B2 LAB TRIBUNE LAB TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2020 Team player: Skilful combination of press and layering technique Part 1 – More room for creativity due to extended IPS e.max Press MT range Three benefits of IPS e.max Press for laboratories • The press technology is the most efficient all-ceramic solu- tion. The method is character- ized by low investment costs, high profitability and efficiency due to time savings. Full-contour restorations mini- mize the risk of chipping. Cases that involve high aesthet- ic requirements can be solved with a cut-back design and then finalised to the final shape and shade with veneering ceramic. Three benefits of IPS e.max Press for clinicians • The brightness of the material is ideal for full-contour designs that minimize both the risk of chipping and the need for re- workings. IPS e.max Press can be used as a replacement for enamel. Only minimally invasive prepara- tion is required. Depending on the indication, clinicians can choose between adhesive, self-adhesive or conventional cementation, without compro- mising the final aesthetic result. A track record of more than 10 years of clinical observations, studies and scientific investiga- tions confirm the high survival rate of IPS e.max Press com- pared with that of other restor- ative materials.1 • • • • in The role of brightness and translucency achieving shade harmony In addition to manual skills and func- tional knowledge, dental technicians should know the basic optical prop- erties of natural teeth and ceramic materials when using the ceramic press technique. Translucency is one of the distinguishing features of the IPS e.max Press ingots. The level of translucency (low, medium, high) is selected in relation to the patient’s oral situation (target tooth shade, shade of the preparation). The resto- ration is finished using either a stain- ing or layering technique. Whichever method is preferred, choosing the “correct” ingot is essential to achiev- ing a successful outcome. The choice of ingot has a significant effect on the result. Monochromatic lithium disilicate ingots in the medium translucency (MT) range bridge the gap between HT and LT ingots. MT ingots are suited for cases where the brightness of an HT restoration would be clearly too low. Given their reduced chroma, the MT ingots offer room for creativity to provide pa- tient-specific customisations. These bright MT ingots are now available in nine A–D and three BL shades. The IPS e.max Press system has only just become even more attractive. MT ingots: advantages and possibilities MT ingots are mainly used for aes- thetic restorations that are expected to offer a lifelike translucency and high level of brightness. A few high- lights of the material include: • MT ingots can be used to press full-contour restorations that exhibit beautiful light optical properties on a par with those of layered ceramics. The press technique allows both the func- tional characteristics and the surface morphology to be faith- fully reproduced in ceramic. In addition, pressed restorations provide a high level of fracture toughness. • With their medium translu- cency, the MT ingots impart restorations with light optical properties that allow them to blend in naturally with their surroundings. The MT ingots feature a high brightness value. This means that even the shade of young teeth can be reproduced and enamel-like replacements can be created. • Allocating the MT ingots on the A–D scale (of brightness) The portfolio of IPS e.max Press MT ingots has now been extended to include five additional shades. It is necessary to create a common un- derstanding of what the term “value” means before positioning the MT in- got in the IPS e.max portfolio. There are three properties that come into play when determining By Aiham Farah, CDT, UAE Press technology is considered an ef- ficient and reliable method to manu- facture all-ceramic restorations. The IPS e.max Press (Ivoclar Vivadent) all-ceramic system enables highly aesthetic restorations that function- ally and aesthetically integrate so well that they are nearly indistin- guishable from the natural denti- tion. Now the IPS e.max Press range has been extended to include five new shades. The writer covers some essential principles in the first part and presents the application of these principles in the second part on the basis of a clinical case. Dental technicians look at new ma- terials with a cautious and critical mind. With our well-trained eye, we in particular scrutinise the light opti- cal properties of any newly launched all-ceramic product. Recently, in- teresting new materials have been introduced with the extension of the IPS e.max Press portfolio (Ivoclar Vivadent). Five new shades (MT A3.5, B2, C1, C2, D2) have been added to the medium translucency MT range of the IPS e.max Press ingots to give technicians even more options to imitate the large diversity of charac- teristics found in the natural denti- tion. The approach that best matches the given indication can be conveni- ently selected, whether this is a full- contour restoration customised with the staining technique or a cut-back with microlayering. 