VOL.19 NO.4 JULY/AUGUST 2022 NEW 100018653NO.POSTPRINT Sophisticated Disc Changer with Smart Functions The NEW DWX-53DC 5-Axis Dental Milling Machine Changing the World of Dental www.rolanddg.com.au/dwx53dcLabs sales@rolanddg.com | 1800 500 119 Elegant new design New and improved high-performance spindle Sealed chamber to keep milling waste isolated Built in webcam for real-time mill monitoring DGSHAPE CLOUD performance visualisation software Optional tablet integration C M Y CM MY CY CMY K Sophisticated Disc Changer with Smart Functions The NEW DWX-53DC 5-Axis Dental Milling Machine Changing the World of Dental www.rolanddg.com.au/dwx53dcLabs sales@rolanddg.com | 1800 500 119 Elegant new design New and improved high-performance spindle Sealed chamber to keep milling waste isolated Built in webcam for real-time mill monitoring DGSHAPE CLOUD performance visualisation software Optional tablet integration C M Y CM MY CY CMY K www.rolanddg.com.au/dwx53dc
eLABORATE | CONTENTS 4 BRIEFS 6 SPECTRUM 24 CPD CENTRE 42 NEW PRODUCTS 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 © 2022 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 facebook.com/elaboratenow twitter.com/eLABORATEnow instagram.com/dentevents On the cover... The new DGSHAPE DWX-53DC offers a swifter, cleaner production experience for all dental applications and an improved, user-friendly support experience through DGSHAPE CLOUD CAD/CAM16 HOW TO RESTORE THE MAXILLARY ARCH USING IPS E.MAX ZIRCAD PRIME ESTHETIC CAD/CAM26 3D PRINTING DENTURES - PART 1: CHOOSING A PRINTER 34CERAMICS EXPECTATIONS MET: HYBRID ABUTMENT CROWN MADE OF ZIRCONIUM OXIDE WITH VESTIBULAR CUT-BACK 40THERMOFORMING CHOOSING MACHINETHERMOFORMINGA VOLUME 19 | NUMBER 4 JULY/AUGUST 2022
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And it seems I’m not alone.
And of course, the Dentevents calendar is filling fast with a full range of educational opportunities through 2023.
Back to normality...
And fresh from packed sessions at Digital Dentistry & Dental Technology 2022, we also ran an Intraoral Scan ning for Digital Dentures course with prosthetist Sam Dias which again sold out. This was Sam’s first full day lecture and he imparted his considerable knowledge to the dentist and prosthetist delegates and received high praise for the comprehensive program.
Several months into the year and we’re flying again, domestically and internationally, dining in crowded res taurants, watching the football in stadiums packed to the gunwales and enjoying the theatre and cinema with impunity.
Joseph Allbeury, Editor and Publisher
I remember back in June, the first time I rang the bell after morning tea on the first day of Digital Dentistry & Dental Technology 2022, people looked at me quizzically. Some asked what I was ringing a bell for... while others thought for a moment and then realised that it was time for the next sessions to begin. Funny how we quickly forget.
Next year, we have a brand new 3D Printing for Den tistry (3DPD) event over two days from February 10-11. Day 1 covers the clinical aspects of 3D printing while Day 2 looks at the technical side. You can choose to do either day or both and if you’re interested in this burgeoning area, you will find value in coming for the entire event. Keep an eye on www.3dpd.events for more info, session and speaker announcements - and note the 90 minute lunch break is designed to give you plenty of time to play with the toys.
By Joseph Allbeury
briefs | NEWS
Software subscriptions now available
Impulsedents appoints new CEO
We’re working on more programs with Sam for 2023 so stay tuned for details.
4 eLABORATE July/August 2022
lowly but surely, my mind is readjusting from COVID normal to the new normal, which, for all intents and purposes, ain’t too different to how life was before the recent unpleasantness.
But it wasn’t as easy as simply flicking a mental switch. I have to keep reminding myself in a very deliberate way as to what I should be doing at any given point in the year based on memories of a mere few years ago. Habits had clearly changed and they need to change back!
Since the last magazine, we packed a full house for Prof. Laurie Walsh’s latest infection control update based on all the changes that occurred in July this year.
Finally, we’re still looking for readers to start contributing videos to Dentevents.TV and each month we’re offering a prize for the video thatr receives the most votes from viewers! Visit www.dentevents.tv to sign in and begin uploading. Stay safe and see you at the next big thing!
We’ve also pencilled in our flagship Digital Dentistry & Dental Technology 2023 event for June 2-3 so please save the date for this. DDDT23 will be bigger and better than ever so keep an eye on www.dentaltechnology.com.au.
I mpulsedent Dental Supplies in Queensland has appointed Thomas Kunz to the role of Chief Executive Officer. Thomas will invig orate marketing initiatives and empower the national sales efforts in Australia. With considerable experience in all facettes of sales and marketing, he will be in charge of services to clients, develop new practices of communication and enlarge the sales activities with fresh ambi tions. “Impulsedent is excited to include Thomas, who is of Swiss origin, into the team,” said Reto Herzog, Managing Director of Impulsedent. “I’m confident and looking forward to achieving new service levels with the enhanced support of Thomas.” If you have any enquiries or questions, contact Thomas Kunz on (07) 3102-3436, email thomas.kunz@impulsedent.com.au or visit the website www.impulsedent.com.au.
A mann Girrbach offers a new service: as part of its so-called Performance Plans, customers not only have the option of buying software, but also of renting it. Lower entry costs, flex ible selection options and included upgrades are the major benefits. The new Performance Plans represent an alternative to purchasing. The prices for the software plans include the license as well as upgrades. New upgrades are made available on a regular basis so that customers can benefit from new workflows to optimise work processes, from new indications and materials, or from process optimizations - for example, through more efficient milling strate gies. The number of included software modules can be adapted flexibly to the respective requirements. In addition, customers have a choice of different plans for hardware maintenance and repair. Details can be requested from the designated dealer. “The idea behind the new Performance Plans is to offer our customers an all-round carefree package. Our customers should always be in a position to use our system optimally and be up to date at all times - the flexible solutions tailored to their individual needs make this possible while at the same time keeping entry costs low. Cus tomers can now decide for themselves whether they wish to buy or rent CAD/CAM software license. By doing so, Amann Girrbach is following the cross-industry trend towards subscription models,” said James Rushton, Head of Global Service at Amann Girrbach. More info and full details of the new Performance Plans can be found at https://www.amanngirrbach.com/service-portfolio
All about NEW Get 5-years warranty AND €900 Automate credits with any 3Shape E-Series scanner purchase Terms and conditions: • Promo is only available to customers within Australia • Credits must be manually claimed by creating an 3Shape Automate account, and emailing automate@3shape.com with account email, contract of purchase and promo code • Receipts will be validated by 3Shape resellers before equivalent design credits is added to the customers account • 3Shape E Scanner €900 design credits is limited to a one-time use, and limited to 1 credit per lab • 3Shape software package €900 design credits is limited to a one-time use, and limited to 1 credit per lab • Customers can redeem up to €1,800 design credits with the purchase of both an 3Shape E Scanner and 3Shape Software package Automate credits have no cash value and are not redeemable for cash • Return and refunds for E-scanners and or software purchases must be made through the reseller • 3Shape reserves the right to change terms and conditions at any time 11049 Promo code: Valid through Dec 31, 2022.
For more information on the new DGSHAPE DWX-53DC dental mill and their complete line of dental products, software and accessories, visit www.rolanddg.com.au/dwx53dc or email sales@rolanddg.com or call 1800-500-119.
The DWX-53DC has a built-in camera that links the device with DGSHAPE CLOUD support. Users can view live produc tion from anywhere with a mobile phone or tablet. The camera also provides recorded video, so users can troubleshoot their device and monitor maintenance activities. VPanel software has a new user interface that allows users to easily access settings, run updates when available, receive support and manage main tenance, tools and job queues. And a new automated cleaning process takes the work out of removing zirconia dust and waste from the device.
6 eLABORATE July/August 2022 spectrum | NEWS
The DWX-53DC’s elegant new design features a separately covered automatic tool changer, keeping tools free of additional material waste. Adapters are easily and quickly interchanged in a newly designed automatic disc changer. The milling chamber is sealed to keep milling waste away from other areas of the milling device and includes an ionizer to allow easy removal of PMMA milling waste.
GSHAPE Corporation, a wholly-owned sub sidiary of Roland DG Corporation and a leading provider of digital fabrication tools worldwide, has announced the release of the DWX-53DC, the next generation desktop milling device that offers a swifter, cleaner production experience for all dental applications and an improved, user-friendly support experience through DGSHAPE CLOUD.
