eLABORATE Nov/Dec 2023 by dentalcommunity

VOL.20 NO.5

NOVEMBER/DECEMBER 2023

Dr. med. dent. Daniela Zeller – Bern, Switzerland MDT Alexander Bassermann – Bern, Switzerland

PRETTAU® 3 DISPERSIVE®

MONOLITHIC SINGLE CROWNS MADE WITH PRETTAU ® 3 DISPERS COLOUR, TRANSLUCENCY AND FLEXURAL® STRENGTH GRADIENT ®

PRETTAU 3 DISPERSIVE PRINT POST NO. 100018653

The digitally-produced single crowns were characterised with ICE Stains 3D by Enrico Steg

® ® MONOLITHIC SINGLE CROWNS MADE WITH 3 DISPERSIVE : ZIRCONIA Fresco Ceramics. To reduceMADE the greyWITH value ofPRETTAU the zirconia restorations, the titanium bases w MONOLITHIC SINGLE CROWNS COLOUR, TRANSLUCENCY FLEXURAL STRENGTH GRADIENTS ® AND individual result, patient data was acquired using the PlaneFinder ® and the Face Hu PRETTAU ®For 3 an DISPERSIVE : ZIRCONIA WITH COLOUR,

were used for functional and aesthetic controls in the patient’s mouth and to give him a ﬁrst TRANSLUCENCY AND FLEXURAL STRENGTH GRADIENTS

The digitally-produced single crowns were characterised with ICE Stains 3D by Enrico Steger and with a minimal Fresco Ceramics. To reduce the grey value of the zirconia restorations, the titanium bases were anodised in a golde

For an individual result, patient data was acquired using the PlaneFinder ® and the Face Hunter 3D facial scanner were used for functional and aesthetic controls in the patient’s mouth and to give him a ﬁrst impression of the futur

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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 5 NOVEMBER/DECEMBER 2023

eLABORATE | CONTENTS

On the cover... Prettau® 3 Dispersive® zirconia features a triple gradient thanks to Gradual-Triplex-Technology with changing translucency and flexural strength levels.

PROSTHETICS

6 BRIEFS 8 SPECTRUM 20 CPD CENTRE 42 NEW PRODUCTS

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VITAPAN EXCELL: FOR PREDICTABLE, AESTHETIC AND FUNCTIONAL RESULTS

CERAMICS

DENTAURUM CERAMOTION Z: ALL ZIRCONIA IS NOT CREATED EQUAL

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CERAMICS

HOW TO BRING MONOLITHIC RESTORATIONS TO LIFE

CERAMICS

SURFACE MATTERS: HOW TO MAXIMISE MONOLITHIC ZIRCONIA RESTORATIONS

THERMOFORMING

OPTIMISING MATERIAL THICKNESS DISTRIBUTION IN THERMOFORMING

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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 Another year over...

New MillBox for Amann Girrbach

s another year ticks over, already my once vivid memories of the COVID-19 pandemic are slipping away. By Joseph Allbeury The beginning of the year will mark four years since the world stopped. As crowds fill the shops, depart to travel the globe and celebrate in unison at the festive end of the year, it’s hard to believe that it’s never always been that way. It’s easy to forget that airlines were grounded. Working from home was the norm, as was home schooling. Travel was restricted. Zoom boomed (and not the teeth whitening system). Toilet paper became a hot commodity as well as hand sanitiser and masks. Pet sales skyrocketed. Streaming services ran hot. As did Peleton. Conspiracy theories abounded. Medical science broke new ground. People queued for PCR and RAT tests... and for vaccination after vaccination. 773 million people caught COVID. And almost seven million people died. And then, somewhere in between, COVID became like any other cold or flu and life rapidly returned to normal. And not the “new normal”. The old one. The pandemic potentially had the abilty to draw a line in the sand as to how the world worked but in its aftermath, much of what changed out of necessity simply changed back. During COVID, online video conferencing tools were seized upon to continue interaction and education. While there were and are a number of these tools available, none entered the vernacular more so than Zoom. We all knew exactly what a Zoom was and how it worked. But if there was a barometer for it’s popularity, then perhaps its share price is telling. At the start of 2020, one share in Zoom Video Communications was priced at around US$72. And at the end of 2023, it’s pretty much exactly the same. However, at the height of the pandemic in October 2020, that same share was worth US$559! Face-to-face education, with its ability to secure focus and isolate the attention of delegates, again reigns supreme... though webinars definitely are still a thing. Another tale from the stock market is interactive exercise company Peloton. Their shares traded at US$31 in January 2020. In December 2023, that same share is only US$6. But in between, in January 2021, it spiked to US$167. Working from home has perhaps become the most lasting and contentious carry over of COVID. Some companies went “all in”, permanently divesting office space in favour of work from home. Many more are now battling to get workers to return full time to the office. And many hybrids of that exist in between. For the dental profession however, that has never been an option. So as another year ticks over in the ever-changing history of the world, we should remember COVID, how it changed us all and what we’ve all learned as a result. Enjoy the edition... Joseph Allbeury, Editor and Publisher

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ith its Ceramill Match 2 CAM software, Amann Girrbach offers users a high degree of process safety, as all products involved in the milling process are integrated into a validated workflow and deliver predictable optimal results. Now as of November 2023, it will also be possible to control Amann Girrbach machines via the “MillBox for Amann Girrbach” software from third-party supplier CIMsystem. In doing so, the company is opening up the CAM application range of its milling machines thus allowing customers to integrate these into an already existing software infrastructure. Users who work with the MillBox can thus create an individual connection to the existing system to digitally operate the Amann Girrbach Ceramill milling machines. “For MillBox users, the ‘MillBox for Amann Girrbach’ software seamlessly integrates into the familiar MillBox environment and workflows and enables access to the familiar MillBox functions. In addition, this open CAM solution offers extended connectivity options for the users of alternative CAD programs such as 3Shape. This makes it easy to import dental CAD designs regardless of source,” explains Christian Ermer, Vice President Marketing & Digital at Amann Girrbach. The “MillBox for Amann Girrbach” software is characterised by its intuitive interface. The stored, automated functions shorten the time required for production and minimises manual errors. CIMsystem is a leader in the development of CAD/CAM software for industrial and dental manufacturing as well as for 3D printing applications. The company was founded in Italy in 1999 with the aim of developing innovative software in line with market trends and customer needs. CIMsystem is recognised worldwide and currently serves more than 25,000 customers around the world with innovative, effective and customised solutions in the mechanical, mold making, marble, gold and wood processing, biomedical and dental industries. Furthermore, the company offers additional services such as consultancy, after sales support, training and development.

For more information about the CAM capabilities of the Ceramill Match 2 CAM software and the connection of the devices via the “MillBox for Amann Girrbach” can be found at www.amanngirrbach.com/en-us/cam-software

November/December 2023

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.”