2a Fig. 0. IPS e.max Press MT in ﬁve additional shades. Fig. 1 Comparison of the different values of LT, MT and HT ingots; A1 shade tabs are used as reference here; however, the differences in value would be similar in conjunc- tion with all A–D shades. 2a 2b 2c 2d Fig. 2a: Differences in value and chroma without the effect on the shade by the abutment; the veneering ceramics do not touch the preparation. Fig. 2b: Differences in value and chroma with the effect on the shade by the abutment; the veneering ceramics touch the preparation (thickness of veneering ceramic: 0.6–0.8 mm). Fig. 2c: ND2 dies with black markings. Fig. 2d: Differences in masking effect: veneering on the marked dies. MT and LT ingots provide a similar masking effect. MT ingots tend to have a slightly increased mask- ing effect. 4a 4b Trust builds conﬁdence: 10-year IPS e.max guarantee IPS e.max Press is a lithium disili- cate ceramic that has been success- fully used in dental laboratories and practices for 15 years. Studies and investigations conﬁrm the ma- terial’s good clinical survival rate of 96%1. The material meets the ex- pectations of patients in every as- pect regarding aesthetics, function and longevity. The 10-year IPS e.max guarantee is as promising as the material itself. www.guarantee.ipse.max.com the shade of a tooth: basic colour (hue), intensity (chroma) and light- ness (value). “Value” describes the amount of light reflected back from an object. This way of seeing colour is based on the Munsell system, one of the most widespread colour order systems. The Munsell system de- scribes “value” on a scale from white to grey/black. Objects with a high brightness value contain less grey and appear lighter, while objects with a low brightness value contain more grey and look darker. Lowering the value means that the amount of light reflected from the object is de- creased and the remaining light is absorbed or scattered elsewhere. The MT ingots are indicated for res- torations that require • a significantly higher value than the HT ingots and • more translucency than the LT ingots (Fig. 1). Given their reduced chroma, the MT ingots offer room for creativity to in- dividualize restorations and achieve a natural-looking transition between dentin and enamel (Figs. 2a–d). Position of the MT ingot in the BL (bleach) range The MT ingots are additionally avail- able in bleach shades (BL). The MT in- gots of the bleach range offer ample scope for creativity in the produc- tion of natural-looking restorations because they feature a balanced re- lationship between value, chroma and translucency and their chroma is based on different intensities of white (by contrast, A–D shades ex- hibit varying intensities of yellow) (Fig. 3). Smooth transitions between dentin and enamel can be achieved with both the staining technique and cut-back/microlayering technique. Figures 4a–b show the bleach ingots in order from the high- est to the lowest value. the The MT bleach ingots are suited for restorations in bleach shades that require • a significantly lower value than can be achieved with an LT in- got and a higher value than provided by the HT ingots. 3a 3b • Fig. 3a Value and masking effect; LT, MT and HT ingots in comparison; thickness of the veneering material: 0.8–1 mm. Fig.3b Same set-up in black and white (grey scale for evaluat- ing the value). Fig. 4a Juxtaposition of various bleach ingots from the IPS e.max Press portfolio (all with identical thickness of veneering material). The value increases from MT BL3 to MO 0. Fig. 4b: Black-and-white image to facilitate evaluating the brightness value. ÿPage B3
B3 ◊Page B2 LAB TRIBUNE LAB TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2020 “Recipe” for choosing the correct ingot Success in the press technique large- ly hinges on selecting the right ingot. By considering some basic principles and following a consistent approach, the best ingot for the given clinical situation can be found. Four aspects come into play: a) Expectations of the patient If the restorations should be adapted to blend in with the neighbouring dentition, the layering technique is best used. If the patient wants to have a “brighter smile”, the focus will be on the bright ingots (IPS e.max MT or LT). Depending on the clini- cal situation, pressed restorations can be completed using the staining technique or the microlayering tech- nique. b) Design and depth of preparation If the preparation is confined to su- perficial enamel (0.3 to 0.5 mm), the HT ingot is a good choice. If the prep- aration extends into the deeper stra- ta of the enamel (0.7 to 0.8 mm), the MT ingot provides a better choice. The MT ingot features enamel-like optical properties and a balanced relationship