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Transcript of › 1946 › images › Asset251746_v1.pdf · 6/12/2015 5 Thickness of sample: 1.2mmKATANA cy...
6/12/2015
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Simplifying All
Ceramics -How to select, adjust
and cement.
Todd Snyder, DDS, AAACD
I report no financial relationships, conflicts of
interest, or other disclosures with respect to the content in this presentation
Todd C. Snyder, DDS, AAACD Private Practice in Laguna Niguel, California
Accredited, American Academy of Cosmetic Dentistry
Former Faculty, UCLA Center For Esthetic Dentistry
Faculty, Esthetic Professionals
F.A.C.E. Graduate
Member of Catapult Elite
Co-Founder of ContentActivator
CEO, Miles To Smiles®
CEO, DENToolz
Free Handout
www.DENTOOLZ.com
Selection Criteria
Adjustment & Polishing Techniques
Cementation / Bonding Techniques
Cases
Simplifying All Ceramics:
Ceramic Selection Criteria Aesthetics
Strength
Placement Technique
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Indirect Restorations
Indirect Restorations
METAL BASED
• Full Cast Metal
• Gold Alloy
• PFM – Porcelain fused to metal
• Many brands, high cost, being
replaced by all-ceramics; FPD
• PFT – porcelain fused to titanium
• Newer; mixed success; implant
supported restorations
• Leucite reinforced glass ceramic
• IPS Empress Esthetic/CAD; Authentic; OPC
• 160 MPa
• Lithium disilicate/silicate *
• IPS e.max Press/CAD; Obsidian
• High esthetics and strong
• 360-400 MPa
• Zirconia (high strength non-etchable) *
• Monolithic: BruxZir; LAVA Plus; KDZ Bruxer; OccluZir; ZirLux FC
• Fastest growing; improved esthetics~1000 MPa
• Zirconia supported: IPS e.max ZirPress; ZirCAD, LAVA DVS,
• High esthetics; may be subject to chipping, fractures; slow cooling
• Zirconia Multi-layered *
• CAP Multi-FZ
• Katana HT, ST, UT
• Translucency, esthetic and strong
• 557-699-1125 MPa
• Polymer
• Resin-nano ceramic: LAVA Ultimate, VITA Enamic
ALL-CERAMIC
Indirect Restorations
Feldspathic (80-120mpa)
Lithium disilicates (360-400mpa)
Lithium silicates (373 mpa)
Zirconia Multi-layered (557-1125mpa)
Inlay Restorations
Feldspathic (80-120mpa)
Lithium disilicates (360-400mpa)
Lithium silicates (373 mpa)
Zirconia Multi-layered (557-1125mpa)
Inlay Restorations
Onlay Restorations
Lithium disilicates (360-400mpa)
Lithium silicates (373 mpa)
Zirconia Multi-layered (557-1125mpa)
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Onlay Restorations
Lithium disilicates (360-400mpa)
Lithium silicates (373 mpa)
Zirconia Multi-layered (557-1125mpa)
Veneer Restorations
Feldspathic (80-120mpa)
Lithium disilicates (360-400mpa)
Lithium silicates (373 mpa)
Zirconia Multi-layered (557-1125mpa)
All-Ceramic Crowns 565-1200+MPa
Multi-Layered Zirconia
0.7 mm - 2.0 mm All Ceramic 1.5 mm - 2.0 mm PFM Above images taken from Glidewell Laboratories
Zirconia (1100mpa-1400mpa)
All-Ceramic Crowns
Zirconia Multi-layered
Zirconia Multi-layered
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Zirconia Multi-layered
All-Ceramic Crowns
Zirconia Multi-layered (557-1125mpa)
Anterior Crowns
Anterior and posterior crown and inlay: Feal Dental Laboratory, veneer:Cusp Dental Supply
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KATANA
Zirconia HT
KATANA
Zirconia ST
KATANA
Zirconia UT
e.max Press LT Prettau Anterior
(%)
High translucent for anterior restoration
The same level translucency as glass ceramic (e.max Press LT)
Wave length of light: 700nm
Thickness of sample: 0.5mm LT (A1) ST (ST10) UT (UT10) HT (HT10) (T0)
Prettau Anterior
Tra
nslu
cency
Lithium
Disilicate Multi-Layer Zirconia
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Thickness of sample: 1.2mm
Tra
nslu
cency
(⊿L(W-B))
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10
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KATANA
Zirconia HT
KATANA
Zirconia ST
KATANA
Zirconia UT
e.max Press LT Prettau Anterior
Multi-Layer Zirconia
LT (A1) (T0)
Prettau Anterior
ST (ST10) UT (UT10) HT (HT10)
High translucent for anterior restoration
The same level translucent as glass ceramic (Lithium Disilicate Press LT)
Lithium
Disilicate
Mechanical Properties
30% Increase Compared to Lithium Disilicate
ISO 6872:2008
(Three-point bending test) Sample size: 3 x 4 x 40 mm
Prettau Anterior 670mpa
Fra
ctu
ral str
ength
.