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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

November/December 2023

AUTOMATION • VALIDATION • REPLICATION

WHITTY

KLIJNSMA

ELSEY

DIAS

TAKAHASHI

KHAW

KAGAOAN

ANDERSON

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 jAnuAry 2024

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

Zirkonzahn dedicates entire factory to Prettau® zirconia production Caninus, the newest Zirkonzahn’s production site overlooking the Dolomites Mountains.

fter Premolaris and Molaris I and II, Caninus is Zirkonzahn’s most recent production site located in the heart of the Dolomite Mountains, specifically built to broaden their Prettau® zirconia production. As unique as these natural monoliths, Prettau zirconia takes its name from the farthest village of the Aurina Valley in South Tyrol and was conceived for aesthetic restorations, from single crowns to monolithic full arches – the so-called Prettau Bridges. The Prettau line includes different zirconia typologies, available in white blanks for further characterisation, pre-coloured and with colour gradient for optimal aesthetics. Blanks are available in different heights (from 5 mm to 40 mm) and diameters - Ø 95, Ø 98 with step, Ø 106 mm, as well as mini blanks to mill single crowns in hardly used colours.

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Zirconia restorations are meant to stay in the patient’s mouth for long periods, or in most cases, permanently, which makes the matter of quality even more important. This is why Zirkonzahn’s work philosophy dictates that nothing must be produced under economic or time constraints. Prettau is manufactured with no compromises, using raw materials accurately selected from reliable suppliers. Upon arrival, the powder undergoes strict controls for quality assurance and, working without constraints, much time can be dedicated to the development of the most refined working processes, in close collaboration with the in-house R&D department. To achieve high homogeneity, the raw material is pressed biaxially and/or isostatically and the most advanced technologies are used to obtain the best aesthetic and mechanical properties. In the last few years, the company’s range of

zirconia has embarked even more on the path of monolithic design with the new Dispersive® line, which includes materials that are already characterised with a natural colour gradient during the manufacturing process, making manual colouring no longer necessary. The gradient is provided through a specially developed technique that does not blend colours into layers but disperses them evenly, lending restorations a beautiful and natural aesthetic. A perfect example of the company’s constant strive for quality and sophistication is the innovative GradualTriplex-Technology, which provides the new Prettau 3 Dispersive material with a triple gradient of colour, flexural strength and translucency, achieving a perfect balance of resistance and aesthetics. Each production batch is accurately checked after every production step, via specific tests and measurements.

November/December 2023

spectrum | NEWS

Bar-supported restoration made with Prettau 3 Dispersive, the latest zirconia developed in-house, with Gradual-Triplex-Technology.

In this way, a blank’s properties of hardness, dimensions, density, milling, colour and translucency as well as the material’s shrinkage factor are constantly controlled, using close-tolerance instruments. Once the production step is concluded, final controls are run on each blank. Being the sole process owners allows Zirkonzahn to have a complete understanding of their products, ensuring that they form an optimum match in the complete workflow. The in-house R&D team constantly works to improve and fine-tune solutions to create a reliable planning and working environment, where hardware, software, tools and materials fit together according to a perfect dental-technical logic. The full control over the testing and production procedures gives the company the possibility to react very quickly to the customer’s needs, not only through constant

November/December 2023

Zirconia blanks production. Each production batch is accurately checked after every production step, via specific tests and measurements to control hardness, dimensions, density, milling, colour, translucency as well as materials’ shrinkage factor, using close-tolerance instruments. product optimisation but also through their wide range of comprehensive education courses (“Die Zirkonzahn Schule” – The

Zirkonzahn School), where participants are trained on the usage of equipment and materials with no knowledge gaps.

eLABORATE 11

spectrum | NEWS

Prettau 3 Dispersive with Gradual-Triplex-Technology: a triple gradient of natural colour, flexural strength and translucency.

Prettau®, the zirconia from the Dolomites for the patients you value

nspired by the base properties of zirconia, MDT Enrico Steger founded his Zirkonzahn company in 2003 with the aim of getting the best out of this dental material. In the heart of the Alps, Zirkonzahn’s team constantly works to imbue zirconia with unique properties, to infuse it with luminosity and extraordinary attributes. The result is a special material: Prettau® zirconia. A material conceived, produced and tested without compromise, to ensure the best quality. Prettau Bridges (monolithic, 14-unit bridges made with Prettau) have been used for more than 15 years to provide patients with aesthetic and long-lasting restorations. Starting from classic Prettau zirconia (1200 MPa), the range has been expanded over the years with new materials, to meet dentists’ and patients’ requests. Prettau 4 Anterior (670 MPa),

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with its extremely high translucency, is the ideal alternative to lithium disilicate. Prettau 2, on the other hand, combines its high flexural strength (1300 MPa) with excellent translucency, becoming the optimal solution for particularly aesthetic full-arch bridges, both monolithic and reduced. With the Dispersive® line, the path of monolithic design has been brought a step forward: indeed, Dispersive materials are characterised already during the manufacturing process by a natural colour gradient thanks to a special technique that does not blend colours into layers but disperses them evenly. The latest innovation within Zirkonzahn’s range of zirconia materials is Prettau 3 Dispersive. The material is already provided with a triple gradient of natural colour, flexural strength and translucency. Therefore, it is particularly suitable for the production of monolithic natural-looking restorations:

• Zirconia with Gradual-Triplex-Technology: triple gradient with natural colour as well as increasing flexural strength and translucency values: n Cervically increasing flexural strength; extremely high flexural strength at the tooth neck; n Incisally increasing translucency; highly translucent incisal edge; and n Colour gradient which reproduces the natural tooth colours from dentine to enamel. • Colour scheme from A1-D4 as well as 3 bleach shades; special zirconia shade guides in the shape of premolar as well as lower and upper incisors (also customisable!); • Manual colouring and further characterisation is no longer required, but can be performed to achieve more patientspecific results; and • Especially suitable for monolithic design, which avoids ceramic chipping.

November/December 2023

MORE INFORMATION

Dr. med. dent. Daniela Zeller – Bern, Switzerland MDT Alexander Bassermann – Bern, Switzerland

PRETTAU® 3 DISPERSIVE® MONOLITHIC SINGLE CROWNS MADE WITH PRETTAU ® 3 DISPERSIVE ® : ZIRCONIA WITH COLOUR, TRANSLUCENCY AND FLEXURAL STRENGTH GRADIENTS The digitally-produced single crowns were characterised with ICE Stains 3D by Enrico Steger and with a minimal layer of Fresco Ceramics. To reduce the grey value of the zirconia restorations, the titanium bases were anodised in a golden shade. For an individual result, patient data was acquired using the PlaneFinder ® and the Face Hunter 3D facial scanner. Mock-ups were used for functional and aesthetic controls in the patient’s mouth and to give him a ﬁrst impression of the future aesthetics.

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

spectrum | NEWS

Touring HeyGears HQ By Terry Whitty

ith the buzz words 3D printing, AI and automation being thrown around in dentistry like pizza dough at Dominos™ on a Saturday night, you could be excused for feeling left behind as everything seems to be moving at light speed. Things are indeed moving fast and without doubt the next big thing in 3D printing is Automation. This is where the machines are capable of taking over a lot of the tasks that we would normally do manually–Taking builds off the machines, washing and post processing for example. A few companies are taking the lead with this and it’s interesting times ahead. Recently I was invited to Guangzhou, China to the HeyGears HQ and 3D printing facility. This is an amazing place where the future is being realised now. HeyGears was founded in 2015 Peiyan Gui as its CEO and now employs over 800 people worldwide. They focus on a wide variety of 3D printing applications such as audiology, dentistry, robotics, prosthetics and other medical applications as well as rapid prototyping and consumer 3D printing

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machines and supplies. While there are a plethora of 3D printer manufacturers and more coming out of the woodwork everyday, if you look a little deeper, you will see this company has already kicked a few goals without too much brouhaha.

