eLABORATE Sep/Oct 2023 by dentalcommunity

VOL.20 NO.4

SEPTEMBER/OCTOBER 2023

12 HOURS CPD

FEB

AUTOMATION

FEB

VALIDATION

PRINT POST NO. 100018653

REPLICATION

AUTONOMOUS PRINTING • VALIDATED WORKFLOWS • AI DESIGN • LATEST TECH D E N T U R E S • A L I G N E R S • S P L I N TS • S U R G I CA L G U I D E S • C R O W N S TGA UPDATE • LATEST MATERIALS • POST-PROCESSING • DEBUGGING FAILURES

DAY ONE - FEBRUARY 9, 2024 - CLINICAL DAY TWO - FEBRUARY 10, 2024 - TECHNICAL

ParkRoyal Darling Harbour Sydney

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Join us again or for the first time at Digital Dentistry & Dental Technology No 5 for a fun, exciting and fully immersive learning experience with the best of the best in the new age of dentistry. This year’s program will again cover Digital Smile Design • Digital orthodontics • Intraoral scanning • 3D Facial Scanning • Digital implantology • Digital full arch restorations and full mouth rehabilitations • Digital Dentures • 3D Printing • Milling • CBCT • Materials and applications • Software and more with MORE Hands-on Sessions • MORE Advanced Sessions • MORE New Products • NEW Masterclasses... and more!

Full details of the speakers and presentations online REGISTRATION FEES

$880 inc gst

INCLUSIONS

PROGRAMME DETAILS

Registration fee includes participation in TWO full days of education (12 CPD hours), all catering and Friday drinks.

FRIDAY 24 MAY 2024 9.00am - 5.00pm - education 5.00pm - 7.00pm - happy hour

EARLY BIRD PRICING $220 before 24 nov 2023 Multiple lectures and workshops are being run concurrently to allow price increases $110 on you to build your own program to suit your specific interests. Price the 2nd of every month VENUE DETAILS

SATURDAY 25 MAY 2024 9.00am - 5.00pm - education

HOURS CPD

is all inclusive.

Novotel Sydney Brighton Beach - The Grand Parade, Brighton-Le-Sands NSW 2216 - Close to Sydney Domestic and International Airports Check the website for details of discounted accommodation rates for the conference • Ample parking available at the hotel

Organised by Dentevents™ a division of Main Street Publishing Pty Ltd ABN 74 065 490 655

www.dentevents.com • info@dentist.com.au • Tel: (02) 9929 1900 • Fax: (02) 9929 1999

www.dentaltechnology.com.au

VOLUME 20 | NUMBER 4 SEPTEMBER/OCTOBER 2023

eLABORATE | CONTENTS

On the cover... Join us again in February for a great two day program on 3D Printing in Dentistry under the theme of Automation, Validation, Replication register now at www.3dpd.events

6 BRIEFS 8 SPECTRUM 24 CPD CENTRE 42 NEW PRODUCTS

facebook.com/elaboratenow

16 32

CAD/CAM

FULLY AUTOMATIC, FLEXIBLE AND VIBRATION FREE WITH Ø 125 MM TELESKOPER ORBIT

CERAMICS

THIRTY YEARS OF USING PRESS TECHNOLOGY TO CREATE GLASS-CERAMIC RESTORATIONS

26 40

CAD/CAM

THERMOFORMING

POLISHED SPLINTS DIRECT FROM THE 3D PRINTER

IDEAL PROPERTIES FOR DENTAL THERMOFORMING MATERIALS

twitter.com/eLABORATEnow

instagram.com/dentevents

Editor and Publisher: Joseph Allbeury Technical Editor: Terence Whitty, Dip. DT (Syd)

eLABORATE™ ISSN 1834-9110 is published six times per year by Main Street Publishing Pty Limited ABN 74 065 490 655 | Printed in AUSTRALIA

PO Box 586, Cammeray NSW 2062 AUSTRALIA Tel: (02) 9929-1900 Fax: (02) 9929-1999 Email: info@dentist.com.au © 2023 All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

briefs | NEWS Don’t miss out...

10th Anniversary of Ceramill Sintron

f you love quality education and you also love a bargain, then register immediately for our two digital dentistry events in 2024. Early bird By Joseph Allbeury rates now apply for both 3D Printing in Dentistry 2024 on February 9-10 plus the fifth instalment of Digital Dentistry and Dental Technology 2024 on May 24-25. Both of these two-day events feature a stellar line-up of expert speakers that are not to be missed. Planning is well underway for 3D Printing in Dentistry 2024 on February 9-10 at the ParkRoyal Sydney Darling Harbour. This event is a single stream conference with multiple speakers and this year, as well as looking at new tech and new materials, we’ll have a particular focus on the next evolution of printers approaching more autonomous operation. There are solutions already available in Australia, some serious, some novel, that are introducing automation at various levels. We’ll also be looking at the importance of validated workflows to ensure consistency in printed objects. The event at the beginning of 2023 highlighted the complexity of the 3D printing process and the need to ensure that every step of the printing, washing and curing process is consistent and inline with manufacturer’s guidelines. To that end, the Therapeutic Goods Administration have also confirmed they will be providing a speaker and we’re working with them to ensure their presentation answers the key questions users of 3D printing are asking that will impact the future of the use of this technology. We’ll also be covering the applications of Artificial Intelligence in the design process, clinical and technical case studies and a range of other topics of interest... plus plenty of interaction and debate delivered by the best speakers from Australia and New Zealand. Then, for the fifth time, we will be staging Digital Dentistry & Dental Technology 2024 on May 24-25. This event attracts some 500 delegates and if you register now, you’ll save 75% off the full price (paying just $220 until November 24). Our signature event brings together dentists, prosthetists and technicians in a multi-stream programme that covers every area of digital technology and its applications in the clinic and the lab. Apart from 3D printing, topics covered include intraoral scanning, 3D facial scanning, milling, CAD and CAM software, materials, smile design, digital dentures, implantology, CBCT, restorative, aligners, orthodontics and more. Digital dentistry continues to define the clinic and the lab and offers tremendous gains in efficiency, time and labour saving that is delivering a revolution in the profession. Both of these events offer clinicians and technicians unprecedented access to expert information to help navigate the transition to digital dentistry and how to take its use to the next level and beyond. So register now and SAVE. Enjoy the edition... Joseph Allbeury, Editor and Publisher

6 eLABORATE

n 2013, Amann Girrbach launched the CoCr sintering metal Ceramill Sintron, which has since enjoyed great popularity worldwide. The Ceramill Sintron CoCr sintering metal is distinguished by innovative supremacy. The non-precious metal revolutionises the manufacturing process, as Ceramill Sintron blanks can be dry milled effortlessly on in-house desktop machines such as the Ceramill Motion 3 due to their wax-like nature. During the subsequent sintering process under inert gas flooding, the frames achieve their final state - a non-precious metal unit with a very homogeneous material structure, precise, without cavities and machinable with any common metal veneer ceramic within the CTE range. A revolution in the fabrication of CoCr restorations, with a manufacturing process that involves only a few steps. According to the data available from now ten years of market surveillance, Ceramill Sintron has proven itself to be an established and clinically proven material. Developed together with the Fraunho-fer IFAM Dresden and validated by independent universities and accredited test laboratories, the material and the matched workflow assure maximum safety for the user and the patient. For more information, visit to www.amanngirrbach.com

New Amann Girrbach Zolid Bion zirconia mann Girrbach brings a new material to market following 15 years of zirconia development work. Zolid Bion is the name of the new high-performance zirconia, which optimises the aesthetics and natural appearance of restorations without compromising on safety. Thanks to the innovative design of the Therm DRS sintering furnace, extremely fast sintering cycles are now possible. Crowns made of Zolid Bion can thus be sintered in just 45 minutes – and without any sacrifice in terms of aesthetics or safety. Zolid Bion is the first material in its class to achieve such speeds and thanks to the raw materials used by Amann Girrbach, a strength of over 1,100/± 150 MPa can also be guaranteed over the entire cross-section of the blank. For more information, visit to www.amanngirrbach.com

September/October 2023

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spectrum | NEWS

3D Printing in Dentistry 2024 focuses on Automation, Validation, Replication

he 2nd annual 3D Printing in Dentistry conference is again being staged at the ParkRoyal Darling Harbour, Sydney on Friday and Saturday, February 9 and 10, 2024. The theme of the event is Automation, Validation, Replication. “From the feedback we received, the inaugural 3D Printing in Dentistry event this year was a highly productive, interactive learning experience for delegates,” said Dentevents’ Joseph Allbeury, the organiser of the event and publisher of this magazine. “The lectures included a mix of clinicians and technicians detailing the use of 3D printing in their daily routines, presentations from material scientists and manufacturers as well as technical information on setting up, using and maintaining 3D printers. “When we craft multi-speaker events like this, we’re really trying to present the right information for delegates at the right time, presented by the best real world educators available. It gives delegates high level access to information in a concentrated form that will allow them to make better decisions, solve problems and grow their use and understanding of these burgeoning, gamechanging technologies.”

