IPS e.max success story may make PMFs quite rare

By now everyone is well aware of the successes of IPS e.max, which has proven to deliver strong, esthetic restorations in all areas of the mouth. In fact, long-time prosthodontist Dr. Kenneth Malament, a world-renowned researcher and educator on all ceramics, says his choice is Ivoclar Vivadent’s ceramic for all of his single unit restorations. But where this material really has a unique spot is in the posterior areas.

Today, a number of clinicians are using zirconia in the posterior, but Dr. Malament, DDS, M.Sc.D., believes IPS e.max is still the best option for posterior single units, the bread and butter cases for many dentists. While many patients and clinicians are moving away from PFMs, they should be aware that while zirconia is an option that provides significant strength, lithium disilicate delivers the best survival data, economics and better esthetics, according to Dr. Malament.

“e.max is the best we have ever worked with,” said Dr. Malament, who has had a prosthodontics practice in Boston since 1977.

The material and science advances that helped bring about a product like IPS e.max may very well lead to a changing of the guard for those clinicians who had grown accustomed to the traditional porcelain fused to metal (PMF) restorations.

According to Ivoclar Vivadent’s IPS e.max Scientific Report Vol. 02 (2001-2013), which is available online at: ivoclarvivadent.us/emax/science, more than 75 million IPS e.max restorations have been delivered, and the crown survival rate is 98.2%. Dr. Malament’s results have been even more impressive.

Originally, Dr. Malament and his colleagues extensively used and studied Ivoclar Vivadent’s Empress with tremendous results. Since switching to IPS e.max, his success numbers have been staggering.

“I have researched all ceramic materials 32 years and have a database where every all ceramic restoration I have ever done is studied with 29 different confounding variables,” said Dr. Malament, who practices with Dr. Dan Nathanson, Professor, Chairman Restorative Sciences, Boston University School of Graduate Dentistry, and Dr. Hans Peter Weber, Professor, Chairman Restorative Sciences, Tufts University School of Dental Medicine. “Of all the of the materials we have ever studied, Empress, all the time, was the best from the point of years of survival. I have cemented up to today, 2,133 Empress restorations over 265 months with 103 failures. A failure is a fractured crown that requires replacement. A chipped restoration is also studied in the database and of the 31 chipped Empress restorations all were easily smoothed and did not need to be replaced.”

Now that he uses IPS e.max, the success rate is significantly higher than those impressive Empress figures.

“As of today, and at 85-86 months (7 years) 546 patients, 1,896 units and I have but one failure,” he said. “We’ve never seen this performance in a ceramic material before ever.”

These are the types of numbers that keep scientists up at night. Dr. Malament and his research colleagues are more than impressed by the data they have accumulated and the science on IPS e.max.

“The one failure has been studied extensively. We were totally obsessed with how this happened and needed to understand the fracture mechanics of the event,” he said. “The lone ‘failure’ was a patient who was a severe bruxer who after four years fractured the lithium disilicate.” Continue reading

Optrasculpt Pad- Interview With Dr. Howard Glazer

Courtesy of Dental Economics: 

Dr. Howard GlazerHow did the idea of a sculpting instrument with foam tips originate?

My two partners, Dr. Dominic Viscomi and Brian Viscomi, and I were fooling around with foam to sculpt a direct resin veneer. We discovered that it would not stick to any composite and left no marks when moving the composite. Brian then went on to design a handle and a way to hold the foam on the handle. 

How did you sculpt sticky composite resins in the past? What were the disadvantages? 

In the past, all we had were metal instruments. Then, over time, other instruments evolved with tips of rubber, silicone, Teflon, or even gold. But none worked well. These types of instruments would leave indentations and a rough appearance to the composite surface. We also have had composite warmers and vibrating/oscillating instruments that all tried to make the composites more fluid to allow for better placement. Sometimes we would use a fine sable brush to move and shape the composite resins. But these brushes would leave striations on the composite surface, and we had to make them disposable since there was no effective way to sterilize them between patients. 

3 Fig *

In what way has OptraSculpt Pad changed your work with composite resins?

OptraSculpt Pad has made it remarkably easy to work with any composite since it is an ideal modeling instrument for shaping and contouring composites. You can work faster and achieve a great esthetic result in less than half the time using any other instrument. A real bonus is how the OptraSculpt Pad leaves the surface in a state that requires little finishing and polishing. 