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A stronger base, sturdier spindle and a new disc changing process allow quick and easy manufacturing of dental applica tions. Users can apply a four-millimeter bur to shorten the time necessary to complete the roughing process. The DWX-53DC allows users to produce PMMA applications like dentures and partials at above industry-standard quality, with industrystandardBundledspeed.with the DWX-53DC are standard and open edge adapters. Users seeking to mill the facial anatomy of long span bridge applications can do so with the newly designed open edge adapter and an increased rotational angle of the B-axis, now a full thirty-five degrees.
DGSHAPE announces release of next generation DWX-53DC dental mill
“In addition to its sleek exterior redesign, the DWX-53DC dry mill is layered with hidden technology. A series of improve ments and new features make it even more user-friendly, swift and dependable,” said Hisashi Bito, DGSHAPE Corpora tion’s President of Operations. “Combined with DGSHAPE CLOUD, the DWX-53DC provides a uniquely comprehensive monitoring and support experience, that users can access from any device.”
The NEW DWX-53DC 5-Axis Dental Milling Machine Changing the World of Dental www.rolanddg.com.au/dwx53dcLabs sales@rolanddg.com | 1800 500 119 Elegant new design New and improved high-performance spindle Sealed chamber to keep milling waste isolated Built in webcam for real-time mill monitoring DGSHAPE CLOUD performance visualisation software Optional tablet integration 5-Axis Dental Milling Machine Changing the World of Dental www.rolanddg.com.au/dwx53dcLabs sales@rolanddg.com | 1800 500 119 Elegant new design New and improved high-performance spindle Sealed chamber to keep milling waste isolated Built in webcam for real-time mill monitoring DGSHAPE CLOUD performance visualisation software Optional tablet integration www.rolanddg.com.au/dwx53dc
also mill individual dental arches and tooth segments for the first time - and all within a validated workflow. Whereby the pearl structure effect of Ivotion Dent Multi creates a particularly harmonious colour gradient. The previous options of milling denture bases or fabricating them via 3D printing technology and then combining them with the prefabricated teeth of leading manufacturers, are now extended to include an aesthetic and cost-effective alternative.
8 eLABORATE July/August 2022
About Amann Girrbach
Ceramill FDS now offers the option of milling dental arches and tooth segments
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In addition, the Ceramill FDS is distin guished by an end-to-end digital workflow and the seamless interaction of software and hardware. In this context, the Ceramill Mind Software has been updated so that all components, materials and the stored gap dimensions and milling strategies are precisely matched. “With the expansion
of tooth libraries, fabrication possibili ties and design options, the Ceramill FDS offers maximum flexibility. Thanks to the update, we are now in an even better posi tion to cover different cost segments, so that individual patient wishes can be opti mally addressed,” says a delighted Maria Stroppe, Product Manager for Laboratory CAD/CAM Software and 3D Printing at Amann Girrbach.
mann Girrbach is expanding its Ceramill Full Denture System (FDS) to include the validated Ivotion mate rials from Ivoclar and is updating the Ceramill Mind software accordingly. This allows even more com ponents to be individually combined in the fabrication of removable full dentures. Users thus benefit from greater flexibility as well as time and cost efficiency.
The Ceramill Full Denture System offers the industry’s broadest range of options for fabricating dentures digitally. By adding the proven Ivotion Dent and Ivotion ® Dent Multi dental materials as well as the impact-resistant denture base material Ivotion Base from Ivoclar, users can now
A s a pioneer in dental CAD/CAM technology, Amann Girrbach is one of the leading innovators and preferred full-service providers in digital dental prosthetics. For more information, visit www.amanngirrbach.com
spectrum | NEWS
Australia www.cit.nsw.edu.au n Digital Dental workflow n CAD CAM n 3D printing n Digital communication Campus located at Chatswood, Sydney Tel: (02) 9411 1516 DiplomaHLT55118of Dental Technology Immerse yourself in digital dental technology n QUALIFICATION Diploma of Dental Technology (HLT55118) n TRAINING PACKAGE Health (HLT), Nationally Recognised Training n DURATION 2 Years Full Time n COSTS Application Fee: $100 (non-refundable) Tuition Fee: $30,000 ($7,500 per semester) Materials Fee: $2,000 ($500 per semester) Materials include: l Initial toolkit that each student keeps on graduation l Dental coat for protection l Equipment needed to complete the course l All consumables needed to complete the course Government VSL Loan available Apply today Visit www.cit.new.edu.au
Figures 6-7. The Double Screw bar onto the implants.
10 eLABORATE July/August 2022 spectrum | NEWS
(Left). High-precision milling of the additional threaded screw channels in Zirkonzahn milling units.
In the current case, a patient presented with complete maxillary edentulism and severe left bone atrophy in the upper jaw. The virtual tooth set-up revealed a strong divergence of implants towards the ves tibular 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.
Double Screw Metal technique for full arch prosthetics on divergent implants
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After milling, the final restoration in Prettau 2 Dispersive zirconia was charac terised with the ICE Stains 3D by Enrico Steger and veneered in the gingival regions with Fresco Ceramics. The tita nium bar was then screwed to the implants and the secondary structure to the bar.
Figuresbar.4-5
Figures 1-2. The set-up revealed strong divergence of the implants towards the vestibular area, which would affect the general aesthetic of the final restoration due to the well visible screw channels in the anterior area.
Figure 8. Basal view of the final restoration. The bar was anodised in gold to increase the final restoration’s biocompatibility and aesthetic, reducing the grey scale value.
The production of full-arch prosthetics on divergent implants is one of the most challenging restorations for a techno-clin ical team. However, with the new Double Screw Metal technique it is now possible to produce highly stable and precise bar-sup
Threaded channels on the metal structure were milled with the M2 Dual Wet Heavy Metal milling unit, showing the machine’s high-precision milling.
he M2 milling units, like all other Zirkonzahn milling units, are perfectly compatible with the company’s software, com ponents and further hardware, in order to guarantee a smooth workflow from the beginning to the end of the treat ment. The case described here exemplifies a smooth workflow made for a patient suffering from maxillary edentulism.
The planned restoration consisted of a titanium bar and a secondary structure in Prettau® 2 Dispersive® zirconia. The design of the primary structure incorpo rated an innovative CAD/CAM workflow, in which four additional screws were inte grated to screw the secondary structure 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 pri mary structure, as well as the ideal fit of the screw head in the superstructure. The additional threaded screw channels were then milled during the bar milling process.
Visit www.zirkonzahn.com and view the case gallery to know more!
Figure 3. The new Double Screw Metal software function allows the generation of additional virtual screw threads within the bar design to screw the superstructure to the
ported rehabilitations even in complex cases without compromising full arch aesthetics.
Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com WATCH THE VIDEO! NEW! M2 MILLING UNIT COMFORT LINE The new M2 milling unit comfort line exempflies precision and flexibility. The line comprises fi ve milling units – M2 Wet Heavy Metal, M2 Teleskoper, M2 Dual Wet Heavy Metal and M2 Dual Double Teleskoper – all equipped with fully automatic 5+1 axis simultaneous milling technology. TELESKOPER ORBIT EXTRA-LARGE Ø 125 mm Extra-large Teleskoper Orbit: for the elaboration of material blanks with Ø 95 mm, 98 mm, 106 mm or even 125 mm, mini zirconia blanks for single crowns as well as glass-ceramic and Raw-Abutments ® blanks. Discs can be removed and reinserted later at exactly the same position with high precision in micron range – particularly useful for adjusting the friction of telescopic jobs and for the two stage production of immediate restorations in case of implant-supported prostheses (Double Milling technique) WET DRY Teleskoper Orbit (Ø 125 mm) Teleskoper Orbit (Ø 125 mm) Ø 95 Ø 98 Ø 106 Ø 125
ith the Ceramill Mind and Ceramill Match 4.2 software, users are able to provide their customers with next generation in-house fabrication while significantly reducing costs. For example, the new software fea tures allow titanium materials to be machined with the Ceramill Matik milling unit. The in-house fabrication of titanium-based implant-supported restorations is associated with external cost savings of up to 40 percent. The entire milling unit can there fore be financed in full by even a small number of cases. Another new feature is the innovative speedlining mode: with the aid of specifically developed tools, users of the Ceramill Matik, Ceramill Motion 3 and Ceramill Motion 2 can “cut-grind” hard block materials at full speed. Dental technicians thus benefit from almost 50 percent faster production while maintaining excellent restoration quality and reliability.
