N L Y A L S O N F E S SI O O R T A L P N E D PUBLISHED IN DUBAI www.dental-tribune.me September-October | No. 5, Vol. 9 An exciting change Comparison of the IPS d.SIGN and IPS Style ceramic systems By Velimir Žujic, Croatia Change is exciting – also in day-to- day dental lab work. The author switched to using IPS Style layering ceramic some time ago. Before he started working with this ceramic system, he thoroughly tested the material and compared it to the product he had previously used. The main aim of switching to a new ceramic system is to improve the quality of one’s results. We regularly used the ﬂuorapatite-leucite glass- ceramic IPS d.SIGN® in our laborato- ry. Then, one day we asked ourselves the following question: Would IPS Style® (the ﬁrst patented metal-ce- ramic material containing oxyapa- tite) offer a sound alternative to our accustomed product? We decided to test the new material on ﬂat cobalt- chromium alloy samples. These test specimens enabled us to take a closer look at the layering ceramic. We used these base metal alloy samples (Co- lado CC) to examine and compare several properties of IPS d.SIGN and IPS Style: for example shade, bright- ness, shrinkage, ﬂuorescence and di- mensional stability. Conditioning and opaquer application One specimen was oxidized at 950°C with a holding time of one minute. The other sample was treated with a bonding agent. Two metal speci- mens with different bases were now sufﬁciently prepared for the ap- plication of the ceramic materials. Next, the samples were coated with IPS d.SIGN Paste Opaquer and IPS Style Ceram Powder Opaquer. The opaquer products of both systems have a smooth consistency. We had never used an opaquer in powder form before, so applying the IPS Style material was completely new to us. Nevertheless, we were impressed by its ease of application and the excel- lent results. Shrinkage behaviour and shade effect In the next step, we compared the Dentin and Transpa T Neutral ma- terials as well as the Opal Effect OE1 materials. Each of the ceramics was applied to one of the metal samples. A line was drawn down the middle of the sample with a spatula for the Fig. 1: Test samples showing shrinkage behaviour. Left: Application of the ceramic on the metal sample. Centre: IPS d.SIGN Right: IPS Style purpose of comparing the shrinkage behaviour. The two different ceram- ics showed the same colour after ﬁring. It was interesting to note that IPS Style exhibited less horizontal shrinkage than IPS d.SIGN (Fig. 1). The vertical shrinkage of both ceramics was almost identical. The samples were held next to each other and examined under a polarizing light. IPS Style was shown to be somewhat brighter than IPS d.SIGN. Both materials exhibited almost the same level of ﬂuorescence. In this comparison IPS Style was at a slight advantage because its Transpa T Neutral and the Incisal materials dis- played a more lifelike ﬂuorescence. Dimensional stability and test results The dimensional stability of the ce- ramics was clearly visible after the ﬁrst ﬁring cycle. The IPS Style layers successfully maintained their shape after ﬁring. In contrast, IPS d.SIGN did not retain its shape completely. After this test series, we felt that we had gained enough information about the new material for our pur- poses. Even though the tests were relatively simple, they provided us with valuable insights into the two ceramic systems. Now we were ready to compare the two materials on the basis of an actual case study. Case study The patient was dissatisﬁed with the appearance of her upper teeth (Fig. 2). She wanted a new tooth colour, but wished the shape and position of her teeth to be maintained as best as possible. This simpliﬁed shade selec- tion, since we “merely” had to select ÿPage B2 Fig. 2: Initial situation. The patient wished to have the appearance of her upper teeth enhanced. Fig. 3: Teeth 15 to 25 were prepared. Fig. 4: Printed model with SLM metal copings Fig. 5: Comparison of the opaquer (left: IPS d.SIGN; right: IPS Style) Fig. 6 & 7: Application of the ceramic margin using the Margin materials of the two ceramic systems (left: IPS d.SIGN; right: IPS Style) Fig. 8 & 9: The ceramic materials were mixed with Liquid Visual Eyes for the purpose of visually comparing the two materials during the layering proces (left: IPS d.SIGN; right: IPS Style) Fig. 10: Comparison of the crowns after the ﬁrst ﬁring (left: IPS d.SIGN; right: IPS Style) Fig. 11: Adjustment of the incisal teeth with Transpa and Mamelon materials (left: IPS d.SIGN; right: IPS Style) Fig. 12: Application of Transpa Dentin, Transpa Incisal and Transpa Impulse for the corrective ﬁring cycle Fig. 13: The two anterior crowns after the corrective ﬁring (left: IPS d.SIGN; right: IPS Style)