What is so special about OptraSculpt Pad?

In addition to what I have mentioned, the fact that there are disposable tips in varying sizes makes it suitable for many types of restorations. The reference scales on the handle are quite valuable when doing direct anterior restorations. 

What are the advantages of OptraSculpt Pad compared with other composite modeling instruments? 

a) It moves composite easily, and leaves no marks.

b) You can place and spread the composite without any pull-back, stickiness (i.e., sticking to the instrument), or leaving any indentations. 

c) Surface requires only minimal finishing and polishing. This saves time and money. 

d) No other instrument to my knowledge has a reference scale that indicates the average size of the anterior teeth and their natural inclination toward the midline. 

In your opinion, what kind of influence does OptraSculpt Pad have on the treatment procedure involving composite resin-filling materials? 

There is no doubt that the profession is rapidly moving toward more direct composite restorations. This is, in part, due to the economy, and in great part, due to the esthetic nature of composite restorations. OptraSculpt Pad will be a genuine asset to the profession in composite placement. 

What kind of advice would you give to colleagues for using OptraSculpt Pad? 

Once you try the OptraSculpt Pad, you will never use a metal instrument on resin again for sculpting and contouring. This is a no-brainer when it comes to time savings and achieving a highly esthetic result. 

 

Before and After: Candulor Case

In the photographs below, a case is shown where Ivoclar Vivadent teeth were used with an upper denture, opposing lower fixed bridge on implants.

BEFORE Teeth AFTER Teeth

 

 

 

 

 

 

In this particular case, the patient presented for a consultation on enhancing her smile. Upon clinical and radiographic examination, we found that she had advanced periodontal disease with severe bone loss. All risks, benefits and alternative treatments were then discussed.

The patient was in good health, however she was a heavy smoker who desired implants. The obvious risks of implant integration with a smoker were discussed with her, however, the patient did wanted dental implant treatment. Because of this, our treatment consisted of full mouth extractions, bone leveling and grafting as well as guided implant placement.

Technical Teeth photoTechnical Teeth 2

 

 

 

 

 

 

In the upper arch the patient would receive a complete denture and fixed partial denture in the lower arch supported by 7 implants. The pictures below show her drastically improved smile!

Before teeth faceAfter Face Teeth

Ivoclar Vivadent supports Breast Cancer Awareness Month this October with Bluephase® Style

breast cancer ribbonOctober is right around the corner and for many of us, this means getting excited about the changing of seasons, colorful leaves and the various fall festivities that come along with this time of year. However, it is important to remember that October has another important characteristic. October is Breast Cancer Awareness Month. So what does Ivoclar Vivadent have to do with Breast Cancer Awareness Month? Well this year, Ivoclar will be supporting this important cause in more ways than one.

  • In Addition to this corporate donation, our employees get involved in supporting the cause by participating in the Susan G. Koman Race for the cure!

So this october be sure to take advantage of this offer to support a great cause and choose PINK!

 

Updated Flyer 2 bca month

Using Virtual® XD with a Dual Phase Impression Technique for a Veneer Restoration

Dr. George Rivera

Although impressions provide the foundation for creating highly esthetic and functional restorations, capturing the complete and precise details of the hard and soft tissues surrounding the affect tooth or teeth can sometimes be challenging. As a blueprint for restorative treatments, taking accurate impressions requires the ideal combination of technique and materials to create a durable, physical replica of the patient’s intraoral condition. Many techniques require extensive steps and can be time consuming to learn and perform.

Additionally, shortcomings inherent to the impression techniques and materials themselves can also complicate the impression taking process. Voids and bubbles introduced into the impression material during application can decrease accuracy and durability. Runny materials can increase patient discomfort and inhibit a dental professional from achieving the desired accuracy. Weak impression materials and those that demonstrate poor dimensional stability can contribute to problems when pouring molds or in the laboratory during the fabrication process, ultimately leading to the worst-case scenarios of retaking impressions and/or remaking restorations.

To overcome these challenges, dental product manufacturers have developed and introduced alternative impression materials and techniques that demonstrate user-friendly and predictable characteristics. As a result, it is now easier for dental teams to effectively capture the details of the preparation and surrounding dentition. In particular, enhanced wash and putty materials demonstrate increased tear strength and durability, ensuring greater stability and repeated impression use.

