› 1946 › images › asset251746_v1.pdf · 6/12/2015 5 thickness of sample: 1.2mmkatana cy...

6/12/2015

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Simplifying All

Ceramics -How to select, adjust

and cement.

Todd Snyder, DDS, AAACD

I report no financial relationships, conflicts of

interest, or other disclosures with respect to the content in this presentation

Todd C. Snyder, DDS, AAACD Private Practice in Laguna Niguel, California

Accredited, American Academy of Cosmetic Dentistry

Former Faculty, UCLA Center For Esthetic Dentistry

Faculty, Esthetic Professionals

F.A.C.E. Graduate

Member of Catapult Elite

Co-Founder of ContentActivator

CEO, Miles To Smiles®

CEO, DENToolz

Free Handout

www.DENTOOLZ.com

Selection Criteria

Adjustment & Polishing Techniques

Cementation / Bonding Techniques

Cases

Simplifying All Ceramics:

Ceramic Selection Criteria Aesthetics

Strength

Placement Technique

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Indirect Restorations


METAL BASED

• Full Cast Metal

• Gold Alloy

• PFM – Porcelain fused to metal

• Many brands, high cost, being

replaced by all-ceramics; FPD

• PFT – porcelain fused to titanium

• Newer; mixed success; implant

supported restorations

• Leucite reinforced glass ceramic

• IPS Empress Esthetic/CAD; Authentic; OPC

• 160 MPa

• Lithium disilicate/silicate *

• IPS e.max Press/CAD; Obsidian

• High esthetics and strong

• 360-400 MPa

• Zirconia (high strength non-etchable) *

• Monolithic: BruxZir; LAVA Plus; KDZ Bruxer; OccluZir; ZirLux FC

• Fastest growing; improved esthetics~1000 MPa

• Zirconia supported: IPS e.max ZirPress; ZirCAD, LAVA DVS,

• High esthetics; may be subject to chipping, fractures; slow cooling

• Zirconia Multi-layered *

• CAP Multi-FZ

• Katana HT, ST, UT

• Translucency, esthetic and strong

• 557-699-1125 MPa

• Polymer

• Resin-nano ceramic: LAVA Ultimate, VITA Enamic

ALL-CERAMIC


Feldspathic (80-120mpa)

Lithium disilicates (360-400mpa)

Lithium silicates (373 mpa)

Zirconia Multi-layered (557-1125mpa)

Inlay Restorations





Inlay Restorations

Onlay Restorations




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Onlay Restorations




Veneer Restorations





All-Ceramic Crowns 565-1200+MPa

Multi-Layered Zirconia

0.7 mm - 2.0 mm All Ceramic 1.5 mm - 2.0 mm PFM Above images taken from Glidewell Laboratories

Zirconia (1100mpa-1400mpa)

All-Ceramic Crowns

Zirconia Multi-layered


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All-Ceramic Crowns


Anterior Crowns

Anterior and posterior crown and inlay: Feal Dental Laboratory, veneer：Cusp Dental Supply

31

38

43 44

37

0

10

20

30

40

50

KATANA

Zirconia HT

KATANA

Zirconia ST

KATANA

Zirconia UT

e.max Press LT Prettau Anterior

(%)

High translucent for anterior restoration

The same level translucency as glass ceramic (e.max Press LT)

Wave length of light: 700nm

Thickness of sample: 0.5mm LT (A1) ST (ST10) UT (UT10) HT (HT10) (T0)

Prettau Anterior

Tra

nslu

cency

Lithium

Disilicate Multi-Layer Zirconia

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Thickness of sample: 1.2mm

Tra

nslu

cency

(⊿L(W-B))

0

5

10

15

20

KATANA

Zirconia HT

KATANA

Zirconia ST

KATANA

Zirconia UT

e.max Press LT Prettau Anterior

Multi-Layer Zirconia

LT (A1) (T0)

Prettau Anterior

ST (ST10) UT (UT10) HT (HT10)

High translucent for anterior restoration

The same level translucent as glass ceramic (Lithium Disilicate Press LT)

Lithium

Disilicate

Mechanical Properties

30% Increase Compared to Lithium Disilicate

ISO 6872：2008

(Three-point bending test) Sample size: 3 x 4 x 40 mm

Prettau Anterior 670mpa

Fra

ctu

ral str

ength

.