Firstly, they released their printer “HiVE” module combination where the printer prints a series of models and then a robotic system slices the models from the build plate and drops them into a receptacle. The printer is then freed up to automatically go ahead and print the next batch of models. This was a groundbreaking system and to see it in the flesh at HeyGears was definitely an interesting encounter. In real life it’s a big unit and heavy, so getting one upstairs may be a challenge. Hence, enter the new UltraCraft A3D automatic All-in-one printer. This machine is amazing; with a fairly small footprint, this automated 3D printer is capable of 24/7 nonstop production. Provided you have the need for a high volume printing solution, one look at the A3D and you’re sold. It’s suitable for any dental applications down to 50 microns so this is the ideal workhorse that larger labs now need. The machine will take 3 litres of resin at a time and automatically refill the machine; if you want completely autonomous operation, there is an auto bulk resin filling unit available. So you can print and print and print all day and all night.

November/December 2023

Supporting this and soon to be available is an automated wash station. This is for the power user indeed and it’s a very interesting approach to automated post-processing. Although not officially released yet, it won’t be long until we see this available too.

November/December 2023

Walking through the HeyGears centre, there were many amazing things on display, lots to look at and lots to touch and feel. I even saw a brace for a chicken that had a broken leg... 3D printed... amazing! The real surprise, however, was the printing centre where there were 100+ 3D

printers in a specially lit room printing away all-day-all-night. It was surreal and reminded me of a science fiction movie– you had to see it to appreciate it. HeyGears is definitely a company to watch, they have Automation and AI in their sights and much is available now.

eLABORATE 15

prosthetic | TECHNIQUES

READ ME FOR

CPD

VITAPAN EXCELL: For predictable, aesthetic and functional results By Darius Northey

Figure 1. Initial situation. The insufficient restorations showed a midline displacement and functional disharmonies.

Figure 2. Two implants were inserted in the incisal region to functionally stabilise the restoration in the mandibular.

Figure 3. A custom-made tray was used in the mandibular for a mucodynamic fixation impression.

Figure 4. A simple bar construction was poured and fixed with synthetic material to the abutments.

or predictable and functional aesthetic results in restorations, in addition to experience, we need a denture tooth designed on the basis of the aesthetic and functional standards set by nature. VITAPAN EXCELL (VITA Zahnfabrik) is an example of this kind of anterior tooth, which is characterised by vibrant shapes with “golden proportions”. Tooth axes, the length/width ratio and angle characteristics are consistently patterned after nature. In addition, its special layered structure enables a natural play of shade. In the following case report, I will show how we were able to successfully use this new denture tooth for an implant-supported restoration.

1. Initial clinical situation

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78-year-old female patient was dissatisfied with the positional stability of her mandibular prosthesis. The acrylic teeth appeared abraded, stained and very dull. After the consultation, the patient decided on two implants in the mandibular in order to achieve greater functional stability and was referred to an oral surgeon. After a healing period of three months, the implants were osseointegrated in the incisal region of the mandibular. First, the patient did not want a new total prosthesis in the maxilla, although the midline was shifted extremely to the right and functional disadvantages due to the well-worn and

November/December 2023

Figure 5. The centric and temporomandibular movements were recorded with the gothic arch.

Figure 6. First, the aesthetic zone of the maxillary duplicate was reduced, then replaced with VITAPAN EXCELL and finally tried-in.

Figure 7. The final wax setup in the articulator with molded gingival anatomy before the try-in.

Figure 8. After the try-in, a mucodynamic impression with setup was taken in the maxilla.

Figure 9. The final occlusion-adjusted, mucodynamic impression in the duplicated denture base.

Figure 10. Based on the bite registration of the setups, the maxilla could be accurately rearticulated.

irregular occlusion were to be expected. She feared that her usual appearance would be altered by a new restoration. However, following a comprehensive consultation, she finally opted for a new restoration.

denture bases. For the mandible, a custom-made impression tray was made, a mucodynamic impression was taken in several steps and the impression cap was affixed. Using the model, a simple bar construction was fabricated and affixed with synthetic material to the attachments. A wax rim was created over the bar in the mandible, and plates for the imaging of the gothic arch positioned on this and the maxillary duplicate. Laterotrusion, protrusion and centric were recorded and affixed. The duplicate was successively reduced in the setup area in order to first position and try in the VITAPAN EXCELL anterior tooth and then the VITAPAN LINGOFORM posterior tooth.

2. First steps towards restoration he restoration in the mandible began with an anatomical alginate impression. So that it could be oriented to the old maxillary prosthesis using the copy denture technique. This was duplicated with putty and reproduced with a cold polymer for

November/December 2023

eLABORATE 17

prosthetic | TECHNIQUES

Figure 11. VITAPAN EXCELL and LINGOFORM were conditioned with VITACOLL to ensure good adhesion to the base.

Figure 12. The vestibular plate was customised with several synthetic material layers in different gingival shades.

Figure 13. The bridge and attachments were integrated by polymerisation of the synthetic material base.

Figure 14. The finished restorations after elaboration and polishing in static occlusion.

was done. The prostheses were processed with fine-cut carbide milling tools and rubber polishers. The final polishing was done with pumice and polishing paste, as well as a buffing wheel. The patient was very satisfied with the functional and aesthetic result. Thanks to the lifelike shapes with “golden proportions”, the three-dimensional anatomically layered construction and the multifaceted surface texture, the prosthetic restoration with VITAPAN EXCELL appears very natural.

About the author Figure 15. Result. The patient was very happy with the natural look of the new restoration.

3. Prostheses fabrication and finalization fter a complete functional and aesthetic try-in, a mucodynamic impression with wax setup on a duplicate base was taken in the maxilla. The bite was registered with silicon. In the maxilla, a final master model was produced and articulated according to the vertical dimension. The maxilla and mandibular setups were embedded in cuvettes, boiled out and pressed with heat-curing polymer into different gingival shades. After polymerisation, both works were rearticulated and an occlusion check

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Darius Northey graduated as a Dental Technician in 1993 after working in the family business for many years. In 1997, he established his own dental laboratory in Sydney, Australia and later completed the Advanced Diploma of Dental Prosthetics to graduate as. Dental prosthetist. He established Jade Dental Laboratory Pty Ltd with his business partner/ceramist Justin Thompson in Buderim on the Sunshine Coast, Australia in 2006. The Laboratory has a denture clinic on site and also another practice on Bribie Island, Queensland, Australia. They employ 11 staff and are a full service lab. Darius specialises in acrylic cases, working with dentists and directly with patients. He has a strong interest in furthering his education and attends regular courses and seminars. He lectures in Australia and overseas on implant over dentures and CAD/CAM bars.

November/December 2023

ALWAYS ESTHETIC. ALWAYS FUNCTIONAL.

VITAPAN EXCELL® VITAPAN VITAPANEXCELL® EXCELL®

VITAPAN EXCELL®

Natural functi Natural Naturalfunctionality, functionality, lifelike beauty Natural functionality, lifelike lifelikebeauty. beauty. lifelike beauty. VITAPAN EXCELL®

Lively, natural and highly esthetic VITAPAN EXCELL anterior teeth and VITAPAN LINGOFORM posterior teeth are a perfectly matched multifunctional combination for all established prosthetic concepts.