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Titanium machining at highest restoration quality, high-speed processes and innovative denture planning without abutments
ith the Upgrade of our Ceramill Mind and Ceramill Match software to Version 4.2, we are yet again focusing on the core principles of in-house fabrication and by doing so, also on the vision of Amann Girrbach. We are delighted to have come a great deal closer to this vision now with the new features, improvements and functions,” said Nikolaus Johannson, Head of the Global Business Unit Lab CAD/CAM at Amann Girrbach. The rollout of the Upgrade started at the end of June and will be implemented worldwide by the end of July. In par allel, Amann Girrbach will be offering users free online training.
I n addition to the fully digital and validated Amann Girrbach workflow for printing implant models and laboratory analogs, the Upgrade also offers numerous other CAD/CAM functions. To give an example, these include the AI-assisted design of bridges using the “Instant Anatomic Morphing” feature or the implementation of the Smile Creator Report in PDF format. This allows patients to see the expected result in advance in a before-and-after compar ison and to participate in the planning process if they so wish. In addition, the Upgrade also offers quick to perform quality checks with the aid of new nesting visualisation: this makes it possible to repeatedly check whether a restoration can be milled success fully. Additional process reliability can thus be created with just a single click. However, as the digitisation of production increases, so does the output of milling units and 3D printers. To stay on top of things, the Ceramill System now enables milled and printed restorations to be marked with notes.
Implants without abutment
spectrum | NEWS
Next generation in-house fabrication
About Amann Girrbach
A nother new feature is that the planning of dentures can now be performed directly on the implant and without abutments - regardless of whether single crowns, multi-part bars and bridges or full dental arches are involved. This innovative implant solu tion is the result of a cooperation between Amann Girrbach and Tri Dental Implants. With matrix, Tri Dental Implants has launched the first approved dental implant specifically designed for dig ital fabrication technologies such as CAD/CAM milling or 3D printers. With the matrix concept, Amann Girrbach now offers its customers a fully comprehensive CAD/CAM-compatible implant system in both a digital and validated workflow. Implant-based Zolid zirconia crowns can thus be produced in less than two hours in combination with the Therm DRS sintering furnace.
AI-supported design and nesting
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One step closer to Amann Girrbach’s vision
A s a pioneer in dental CAD/CAM technology, Amann Girrbach is one of the leading innovators and preferred full-service providers in digital dental prosthetics. With its high degree of expertise in development and commitment to customer orientation, the ambitious Austrian company creates sophisticated system solutions and highest quality materials for tomorrow’s workflows. Its customers in around 90 countries worldwide are mainly made up of dental laboratories and dental technicians. Amann Girrbach employs a total of around 500 people. In addi tion to the R&D and production sites in Koblach (headquarters) and Rankweil (Austria), Amann Girrbach operates sales offices in Pforzheim (Germany), Verona (Italy), Jossigny (France), Charlotte (USA), Singapore (city), Curitiba (Brazil), Beijing (China) as well as Kyoto (Japan). For more information, visit www.amanngirrbach.com
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Digital Dentistry & Dental Technology SYDNEY 2-3 JUNE 2023 NOVOTEL SYDNEY BRIGHTON BEACH TWO DAYS OF LECTURES AND WORKSHOPS ON DIGITAL DENTISTRY FOR DENTISTS, SPECIALISTS, DENTAL TECHNICIANS AND DENTAL PROSTHETISTS dentevents presents... INDUSTRYSPONSORSSUPPORTERS
Full details of the speakers and presentations www.dentaltechnology.com.auonline 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 REGISTRATION FEES $880 inc gst EARLY BIRD PRICING $220 before 2 Dec 2022 price increases $110 on the 2nD of every month RegistrationINCLUSIONSfee includes participation in TWO full days of education (12 CPD hours), all catering and Friday drinks. Multiple lectures and workshops are being run concurrently to allow you to build your own program to suit your specific interests. Price is all inclusive. VENUE DETAILS 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 PROGRAMME DETAILS FRIDAY 2 JUNE 2023 9.00am - 5.00pm - e D ucation 5.00pm - 7.00pm - happy hour SATURDAY 3 JUNE 2023 9.00am - 5.00pm - e D ucation 12 HOURS CPD Join us again or for the first time at Digital Dentistry & Dental Technology 2023 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 cover Digital Smile Design • Digital orthodontics • Intraoral scanning • Digital implantology • Digital full arch restorations and full mouth rehabilitations • Digital Dentures • 3D Printing • Milling • CBCT • Material and applications • Software and more with MORE Hands-on Sessions • MORE Advanced Sessions • MORE New Products • NEW Masterclasses and more! ONLY $220 FOR 2 DAYS OF EDUCATION (12 HOURS OF CPD) IF YOU REGISTER BEFORE 2 DECEMBER 2022 (SAVE 75%)
Treatment plan
The weakened enamel of teeth 14-24 and teeth 34-44 had begun to break away during normal function, causing hypersensitivity, decreased function and an unaesthetic appearance. The patient had generalised reces sion, extensive wear and compensatory eruption (Figure 1).
Since this new generation of zirconia offers a seamless gra dient from dentine to incisal that offers the desired aesthetics and translucency without the loss of mechanical strength, it can be milled to full contour and characterised using simple timesaving techniques.
The positioning, shape and location of the maxillary anterior teeth dictated the entire direction for the reconstruction, from design to completion.
Upon examination, it was determined that his posterior teeth were sound with no decay and his vertical dimension of occlusion and chewing surfaces had not been damaged by his bruxing habit to the point of needing to be restored.
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Figure 2. Pre-operative photo.
16 eLABORATE July/August 2022
Figure 1. The patient had generalized recession, extensive wear and compensatory eruption.
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The dental team then made the decision to choose Ivoclar’s IPS e.max ZirCAD Prime Esthetic to restore this case due to the high strength required and the optimal aesthetics of the mate rial that would ensure long-term integrity and natural-looking final
cad | CAM
How to restore the maxillary arch using IPS e.max ZirCAD Prime Esthetic
By Yuki Momma, RDT, Ceramic Artisan Dental Lab and Yousef Sidki, DMD, Chelmsford Dental
he clinician explained that to restore the balance of function and aesthetics to the patient’s smile, the dental team would create very strong, highly aesthetic and natural-looking crowns for teeth 14-24 and 34-44. The discussion led to a sequential treatment plan with the maxillary arch being restored to improve his smile, as this was his chief complaint and the mandibular arch treated at a later date for a fully functional reconstruction.
male patient presented for his annual exam. Although some clinicians may have prescribed only a nightguard, the patient’s bruxism, heavily acidic diet and parafunctional habits called for a more comprehensive treatment.
Historically,restorations.achieving lifelike aesthetics in milled zirconia monolithic restorations has meant either a sacrifice in mechanical strength or a sacrifice in labour efficiency.
Figure 7. Models of the approved temporaries created from the impressions.
Yuki Momma created a diagnostic wax-up of the proposed treatment plan which allowed Dr Sidki to prepare the teeth with the most conservative approach (Figure 3).
Stage 1
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Figure 5. Teeth prepped to receive full contour zirconia crowns. Figure 6. Chairside temporaries in situ.
t the laboratory, models of the patient’s prepped teeth and approved temporaries were created from the impressions (Figure 7).
took videos of the patient speaking, laughing and smiling to ensure the final restorations would meet his expectations. Once the patient approved the aesthetics and function of the tempo raries, an impression was taken and sent to the laboratory.
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r Sidki took pre-operative photographs of the patient’s existing arches and videos of the patient speaking (Figure 2) and alginate impressions using Jeltrate Plus (Dentsply Sirona).
r Sidki prepped teeth 14-to 24 to receive full contour zirconia crowns; a few teeth in the lower jaw were adjusted to prevent interference with the maxillary restorations until the mandibular teeth were restored (Figure 5).
Dr Sidki took the final impressions and fabricated the chairside temporaries (Figure 6). He and Momma evaluated the temporaries for shade, function and aesthetics as well as phonetics and again,
Figure 3. Diagnostic waxup of proposed treatment plan. Figure 4. Diagnostic mockup of the maxillary restorative design.
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cad | CAM
Stage 3
Momma’s diagnostic mock-up of the maxillary restorative design lengthened teeth 11 and 21 to the aesthetic standard of 10-11mm in order to set the parameters of the case and balance the aesthetics and functionality of the patient’s smile (Figure 4). Once the clinician and ceramist agreed on the final design, Momma created a putty matrix and delivered it to the practice prior to the prep appointment.
Stage 2
July/August 2022 eLABORATE 17
Figure 13 shows the final restorations after sintering.
