Contents Editorial
Transcrição
Contents Editorial
MAGAZINE June 2004 No. 5 Year 2 An Innovative Magazine for Dentists from 3M ESPE Editorial Dear Readers, By offering a unique range of products for the entire spectrum of restorative and preventative dentistry, 3M ESPE enables its customers to select a special material for the preferred method of treatment. In this edition you can read more about a new VPS silicone specially designed for the putty wash impression technique. Another field of innovation is Nanotechnology, which indeed may be a candidate to become the word of the year. Within dentistry, the word Nanotechnology is often used to describe very small filler particles in restorative materials, but for 3M ESPE it means much more than filler size only: instead it is a completely new approach to designing, producing and then introducing special fillers into resin matrices to improve the technical properties of resin composite materials. Using 3M Nanotechnology, the recently launched Filtek™ Supreme Universal Restorative, which combines the aesthetic advantages of a microfiller with the mechanical properties of a hybrid composite material, is now followed by a new single dose adhesive. Both products and technologies are discussed in different articles in this Espertise Magazine. In addition we continue the series of clinical cases and user reports using 3M ESPE materials from prep to crown, reflect upon some scientific education activities and help you with further information about daily practice. Contents Editorial & Contents ™ ™ Express Penta Putty Vinyl Polysiloxane: 1 2 A New Era in Impression Material Technology Adper™ Scotchbond 1 XT Adhesive: 4 Picture this ... a Total-Etch Adhesive in a Unit-Dose Filtek™ Supreme Universal Restorative: 6 Nanovations in Dental Composite Filler Technology Filtek™ Supreme Universal Restorative: 8 The Winner is .... ! Lava™ Crowns and Bridges: 9 Restoration of a Fractured Molar Enjoy reading! From Prep to Crown: 10 Dental Materials in the Daily Practice Filtek™ Supreme Universal Restorative: 12 Tooth 13 – Incisal Edge Extension Lava™ Crowns and Bridges: Gerhard Kultermann, Editor 3M ESPE, Seefeld, Germany 14 Focus on Zirconium Oxide – All-Ceramic Symposium in Munich Dental Practice Forum: 15 Marketing Ideas for your Dental Surgery Lava™ Crowns and Bridges: 16 Copying Nature and Creating Oral Harmony General Information 16 Product Information Express™ Penta™ Putty Vinyl Polysiloxane A New Era in Impression Material Technology Laslo Faith; 3M ESPE, Germany Hand-mixing of impression materials started in the 1950s when the first condensation cure silicone putty was launched. In 1975 the first vinyl-polysiloxane (VPS) putty materials arrived in dentists’ operatories and hand-mixing continued, but in a more skin-friendly way because activator liquids were not required. Putty materials are mainly used for 2step impressions. These very high viscosity materials give dentists control when inserting the tray. By feeling resistance of the material there is better tactile control of the tray and there is a sort of “feed-back” concerning the correct position of the first impression. This rigid first impression will provide also a good “frame” for the second impression with light-body wash materials and will minimize risk of distortion. Market research in 2001 – 2003 showed that there are a significant number of dentists using putty materials in Europe. 2 So far, the highly viscous quality of these materials made hand-mixing mandatory. The forces which are necessary for a proper mixing of the two components are significant, and mixing must be done in a limited amount of time. The person doing the mixing must avoid including any air bubbles in the material, this is nearly impossible. Additionally hand-creams and other chemicals which might be still on the skin, even after hands are washed thoroughly, will inhibit proper setting of the material. Latex gloves will also induce inhibition and incomplete setting. Vinyl gloves will avoid all this, but putty mixing with gloves is always a bit of a challenge. The Pentamix™ automatic mixing device was introduced in 1993/1994. This device was developed to mix medium viscosity polyether materials, which, up to this point, had been mixed using a spatula on a mixing pad. In the Pentamix the materials are pressed through a small rotating mixing tip and are mixed in a homogeneous way. VPS putties were far too rigid to be mixed with the original Pentamix System. The excellent acceptance of automatic mixing using the Pentamix showed the future of impressioning. Homogenously mixed pastes, fully compliant with user information on working and setting times are the result (Pospiech, Wildenhain et al., Abstract no. 1062, IADR, 1998). The Pentamix Automix (left) versus Hand mix (right) Contamination of material in the jars might also occur. Imperfect setting of putty for “unknown reasons” happens once in a while and