Scan the QR code and discover other interesting clinical cases in detail: www.vita-zahnfabrik.com/EXCELLcases

brilliant play of shade and light • variety of natural tooth shapes • excellent abrasion durability •

• brilliant brilliant playplay of shade of shade andand light light For• more information contact us shapes • variety variety of natural of natural tooth tooth shapes ! n, call us tiolab@henryschein.com.au a on• 1300 65 88 in 11fo orrm email excellent abrasion durability durability play of shade more abrasion 8 22and light o• rbrilliant Fexcellent +1300 65 8 s la a H in e ry Sch of natural H•envariety u tooth shapes hein.com.a sc ry n e h @ la•b excellent abrasion durability •

Find Find outout more! more!

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 prosthetic | TECHNIQUES

ceramic | TECHNIQUES

READ ME FOR

CPD

VITAPAN EXCELL: For predictable, aesthetic and functional results By Darius Northey

Figure 1. Initial situation. The insufficient restorations showed a midline displacement and functional disharmonies.

Figure 2. Two implants were inserted in the incisal region to functionally stabilise the restoration in the mandibular.

Figure 3. A custom-made tray was used in the mandibular for a mucodynamic fixation impression.

Figure 4. A simple bar construction was poured and fixed with synthetic material to the abutments.

1. Initial clinical situation

16 eLABORATE

READ THE ARTICLES AND ANSWER THE QUESTIONS ONLINE

a. Perfect and no need to replace. b. The wrong shade. c. Abraded. d. None of the above. Question 2. In their design, Vita Excell uses... a. The golden rule. b. The golden goose. c. The golden triangle. d. The golden proportion. Question 3. The healing time for the implants was... a. Three weeks. b. Three months. c. Three years. d. Three minutes. Question 4. Centric and temporomandibular movements were recorded with... a. Gothic Gibson Explorer. b. Doric tracer. c. Gothic arch tracer. d. Ionic tracer. Question 5. At the try-in, an impression wax taken. It’s type was...

Dentaurum ceraMotion Z: All zirconia is not created equal By Terence Whitty

Figure 1. Zirconia is a white oxide of the metal Zirconium.

Figure 3. The mineral Zircon.

ne of the most most significant changes in restorative dentistry this decade has been the largescale, widespread use of zirconia in everyday dental prosthetics. Several factors have assisted the success of this material, including the rising cost of precious metals, increased demand for

Figure 2. Zirconium is a metal.

Figure 4. The source of the raw materials is very important for end product quality. aesthetics, advancements in digital design and laboratory milling, new techniques for bonding and developments in dental zirconia itself. Zirconia (Figure 1) is a white crystalline oxide of Zirconium. An oxide is a chemical compound containing an oxygen atom and other elements. Most of the earth’s crust consists of oxides. Oxides result when elements are oxidised by air. The Australian outback is red because

of the copious amounts of iron oxide on the surface. Zirconia is really Zirconium dioxide (ZrO2) but zirconia is a valid name. Zirconium (Figure 2) is an element and a metal. Because metals are familiar to us, little explanation is needed here. Essentially, metals are opaque, lustrous elements that are good conductors of heat and electricity. The chemical symbol for Zirconium is Zr.

24 eLABORATE

November/December 2023

Question 1. The original prosthetic the teeth looked...

a. Mucodynamic. b. Plaster. c. Mucostatic. d. Zinc Oxide primary.

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November/December 2023

Question 6. One of the factors that contributed to the rise of zirconia restorations were... a. Apple iPhone. b. Rising price of precious metals. c. Sulphate in gold restorations. d. None of the above. Question 7. Zirconium is a... a. Mineral. b. Glass. c. Metal. d. Polymer. Question 8. What is Zirconia? a. A white crystalline oxide of Zirconium. b. A metal. c. Lithium silicate in disguise. d. A metamorphic rock. Question 9. Green state of zirconia refers to... a. When zirconia turns green in a sintering furnace. b. The softer state that is usually partially sintered and pressed that allows zirconia to be milled easily. c. The fully sintered state of zirconia that has undergone phase transformation. d. Discolouration of zirconia restorations in the mouth due to copper oxide. Question 10. Isostatic pressing can achieve theoretically dense compaction of... a. 20-30% b. 10-20% c. 0.5-2% d. 60-80%

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 Nov/Dec 2023 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD. If you do not have a free login, call (02) 9929-1900.

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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.

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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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Dentaurum ceraMotion Z: All zirconia is not created equal By Terence Whitty

Figure 1. Zirconia is a white oxide of the metal Zirconium.

Figure 3. The mineral Zircon.

24 eLABORATE

Figure 2. Zirconium is a metal.

November/December 2023

ceramic | TECHNIQUES

Figure 5. ceraMotion Z range of zirconia disks.

Figure 6. Isostatic pressing. Zircon (Figure 3) is a mineral and minerals are made up of elements or chemical compounds that are normally crystalline and that have been formed as a result of geological processes, so they are naturally occurring. Zircon has the chemical name zirconium silicate and its corresponding chemical formula is ZrSiO4. It is well-known that typically dental zirconia is milled in a “green” or unsintered state and then put through a sintering cycle in a high temperature furnace, usually at around 1450-1530˚C. The reason for this is to allow the material to go through “phase transformation” whereby the crystal structure changes with a rearrangement of atoms occuring, adding greater strength. Zirconia, in general, has a monoclinic crystal structure at room temperature and transitions to a tetragonal structure and cubic structure at increasing temperatures. This increases the volume of the material and this volume expansion caused by the cubic to tetragonal to monoclinic transformation induces very high stresses. These stresses will cause pure ZrO2 to crack upon cooling. Several different oxides can be added to Zirconia to stabilise this

November/December 2023

Figure 7. Ready to mill. process to prevent cracking. These include Magnesium Oxide (MgO), Yttrium Oxide (Y2O 3), Calcium Oxide (CaO) and Cerium Oxide (Ce2O3), amongst others.

ceraMotion Z ecently, a new zirconia, ceraMotion Z by Dentaurum, has hit the market that has really made a difference to the whole landscape of dental zirconia. Many of you will already know Dentaurum and many will know the ceraMotion name. It’s used by the company as the umbrella name for their ceramic products such as the wonderful ceraMotion One Touch stain and glaze that has been discussed and demonstrated globally. So what exactly is so special about ceraMotion Z and what makes it different? It all starts with the raw material sourced from Europe and Asia. This is where they look for the best quality materials available. When creating zirconia, having the best building blocks makes a huge difference. Next, comes the high tech manufacturing of the material where the powder is isostatically cold pressed. Cold

Isostatic Pressing is a powder-compacting process for obtaining 60-80% theoretically dense parts ready for sintering. It is done at room temperature and because of the good green (pre-sintered) strength obtained with this forming method, pre-machining before initial sintering is feasible without causing breakage. This is perfect for CNC machining of different shapes and sizes for dental use in just the pressed green state. After the isostatic pressing procedure, the zirconia is rigorously tested and a shrinking factor is calculated. This shrinking factor is incredibly important as it will mean the difference between fit and no fit of your restorations. The calculation of the shrinkage factor is actually a bit of a complex trade secret but nonetheless, must be done with every batch made. The good news is that Dentaurum have a facility that does all this with a quality control second to none so you know your zirconia is the best money can buy. All of these processes contribute to manufacturing the state-of-the-art product ceraMotion Z zirconia, which is now available for use by dental laboratories and clinics in Australia and New Zealand.