To add the final lifelike touch, the ceramist added a white spot on the incisal edge of crowns 11 and 21 using Ivocolor Essence E01White and then executed the final firing (Figure 15).
Figure 10. IPS e.max ZirCAD Prime Esthetic.
cad | CAM
The models were scanned using 3Shape for the final CAD design which included surface characterisations that would be replicated during the milling process (Figures 8-9).
Figures 8-9. CAD design of restorations.
IPS e.max ZirCAD Prime Esthetic is a high-strength, preshaded zirconia disc with a gradual shade and translucency gra dient. Made from 4Y-TZP and 5Y-TZP zirconia raw materials, IPS e.max ZirCAD Prime Esthetics powders are coordinated with the A-D tooth shade guide.
The full contour crowns for teeth 14-24 were milled from IPS e.max ZirCAD Prime Esthetic A1 with the Zenotec Select Hybrid mill from Wieland (Figures 10-11).
Figure 14 shows the crowns after the initial staining.
he clinician seated the restorations and fabricated a custom nightguard to ensure these wouldn’t be damaged pending finalisation of the mandibular restorative process (Figures 16-17). The patient was highly satisfied with the aesthetic result of his new smile; in fact, he was so pleased he scheduled an appoint ment for restoring his mandibular teeth just two weeks later!
Figure 12. Final restoations after sintering.Figure 11. Restorations milled from IPS e.max ZirCAD Prime Esthetic.
Final result
To create the natural aesthetics the patient desired, the cera mist stained each restoration using IPS Ivocolor E16 Ocean, E04 Sunset, E02 Cream, Shade 2 and glazed with IPS Ivocolor Glaze Paste (Figure 14).
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Figure 14. Characterisation using IPS Ivocolor.
Figure 15a-b. Final characterisation and firing.
Figures 16-17. Final restorations in situ.
For more info, contact Ivoclar in Australia on 1300-IVOCLAR or in New Zealand, call 0508-IVOCLAR or visit www.ivoclar.com
About the authors
20 eLABORATE July/August 2022 cad | CAM
Yousef Sidki, DMD has been practicing in private practice since graduating from Boston University Dental School. He Sidki has led several practices and has had an extensive track so far in continuing education in the fields of cosmetics, implantology and treating worn dentition, as well as attaining fellowship status in the International Dental Implant Association.
Yuki Momma, RDT graduated from Yukioka Dental Technician School in Japan. He then started his career at Dental Lab Obal in 1998. In 2000, Yuki joined the Miyamoto Dental Clinic where he received direct feedback on each restoration he made. While working at the clinic, he challenged himself by studying at Osaka Ceramic Training Center. Upon his completion at the training center, he moved to Boston and started working as a Master Ceramist at Gnathos Dental Studio in Weston, Massachusetts.
Originally published in LMT. Reprinted with permission.
Figure 13. Crowns following initial staining.
Register Online Now at www.3dpd.events REGISTRATION FEES One Day $660 inc gst Two Days $990 inc gst sAVE $220 BEforE 10 DEc 2022 DATE AND TIME 10-11SYDNEYFebruary 2023 Starts 8.30am | Ends 5.00pm | Rego opens 8.00am See the website for venue details 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 © 2022 Main Street Publishing Pty Ltd WHITTY KLIJNSMA ELSEY YAHYA DAY ONE - FEB 10 - CLINICAL n Selecting the right printer for your practicedo you really get what you pay for? n The 3D printed crown - is it a reality? n Workflows for designing and printing temporaries n 3D printing software apps n Designing and printing surgical guides & splints n Workflows for producing chairside aligners n Is printing the solution for digital dentures? n What is accuracy in 3D printing? DAY TWO - FEB 11 - TECHNICAL n Selecting the right printer for your laboratory n Modern 3D printing technologies for dentistrya comparison n Workflow and manufacturing optimisation n Workflows for printing digital dentures n Correct methods for cleaning and post curing printable resins n Materials update and future directions n Safety and regulatory compliance n Effective troubleshooting of printer errors 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. THIS EVENT IS DESIGNED FOR DENTISTS, SPECIALISTS, DENTAL PROSTHETISTS & DENTAL TECHNICIANS
This one day course will cover changes in regulations and guidelines from 2018 to 2020 including:
dentevents presents...
Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines 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 will provide a summary of how those changes interlink with one another.
n Biofilm reduction strategies.
n Correct use of chemical and biological indicators.
dentevents presents...
The course will cover 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. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.
2020
n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover.
n Hand hygiene and hand care practices.
26
This one day course will cover changes in regulations and guidelines from 2018 to 2020 including:
n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover.
n Correct use of chemical and biological indicators.
The course will cover 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. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.
6 HOURS CPD Register Now: www.boosterinjection.com.au ON DEMAND ONLINE LEARNING PROGRAMME
n Risk-based precautions.
INTERACTIVE Q&A SUPPORT WEBINARS
n Addressing common errors in personal protective equipment.
n Requirements for record keeping for instrument reprocessing.
n Correct operation of mechanical cleaners and steam sterilisers.
n Wrapping and batch control identification.
Infection Control BOOT CAMP
26 VIDEOS - 6+ HOURS OF EDUCATION
COURSE TOPICS
Presented by Professor Laurence J. Walsh AO
n Risk-based precautions.
n Hand hygiene and hand care practices.
n Biofilm reduction strategies.
n Wrapping and batch control identification.
COURSE TOPICS
INTERACTIVE Q&A SUPPORT WEBINARS
n Addressing common errors in personal protective equipment.
n Correct operation of mechanical cleaners and steam sterilisers.
Presented by Professor Laurence J. Walsh AO
n Requirements for record keeping for instrument reprocessing.
6 HOURS CPD Register Now: www.boosterinjection.com.au
ON DEMAND ONLINE LEARNING PROGRAMME BOOT CAMP Infection Control BOOT CAMP 2020 VIDEOS - 6+ HOURS OF EDUCATION
Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines 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 will provide a summary of how those changes interlink with one another.
Professor Laurence Walsh AO is a clinically active specialist in special needs den tistry who is based at the University of Queensland in Brisbane. Laurie has been teaching infection control and clinical microbiology for over 25 years at postgrad uate level and has been the chief examiner in microbiology for the RACDS for the past 20 years. He has presented invited courses and lectures on infection control across Australia and internationally. Laurie has written over 60 articles on infection control and in addition published over 320 journal papers and a further 190 technical reports and literature reviews. He serves on two committees of Standards Australia (personal protecting equip ment; and instrument reprocessing) and in recent years has been an adviser to the Communicable Diseases Network of Australia and the Australian Commission on Safety and Quality in Health Care. Laurie has been a member of the ADA Infection Control Committee since 1998. He has contributed to various protocols, guidelines and checklists and manuals used in Australia.
Register Now: www.boosterinjection.com.au REGISTRATION FEES Dentists $660 inc gst Others $330 inc gst REGISTRATION INCLUDES n On-Demand access to 26 Online Learning Videos (Over 6 hours of education). n Online Learning Companion Booklet. n Suggested Reading Material Booklet. n Access to regular Q&A Webinar(s). n Online Questionnaire to earn 6 Hours of CPD. 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 © 2020 Main Street Publishing Pty Ltd UPDATE!FULL All the changes to InfectionGuidelinesControlin2020 dentevents.tv
Register Now: www.boosterinjection.com.au REGISTRATION FEES Dentists $660 inc gst Others $330 inc gst REGISTRATION INCLUDES n On-Demand access to 26 Online Learning Videos (Over 6 hours of education). n Online Learning Companion Booklet. n Suggested Reading Material Booklet. n Access to regular Q&A Webinar(s). n Online Questionnaire to earn 6 Hours of CPD. 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 © 2020 Main Street Publishing Pty Ltd dentevents.tv
with the implant is made of titanium. This eliminates the danger of material wear caused by direct contact between zirconia on metal. Released titanium particles could lead to negative aesthetic effects on the gingiva (titanium tattooing). The hybrid abutments also have a comparably high strength or fracture load because the titanium bonding bases increase the stability.
over
dentures. For manufacturing, there are essentially two methods currently favoured namely milling or 3D printing. And you can also do a combination of both as well as incorporating “carded” teeth and there are other options and hybrids as well. READ ME FOR CPD 34 eLABORATE July/August 2022 ceramic TECHNIQUES
M
Question 7. With multilayered zirconia, high aesthetics is often achievable...
READ ME FOR CPD
a. Use a light blocker. b. Use zinc oxide cement. c. Use cyanoacrylate. d. It’s not necessary to conceal the titanium base.
