Dental Tribune U.S. Edition

Cosmetic Tribune U.S. Edition | April 2014C2 Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com President & Chief Executive Officer Eric Seid e.seid@dental-tribune.com Group Editor Kristine Colker k.colker@dental-tribune.com Editor in Chief Dental Tribune Dr. David L. Hoexter feedback@dental-tribune.com Managing Editor U.S. and Canada editions Robert Selleck r.selleck@dental-tribune.com Managing Editor Fred Michmershuizen f.michmershuizen@dental-tribune.com Managing Editor Sierra Rendon s.rendon@dental-tribune.com Marketing DIRECTOR Anna Kataoka a.kataoka@dental-tribune.com Education Director Christiane Ferret c.ferret@dtstudyclub.com Accounting Coordinator Nirmala Singh n.singh@dental-tribune.com Projects & Events Coordinatorer Robert Alvarez r.alvarez@dental-tribune.com Tribune America, LLC 116 West 23rd St., Ste. #500 New York, N.Y. 10011 (212) 244-7181 Published by Tribune America © 2014 Tribune America, LLC All rights reserved. Tribune America strives to maintain the utmost ac- curacy in its news and clinical reports. If you find a factual error or content that requires clarification, please contact Managing Editor Robert Selleck at r.selleck@dental-tribune.com. Tribune America cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume respon- sibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Tribune America. Editorial Board Dr. Joel Berg Dr. L. Stephen Buchanan Dr. Arnaldo Castellucci Dr. Gorden Christensen Dr. Rella Christensen Dr. William Dickerson Hugh Doherty Dr. James Doundoulakis Dr. David Garber Dr. Fay Goldstep Dr. Howard Glazer Dr. Harold Heymann Dr. Karl Leinfelder Dr. Roger Levin Dr. Carl E. Misch Dr. Dan Nathanson Dr. Chester Redhead Dr. Irwin Smigel Dr. Jon Suzuki Dr. Dennis Tartakow Dr. Dan Ward Tell us what you think! Do you have general comments or criticism you would like to share? Is there a particular topic you would like to see articles about in Cosmetic Tribune? Let us know by e-mailing feedback@dental-tribune.com. We look forward to hearing from you! If you would like to make any change to your subscription (name, address or to opt out) please send us an e-mail at database@dental-tribune.com and be sure to include which publication you are referring to. Also, please note that subscription changes can take up to six weeks to process. Strength, esthetics drive selection of restorative material in unusual case By Drake Laboratory Staff In the esthetic restorative material arena, Ivoclar Vivadent once again has found an ideal niche with its IPS e-max® lithium disilcate product. The applica- tion as a full contour restorative mate- rial provides improved strength and cementability that compares to the original, extremely successful, pressed Empress formulation Designed with simplicity and versatil- ity in mind, e-max is available for both the PRESS and CAD/CAM techniques. When utilizing the PRESS technique, two different types of ingots are avail- able: IPS e.max Press, a high-strength glass-ceramic, and IPS e.max ZirPress, an esthetic glass-ceramic that is pressed onto zirconium oxide in a fast and ef- ficient procedure. Pressed flexural strength is 400 mpa. For CAD/CAM applications, either the highly esthetic IPS e.max CAD ceramic glass blocks or the high-strength IPS e.max ZirCAD zirconium oxide can be selected, depending on the case require- ments (Fig. 1). The nano-fluorapatite layering ce- ramic IPS e.max Ceram completes the all-ceramic system. This material is used to veneer all IPS e.max components, no matter if they are glass-ceramic or zirco- nium oxide. Milled flexural strength is 360 mpa. Case study The patient presented with a desire to improve the appearance of her smile. She is an early-40s female in excellent general health. The overall patient desire was a bright and white smile with as many improve- ments to gingival outline and occlusal relationship as possible. The patient was not interested in orthodontic treatment and wanted as much improvement as could be created with restorative treat- ment. The entire upper arch was in need of restorative treatment, so a full arch plan was developed (Fig. 2). Following standard procedure with cases involving anterior guidance, the procedure began with facebow-mounted models in centric relation. It was deter- mined that a slight increase in vertical dimension was indicated for restorative convenience. Also, the lower occlusal plane was erratic and inappropriate. A complete diagnostic wax-up was de- veloped to simulate the improved occlu- sal plane and proposed gingival outline of final restorations at the raised vertical. Incisal edge position, and final restora- tion contours were developed with this wax-up. Upon approval, the wax-up was con- verted to a provisional restoration through the use of a putty matrix. The entire arch was prepared and the provi- sional was relined to accommodate the preparation discrepancy and gingivecto- my performed at the time of preparation. The patient was evaluated multiple times postoperatively to perfect the ap- pearance of the provisional and to evalu- ate lip support, occlusion and phonet- ics. Once all patient expectations were achieved, the provisional was impressed to be used as the final blueprint for the case. Final impressions were taken, and the case was mounted in such a way as to cross mount the approved provisional and the die model. A labial incisal matrix was developed, into which the perma- nent restorations could be built. Based on its physical and esthetic properties, e-max was chosen as the re- storative material. Wax patterns were developed for pressing, simulating a “cut back” upon which final porcelain layer- ing could be accomplished. The case was developed by Drake Labo- ratory (Charlotte, N.C.) and delivered. Post-op visits consisted of minor occlusal modifications and production of an oc- clusal splint to be worn at night. The patient was very pleased with the final result. Although the case was com- promised because of the lack of pretreat- ment orthodontics, the final outcome was deemed a success by both the restor- ing dentist and the patient (Figs. 3, 4). Conclusion The type of predictability exhibited in this case study is possible because of many factors. Chief among them are proper evaluation and planning com- bined with the skill of the clinician and technician. The Ivoclar IPS e-max material select- ed for the case ensured functional and esthetic success. COSMETIC TRIBUNE INDUSTRY CLINICAL Fig. 2: The entire upper arch is in need of restorative treatment, so a full arch plan is developed. The patient was not interested in orthodontic treatment but wanted as much improvement as could be created with restorative treatment Fig. 1: For CAD/CAM applications, either the highly esthetic IPS e.max CAD ceramic glass blocks or the high-strength IPS e.max ZirCAD zirconium oxide can be selected, depending on the case require- ments. Photos/Provided by Drake Laboratory Fig. 3: The case is developed by Drake Laboratory, Charlotte, N.C., and delivered. Post-op visits consist of minor occlusal modifications and production of an occlusal splint to be worn at night. Fig. 4: Final outcome is deemed a success by the restoring dentist and patient. The patient was very pleased with the final result.