8 eLABORATE

Mr Allbeury said that the event included a high level of interaction between the audience and presenters, enhancing the learning experience and highlighting the commonality of issues faced in implementing 3D printing technologies into clinics and labs. “Many delegates came with questions and the format of the event allowed these to be answered, either directly through the presentations or via lively exchanges and Q&A’s with the presenters.” Mr Allbeury said that the event highlighted the level of complexity involved in the 3D printing process and the need for quality education focussed on establishing replicable processes, procedures and workflows to ensure optimal results. “For the 2024 event, we will again cover a broad range of topics covering hardware, software, materials and solutions, plus we’re adding sessions that focus on a couple of aspects of 3D printing that are driving future directions,” Mr Allbeury said. “One of these areas is automation, whereby many printer manufacturers are now looking at what happens beyond the build, working towards more autonomous operation. This is similar to the evolution we saw in milling machines with the addition of automated tool and material changing that allows mills to work

unattended, in some cases 24/7. 3D printers are evolving the same way, though through very different means. “Another area is the validated workflow. Particularly in 3D printing, where the finished product is the result of an essentially complex chemical process, the creation and validation of workflows that ensure 3D printed objects are accurately replicated time and again through printing, washing and curing to guarantee patient safety will only grow in importance to the point where government may well be involved in oversight.” Mr Allbeury said that they are currently engaging with key players in the 3D printing landscape in Australia and New Zealand to devise a programme that is representative of the current needs of local clinicians and dental technicians. “3D printing is clearly a game changer in dentistry and we are once again aiming to deliver a programme that will empower delegates to either take up the technology or take their current investment to an entirely new level. I hope that everyone interested in 3D printing in dentistry will join us in February for another fun, interactive and informative two days.” For more information or to register visit www.3dpd.events

September/October 2023

AUTOMATION • VALIDATION • REPLICATION

WHITTY

KLIJNSMA

ELSEY

TGA

VISIT THE WEBSITE FOR UPDATES ON MORE SPEAKERS

Join Australia’s leading experts on dental 3D printing at this two day event exploring the applications of 3D printing in both the clinic and the laboratory. Visit the website for information and additional speakers. BOTH DAYS ARE DESIGNED FOR DENTISTS, SPECIALISTS, DENTAL PROSTHETISTS & TECHNICIANS PLUS A SPECIAL PRESENTATION BY THE THERAPEUTIC GOODS ADMINISTRATION

DAY ONE - FEB 9 - CLINICAL n Importance of validated workflows n In-house clear aligner production

n Full and partial digital denture workflows n Printed crowns - an update

n Applications of 3D printing in cosmetic dentistry n Printing Class IIa appliances in-house

n The advantages of outsourcing design n And more...

DAY TWO - FEB 10 - TECHNICAL n Latest advances in 3D printer materials n Autonomous printing solutions

n Automated post-processing solutions

n Artifical intelligence and design automation n Digital denture production n Debugging print failures

n Workflows for optimising 3D printed results n And more...

REGISTRATION FEES

DATE AND TIME

One Day

$660 inc gst

SYDNEY 9-10 February 2024

Two Days

$990 inc gst

Starts 8.30am | Ends 5.00pm | Rego opens 8.00am

sAVE $330 BEforE 9 octoBEr 2023

ParkRoyal Sydney Darling

3D Printing in Dentistry is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • 3D Printing in Dentistry™ and Dentevents™ are trademarks of Main Street Publishing P/L © 2023 Main Street Publishing Pty Ltd

spectrum | NEWS

The VITA Excellence Award 2023 goes to an outstanding patient case

Figure 2a. Patient case, initial situation.

entures need expertise and experience. With the VITA Excellence Award, VITA Zahnfabrik celebrates particularly successful applications achieved using the VITAPAN EXCELL denture tooth. In 2023, Dr Iris Kraljevic, a dentist who specialises in reconstructive dentistry and master dental technician Fernando Pasamontes impressed with a case from the group practice Zahnmedizin Zürich Nord in Zurich.

Impressive in every respect xcellent function, natural aesthetics, an incredibly natural appearance - that was why the jury chose this case for the award. A picture of the patient approximately 20 years ago with his natural teeth was a particularly crucial image to demonstrate the challenging case. The new dentures from Dr Kraljevic and Mr Pasamontes were the perfect reproduction - a genuinely “Perfect match”.

Figure 2b. Final outcome: The final, full denture blended in harmoniously with the overall appearance. “I like replicating nature,” explained Dr Kraljevic. “To do that, I always ask for an old photo of the patient before creating an anterior setup. VITAPAN EXCELL is particularly suited to achieving natural-looking results.” A dentist who specialises in reconstructive dentistry, Dr Kraljevic has been with the group practice Zahnmedizin Zürich Nord in Zurich, Switzerland since 2019. In her role as a trainer, she also gives lectures at the Zurich Center for Preventive Dentistry (PZZ) and is a member of the board of the Swiss Society for Reconstructive Dentistry (SSRD).

10 eLABORATE

VITAPAN EXCELL for the “Perfect Match” he VITA Excellence Award honours outstanding work with the VITAPAN EXCELL anterior tooth set. Any posterior teeth may be used, however, VITAPAN LINGOFORM is a particularly good choice.

September/October 2023

spectrum | NEWS “VITAPAN EXCELL offers a great variety of denture tooth moulds,” said the master dental technician Fernando Pasamontes. “In addition to VITA classical, they are also available with VITA SYSTEM 3D-MASTER and have a very natural appearance. VITAPAN LINGOFORM posterior teeth have a good basic shape that allows a variety of denture occlusal concepts to be achieved. And with the compatible VITA AKZENT LC stains, you can give the teeth an added lifelike appearance.” Mr Pasamontes has been working as a master dental technician for more than 30 years, and manages his own laboratory in the Swiss federal state of Zug.

VITA Excellence Award for excellent denture work he VITA Excellence Award was presented for the first time in 2023. A jury of four selected the winning case from numerous entries based on the following criteria: Aesthetics; function; documentation; and preparation work. The winners were announced in mid-March at the International Dental Show (IDS) in Cologne and had the opportunity to present their case to an international audience.

For more information on VITAPAN EXCELL anterior tooth set, visit www.vita-zahnfabrik.com/VITAPAN_EXCELL Figure 1. Dr Emanuel Rauter (left) with Dr Iris Kraljevic (right), winner of the VITA EXCELLENCE AWARD.

For more information on the VITA Exccellence Award, visit www.vita-excellence-award.com

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spectrum | NEWS

New Asiga Composer 2.0 By Terry Whitty

Figure 1. New simplified main interface.

Figure 2. Machine management.

Figure 3. New Wizard menu.

Figure 4. Import file.

o one can argue that Australian company Asiga has taken 3D printing in dentistry to a new level on the world stage. The company has accomplished amazing patented technology for 3D printers that is the envy of many other companies. Their products are highly regarded in the profession for their precision, predictability and repeatability. However, in the ever-evolving landscape of dental technology, where precision is paramount and innovation is constant, one unsung hero quietly plays a pivotal role in transforming the way dental professionals approach their working day. It’s not the dazzling hardware or the groundbreaking materials; it’s the setup software that truly holds the key to unlocking the full potential of 3D printing in dentistry. Asiga has now unveiled its latest Version 2.0 of their Composer software for the Asiga range of 3D printers.

12 eLABORATE

This new release is a major update, sporting a completely new interface and packed with features, some previously available but less accessible or obvious and some brand-new features. To be fair, previous versions of the Composer software worked very well but from a user’s point of view, it was very industrial, sometimes slightly confusing and not very intuitive. With Version 2.0, everything has now changed. To start with, as mentioned, there is a brand new interface. It’s elegant and stripped down to offer simplicity - surprisingly not an easy feat! When I upgraded my version, I was a bit confused as it did not look any different! A simple selection in the preferences, however, loaded the new interface - in either light or dark mode - and if you like the way previous versions looked, don’t despair, you can have the previous interface if you desire which had loaded by default on my computer.

