takes
next to no time, be it for monolithic
crowns, onlays or veneers, whereby
we use a compact wet grinding machine also used by many of our customers. This is not difficult to reproduce even for smaller laboratories:
for example, the Finocam W is an
inexpensive wet grinding machine
which often delivers better results
than far more expensive chairside
CNC machines.
What needs to be observed in
general terms when processing
CAD/CAM composite blocs?
M. Bildhäuser: Of course every technician has his own style. A somewhat
slower speed is generally recommended for composite. It is important to apply only little pressure on
the material. And as the processing
time is short anyway, one can take
a more relaxed approach. Of course,
with a new material one always
needs to first try out the pressure effects of the grinding tools. After one
to two units, processing is possible
with comparatively little effort. The
final finishing and polishing is separated from the carrier with a thin
disc. I then smooth the surfaces with
a soft rubber polisher. For further
processing I use the DIATECH ShapeGuard from COLTENE, this adapts
perfectly to the respective surfaces.
This is followed by meticulous postpolishing with the margin polishing
paste - and finished!
Which material is currently in
particularly high demand in
laboratories?
Dr. Rohde: Zirconium remains the
gold standard in the industry, last
not least because of its favourable
price structure. At approximately 25
units per blank, the circular blank is
certainly in a different price category than the conventional blocs for
chairside grinding systems. At the
same time, zirconium has a convincing flexural strength of over 1,000
megapascals. At approximately 600
megapascals the value is of course
somewhat lower for highly translucent pieces. On the downside, zirconium needs to be sintered for a very
long period to achieve an aesthetic
solution. 14 hours for production is
quite common. When using CAD/
CAM composite blocs we can process
orders from laboratory customers
quicker as the firing process is eliminated. If we have the data by 3 p.m.,
our milling centre can generally deliver on the same day.
Who benefits most from rapid
processing?
Dr. Rohde: If the dentist has a CAD/
CAM device in the practice, a crown
can be produced within an hour and
be fitted during the same session.
The patient saves the need for a second session and is pleased by the immediate treatment. Also in the laboratory, production only takes one
hour, in other words: the patient can
have his dentures a few days later
which is still considerably faster than
in the past.
...does this mean there are no
limits to patients‘ demands?
M. Bildhäuser: Today, patients obtain extensive information via the
Internet on various indications and
the treatment methods available.
This increases the wish for highly
aesthetic restorations and patients
do take a closer look. In view of the
marked quality awareness of many
customers, one is of course delighted
to deliver work to laboratories distinguished by a fantastic gloss.
Dr. Rohde, how has the competition from the Far East
changed the domestic laboratory market in your opinion?
Dr. Rohde: As leading mail order
company we export to over 100
markets and monitor the development in Europe with mixed feelings.
The pressure on margins is no doubt
increasing if dentists outsource their
laboratory work more and more
to India or China. Investment into
CAD/CAM technology is therefore
a good approach for the individual
dental laboratory: machine fabrication largely eliminates the intermediate labour-intensive steps, making
production costs competitive again.
Usually the unit labour costs are the
deciding factor in the calculation.
M. Bildhäuser: Add to this that the
starter models for CAD/CAM have
meanwhile become affordable, together with a manageable learning
curve. In the past you more or less
had to be an engineer to operate
the devices, these days dental technicians attend one of our training
courses at the beginning, the rest follows automatically.
And finally: what properties
would you want the dental
material of the future to have?
Dr. Rohde: (laughs) The all-in-one
solution for every purpose would be
a material with the flexural strength
of zirconium, the aesthetics of e.max
and the processing characteristics of
composite, but we place our trust in
the inventiveness of the manufacturers. The amazing development
of modern high performance composites over the past years would
suggest that it is not only processing
time in the laboratory which will undergo rapid progress. And we would
be pleased to actively support easing
the work burden for dental technicians.
Dr. Nicolas Rohde
Since 2016: Division Manager - Head
of Digital & International Division at
DT&SHOP GmbH
Manfred Bildhäuser
Since 2014: Technician in the DT&SHOP
milling centre
DT&Shop GmbH
Dr. Nicolas Rohde
Head of Digital & International Division
www.dt-shop.com
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