there will be no solution. Up to now, automatic mixing systems, like the hand dispenser for light body materials, were unable to mix putties, because these devices were not powerful enough. Mixing medium viscosity materials with a hand dispenser is already too difficult for some surgery assistants. gives automatically mixed materials that are reliable and repeatable results1. The challenge in the case of automixing of VPS putty materials is their rigidity, which is not compatible with the standard mixing tips. First of all, with the Pentamix 2 a much stronger device was available. Changes in the mixing tip, combined with MAGAZINE stronger cartridges and foilbags have created the hardware components which are necessary for this challenge. In this environment the material Express™ Penta™ Putty was created. With this 3M ESPE achieved a breakthrough in impression material technology. Pressing a button is now all that you need to do to mix and apply a putty material. The material will be homogenous and the tray will be filled with no stress and time pressure. In the end this was a small step for 3M ESPE but a big leap for dentistry! Combining these two materials creates a system with excellent performance. Express Penta Putty is the end of the era for hand mixing and the beginning of the “button pressed” era of stressfree impression taking. This material is a true putty, which behaves exactly as it should while seating the tray, during and after setting. There is the characteristic resistance when inserting the tray in the mouth and the high final rigid set. For Express Penta Putty a special version of patented Vinyl Polysiloxane materials is used. This VPS will make the material easier to mix, but it will behave as a true putty after mixing, e.g. one can cut it in the same way as a real putty. As the wash component of the system 3M ESPE developed an ultralight body material – 3M ESPE Express Ultra-Light Body Vinyl Polysiloxane Impression Material. This orange material is very flowable and is showing a very high tear strength. 1 (Pospiech, Rammelsberg, Zur Abformung mit Polyätherabformmassen ...) Die Quintessenz, July 1994). 3 June 2004 No. 5 Year 2 Adper™ Scotchbond™ 1 XT Adhesive Picture this … a TOTAL-ETCH Adhesive in our UNIT DOSE Jon W. Fundingsland; 3M ESPE, USA and Roland Richter; 3M ESPE, Germany Technology In the following sections technical details are summarised, which relate to the innovative composition of the adhesive, based on the addition of nanofillers, as well as the latest test results of scientific studies. 4 Adper Scotchbond 1 XT incorporates 10% by weight of 5 nanometer-diameter silica particles. These silane pretreated particles are added in a manner that does not allow them to agglomerate. As discreet particles, their extremely small size keeps them in colloidal suspension, so no shaking of the bottle is needed to re-disperse the filler prior to clinical use. These particles are not the relatively large and random particles formed using the fuming process, but are discreet particles, roughly spherical in shape. The following TEM photographs illustrate this difference. Note, the TEMs are not at the same magnification. Scotchbond 1 XT 3M ESPE nanoparticles competitor’s filler Performance It is the purpose of an adhesive to produce adhesion between restoration material and tooth structure and, at the same time, to perfectly seal the prepared surface of a tooth. Consequently, the most common method of determining the performance of an adhesive is by measuring the bond strength between restoration material and enamel or dentine after application of the adhesive being examined. In addition to this, investigations with an electron microscope OptiBond Solo™ Plus ➤ ➤ ➤ Adper Scotchbond 1, which has been clinically proven for many years now, has been further optimised by the addition of nanofillers. It is available since May 2004 in a bottle version and in a user-friendly, unit dose delivery system. With the introduction of Adper Scotchbond 1 XT, the 3M ESPE Unit Dose will for the first time be made available to users of the "Total-Etch system". The 3M ESPE Unit Dose is characterised by simple handling coupled with great hygiene and little waste. The obvious similarities to Adper™ Prompt™ L-Pop™ SelfEtch Adhesive are limited to the application unit used. The etching process and the application of the two products are in fact significantly different. Adper Scotchbond 1 XT is, like all Total-Etch adhesives, to be used in combination with a separate phosphoric acid – Scotchbond™ Etching Gel! Adper Scotchbond 1 Dental Adhesive is an ethanol/water based, 5th generation adhesive that is widely known for excellent in vitro and in vivo clinical performance. The objective of Adper Scotchbond 1 XT was to improve this product via incorporation of discreet, nanometer sized particles using a technology similar to that first used in Filtek™ Supreme Universal Restorative. MAGAZINE 18 16 14 12 10 Enamel Dentine 8 6 can provide information about the quality of the micromechanical bond between adhesive and tooth structure. 