1125
699
557
427
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200
400
600
800
1000
1200
KATANA
Zirconia HT
KATANA
Zirconia ST
KATANA
Zirconia UT
e.max Press LT
Multi-Layer Zirconia
LT (A1) Lithium
Disilicate
ST (ST10) UT (UT10) HT (HT10)
Restoration Placement? Bonded
Margin placement Moisture Control
Technique Sensitive Materials
Self Adhesives Bonding agent (TE or
SE) & luting resin
Cemented
Margin placement
Moisture Tolerant
Retention Required
Materials
RMGI
Ceramir
Cement Selection
Traditional Cementation Options
Glass Ionomers Resin Modified Glass Ionomers
Acidic pH Moisture Tolerant Fluoride Release Degrades over time
Low bond strength Biocompatibility-Fair Bioactivity-None Sealing Quality-Ok
Acidic pH Insoluble Moisture Tolerant Fluoride Release
Stronger Than Traditional GIs Degrades over time Improved bond strength Biocompatibility Ok Bioactivity-None Sealing Quality-Ok
Cement Selection
Cement Options Ceramir Alkaline pH Moisture Tolerant Self Sealing Apatite Formation
Insoluble Stronger with time Semi / Translucent Biocompatibility-Excellent Bioactivity-Apatite formation Sealing Quality-Excellent
Cement Selection
Crown Retention Results Zirconia crowns (Kg/F)
Material Result (Zirconia crowns) Kg/F
Ceramir Crown & Bridge 32.1 ± 6.3
RelyX Unicem (3M) 27.8 ± 11.3
Dyract Cem (Dentsply) 12.2 ± 3.1
Rely X Luting (3M) 10.9 ± 6.5
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Ceramir Crown & Bridge RelyX Unicem (3M) Dyract Cem (Dentsply) Rely X Luting (3M)
Cement Selection
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Cement Selection
Cementation Technique
Cement Selection
Lithium Disilicate
Cement Selection
Zirconia Restorations -cleaning w/ phosphate
scavengers is not necessary
-silane is contraindicated -no bonding agent necessary
Cement Selection
Ceramic Adjustments
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Adjustments
Interproximal
Occlusal
Chairside
Adjustments Interproximal (Rare)
Model work or provisional cause?
Location to be adjusted?
Surface treatments
Air abrasion
Stone
Fine diamond
Chairside
Interproximal Adjustment
Interproximal Adjustment
Interproximal Adjustment Interproximal Adjustment
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Check margins first
visual
explorer
Check proximal contacts
sprays
paints
Ribbon/paper
dental floss
Interproximal Adjustment
Interproximal Adjustment
Articulating Papers Use the thinnest brands available
Troll Dental 8um
Microcopy 10um
Interproximal Adjustment
Panadent
Interproximal Adjustment
Dura-Green DIA A vitrified bonded diamond abrasive ideal for
contouring and finishing porcelains, zirconia, lithium disilicate and ceramic copings
8 Handpiece Shapes
What is Dura-Green DIA The simplest answer is Dura-Green DIA is a “diamond
version of a Carborundum point”.
Dura-Green DIA is similar to Dura Green Stones, but
made with diamonds rather than silicon carbide
It consists of diamond abrasive grains, a glass binder and air holes.
Dura - Green
Dura – Green DIA
• Silicone Carbide
• Larger
grain size • Less dense
• Diamonds • Smaller grain
size
• More dense
Glass Binder
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Features of Dura-Green DIA High cutting ability and durability
Minimized surface contamination
Minimizing chipping and heating
Smooth surface finish
User experience similar to
Carborundum points
Two Striper® ZTech™ Diamonds REALITY
Ranked 1st with 4.4 stars in 2012 & 2013
Zirconia cutting diamond from Premier
3 CRA articles
CR Foundation rated Ztech diamonds as excellent in reducing the degree of micro fractures
Adjustments Microfractures
Roughness
Increased wear
Irreversible damage
Plaque accumulation
Gingival inflammation
Reduced strength
Chairside
Ceramic Polishers
Brasseler
Axis
Komet
Diamond Twist SCO™ Single-paste system for Ceramics & Composite
REALITY
Ranked 1st with 4.3 stars in 2012
CRA articles
Sept 2009 State of the Art Polishing Systems
Ceramic Polishing Aesthetics
Preparation Design
Function
Strength
Moisture Control
Cementation/Bonding
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Cementation/Bonding Cementation/Bonding
Bonded Adhesion Bonded Adhesion
Bonded Adhesion Bonded Adhesion
Increasing strength demands
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Minimally Invasive
Aesthetics
Function
Bonding Adhesion
Feldspathic Veneers
-enamel bonding
-etch
Bonded Adhesion Bonded Adhesion
Bonded Adhesion Bonded Adhesion
Bonded Adhesion Bonded Adhesion
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Bonded Adhesion
Cosmetic cases….
