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Dental Tribune Middle East & Africa Edition

30 Dental Tribune Middle East & Africa Edition | September-October 2014industry Dr. Otmar Rauscher 1991: Doctorate degree awarded by the University of Munich, Germany Since 1992: Own dental practice in Munich, Germany Since 1995: CEREC user Since 2001: Lecturer for CEREC training courses nationally and internationally Since 2006: ISCD-certified CEREC trainer Consultant in the further de- velopment of CEREC and inLab software 2010: Establishment of a spe- cial commercial laboratory for CEREC Connect and CEREC inLab Contact: praxis@dr-otmar-rauscher.de About The Author VITA ENAMIC: a greater similarity to natural dentition and more cost-effective than previous CAD/CAM ceramics? ByDr.OtmarRauscher T he hybrid ceramic VITA ENAMIC is an innova- tive CAD/CAM mate- rial. Using a clinical case as an example, this report explains how VITA ENAMIC offers com- mercial benefits in comparison with similar materials. The time required to complete pro- cessing and the service life of milling tools are criteria that are worth looking at from an economic perspective. New structure, new possibili- ties The innovative hybrid ce- ramic, which is comprised of a structure-sintered ceramic matrix, together with an inte- grated polymer network, offers abrasion behavior similar to enamel as well as a modulus of elasticity of 30 GPa, which is similar to that of dentin. The hybrid ceramic demonstrates unusual properties thanks to a combination of flexibility and load capacity. For example, the static fracture load is ap- prox. 2890 newtons while the Weibull modulus, an indication of material reliability, is 20. As a result, VITA ENAMIC is rec- ommended as a CAD/CAM ma- terial particularly in the case of minimally-invasive restora- tions and in areas subject to high occlusal load. Even inlays with a wall thickness of just 0.2 mm can be reliably implement- ed. During processing, the hy- brid ceramic also demonstrates high edge stability in the case of restorations with thin mar- gins. This stability combined with integrated cracking pre- vention allows milling to be performed in fast milling mode even if walls are thin. Thanks to the short milling time and long service life in the case of milling tools, VITA ENAMIC is an interesting option from an economic standpoint. No firing is required either. Case study In a 30-year-old patient, tooth 45 had been fitted with an inad- equate acrylic restoration and also showed secondary caries (Fig. 1). The goal of treatment was to provide a new minimal- ly-invasive restoration using an inlay. VITA ENAMIC was se- lected as the material, promis- ing rapid chairside fabrication in combination with CEREC MC XL (Sirona). Shade 2M2 was the outcome following de- termination of the correct tooth shade using VITA Easyshade (Fig. 2). A HT (high translucen- cy) VITA ENAMIC block was used. The acrylic filling and caries (Fig. 3) were removed first, and preparation performed in accordance with all-ceramic guidelines. CEREC Optispray powder was then applied, fol- lowed by scanning of the pre- pared tooth and the antago- nists. Digital processing of the model was carried out using CEREC SW 4.03. Once a new case had been created (Fig. 4), VITA ENAMIC was selected in the program as the mate- rial (Fig. 5). Using the digital impression data of the prepa- ration, antagonists and maxi- mum intercuspation, digital models were created (Fig. 6 to 8). The software also generated buccal bite registration (Fig. 9 and 10). Figure 11 shows the occlusal contacts. In the next step, concrete planning of the new inlay began with the defi- nition of the preparation mar- gin (Fig. 12). When determin- ing the modeling parameters, using the “Minimal Thickness (Radial)” setting (Fig. 13) al- lowed margins to be delicately milled so that one of the special properties of VITA ENAMIC could be used to full effect. A software-generated model was then suggested for the in- lay (Fig. 14). Following slight adjustment of the design, the block was selected (Fig. 15) and the milling preview dis- played (Fig. 16). Fabrication was performed using CEREC MC XL. The processing time for an inlay using normal mill- ing mode is just under eight minutes; in fast milling mode, approximately four-and-a-half minutes. Tests conducted by the manufacturer show that a longer service life can be achieved: using one set of mill- ing tools, it was possible to fab- ricate 148 posterior crowns in normal milling mode and 132 posterior crowns in fast milling mode. Initial practice experi- ence confirms this trend. The fact that no firing is re- quired at all also saves time. The VITA ENAMIC STAINS KIT (six stains including acces- sories) can be used for shade characterization. The stains are bonded to the restoration as part of a polymerization pro- cess and surface sealing can be performed using the chemical glaze material VITA ENAMIC GLAZE. Try-in was carried out for the inlay followed by adhesive bonding using VITA Duo Ce- ment. Final polishing was per- formed for one minute in each case using the VITA ENAMIC Polishing Set clinical and sili- con carbide polishing instru- ments, and was followed by high-gloss polishing using gray diamond burrs. The final re- sults blend in perfectly with the remaining natural dentition (Fig. 17). Summary VITA ENAMIC is a material that is convincing, not only because of its properties similar to those of natural dentition, but also because of its outstanding effi- ciency thanks to ideal process- ing characteristics, which has been proven in practice. The hybrid ceramic helps save you both time and money in a range of steps. The patient also ben- efits from shorter treatment times – as well as from superior quality results that offer prop- erties similar to natural denti- tion in terms of look, feel and functionality. Fig. 1: Tooth 45 (initial situation): inadequate acrylic filling. Fig. 4: Inlay modeling using in CEREC SW 4.03. Fig. 7: … and of the antagonists. Fig. 5: Material selection. Fig. 8: Buccal bite registration. Fig. 6: Generated based on the scan data, a view of the prepared tooth... Fig. 9: Bite registration of the upper and lower jaw separately… Fig.11:Viewoftheocclusalcontacts. Fig.12:Definitionofthepreparation margin. Fig. 10: … and in occlusion. Fig. 13: Selection of the model pa- rameters. Fig. 14: Virtual design suggested for the inlay. Fig. 16: … and the milling preview shown. Fig.17: Final result: the inlay blends in perfectly. Fig.15: The material block is select- ed … Fig. 2: VITA Easyshade Advance 4.0 for precise shade determination. Fig. 3: Following preparation.

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