B2 ◊Page B1 LAB TRIBUNE Dental Tribune Middle East & Africa Edition | 5/2019 Fig. 14: The ﬁnal restoration (IPS d.SIGN) after the second corrective ﬁring cycle Fig. 15: The ﬁnal restoration (IPS d.SIGN) after the second orrective ﬁring cycle Fig. 16: In terms of ﬂuorescence, both materials met our criteria. Fig. 17: The ﬁnal choice fell on the IPS Style restorations: shown in the mouth. Fig. 18: The seated restorations (layered with IPS Style) harmoniously blend into the overall natural oral envi- ronment. a slightly lighter tooth shade. Next, the teeth 15 to 25 were prepared (Fig. 3). Then a digital impression of the situation was taken with an intraoral scanner. From the manufacturing centre we were able to order both printed models and selective laser melting (SLM) metal copings. Both the models and the copings were produced simultaneously. This al- lowed us to start with the ceramic application immediately (Fig. 4). The restorations were built up on the frameworks with the two ceramic materials so that we could compare IPS Style and IPS d.SIGN in the pa- tient’s mouth. A detailed description of the procedure involving the two ceramics is provided below. Preparation of the copings First, the metal copings were oxi- dized according to the instructions of the manufacturer and then the opaquer was applied. The IPS d.SIGN Paste Opaquer and the IPS Style Ceram Powder Opaquer exhibited excellent ﬂow and masking proper- ties (Fig. 5). Two ﬁring cycles were adequate for producing the desired masking effect. The opaquer in paste form was easy to apply, since the ma- terial is supplied ready for use from the syringe. Depending on its appli- cation, the rather dense paste may have to be diluted with some Paste Opaquer Liquid. The IPS Style Ceram Powder Opaquer, however, is mixed to the desired consistency with a matching liquid component. The product is easy to apply with a brush or a glass- ceramic or ceramic instrument. Margin material was used to create a shoulder, thereby enhancing the aesthetic appearance of the restora- tion and establishing a tight seal to the gingiva. The Margin materials of the IPS Style and IPS d.SIGN systems helped to create a beautiful margin (Figs 6 and 7). First firing In order to make a visual compari- son of the layers placed with the two ceramics, the materials were mixed with Liquid Visual Eyes (Harvest Dental). The Visual Eyes Liquid is a product that renders the colour of the ﬁred ceramic visible before the material is actually ﬁred (Figs 8 and 9). The basic dentin layer was created with 25 % Cervical Transpa orange- pink and 25 % Cervical Transpa khaki mixed with 50 % Dentin B2. Un- mixed Dentin material was used in the central part. The incisal mamel- ons were produced with a mixture of 80 % Dentin B2 and 20 % Special In- cisal grey. In the horizontal cut-back space, Effect material Inter Incisal white-blue was applied. The incisal margin was completed with Opal Effect OE 1 and Transpa materials (neutral, orange grey). The mamel- ons and internal characteristics were created with a very ﬁne separating instrument. After the ﬁrst ﬁring, the colours of IPS Style and IPS d.SIGN looked good and appeared almost identical (Fig. 10). IPS Style Ceram and IPS d.SIGN Transpa as well as Mamelon materials were used to make some slight adjustments to the shape of the anterior teeth. At this stage, a comparison showed that a few distal areas in the incisal edge of the IPS d.SIGN restoration were slightly more translucent. Customisation of the layers and second firing After the ﬁrst corrective ﬁring cy- cle, the teeth were customized with suitable IPS Ivocolor® stains. These materials are used to characterise restorations (e.g. mamelons), imitate enamel cracks and adjust the colour intensity and translucency of certain areas. Subsequently, the stains were ﬁred. In this case, a reddish hue was im- parted to the incisal edge with IPS Ivocolor Essence E21 basic red to achieve a “lip gloss inﬁltrated” effect in the dental enamel. For the second ﬁring, the crowns were coated with Transpa Dentin, Transpa Incisal and Transpa Impulse (Figs 11 to 13). Comparison of the results After the second corrective ﬁring of the different IPS Style Ceram Transpa materials, we were convinced that the product fulﬁlled all our criteria: The dimensional and shade stability of the ceramic was impressive. We effectively