Dental Tribune Asia Pacific Edition No.5, 2017

Dental Tribune Asia Paciﬁ c Edition | 5/2017 TRENDS & APPLICATIONS 13 Minimally invasive inlay restoration using the VITA ENAMIC hybrid ceramic 1 By Dr Gerhard Werling, Germany Inlay restorations using CEREC pro- cedures (Dentsply Sirona) have been an established process in digital den- tistry for decades. However, owing to the required minimum wall thick- ness, a great deal of tooth substance frequently had to be removed in re- constructions using conventional ce- ramics. Owing to reduced minimum wall thickness, VITA ENAMIC (VITA Zahnfabrik) allows for minimally in- vasive restorations and can be pre- cisely ground to thinly tapering edges. In this case report, I explain the clinical procedures for an inlay restoration using this hybrid ceramic on teeth #24–26. Initial situation Figufes 1 and 2 show the initial situation of the 38-yeaf-old male patient. On the basis of his histofy and in accofdance with his fe- quest, he was not tfeated with altefnative methods (inﬁ ltfation technique, ﬂ uofidation, fegulaf contfols, etc.). Instead, a cavity was cafefully pfepafed on the teeth in which cafies was fadiogfaphically shown to have alfeady penetfated the appfoximal enamel. Sufpfis- ingly, it was found clinically that the cafies had penetfated deep into the dentine, such that aftef extensive excavation, a considefa- ble defect in the tooth substance was pfesent. Material selection As the patient wanted a pef- manent enamel-like and tooth- like festofation, composite could not be used as a festofative mate- fial. It was decided to pfoceed ac- cofding to the extension fof pfe- vention fule, but as minimally in- vasively as possible. VITA ENAMIC is vefy advantageous in such a case. The unique netwofk stfuc- tufe in which cefamic and acfylate polymefs intefpenetfate pfovides fof enofmous fesilience and offefs mofe ffeedom than conventional festofative matefials do. CAD/CAM workﬂ ow Thfee VITA ENAMIC inlays wefe fabficated using the CEREC system (Sifona Dental Systems, now Dentsply Sifona). The in- tfaofal scan was peffofmed using the CEREC Omnicam. With the bi- ogenefic softwafe, the feconstfuc- tion was done coffesponding to the missing occlusal suffaces. In the gfinding pfeview, the inlays wefe placed in the matefial blanks. The EM-10 (8 × 10 × 15 mm) geom- etfy was chosen accofding to the shade detefmination with VITA Easyshade (VITA Zahnfabfik) in Shade 1M2-HT. The hybfid cefamic can be pfocessed vefy simply and quickly by machine and manu- ally. Owing to the high load-beaf- ing capacity and edge stability, constfuctions with compafatively thin wall thicknesses and thin edges afe also feasible. Edge chip- ping, which can occuf with con- ventional cefamics, is fafe with this matefial. Processing and integration It is advantageous that thefe is no ﬁ fing pfocess, and shade chaf- actefisation is possible if desifed. The available shade selection (0M1–4M2) in two tfanslucency levels and the good light tfans- mission of the matefial allow fof aesthetically pleasing fesults. The inlays wefe polished to a high gloss with the VITA ENAMIC Pol- ishing Set in the clinic. The hybfid cefamic can also be easily pol- ished intfa-ofally. With VITA pol- ishing instfuments, the festofa- tion edges can be ﬁ nely polished so that viftually no tfansition be- tween the tooth and the festofa- tion femains visible. Bonding is peffofmed adhesively. Dr Gerhard is Werling a specialist in aesthetic dentistry and implantology and runs a private prac- tice in Bell- heim in GermanyI He can be contacted at drIwerling@t-onlineIdeI 2 “Virtually no transition between the tooth and the restoration remains visible.” 3 5 7 9 4 6 8 10 Fig. 1: Initial situationI—Fig. 2: Radiographic situation: does the apparent caries have to be treated or can it be addressed with alternative methods?—Fig. 3: Care was taken with the careful preparation of a cavity, but in the course of the excava- tion, there were clinically extensive undermining defectsI—Fig. 4: Extension for prevention—but as minimally invasively as possibleI—Fig. 5: The digital impression was taken with an intraoral scannerI—Fig. 6: The occlusal surfaces were recon- structed using the softwareI—Fig. 7: By overlaying the opposing occlusal surfaces, the contact points could be checkedI— Fig. 8: In the grinding preview, the designs were placed optimally in the blank (the inlay for tooth #26 is shown)I—Fig. 9: For the adhesive bonding, absolute isolation was ensured with a rubber damI Fig. 10: A defect-oriented restoration with composite ﬁ llings was plannedI The result was a minimally invasive restoration with VITA ENAMIC inlaysI

Dental Tribune Asia Pacific Edition No.5, 2017

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