B2 ◊Page B1 LAB TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2018 Initial clinical situation A 78-year-old female patient was dissatisfied with the positional sta- bility of her mandibular prosthesis. The acrylic teeth appeared abraded, stained and very dull. After the con- sultation, the patient decided on two implants in the mandibular in order to achieve greater functional stability, and was referred to an oral surgeon. After a healing period of three months, the implants were os- seointegrated in the incisal region of the mandibular. First, the patient did not want a new total prosthesis in the maxilla, although the midline was shifted extremely to the right and functional disadvantages due to the well-worn and irregular occlu- sion were to be expected. She feared that her usual appearance would be altered by a new restoration. How- ever, following a comprehensive consultation, she finally opted for a new restoration. First steps towards restoration The restoration in the mandible began with an anatomical alginate impression. So that it could be ori- ented to the old maxillary prosthesis using the copy denture technique, this was duplicated with putty and reproduced with a cold polymer for denture bases. For the mandible, a custom-made impression tray was made, a mucodynamic impression was taken in several steps and the impression cap was affixed. Using the model, a simple bar construction was fabricated and affixed with syn- thetic material to the attachments. A wax rim was created over the bar in the mandible, and plates for the im- aging of the Gothic arch positioned on this and the maxillary duplicate. Laterotrusion, protrusion and cen- tric were recorded and affixed. The duplicate was successively reduced in the setup area in order to first position and try in the VITAPAN EX- CELL anterior tooth and then the VI- TAPAN LINGOFORM posterior tooth. Prostheses fabrication and finalisation After a complete functional and aesthetic try-in, a mucodynamic impression with wax setup on a du- plicate base was taken in the maxilla. The bite was registered with silicon. In the maxilla, a final master model was produced and articulated ac- cording to the vertical dimension. The maxilla and mandibular setups were embedded in cuvettes, boiled out and pressed with heat-curing polymer into different gingival shades. After polymerization, both works were rearticulated and an oc- clusion check was done. The pros- theses were processed with fine-cut carbide milling tools and rubber pol- ishers. The final polishing was done with pumice and polishing paste, as well as a buffing wheel. The patient was very satisfied with the function- al and aesthetic result. Thanks to the lifelike shapes with “golden propor- tions,” the three-dimensional ana- tomically layered construction and the multifaceted surface texture, the prosthetic restoration with VITAPAN EXCELL appears very natural. Darius Northey, CDT, Australia Graduated as a Dental Technician after working in the family business for many years. 1997 Established his own dental laboratory in Sydney, Australia. 2004- 2006 Completed the ‘Advanced Diploma of Dental Prosthetics’. All-ceramics for every need By Dentsply Sirona Zirconia and Zirconia-Reinforced Lithium Silicate (ZLS) complement each other when it comes to all-ce- ramic oral rehabilitation with excel- lent performance. The aesthetic ap- pearance is further perfected either by using the staining technique or by providing a uniform type of ve- neer with a single ceramic material. The following report illustrates the laboratory workflows when using this material, along with the poten- tial benefits to the dental laboratory in terms of added business opportu- nities. Zirconia and Zirconia-Reinforced Lithium Silicate (ZLS) are high-per- formance ceramics with comple- mentary — and sometimes over- lapping — indications. This mainly applies to crowns and, in the case of pressable ZLS (Celtra® Press), three- unit anterior bridges whose distal- most abutment can be any tooth between the lateral incisor and the second premolar. The three clinical cases shown here present three ex- amples of aesthetic restorative de- signs (Fig. 1). Example 1: Extra-translucent zirconia, monolithic The task is to reproduce an A2 shade on a monolithic crown made of the extra-translucent zirconia material Cercon® xt (Fig. 2). The correct selec- tion of the most suitable ingot is a good start. The framework mate- rial is available in all VITA¹ classical shades. To achieve pleasing basic aesthetics, a final individualisation is performed with three universal stains and glaze. The crown body is first customised with a bit of Pink (Fig. 3). The enamel ridges are highlighted with Incisal Stain i1, while the incisal area with its mamelon structures is refined with a bit of Crème (Figs. 4 and 5). After the stain firing, a single glaze (Universal Stain & High Flu Glaze) is applied, covering the monolithic restoration (Fig. 6). The final shade check using shade tabs confirms the quick and easy shade reproduction and great aesthetics (Fig. 7). ÿPage B3 Fig. 1: The smart Celtra® Press stain recipe simplifies the selection of shades and reduces inventory costs. Fig. 2: The goal was to reproduce the A2 shade on a monolithic crown made of extra-translucent zirconia. Fig. 3: Individualisation with three universal stains and glaze. Some Pink is applied to the crown body first. Fig. 4: The enamel ridges of the occlusal surfaces are highlighted with Universal Stain i1. Fig. 5: In the incisal region, the mamelon structures are refined with the Universal Stain Créme. Fig. 6: Finally, the glaze is applied (High Flu). Fig. 7: Checking the shade - A perfect A2 shade match. Fig. 8: The goal was to reproduce an A2 shade on a crown framework made of extra-translucent zirconia. Fig. 9: The entire VITA1 range is available when selecting the ingot (True Colour Technology). The result is a framework that already approximates the desired shade. Fig. 10: The labial and palatal aspects of the enamel are built up with Enamel. Fig. 11: Finishing. This is how the desired shape and surface texture are incorporated. Fig. 12: Design of the incisal edges - A fine line of Créme.