Once you select what you would like to do from 3 main options, you go to machine selection. Here it will auto detect any connected Asiga 3D printer and use a new wizard interface to start the pre-printing process. You can load files to print, automatically position the work items, generate supports, adjust the build properties and of course slice, ready for printing. In addition, a new feature is the ability to generate multi-stacking. This is useful if you want to print a lot of items overnight for example as it will print supports to create row above row and it can work very well indeed. The downside of this is, of course, that a fair bit of resin is used and if you do have a failure, it can be catastrophe (Lucky you are using an Asiga printer as the percentage of failures are very low when used correctly). You can also view the status of the selected printer via a web-browser and it will give you all the information from

September/October 2023

spectrum | NEWS

Figure 5. Automatic placement.

Figure 6. Support generation.

Figure 7. Different types of supports are available.

Figure 8. Dark mode!

Figure 9. You can bring in multiple files at once.

Figure 10. Printing parameters.

VIDEO

Figure 11. Access the front panel via a web browser.

September/October 2023

the front panel of the printer and more. You can see the status of a build, tray data, power off the machine and various other useful data. If you really want to get your hands dirty, you can get into all the deep features of the software but this is really for more experienced users or those wanting to experiment with new materials, however Asiga already supports over 500 different materials from many manufacturers large and small. All in all this is an excellent move in the right direction for Asiga; a great new interface, a new wizard and very easy to navigate software really is a massive time saver. And don’t forget dark mode for those who love the dark side.

eLABORATE 13

spectrum | NEWS

Digital Dentistry & Dental Technology conference back for 5th edition in 2024

igital Dentistry & Dental Technology is back for a 5th edition in 2024 in Sydney on May 24-25. The two-day, multistream event is proving as popular as ever with its unique format, allowing delegates to create their own event within an event. “We’re looking forward to celebrating 5 editions of Digital Dentistry & Dental Technology with the biggest and best event yet,” said Dentevents’ Joseph Allbeury, the organiser and publisher of this magazine. “We’re already working with sponsors and supporters to bring in top international speakers to present alongside the stellar local talent from Australia and New Zealand we always feature.

“Back in 2019, we had over a dozen internationals alongside speakers from Australia and New Zealand and now that COVID is behind us, we’re hoping to bring back the international flavour.”

Digital Dentistry and Dental Technology 2023 presented delegates with a choice of over 90 education sessions including 18 workshops - 94 hours of

content - in 8 concurrent streams presented by 46 speakers over two days at the Novotel Sydney Brighton Beach. Topics covered included 3D printing, intraoral scanning, 3D facial scanning, milling, CAD and CAM software, materials, smile design, digital dentures, implantology, CBCT, restorative, aligners, orthodontics and more. “If you’ve never attended before, have been multiple times or attended every event, we would encourage you to take advantage of the 75% off early bird discount available and register for only $220 until November 24.” For more info or to register for Digital Dentistry & Dental Technology 2024, visit www.dentaltechnology.com.au

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14 eLABORATE

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September/October 2023

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Changing the World of Dental Labs Elegant new design

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Sealed chamber to keep milling waste isolated Built in webcam for real-time mill monitoring

DGSHAPE CLOUD performance visualisation software Optional tablet integration

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cad | CAM

Fully automatic, flexible and vibration free with Ø 125 mm Teleskoper Orbit

Figure 1. The M2 milling unit comfort line includes five machine models, available with one or two milling chambers (Dual versions). According to the model, they are equipped with the extra-large Teleskoper Orbit with a diameter of 125 mm.

Figure 2. The latest generation of M2 machines are fully vibration-resistant thanks to the particularly stable double bearing suspension and the new, more powerful and compact spindle.

Figure 3. The M2 milling units are characterised by the optical identification of the milling burs, which ensures greater safety during milling and a separated, contamination-protected tool chamber.

he new M2 milling unit comfort line from Zirkonzahn was developed with a specific mission: to guarantee high precision milling. The M2 Wet Heavy Metal; M2 Teleskoper; M2 Dual Wet Heavy Metal; M2 Dual Teleskoper; and M2 Dual Double Teleskoper enable the processing of all common soft and hard material blanks. All M2 machines are now fully vibration-resistant thanks to the particularly stable double bearing suspension and the new, more powerful and compact spindle. The absence of vibration allows the ability to mill very smooth surfaces, which is essential for the production of telescopic works. The M2 milling units are stand-alone solutions: it is possible to start milling and calibration processes or load elaborate tools directly from the machine via the integrated PC with touchscreen. The optical tool identification ensures greater safety during milling and the automatic self-cleaning and drying function together with the Cleaning Kit helps to keep the milling chamber clean and contamination-free. The machines included in the M2 line are available with one or two milling chambers (Dual versions), which give the user the freedom to mill dry and wet restorations in series without in-between cleaning.

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The highlight in terms of flexibility is the extra-large Teleskoper Orbit (Ø 125 mm) for adjusting the friction of telescopic works and for performing the Double Milling technique ith a 125 mm diameter, the extra-large Teleskoper Orbit allows - in combination with special holders (Blank Holders) - the processing of all common soft and hard material blanks with a diameter of 95, 98, 106 and even 125 mm. This means it’s possible to process material blanks with 4 different diameters with just one orbit and easily place oversized restorations that previously could not be milled in standard blanks (Ø 95 mm, Ø 98 mm). In this way, the number of splints capable of being produced doubles and the number of crowns milled is considerably increased. Thanks to special holders, the Teleskoper Orbit permits milling up to nine glass-ceramic blanks or six Raw-Abutments® in just one process.

September/October 2023

Figure 4. With a 125 mm diameter, the extra-large Teleskoper Orbit allows - in combination with special holders (Blank Holders) the processing of all common soft and hard material blanks with a diameter of 95, 98, 106 and even 125 mm.

Figure 5. One of the major advantages of the Teleskoper Orbit is that material blanks can be removed from the orbit and reinserted later at the same position with micron-range precision.

Figure 6. Thanks to the new Double Screw Metal technique, it is possible to produce highly aesthetic and stable bar-supported restorations in cases of divergent vestibular implants.

One of the major advantages of the Teleskoper Orbit is that material blanks, together with the relative Blank Holders, can be removed from the orbit and re-inserted later at the same position with micron-range precision. This is particularly helpful in different cases: • For adjusting the friction of telescopic works: if after milling the friction is too strong, it can be reduced by re-milling the inner part of the structure and if necessary, this can be repeated until perfect. • For the two-stage production of immediate restorations in the case of implant-supported prostheses (Double Milling technique). With new techniques, it is now possible to mill the occlusal side of a restoration even before the dentist sends all

information about implants positions. Once the occlusal side is milled, the Blank Holder and the blank with the immediate restoration can be removed from the Teleskoper Orbit and the machine can be used to mill other restorations. When the dentist sends the implant impression, you can choose the type of implant, design the basal surface, place the blank back into the orbit and recalculate the nesting to finish the milling process. • If an error message appears on the milling unit display and the milling process is suddenly interrupted, you can remove the Blank Holder with the partially achieved restoration and place it into another milling unit equipped with Teleskoper Orbit. The milling unit will continue the milling process at the same point where it was interrupted.

September/October 2023

eLABORATE 17

Figure 7. The virtual tooth set-up revealed a strong divergence of the implants towards the vestibular area.

Figure 8. The new Double Screw Metal software function allows the generation of additional virtual screw threads within the bar.

Figure 9. The 3D rendering provides the optimal position of the screw channel, as well as the ideal fit of the screw head.

Figure 10. Precise milling of the threaded screw channels with the M2 Dual Wet Heavy Metal.

Figure 11. Precise milling of the threaded screw channels with the M2 Dual Wet Heavy Metal.

Figure 12. The analogic screw in the threaded screw channel virtually created.

• If you’re milling a restoration but you need to quickly complete another structure, you can stop the current milling process and start a new one. All you have to do is remove the Blank Holder with the partially-milled structure from the Teleskoper Orbit and place another Blank Holder in the orbit with the blank needed for the new restoration. Once the milling process is finished, the blank with the partially-milled job can be reinserted into the orbit in order to continue the interrupted milling process. • In the M2 Dual Teleskoper milling units, equipped with two separate chambers, it’s possible to stop a milling process in one chamber and start a new one in the other. As soon as the process is finished, the spindle automatically returns to the chamber where the milling process was previously interrupted to complete the milling process.

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Precise titanium milling: Production of full-arch prosthetics on divergent implants with the Double Screw Metal technique he M2 milling units, like all other Zirkonzahn milling units, are perfectly compatible with the company’s software, components and further hardware, in order to guarantee a smooth workflow from the beginning to the end of the treatment. The case described in this article exemplifies a smooth workflow made for a patient suffering from maxillary edentulism. Threaded channels on the metal structure were milled with the M2 Dual Wet Heavy Metal milling unit, showing the machine’s high-precision milling. The production of full-arch prosthetics on divergent anterior implants is one of the most challenging jobs for a technoclinical team. In the current case, a patient presented with complete maxillary edentulism and six implants already placed in the upper jaw. The virtual tooth set-up revealed a strong divergence of implants towards the vestibular area. To strike a balance between function, stability and aesthetics in the final restoration, a primary bar was integrated using the Double Screw Metal technique. The planned restoration consisted of a titanium bar and a secondary resin framework with 14 individual resin crowns.