4 2 0 Scotchbond™ 1 Scotchbond™ 1 XT Optibond Solo™ Plus Enamel Interface The film thickness of Adper Scotchbond 1 XT was measured at the University of North Carolina. Film thickness was less than 10 microns in this study. The first adhesive strength tests with Adper Scotchbond 1 XT were carried out at the University of Minnesota by Dr. Jorge Perdigao using the microtensile bond strength test. The classic Scotchbond 1 as well as another filled adhesive, OptiBond Solo™ Plus, served as control groups (Perdigao et al. Data in MPa). By adding nanofillers, the adhesive strength is significantly increased. This is because the fillers penetrate and consequently stabilise the hybrid layer and the resin tags due to their nanoscale size. 60 50 40 Dentine Prepared Enamel Unprepared Enamel 30 20 10 0 Scotchbond™ 1 Delivery Options Dentinal Interface The above illustrations, from the University of North Carolina, indicate good adaptation to etched enamel and dentinal surfaces. To produce these images, Adper Scotchbond 1 XT was first placed onto tooth structure and then cured. After sectioning, a mild acid treatment was used to remove a portion of the tooth. Since the acid does not attack the cured adhesive, the resin tags are clearly visible. Adper Scotchbond 1 XT is available in both the conventional bottle, and a novel, single dose delivery system. Of special interest in comparison to competitive unit dose systems is the fact that adper Scotchbond 1 XT has an attached brush. Film thickness Scotchbond™ 1 XT Optibond Solo™ Plus Bond strength in MPa. (Perdigao et al.) Analysis with an electron microscope Adper Scotchbond 1 XT is indicated for use with RelyX™ ARC Resin Cement for bonding indirect restorations. In this application, the adhesive is cured prior to placement of the indirect restoration. Hence the film thickness of the cured adhesive is critical. There are several ongoing investigations, in both the US and Europe, with the objective of elucidating the bonding interface with Adper Scotchbond 1 XT. 5 June 2004 No. 5 Year 2 Ask the Expert Filtek™ Supreme Universal Restorative Nanovations in the Dental Composite Filler Technology Paul Lambrechts, Dimple Bharadwaj, Jan de Munck, Bart van Meerbeek; University of Leuven, Belgium The fillers used in dental composites are either amorphous silica, quartz, ground glass based on barium, strontium, or other silicates, or zirconium-silica fillers produced by a sol-gel process. The future in filler technology probably lies in the expanded use of sol-gel processing of particles for composites with excellent radiopacity and abrasion resistance. Nanoparticles Nanocluster TEM 100 nm thin section of cured sample. Nanomer-particles of 75 nm and nanoclusters in Filtek Supreme Incisal (205,000 x). The individual nanospheres are well bonded by the resin matrix. 6 Nanotechnology in itself is a booming science in research and industry. Research at the nanoscale frontier is unified by the need to share knowledge, tools and techniques, and expertise on atomic and molecular interactions. We are living in a nanoscale world. The main definition is that it is a technology in which dimensions and tolerances are in the range of 100 nm to 0.1 nm (nanometers). 1 nm = 10-9 m. The same measurement can be described in nm or µm. It doesn't change the size, just the unit of measurement. A 40 nm size particle is equivalent to 0.04 micron. Nanofillers are not completely new in dentistry, but have never been recognized as such. Ultrasmall filler particle sizes have been used already in many microfill and microhybrid composites. Since the 1970's, microfillers (in fact nanofillers) have been used in dental composites like (Silux™, 3M; Heliomolar™, Ivoclar-Vivadent; Estic Microfil, Kulzer etc.). The fillers in those microfilled composites are spherical shaped fumed silica particles with a particle size of about 30–80 nm. A new nanofilled resin composite material, Filtek Supreme (3M ESPE), is launched with a unique combination of nanofillers. The incisal, translucent, non radiopaque version is a combination of a non-agglomerated/non-aggregated, 75 nm silica nanofiller, and a loosely bound agglomerate silica nanocluster consisting of agglomerates of primary silica nanoparticles of 75 nm size fillers. The cluster size range is 0.6 to 1.4 microns. The other shades (Dentin, Enamel, Body) are radiopaque and are a combination of a non-agglomerated/nonaggregated, 20 nm silica nanofiller, and loosely bound agglomerated zirconia/silica nanoclusters, consisting of agglomerates of primary zirconia/silica particles with size of 5–20 nm fillers. The cluster size range is 0.6 to 1.4 microns. These ultrasmall particles, the nanofillers, are primarily responsible for special clinical features like, low wear, low friction, smooth surfaces with