Lab Tribune Middle East & Africa No. 3, 2017Lab Tribune Middle East & Africa No. 3, 2017Lab Tribune Middle East & Africa No. 3, 2017

Lab Tribune Middle East & Africa No. 3, 2017

Team players: function and esthetics / Full range of product offering for dental technicians at Dentsply Sirona

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DTMEA_No.3. Vol.7_LT.indd





PUBLISHED IN DUBAI

May-June 2017 | No. 3, Vol. 7

www.dental-tribune.me

Team players: function and esthetics
A systematic approach to full-mouth rehabilitation with all-ceramics
IPS e.max Smile Award 2016: The following article describes the complex full-mouth rehabilitation of a
female patient who consulted our practice because she was dissatisfied with the appearance of her smile.
A reliable and efficient approach made the most of the interplay of esthetics and function and all-ceramic
materials.
By Anna Giorgadze and Ilias Psarris,
DT, Greece
Esthetics and function – these two
requirements are inseparable in restorative dentistry. The case outlined
in this article highlights just how
tightly these two aspects are connected. The patient primarily wanted the treatment to enhance her appearance. The dental team, however,
could not fulfil these esthetic demands without taking into account
the functional considerations. Their
aim from the time of the treatment
planning stage was to achieve a harmonious result. The extensive prosthetic work required a systematic
treatment approach.

Case presentation
The young female patient consulted our dental practice about a
smile enhancement. Her upper and
lower anterior teeth were severely
abraded and stained (Fig. 1). Moreover, she had received inadequate
restorations in the past. The metalreinforced bridges in the posterior
region did not provide suitable function and esthetics. The patient was
dissatisfied with the entire situation
(Fig. 2). The unesthetic appearance of
her teeth was an embarrassment to
her, especially when she smiled.

Diagnosis and planning
The first general diagnosis was based

speaking and smiling constituted
important diagnostic tools in the
treatment process. They provided
us with valuable information for the
design of the diagnostic wax-up. Impressions were taken for the fabrication of the models. A facebow record
was taken for the skull-related transfer of the situation into the articula-

ÿPage B2

Figs 1 and 2: Severely abraded upper anterior teeth and compromised esthetics

on the needs of the patient. Furthermore, specific aspects of the situation were assessed. A corresponding
diagnosis was made and the patient
was presented with a preliminary
treatment plan. In accordance with
our protocol, the plan focused on
attaining a satisfactory balance between the functional and esthetic
requirements. Furthermore, mainly
additive measures were planned,
which would make the treatment
minimally invasive. The clinical diagnosis revealed the extent of the damage. Severe abrasion had considerably shortened the front teeth, which
showed well-defined wear facets. The
vertical dimension of occlusion was
clearly too low. The patient’s smile
line was not ideal and therefore, it
negatively impacted her expression. The patient was in good general
health. She did not complain of any
temperomandibular joint pain or of

tight jaw muscles. In the development of the final treatment plan, we
first concentrated on the functional
requirements. In the process, we established that the vertical dimension
of occlusion needed to be raised by
one millimetre and a new occlusal
scheme created. Therefore, we proposed the following steps: stabilize
the situation with the help of longterm temporaries before starting
the prosthetic treatment; place two
implants to close the gaps left by the
loss of tooth 46 and 36; restore the
dentition with all-ceramic crowns,
bridges and veneers (IPS e.max Press,
Ivoclar Vivadent) and provide the
patient with a bite guard to protect
the teeth after the treatment. The patient agreed to this plan.

LIFELIKE ESTHETICS –
EFFICIENTLY PRESSED

Prosthetic pretreatment
Portrait pictures and video clips
showing the patient when she is

IPS e.max PRESS MULTI
®

Fig. 3: The master cast clearly shows the functional and esthetic
shortcomings.

THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT

Fig. 4: Additive build-up of the anterior teeth for the diagnostic
wax-up

• 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. 5: The wax-up with approx. 1 mm higher vertical occlusion

Fig. 6: The mock-up fabricated on the basis of the wax-up on the
model

Bendererstrasse 2 | 9494 Schaan | Liechtenstein
Tel.: +423 235 35 35 | Fax: +423 235 33 60


[2] => DTMEA_No.3. Vol.7_LT.indd
B2

LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 3/2017

◊Page B1

Fig. 8: Prepared teeth ready for the permanent restorations
Fig. 7: Try-in of the mock-up and validation of the functional and
esthetic parameters

required only light preparation. The
upper anterior teeth were prepared
for 360° veneers and the lower anterior teeth for ultra-thin veneers (Fig.
8). We pursued a minimally invasive
strategy, which was quite easy to
implement due to the additive approach of the treatment plan. An impression of the situation was taken.
Based on the mock-up, long-term
composite resin temporaries (Telio
Lab, Ivoclar Vivadent) were fabricated. During the next three months,
the patient was able to accustom herself to the new conditions. She was
given the possibility to test the new
vertical dimension of occlusion and
inform us about any esthetic and
functional needs.