Virtual® XD Impression Materials

Developed to provide an alternative solution for the many complications associated with traditional impression materials, Virtual® XD from Ivoclar Vivadent (Amherst, NY) is formulated for accuracy, precision, easy handling, and convenient working times. Demonstrating improved thermo-sensitivity and dimensional stability, once the impression tray is seated in the patient’s mouth, the Virtual® XD setting reaction accelerates immediately, saving valuable chair time and reducing the risk of deformation caused by impression try movement during seating. The improved dimensional stability allows Virtual® XD impressions to be viable for up to two weeks, giving dental teams the ability to pour several models from one impression, with easily disinfection.

This advanced line of vinyl polysiloxane (VPS) impression materials exhibits optimized flow, advanced wetting ability, and high tear strength. Optimized flow ensures that the impression material exhibits an ideal viscosity, one that doesn’t run or slump off of the tray. This allows for deeper penetration and improved preparation coverage. Additionally, the wash materials displace oral fluids deep in the sulcus, capturing the fine details of margins and all prepared surfaces. With their advanced wetting ability, Virtual® XD materials demonstrate very low contact angles, which allows them to precisely reproduce soft and hard tissue details. This characteristic also enhances the ability of the wash materials to spread easily across the preparation surfaces to create precise impressions. Easy to remove due to excellent tear resistance and outstanding elongations, Virtual® XD materials also reduce the risk of tearing fine margins. Upon removal from the mouth, Virtual® XD impressions demonstrate high tear strength to maintain the integrity of preparation margins and fine details. Heavy and light body Virtual® XD materials are indicated for many impressions, including those for crowns, bridges, inlays, onlays, veneers, implants, and edentulous patients. In addition, the materials can be used with all impression techniques.

Case Presentation

A 56- year old female presented with a fracture on central incisor tooth #9 due to trauma (Figure 1). The tooth was assessed and determined to be vital, with an intact root. After thorough examination, an indirect veneer was agreed upon as the most appropriate and ideal treatment for restoring esthetics and function. Therefore, an impression captured using a dual phase technique in order to obtain an accurate representation of the preparation and occlusion would be needed.

Dual Phase Impression Technique

  1. A lip and cheek retractor (OptraGate®, Ivoclar Vivadent, Amherst, NY) was placed in the patient’s mouth to isolate the oral cavity.
  2. A retraction cord (GingiBRAID+ #2, Dux Dental, Oxnard, CA) was then placed to isolate tooth #9 prior to treatment (Figure 2).
  3. Tooth #9 was prepared for a veneer restoration (Figure 3).
  4. The appropriately sized impression tray was selected, tried in the patient’s mouth and the fit evaluated.
  5. Tray adhesive was applied to all areas of the tray that would come into contact with the Virtual® XD impression material.
  6. The two-cartridge dispenser was loaded with Virtual® XD light body wash material and tray material, and then bled to verify an even flow of base and catalyst before applying the mixing tip.
  7. The Virtual® XD light body fast set wash material was placed around the preparation (Figure 4), after which the Virtual® XD heavy body fast set tray material was loaded into the impression tray. The intramural syringe tip was buried into the material to avoid voids, air, and bubbles.
  8. The impression tray was inserted into the patient’s mouth and held in place for 2 ½ minutes to set (Figure 5).
  9. Prior to removal, the material was checked to verify it set, and then removed.
  10. The impression was then rinsed, dried and disinfected (Figure 6).

After the impression was completed with the Virtual® XD materials and forwarded to the laboratory, the veneer was fabricated from a leucite reinforced glass ceramic (IPS Empress HT, Ivoclar Vivadent, Amherst, NY).  At the cementation appointment, a light curing, fluoride releasing, single-component total-etch adhesive (ExciTE F, Ivoclar Vivadent) was applied to the surface of the preparation (Figure 7) and cured. Then, a light-curing luting composite (Variolink Veneer, Ivoclar Vivadent) was applied to the veneer, after which it was seated, light cured (Bluephase, Ivoclar Vivadent, Amherst, NY) (Figure 8), and finalized (Figure 9).

Conclusion

Dental impressions serve as the blueprint for final restorations, and using a simple technique and predictable impression materials can improve the predictably and accuracy of the impression taking process. The Virtual® XD impression materials, when used with a  dual phase impression technique, produce a precise representation of a patient’s preparation, soft tissue architecture, and surrounding dentition. In this case, it allowed the dentist and laboratory to provide the patient with a long-lasting, well fitting, and highly esthetic final veneer restoration.