a high surface gloss. There are however limitations to the use of nanofillers in composites. Esthetic translucency limitations. The refractive index of Silicium oxide is very constant and therefore certain monomers have to be used to maintain a good translucency. MAGAZINE Handling criteria Radiopacity limitations The smaller the particle size, the higher the surface area and the more monomer is needed to wet the surface of the filler. If the amount of monomer is increased, the polymerization shrinkage logically increases. This can be partly compensated by pre-polymerization, agglomeration or filler clustering. Adding a critical amount of clustered particles, a better rheological control can be obtained. This permits a high packing density, less stickiness or stiffer viscosity with little remaining space among individual particles. Whilst it is important for the composite not to stick to the dental instruments, it is still important for it to stick to the cavity walls. Therefore, the quality of being nonsticky or nontacky is a relative one. Manufacturers have eliminated stickiness by slightly altering filler content and, at the same time, reducing the matrix viscosity by using varied matrix monomers. This ensured sufficient flow to adapt the composite to the cavity preparation during packing. Most nanofillers are based on radiolucent silicium oxide. This can be solved by adding zirconium oxide nanofillers (3M ESPE) or ytterbium trifluoride (Ivoclar-Vivadent). Strength • Nonsticky, wets tooth surfaces, easily transferable, and packable A high modulus of elasticity (stiffness) and a high strength are necessary to withstand the chewing forces in the mouth at occlusal contact areas and determine to a certain extend the clinical durability. The strength of a composite is predominantly influenced by the volume percentage of filler and degree of conversion. With a filler loading of 59.5 vol%, Filtek™ Supreme comes close to the goal of 60 vol% for posterior composite candidates. That's why most popular universal materials being developed and used today are fine particle microhybrids in order to optimize physical properties, handling characteristics and esthetics. They use grounded radiopaque glasses (Ba, Sr, La…) with a mean particle size of about 0.4 µm (Point 4, Kerr), with variable refractive indices, translucency and radiopacity combined with a wide variety of monomers. Often these fine particle hybrids contain additional nanofillers in their composition. • Cures rapidly to final hardness, but with minimal residual stress • Little or no shrinkage on curing • Easily carved, burnished, smoothened (requires minimal finishing and polishing) References • J. L. Ferracane: Status of research on new fillers and new resins for dental composites. In: Advanced adhesive dentistry, 2000 ISBN 88-87961-00-X • Ivoclar-Vivadent: Nanofillers? August 2003 • Degussa: Aerosil and Silanes. 09/2001 Filtek Supreme has the ambition to reach the desirable characteristics for direct filling restorative materials. Long-term clinical durability studies will tell us if the ambition will be fulfilled: • Moisture tolerant • Unset material flows without much elastic recovery (is not viscoelastic) Prof. Paul M.I. Lambrechts, Belgium. Born 1955. Education: 1974-1978 dental education, 1978 DDS degree, Lic. Dentistry at Catholic University of Leuven, 1978-1983 PhD. Present position: Full Professor (Professor in Cariology and Endodontics), Dept. of Operative Dentistry at the Catholic University of Leuven; Head of the Dept. of Operative Dentistry. • Good rheology and high critical shear strength for flow (holds proximal contact of matrix band) • No access problems for cure (uses bulk cure, chemical cure, or has excellent visible-light depth-of-cure) 7 June 2004 No. 5 Year 2 Clinical Case Report Filtek™ Supreme Universal Restorative The Winner is . . . ! 1. Spanish Photo Contest José Ignacio Gamborena; Dentist, Spain Case awarded first prize in the Filtek Supreme Photo Contest in Spain Class III and IV restoration on anterior teeth using 3M ESPE Filtek Supreme. A 43-year-old female patient came to our practice requesting treatment of an aesthetic problem affecting teeth 21 and 22. Initial situation. There was organic displacement of the middle and left tooth and substantial composite restorations in less than perfect condition as regards sealing, colour, texture and form. A number of alternatives were suggested to the patient, ranging from veneers, as the longest-lasting option, to preparation of simple composites of the Class III mesial and distal of tooth 21 and the Class IV on tooth 22. The main problem in this case - both for treatment with veneers and the preparation of very aesthetic composites - was the very dark coloration around “A5” of both teeth. Consequently, it was suggested to the patient that internal bleaching of both teeth be carried out in order to match the shade to the rest of the teeth and thus