Permanent prosthetic
restorations

Fig. 9 Grinding in of functional abrasion facets on the veneers in
the lower jaw

Fig. 10 The finished all-ceramic restorations on the model of the
lower jaw

Fig. 11: Harmonious picture of the all-ceramic restoration in situ

Fig. 12: Examination of the functional parameters

Figs 14 and 15: The recall examinations of the ceramic restorations showed that the soft tissue in the cervical region of the upper and lower teeth was strong and healthy.

tor. Furthermore, the new vertical dimension was verified in the mouth
and it was raised by about 1 mm
compared with the original state.

From wax-up to mock-up
The models were articulated and
then a diagnostic wax-up (Figs 3 to
5) was created. The teeth were built
up according to the new vertical dimension of occlusion. The anterior
teeth were designed in such a way
that their shape and length would
suit the face of the patient. The esthetic parameters, such as the smile
line, mid-line and the buccal corridor, were given as much attention as
the functional requirements of the

Fig. 16: Six months later. The patient is highly satisfied with the
result. She can smile with confidence.

occlusion. Since we wanted to check
the planned tooth length and shape
in the patient’s mouth, we fabricated
an acrylic mock-up on the basis of
the wax-up (Fig. 6). The try-in of the
mock-up allowed the dental team to
obtain indispensible insight into the
esthetics and function of the restoration. It also provided the patient
with a preview of the restoration and
helped her to get used to her new appearance. Actively involving patients
in the planning process at this stage
has a highly motivating effect and it
positively influences the treatment
result. During the try-in, the function
of the restoration was tested in terms
of the static and dynamic occlusion.

Phonetic criteria were also checked
in the process. Finally, some esthetic
details were discussed (Fig. 7). The
patient asked for light teeth and bold
tooth shapes.

Implant insertion
and preparation
The prosthetic restorations in the
lower jaw were removed and implants were placed in the gaps left
by tooth 46 and 36. The wounds took
about three months to heal. Following the osseointegration of the implants and the conditioning of the
soft tissue, the teeth were prepared
for receiving the prosthetic restorations. The premolars and molars

The patient had no trouble adjusting to the new situation. She eagerly anticipated the placement of
the permanent restorations. At this

Fig. 13: Harmonious appearance. The
tooth shape and shade perfectly match
the face of the young woman.

stage, she emphasized her requirements again: beautiful and above all
light teeth. We decided to create the
veneers with the press technique using a very light material (IPS e.max
Press, HT BL 3). The copings for the
crowns in the upper and lower jaw
were fabricated with the press technique (IPS e.max Press, LT BL 3) and
they were individually veneered (IPS
e.max Ceram). The long-term temporaries served as a template. The
restorations were produced according to the established protocol. The
requirements of both function and
esthetics were fulfilled. As requested
by the patient, the anterior teeth
were given a bold shape. The surface
of the ceramic was imparted with a
distinctive micro and macro-texture,
which produced a play of light similar to that of natural teeth (Figs 9 and
10).

Placement of the restorations
In preparation for the adhesive cementation of the restorations, the
provisionals were removed and the
teeth were cleaned. The anterior restorations were checked in the mouth
using a try-in paste and the esthetic
results were subsequently assessed.
The occlusion was checked in detail.

Next, the ceramic restorations were
etched with 5% hydrofluoric acid
for 20 seconds. They were cleaned
in an ultrasound bath and dried.
Their contact surfaces were silanized
(Monobond Plus). Thereafter, a bonding agent (Heliobond) was applied.
The individual ceramic components
were temporarily stored in a container which protected them from light
and contamination. Then the teeth
were conditioned. A rubber dam was
placed and the teeth were carefully
air-abraded with aluminium oxide
(0.50 microns). Subsequently, phosphoric acid gel (37%) was applied and
thoroughly rinsed off after a reaction
time of 15 to 20 seconds. The preparations were dried to the extent
that a slightly moist shimmering
dentin surface was visible. The application of the bonding agent (Syntac) followed. The restorations were
placed with the light-curing luting
composite Variolink Veneer (Ivoclar
Vivadent). First, the veneers of the
two central incisors were seated and
their fit was checked. Then one restoration after the other was placed on
both sides. Before the restorations
were light cured for the last time, the
margins were coated with glycerine
gel to prevent the formation of an
inhibition layer. We removed excess
with fine diamonds and polishers
and then we polished and smoothed
the margins. After the final examination, we checked the esthetic and
functional parameters in particular
(Figs 11 and 12). We provided the patient with a protective bite guard and
then released her from the practice.

