powerpoint presentation...6/27/2019 3 retention form 2.5 -8 resistance form prepared tooth 4mm+ tall...

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Accredited Fellow, American Academy of Cosmetic Dentistry

Fellow, International Academy for Dental Facial Esthetics

Member of The American Society For Dental Aesthetics

Former Faculty, UCLA Center For Esthetic Dentistry

LEGIONpride.com, Online Training Challenge for Dentists

Todd Snyder, DDS, FAACD, FIADFE, ASDALaguna Niguel, CA

Aesthetic Dental Designs®

[email protected]

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Retention form 2.5°-8° Resistance form Prepared tooth 4mm+ tall

Line of draw

0.7 mm - 2.0 mm All Ceramic1.5 mm - 2.0 mm PFMAbove images taken from Glidewell Laboratories

Preparation Design- Zirconia

Zirconia (1100mpa-1400mpa)

Prep counter clockwise Less tissue damage (rotation is rolling on tissue) & faster tooth reduction.

Prep clockwise Tissue removal due to bur rotating opposite direction

rolling on tooth creates less reduction of tooth structure.

Place a single cord after preparing interproximal area

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• Bur system that allows for easy depth reduction/identification

• Retention 2.5°-8° (burs have 2°-3°)

• Resistance form (box/grooves)

• Crown height (4mm+)

• Reduction Variations

• Full Gold (0.5mm+)

• PFM (1.5-2mm)

• All Ceramic

• Lithium Disilicate

• Zirconia 0.8mm

K0095 Preparation Kit (

Preparation Design

Margin Refinement

K0095 Preparation Kit (Brasseler USA)

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Dent Mater. 2008 Jul;24(7):978-85. doi:

10.1016/j.dental.2007.11.019. Epub 2008 Jan

15.

Bond strength of self-etch adhesives to dentin

prepared with three different diamond burs.

Ermis RB, De Munck J, Cardoso MV, Coutinho

E, Van Landuyt KL, Poitevin A, Lambrechts

P, Van Meerbeek B.

Oper Dent. 2010 Nov-Dec;35(6):624-33. doi:

10.2341/09-379-L.

Effect of surface preparation on bond strength

of resin luting cements to dentin.

Peerzada F, Yiu CK, Hiraishi N, Tay FR, King NM.

Preparation DESIGNS-Burs

Margin refinement with electric

handpiece @ 5-10,000 rpms

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http://www.ncbi.nlm.nih.gov/pubmed/18199476?d96a349c52fc4f68eea46a47ccb3d360

http://www.ncbi.nlm.nih.gov/pubmed?term=Ermis%20RB%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed?term=De%20Munck%20J%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed?term=Cardoso%20MV%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed?term=Coutinho%20E%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Landuyt%20KL%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed?term=Poitevin%20A%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed?term=Lambrechts%20P%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed?term=Van%20Meerbeek%20B%5bAuthor%5d&cauthor=true&cauthor_uid=18199476

http://www.ncbi.nlm.nih.gov/pubmed/21180001?d96a349c52fc4f68eea46a47ccb3d360

http://www.ncbi.nlm.nih.gov/pubmed?term=Peerzada%20F%5bAuthor%5d&cauthor=true&cauthor_uid=21180001

http://www.ncbi.nlm.nih.gov/pubmed?term=Yiu%20CK%5bAuthor%5d&cauthor=true&cauthor_uid=21180001

http://www.ncbi.nlm.nih.gov/pubmed?term=Hiraishi%20N%5bAuthor%5d&cauthor=true&cauthor_uid=21180001

http://www.ncbi.nlm.nih.gov/pubmed?term=Tay%20FR%5bAuthor%5d&cauthor=true&cauthor_uid=21180001

http://www.ncbi.nlm.nih.gov/pubmed?term=King%20NM%5bAuthor%5d&cauthor=true&cauthor_uid=21180001

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Zirconium

Crowns

Disposable Single Use Diamonds

-medium or coarse grit

Round end taper 1122.8/1121.8

End Cutter 5014

Egg 1900

Modified Flap End Taper KR 0816.8

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Important: Minimize tissue damage allows for less time utilized in managing bleeding.

Important: Minimize tissue damage allows for less time utilized in managing bleeding.

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TISSUE MANAGEMENT…

Types of Moisture

Saliva

Crevicular Fluid

Bleeding

Fluid/Tissue Management

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Superoxol

Epinephrine

Ferric Sulfate

ViscoStat 20%

Astringent 15.5%

Aluminum Chloride Viscostat Clear 25%

Expa-syl

Hemostasyl

Aluminum Sulfate

Tissue Goo 25%

Various Cords

Enhancing Moisture Control



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Lasers (Diodes) Fast

Hemostasis

No crevicular fluid

No cord

Better healing

Enhancing Moisture Control


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A soft tissue laser incision at 1000x magnification

Laser cut

Superficial coagulation

Heat dissipation with little/no edema

Aesthetic Contouring

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Aesthetic Contouring

Time??