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Final Restorations
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Aesthetics
Preparation Design
Function
Strength
Bonded Adhesion
Lithium Disilicate
Bonded Adhesion Bonded Adhesion
Bonded Adhesion
Ceramic Try-in
Make sure it is etched properly from lab Silanate prior to try-in (unless using Ceramir) Ultrasonic with ethanol after try-in
Zirconia silanate prior to try-in
(Ultrasonic with ethanol after try-in)
Or
Sandblast after try-in and use a MDP based cement
Silanes
Universal Adhesives (w/MDP)
Silane Primer + MDP
Organo-Phosphate Monomer (MDP)
Silane Primers
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BONDS WITH OR WITHOUT HF
ACID ETCHING
THE “NO-WATER” SILANE
INSTANT ACTIVATION
LESS DEGRADATION
(More Stable 2 Year Shelf-Life)
Silane:
Silica based ceramics
Lucite based
ceramics
Glass Fiber Posts
Composite
Restorations
CLEARFIL CERAMIC PRIMER
Unique Silane that bonds to Zirconia, Alumina, Porcelain, Micro Hybrid & Nano Filled Composite & Base Metals.
Contains Silane, ethanol & MDP Monomer-it is the main ingredient in Panavia resin cements which bond directly to high strength ceramics (Zirconia & Alumina).
MDP:
High-Strength
Ceramics (Zirconia &
Alumina)
Base Metals
UNIVERSAL ADHESION
Self Adhesive Resin Bonding Agent w/ Resin Acidic/Neutral pH Not moisture tolerant Low-moderate initial bond
strengths Decreased bond strength
over time Water sorption Biocompatibility-Ok Bioactivity-None Sealing Quality-Ok
Acidic/Neutral pH Not moisture tolerant Best initial bond strengths
but can decreases w/time Decreased bond strength
over time Water sorption Biocompatibility-Ok Bioactivity-None Sealing Quality-Good but
technique sensitive
Resin Cement Options
What substrate are we treating?
Class I or II
:Composite Preparation
3x Tubule Density Equals Higher Fluid &
Increased Difficulty for Bonding
%30 Decrease in Bond Strengths with most
bonding systems.
Resin Bond Degredation
Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. Compend Contin Educ Dent. 2011 Sep;32(7):60-4, 66.
Resin-dentin bonds are not as durable as was previously thought. Microtensile bond strengths often fall 30% to 40% in 6 to 12 months.
Factors that compromise bond durability in restorative dentistry
“The major shortcoming of contemporary adhesive restoratives is their limited durability in vivo.”
Hydrophilic dentin bonding (1956 - )
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Total etch Self etch # of
components
Etchant
Primer
Adhesive
The Bonding Agents
Generation 4th 5th 6th 7th
Courtesy Pacific University (Dr Marc Guisberger)
InstroN
Ultra Tester (Ultradent)
Ultra Jig (Ultadent)
Maximum/Minimum Shear Bond
Strength per Bonding Material
Courtesy Pacific University (Dr Marc Guisberger)
Shear Bond Test Results - 2012
When bonding to enamel, an etch & rinse approach is definitely preferred, indicating that simple micro-mechanical interaction appears sufficient to achieve a durable bond to enamel. When bonding to dentin, a mild self-etch approach is superior, as it involves (like with glass-ionomers) additional ionic bonding with residual HAp. This additional
primary chemical bonding definitely contributes to bond durability. Altogether, when bonding to both enamel and dentin, selective etching of enamel followed by the application of the 2-step self-etch adhesive to both enamel and dentin currently appears the best choice to effectively and durably bond to tooth tissue
Van Meerbeek B, et al. Relationship between bond-strength tests and clinical outcomes. Dent Mater (2009), doi:10.1016/j.dental.2009.11.148
Developed by Kuraray 1983
• Acidic Monomer Activates Silanes & Chemically Bonds to Metal Oxide Ceramics (Zirconia & Alumina).