1125

699

557

427

0

200

400

600

800

1000

1200

KATANA

Zirconia HT

KATANA

Zirconia ST

KATANA

Zirconia UT

e.max Press LT

Multi-Layer Zirconia

LT (A1) Lithium

Disilicate

ST (ST10) UT (UT10) HT (HT10)

Restoration Placement? Bonded

Margin placement Moisture Control

Technique Sensitive Materials

Self Adhesives Bonding agent (TE or

SE) & luting resin

Cemented

Margin placement

Moisture Tolerant

Retention Required

Materials

RMGI

Ceramir

Cement Selection

Traditional Cementation Options

Glass Ionomers Resin Modified Glass Ionomers

Acidic pH Moisture Tolerant Fluoride Release Degrades over time

Low bond strength Biocompatibility-Fair Bioactivity-None Sealing Quality-Ok

Acidic pH Insoluble Moisture Tolerant Fluoride Release

Stronger Than Traditional GIs Degrades over time Improved bond strength Biocompatibility Ok Bioactivity-None Sealing Quality-Ok

Cement Selection

Cement Options Ceramir Alkaline pH Moisture Tolerant Self Sealing Apatite Formation

Insoluble Stronger with time Semi / Translucent Biocompatibility-Excellent Bioactivity-Apatite formation Sealing Quality-Excellent

Cement Selection

Crown Retention Results Zirconia crowns (Kg/F)

Material Result (Zirconia crowns) Kg/F

Ceramir Crown & Bridge 32.1 ± 6.3

RelyX Unicem (3M) 27.8 ± 11.3

Dyract Cem (Dentsply) 12.2 ± 3.1

Rely X Luting (3M) 10.9 ± 6.5

0

5

10

15

20

25

30

35

Ceramir Crown & Bridge RelyX Unicem (3M) Dyract Cem (Dentsply) Rely X Luting (3M)

Cement Selection

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Cement Selection

Cementation Technique

Cement Selection

Lithium Disilicate

Cement Selection

Zirconia Restorations -cleaning w/ phosphate

scavengers is not necessary

-silane is contraindicated -no bonding agent necessary

Cement Selection

Ceramic Adjustments

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Adjustments

Interproximal

Occlusal

Chairside

Adjustments Interproximal (Rare)

Model work or provisional cause?

Location to be adjusted?

Surface treatments

Air abrasion

Stone

Fine diamond

Chairside

Interproximal Adjustment


Interproximal Adjustment Interproximal Adjustment

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Check margins first

visual

explorer

Check proximal contacts

sprays

paints

Ribbon/paper

dental floss



Articulating Papers Use the thinnest brands available

Troll Dental 8um

Microcopy 10um


Panadent


Dura-Green DIA A vitrified bonded diamond abrasive ideal for

contouring and finishing porcelains, zirconia, lithium disilicate and ceramic copings

8 Handpiece Shapes

What is Dura-Green DIA The simplest answer is Dura-Green DIA is a “diamond

version of a Carborundum point”.

Dura-Green DIA is similar to Dura Green Stones, but

made with diamonds rather than silicon carbide

It consists of diamond abrasive grains, a glass binder and air holes.

Dura - Green

Dura – Green DIA

• Silicone Carbide

• Larger

grain size • Less dense

• Diamonds • Smaller grain

size

• More dense

Glass Binder

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Features of Dura-Green DIA High cutting ability and durability

Minimized surface contamination

Minimizing chipping and heating

Smooth surface finish

User experience similar to

Carborundum points

Two Striper® ZTech™ Diamonds REALITY

Ranked 1st with 4.4 stars in 2012 & 2013

Zirconia cutting diamond from Premier

3 CRA articles

CR Foundation rated Ztech diamonds as excellent in reducing the degree of micro fractures

Adjustments Microfractures

Roughness

Increased wear

Irreversible damage

Plaque accumulation

Gingival inflammation

Reduced strength

Chairside

Ceramic Polishers

Brasseler

Axis

Komet

Diamond Twist SCO™ Single-paste system for Ceramics & Composite

REALITY

Ranked 1st with 4.3 stars in 2012

CRA articles

Sept 2009 State of the Art Polishing Systems

Ceramic Polishing Aesthetics

Preparation Design

Function

Strength

Moisture Control

Cementation/Bonding

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Cementation/Bonding Cementation/Bonding

Bonded Adhesion Bonded Adhesion


Increasing strength demands

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Minimally Invasive

Aesthetics

Function

Bonding Adhesion

Feldspathic Veneers

-enamel bonding

-etch




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Bonded Adhesion

Cosmetic cases….