Result
Esthetic results that work. The allceramic restorations look completely natural in the patient’s face. Her
facial expression has completely
changed. The young woman appears
relaxed and enjoying her new smile
(Fig. 13). The first recall examination
took place three days after the restorations were placed. At that stage,
the condition of the soft tissue was
excellent. It had fully adapted to the
ceramic surfaces (Figs 14 and 15). The
success of the treatment was confirmed after the six-month and the
twelve-month recalls (Fig. 16).

Conclusion
Sound functional principles, excellent esthetic design skills and an outstanding materials system teamed
up to fulfil the patient’s ardent wish
for a smile makeover. The restorations have given her new zest for life
and they have improved her health
at the same time.
Dr Anna Giorgadze
11141 Galats, Greece
annaesthdent@yahoo.gr
Ilias Psarris
Ilias Psarris Dental Laboratory
16561 Athens, Greece
info@psarris-ilias.gr


[3] => DTMEA_No.3. Vol.7_LT.indd
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Glidewell Direct is actively seeking distribution channels.


[4] => DTMEA_No.3. Vol.7_LT.indd
B4

LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 3/2017

Full range of product offering for dental
technicians at Dentsply Sirona
By Dentsply SIrona
As the world’s largest manufacturer
of dental products, Dentsply Sirona
has a variety of intelligent solutions
that have been developed to meet
the requirements of dental laboratories. Thanks to the combined
power of the business units Dentsply Sirona CAD/CAM, Dentsply
Sirona Prosthetics and Dentsply Sirona Implants, these solutions include both materials and devices
for conventional manufacturing
procedures and materials as well as
hardware and software solutions for
digital work processes. This results in
a decisive advantage for dental technicians: At Dentsply Sirona, dental
technicians can find the entire world
of dental technology under one roof,
and can take advantage of products
and workflows that have been coordinated with each other.
As one of the central subjects in the
area of modern dental technology,
CAD/CAM-supported production
of dental restorations for the laboratory is playing an ever more important role. With its three business
units – CAD/CAM, Prosthetics and
Implants – focusing on dental technology, Dentsply Sirona possesses
concentrated competence in dental
technology and offers solutions for
all steps within this production process. This brings clear added value to
the dental laboratory as it combines
specialists for the digital workflow
and the inhouse production of restorations: one for dental materials and
one for the centralized fabrication of
abutments and implant-supported
structures. In this way the whole
process from impression taking to
the final restoration can be handled
with products from Dentsply Sirona
– while still allowing for the freedom to include components from
other open CAD/CAM-systems. In all
branches of dental technology, Dentsply Sirona’s innovation leadership
is a benefit to the lab.

Software updates for
new possibilities
The current software updates inLab CAD SW 16.0 and inLab CAM
SW 16.0 are perfect examples of

such possibilities. They expand the
range of indications and provide
new functions for an even more efficient computer-aided production
process that is oriented towards dental requirements. Now, for the first
time, occlusal splints and individual
impression trays can be designed
with the inLab software via the new
plugin inLab Splint in the “Removable Dentures” module. The new
inLab Check plugin is being used in
dentistry for the first time. The program supports the user via the FEM
analysis of the restorations designed
for critical stress-sensitive areas, and
visualizes them. With screw-retained
bridges and bars at the implant level,
there is an additional indication that
makes the immediate synergy effect
with the central production service
Atlantis from Dentsply Sirona useful
for the laboratory for the first time.
With the accurate inEos X5 scanner
and the Atlantis FLO-S scan body,
inLab SW users can scan cases from
all major implant systems for ordering of Atlantis suprastructures. This
initial order option available with
the inLab CAD SW 16.0 creates more
versatility for the dental laboratory.
Additional new production possibilities arise from the manufacturing of
one-piece individual titanium abutments with the inLab MC X5 5-axis
milling unit. The STL/XML import
function for implant restorations
with screw channels from other
CAD software has been expanded to
include the current inLab CAM SW
16.0.