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 Jul/Aug 2022 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.
a. Only with pre-sintered staining. b. Without veneering porcelains. c. With the addition of titanium oxides. d. None of the above.
To retrieve your FREE Dental Community Login, Call (02) 9929 1900 or email joseph@dentist.com.au
Question 2. One major advantage of printing dentures over milling is...
packages and then manufacturing the
Part
H
past decade, there are other factors in to play here including an ageing population, increases in life expectancy and population growth to name a few. Couple with the
decline
Question 4. In Australia, the demand for dentures is...
Question 5. Very good printable denture base materials...
a. Digital from an Intra Oral Scanner b. CBCT c. Conventional d. Compound
a. Always insert the disk upside down. b. Always insert the disk right side up. c. Position the restoration in the disk nesting software correctly. d. Position the restoration sideways.
When fabricating a hybrid abutment crown, the choice of material plays an important role. The framework material should provide high stability as well as having translucent properties and a tooth-like appearance. The author describes why he prefers NexxZr T Multi (Sagemax) zirconia and how he deals with the clash between high aesthetics and economic requirements
aving a look at the recent statistics for edentulism in Australia and other places in the world, you would think that the demand for dentures is on the decline. However, things could not be further from the truth. In a nutshell, as far as Australia goes, roughly 1 in 10 adults 45 years and over and 1 in 5 adults 65 years older are edentulous. While there has a in edentulism the shortage of skilled dental technicians, especially for removable prosthetics and Houston... we have a problem. This is exactly why people are now pushing the digital denture barrow down your street and it’s no surprise it has been on the boil for many years as digital technology continues to permeate all areas of dentistry. A simple overview of the workflow encom passes scanning either intraorally or on a bench-top scanner taking records, software digital
READ THE ARTICLES AND ANSWER THE QUESTIONS ONLINE
Question 6. In this case the impression was...
been
a. No need for a pressure vessel. b. You can print multiple parts at the same time. c. Parts can be printed in 1 minute. d. No need to post cure any parts.
a. A DMD device comprising of micro mirrors. b. Laser tracing.
Question 9. To conceal the titanium base...
3D printing dentures1: Choosing a printer
Patient case
By Mark Bultmann, Master Dental Technician Clinical work by Dr med. dent. Katharina de Buhr
The osseointegrated implant in position 14 required fitting with an all-ceramic crown. In theory, this can be covered in the digital workflow; increasingly, we receive the dataset from the intraoral scanner. In this case, a conventional impression was taken. The master model was digitised with the scanbody and the data uploaded into the CAD software. The decision about the type of restoration was made in agreement with the dental practice. We fabricate almost exclusively all-ceramic abutments. One-part and two-part abutments are differentiated.1-3 In this case, a hybrid abutment crown (two-part) was fabricated. The all-ceramic CAD/CAM crown was cemented onto a titanium bonding base. In contrast to the one-part zirconia abutment, the contact surface
c. An LCD screen and LED array. d. An incandescent light bulb.
Framework fabrication
Question 1. DLP technology uses...
Question 3. Most 3D printing resins for dentures are...
and
a. Nylon-based b. Polypropylene c. Photopolymers d. PMMA
digital design using CAD
eeting expectations is part of the routine in the dental laboratory, but the challenge comes up again and again. Every patient has concrete expectations for the outcome that are driven by individual desires and spe cific needs. Working together with the dental practice, as dental tech nicians we are obliged to satisfy these expectations. In implant prosthetics we are responsible for effectively realising implant dentistry therapy with an aesthetic restoration. A delicate task for all ambitious dental technicians. To prevent excessive pressure due to placing too many demands on ourselves, we need to rely on tested processes and premium materials.
and
a. On the decline b On the rise c. Stable d. Not relevant anymore due to fluoride
Expectations met: hybrid abutment crown made of zirconium oxide with vestibular cut-back
a. Will never be available. b. Are 10 years away. c. Are 5 years away. d. Are now available.
Question 10. In this case, the titanium base was adhered to the crown using...
a. Superglue b. Ivoclar Multilink Hybrid Abutment c. PVA adhesive d. Elmer’s glue all
Amonolithic crown was constructed taking into account the functional criteria. A cut-back was created in the vestibular area. It is often possible to achieve a natural aesthetic without veneering with multi-layer zirconia. However, to meet the high aes thetic expectations in this case, vestibular veneering was required. After construction, the abutment crown was milled from NexxZr T Multi (Sagemax). This multi-layer zirconia combines two generations of zirconia (3Y-TZP and 5Y-TZP). This results in a high flexural strength (1170 MPa) in the cervical region that is associated with high incisal translucency. Unlike some other multi-layer zirconia, NexxZr T Multi has a smooth colour and translucency gradient and is free of visible layers. As a result, the restorations appear very natural and in many situations mono lithic implementation without aesthetic compromises is possible. To be able to optimally utilise the colour gradient when nesting, ensure that the crown is correctly positioned in the milling blank. Morphological details are touched up after the milling. Caution: Zirconia is a “delicate petal” - particularly in the white chalk-like state (before sintering) - and it must be handled with care. Do not use laboratory turbines or steam!
Answer the questions online at www.dentalcommunity.com.au
Question 8. To correctly achieve the colour gradient when milling...
By Terry Whitty
ONLINE CPD CENTRE 26 eLABORATE July/August 2022 cad CAM
Straumann Pty Ltd/Straumann New Zealand Limited 93 Cook Street, Port Melbourne VIC 3207, Australia AU Toll Free 1800 660 330 | NZ Toll Free 0800 408 370 Email customerservice.au@straumann.com www.straumann.co.nzwww.straumann.com.au ©Institut Straumann AG, 2021. All rights reserved. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates. Play your cards right. Contact your Straumann Group Solutions Specialist to claim your free trial Straumann Pty Ltd/Straumann New Zealand Limited 93 Cook Street, Port Melbourne VIC 3207, Australia AU Toll Free 1800 660 330 | NZ Toll Free 0800 408 370 Email customerservice.au@straumann.com www.straumann.co.nzwww.straumann.com.au ©Institut Straumann AG, 2021. All rights reserved. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates. Compatible with Neoss® & MegaGen Implant Systems Medentika® MPS Multi Platform System NE & MG SERIES
A simple overview of the workflow encom passes scanning either intraorally or on a bench-top scanner and taking records, digital design using CAD software packages and then manufacturing the digital dentures.
3D printing denturesPart 1: Choosing a printer
In a nutshell, as far as Australia goes, roughly 1 in 10 adults 45 years and over and 1 in 5 adults 65 years and older are edentulous. While there has been a decline in edentulism over the past decade, there are other factors in to play here including an ageing population, increases in life expectancy and population growth to name a few. Couple with the
shortage of skilled dental technicians, especially for removable prosthetics and Houston... we have a problem. This is exactly why people are now pushing the digital denture barrow down your street and it’s no surprise it has been on the boil for many years as digital technology continues to permeate all areas of dentistry.
For manufacturing, there are essentially two methods currently favoured - namely milling or 3D printing. And you can also do a combination of both as well as incorporating “carded” teeth and there are other options and hybrids as well.
READ ME FOR CPD
By Terry Whitty
26 eLABORATE July/August 2022 cad | CAM
H
aving a look at the recent statistics for edentulism in Australia and other places in the world, you would think that the demand for dentures is on the decline. However, things could not be further from the truth.
hat is best? Up until a year or so ago, I would have always said milling is the way to go and it still gives you premium results as it works with materials we already know and have used for years, namely PMMA. However, it does have limitations, for example, one mill can only mill one denture at a time,regardless of the size of the mill, be it base or teeth or a combination of both and some denture bases cannot be milled due to geometry limitations. It’s also quite a time-consuming process and let’s face it, milling equipment is a fairly hefty invest ment in both dollar terms and time spent learning the procedures. I’d love to say every digital manufacturing procedure like this was plug and play but It’s just not. Although it’s usually very good and reliable, you can get a curve ball you may well just want go back to pack and press.
Figure 2. General vat polymerisation 3D printer parts.
cad | CAM
Figure 1. Printed dentures.
Figure 4. Digital Light Projection.
W
July/August 2022 eLABORATE 27
Figure 5. Masked Stereolithography.
Additive or subtractive?
With 3D printing, in comparison, the manufacturing of dentures is a lot easier and less expensive to get into and the learning curve is a little easier than with milling. You can print multiple parts at a time, for example, multiple denture bases or multiple sets of teeth. You can print any geometry so that patient with the huge anterior tissue undercut can be printed exactly. You have a choice of many materials and more and more materials are coming to market as the demand is growing. I will say the perfect 3D printable denture base material is not here yet, but things have improved so much in the last couple of years that it’s now very feasible to create a good denture with 3D printing.