ROI??

Aesthetic Contouring & Provisional

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Laser Tissue re-contouring, Provisional & Impression

Bite Registration

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Verify bite Shimstock

Over Impression Preparation Bite Registration

Dead soft Delar Wax Firm, Hard Bite Reg

Shimstock

Facebow Full Arch Impression Provisional Lab Articulation

Centric Occlusion DentistryExample

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Red Blood Cells 2 – 5um

200-500nm

Human Hair 60 –120um

6,000 – 12,000nm

?

Shimstock & Articulating Paper

What do you use…..

.…and why?

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Parkell Accufilm II is 21µm for dentistry

Great Lakes articulating ribbon 12µm

8µm Almore Shimstock foil

8µm articulating paper??

Shimstock & Articulating Paper

What do you use…..

.…and why?

8µm articulating paper

Available in blue

And red too!

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The range of PDL width: 0.15mm ~ 0.38mm

• Average PDL width by age:

o 11 ~ 16 years old: 0.21mm

o 32 ~ 52 years old: 0.18mm

o 51 ~ 67 years old: 0.15mma

• The PDL width decreases with age.

• The PDL width is thinnest around the middle 1/3 of the root.

Tooth with more function has bigger PDL space

PDL & Occlusal Records

Bite Registration & Occlusal IndexingTIP

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Built in errors!Thickness??Rotation?? Rocking??

Function & Failures

Closed Bite Trays (most common)

Lack of rigidity may cause distortion

Spring back after impression potential

No cross arch stabilization

Thin spots or perforations can cause distortion

Impression material shrinks towards bulk

Unable to recreate excursive movements

Potential for errors & adjustments extremely high

Impression Trays

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Quad Tray Extreme (Clinician’s Choice) & Bite

Registration

Quadrant & Disposable articulators

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Bite Registration Importance

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Disposable Articulators

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Semi Adjustable

not on Hinge Axis

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Semi Adjustable

not on Hinge Axis

TRY-IN / NO ADJUSTMENTS…

A few steps makes

a big difference

Patients notice the

difference.

Do you want to be

like everyone else?

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Key to adjustments Full Arch Impressions

Facebow

Bite Registration

Semi Adjustable Articulator

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Ceramic Adjustment Jiffy Ceramic Polishers (Ultradent)

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Occlusal Record/Bite Registration

Fast Setting Rigid PVS

Or

Wax

MODEL ARTICULATION & EQUILIBRATION

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Incisal Pins

◦ Open Bite Trays

Plastic-full or quadrant

Metal-full or quadrant

Custom Trays

Non-perforated or perforated (metal or plastic)

Rigidity can eliminate tray distortion and rebound

Spring back after impression is possible with plastic

Cross arch stabilization

Ideal occlusal stops for proper model articulation

Able to recreate excursive movements if mounted on

a semi or fully adjustable articulator.

Potential for errors & adjustments are low

Impression Trays

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Stock tray sizes

Impression Trays

Difficult for ideal fit

Impression Trays

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Custom trays create more ideal placement

Thinner material creates less distortion

USE TRAY ADHESIVES for all open bite

trays, not just custom trays.

Only negative is time

Impression Trays

Custom trays create more ideal placement

Thinner material creates less distortion

USE TRAY ADHESIVES for

all open bite trays, not just custom trays.

Only negative is time

Custom Tray

Impression Trays

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4 upper & lower trays

60 sec. @ 158°F

Fast, efficient

Virtually custom

30% less impression

material used

HeatWave by Clinician’s Choice

TIP

Impression Trays

Measure on a model or in the mouth to determine size of tray needed.

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Trays are unique and fit very well with minimal adjustments typically being needed.

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Impression Trays

Impression Trays

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Impression Trays

Impression Trays

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Make cases easy

Make cases easy, make your patients happy

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Make cases easy, make your patients happy

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Impression Materials

Still account for 85%-90% of

the market.