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ceramic | TECHNIQUES

Figure 8. Milled implant crown.

Figure 10. Milled full arch.

Figure 12. Perfect shade match.

Figure 11. Sintering curve of ceraMotion Hybrid.

multishade. It has a strength of 600 MPa and a translucency of 49%, making it perfect for restorations in the aesthetic zone where ultra high translucency is required. HT Multishade is a product that has a strength of 1100 MPa and a translucency of 43%. Don’t need super high translucency? Then this is the one to choose as it gives you get high strength. HT Shade is a monochromatic zirconia with a translucency of 43% and a strength of 1100 MPa, great for those who want to layer their own zirconia and again, suitable for all indications. The next two zirconias in the range are pure white, both with a high strength of 1200 MPa. The HT White has a translucency of 43% and the standard White has a translucency of 39%. You can see easily that Dentaurum’s ceraMotion Z range has everything covered for any indication that you could possibly need and the shade selection is impressive too, with also every shade you would need to meet any situation. Peruse the website for more information on the disks varieties and their properties.

ceraMotion range he range of zirconia from Dentaurum is impressive and will cover any application where zirconia is indicated. The first material to highlight is the multi-purpose ceraMotion Hybrid. This will be everyones’ “go-to” zirconia and in my opinion, the best one to try first. It’s a multi-shaded, ultra high translucent, high strength zirconia. Having a strength of 13001020 MPa and a translucency of 44-47%, it’s perfect for any indication from a veneer to a full arch restoration. Next, if you’re looking for something with a slightly higher translucency but do not need super strength, use the Cubic

26 eLABORATE

Sintering s with all contemporary zirconia materials, to achieve its final properties, a sintering process is required following milling. For ceraMotion Z, this is a highly important procedure that can literally make or break the job! Commercially available furnaces are suitable for sintering but be mindful to have a high quality furnace that is calibrated correctly if you expect best results. To avoid impairing the sintering process, it must be ensured that no other ceramic materials are in the furnace. If other ceramic materials have previously been treated in the furnace, an empty firing at maximum furnace temperature is recommended before

November/December 2023

ceramic | TECHNIQUES sintering zirconia ceramics. Use the appropriate sintering program for the sintering process (see example for ceraMotion Hybrid). After sintering and a temperature of 800°C has been reached during the cooling process, continuous cooling to room temperature should take place. The framework can then be removed.

Sandblasting andblasting of zirconia is a contentious issue, however, using the right media at the correct pressure is the real answer. Blasting of ceraMotion with Al2O3 and a grain size of 50 μm with 2.0 bar pressure is permitted. If you follow the instructions for use, you will achieve fabulous results with ceraMotion Z and be amazed at how good the product is. I can honestly tell you when we switched from a well-known brand to ceraMotion Z without telling our customers we were trying something new, it was the customers’ comments on how much better the zirconia was that sold us. Let’s face it, the only real test of how good something looks is when it’s in the mouth.

Figure 12. The only true test is in the mouth.

Economics inally a word on economics. It’s easy to find cheap zirconia. Amazon and eBay are full of it. But you will get what you pay for and if you’re looking for cheap, you will get cheap results. It’s really that simple. ceraMotion Z is not expensive, it is a top quality material at a realistic price, its great value and always remember “Price is only an issue in the absence of value”. You will not be disappointed in the ceraMotion Z. Try it today.

Figure 13. ceraMotion is suitable for airing or micro layering.

About the author

Figure 14. ceraMotion Z is suitable for all indications including full arch.

28 eLABORATE

Terence Whitty is a well-known dental technology key opinion leader and lectures nationally and internationally on a variety of dental technology and material science subjects. He is the founder and owner of Fabdent, a busy dental laboratory in Sydney specialising in high tech manufacturing. Using the latest advances in intra- and extra-oral scanning, CAD/CAM, milling, grinding and 3D printing, most specialties are covered including ortho, fixed and removable prosthetics, computerised implant planning and guidance, TMD, sleep appliances and paediatrics.

November/December 2023

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How to bring monolithic restorations to life By Aiham Farah, CDT

Figure 1. Patient presented with two failing three-unit bridges.

ou can add a touch of individuality and natural beauty to monolithic zirconia restorations by manually creating surface texture and applying external shade effects. This process involves less work than the conventional layering technique and achieves comparable aesthetic results. Success requires the technician’s skilled craftsmanship and creativity as well as a coordinated range of materials such as Ivoclar’s high-strength IPS e.max ZirCAD Prime and the IPS Ivocolor stains and glazes. IPS e.max ZirCAD Prime is a zirconia material suitable for bridges up to 14 units and produced with a Gradient Technology (GT) that allows two powders (3Y-TZP and 5Y-TZP) that normally sinter at different intervals to be combined into one material that sinters uniformly. The cold isostatic process optimises the translucent properties and also allows the material to be sintered at shorter intervals, improving efficiency and aesthetics. The innovative filling technology creates a seamless progression of shade and translucency. The material combines two raw zirconium oxides: • The high-strength 3Y-TZP in the dentine zone has a flexural strength around 1,200MPa that offers stability and enables the fabrication of restorations with a reduced wall thickness and the use of a minimally invasive preparation technique; and • The highly translucent 5Y-TZP in the incisal area features a lower flexural strength, however, that doesn’t limit the material’s wide spectrum of indications. While the excellent optical properties give monolithic restorations a naturally vibrant

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Figure 2. Stump shade taking. appearance without additional characterisation, IPS e.max ZirCAD Prime restorations can also be customised using the infiltration, staining or micro layering techniques; this is especially advantageous in the anterior region.

Case study he following case demonstrates my techniques for using the IPS Ivocolor stains and glazes on IPS e.max ZirCAD Prime to create highly aesthetic monolithic restorations. Restorative challenge: The patient presented with two failing three-unit anterior bridges replacing missing lateral incisors. The Quadrant Two bridge had noted mobility and, when removed, exposed a non-restorable #23.

Treatment plan y client, Dr Volinder Dhesi, DMD (Calgary, AB, Canada) and I decided to replace the Quadrant One bridge, restore #21 with a single unit crown, have an implant placed for #23 and restore #22 with a cantilever bridge. Being a young professional in a role that often involves media appearances as well as a strong presence on social media, the patient wanted natural aesthetics. Given the deep bite, as well as missing lateral incisors, our most predictable restorative options were zirconia bridges or metal frameworks layered with ceramic. While in the past, these choices provided aesthetic challenges and the risk of veneering ceramic failure, recent material advances such as IPS e.max ZirCAD Prime mean we no longer have to choose between strength, durability and aesthetics.

November/December 2023

ceramic | TECHNIQUES

Step 1. he mockup design was inserted in the patient’s mouth for final approval. The AurumGroup designers milled the final restorations from IPS ZirCAD Prime, following all the nesting instructions thoroughly to ensure a consistent shade progression and match among all the restorations.

Step 4 characterised the incisal area using IPS Ivocolor incisal shades SI1-SI3 to replicate the blue hue spectrum; the materials impart an incredible illusion of opalescence and translucency.