(Key Ingredient to make a Silane Universal)
• Hydrophilic & Hydrophobic
• Very Durable Dentin Bond
(Creates An Insoluble, calcium Salt with Dentin)
• Is The Most Copied Monomer In Dentistry
• The Most Researched Monomer In Dentistry
• 20 + Years Of Research On Metal Oxide Ceramics (Zirconia & Alumina)
• Strongest & Most Durable Bond to Metal Oxide (Zirconia & Alumina) Ceramics
MDP Adhesion Monomer:
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MDP Penta-P MDP BPDM
Adhesive Functional Monomers
MDP GPDM
All porcelain cementation use a bonding agent and resin cement
Self-Adhesive Resin Cements
No Primer or Bond? Gel State?
No Primer or Bond
Durability & Wettability ???? Self-Adhesive Resin Cements Without a Primer or Bonding Agent have less: • Wettability
• Which Results in Less Contact to the Tooth
• Which May Result in a Less Durable Bond
• Convenience
What do you use?
Shear bond strength to tooth structure
(N. Iwamoto, S. Uctasli, M. Ikeda, M. Nakajima J. Tagami, Tokyo Medical and
Dental University, 2008, Japan)
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CLEARFIL™
SA CEMENT
Multilink™
Sprint
RelyX™
Unicem
Vitremer™
Paste
GC Fuji
Luting S
RelyX™
Unicem
Clicker™
Shear bond strength (MPa)
Enam el
Dentin
Bond strength to Tooth structure
Panavia SA Cement
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10
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25
30
35
CLEARFIL™
SA CEMENTResiCem™ G-CEM™
CAPSULERelyX™UnicemAplicap™
maxcem™ RelyX™UnicemClicker™
Shear
Bond
Str
engt
h (
MPa)
Shear bond strength of self-adhesive resin cement to zirconia (LavaTM)
(M. Irie and K. Suzuki, Okayama University, P-39 International Symposium of Adhesive
Dentistry 2008, Kanazawa, Japan)
Bond strength to Zirconia (Lava)
Panavia SA Cement
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All Ceramic Crown Microleakage
MDP Resin Cement SE Auto Resins
After simulated aging through cyclic loading (1.2 million) and dye penetration test to
detect Microleakage. LSU Dental School. IADR 2006, Abstract #2090.
High Performance MDP Resin Cement
Universal Clear White Brown Opaque
√
High Performance Cement
√
Zirconia Ceramic Conditioning
• Primer was applied
on Zr surface
• Ultrasonicated in ethanol to remove unreacted resin components
0.0
20.0
40.0
60.0
80.0
NP AZ ZP MP CC SBU ABU
Pure
ZrPrimer Silane
ZrPrimer
Silane
ZrPrimer
Adhesive
ZrPrimer
Adhesive
LC required
Contact Angle as
Zr Primer
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MDPKuraray
MDPPCM
MDPDMI
24hr
TC100000
Bond durability of phosphate monomers with different purity Okayama Univ. (Yoshihara K, et al.)
The 33rd Meeting of the Japanese Society for Adhesive Dentistry, 2014, P-7
Primer:15% MDP solution Bond: CLEARFIL SE Bond Composite: CLEARFIL AP-X
Micro tensile bond strength to Dentin
(MPa )
“MDP”s perform differently
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Contains two main monomers:
y-MPS (Silane) for glass ceramics
MDP For Metal & Zirconia
CLEARFIL CERAMIC PRIMER
Treats All Indirect Restorations
(Ceramics, Metal, Zirconia,
Lithium Dislicate)
How MDP Bonds to Zirconia MDP-containing material bonds to Zirconia
CLEARFIL™ CERAMIC PRIMER
MDP
γ-MPS
Ethanol
118
Silane Treatments
eMax™ Zirconia
1. HF Etch 1. Sandblast (20-50psi)
2. Ultrasonic Clean or Ivoclean 2. Ultrasonic Clean, Ivoclean
3. Apply Ceramic Primer & Air Dry
3. Apply MDP-Based, Self-Adhering Cement or MDP-Based Silane
Review Ceramic Selection
Aesthetics
Strength
Cementation Placement Technique based on isolation
NEW Multi-Layered Translucent Zirconia
Polish after adjusting
Silanate with MDP material prior to try in of ceramics
Cementation High bonds to enamel with etching, adhesive and resin
High bond strength & durability for longevity with MDP monomer technologies on ceramic & dentin
Use a bonding agent with cement for highest bond strengths to tooth structure
Thank you!
Todd C. Snyder, DDS, AAACD
www.drtoddsnyder.com
www.facebook.com/todd.snyder.dds