Figure 3. SLA printing using laser light.
Of course, we will always be comparing 3D printed dentures with the materials we know, like PMMA, but if you look a little past that comparison, you’ll find it a great addition and a fantastic way to start your digital journey.
once you start relying on it as an option for professional manufacturing for dentistry, you’ll most likely be sadly disappointed and look around for something better.
Figure 7. ASIGA PRO 4K printer.
28 eLABORATE July/August 2022
The internet is awash with 3D printers, especially the temptingly cheap ones that promise the world and if you want to have a dabble, by all means buy one and print some chess pieces and the like. However,
Figure 8. Formlabs Form 3 printer.
is that every manufacturer will tell you that their product is the best. They have glossy brochures, amazing websites and throw crazy numbers and statistics at you, 4K, 6K, 8K, 10-200µm layers, etc, all of which actually means nothing unless understood in context.
S electing a 3D printer for dentures can be confronting and difficult to the uninitiated. The main reason for this
Figure 6. ASIGA MAX UV printer.
Figure 11. Ackuretta SOL printer.
Printer selection
For polymer printing, the standard process involved uses a vat of photo polymerising resin where a light source underneath cures layers of the object being printed one at a time, gradually building up the shape. A build platform moves up in small increments, usually 50 or 100 microns, until the object is printed.
cad | CAM
Figure 10. NextDent 5100 printer.
Figure 9. UNIZ NBEE high speed MSLA printer.
MSLA can print quite quickly and as mentioned, uses an LCD screen that is directly under the build platform. The for mation of resin layers creates quite a lot of heat, the LCD screen therefore must be able to withstand quite high temperatures and this is why they are often cooled with fans. Some manufacturers even use liquid cooling, not unlike the cooling system to cool engines in automobiles. Eventually they fail and need to be replaced, but this a known consumable part.
omparing the light technologies,
2. DLP - Digital Light Projection; and
Light sources
Pro S SprintRay DLP Yes Limited
NextDent 5100 Next Dent DLP Yes No
cad | CAM
Form 3 Formlabs SLA Yes No
SOL Ackuretta MSLA Yes Limited
There are 3 main technologies:
Essentially, the technologies are the same except for the light source. Whereas SLA uses a laser bounced off a mirror, DLP uses an ingenious array of micro mir rors to process and project a light source while MSLA uses LED lights and an LCD screen in a similar way to how an LED TV works.
PRO 4K ASIGA DLP Yes Yes
cara Print 4.0 Kulzer DLP Yes No
Figure 12. cara Print 4.0 from Kulzer. Figure 13. UNIZ SLASH 2 PRO. Figure 14. Pro S from SprintRay.
DLP can also print quite quickly but there is no contact with sensitive parts, so the heat generated potentially does not damage anything. It’s also a very reliable technology. Other consumable parts to be aware of are resin tanks, these hold the resin and incor porate a special non-stick film within. This film wears out over time and needs to be replaced. Often you can trace misprints to the wear of this film but because it’s incred ibly difficult to assess this by eye, a system that monitors it for you and advises when replacement is required is best. Of course, the resin is a consumable, but we will cover biocompatible denture resins in an upcoming article.
SLASH 2 PLUS UNIZ MSLA Yes Yes
Accuracy
STL File Support for 3rd Printer Manufacturer Technology Support party resins
NBEE UNIZ MSLA Yes Yes
M any people ask the same question, “how accurate is the printer” and to answer that in detail, see Dental 3D printing: Is it accurate and precise? (eLABORATE Volume 18, Number 04, Jul/Aug 2021) where I have written an entire article on that subject. Always look beyond the quoted “build resolution” figure as there is way more to it than that. Suffice to say, all the quality printers available for dentistry these days show good dimensional accuracy - and possibly more importantly repeatability - and can be used to print denture bases and teeth. However, as with a lot of things in life, generally you will get what you pay for so if a printer appears to be an absolute bargain, there will be a reason why - you will sacrifice something.
SLA tends to be quite a slow pro cess as the laser has to “draw” each layer to be printed, whereas DLP and MSLA expose the entire layer all at once. So if speed is important, SLA may not be your best choice.
MAX UV ASIGA DLP Yes Yes
TABLE 1.
3. MSLA - Masked Stereo Lithography.
C
30 eLABORATE July/August 2022
1. SLA - Stereo Lithography;
1300 878 336 Contact us today and we will show you how to integrate 3D Printing into your Laboratory fabdent.com.au PRINT MODELS IN 5 MINUTESUNBEELIEVABLE1300878336Contact us today and we will show you how to integrate 3D Printing into your Laboratory fabdent.com.au PRINT MODELS IN 5 MINUTES UNBEELIEVABLE Scan the QR code to see six models printed in 5 minutes on the amazing NBEE 3D Printer from UNIZ
Table 1 shows a comparison of a selec tion of current locally available 3D printers suitable for denture manufacturing.
Materials
Terence Whitty is a well-known dental technology key opinion leader and lec tures nationally and internationally on a variety of dental technology and material science subjects. He is the founder and owner of Fabdent, a busy dental labora tory 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 pros thetics, computerised implant planning and guidance, TMD, sleep appliances and paediatrics.
Figure 15. The applications for 3D printing in dentistry continue to expand as new materials safe for in-mouth use are released.
cad | CAM
The alternative is getting a “do all” printer, one that can print any material regardless of whether it is available now or in the future. These printers allow you to tweak any setting of the printer so you
32 eLABORATE July/August 2022
can match the parameters needed to print the desired resin. This is a good thing and allows a lot of flexibility so you must really consider this as a “must have” fea ture in my opinion for denture printing.
About the author
O ne really important feature of 3D printers for dentures is the ability to print materials from different manu facturers. Some printers lock you in to their resins and you cannot print 3rd party resins. Now of course, that’s a smart thing to do from one perspec tive; it’s like saying “use our resin and our printer and everything will be fine”. And it will usually be fine until a new breakthrough material comes to market or prices increase. What if you want to start printing new Brand X super supreme denture material?
Track record
L ast but not least, you have to look at the track record of the company behind the printer. Has the manufacturer been around for a while or are they a startup yet to secure its future. What is their service and support like? Do they have local agents and service centres near you (that can repair the product in Australia) and is after sales training available both online and by remote support. This is very important for digital dental technology, especially when you want to dive in to something new.
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monolithic crown was constructed taking into account the functional criteria. A cut-back was created in the vestibular area. It is often possible to achieve a natural aesthetic without veneering with multi-layer zirconia. However, to meet the high aes thetic expectations in this case, vestibular veneering was required.
When fabricating a hybrid abutment crown, the choice of material plays an important role. The framework material should provide high stability as well as having translucent properties and a tooth-like appearance. The author describes why he prefers NexxZr T Multi (Sagemax) zirconia and how he deals with the clash between high aesthetics and economic requirements
READ
he osseointegrated implant in position 14 required fitting with an all-ceramic crown. In theory, this can be covered in the digital workflow; increasingly, we receive the dataset from the intraoral scanner. In this case, a conventional impression was taken. The master model was digitised with the scanbody and the data uploaded into the CAD software. The decision about the type of restoration was made in agreement with the dental practice. We fabricate almost exclusively all-ceramic abutments. One-part and two-part abutments are differentiated.1-3 In this case, a hybrid abutment crown (two-part) was fabricated. The all-ceramic CAD/CAM crown was cemented onto a titanium bonding base. In contrast to the one-part zirconia abutment, the contact surface
with the implant is made of titanium. This eliminates the danger of material wear caused by direct contact between zirconia on metal. Released titanium particles could lead to negative aesthetic effects on the gingiva (titanium tattooing). The hybrid abutments also have a comparably high strength or fracture load because the titanium bonding bases increase the stability.4,5
34 eLABORATE July/August 2022 ceramic | TECHNIQUES
eeting expectations is part of the routine in the dental laboratory, but the challenge comes up again and again. Every patient has concrete expectations for the outcome that are driven by individual desires and spe cific needs. Working together with the dental practice, as dental tech nicians we are obliged to satisfy these expectations. In implant prosthetics we are responsible for effectively realising implant dentistry therapy with an aesthetic restoration. A delicate task for all ambitious dental technicians. To prevent excessive pressure due to placing too many demands on ourselves, we need to rely on tested processes and premium materials.
