Practicing Minimally Invasive Dentistry with Durability ... Practicing Minimally Invasive Dentistry

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    Clinical Applications of CAD/CAM and All Ceramic Restorations in 2014

    Practicing Minimally Invasive Dentistry In light of Current Technologies

    Practicing Minimally Invasive Dentistry with Durability

    and Esthetic in Mind

    Current status of ceramic restorations

    50%-80%

    Glidewell Laboratories Glidewell Laboratories

    Most commonly suggested all ceramic restorations in 2013!

    u Indications! u Contraindications! u Clinical parameters ! u Clinical procedures! u Suggested products! u Laboratory communication !

    Commonly Suggested Dental Ceramics! A. Lightly filled, high silica, low crystal, so-called feldspathic. B. Heavily filled, low silica, high crystals, i.e. e. max 1. Press

    2. CAD C. Polycrystalline, no glass

    1. Monolithic 2. Layered

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    Commonly Suggested Dental Ceramics!

    A. Lightly filled, high silica, low crystal, so-called feldspathic.

    Minimally Invasive with Etched Ceramic Bonded veneers

    Commonly Suggested Dental Ceramics!

    B. Heavily filled, low silica, high crystals, i.e. e.max 1. Press

    2. CAD

    Commonly Suggested Dental Ceramics!

    C. Polycrystalline, no glass 1. Monolithic 2. Layered

    The basic color on centrals is opacious,

    A less translucent polycrystalline ceramic creates the desire color

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    5-7 mm

    IPS e.max Lithium-Disilicate

    A high translucent clinical outcome is best achieved with a high silica ceramic

    Etched Ceramic restorations

    Reminiscent of minimally invasive procedures

    An artistry Norm vs Exception

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    Variables involved

    u Different conditions

    All Ceramic Restorations in 2014 Variables involved

    u Different ceramics

    All Ceramic Restorations in 2014

    Variables involved u Different surface treatments

    All Ceramic Restorations in 2014

    Variables involved

    u  Different clinical outcomes

    All Ceramic Restorations in 2014

    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½

    )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    ZIRCONIA

    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½

    )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    ZIRCONIA

    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½ )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    ZIRCONIA

    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½ )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    ZIRCONIA

    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½ )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    Lava

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    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½ )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    Lava

    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½ )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    Lava

    © 3M 2010. All Rights Reserved.

    FILSER et al. 2002

    All Ceramic Materials

    2

    8

    6

    4

    600 400 200 800 1000

    Flexural strength (MPa)

    OMEGA

    EMPRESS 2,

    e.max CAD

    DICOR MGC

    EMPRESS MK II

    INCERAM -Al

    INCERAM -Zr PROCERA

    Fr ac

    tu re

    T ou

    gh ne

    ss (M

    P a

    m ½ )

    CLASSIC PORCELAINS

    INFILTRATED CERAMIC

    GLASS CERAMIC

    ALUMINA

    Lava

    u  Truth and myth u  Current status u  Digital or analog or both u  Minimal invasive procedure u  Polychromatic restorations u  Cementation / bonding u  Handling

    Digital Dentistry, CAD/CAM Technology

    MPa Ultradent Jig

    Bond or Cement

    Universal simplified adhesives

    Scientific Information Variables involved u  Different luting and bonding Materials

    All Ceramic Restorations in 2014

    u  Sufficient enamel. u  Canine guided occlusion u  Surface texture and characterization u  Good harmonious color u  No parafunction

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    u  Monolithic zirconia u  Layered zirconia u  Monolithic e.max u  Layered e.max u  Layered feldspathic

    Layering technique and feldspathic is suggested when prerequisites are met

    It is technically difficult to fabricate ��� single anterior monolithic lithium

    disilicate or zirconia restorations

    Patient desire

    • Tooth color restorations • Less open bite

    Ideal restorations

    Layered feldspathic crowns

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    Ideal treatment option

    Functional occlusion and selection of ceramic

    Ideal occlusion, sufficient enamel, no flexural loading, excellent color

    Minimal invasive, excellent prognosis, excellent outcome

    Large composite build ups and long ferrule ext.

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    u  Extensive composite build ups! u  Long ferrule extension ! u  Supra-gingival margins! u  Light occlusal contacts!

    Best Option: Layered e. max or feldspathic

    Patient re Patient request: Bleached teeth

    8 & 9 crowns, 7 & 10 Veneers • Excessive tooth loss of 8 & 9

    • Excessive loading

    • Excessive thickness of porcelain

    u  Monolithic zirconia u  Layered zirconia u  Monolithic CAD/CAM e.max u  Layered presses e.max u  Layered feldspathic

    8 & 9 crowns, 7 & 10 Veneers 8 & 9 crowns, 7 & 10 Veneers

    Best Option: Layered pressed e. max

    Important

    Three of them are covered with a similar strength silica based porcelain

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    Important

    Under the ideal condition, three three of them provide similar

    clinical outcomes

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    Tight over-jet

    u  Extensive build up with composite! u  Short ferrule extension ! u  Sub-gingival margin! u  Light occlusal contacts!

    Endodontically treated # 8, restored with DT Post���

    Pre-op; Feldspathic Post-op; Zirconia

    Restored with facially layered Zr crown

    All Ceramic Restorations

    u  Layered feldspatic

    Excellent for anterior etched porcelain bonded to enamel veneers (non- discolored teeth)

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