September/October 2023

VIDEO!

TELESK (Ø 125 m OPER ORBIT m): 1 OR BIT FOR Ø 95, Ø 9 8, Ø 106 ,Ø

WET

125 mm

DRY

Thanks to the particularly stable double bearing suspension and the new, more powerful and compact spindle, the M2 milling unit is fully vibration-resistant and ideal for milling metals. During the milling of resin, to ensure clean resin processing and signiﬁcantly shorter cleaning times, a “ioniser” can be added to the equipment.

NEW! M2 DUAL DOUBLE TELESKOPER MILLING UNIT WITH TWO MILLING CHAMBERS AND TWO EXTRA-LARGE TELESKOPER ORBITS (Ø 125 mm) FOR PROCESSING MATERIAL BLANKS WITH Ø 95, 98, 106 OR EVEN 125 mm In combination with special holders, the Teleskoper Orbit permits the processing of all common soft and hard material blanks with ø 95 mm, ø 98 mm, ø 106 mm or even ø 125 mm as well as small zirconia blanks for single crowns, glass-ceramics and Raw-Abutment® blanks. Blanks can be removed from the orbit and re-inserted back at the same position with high precision in micron range. This is particularly useful for adjusting the friction of telescopic jobs and for the two-stage fabrication of immediate restorations in case of implant-supported prostheses (Double Milling technique).

MILLED WITH THE M2 DUAL DOUBLE TELESKOPER MILLING UNIT.

Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com

cad | CAM

Figures 13-15. With the Double Screw Metal technique, the titanium bar is screwed to the implants and the secondary structure is screwed to the bar, avoiding non-aesthetic vestibular channels and improving post-operative maintenance and hygiene.

Screwed titanium bar

Model Blank Beige

Denture Gingiva Base

Abro® Basic Multistratum®

Gingiva-Composites

The design of the primary structure incorporated an innovative CAD/CAM workflow, in which four additional screws were integrated to screw the superstructure to the bar. The virtual position of the screws was visualised using the new Double Screw Metal function of the Zirkonzahn.Modellier design software (Attachment module), which allows the generation of virtual screw threads within the bar design. The 3D rendering provides the optimal position of the screw channel in the primary structure, as well as the ideal fit of the screw head in the superstructure.

20 eLABORATE

The additional threaded screw channels are milled during the bar milling process. The titanium bar is then screwed to the implants and the secondary structure is screwed to the bar. With the Double Screw Metal technique, it is now possible to avoid unaesthetic vestibular channels, in order to produce highly stable, bar-supported rehabilitations even in complex cases without compromising full arch aesthetics. Do you want to know more? Visit www.zirkonzahn.com

September/October 2023

MORE INFORMATION ABOUT SINTERNIT

SINTERNIT MILL METAL STRUCTURES IN YOUR OWN LABORATORY The cobalt-chromium blanks (non-precious metal) are highly pre-compressed and slightly sintered, which enables the milling of all dental restorations. The raw material has a shrinkage factor of just 7 %: for this reason, its torsional stability during the sintering process is very high, permitting the sintering of dental restorations with a total lack of stresses (full arches, single crowns, bridges, telescopic crowns, bars and attachments). Sinternit is suitable for full-contour restorations as well as up to 14-units structures requiring ceramic layering.

PROPERTIES AT A GLANCE: -

High performance cobalt-chromium alloy

100 % deformation resistant – no distortions or stresses in the metal structure

No impurities in the metal structure

High ﬂexural strength through seamless material bond and smooth surfaces (ﬁnal density > 98 %)

High edge stability

Your CAD/CAM system does not have to be upgraded

Oxygen-free sintering in the Zirkonofen 700 Ultra-Vakuum sintering furnace with high vacuum and special sintering adapter (no additional furnace is required) or in the Sinterofen 300S sintering furnace

Sintering without shielding gas

Due to perfect temperature distribution in the furnace, manufacturing up to 14-unit restorations is possible

Milling time depending on milling unit: ca. 15 minutes

Electroplating to reduce the grey value of zirconia secondary structures

Faster than the casting technique

Single crowns made of Prettau® 4 Anterior® zirconia on a gold-plated Sinternit structure

Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com

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Learn from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control including from the Dental Board of Australia (July 2022), the ADA (4th edition guidelines August 2021 and the ADA Risk management principles for dentistry during the COVID-19 pandemic (October 2021)), the new guidelines

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from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course provides a summary of how those changes interlink with one another and also covers practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening.

COURSE TOPICS This one day course will cover changes in regulations and guidelines from 2018 to 2022 including: n Risk-based precautions. n Hand hygiene and hand care practices. n Addressing common errors in personal protective equipment. n Biofilm reduction strategies. n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. n Correct operation of mechanical cleaners and steam sterilisers. n Wrapping and batch control identification. n Requirements for record keeping for instrument reprocessing. n Correct use of chemical and biological indicators.

FULL UPDATE! All the changes to Infection Control Updated in 2022

Laurie Walsh is a specialist in special needs dentistry who is based at the University of Queensland in Brisbane, where he is an emeritus professor. Laurie has been teaching and researching in the areas of infection control and clinical microbiology for over 25 years and was chief examiner in microbiology for the RACDS for 21 years. His recent research work includes multiple elements of infection control, such as mapping splatter and aerosols, COVID vaccines and novel antiviral and antibacterial agents. Laurie has been a member of the ADA Infection Control Committee since 1998 and has served as its chair for a total of 8 years, across 2 terms. He has contributed to various protocols, guidelines and checklists for infection control used in Australia and represented dentistry on 4 committees of Standards Australia and on panels of the Communicable Diseases Network of Australia and of the Australian Commission on Safety and Quality in Health Care.

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Infection Contol Boot Camp is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Boot Camp™ and Dentevents™ are trademarks of Main Street Publishing P/L © 2022 Main Street Publishing Pty Ltd

ONLINE CPD CENTRE

Answer the questions online at www.dentalcommunity.com.au To retrieve your FREE Dental Community Login, Call (02) 9929 1900 or email joseph@dentist.com.au cad | CAM

ceramic | TECHNIQUES

Figure 1. Asiga 3D Printer.

Polished splints direct from the 3D printer By Jeroen Klijnsma

s a certified dental technician, I have worked in, managed and owned several laboratories around the world. This has exposed me to many different analogue, digital and cross-over techniques. Even though digital technology has been widely available in our industry for over two decades, the up-take and trust in this technology is still fairly low compared to conventional, analogue methods. Even if the digital technology is available in a clinic or laboratory, the knowledge around it is most often limited. Knowing the benefits, limitations and especially how to operate the technology as efficiently as possible, are key.

26 eLABORATE

I am personally a huge fan of additive manufacturing (3D printing) and the possibilities this technology offers. The high accuracy, low entry costs and minimal amount of geometric limitations in our manufacturing processes makes 3D printers our best equipment in this modern world. In our fully digital dental laboratory, we have eliminated traditional plasterwork negating the need for investment in a plaster room. 3D printing has taken over and allowed us, every single time, to create the highest quality dental models and objects for other dental applications. If we look at hardware amongst affordable 3D printing systems, there have been few jaw-dropping innovations. Recent innovations have been largely dominated by developments in 3D printing resins.

READ THE ARTICLES AND ANSWER THE QUESTIONS ONLINE

Thirty years of using press technology to create glass-ceramic restorations By Prof. Dr. med. dent. Daniel Edelhoff and Oliver Brix

n most areas of restorative dentistry, all-ceramic materials offer a scientifically recognised alternative to metal-based restorations and a way to implement minimally invasive treatment concepts while maintaining high biocompatibility and aesthetics. With the introduction of press technology 30 years ago, a reliable and straightforward technique for creating glass-ceramic restorations became available, contributing significantly to the advance of all-ceramics. The press technique enabled largely standardised working steps, leading to highly aesthetic, long-lasting single-tooth restorations.