controlled the brightness of the material by adding Transpa T neutral. All in all, we were completely satisﬁed with the result. The colours of IPS Style were lifelike and they were identical to those of IPS d.SIGN. A direct comparison clearly shows the excellent colour coordination of the different ceramic ranges (Figs 14 and 15). Furthermore, the same shade system applies to the IPS e.max® all- ceramics and the SR Nexco® light- curing laboratory composite. Summary IPS Style is deﬁnitely capable of re- placing IPS d.SIGN, which we used in our laboratory for quite some time. It completely satisﬁed us in terms of its shade and dimensional stability and its high strength. This ceramic offers us incredible ﬂexibility and satis- ﬁes all our demands. Moreover, the ceramic system is geared towards modern manufacturing techniques: At present, we use printed, milled and conventionally cast metal to fabricate the frameworks used in our laboratory. The different fabrication methods involve a wide range of CTEs. IPS Style accommodates this requirement and does not cause any problems related to fracture during ﬁring. The ceramic is characterized by minimal shrinkage and high di- mensional stability. IPS d.SIGN, however, shows less di- mensional stability and therefore does not perform as well in inter- dental areas and deep ﬁssures. In this respect, it is less predictable than IPS Style. Nevertheless, the shade stabil- ity of IPS d.SIGN is comparable to that of IPS Style. In terms of ﬂuores- cence, both materials equally meet our criteria (Fig. 6). IPS Style Ceram Incisal and IPS Style Ceram Transpa T Neutral have a slightly more lifelike ﬂuorescence than the corresponding IPS d.SIGN materials. Conclusion In the end, the IPS Style solution had a slight advantage. We chose it for the ﬁnal restoration because of its beautiful tooth shapes and vital ap- pearance in the mouth (Figs 17 and 18). Acknowledgements I would like to thank Dr Patricia Žujic for her collaboration on this case and Iris F., our patient, for her patience during this project. I would also like to thank all my colleagues and friends from the TTT Group at Ivo- clar Vivadent in Vienna. This group provides us with incredible opportu- nities to exchange experiences and new ideas. About the author Velimir Žujic Privatni zubotenicki laboratorij Franje Belulovica 15 51000 Rijeka, Croatia firstname.lastname@example.org AD PRINT EVENTS EDUCATION DIGITAL Dental Tribune International The World's SERVICES Largest Dental Marketplace www.dental-tribune.com
Dental Tribune Middle East & Africa Edition | 5/2019 LAB TRIBUNE B3 The new Multimat Cube from Dentsply Sirona: powerful, user-friendly, reliable By Dentsply Sirona Working with the Multimat ceramic furnaces has been a staple for dental lab technicians worldwide for many years due to their ease of use and re- liable performance. Dentsply Sirona is excited to introduce the Multimat Cube and Multimat Cube press. Both the Multimat Cube and Multimat Cube press combine the classical vir- tues of previous models with mod- ern comfort of the digital world. First of all, the Multimat Cube and Multimat Cube press deliver exactly what every experienced dental tech- nician expects of them. It is a uni- versal furnace for all commercially available dental ceramics, including lithium silicate and lithium disili- cate. A multi-stage heating program and a two-stage cooling program, together with the automatic re- sumption of the program after a brief power cut, ensure a high level of process reliability and guarantee cutting-edge ﬁring results. Speciﬁcally, the intelligent pre-heat- ing program and the reliability of the restoration impresses users. A mobile furnace chamber indepen- Fig. 1: As a universal furnace for all commercially available den- tal ceramics, theMultimat Cube scores in the dental lab thanks to its ﬂexibility and process reliability. Fig. 2: The new variation of the furnace, Multimat Cube press, is also suitable for processing pressable ceramics – for example, for the popular high-strength glass ceramic Celtra Press. dently balances out any vibrations. The Multimat Cube represents qual- ity “Made in Germany”, and it is also approved according to international standards (ETL). This abbreviation stands for Edison Testing Laborato- ries, a renowned safety seal of ap- proval that originates from the fa- mous inventor, Thomas Edison. Besides the high level of perfor- mance and reliability, the operation is also intuitive. It is operated via a large, clear touch display. It has a highquality, three-millimeter thick