Step 2. fter I softened the surface of the restorations using a diamond bur, the material has a smooth progression of shade and translucency and a slightly higher brightness than the shade tab. I assessed the shade accuracy of the Prime BL4 using the bleach shade guide from Ivoclar.

Step 5

PS Ivocolor shade dentin SD0 has a light brownish hue that enables me to easily use one recipe to reproduce the 4 bleach shades.

Step 6

Step 3

applied vertical textural features, the first step in creating a natural-looking morphological surface.

November/December 2023

his photo shows the progression of shade from cervical to incisal after staining and firing.

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ceramic | TECHNIQUES

Step 7 he glazed monolithic restorations: The optimal opacity in the cervical third (3Y-TZP) masks even the opaqued implant abutment on crown #23 perfectly.

Step 8 he glazed restorations on the control model. I applied IPS Ivocolor Glaze FLUO, a fluorescent glaze material, in two thin coats to retain the textural features.

Final results he patient was happy with the outcome and the transformation of his smile. We achieved durable, highly aesthetic results in harmony with his face and lips.

T Step 9 r Dhesi fine-tuned the occlusion and assessed the aesthetic outcome which was exceptional, including an impressive shade progression and match despite the two pontics and the diverse facial wall thicknesses among the bridge, crown and splinted crowns. He said, “The overall design of the restorations allowed us to provide a natural transition from one tooth to the next. We were exceptionally pleased with the ability to create defined interproximal embrasures while maintaining the necessary zirconia volume in the connector. Material science is continuing to allow us to do things we have never been able to accomplish before.”

32 eLABORATE

For more information on IPS ZirCAD Prime and IPS Ivocolor stains and glazes, visit ivoclar.com. Reprinted with permission from Feb 2023 LMT, LMTmag.com.

About the author Aiham Farah, CDT, is a consultant and National Trainer of Comprehensive Esthetics with The Aurum Group in Calgary, AB, Canada. Since 2009, he has been a technical consultant for Ivoclar. Farah lectures internationally on ceramic materials, aesthetic CAD/CAM solutions, teamwork in dentistry, dental psychomorphology and advanced cosmetic characterisation.

November/December 2023

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Figure 1. Surface textures (left) are contoured by hand to impart a natural appearance to the restoration.

Surface matters: How to maximise monolithic zirconia restorations By Aiham Farah

odern zirconia materials incorporate a wide range of lightoptical properties that impart an inherent natural appearance to restorations. In spite of these highperforming material characteristics, it is in the hands of the technician to use these materials to their best advantage. Results that are virtually indistinguishable from the original, the beautiful natural dentition can be achieved by creating suitable textural and morphological features and, in some cases, by adding external shade effects. Here, the author uses a monolithic anterior restoration to introduce his technique to create beautiful zirconia restorations. A state-of-the-art zirconia (IPS e.max ZirCAD Prime, Ivoclar), skilled craftsmanship and a well-rounded range of stains and glazes (IPS Ivocolor, Ivoclar) help him achieve highly aesthetic restorations.

34 eLABORATE

Nature’s perfection is reflected in intricate details, such as the pattern of incident light on the surfaces of natural teeth. The typical appearance of “naturalness” arises from their richly faceted surfaces on which even the smallest rays of light create specific patterns. However, nature does not produce perfectly straight lines, while CAD/CAM milling machines do. So is the CAD/CAM fabrication of monolithic restorations incompatible with natural aesthetics? No, this is not the case, because there is a remedy: If CAD/CAM technology and monolithic materials are used to generate as perfect a copy of the natural tooth as possible, the resulting restoration should be finalised by hand. This gives the dental technician an opportunity to refine the secondary anatomy with craftsmanship and skill. Think surface texture! Morphological details can be created with the aid of fine diamonds that have a geometrical configuration that is amenable to surface contouring. And while the morphological details are being created, the tooth is gradually “springing to life” (Figure 1).

November/December 2023

ceramic | TECHNIQUES Figure 2. IPS e.max ZirCAD features a continuous and smooth progression of shade and translucency. The material combines two zirconia raw materials (5Y-TZP and 3Y-TZP) in one product.

Monolithic CAD/CAM zirconia restorations can be given an additional touch of individuality and natural beauty by applying external shade effects to refine the surface texture (secondary anatomy). When the staining technique was introduced in the 1980s, it revolutionised the manufacture of ceramic restorations. Its success was based on its user-friendly technique and reliability. In recent years, the layering technique has experienced a revival in response to the increase in aesthetic expectations. At the same time, polychromatic ceramic materials have begun to compete successfully with conventional layering methods due to their efficiency. Innovative restorative materials have outperformed the layering ceramics in a number of areas. So, what could be more tempting than creating monolithic restorations and customizing them with the staining technique? Ivoclar is a company that has been aware of this change in expectations from an early stage. The company’s product developers realised that a skilful combination of framework material with a matching staining system had the potential to achieve enhanced results in terms of aesthetics, reliability and economic efficiency. Today, this combination of materials is available to dental laboratories: it consists of the high-strength IPS e.max ZirCAD Prime and the versatile IPS Ivocolor range of stains and glazes.

Looking at the materials science of a contemporary innovative zirconia material he zirconia material IPS e.max ZirCAD Prime is based on a unique manufacturing technology which, among other things, produces discs that offer a seamless internal progression of shade and translucency (Figure 2). Unlike conventional blocks that are built up in multiple layers, this zirconia features a continuous

November/December 2023

seamless progression of shade and translucency and combines two zirconia raw materials into one product: In the dentine zone, the high-strength zirconia 3Y-TZP (flexural strength of around 1,200 MPa) endows the material with stability. This attribute enables the fabrication of restorations with a reduced wall thickness and a minimally invasive preparation technique. Given its high strength, IPS e.max ZirCAD Prime is suitable for bridges with up to 14 units. In the incisal area, the disc contains the highly translucent zirconia 5Y-TZP. This zirconia compound features a lower flexural strength, which has no limiting effect in the incisal area and in areas away from the connectors. Its high translucency is a major advantage, as it is optimally coordinated with the incisal area. The excellent optical properties give monolithic restorations a naturally vibrant appearance, even without additional characterisation work. IPS e.max ZirCAD Prime delivers an accurate shade match. And yet, it leaves all options open. If desired, the restorations can be customised using the infiltration, staining or layering technique. This is especially advantageous in the anterior region, where the already high potential can be maxed out.

Processing the restoration after CAD/CAM milling and sintering his report focuses on the process to finalise monolithic zirconia restorations, create the restoration’s secondary anatomy and apply external shade effects. Full-contour anterior crowns milled from IPS e.max ZirCAD Prime are used to demonstrate a proven approach. Once the crowns are sintered, fitted on the working model and their contact points adjusted, the attention is turned to the restoration’s surface texture.

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ceramic | TECHNIQUES

Figure 3. Grinding over the entire surface with a long diamond bur.

Figure 4. Polychromic zirconia with subtle progression of shade and translucency.

Figure 5. Contouring the surface using a diamond rubber.

Figure 6. Creating natural textural features using stone burs.