Introduction

he IPS Empress System was developed towards the end of the 1980s by Arnold Wohlwend, MDT and Ivoclar Vivadent. When it was launched in 1989, it ushered in a new era of ceramic processing. This [then] newly developed technology used an industrially prefabricated ingot of leucite-reinforced glass-ceramic, which is pressed into an investment mould at high pressure and high heat using the lost-wax technique [Heinenberg BJ 1991]. Resin-bonded single-tooth restorations made of IPS Empress ceramic demonstrated excellent aesthetics and high clinical reliability in several long-term clinical studies [Beier 2012, Layton DM 2013, Frankenberger R 2008]. Similar results were found for crowns in the anterior and premolar region. Slightly increased fracture rates were observed in crowns placed in areas exposed to more severe masticatory forces, such as in canine and posterior regions [Heintze SD, Rousson V. 2010].

The further development of press technology made it possible to utilise lithium disilicate ceramic (IPS Empress 2 System) for the first time in dental applications, offering an almost three-fold increase in flexural strength over the original IPS Empress [Fischer H, Marx R 1999]. Even though the increase in flexural strength allowed the field of applications to be extended to include small bridges in the anterior and premolar region on strict indications, the main area of use continued to be single-tooth restorations in their various expressions, ranging from veneers, inlays and onlays to partial and full-coverage crowns [Garling et al 2019, Teichmann et al. 2017]. The press technology and lithium disilicate ceramic materials were further improved with the introduction of IPS e.max in 2005 [Stappert et al. 2005]. Ingots in a multitude of shades and levels of opacity were now available so that a tailor-made restorative solution could be found for almost any clinical situation. The range of indications was further expanded as full-contour restorations could be created using lower material thicknesses and, in combination with the lost-wax technique, suitable occlusal concepts could be applied more easily to the occlusal design allceramic restorations. Since then, the IPS e.max press technology has gone from strength to strength through ongoing fine-tuning of the system and the introduction of additional ingots, such as the IPS e.max Press MT and polychromatic IPS e.max Press Multi ingots. This explains why it is now considered one of the most sophisticated, well-designed and clinically studied all-ceramic systems available on the market [Edelhoff et al. 2019, Liebermann et al. 2020, Teichmann et al. 2019, van den Breemer et al. 2017].

32 eLABORATE

July/August 2023

Question 1. Additive manufacturing is otherwise know as...

Question 6. The technology of press ceramics was introduced...

a. Milling b. Pack and Press c. 3D Printing d. None of the above

a. 10 years ago b. 50 years ago c. 30 years ago d. 1050 AD

Question 2. Biocompatible long term resins are usually...

Question 7. With the introduction of Empress 2...

a. Class I b. Class II c. Class III d. Class IV

a. A 3-fold increase in flexural strength over previous systems. b. A 5-fold increase in flexural strength over previous systems. c. A 7-fold increase in flexural strength over previous systems. d. No increase in strength occurred.

Question 3. It’s always desirable when designing a splint to have the scans...

Question 8. Resin bonded veneers...

a. With bite opening or construction bite. b. In centric occlusion. c. In centric relation. d. In protrusion. Question 4. If you print with the anterior downwards... a. You never have to remove supports. b. You never have to have supports. c. You need to remove the supports and trim and polish. d. You do not need to polish anything.

a. Are rarely used. b. Offer a considerably less invasive alternative to crowns. c. Are too weak. d. Are never successful. Question 9. Major risk factors for veneer survival include... a. Eating soft food. b. Bruxism and insufficient enamel support. c. Splint use. d. None of the above.

Question 5. Do Ultragloss Trays from Asiga work with any material...

Question 10. For all ceramic occlusal onlays the min thickness recommended is...

a. Never b. Sometimes c. Unknown d. Technically, yes

a. 1 mm b. 10 mm c. 0.1 mm d. 0.01mm

INSTRUCTIONS: eLABORATE™ is now offering subscribers the ability to gain 1 Hour CPD credit from reading articles in this edition of the magazine and answering the questions above. To participate, log in to the Dental Community website at www.dentalcommunity.com.au and click on the CPD Questionnaires link; select the eLABORATE Sep/Oct 2023 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD. If you do not have September/October a free login, call (02) 9929-1900. eLABORATE 2023

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Figure 1. Asiga 3D Printer.

Polished splints direct from the 3D printer By Jeroen Klijnsma

26 eLABORATE

September/October 2023

Figure 2. Raw PLY scan-open bite.

Figure 3. 3Shape Orderform.

Figure 4. Splint Studio-blockout.

Figure 5. Splint Studio design.

Think about denture bases, biocompatible resins and especially hybrid resins. The latter (biocompatible, Class II) hybrid resins, now allow us to print long-term (permanent) approved restorations. In recent years, how we manufacture nightguards/splints has evolved dramatically. However, manual adjustments or manual polishing is still a tedious, labour-intensive task. When ASIGA asked me to try a new type of resin tray that would eliminate/minimise manual post-processing, I was initially sceptical. How could just a different tray make such a difference? After printing my first splint with this new tray, I knew it was a game-changer and one of the best new products on the market. Let me introduce you to the new Asiga UltraGLOSS resin tray. (Figure 1). The outcome of printing with this tray is a smoother finish of the printed object. One of the tricks is that by increasing the number of layers (making the layer height smaller), there will be less visible layers and the magic of the tray does the rest. In the following article, I will explain our processes when we manufacture splints.

In this case, an intraoral scanner was used (Figure 2). A spacer/leaf gauge is used to record an open bite in centric relation independent of tooth contact. In this position, the mandible is restricted purely to rotary movement. From this unstrained, physiologic position, the patient can make vertical, lateral or protrusive movements. We only accept scans with an open occlusion, as virtual opening (static/dynamic) of the bite might result in incorrect interpretation of a patient’s condyle/occlusal guidance and bite.

Data recording n order to digitally design a nightguard/splint, we need to have a digital recording of the oral cavity (upper + lower arch and bite registration). This can be done in several ways: • Traditional impression - pouring plaster model - scanning with desktop scanner; • Traditional impression - impression scanning with desktop scanner; or • Digital impression by using an intraoral scanner.

September/October 2023

Order-form setup fter receiving the scans, we start designing the splints using the CAD program Splint Studio from 3Shape. In our order form (Figure 3), we select a digital impression and then the upper jaw. Next, we select what we would like to design - a splint and the material we would like to use. In our case, we print our splints with KeySplint Soft from Keystone. After we have setup the order-form, we import our IO scans and open Splint Studio.

Computer Aided Design nce Splint Studio has opened, we confirm the given bite and select our path of insertion. Here we can also add/remove the space in the block-out stage to determine if the splint needs to engage more or less. By adding material on the palatal gingival margins, we avoid any local pressure and increase the comfort when wearing the splint (Figure 4). Most common designs in our lab are Michigan or flat-plane. However, all of them have canine-extensions for additional retention and to help avoid “tipping” during the articulation (Figure 5).

eLABORATE 27

cad | CAM

Figure 6. Setting up the splints in Asiga Composer with minimal supports. Note there are many ways to orient the splints that will yield a successful print.

Figure 7. Closeup view in Asiga Composer of minimal supports.

Figure 8. After printing.

Print setup here are many ways we can setup splints, but the goal is to minimise or even eliminate polishing after post-processing. Often, we see a splint nesting position close to horizontal. This can result in inaccurate prints (printer dependant) and requires more manual post-processing. We put in a huge effort to design the perfect splint and placing support pins on the occlusal surface would undo a lot of our hard work as well as creating more manual post-processing work. By orientating the splint near vertically, we automatically create the following benefits: • The splint is self-supporting; • Smaller surface area, therefor fewer pulling forces; and • Smaller chance of seeing print layers on the occlusal surface. When we position a splint in the vertical position, we have two options. Either placing the anterior or the posterior area towards the build platform (Figure 6). Each has their own benefits and it depends on what suits you best and if you prefer to perform a final polish. I have printed them both to demonstrate the difference. We printed on our Asiga MAX UV printer, but UltraGLOSS trays are also available for its big brother, the PRO 4K series.

28 eLABORATE

Anterior downwards hen placing a splint with the anterior area towards the build platform, we need to apply support pins. There can be a minimal amount of these, but it means that after printing, cleaning and final light curing, the anterior area needs to be trimmed, smoothened and polished. This can be seen as a disadvantage. An advantage is that we need one area (anterior ridge) to successfully print to get towards the posterior area of the splint.

Posterior downwards he advantage of printing in this orientation is that we don’t need support pins and therefore no manual finishing, except for the area that was touching the build platform. A disadvantage of going from both posterior areas towards the anterior area can be that we need two areas to successfully print (Figure 7). Most of our clients prefer a high shine polished appliance, so we print mainly with the anterior area downwards and minimise the risk of a failed print. We see the biggest benefit as the massive reduction in time of our polishing processes. Our team is now spending less than half the time polishing that they did before as the splints come out much smoother and shinier.

September/October 2023

cad | CAM

Figure 9a. Printed splint post-processing.