achieve better aesthetic results. This could be done with both veneers and composite restorations. After bleaching, the patient decided on composite restora- 8 tions. We used the 3M ESPE composite Filtek Supreme, since it was ideally suited to this particular case where translucence and incisal effect were of central importance to obtain accurate colour matching and ensure that the restoration was entirely successful aesthetically. After the cavities were opened, rubber dam was fitted and, following application of the self-etching adhesive Adper™ Prompt™ L-Pop™, we began by applying the dentine shade A2D, which was used to define not only the cervical aspect but also the position of the mamelons on the incisors. Then the body shade A1B was applied somewhat further towards incisal over the mamelons of the dentine layer A2D. After that, we applied the translucent colour G incisally, which we gave a hardly perceptible blue shade using tone-down colours, and still further towards incisal we applied a dentine corona using WD. After all these materials were applied, the vestibular and palatinal aspects were covered with a layer of white enamel (WE) colour to enable us to see the final effect of all the colours used. After all the layers were applied, the rubber dam was removed to gain a better overall view and facilitate rehydration of the teeth. This enabled the restorations to be assessed in context. After finishing the interproximal and occlusal contact points, we concentrated on the form and texture and on final polishing with diamond points, silicone abrasives and Sof-Lex™ discs. Now it is possible to see how the restorations actually look after internal bleaching and finishing with the composite Filtek Supreme. After internal bleaching of teeth 21 and 22. Preparation of the Class IV cavity on tooth 22. Form, texture and polishing after removal of the rubber dam. Final situation after rehydration. Clinical Case Report MAGAZINE Lava™ Crown and Bridges Zirconium Oxide Restoration of a Fractured Molar Hongyan Chen; University of Munich, Germany Fig. 1: Initial situation: Fractured filling in endodontically treated tooth 26. Fig. 5: CAD/CAM all-ceramic crown made of LAVA zirconium oxide, fabricated by the dental lab. The framework of the crown was milled in the pre-sintered green model state, individually coloured, sintered under controlled conditions in a special kiln and then veneered with LAVA Ceram feldspar. Fig. 11: Situation following removal of the temporary restoration. Fig. 6: Close-up occlusal view. Fig. 13: The crown was fixed conventionally with the Glass Ionomer Luting Cement Ketac™ Cem from 3M ESPE. Fig. 2: After removal of the restoration, a fracture line was visible in the tooth running mesio-distally. To stabilise the tooth, it was prepared with extended chamfer for an allceramic zirconium oxide crown. The preparation margin was electrosurgically exposed for the impression. Fig. 3: Temporary crown with Protemp™ 3 Garant Composite for Temporary Crowns and Bridges. Fig. 10: View of the inside of the crown. The high-strength coping made of zirconium oxide ceramic is veneered with feldspar which is exactly matched to the framework material in its heat expansion co-efficient. 9 June 2004 No. 5 Year 2 Clinical Case Report Replacement of Missing Teeth with Sinfony™ Light Curing Composite and Glass Fibres From Prep to Crown – Dental Materials in Daily Practice Luca Ortensi; Bologna, Italy Contemporary composite resin materials have evolved significantly, facilitating the delivery of aesthetic and functional restorations. The stiffness, strength and toughness of composite resin can be increased when applied to the glass fibres. The objective of this article is to describe the construction and the cementation of a fibre-reinforced composite bridge and an indirect composite restoration. Fig. 1: Preoperative view shows metal-resin bridge and amalgam restoration to be removed. Fig. 2: X-ray shows infiltration of the carious lesion at the margin of the crown (distal zone). Fig. 3: The operative area was isolated with rubber dam. It is possible to see the carious lesion in the distal zone of premolar. Fig. 4: Build-up of the first molar with flowable composite. Fig. 5: Preparation of the premolar. An adhesive preparation was made with butt margin and rounded surfaces. Fig. 6: Tooth preparation was performed for proper fibre-reinforced composite bridge and overlay. The first molar was prepared with a diamond bur to obtain butt joint margins and rounded internal line angles.The premolar was prepared with butt margin and rounded surfaces (Fig. 5, Fig. 6). Approximately 0,7 mm of palatal enamel was removed from the canine. An impression of the prepared teeth was taken using the polyether impression material Impregum™ Penta™ H/L DuoSoft from 3M ESPE (Fig. 7). The provisional restorations were fabricated with Protemp™ 3 Garant (3M ESPE) and were cemented with a eugenol-free