 

A 56- year-old female presented with a fracture on central incisor tooth #9 sure to trauma.

FIGURE 1: A 56- year-old female presented with a fracture on central incisor tooth #9 sure to trauma.

A retraction cord (GingiBRAID+ #2, Dux Dental, Oxnard, CA) was placed to isolate tooth #9 prior to treatment.

FIGURE 2: A retraction cord (GingiBRAID+ #2, Dux Dental, Oxnard, CA) was placed to isolate tooth #9 prior to treatment.

FIGURE 3: Tooth #9 was prepared for the veneer restoration.

FIGURE 3: Tooth #9 was prepared for the veneer restoration.

FIGURE 4: The Virtual® XD light body fast set wash material was syringed around the preparation, with the tip buried into the material to avoid air, bubbles, or kids in the impression.

FIGURE 4: The Virtual®XD light body fast set wash material was syringed around the preparation, with the tip buried into the material to avoid air, bubbles, or kids in the impression.

The Virtual® XD heavy body fast set tray material was dispensed into the tray and seated in the patient's mouth for 2 ½ minutes.

FIGURE 5: The Virtual®XD heavy body fast set tray material was dispensed into the tray and seated in the patient’s mouth for 2 ½ minutes.

After the impression was checked, it was removed from the mouth, rinsed, dried, and disinfected.

FIGURE 6: After the impression was checked, it was removed from the mouth, rinsed, dried, and disinfected.

A light curing, fluoride releasing, single-component, and total-etch adhesive (ExciTE F, Ivoclar Vivadent, Amherst, NY) was placed on the preparation and light cured.

FIGURE 7: A light curing, fluoride releasing, single-component, and total-etch adhesive (ExciTE F, Ivoclar Vivadent, Amherst, NY) was placed on the preparation and light cured.

FIGURE 8: The restoration was seated into place using an esthetic luting composite (Varliolink Veneer, Ivoclar Vivadent) and cured using an LED curing light (Bluephase, Ivocalr Vivadent); no contact adjustment was necessary due to the accuracy of impression.

FIGURE 8: The restoration was seated into place using an esthetic luting composite (Varliolink Veneer, Ivoclar Vivadent) and cured using an LED curing light (Bluephase, Ivocalr Vivadent); no contact adjustment was necessary due to the accuracy of impression.

The final postoperative view of the veneer restoration on tooth #9.

FIGURE 9: The final postoperative view of the veneer restoration on tooth #9.

Ivoclar Vivadent launches consumer and professional websites for More Than a Denture!

Consumer and professional sites emphasize patient awareness and a simple, systematic approach

Ivoclar Vivadent announces the launch of its More Than a Denture consumer and professional websites. Designed to make today’s innovative solutions for removable dentistry easy for patients and professionals to take advantage of, the websites emphasize a simple and predictable approach for creating smiles that are comfortable, durable, and natural-looking. At the heart of the More Than a Denture system are Ivoclar Vivadent Removable (IVR) solutions.

%22Its your smile%22The More Than a Denture websites are extensions of the company’s highly successful patient education campaigns and online professional resources. The consumer-oriented www.morethanadenture.com website features a variety of real-life stories that denture patients can relate to, in addition to a wealth of easy to understand information that guides them through the denture selection and fabrication process.

“Most denture wearers don’t realize there are choices when it comes to the quality of their dentures,” explains Dr. Michael Gaglio, Vice President of Ivoclar Vivadent. “That’s why Ivoclar Vivadent has created a patient education site to better inform patients about their options.”  The More Than a Denture professional site provides a variety of helpful tools for denture tooth selection, prescribing premium dentures, and designing smiles. Additionally, an assortment of helpful patient education materials—from a reception area video to brochures—are available.

“To help dental professionals achieve better results, Ivoclar Vivadent has created a professional site that not only informs them about better materials and processes, but also connects the clinician and laboratory through an Authorized Ivoclar Vivadent Removable Laboratory list,” says Dr. Gaglio. Dental laboratories can also become an Authorized Ivoclar Vivadent Removable Laboratory directly through the www.morethanadenture.com/pro website.

IV Removable for dental professional