Figure 9b. Splint on model.

Figure 9c. Occlual view of splint on model.

Print time hen printing in an upwards or vertical position, we can fit more splints on a build platform, but we’re increasing the print time. The print-time is also increased as we print with an UltraGLOSS tray on 50 microns to achieve the best possible smooth surface. However, if we look at time management in our manufacturing processes, we recommend to start printing splints at the end of the day. They will be finished during the night and

September/October 2023

ready to take out of the printer in the morning. As much as I could sit and watch a 3D printer do its work, it doesn’t bring anything to the table. Manufacture during the night and if anything goes wrong or there is an urgent case, you can print that during the day. This protocol is the same if you were to do subtractive manufacturing with a milling machine with a material loader/changer.

eLABORATE 29

cad | CAM

Figure 10a-c. Splint in-situ.

Washing fter printing (Figure 8), we need to remove any excess material by washing it in Isopropyl Alcohol (IPA). We clean our splints by using an ultrasonic cleaner and have a pre-wash and post-wash container filled with IPA. These containers are widely available. We use individual cleaning solutions for each material so that we don’t have any cross-contamination or lose our Biocompatibility Classification. Because it’s an ultrasonic cleaner and not a stirring cleaner, the splints don’t slam and rub against the cleaning containers and therefore don’t damage the surface and stay more transparent.

“When ASIGA asked me to try a new type of resin tray that would eliminate/minimise manual post-processing, I was initially sceptical. How could just a different tray make such a difference? After printing my first splint with this new tray, I knew it was a game-changer...”

Light curing fter carefully cleaning and drying, we must do a final light cure. We have different light curing units that are all validated to work with KeySplint Soft. However, we had best results with light curing units where we are able to remove the oxygen. By removing the oxygen, we avoid having an oxygen inhibition layer (OIL). This is a sticky, resin-rich, uncured layer that is always present when polymerising in air. We achieved the best results when we used our NK-Optik G171-6 (with Nitrogen connection) or when we used our Straumann/Rapidshape Vacuum curing unit (Figures 9a-c).

30 eLABORATE

Polishing s mentioned earlier, most of our clients prefer a highly polished splint. We remove the support pins by using a Scotch-brite wheel and then use pumice on a lathe to smooth the splint (where required). We finalise the splint by giving it a high shine buff and a proper steam clean ready for insert and happy days (Figure 10a-c)! I do have to emphasise that the more we work with the ASIGA UltraGLOSS tray and also learn how to optimise the post processing, we can foresee that manual polishing will soon be something of the past. One of the questions I received during one of my courses was “Does it work with every material?”. Technically yes... We can print everything with these wonderful trays. You only have to ask yourself the question... does it makes sense? Would you print a model or custom-tray on 50 microns and would it be of any real added-value? In contrast, printing denture bases with a lot of detail would tremendously benefit as there will be less manual finishing. Therefore, I am a firm believer that the UltraGLOSS printing technique from ASIGA is an absolute winner and we all benefit, independent of how we would like our products to be finished.

About the author Jeroen is a European-trained Dental Technician, Digital Specialist and global speaker with extensive experience in 3D manufacturing, like printing, milling and digital workflows. Collaborating with industry leading manufacturers allows him to be up-to-date with the latest technologies and materials. He is the founder of Dentiq, a full service digital dental laboratory and consultancy/training centre in Melbourne housing many of the world’s leading digital dental technologies. Being a certified 3Shape trainer, KOL for several brands and having owned and operated multiple labs in Europe and Asia, he can support you with the latest workflows and innovating trends that are upcoming. For more information, visit www.dentiq.com.au, see www.facebook.com/DentiqDentalServices or visit www.instagram.com/dentiq.dentalservices

September/October 2023

ceramic | TECHNIQUES

READ ME FOR

CPD

Thirty years of using press technology to create glass-ceramic restorations By Prof. Dr. med. dent. Daniel Edelhoff and Oliver Brix

Introduction

32 eLABORATE

September/October 2023

ceramic | TECHNIQUES

Figure 1a. Preoperative situation. View of upper anterior teeth in a 42-year old patient with a worn dentition.

Figure 1b. Full-coverage veneers from 13 to 23, featuring a minimum marginal layer thickness of 0.3 mm, as part of a complex dental rehabilitation involving an increase in the vertical dimension of occlusion (VDO). IPS e.max Press was used as the core material, veneered with IPS e.max Ceram.

Figure 1c. Try-in of the full-coverage veneers on 13, 11 and 22 using try-in paste. The preparation designs on teeth 12, 21, and 23 are examples of a minimally invasive, enamel preserving approach.

Figure 1d. Situation after almost 9 years of wear in the oral cavity. The restorations are in an excellent condition and show enamel-like wear patterns (attrition) (e.g. tooth 13).

All-ceramic veneers

after 10 years and 83% after 20 years for this type of material [Beier et al. 2012]. Variants based on lithium-disilicate ceramic have been found to have the highest strength and can be considered a predictable and successful restorative treatment option [Aslan 2019, Imburgia 2019]. Very promising clinical results have been obtained in first prospective clinical studies investigating the long-term performance of veneers with overlap and full veneer preparation designs with elimination of the proximal contact areas [Guess 2014, Liebermann 2020] (Figures 1a to 1e).

esin-bonded veneers offer an attractive and considerably less invasive alternative to full-coverage crowns in many indications [Edelhoff 2002; Magne, Douglas 1999]. Silicatebased ceramic materials are considered the material of choice for replacing lost dental enamel due to their favourable optical and mechanical properties [Layton DM 2013]. A retrospective study documented an estimated clinical survival rate of 93.5%

September/October 2023

eLABORATE 33

Figure 2a. Preparation of teeth 17, 16, 15 and 14 for the placement of crowns made of lithium disilicate ceramic.

Figure 2b. The crowns pressed to full contour from IPS e.max Press (degree of opacity: LT) exhibit a similar progression of translucency as the natural tooth structure.

Figure 2c. The full-contour pressed crowns after having been placed adhesively using a dual-curing luting composite (Syntac/ Variolink II with catalyst).

Figure 2d. Situation after more than 9 years of clinical wear. The direct contact areas with the antagonist restorations (CADon crowns on implants in the opposing jaw) show a slight loss of glaze material, which has not been remarked upon negatively.

Major risk factors undermining the survival of veneers include bruxism, insufficient enamel support and endodontically treated teeth [Beier et al. 2012, Burke 2012, Gurel 2013]. Veneers pressed to full contour without the application of a layering ceramic (IPS e.max Press HT, staining technique) are suited for those cases where functional criteria, e.g. increased masticatory forces, are of primary concern, such as in the reconstruction of canine guidance.

All-ceramic onlays

All-ceramic crowns ll-ceramic crowns have come to be seen as a highly aesthetic and reliable alternative to metal-ceramic crowns, provided that the correct choice of material is made. Veneered anterior crowns made of lithium disilicate demonstrated survival rates between 93.8% and 98.2% for observation periods of 5, 8 and 10 years [Gehrt et al. 2013, Simeone, Garcis 2015, Steeger 2010, Valenti 2009]. Survival rates of up to 98.2% were reported for veneered posterior crowns made of lithium disilicate after an observation period of 10 years [Gehrt et al. 2013, Marquardt, Simeone 2015, Steeger 2010, Valenti 2009]. These results were also true for lithium disilicate crowns on implants [Gehrt et al. 2013]. This means that the survival rates of all-ceramic crowns made of lithium disilicate ceramic are comparable to those of metalceramic crowns [Kerschbaum, Walton 1999, Walton 2013]. Full-contour lithium disilicate crowns (staining technique) demonstrate higher strength values than veneered versions and provide convincing aesthetic properties (Figures 2a and 2d) [Guess 2010]. The aesthetic properties of full-contour lithium-disilicate crowns have been further enhanced with the availability of polychromatic press ingots (IPS e.max Press Multi) while maintaining high strength [Edelhoff et al. 2017].