tempered glass cover and guaran- tees clear access to the programs. The system gives the dental lab technician constant feedback on the current status of the ﬁring process via an LED indicator. Two USB ports enable you to back up the data on a USB stick. The programs for ceramic systems by Dentsply Sirona are pre-installed. Performance, reliability and operat- ing comfort are also integral features of the Multimat Cube press. Besides the range of applications offered by the Multimat Cube, it also offers the possibility of processing pressable ceramics. For example, this system allows the user to press the popular high-strength glass ceramic Celtra Press using pre-installed programs, and then to ﬁre the veneering ce- ramic Celtra Ceram. With their minimalistic design, both of the new models are real eyecatch- ers when seen in the lab. Both the Multimat Cube furnace and the Mul- timat Cube press pressing and ﬁring unit are recommended as reliable options, which are robust in day-to- day operation and offer a high level of user comfort. AD Dental Lab Technicians: Aesthetics as its Best Sponsored by: SEMINAR + HANDS-ON COURSE with Ümit Pak, Germany 08-09 Nov 2019 Friday-Saturday InterContinental Hotel DFC Dubai | UAE Area of interest: Dental Technicians Starting from 450 AED Ümit Pak, Germany Ümit Pak is a dental technician of strong character from Dinslaken, Germany. After his training as a dental technician he gained a lot of experience in various commercial and in-oﬃce laboratories, where he got to know all facets of dental technology. Course Objectives In this seminar and hands-on course, two highly aesthetic framework materials are combined with the same veneering ceramic. Diﬀerent procedures such as aesthetic veneering, cut-back technique or painting and glazing are demonstrated. Every day new challenges arise for a dental technician. Diﬀerent materials, depending on the indication, must have the same colour in the ﬁnal restoration. Every dental technician knows from experience that the perfect shade selection is crucial for an aesthetically satisfying result. Choosing the right framework material with the right translucency and colour saves time and extra work. This is important when diﬀerent preparation shapes have to be managed in parallel in the same jaw. Reﬁnements using the cut-back technique add extraordinary aesthetic value at low cost in terms of time and eﬀort. The aim of the workshop is to beneﬁt from the speaker's experience in selecting the shade to accelerate lab processes by purpose- ful shade matching. Simple build-ups and staining with maximum eﬀect, shapes and surface structures with little eﬀort and the ﬁnal restoration with diﬀerent materials and with diﬀerent materials the same colours. www.cappmea.com/dental-lab-aesthetics
B4 LAB TRIBUNE Dental Tribune Middle East & Africa Edition | 5/2019 Successful collaboration between Fraunhofer scientists and Dentsply Sirona Award goes to ZLS researchers By Dentsply Sirona The Fraunhofer-Gesellschaft (Fraunhofer), Mu- nich, a globally recognized link between basic research and applied sciences, awarded its re- nowned Joseph von Fraunhofer research prizes on May 8, 2019. In the category "Technik für den Menschen" [Human-Centered Technology], Dr. Bernhard Durschang and Dr. Jörn Probst from the ISC (Fraunhofer Institute for Silicate Re- search, Würzburg, www.isc.fraunhofer.de) won the award with the prosthetic material ZLS (zirconia-reinforced lithium silicate). A wealth of ideas and successful collaboration with in- dustrial partners, including Dentsply Sirona Lab (formerly: DeguDent), contributed to the success, but the main factor here was courage. German Chancellor Dr. Angela Merkel did not miss out on personally appearing at the awards ceremony and making a welcome speech, which included offering her congratulations for the big anniversary (70 years of Fraun- hofer). "The Fraunhofer Model is a shining example of successful collaboration between science and the economy," she said, outlining in her speech a whole series of various ﬁelds of innovation, from digitalization to artiﬁcial intelligence and robotics, right through to bat- tery cell production. In the category "Technik für den Menschen" [Human-Centered Technology], the Fraun- hofer-Gesellschaft honored two researchers REGISTER FOR FREE! DT Study Club – e-learning platform rial required subsequent process steps such as crystallization ﬁring (20-40 minutes). A block for all cases A handful of researchers did not want to accept that the status quo that existed at that time is the best