New opportunities with
Atlantis solutions
The Atlantis solutions line offers
a range of digital services that are
continuously developed. The possibility to order Atlantis abutments
and Atlantis suprastructures via
the Dentsply Sirona lab-design software creates new opportunities for
the dental laboratory to offer more
implant-based restorations to the
dentist. The latest innovation from
Atlantis is the Atlantis CustomBase
solution for single tooth screw-retained restorations. It combines an
Atlantis Abutment and an Atlantis
Crown with a screw access hole. The
crown is cemented to the abutment

Fig. 1: New indication with inLab CAD SW 16.0 Splints and individual impression trays.

extraorally and screw-retained into
the implant, avoiding potential complications caused by excess cement.
The Atlantis Crown can be ordered
as a physical crown or as a digital
unique file.
The digital file is either a “ready-tomill crown” that can be imported
directly into the inLab CAM SW or an
Atlantis Core File. This file includes
the abutment designed by Atlantis,
which can be used by the lab team as
the basis for their own crown design.
The Atlantis CustomBase solution
is available in gold-shaded titanium
and titanium, and is available for all
major implant systems.1
In addition, the Atlantis patientspecific suprastructure has state-ofthe-art design software and additive
manufacturing of titanium and cobalt-chrome implant-retained fixed
restorations.

High performance materials
for the modern lab
Materials are also a part of the range
of products from Dentsply Sirona,
along with the new denture base
material Lucitone HIPA (high impact pour acrylic) that is being presented at the IDS. This new denture
base material offers extraordinarily
high strength, color stability and fitting accuracy. At the same time, the
material specialist also has a new
development in the area of zirconia
ready for the ceramic sector: Cercon
xt with a level of translucency that is
around 19% higher than that of Cercon ht. Cercon xt provides the dental
laboratory with an even better level
of esthetics, particularly for mono-

lithic
restorations. True Color Fig. 2: The inCoris CCB sintering metal disks from Dentsply Sirona
T e c h n o l o g y are available as standard disks (diameter 98.5 mm) in six differensures a pro- ent heights
nounced level of
color reliability and reproducibility. analog towards digital. Using the
As was the case with the Cercon ht, example of an additional ceramic
the Cercon xt blanks are available in innovation from Dentsply Sirona, i.e.
pre-colored variants in the classic 16 Celtra Press, it is clear that benefits
VITA2 colors and in white. Thanks to for the dental laboratory can equally
the standard format (98 mm disks), result from a contrary development.
the new material can be used in all This is actually a material version of
common open CAD/CAM systems, the zirconia-reinforced lithium siliand is also available as a 105 mm disk cate (ZLS) Celtra Duo that had been
for processing in the brain expert developed for CAD/CAM processing.
and brain xpert milling units.
As the name suggests, Celtra Press is
now suitable for the traditional press
Here, the benefits of the combined method. Hence the benefits of the
level of dental expertise that Dent- special micro-structure of ZLS can
sply Sirona possesses come into ef- now also be used in this processing
fect. Along with high-performance method that is used in nearly every
materials such as Cercon, with the laboratory. This includes a particu5-axis milling unit inLab MC X5, the larly high strength of over 500 MPa
company can also provide a ma- as well as outstanding mechanical
chine that can be used to process and light-optical properties that
standard disks. This production unit in particular achieve a profoundly
is also compatible with an additional near-natural chameleon effect. The
new material option for the digital system components that have been
workflow: the sintering metal disk specially matched with the new mainCoris CCB now enables dental tech- terial ensure rapid processing and
nicians the option to mill using nonoutstanding results when using Celtprecious metals in their laboratory’s ra Press: The Celtra Press Investment
own inLab MC X5. Here, the expan- material is partially responsible for
sion of the range of indications to the fact that only a minimal reaction
include long-span work across four layer is formed during pressing, and
units in particular has shown itself this layer is removed by sandblasting
to provide added value. As a result, during divesting. The Celtra Ceram
an even larger number of cases can veneering ceramic is available to the
be handled using this processing laboratory for esthetic individualizamethod that is quicker, cleaner and tion.
more cost-effective in comparison to In addition to this variety of interestthe casting method.
ing new products, Dentsply Sirona’s
range of products of course also includes just as many long-established
Conventional procedures,
materials and hardware and softnew chances
ware solutions. They allow the laboBut the path of progress does not ratory to benefit from workflows and
necessarily always move from products that have been coordinated
with each other with
a particularly wide
range of indications.
Due to various certification and registration
periods, not all products are immediately
available in all countries.

References
1 For details see the
Atlantis implant compatibility charts
2VITA is a registered
trademark of Vita
Zahnfabrik H. Rauter
GmbH & Co. KG, Bad
Säckingen.

Fig. 3: The new zirconium oxide-reinforced lithium silicate Celtra Press as well as the veneering porcelain Celtra Ceram and the investment material Celtra Press Investment are now available.

Fig. 4: The new Atlantis CustomBase solution, combining
an Atlantis Abutment and a crown, for screw-retained
single tooth restorations.


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