34 eLABORATE

esin-bonded, all-ceramic partial restorations represent a reliable treatment option even in the posterior region [Frankenberger 20, van Dijken]. The majority of long-term clinical studies refer to leucitereinforced glass-ceramic materials, whereas in the meantime ceramics based on lithium disilicate have become available and these ceramic versions offer a considerably increased flexural strength and fracture toughness [Guess PC, Selz CF. 2013]. The increase in flexural strength has made it possible to reduce the minimum occlusal layer thickness of full-contour restorations to 1 mm (staining technique). As a result, the guidelines recommend significantly reduced tooth reduction rates for the preparation of glass-ceramic onlays. Today, minimum thicknesses of 1 mm are recommended for the occlusal surface of full-contour restorations (staining technique). As they enable a defect-oriented preparation technique and eliminate the need for retentive preparation designs, all-ceramic onlays provide a sound treatment option to avoid conventional, more invasive prosthetic measures [Edelhoff, Sorensen posterior 2002]. A clinical study involving leucite-reinforced partial restorations on vital natural teeth reported a failure rate of 20.9% after an observation period of 12.6 years. This rate increased to 39% on endodontically treated abutment teeth [van Dijken]. Full-contour onlays made of lithium disilicate ceramic (IPS e.max Press) showed an excellent survival of 100% in a prospective long-term clinical study involving 103 restorations and up to 11 years of observation [Edelhoff 2019]. Only minor complications such as isolated cases of marginal staining and a crack occurred (Figures 3a to 3e).

September/October 2023

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ceramic | TECHNIQUES

Figure 3a. Initial situation: Inserted implant (Camlog Screw Line Promote Plus) at the site of 46 with hybrid abutment restoration (zirconia bonded to titanium bonding base). All-natural teeth are affected by extensive combination defects caused by erosion and attrition.

Figure 3b. Situation after preparing teeth 44, 45 and 47 for glass-ceramic veneer and onlay restorations.

Figure 3c. The partial restorations for 44, 45 and 47 were pressed to full-contour from IPS e.max Press HT and the fullcontour implant crown was pressed from IPS e.max Press LT.

Figure 3d. The full-contour pressed partial restorations on 44, 45 and 47 after having been placed adhesively using a light-curing luting composite (Syntac/Variolink II). The implantsupported crown was inserted using a glass-ionomer cement (Vivaglass) because of the easy clean-up procedure involved with this material.

About the authors

Figure 3e. Situation after more than 9 years of clinical wear. A localised loss of glaze and ceramic material can be observed in those area in direct contact with the restorations in the opposing jaw (IPS e.max Press occlusal onlays). The clinical wear behaviour of lithium disilicate ceramic has shown excellent results in antagonistic applications, for instance in cases where the vertical dimension occlusion has been raised. This has found to be true for both the veneering and staining technique (Figures 4a to 4c) [Güth 2020].

Conclusion and implications for practice ll-ceramic single-tooth restorations made of lithium disilicate ceramic (IPS e.max Press) have become a mainstream treatment in many areas of restorative dentistry. They provide an alternative to metal-supported restorations and achieve comparable survival rates. Introduced 30 years ago, the press technology has contributed significantly to this development and will continue to be a success story due to its easy application, versatile range of indications and high clinical reliability.

36 eLABORATE

Daniel Edelhoff is currently Director and Chair at the Department of Prosthetic Dentistry at the Ludwig-Maximilians-University (LMU) in Munich. He is board certified Specialist in Prosthodontics and member of the advisory board of the German Society of Prosthodontics and Biomaterials, as well as Associate Member of the American Academy of Esthetic Dentistry (AAED). Since 2014 he is Active Member of the European Academy of Esthetic Dentistry (EAED) as well as Section Editor of the multidisciplinary international research journal Clinical Oral Investigations. 2016 he became President of the German Association of Dental Technology (ADT) and 2019 Dean for Studies in Dental Medicine at LMU. Oliver Brix trained in dental laboratory technology from 1985-1989 after which he has worked in various laboratories and practices specialising in aesthetics and function; PFM ceramics and all-ceramics; Biomechanical design of occlusal surfaces - Electroplating - Implants. From 1990-1998 he participated in numerous advanced education programmes at home and abroad. From 1997 he has collaborated with Dr.H.Mayer/K.Stryczek Frankfurt/M Practice specialising in implantology, mucogingival surgery and aesthetic dentistry moving on to his own laboratory in 2002. He has lectured internationally and given courses on aesthetics and ceramics for Ivoclar Vivadent and since 1997 has been a Member of the dental laboratory working group of Düsseldorf, a Board member of DGÄZ (German association of aesthetic dentistry) and in March 2001 the Author of “Fundamentals of aesthetics”.

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Market Place Employment Opportunities, and Free Classifieds* Stay informed withfor regular news from within the profession, association, search or post an ad in the classifieds, and adopt useful information from articles into your place of business. Market Place for Employment Opportunities, and Free Classifieds* Market Place for Employment and Free Classifieds* the classifieds, andand adopt useful information from articles into your of business. Reach like minded interested parties by Opportunities, posting your Vacancies orplace Classifieds within the Market Place for Employment Opportunities, and Free Classifieds* Market Place for Employment Opportunities, and Free Classifieds* Reach like minded and interested parties by posting your Vacancies or Classifieds within the Market Place for Employment Opportunities, and Free Classifieds* ADTA marketplace. 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ceramic | TECHNIQUES

Figure 4a. IPS e.max Press restorations for the complete maxillary arch, placed within the scope of a complex rehabilitation involving an increase in VDO. The anterior full-coverage veneers were made of IPS e.max Press as the core material, veneered with IPS e.max Ceram. The posterior restorations (occlusal onlays made of IPS e.max Press) were fabricated using a full-contour design (staining technique).

Figure 4b. Situation after resin-bonding with a light-curing luting composite (Syntac/Variolink II). The restorations have led to an excellent aesthetic result, coupled with an adequate occlusal design (anterior-canine-protected dynamic occlusion with freedom in centric).

Figure 4c. Sectional view of the full-arch rehabilitation after more than 9 years of wear. Enamel-like wear patterns can be seen in the area of the veneering ceramic (palatal and incisal faces of complete-coverage veneer on 13) and on the fullcontour occlusal inlay (palatal cusp of 14).

References 1. Aslan YU, Uludamar A, Özkan Y. Retrospective analysis of lithium disilicate laminate veneers applied by experienced dentists: 10-year results. Int J Prosthodont 2019;32(6):471-474. 2. Beier US, Kapferer I, Burtscher D, Dumfahrt H. Clinical performance of porcelain laminate veneers for up to 20 years. Int J Prosthodont 2012;25:79-85. 3. Burke FJ. Survival rates for porcelain laminate veneers with special reference to the effect of preparation in dentin: a literature review. J Esthet Restor Dent 2012;24:257-265. 4. Edelhoff D, Güth JF, Erdelt K, Brix O, Liebermann A. Clinical performance of occlusal onlays made of lithium disilicate ceramic in patients with severe tooth wear up to 11 years. Dent Mater 2019;35(9):1319-1330. 5. Edelhoff D, Schweiger J, Prandtner O, Trimpl J, Stimmelmayr M, Güth JF. CAD/CAM splints for the functional and esthetic evaluation of newly defined occlusal dimensions. Quintessence Int. 2017;48(3):181-191. 6. Edelhoff D, Sorensen JA. Tooth structure removal associated with various preparation designs for anterior teeth. J Prosthet Dent 2002;87(5):503-509. 7. Edelhoff D, Sorensen JA: Tooth structure removal associated with various preparation designs for posterior teeth. Int J Periodont Restorative Dent 2002;22:241-249. 8. Fradeani M, Barducci G, Bacherini L, Brennan M. Esthetic rehabilitation of a severely worn dentition with minimally invasive prosthetic procedures (MIPP). Int J Periodontics Restorative Dent 2012;32:135-147. 9. Frankenberger R, Taschner M, Garcia-Godoy F, Petschelt A, Krämer N. Leucite-reinforced glass ceramic inlays and onlays after 12 years. J Adhes Dent 2008;10(5):393-398. 10. Gehrt, M., Wolfart, S., Rafai, N., Reich, S., Edelhoff, D.: Clinical results of lithium-disilicate crowns after up to 9 years of service. Clin Oral Investig 2013;17:275-284. 11. Guess PC, Selz CF, Steinhart YN, Stampf S, Strub JR. Prospective clinical split-mouth study of pressed and CAD/CAM all-ceramic