cement. The impression was poured with high-strength dental stone for master model fabrication (Fig. 8). Case presentation A 25-year old male manifested pain to the second left bicuspid. The clinical and radiographic examination revealed a metal-resin crown on the second bicuspid with an extension which replaced the first bicuspid. An amalgam restoration was present on the first molar (Fig. 1, Fig. 2). The second bicuspid presented a carious lesion. A fibre reinforced bridge between the second premolar and the palatal surface of the canine was suggested to the patient as an option of treatment as replacement of the metalresin bridge after curing of the carious lesion. An indirect composite restoration was proposed to replace the old amalgam filling on the molar. The patient accepted the treatment plan. During the following appointment, the teeth were isolated with a rubber dam, and the preexisting amalgam restoration and the metal-resin bridge were removed with high-speed tungsten carbide burs (Fig. 3). The carious lesion, present on the second bicuspid, was eliminated and a build-up was carried out with a flowable composite (Filtek™ Flow, the flowable composite from 3M ESPE) (Fig. 4). 10 The fibre-reinforced composite bridge and the indirect composite restoration were constructed on the master model using a layering technique (Sinfony, 3M ESPE; Vectris, Ivoclar-Vivadent) (Fig. 9). MAGAZINE Fig. 7: A polyether impression of the preparation was obtained. Fig. 8: Master model. It is possible to see the preparation of the distal surface of the canine. Fig. 9: The external aspect of the fibre-reinforced composite bridge was completed and returned to the clinician for try-in. Fig. 10: Cementation of the overlay with RelyX™ Unicem Self Adhesive Universal Resin Cement. At the cementation appointment the restorations were tried-in and checked for the color match prior to placing the rubber dam. The abutments were sandblasted with 50 microns aluminium oxide to obtain a cleaned surface. The overlay was cemented with RelyX Unicem (Fig. 10). The fibrereinforced composite bridge was cemented with two different systems at the same time. We used RelyX Unicem for the premolar and the RelyX™ ARC Adhesive Resin Cement for the canine, due to the large amount of enamel present on the canine preparation. Before the cementation the palatal surface of the canine was acid-etched for 30 seconds and treated with an adhesive system (Scotchbond™ 1, 3M ESPE). Excess Fig. 11: Postoperative occlusal view of the fibre-reinforced composite fixed partial denture. Note the good integration and the natural effect obtained by the restoration. luting material was removed with a small brush and floss. The luting composite was light-cured for 120 seconds. Following the removal of the rubber dam, the occlusion was adjusted with diamond finishing burs (Fig. 11). Special thanks to Mr.Manuel Civolani and the Laboratory Ortensi & Fabulli which produced the prosthetic restorations. 11 June 2004 No. 5 Year 2 Scientific Activities in Europe Filtek™ Supreme Universal Restorative Tooth 13 – Incisal Edge Extension Karl-Heinz Kunzelmann, University of Munich, Germany Diagnosis: Incisor-molar hypomineralisation Initial situation: A case of what is known as incisor-molar hypomineralisation, also affecting the first molars. Cause: unclear Tooth 13 – minimally prepared, the discolouration is localised in the pores of the outer layer of enamel. Slight preparation can achieve a substantial improvement in colour. At the same time the surface of the enamel is made more reactive to the dentine adhesive. Fig. 1: Individual colour-matching by application and curing of small amounts of composite. Because of the high mechanical load on a canine tooth and the unclear degree of mineralisation, conventional etching is carried out with phosphoric acid for 30 s. Checking the etch pattern. Etching is taken a little beyond the preparation margin; this helps to avoid later discolouration of small amounts of excess composite. The dentine bonding agent (DBA) is polymerised. Checking application of the DBA: the whole surface should have a reflective shine. Fig. 2: 13 – minimally prepared. Symmetry check to estimate the reconstruction length of required for tooth 13. Fig. 3: Conventional etching is carried out with phosphoric acid for 30 s. Fig.4: The palatinal wall is built up using a dentine material. 