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Dental Tribune Middle East & Africa Edition | 3/2017 NEWS 43 Minimally invasive inlay restoration from the hybrid ceramic VITA ENAMIC By VITA Inlay restorations using CEREC pro- cedures have been an established process in digital dentistry for dec- ades. However, due to the required minimum wall thickness, a lot of tooth substance frequently had to be dissected in reconstructions of traditional ceramics. Due to reduced minimum wall thicknesses, VITA ENAMIC (VITA Zahnfabrik, Bad Säck- ingen, Germany) allows minimally invasive restorations and can be precisely ground in thinly tapering edge areas. In the report, Dr. Gerhard Werling (Bellheim, Germany) ex- plains the clinical procedures for an inlay-restoration of hybrid ceramic in region 24-26. Initial situation Figures 1 and 2 show the initial situa- tion. On the basis of the patient's his- tory and according to the patient's request (male, 38 years), he was not treated with alternative methods (infiltration technique, fluoridation, regular controls, etc.). Instead, a fill- ing cavity was carefully dissected on the tooth in which the caries had already penetrated the approximal enamel in the X-ray image. Surpris- ingly, in the clinical image, the caries had penetrated deep into the den- tine, so that after extensive excava- tion, a considerable defect in the sub- stance was present. Material selection Since the patient wanted a perma- Fig. 1: Initial situation Fig. 2: X-ray status – do the recognizable caries have to be treated, or can they be processed with alternative methods? nent enamel-like and tooth-like restoration, composite could not be used as a restoration material. It was decided to proceed according to the "extension for prevention" rule - but as minimally invasive as possible. The hybrid ceramic VITA ENAMIC is very advantageous in this case. The unique network structure in which ceramic and acrylate polymers in- terpenetrate, provides for enormous resilience and offers more freedom than traditional restoration materi- als. CAD/CAM workflow Three VITA ENAMIC inlays were fabricated using the CEREC System (Sirona Dental, Bensheim, Germa- ny). The intraoral scan was done us- ing the CEREC Omnicam. With biogeneric the software, the reconstruction was done analo- gously the missing chewing surfaces. In the grinding pre- view, the inlays were placed in to the material blanks. The geometry EM-10 (8 x 10 x 15 mm) was chosen according to the shade determina- tion with VITA Easyshade (VITA Zahnfabrik) in the color 1M2-HT. The hybrid ceramic can be processed very simply and quickly by machine as well as manually. Thanks to the high load-bearing capacity and edge stability, constructions with com- paratively small wall thicknesses and thin-running edges are also feasible. Edge chipping, which can occur in traditional ceramics, are rare with this material. Processing and integration It is advantageous that there is no firing process, and a shade charac- terization is possible if desired. The available shade selection (0M1 - 4M2) in two translucent steps, plus the good light transmission of the ma- terial allow for esthetically pleasing results. The inlays have been pol- ished to a high gloss with the VITA ENAMIC Polishing Set in the clinic. The hybrid ceramic can also be easily polished intraorally. With VITA pol- ishing instruments, the restoration edges can be polished in a unique, fine manner so that virtually no transition between the tooth and the restoration remains visible. Bonding is performed adhesively. VITA® and other VITA products men- tioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany. Dr. Gerhard Werling, Dentist, Bellheim, DE Arndt Lommerzheim Head of Public Relations & Training T: + 49 (0) 7761 562 242 F: + 49 (0) 7761 562 233 E: a.lommerzheim@vita-zahnfabrik.com W: www.vita-zahnfabrik.com Rebecca Linge PR coordinator T: + 49 (0) 7761 562 210 F: + 49 (0) 7761 562 233 E: r.linge@vita-zahnfabrik.com Fig. 3: Care was taken with the careful dissection of a filling cavity, but in the course of the excavation there were clinically extensive undermining defects. Fig. 4: "Extension for prevention" – but as minimally invasive as possible. Fig. 5: The digital impression was made with an in- traoral scanner. Fig. 6: The chewing surfaces were reconstructed using the biogeneric software. Fig. 7: By overlaying the counterbite, the contact points can be checked. Fig. 8: In the grinding preview, the designs were placed optimally in the blank (the inlay for tooth 26 is shown). Fig. 9: For the adhesive bonding, absolute drainage is ensured with a rubber dam. Fig. 10: Result: A defect-oriented restoration with composite fillings was planned. The result was a min- imally invasive restoration with VITA ENAMIC inlays. King's College London ranked top university in Europe for dentistry By King's College London The 2017 QS World University Rank- ings by subject have scored Dentist- ry at King’s College London first in Europe, and number 4 in the world for the second year running. The QS rankings highlight the world’s top universities across 42 popular subject areas. Institutions are assessed on academic reputa- tion, citations to publications and employer reputation to give an overall score. Executive Dean Pro- fessor Mark Woolford said: ‘Ris- ing to first in Europe in the global rankings reaffirms our position as a world-class institution and reflects the dedication, commitment and innovation of our academic and professional staff, our students, and our alumni.’ King's College London Dental Institute London SE1 9RT United Kingdom W: www.kcl.ac.uk/dentistry