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partial-coverage restorations: 7-year results. Int J Prosthodont 2013;26(1):21-25. 12. Guess PC, Selz CF, Voulgarakis A, Stampf S, Stappert CF. Prospective clinical study of press-ceramic overlap and full veneer restorations: 7-year results. Int J Prosthodont 2014;27(4):355-358. 13. Guess PC, Zavanelli RA, Silva NR, Bonfante EA, Coelho PG, Thompson VP. Monolithic CAD/CAM Lithium Disilicate Versus Veneered Y-TZP Crowns: Comparison of Failure Modes and Reliability After Fatigue. Int J Prosthodont 2010;23(5):434-442. 14. Güth JF, Erdelt K, Keul C, Burian G, Schweiger J, Edelhoff D. In vivo wear behavior of CAD-CAM composite versus lithium disilicate full coverage first-molar restorations: A pilot study over 2 years. Clin Oral Investig 05-2020 online. 15. Gurel G, Sesma N, Calamita MA, Coachman C, Morimoto S. Influence of enamel preservation on failure rates of porcelain laminate veneers. Int J Periodontics Restorative Dent 2013;33:31-39. 16. Heinenberg BJ. IPS-Empress mit neuer Keramiktechnologie [IPS-Empress with new ceramic technology]. Quintessenz Zahntech 1991;17(4):475-479. 17. Heintze SD, Rousson V. Fracture rates of IPS Empress all-ceramic crowns-a systematic review. Int J Prosthodont 2010:23(2):129-33. Adhesively luted IPS Empress crowns showed a low fracture rate for incisors and premolars and a somewhat higher rate for molars and canines. The sample size of the conventionally luted crowns was too small and the observation period too short to draw meaningful conclusions. 18. Imburgia M, Cortellini D, Valenti M. Minimally invasive vertical preparation design for ceramic veneers: a multicenter retrospective follow-up clinical study of 265 lithium disilicate veneers. Int J Esthet Dent 2019;14(3):286-298. 19. Kerschbaum T. Langzeitüberlebensdauer von Zahnersatz. Eine Übersicht. Quintessenz 2004;55:1113-1126. 20. Layton DM, Clarke M. A systematic review and meta-analysis of the survival of non-feldspathic porcelain veneers over 5 and 10 years. Int J Prosthodont 2013;26(2):111-124. 21. Liebermann A, Erdelt K, Brix O, Edelhoff D. Clinical Performance of Anterior Full Veneer Restorations Made of Lithium Disilicate with a Mean Observation Time of 8 Years. Int J Prosthodont 2020;33(1):14-21.

22. Magne P, Douglas WH. Additive contour of porcelain veneers: a key element in enamel preservation, adhesion, and esthetics for aging dentition. J Adhes Dent 1999;1(1):81-92. 23. Marquardt P, Strub JR. Survival rates of IPS empress 2 all-ceramic crowns and fixed partial dentures: results of a 5-year prospective clinical study. Quintessence Int 2006;37(4):253-9. 24. Simeone P, Gracis S. Eleven-Year Retrospective Survival Study of 275 Veneered Lithium Disilicate Single Crowns. Int J Periodontics Restorative Dent 2015;35(5):685-94. 25. Stappert CF, Denner N, Gerds T, Strub JR. Marginal adaptation of different types of all-ceramic partial coverage restorations after exposure to an artificial mouth. Br Dent J 2005;199(12):779-783. 26. Steeger, B.: Survival analysis and clinical follow-up examination of all-ceramic single crowns. Int J Comput Dent 2010;13:101-119. 27. Teichmann M, Göckler F, Weber V, Yildirim M, Wolfart S, Edelhoff D. Ten-year survival and complication rates of lithium-disilicate (Empress 2) tooth-supported crowns, implant-supported crowns, and fixed dental prostheses. J Dent 2017;56:65-77. 28. Teichmann M, Göckler F, Rückbeil M, Weber V, Edelhoff D, Wolfart S. Periodontal outcome and additional clinical quality criteria of lithium-disilicate restorations (Empress 2) after 14 years. Clin Oral Investig 2019;23(5):2153-2164. 29. Valenti M, Valenti A. Retrospective survival analysis of 261 lithium disilicate crowns in a private general practice. Quintessence Int 2009;40:573-579. 30. van den Breemer CR, Vinkenborg C, van Pelt H, Edelhoff D, Cune MS. The Clinical Performance of Monolithic Lithium Disilicate Posterior Restorations After 5, 10, and 15 Years: A Retrospective Case Series. Int J Prosthodont 2017;30(1):62-65. 31. Van Dijken JW, Hasselrot L. A prospective 15-year evaluation of extensive dentin-enamel-bonded pressed ceramic coverages. Dent Mater 2010;26:929-939. 32. Walton, TR. A 10-year longitudinal study of fixed prosthodontics: Clinical characteristics and outcome of single-unit metal-ceramic crowns. Int J Prosthodont 1999;12:519-526. 33. Walton, TR. The up to 25-year survival and clinical performance of 2,340 high gold-based metal-ceramic single crowns. Int J Prosthodont 2013;26:151-160.

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thermoforming | TECHNIQUES

Ideal properties for dental thermoforming materials By Peter Herring, Adv Dip Dent Tech, ACCDP

he applications of thermoforming materials in the dental sector has surged in the last decade. Dental thermoforming materials are employed in creating a variety of products, ranging from custom-fit mouthguards to orthodontic aligners. However, not all thermoforming materials are equally suited for dental applications. A myriad of factors such as durability, clarity, biocompatibility, suitability and more must be considered when selecting an appropriate material. Below are the ideal properties that dental thermoforming materials should possess for optimal manufacturing effectiveness and patient satisfaction.

Bio-compatibility ne of the most critical attributes of any dental material is bio-compatibility, which ensures that the material is safe when in direct contact with oral tissues. It should be free from allergens and should not elicit any inflammatory or immunological responses. Most dental thermoforming materials are made of medical-grade plastics, such as polyethylene or polypropylene, which are tested rigorously for bio-compatibility. A check of the relevant Material Safety Data Sheet (MSDS) will confirm this as well as any specific conditions. The TGA website can also be helpful, confirming registration and origin.

Durability and strength ental applications are subject to varying degrees of mechanical stress. Whether it’s a night guard designed to withstand teeth grinding or a retainer meant to hold teeth in place, the material needs to be strong and durable. It must resist wear and tear and be impervious to cracks and fractures over time. The ideal material should have excellent tensile strength to withstand constant flexing and pressure over the expected life span of the appliance.

Transparency, clarity or colour larity is an important factor, especially in cosmetic dental applications such as clear aligners and retainers. For these applications, patients generally prefer appliances that are less noticeable. Therefore, these dental thermoforming materials should offer excellent transparency for aesthetic purposes. Moreover, clarity is crucial for practitioners during the inspection and fitting process, as it allows for easy identification of any issues with the fit or structure. Other appliances such as sports mouthguards rely on colour to increase their appeal and hence compliance. In these cases, we want vibrant colours to create and maintain consumer interest.

40 eLABORATE

Ease of processing rom a manufacturing standpoint, the material must be easy to process. It should heat uniformly and be able to form well-defined shapes without warping or thinning. This ensures a precise and comfortable fit. A poorer quality material can often be identified by its reaction to heating. Failing to plasticise evenly will subsequently produce imperfect forms. The material should also allow for quick and easy trimming and finishing procedures, which can significantly reduce production time and costs.

Chemical stability ral environments are complex, often subject to drastic changes in pH and temperature. An ideal dental thermoforming material should maintain its structural integrity and not degrade or discolour when exposed to these variables. It should also be resistant to common staining substances like coffee, tea and wine.

Cost-effectiveness hile the above features are important, the cost cannot be overlooked. Dental thermoforming materials should be economically viable to produce and purchase. The cost of the thermoforming materials used per appliance generally compares more than favourably with the costs of other methods of manufacture.

September/October 2023

thermoforming | TECHNIQUES Conclusion he thermoforming material chosen is the foundation for a successful appliance. Selecting the right dental thermoforming material is a multi-faceted decision that depends on a balanced

With aligner made from Erkodur-al

combination of bio-compatibility, strength, clarity, ease of processing, chemical stability and cost-effectiveness. Materials may be used for different applications and manufacturers provide

Without aligner

recommendations and data to assist with your selection and this should be taken into consideration. As research progresses, we can expect the development of materials that better meet these criteria, improving not only the quality of dental products but also patient comfort and satisfaction. For dental aligners and retainers, patients prioritise aesthetics, durability and stain resistance. The need for “invisible” appliances is important for discreet treatment, especially among adults in professional environments and self-conscious teens. Durability ensures the appliance withstands daily wear and stain-resistance maintains its appearance. In contrast, athletes prefer sports mouthguards that feature vibrant colours and comfort. Colours enhance team spirit and visibility, while comfort is crucial for optimal performance during rigourous activities. In both cases, the choice of material is key. Thermoplastics for aligners and specialised elastomers for mouthguards influence not only their functional efficacy but also their comfort and appearance. Thoughtful and studied material selection enhances the overall manufacturer and user experience, meeting varied needs for durability, aesthetics and functionality.

About the author Peter Herring is a dental technician, prosthetist and a regular contributor to eLABORATE. He is the Australasian and Indonesian distributor for Erkodent products and spends his time between offices in Perth and Bali. He also operates a busy Australian lab dedicated to thermoformed appliances. He can be contacted at pjh@erkodent.com.au or for general enquires, call Freecall 1800-242-634.

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eLABORATE 41

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