12 MAGAZINE June 2004 No. 5 Year 2 The palatinal wall is built up using a dentine material whose high opacity is designed to prevent the restoration appearing grey against the background of the dark interior of the mouth. The palatinal wall is modelled free-hand. Curing of the individual increments. The increments are cured to facilitate further modelling as the previous increment can then no longer deform. In the dentine composite tray a further layer of dentine colour is applied and cured to mask the darker dentine parts. The restoration is then completely reconstructed using body shade. Enamel material is not used because the contra-lateral canine does not display significant transparency effects. Fig. 6: The restoration is then completely reconstructed using body shade. The restoration is contured with finishing diamonds where the enamel meets the filling. This is easier while the rubber dam is still in place, since then the lip is not in the way. The incisal edge is shaped after the rubber dam is removed and both occlusion and articulation are checked. The end result after removal of the rubber dam. The teeth are lighter because they have dried out. The edges of the rubber dam are visible. The tooth will darken after rehydration.glossy shine. Fig. 5: A further layer of dentine colour is applied and cured. Fig. 7: The restoration is contoured with finishing diamonds at the transition between enamel and restoration. Fig. 8: The end result soon after removal of the rubber dam. 13 Scientific Activities in Europe Lava™ Crowns and Bridges Focus on Zirconium Oxide – Espertise™ All-Ceramic Forum in Munich Gerhard Kultermann; 3M ESPE, Germany rial are its mechanical strength and natural aesthetics based on colourable still translucent frameworks as well as its excellent biocompatibility. Now, a consistent and reliable (i.e. strong and durable) metal free alternative for anterior and posterior restorations is given. “With zirconium oxide, 3M ESPE is concentrating on the material that the company regards as having the most successful future.” Conventional cementation “More and more patients are looking for a metal-free alternative” Zirconium oxide (zirconia) is becoming an increasingly popular dental ceramic material, and the Espertise All-Ceramic Forum held in Munich on 24 March showed why. Around 320 dental technicians and dentists attended the informative and exciting presentations, and took part in lively discussions about the highly promising dental material and the CAD/CAM system known as Lava. They were able to see restorations with excellent natural aesthetics, and they found out why zirconium oxide is simple to use in the dental surgery with successful results. Metal free, aesthetic & strong “Increasingly, patients are refusing metal restorations for fear of an allergic reaction, and are asking for a metal-free alternative.” In the view of the Lava project manager, Dr.-Ing. Daniel Suttor, the outstanding features of this specific zirconium oxide mate- 14 “The high strength of Lava restorations means also that, as a rule, they can be cemented conventionally. This is a great advantage for the dentist, especially in the case of deep preparations and posterior teeth.” Indications At present, the Lava system can be used for making crowns and three- or four-unit bridge frameworks up to a length of 38 millimetres. These indications have been tested carefully and are reliable. Long bridge spans are also possible in the fully loaded posterior region. Further indications are currently examined. The longest wearing period for Lava restorations is now almost four years.” Like Dr. Suttor, Prof. Dr. HansChristoph Lauer from the University of Frankfurt also sees a trend towards biocompatible, tooth-coloured and fixed restorations. “We are fitting more and more all-ceramic restorations made of zirconium oxide. Few patients are willing to accept goldcoloured masticatory surfaces nowadays.” In Prof. Lauer’s view, the marginal gap problem is solved with the combination of zirconium oxide and CAD/CAM, if applied correctly. The university professor also uses Lava frameworks for primary parts in tapered prostheses combined with electroplating, and also for implantology suprastructures. Improved cost-effectiveness The Espertise event held in Munich gave dentists and dental technicians an excellent insight into the state of the art with regard to zirconium oxide and CAD/CAM. In conjunction with the corresponding veneer porcelain, Lava allows permanent and aesthetically natural looking restorations. In the models presented for the laboratory and dental surgery it was clear that zirconium oxide systems such as Lava are also an attractive choice from the point of view of cost-effectiveness. Dental Practice Forum MAGAZINE Creating a good image Marketing ideas for your dental surgery The concept of “marketing” has become familiar in the world of dental surgery. Many dentists have recognised that when patients choose a dentist, they increasingly value the quality of service offered and a pleasant relaxed atmosphere at the dental surgery. The typical “dental surgery atmosphere” has disappeared from many practices. Attractively designed waiting and consulting rooms, a friendly and well-organised dental surgery team and range of services take away the fear of visiting the dentist and increase customer loyalty as well. Marketing at your dental surgery Dental surgery marketing involves consistently catering to patient needs at the surgery. This includes