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