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Final Restorations

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Aesthetics

Preparation Design

Function

Strength

Bonded Adhesion

Lithium Disilicate


Bonded Adhesion

Ceramic Try-in

Make sure it is etched properly from lab Silanate prior to try-in (unless using Ceramir) Ultrasonic with ethanol after try-in

Zirconia silanate prior to try-in

(Ultrasonic with ethanol after try-in)

Or

Sandblast after try-in and use a MDP based cement

Silanes

Universal Adhesives (w/MDP)

Silane Primer + MDP

Organo-Phosphate Monomer (MDP)

Silane Primers

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BONDS WITH OR WITHOUT HF

ACID ETCHING

THE “NO-WATER” SILANE

INSTANT ACTIVATION

LESS DEGRADATION

(More Stable 2 Year Shelf-Life)

Silane:

Silica based ceramics

Lucite based

ceramics

Glass Fiber Posts

Composite

Restorations

CLEARFIL CERAMIC PRIMER

Unique Silane that bonds to Zirconia, Alumina, Porcelain, Micro Hybrid & Nano Filled Composite & Base Metals.

Contains Silane, ethanol & MDP Monomer-it is the main ingredient in Panavia resin cements which bond directly to high strength ceramics (Zirconia & Alumina).

MDP:

High-Strength

Ceramics (Zirconia &

Alumina)

Base Metals

UNIVERSAL ADHESION

Self Adhesive Resin Bonding Agent w/ Resin Acidic/Neutral pH Not moisture tolerant Low-moderate initial bond

strengths Decreased bond strength

over time Water sorption Biocompatibility-Ok Bioactivity-None Sealing Quality-Ok

Acidic/Neutral pH Not moisture tolerant Best initial bond strengths

but can decreases w/time Decreased bond strength

over time Water sorption Biocompatibility-Ok Bioactivity-None Sealing Quality-Good but

technique sensitive

Resin Cement Options

What substrate are we treating?

Class I or II

:Composite Preparation

3x Tubule Density Equals Higher Fluid &

Increased Difficulty for Bonding

%30 Decrease in Bond Strengths with most

bonding systems.

Resin Bond Degredation

Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. Compend Contin Educ Dent. 2011 Sep;32(7):60-4, 66.

Resin-dentin bonds are not as durable as was previously thought. Microtensile bond strengths often fall 30% to 40% in 6 to 12 months.

Factors that compromise bond durability in restorative dentistry

“The major shortcoming of contemporary adhesive restoratives is their limited durability in vivo.”

Hydrophilic dentin bonding (1956 - )

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Total etch Self etch # of

components

Etchant

Primer

Adhesive

The Bonding Agents

Generation 4th 5th 6th 7th

Courtesy Pacific University (Dr Marc Guisberger)

InstroN

Ultra Tester (Ultradent)

Ultra Jig (Ultadent)

Maximum/Minimum Shear Bond

Strength per Bonding Material

Courtesy Pacific University (Dr Marc Guisberger)

Shear Bond Test Results - 2012

When bonding to enamel, an etch & rinse approach is definitely preferred, indicating that simple micro-mechanical interaction appears sufficient to achieve a durable bond to enamel. When bonding to dentin, a mild self-etch approach is superior, as it involves (like with glass-ionomers) additional ionic bonding with residual HAp. This additional

primary chemical bonding definitely contributes to bond durability. Altogether, when bonding to both enamel and dentin, selective etching of enamel followed by the application of the 2-step self-etch adhesive to both enamel and dentin currently appears the best choice to effectively and durably bond to tooth tissue

Van Meerbeek B, et al. Relationship between bond-strength tests and clinical outcomes. Dent Mater (2009), doi:10.1016/j.dental.2009.11.148

Developed by Kuraray 1983

• Acidic Monomer Activates Silanes & Chemically Bonds to Metal Oxide Ceramics (Zirconia & Alumina).

(Key Ingredient to make a Silane Universal)

• Hydrophilic & Hydrophobic

• Very Durable Dentin Bond

(Creates An Insoluble, calcium Salt with Dentin)

• Is The Most Copied Monomer In Dentistry

• The Most Researched Monomer In Dentistry

• 20 + Years Of Research On Metal Oxide Ceramics (Zirconia & Alumina)

• Strongest & Most Durable Bond to Metal Oxide (Zirconia & Alumina) Ceramics

MDP Adhesion Monomer:

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MDP Penta-P MDP BPDM

Adhesive Functional Monomers

MDP GPDM

All porcelain cementation use a bonding agent and resin cement

Self-Adhesive Resin Cements

No Primer or Bond? Gel State?