Applying secondary anatomical features to the monolithic framework n the first step, a long diamond bur (usually coded with a red ring) is used to grind over the entire restoration lightly, without applying pressure (Figure 3). By slightly roughening the surface, the actual shade of the zirconia material can be seen more accurately. After sintering, zirconia surfaces tend to have a mirror-like reflective appearance. Because of this, their shade tends to be slightly distorted. By removing the reflective layer, the proper shade comes to the fore. If this step is performed correctly, the real base shade of the zirconia is revealed. Additionally, the subtle natural progression of shade and translucency incorporated into IPS e.max ZirCAD Prime can be observed, without having to illuminate the restoration with a light source from any particular angle (Figure 4). In the next step, the tooth shape is checked to make sure that the milling machine has faithfully translated all the details of the technician’s design to the restoration. A diamond rubber is a good choice for applying any necessary corrections and for surface contouring (Figure 5). When fine-tuning the shape of anterior crowns, it is essential to bear in mind that the gradation in translucency (from cervical to incisal) is more visible if there is a vestibular curvature. This makes the translucency of the incisal third appear more clearly.

36 eLABORATE

In the third step, the transition lines are accentuated and then the surfaces are checked to see if they are symmetrical. This check can be carried out with the help of a pencil or a direct light source. Attention is now turned to creating the macrotexture. This step is essential to reproduce the 3-dimensional features typical of natural teeth. Eroded green stone burs, applied at low rpm, have been shown to provide good results here. The natural texture of the teeth can be emulated in a targeted fashion using the tip of the stone (Figure 6). Now the vertical microstructure is applied. Diamond burs are again very useful here. In the case shown here, a bur that looks a bit like an American football (Figure 7) produces a delicate texture without leaving aggressive grooves. The tip of the bur creates a fine pattern of micro grooves that gradually and softly open out, resembling very closely the natural tooth structure. A direct light source is ideal for visualising these fine details. In the absence of an adequate light source, the intensity of the texture can be visualised with an auxiliary method, such as dusting the surface with silver powder or passing over the surface with articulating paper. Visualising the textures assists in observing the differences between highly reflective zones (e.g. prominent areas such as angle lines or strong contours) and shaded zones (e.g. depressions or fine grooves).

November/December 2023

ceramic | TECHNIQUES

Figure 7. Applying vertical microtextures using a diamond bur with a tip in the shape of an American Football.

Figure 8. Creating the horizontal microtexture.

Figures 9a-b. Comparison of various differently textured teeth. Note: The more texture, the more reflection.

Figures 10a-c. The shade match is assessed after the shade tabs (shade guide) have been given a matte finish (by sandblasting) and both the restorations and shade tabs have been moistened with glaze paste. Lens- or ball-shaped diamond burs are used for creating the horizontal microtexture (Figure 8). Important rule for creating a natural surface texture: when creating perikymata and grooves, make sure that vertical lines run parallel to the long axis of the tooth and horizontal lines run perpendicular to the long axis. After that, any sharp angles created while texturing the surface are softened using a rubber wheel (small diameter). Excessively textured areas are slightly smoothed over. Subsequently, the restoration is blasted with aluminium oxide (50 µm, 1.5 bar) to remove any contamination or deposits left by the diamond-coated burs or rubber wheels. Ideally, the incisal third of the crown is not too heavily textured. This is because the more textured the surface, the more reflective it is. Figure 9 shows a selection of differently textured surfaces next to each other. To take the picture, the restorations were illuminated from behind to better visualise their textures.

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One set of crowns have been textured as described in the procedure above, the others have not been. Clearly noticeable: The more pronounced the texture, the more light is reflected. This has also an effect on translucency. For this reason, surface textures should be kept light; especially in the incisal third, where a high degree of translucency is essential for the monolithic crown to look natural. The shade is checked one more time before proceeding to applying the external shade effects. However, there is a problem when evaluating the shade using a conventional shade guide and this problem needs addressing: To start with, shade guides and zirconia restorations are made from different materials with a different surface behaviour (light reflection, etc.). What is more, the tabs of the shade guide have a high gloss finish while the zirconia crowns have a matte finish after having been blasted. To create a level playing field, the shade guide is first sandblasted and then, together with the crowns, moistened with glazing material (Figure 10).

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ceramic | TECHNIQUES

Figure 11a. Characterizing the incisal area using IPS Ivocolor Shade Incisal.

Figure 11b. Applying a thin veneering layer using the materials of the IPS e.max Ceram range.

Figure 12. Optimally coordinated opacity of monolithic CAD/CAM crowns.

This enables an accurate evaluation of the shade match. In the clinical case shown here, the shade of the crowns (IPS e.max ZirCAD Prime) harmonises beautifully with the target shade on the shade guide (BL2 Bleach). Additional shade adaptations are not a must. In principle, the crowns could now be simply glazed and finished. In the mouth, their shade would look beautiful and natural. However, additional customisations – such as a youthful opalescence and mamelons – can be created at this stage by applying external shade effects using the staining technique.

External shading and characterisation using IPS Ivocolor and IPS e.max Ceram for 3D effects he middle area of the monolithic crowns shows a shade that matches the IPS Ivocolor Shade Incisal 2 (SI2). In principle, this would be the shade that is used to create the desired translucency according to the shade guide to achieve a progression of shade. However, the crowns have been made from a polychromatic material, with the translucency incorporated into the incisal edge. So, there is no need for painting a translucent effect onto the restoration and the focus can be placed straight away on creating the opalescent effect. For this purpose, Shade Incisal 3 (SI3) is used. The bluish hue of this ceramic material provides incredibly

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natural-looking illusions of opalescence, which can hardly be attained with other stains, especially not in Bleach areas. The mesial and incisal edges are characterised using SI3. The technician should not be shy to move the brush slightly down (toward the dentine) to achieve a soft transition. After that, a small line of interrupted dashes is applied horizontally under the incisal edge with the tip of the brush using Shade Incisal 1 (SI1). The shades applied to the restoration are now fired at a low temperature (e.g. 700°C) to fix them in place (Figure 11a). Subsequently, the mamelon and halo effects can be applied. Mamelon effects can be produced by applying one of the light-reflecting bright stains of the Essence kit. To create an additional “true-to-life”, three-dimensional effect, the shade is mixed with 10% layering material, such as IPS e.max Ceram Opal Effect 4 (OE4). As a Bleach shade is used in the case shown here, this “thin veneering layer” is applied. The blend consists of IPS e.max Ceram OE4 and IPS Ivocolor Essence white, mixed together with IPS e.max ZirCAD Zirliner liquid. In my opinion, the IPS e.max ZirCAD Zirliner features a better consistency for mixing the materials than the Build-up Liquid. When applied to the surface, the mixture stays in place and can be placed exactly where wanted (Figure 11b).

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ceramic | TECHNIQUES

Figure 13. Completed zirconia restorations on the model.

Figures 14a-b. Inserted restorations offering natural-looking shade effects and a natural surface texture.

The opacity of the monolithic crown is optimally coordinated, especially in the cervical third and makes for an impressive result (Figure 12). In spite of the dark shade of the preparation, the restoration accurately matches the shade of the BL2 shade guide. Finally, glaze material is applied to smooth out any uneven areas created between the layered 3D mamelon structures. This is done with a fluorescent glaze material (IPS Ivocolor Glaze FLUO). Fluorescent glazes are generally recommended for monolithic zirconia surfaces. The restoration is fired using the standard glaze firing program. After that, the entire surface is coated with a second, extremely thin layer of fluorescent glaze material. This time, the material is applied in a slightly thinner consistency to make sure that the textural features are retained (Figure 13).