Patient case
Framework fabrication
M
A
After construction, the abutment crown was milled from NexxZr T Multi (Sagemax). This multi-layer zirconia combines two generations of zirconia (3Y-TZP and 5Y-TZP). This results in a high flexural strength (1170 MPa) in the cervical region that is associated with high incisal translucency. Unlike some other multi-layer zirconia, NexxZr T Multi has a smooth colour and translucency gradient and is free of visible layers. As a result, the restorations appear very natural and in many situations mono lithic implementation without aesthetic compromises is possible. To be able to optimally utilise the colour gradient when nesting, ensure that the crown is correctly positioned in the milling blank. Morphological details are touched up after the milling. Caution: Zirconia is a “delicate petal” - particularly in the white chalk-like state (before sintering) - and it must be handled with care. Do not use laboratory turbines or steam!
T
By Mark Bultmann, Master Dental Technician Clinical work by Dr med. dent. Katharina de Buhr ME FOR CPD
Expectations met: hybrid abutment crown made of zirconium oxide with vestibular cut-back
Completing the abutment crown
he sintered crown (NexxZr T Multi) showed the usual good fit and after sintering, had wonderful optics and a smooth colour gradient. The vestibular veneering (ZI-CT, Creation) was per formed in five steps. For the first firing - Frame Shade bonding agent - the veneering surface was coated with a high-fusing, fluo rescing ceramic material. The second firing is similar to the wash firing. Using the sprinkle technique, fluorescing shoulder mate rial was sprinkled onto the framework. This produces a slightly roughened or glazed surface that creates vivid colours and sup ports the bond between the zirconia and the veneering ceramic. For the dentine firing, the crown was coated with the dentine
July/August 2022 eLABORATE 35
Figure 1. Milled hybrid abutment crown (NexxZr T Multi, Sagemax).
Figures 3 and 4. Opaquing the adhesive surfaces (screw channel) with a light blocker (LightBlock) to conceal the titanium base.
T
Figure 2 Manual finishing; here, removing the fissures with a square cutter.
Cementation of the titanium base and insertion
ementing a crown to the titanium base requires a reliable protocol because the bond determines the long-term success. Blasting and conditioning of the titanium base and the zirconia adhesive surface and cementation with the luting composite (Mul tilink Hybrid Abutment, Ivoclar) were performed according to the information from the manufacturer. Thorough removal of residual composite near the cementation joint followed manual polishing of the basal parts. A certain micro-roughness is recommended in the transmucosal area to encourage the growth of the gingiva while at the same time counteracting the deposition of plaque.3 A final check on the model confirms the fit and correct adjustment of the proximal contact surfaces. The restoration was sent to the practice and screwed occlusally into the patient’s mouth.
ceramic | TECHNIQUES
C
To conceal the titanium base, the crown is coated inside the screw channel with a light blocker (LightBlock, Briegel Dental). This opaque liquid prevents the titanium base showing through without negatively affecting the translucency of the zirconia. During sintering, the liquid diffuses into the zirconia and masks the titanium base.
and enamel materials. Because NexxZr T Multi has a tooth-like colour already, only a thin veneer layer is necessary. This step was followed by a corrective firing and, after working the surface texture, by the final glaze firing.
Figure 6a and b. Preparation of the surface for the vestibular veneering: “Sprinkle technique” - sprinkling of fluorescing shoulder material for a vivid internal colour.
Figure 5b. Familiar precise fit of a restoration made from NexxZr T zirconia.
Figure 7. Veneering completed and final ised after working the surface texture.
References
he exceptionally natural appearance of the light optics of the hybrid abutment crown is confirmed intraorally. The restora tion appears warm and vibrant from the inside out. The titanium base is completely concealed; nevertheless, the crown has a beau tiful translucency. In theory, NexxZr T Multi and its colour and translucency gradient allow the fabrication of monolithic res torations. Because the esthetic demands in this case were high, vestibular thin-layer veneering was carried out. The functional surfaces remain monolithic, which provides a high level of pro tection against chipping. The expectations of the patient were met in full. The implant dentistry therapy is successfully completed. At the same time, this efficient method of fabrication is in accord with the economic requirements of the dental laboratory.
1. Gehrke P, Dhom G, Brunner J, Wolf D, Degidi M, Piattelli A. Zirconium implant abutments: fracture strength and influence of cyclic loading on retaining-screw loosening. Quintessence Int 2006; 37:19–26
T
36 eLABORATE July/August 2022 ceramic | TECHNIQUES
Conclusion
3. Gehrke P, Kaiser W, Fischer C. Comparative analysis of surface topography of custom of CAD/CAM zircona abutments by means of optical profilometry. In progress.
4. Stimmelmayr M, Sagerer S, Erdelt K, Beuer F. In vitro fatigue and fracture strength testing of one-piece zirconia implant abutments and zirconia implant abut ments connected to titanium cores. Int J Oral Maxillofac Implants 2013; 28:488–493.
5. Yilmaz B, Salaita LG, Seidt JD, McGlumphy EA, Clelland NL. Load to failure of different zirconia abutments for an internal hexagon implant. J Prosthet Dent 2015; 114:373–377.
2. Gehrke P, Johannson D, Fischer C, Stawarczyk B, Beuer F. In vitro fatigue and fracture resistance of one- and two- piece CAD/CAM zirconia implant abutments. Int J Oral Maxillofac Implants 2015; 30:546–554.
Figure 5a. Immediately after the sintering: Wonderful aesthetic properties with a smooth colour and translucency gradient.
• Opening Breakfast • Free childcare • Free business growth seminars • Latest technology & innovations • Women in Dentistry Breakfast • Australian Dental Association Queensland professional CPD program Brisbane Convention & Exhibition Centre Highlights include: REGISTER NOW AUSTRALIA’S PREMIER DENTAL EVENT See you at 27 - 29 October 2022 @ausdental / ADX expo @ ad x expo adxbrisbane.org.auFREEENTRY #ADXexpo #ADXBrisbane
NexxZr+ Multi multilayer zirconia
Figure 9. Fit check on the model.
Sagemax NexxZr T Multi is the latest gen eration multilayer zirconia (3Y-TZP cervical, 5Y-TZP incisal). The com bination of the very high flexural strength (1170 MPa cervical, 630 MPa incisal) and the smooth gradient of colour and translucency makes the difference. This combination offers optimal conditions for the fabrication of monolithic or anatomically reduced single-tooth and bridge restorations.
For more info, contact Impulsedent Australia on 1300-303-638 or (07) 3200-4750 or visit www.impulsedent.com.au.
About the author
38 eLABORATE July/August 2022 ceramic | TECHNIQUES
Figure 10. Hybrid abutment crown cemented on the titanium base, prepared for screwing into the patient’s mouth.
Mark Bultmann is a master dental technician and owner of Via Denta GmbH, a dental laboratory founded in March 2006 in Germany. He believes in taking a holistic approach to patient care and designing restorations based on comprehensive scien tific backing and research.
Figure 8. Cementation of the hybrid abutment crown onto the titanium base.
Dr med. dent. Katharina de Buhr studied dentistry at the University of Ulm. She currently works in her own private dental practice Zahnwerk Westerstede in Westerstede, Germany.
Figure 11. Restoration after being screwed onto the implant at position 14.
sagemax.com © 2022 Sagemax Bioceramics, Inc., Federal Way, WA, US, Sagemax and NexxZr are registered trademarks of Sagemax Bioceramics Inc. 50 Natalie Road, Buccan QLD 4207 T: 1300 303 638, (07) 3200 4750 F: (07) 3200 4752, E: www.impulsedent.com.aucontact@impulsedent.com.au Get your disc here: ... it's NOT just Multia ... 630 MPa 49 % Translucency Multi 1170 MPa 42 % Translucency NexxZr® T Multi Multifunctional aesthetics. Multiple indications. › In 20 Colors › Smooth color and translucency gradient › Single-unit restorations up to multi-unit bridges First Impulsedent–10order%reduction**Specialconditionsforalimitedtimeonly!NexxZrTMulti
When choosing a thermoforming machine, it’s tempting to start with com paring the machinery or fitting to a budget but in my opinion, the best starting point is with the question “What do I want to use the machine for now and into the anticipated future”. Finding the best ther moforming unit to answer this question will set you on a path for success in the longer term.
B oth pressure and vacuum thermo forming units broadly achieve the same result but each has unique character istics that predispose them to suit different use cases and environments.
40 eLABORATE July/August 2022
Choosing a thermoforming machine
W
So, what do you want to make?
thermoforming | TECHNIQUES
So when considering which machine to purchase, it’s important to choose the unit that is best suited to produce the appli ances that you want to make now and also to try and predict what you may wish to produce in the future.
