Gold Advantage E-Newsletter - January 2009

Materials Update

by Rob Maatta

Changes in dental materials occur seemingly at the speed of light! The following represents a current overview and snapshot from the perspective of your ceramist to assist in providing the very best for your patients. We will focus on the following materials for the purpose of this article:

All-ceramic Category including Empress Esthetic, Authentic,
Ceramco 3 and EmpreThins
Lithium Disilicate utilizing e.max®
Lava™ Zirconia
Composite
PFM/POM
Wax ups and wax up kits

All-ceramic
Gold Dust ceramists has extensively tested and sampled numerous all ceramic systems. Currently, we specialize in all ceramic fabrication and achieve the best results with the following systems. IPS Empress Esthetic, Authentic, Ceramco 3 refractory, Emprethin minimal prep veneers/no prep veneers
- IPS Empress Esthetic - this is probably the most popular restoration done at Gold Dust. The primary ingots used are E03, E02, E01, ETC0, ETC1, and EOC1. There are several other choices but these represent the most common ingots used in smile design cases. (The other ingots are for the darker shades that might be needed in single unit cases.)
  
  The way an ingot is selected is like a formula. We utilize the prep shade, the desired final shade, and then analyze the thickness of the veneers. It requires all three components to appropriately choose an ingot. Never choose an ingot without knowing the thickness of the wax because it is such a determinate in achieving an ideal result. For instance, many times in a smile design case in which the buccal corridor needs to be brought out, it is sometimes useful to use a slightly darker ingot on the bicuspids because the thickness of the bi's tend to be much thicker than the anteriors. The thickness, will make the bicuspid very bright if not chosen properly.
- Authentic - this product is very comparable to Empress aesthetically and may be a little more versatile when it comes to non-uniform preparation shades. Empress has a real affinity for grey. If there is any grey on the preparation, it will draw it though the Crown/Veneer and leave you with a slightly grey restoration. Authentic on the other hand has three levels of opacity for each shade. A1 is very translucent, A1+ has a bit more opacity, and A1++ will block out most non-black stains or metals. Ingots come in all vita shades and all three levels of opacity. Another key feature of Authentic is the ability to have a metal substructure for bridges or single unit crowns.
- C. Ceramco 3 refractory is a powder liquid build up technique that can be used only in veneer cases. This technique is especially useful in tetracycline cases. The opacious dentin can be placed in the exact area that needs to be blocked out and the translucent dentins can allow for beautiful transitions. The reason we use refractory instead of the foil technique is for improved accuracy and marginal integrity. One disadvantage is there is no wax up involved in the process, so all occlusal issues must be worked out in porcelain.
- EmpreThin Veneer is on the cutting edge of dentistry. They can be fabricated and inserted as completely prepless veneers. The thickness of the finished veneer can end up at 0.2mm and slightly less at the margin. Patients are asking for this type of dentistry because of the national ad campaigns that Lumineers has produced. However, Emprethins are much more aesthetically beautiful! This type of veneer is completely reversible for the patient if he/she decides to have them removed (call for removal technique). The ideal cases for this prescribed restoration are ones that are lingually inclined, require a slightly brighter shade, or present with wear. This restoration is not indicated for protruding teeth or any slightly rotated dentition. In the case of a slight rotation simple modifications to the dentition is will allow this product to be used.
e.Max Press (Lithium Disilicate) is the product we use. It's a very versatile product indicated for posterior/anterior crowns, bridges, and veneers. It has proven to be superior in strength and very aesthetic with a broad array of indications. Its ability to block out with the use of LT ingot and maintain a natural translucency with an HT ingot, makes this restoration one of our favorites. Also, if the restoration is only stained and glazed it's the strongest material next to gold that we use here at Gold Dust.
Lava (Zirconia) - a 3M ESPE zirconium substructure. There are many types and brands of Zirconia on the market and in our experience, they are not created equal. Simply prescribing a Zirconia coping will not ensure the strength and longevity that we have found with the 3M Lava Product. Gold Dust waxes over the Lava core and presses an E.max Zirpress ingot. Typically we use a high water Lava coping to allow for 360 degree porcelain margins. Prescribing bridge framework with this material allows us to produce the most aesthetic all ceramic bridge combinations. This restoration can be produced with all Lava margins as well (called a PFL - porcelain fused to lava) it's a 360 degree lava margin coping with Emax ceram stacked over the coping. The strength is incomparable and in many instances, we can make an undetectable bridge restoration with this combination of materials. In our opinion, Lava can provide the results in single unit, bridge restorations and implant abutments that would replace the need to prescribe Everest, Procera, or Captek.
belleGlass (now named Premise) and Tescera (Heat and Pressure Cured Composite) Light, heat and pressure produce the highest degree of material conversion (98.5%), giving belleGlass/Premise superior strength and wear characteristics. The opaceous dentin's high filler content exceeds 87%, providing exceptional strength and shrinkage of less that 0.94%, which means better margin integrity and less chance of microleakage. We find belleGlass/Premise is the most user friendly and looks the best intra-orally. Tescera may have a bit more strength but tends to comes out a little more opaque than belleGlass/Premise.

Both materials are a great option when considering wear resistance, strength and longevity in a more conservative inlay/onlay preparation.
PFM/POM – PFM's are traditional powder liquid build up. High noble metal's are used. POM's are waxed and pressed restorations that are great for posterior restorative dentistry. Gold Rush- www.goldrushdental.com Gold Dust's under $200 posterior department. Only a few products are offered at this price right now but we hope to soon offer several more. As of today we have available Empress, Authentic, POM, Emax Press, Emax Zirpress over Lava and Belleglass. The reason we decided to offer this product line is because several dentists were using two labs, one for Smile Design and another for day to day restorative needs. We prefer to service all of our client's needs. By utilizing a pressed and stained method, as opposed to the more aesthetic cut back and layered restoration, we are able to provide a quality restoration at a competitive price.
Wax ups - a wax up can be done in an A1 shade on a white model or a tan wax on a tan model. All wax ups are mounted on either a Stratos or Panadent articulator. All function and guidance will be built in and anterior coupling will be forced. Removable molars can be made to assure the bite is correct and occlusal mapping of interferences is available. Wax kit includes a reduction model, reduction guide, clear stint, and two stage matrix utilized to plan and execute the design of the preparation appointment.

At the tremendous rate of change in dentistry, we expect materials to constantly change. Gold Dust's expertise in utilizing cutting edge yet proven technology and materials, allow you to rely on us to keep you updated on what's happening in the development of new restorative materials.

As always, don't hesitate to call and discuss your case specifics. We look forward to providing you excellence in materials and unparalleled restorations.