Conclusion onolithic zirconia restorations can be “brought to life” by manually creating surface textures and, as an option, by applying external shade effects. To do so successfully, the skilled craftsmanship and creativity of the dental technician are required in addition to a coordinated range of materials. The procedure presented in this report involves clearly less work than the conventional layering method; the result, however, comes very close to the high benchmark set by layered restorations. When using IPS Ivocolor, it is possible to create monolithic restorations with brilliant aesthetics that are a near perfect representation of the natural tooth – even in the anterior region. (Figure 14a and b).

About the author Aiham Farah is a certified dental technician with his work focused on aesthetic dentistry. In 2003-2006 and 2009-2012 he specialised in the field of aesthetic restorative dentistry. From 2010-2011, he was a teacher lecturer at the Department of Dental Technology at the University of Kalamoon. Since 2009, he has been a materials consultant for Ivoclar in the Near East and Orient. He is a member of the National Association of Dental Laboratories (NADL) and an ICDE Ivoclar (Switzerland) certified Master Trainer. Thank you to Dr Gordon Chee DDS for the excellent teamwork.

November/December 2023

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thermoforming | TECHNIQUES

Optimising material thickness distribution in thermoforming By Peter Herring, Adv Dip Dent Tech, ACCDP

hermoforming involves the molding of plastic foils through controlled heating and then an adaptation onto dental models. This method introduces various thickness differentials in the foil, stemming from two primary sources: the adaptation process itself and the prior application of heat.When heat is applied, the plasticised material experiences slight thinning and sagging, followed by shrinkage as it cools. Although we have limited control over these heat-induced changes, we can minimise them by precisely managing the heating process (temperature) and employing spacing foils to compensate for material shrinkage (also eliminating the need for model separators). In contrast, the distribution of material thickness during the adaptation process can be significantly influenced and fine-tuned. In this article, we will show the factors that impact material thickness distribution during the thermoforming adaptation phase and explore strategies to optimise this aspect of the process. When thermoforming, the plasticised material undergoes stretching, resulting in a noticeable reduction in material thickness with subsequent impact on the wall thickness. It’s useful to note that a 1 cm increase in thermoforming height corresponds to approximately a 25% loss in material thickness. To maintain the material thickness as close as possible to the original foil, it is advisable to perform thermoforming at the minimal model height. This can be achieved by embedding the model in granules, which is the most versatile and preferred method, or by grinding the base of the model to reduce its height if forming on a flat plate. Material thickness over the occlusal surfaces of premolar and molar teeth remains relatively consistent, but it tapers downwards on the lateral regions. On the incisal areas, particularly on the maxillary anterior teeth, the distribution of thickness is inverted, with material thinning over the incisal regions (the most vulnerable in the case of a sports mouthguard). This incisal thinning is a key factor driving the need for laminated mouthguards, as the addition of a second layer creates the opposite effect—increasing thickness significantly in the incisal region and gradually thinning towards the peripheries. It’s essential to note that these effects become more pronounced with greater model height, underscoring the importance of control of model height in the thermoforming process to achieve optimal results. The alignment of the models relative to the adapting foil plays a significant role in determining material thickness. When models are inclined anteriorly, thicker palatal areas are observed, while palatally inclined models result in thicker labial areas. To maintain a consistent material thickness, it is advisable to keep the anterior teeth as close to a vertical alignment as possible during the thermoforming process. This attention to alignment helps maintain uniform material distribution, leading to more consistent outcomes.

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November/December 2023

thermoforming | TECHNIQUES Models featuring substantial undercuts can be strategically inclined, as illustrated. This approach serves to mitigate the material thinning that typically occurs in these undercut areas due to the extended thermoforming distance. However, it’s crucial to strike a balance between addressing undercut concerns and adhering to other model alignment requirements to achieve the desired outcomes. With regards to the equipment used, a vertical foil approach is optimal. The angle of adaptation significantly influences material thickness during the thermoforming process. If the approach angle is not vertical, such as with some thermoforming units, when the heated foil is turned over onto the model, it can result in an uneven material thickness caused by the distorted sagging of the hot, plastic material during the turning-over process. Conversely, a vertical adaptation of the foil eliminates this issue and guarantees a more uniform material thickness, making it a preferred choice to ensure consistent results.

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.

www.erkodent.com.au www.erkodent.co.nz 24 hour online ordering

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telephone toll free 1800 242 634 - email info@erkodent.com.au online shop www.erkodent.com.au November/December 2023

eLABORATE 41

new | PRODUCTS Information contained in this section is provided by the manufacturers or distributors. eLABORATE does not assume responsibility for the accuracy of the data.

New ceraMotion® Z zirconia blanks

Perfit FS fully sintered Zirconia blocks

The six different ceraMotion Z blanks from Dentaurum cover all zirconia-based indications and offer maximum reliability in shading and processing. State-of-the-art materials technology within a logical overall concept makes ceraMotion Z the smart choice for natural all-ceramic restorations, created to meet high demands. In particular, the multishaded, multi-layered zirconia ceraMotion Z Hybrid is a truly multi-purpose material. In one blank, it combines the aesthetics of a 1000 MPa

VATECH Perfit FS is the World’s first fully sintered machinable zirconia block. Perfit FS is the most naturallooking zirconia with a flexural strength of 500 MPa. It does not need to be fired, so you can save time and concentrate on your patients. Perfit FS features include saving time, as no firing is required; seamless 3-layered structure; high level of crack resistance; and high

zirconia with the strength of a tetragonal, highly translucent zirconia. ceraMotion Z Hybrid is pure aesthetics and suitable for all work in the anterior and posterior tooth area. ceraMotion Z is also available in White, HT White, HT Shade, HT Multishade and Cubic Multishade. Available: Dentaurum Australia AU Tel: 1300-880-782 NZ Tel: 0800-336-828 shop.dentaurum.com.au info@dentaurum.com.au

flexural strength of 500MPa. With VATECH Perfit FS, all you have to do is mill it. It is the perfect solution for rush those cases.

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Ceramill Map FX 3D desktop scanner

ASIGA UltraGLOSS a game changer

The new laboratory scanner from Amann Girrbach offers high precision with short scanning times and maximum versatility. The groundbreaking technology of the modular Ceramill Map FX laboratory scanner represents the perfect complement to the CAD/ CAM system in the laboratory. The compact scanner operates with high precision and repeat-

The new UltraGLOSS tray by Asiga allows you to 3D print clear parts directly with a glossy / pre-polished surface removing the need for manual post-polishing. No special post processing steps are required. Simply 3D print your parts using Asiga’s new UltraGLOSS™ material trays and then wash and cure as normal following the material

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ability while keeping scanning times short at the same time. To ensure safe and efficient processes, the Ceramill Map FX is fully integrated into the digital workflow. Available: Innovatio Dental Supplies Tel: (02) 8575-8675 innovatiodentalsupplies.com.au

manufacturer’s guidelines. The result – a pre-polished finish direct from the 3D printer. UltraGLOSS™ is compatible with the Asiga MAX UV, MAX X and PRO 4K. Available: ASIGA Dealers Tel: (02) 9417-6660 info@asiga.com www.asiga.com/australia

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