between brightness and translucency. If the preparation extends into the dentin, a low trans- lucency (LT) ingot is indicated as this is the ingot that looks the most like dentin. c) Tooth shade and shade of the prepared tooth Depending on the difference be- tween the shade of the tooth and the preparation, a HT ingot may appear to provide the best choice (depend- ing on the depth of the preparation). However, HT ingots do not provide sufficient brightness to conceal, e.g., a dark preparation. In this case, the alternative is to use an MT ingot. d) Technique employed to com- plete the restoration The translucency of the neighbour- ing natural dentition has an effect on the technique used to complete the pressed restoration, i.e. either by staining technique (IPS Ivocolor) or by cut-back and layering technique (IPS e.max Ceram). Macrophotogra- phy provides an easy way to estab- lish if a low, medium or high translu- cency is required. In the case of high translucency, recommended approach is to use the layering tech- nique for the entire restoration or a cut-back combined with a veneering ceramic to reproduce the features the translucency, (e.g. transparency, opalescence) of the natural neigh- bouring teeth. If the right materials are used, it is in some cases possi- ble to use the staining technique to emulate the appearance of natural enamel. The second part of this report dis- cusses the way these principles are applied to the restorative treatment of a clinical case. In this case, the po- tential of IPS e.max Press, or rather the power of the MT ingot, comes to fruition through a smart symbiosis of monolithic pressing and micro- layering. Advantages of a digital workﬂow About the author Aiham Farah, CDT, UAE Aiham is a Certiﬁed Dental Technician by the national board for certiﬁcation in USA 2007, with a specialty of (Dental Ceramic Material), currently, he is a Consultant & Trainer for Ivoclar Vivadent company, in the region of near east & orient since 2009 with a more than 25 training ses- sion a year. Aiham is also a speaker in den- tal local and international conferences and demonstrator in courses and work- shops for dental teams in MENA region. He writes and publishes articles in dental magazines like (Reﬂect, Dental Tribune, Arab Dental Labor Magazine, Arab Dental News), and presents in seminars for dental education programmes and universities. AD Germen Versteeg By Brendan Day Dental Tribune In- ternational Germen Versteeg is the founder of DTL Mediaan, a dental laboratory in Heerhugowaard in the Netherlands. In this interview, he talks about the advantages of hav ing adopted a digi- tal workflow in his laboratory and the advice he has for other laborato- ries that are planning to do the same. Mr Versteeg, could you tell us a lit- tle bit about yourself. I’m a denturist and the owner of DTL Mediaan. We work with a team of eight dental technicians, and as a com pletely digital dental lab, we pro- vide all kinds of services— implant cases, dental crowns and bridges, dentures, orthodontic solutions, and more. Do you find that a digital workflow saves time compared with an ana- logue workflow? Yes, it can take a lot of time to pro- duce something with an analogue workflow. For example, it would take up to one whole working day to produce a set of dentures from beginning to end. Since going digital, we have saved a lot of time and can now make a set of dentures in 2 to 2.5 hours. We can achieve a really high stand- ard of quality because of the accu- racy of 3Shape’s scanners. At every step of the workflow, we can refer to the design or the manu facturing process, and we can reproduce or conduct a correction for any case. What percentage of your cases use intra-oral scans? About 30 to 40% of our cases involve intra oral scans, which is also a big benefit of working digitally. What has your experience using the 3Shape Dental System been like? Our experience with the 3Shape Dental System has been really great. There are a lot of automated and guided workflows in the software, but you also have the pos sibility of being creative in your approach. For example, we can use a 2D or 3D im- age in the software for the design in such a way that we are able to copy the patient’s dentition and transfer it to the dentures. When you become familiar with the system and get to know the ideas be- hind it, you will be amazed at what you can do with this powerful soft- ware. Has going digital led to an increase in productivity for DTL Mediaan? Yes, we really are more productive. Our labour costs were around 50% of our total costs when we were an ana- logue focused lab. Now, thanks to the 3Shape Dental System, our labour costs have dropped down to 20% of our total costs. What advice do you have for den- tal labs planning to go digital? My advice for dental labs that want to begin working according to a digi- tal workflow is that they should go fully digital and start implementing it immediately.