all kinds of services, starting from the design and layout of your dental surgery to presentation of the range of services and individual patient care. Would you too like to make your dental surgery more attractive and enhance your workplace through skilful marketing strategies? Here we offer you a few tips on how to amaze your patients at one of their next visits with a new service concept! Step 1 – Collect ideas Ideas for marketing-oriented services at the dental surgery can be found everywhere: in magazines, at doctors’ surgeries where you yourself are a patient but also from other service-providers. It is also worth surfing around colleagues’ websites on the Internet and looking at what they offer their patients. Step 2 – Draw up a hit list When you have collected enough ideas, you should draw up a list in which you then sort your ideas under headings and give them weightings. With this list you can set priorities and discuss with your team which measures can be realised in the short term with little effort. Step 3 – Brainstorming session Many ideas involve a more lengthy planning phase and possibly involve greater financial costs. For this reason it is important for the team to put their heads together and consider what services are to be offered by the dental surgery in the future. It is advisable to set a “vision” as your objective and to also put it down in writing. Planned changes can then be examined with regard to this “vision”. Step 4 – Implementation Draw up a schedule together showing which changes are to be made when. You should also decide who is going to be responsible for what – for each project, choose a “coordinator”. This will help you to coordinate the individual measures and to involve all members of the dental surgery team according to their abilities. 15 June 2004 No. 5 Year 2 General Information MAGAZINE Lava™ Crowns and Bridges Copying Nature and Creating Oral Harmony Gabriele Brzoska; 3M ESPE, Germany “Concentrating on essentials does not mean working less well, but rather leaving nothing to chance” – Quotation: Jan Langner A new series of Lava Ceram courses kicked off on 12th/13th February 2004 with a 2-day master class with Jan Langner here at the training laboratory in Seefeld, Germany. Copying nature and creating oral harmony is a complex issue, particularly in the area of tooth restoration. A thorough understanding of the interaction of form, function, surface structure and, above all, the colour composition of natural teeth is the basis for aesthetically effective restorations. As an experienced ceramist, Jan Langner is just the man to help interested course participants increase their knowledge and put the elements described above into practice effectively. There is much discussion about veneer ceramics, ranges with a wide variety of colours and surfaces. Jan Langner demonstrated that, with our very well-designed basic Lava™ Ceram Master set range, convincing and aesthetic results can be achieved. Calendar of Events June to October 2004 IADR/AADR German Dental Symposium, Nanjing www.vvdi.de SINO DENTAL, Peking June 2 - 4, 2004 June 8 – 11, 2004 DMA Summer Meeting, San Diego www.dmanews.org August 11 – 15, 2004 IDEX, Istanbul www.cnr-idex.com September 2 – 5, 2004 KDX 2004, Seoul www.kdx.co.kr September 3 – 5, 2004 Cede, Lodz www.cede.pl September 9 – 11, 2004 Jan Langner with the particpants in Seefeld The particularly well-prepared documentation for this course made it easy for the participants to master even a very difficult case. “We are able to learn a lot here”– was the unanimous opinion of the course participants. EDITORIAL INFORMATION Published by: 3M ESPE AG ESPE Platz 82229 Seefeld Germany Telephone: +49 (0) 8152 / 7 00-0 Telefax: +49 (0) 8152 / 7 00-1586 E-Mail: [email protected] Internet: http://www.3mespe.com Editor: Gerhard Kultermann Editorial team: Keith R. Haig, Dieter Klasmeier, Roland Richter, Markus Roepke, Laurence Settekorn 92nd FDI World Dental Congress, New Delhi www.fdiworldental.org September 10 – 13, 2004 Coordination: Laurence Settekorn Dental Expo, Moscow www.dentalexpo.ru September 14 – 17, 2004 Final editing and production: Markus Roepke ADA, Orlando www.ada.org September 30 – October 2, 2004 3M ESPE AG ESPE Platz, 82229 Seefeld Telephone: +49 (0) 81 52 / 7 00-0 • Telefax: +49 (0) 81 52 / 7 00-15 86 E-Mail: [email protected] • Internet: http://www.3mespe.com 3M, ESPE, Adper, Espertise, Express, Filtek, Garant, Lava, Penta, Pentamix, Protemp, RelyX, Scotchbond, Sinfony are trademarks of 3M or 3M ESPE. OptiBond Solo Plus is a trademark of Kerr Dental. All rights reserved. © 3M ESPE 2004. Global circulation: 80.000 We accept no liability for unsolicited manuscripts or photographs. Court of Jurisdiction: Munich © 3M ESPE AG, Seefeld, 2004 Alternative Headline and Visual for Page 4 “Adper Scotchbond 1 XT” Adper™ Scotchbond™ 1 XT Adhesive How to Make a Good Product even Better Roland Richter; 3M ESPE, Germany