Pressure or vacuum?
models may prefer a “plug and play” auto matic pressure unit. While a production laboratory might use both a rapid vacuum unit and a pressure unit to take advantage of each machines’ strengths.
With Erkopress - automatic pres sure forming - the material is “pushed” onto the model in a closed chamber. If the forming pressure is high enough, there are always good results.
hether you are new to thermoforming or an experienced user, today’s market gives you plenty of choice of equipment. There are options of pressure forming, vacuum forming, auto mation, attachments, a wide range of price points and so on.
outhguards, splints, impression trays, base plates, temporary crowns and bridges, orthodontic appliances, snore guards, bleach trays, temporary dentures, surgical guides and more, the applications for dental thermoforming are expansive and engages a wide range of skill levels and equipment needs. As examples, a surgery which wants to add the simple capability of in-house whitening trays, retainers, mouthguards and the occa sional splint will need a machine that can be easily operated by multiple staff with minimal training and would be best served by an automatic rapid vacuum unit. An orthodontic practice producing quantities of retainers and aligners on 3D printed
With Erkoform - automatic rapid vacuum - the material is “pulled” onto the model and accessible during the forming process. Rapid (sudden) vacuum gives results clinically equivalent to pressure.
M
By Peter Herring, Adv Dip Dent Tech, ACCDP
July/August 2022 eLABORATE 41 telephone toll free 1800 242 634 - email info@erkodent.com.au online shop www.erkodent.com.au www.erkodent.com.au 24 hour online ordering Technical support, service and training Downloads, instructions & new products thermoforming | TECHNIQUES
air supply, are quiet, easy-to-use and leave the model accessible during the forming process. Access to the model allows the use of optional articulator type attach ments which make it possible to add the bite into a splint or mouthguard at the same time as thermoforming is taking place.
Pressure machines operate either from an external compressed air supply or via an inbuilt compressor, operating at pres sures of up 6 atmospheres.
The less aggressive nature of these machines can make appliances, in par ticular hard retainers and splints, more passive and comfortable for patients to wear. Model quality is less particular than with the pressure units.
Pressure machines are recommended for use by more experienced operators and are especially good for orthodontic bracket transfer appliances, retainers/aligners on printed models and essential for tech niques that involve self cure acrylics.
With pressure, there is the advantage of very high thermoforming power but with the disadvantage that more atten tion to model quality and blocking out procedures is required. The model is not accessible during the forming process and a clean supply of compressed air may be required. These machines are the “uni versal” thermoforming machines and can be used to make any appliance. They are most often used by commercial dental laboratories that have good facilities for high quality model production and well trained operators and for orthodontic sur geries where the machines with inbuilt air compressors provide a “plug and play” automatic pressure solution.
These machines are preferred for gen eral production of bleach trays, splints (with articulator type attachment), lami nated “Playsafe” type mouthguards, custom trays, orthodontic retainers, etc. The automatic operation and ease of use makes these machines more suitable for use by a variety of dental office staff.
About the author
Automatic rapid vacuum machines are widely used in both labs and surgeries. Requiring no external air supply, they operate by accumulating a vacuum in an internal reservoir using a self-contained vacuum pump. When the heating cycle is complete, the automatic forming process brings the foil to the model and the stored vacuum is released, thereby forming the foil rapidly downwards over the model. It is this rapid forming process that allows the creation of the detail and fit which is clinically the equivalent to pressure forming. The rapid vacuum machines have the advantage of requiring no compressed
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 dedi cated to thermoformed appliances. He can be contacted at pjh@erkodent.com.au or for general enquires, call Freecall 1800-242-634.
Tel: rolanddg.com.au/dwx53dcsales@rolanddg.com1800-500-119
Next generation desktop milling
and controlled manner. Colour is aqua and the box contains 2 x 3ml syringes and 10 appli cation cannulas.
Tel: (02) www.info@alphabond.com.au9417-6660alphabond.com.au
Bredent Compoform UV Modelling Resin
Bredent Compoform UV is a light-curing composite for modelling, fixation of sepa rated bridges and for quick fabrication of post and core restorations. Compoform UV burns out without leaving any residue and produces homoge neous casting results. It allows individual modelling directly from the syringe and thanks to immediate hardening with a polymerization lamp, the model can be built up in a safe
Information contained in this section is provided by the manufacturers or distributors. eLABORATE does not assume responsibility for the accuracy of the data.
A range of “pucks” suitable for 98mm milling units are avail able in 3 types: Wax Blocks - Easy to apply, excellent adhesion to the die stone with a great machinable quality for smooth contouring on the die. It has a high melting tempera ture (102°C) so it will not be affected or distorted when other waxes are applied over it. Monolayer Blocks - Acrylic teeth material, combined with the advanced CAD/CAM mod elling technique. Monolayer blocks are made of highly cross-linked PMMA mate
AlphabondAvailable: Dental
newly designed automatic disc changer. The milling chamber is sealed to keep milling waste away from other areas of the milling device and includes an ionizer to allow easy removal of PMMA milling waste. The DWX-53DC has a built-in camera that links the device with DGSHAPE CLOUD support. Users can view live production from anywhere with a mobile phone or tablet. The camera also provides recorded video, so users can troubleshoot their device and monitor maintenance activi ties. A new automated cleaning process also takes the work out of removing zirconia dust and waste from the device.
Tel: (02) www.info@alphabond.com.au9417-6660alphabond.com.au
AlphabondAvailable: Dental
rial; Multilayer Blocks - Four layers of different shade inten sity. Multilayering ensures natural aesthetic results, in particular when fabricating long-term temporary ante rior restorations. Available in 98x20 thickness for milling PMMA teeth.
Sinter Furnace Beads - 50 grams
The DGSHAPE DWX-53DC next generation desktop milling unit offers a swifter, cleaner production experience for all dental applications and an improved, user-friendly support experience through DGSHAPE CLOUD. The DWX-53DC’s elegant new design features a separately covered auto matic tool changer, keeping tools free of additional mate rial waste. Adapters are easily and quickly interchanged in a
new | PRODUCTS
42 eLABORATE July/August 2022
Shandong Huge 99mm CAD/CAM Pucks
These 1.5mm sized sintering beads are made from zirconia. The use of zirconia sintering beads will reduce the atmos phere inside the sintering tray to ensure perfect results. They prevent crowns and bridges from sticking or jamming during the sintering process. It must be ensured that single crowns are embedded in sin tering beads up to their upper
AlphabondAvailable: Dental Tel: (02) www.info@alphabond.com.au9417-6660alphabond.com.au
edge. Though, it must be ensured that they should not enter the crowns in order not to hinder the sintering shrinkage.
DGSHAPEAvailable: dealers
1300 878 336 Contact us today and we will show you how to integrate Affordable Digital Dental Technology into your business. • Model Scanning • Impression Scanning • Colour Scanning • Texture Scanning • Articulator Scanning • Compatible with every major 3D printer, Mill and Software • Crown and Bridge, Implants, Digital Dentures, Partials, Orthodontics The new Shining 3D DSEX PRO GOLD Scanner combines unbeatableperformanceamazingwithvalueGOFOR GOLD ! BUY BEFORE JUNE 30 FOR INSTANT ASSET TAX WRITE OFF !
² ceramill® motion 2 INSIDE100% Amann Girrbach AG Tel +43 5523 www.innovatiodentalsupplies.com.ausales@innovatiodentalsupplies.com.auTelwww.amanngirrbach.com62333-1050285758675
FOR RFID READY FOR
READY
The latest Mark IV machine generation represents the benchmark in terms of fabrication quality. The Ceramill Motion 2 convinces with new features and 3 attractive packages for wet and dry processing. Thanks to the innovative DNA control technology and the robust machine concept, the Ceramill Motion 2 is a future-proof guarantor for costeffectiveness and precision.
Ceramill Matik opens up a still unique segment within the digital dental world. As the first full service unit, it combines three machines in one. Apart from the actual processing station, the system also performs the functions of a fully automated stock management system as well as a machine cleaning device.
Zirconia stands for the highest standards in terms of the spectrum of indications, esthetics and cost-effectiveness.
² ceramill® motion 3 WELCOME TO THE AGE OF DIGITAL DENTAL TECHNOLOGY #DigitalPaceForDentalPeace READY FOR RFID
With the Ceramill Motion 3, you will be adding the world's most intelligent 5-axis hybrid machine to your laboratory. The milling unit not only combines wet and dry processing in a single machine, but also enables an end-to-end digital workflow.
² ceramill® matik