No Primer or Bond

Durability & Wettability ???? Self-Adhesive Resin Cements Without a Primer or Bonding Agent have less: • Wettability

• Which Results in Less Contact to the Tooth

• Which May Result in a Less Durable Bond

• Convenience

What do you use?

Shear bond strength to tooth structure

(N. Iwamoto, S. Uctasli, M. Ikeda, M. Nakajima J. Tagami, Tokyo Medical and

Dental University, 2008, Japan)

0

5

10

15

20

25

30

CLEARFIL™

SA CEMENT

Multilink™

Sprint

RelyX™

Unicem

Vitremer™

Paste

GC Fuji

Luting S

RelyX™

Unicem

Clicker™

Shear bond strength (MPa)

Enam el

Dentin

Bond strength to Tooth structure

Panavia SA Cement

0

5

10

15

20

25

30

35

CLEARFIL™

SA CEMENTResiCem™ G-CEM™

CAPSULERelyX™UnicemAplicap™

maxcem™ RelyX™UnicemClicker™

Shear

Bond

Str

engt

h (

MPa)

Shear bond strength of self-adhesive resin cement to zirconia (LavaTM)

(M. Irie and K. Suzuki, Okayama University, P-39 International Symposium of Adhesive

Dentistry 2008, Kanazawa, Japan)

Bond strength to Zirconia (Lava)

Panavia SA Cement

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All Ceramic Crown Microleakage

MDP Resin Cement SE Auto Resins

After simulated aging through cyclic loading (1.2 million) and dye penetration test to

detect Microleakage. LSU Dental School. IADR 2006, Abstract #2090.

High Performance MDP Resin Cement

Universal Clear White Brown Opaque

√

High Performance Cement

√

Zirconia Ceramic Conditioning

• Primer was applied

on Zr surface

• Ultrasonicated in ethanol to remove unreacted resin components

0.0

20.0

40.0

60.0

80.0

NP AZ ZP MP CC SBU ABU

Pure

ZrPrimer Silane

ZrPrimer

Silane

ZrPrimer

Adhesive

ZrPrimer

Adhesive

LC required

Contact Angle as

Zr Primer

0

5

10

15

20

MDPKuraray

MDPPCM

MDPDMI

24hr

TC100000

Bond durability of phosphate monomers with different purity Okayama Univ. (Yoshihara K, et al.)

The 33rd Meeting of the Japanese Society for Adhesive Dentistry, 2014, P-7

Primer：15% MDP solution Bond： CLEARFIL SE Bond Composite： CLEARFIL AP-X

Micro tensile bond strength to Dentin

(MPa )

“MDP”s perform differently

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Contains two main monomers:

y-MPS (Silane) for glass ceramics

MDP For Metal & Zirconia

CLEARFIL CERAMIC PRIMER

Treats All Indirect Restorations

(Ceramics, Metal, Zirconia,

Lithium Dislicate)

How MDP Bonds to Zirconia MDP-containing material bonds to Zirconia

CLEARFIL™ CERAMIC PRIMER

MDP

γ-MPS

Ethanol

118

Silane Treatments

eMax™ Zirconia

1. HF Etch 1. Sandblast (20-50psi)

2. Ultrasonic Clean or Ivoclean 2. Ultrasonic Clean, Ivoclean

3. Apply Ceramic Primer & Air Dry

3. Apply MDP-Based, Self-Adhering Cement or MDP-Based Silane

Review Ceramic Selection

Aesthetics

Strength

Cementation Placement Technique based on isolation

NEW Multi-Layered Translucent Zirconia

Polish after adjusting

Silanate with MDP material prior to try in of ceramics

Cementation High bonds to enamel with etching, adhesive and resin

High bond strength & durability for longevity with MDP monomer technologies on ceramic & dentin

Use a bonding agent with cement for highest bond strengths to tooth structure

Thank you!

Todd C. Snyder, DDS, AAACD

[email protected]

www.drtoddsnyder.com

www.facebook.com/todd.snyder.dds

mailto:[email protected]

http://www.drtoddsnyder.com/

› 1946 › images › asset251746_v1.pdf · 6/12/2015 5 thickness of sample: 1.2mmkatana cy...

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