option. Therefore, the joint efforts of the Fraunhofer researchers and the industrial companies involved (DeguDent, Vita Zahn- fabrik) produced CAD/CAM blocks for all cases (e.g., Celtra Duo) in 2013. This resulted in a com- bination of the beneﬁcial properties of zirconia and lithium disilicate. After grinding, the (sin- gle tooth) restoration could be inserted imme- diately (e.g., for inlays, onlays, partial crowns) or it could be glaze ﬁred to give it the strength of lithium disilicate (e.g., crowns), now going clearly beyond this. Furthermore, pressable ZLS (e.g., Celtra Press, Dentsply Sirona Lab) is now available. Dental technicians value it for both its esthetics and its higher strength. It even allows three-unit bridg- es in the anterior tooth region up to the second premolar as the terminal abutment. An essential requirement: The course of devel- opment enabled the microstructure and sur- face quality of high-strength glass ceramics to be signiﬁcantly improved. This allowed ﬁelds to be explored such as those that – putting it mildly – no-one had ever thought possible. Complete analytical method specifically for ZLS research At the industrial partner Dentsply Sirona Lab (or DeguDent), the material testing team de- veloped a number of things including a new method speciﬁcally for the analysis of crystal distributions and densities. This does not re- quire the usual etching of the test specimen. Differential thermal analysis (DTA) was also used. This helped to clarify how the structure behaves at different temperatures, where phase transitions occur, and how they affect the manufacturing process. Even the research- er group was amazed by how well its ZLS could ultimately be milled in the machine, e.g., the inLab MC XL (Dentsply Sirona Lab), in its ﬁnal, crystallized (tooth-colored) state. Since then, zirconia-reinforced lithium sili- cate has become a key all-ceramic material as it enables the dental technician to make ﬁrst- class restorations quickly and safely, impress- ing both dentists and patients. The result can always be predicted well, just like the effort required for it. Fig. 1: High-strength glass ceramics have been developed with vast detailed knowledge, a new analysis method, and great courage – the pressable zirconia-reinforced lithium silicate Celtra Press from Dentsply Sirona Lab in A1, A2 and A3, in B1, B3, C1, C3 and D2 and D3 as well as in B3, C3 and D3, each available in MT (medium translucency) and LT (low translucency). MO1 and MO2 (medium opacity) are available to cover discolored or devitalized stumps. who developed a new material for prosthetic restorations in collaboration with the industry. The high level of effort with which the partner Dentsply Sirona carries out its research and development paid off. Dentsply Sirona's in- vestments in this ﬁeld amount to around 150 AD million dollars each year. This results in a mul- titude of innovations in the digital and analog ﬁelds of dentistry. The high number of equally competent and motivated employees in the various research departments secures the company's leading role and makes it the part- ner of choice for universities and other scientif- ic institutes. "The project to develop ZLS shows an outstanding example of these successful collaborations," said Dr. Markus Vollmann, Re- search & Development at Dentsply Sirona Lab. Why did it need such a high level of courage? Quite simply because the researchers attempt- ed something that was supposedly physically impossible. Until six years ago, glass ceramics were considered to be exhausted for use in dentistry. People were more or less resigned to this fact: Zirconia ceramics for structures with high strength (e.g., posterior bridges) and glass ceramics for beautiful, high translucency, but with considerable limitations regarding the indication. If you explore the topic further, until six years ago there were two types of glass ceramics available on the market: The conventional variant was able to be integrated directly after milling. The high-strength lithium disilicate, however, stood out due to its higher strength and its ability to (non-adhesively) bond with glass ionomer cement. However, this mate- Join the largest educational network in dentistry! www.DTStudyClub.com Tribune Group GmbH is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Tribune Group GmbH designates this activity for one continuing education credit. Fig. 2: Celtra Ceram: A highly versatile veneering system speciﬁcally for all-ceramic frameworks made of materi- als such as lithium silicate and zirconia.