Types

Vinylpolysiloxanes

Polyethers

Vinylsiloxanether (VSXE)

Panasil Initial Contact Lowest contact angle of any VPS impression

material

Fast set and Regular set

Best Value Materials Available

Kettenbach

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Cracked toothKettenbach

Panasil Initial ContactKettenbach

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Panasil Initial ContactKettenbach

Syringe Placement Dry all teeth in arch

Place tip in most difficult area first

Keep tip on margin and immersed in material

Go around entire margin first

Next go to adjacent teeth

Then do coronal aspect of teeth

Double Mix Single Impression is the most accurate

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Provisionals

• Utilize an accurate preliminary over impression

• Maintain over impression

• Check contacts and occlusion

Provisionals

-Visalys (Kettenbach)

-Inspire (Clinician’s Choice)

-Structure (VOCO)

Luxatemp (DMG)

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Simplified Provisionals**

Siltech Putty Matrix

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Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.

Duplicate waxup model in stone

Scribe a 0.5-1mm line with a sharp instrument into the

model where the tissue and tooth come together.

Provisionals (Bead Line Technique)

Duplicate model with a fast setting polyvinyl impression material.

I have used light and medium body washes with a heavy body tray

material.


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The scribed line creates the Bead Line in the over impression of the cast.

The Bead Line in the over impression creates pressure along the tissue

and preparation margin. This causes a thin cut or separation of the

acrylic flash from the provisionals for easier clean up.


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Typically the excess acrylic can be removed with fingers, a spoon or discoid instrument. Minimal

to no effort is required to remove excess flash. If a void or a margin is exposed simply fill the

void with a flowable. Etching and a bonding agent are not required as the flowable will adhere to

the air inhibition layer of the temporary acrylic and you do not want to adhere to the tooth.


The Bead Line Provisional Technique creates less work and risk of damaging tissues and tooth

structure. Typically the process takes 5-10 minutes to make provisionals. Consepsis (Ultradent)

can be placed on the teeth and dried prior to fabricating provisionals.


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-Visalys (Kettenbach)

-TempSmart (GC America)

-Inspire (Clinician’s Choice)

-ExperTemp (Ultradent)

PROVISIONALS

Cling 2 (Clinician’s Choice) for all my full crowns & bridges, retentive

inlays & onlays.

MY FAVORITE TEMPORARY CEMENTS

ClearTemp LC (Ultradent)

For either veneers or thin

anterior cosmetic restorations

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-Aesthetics

-Function

-Gingival Embrasures

-Excess cement

-Patient homework & questions

Post-Op Check

From Imaging & Diagnostic Wax-up the entire case was duplicated

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Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.

Cosmetic Provisionals (Bead Line Technique)

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http://d1ue90e5sp4tcv.cloudfront.net/668/images/Grid_Image_20945_22_v1.pdf

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Scribe a 0.5mm-1mm groove into tissue & a little on tooth


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No Polish Necessary if you use a good model

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Indirect Restorations

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Crown Classification

• 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


Clinical Application Related to Ceramic Strength

ISO6872

Listed by Fracture Toughness from weak to strong

Class I porcelains (feldspathic, low fusing)

KIC<1.0 fracture toughness and <100MPa

Inlays, onlays and veneers adhesively cemented

Christensen, G. Dental Economics 06.2019 p 80-81

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Class 2 Leucite Glass Ceramics (Vita Mark

II, IPS Empress)

KIC>1.0 fracture toughness and >100 Mpa

Single unit anterior or posterior adhesively

cemented.

Class 3 Lithium Disilicate, Lithium Silicate

(IPS e.max, Obsidian)


Single unit or three unit anterior

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Class 4 Cubic containing zirconia (Katana

STML/UTML, Lava Esthetic)

KIC>3.5 fracture toughness and >500MPa

Single units, three unit anterior or posterior

Class 5 Tetragonal zirconia (Bruxzir, Lava

Plus)


One to four or more units anterior or

posterior

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All-Ceramic Crowns565-1200+MPa

Multi-Layered

Zirconia


Zirconia Multi-layered

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All-Ceramic Crowns


(557-1125mpa)

Anterior Crowns

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0

10

20

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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

ce

ncy

Lithium

DisilicateMulti-Layer Zirconia

Thickness of

sample: 1.2mm

Tra

nslu

ce

ncy

(⊿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

Lithium

Disilicate

The same level translucency as

glass ceramic (e.max Press LT)

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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 s

tre

ng

th

.

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)

Zirconia Aesthetics

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Zirconia Aesthetics

Zirconia Aesthetics

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Traditional Resin CementationConventional methods applied to the bonding of

silica-based ceramics are not successful. You cannot acid etch and silanate the intaglio surface of metal

oxide ceramics as you can with lithium disilicate

(e.max) or other glass ceramic restorations.

HF acid does not sufficiently alter the surfaces ofmetal oxide ceramics, and conventional silane

coupling agents cannot provide chemical bonds to

these materials because of the lack of silica.

Zirconia CasesShould be delivered from the lab having been

sandblasted with aluminum-oxide particles. Research shows small particles (30 µm) @ low pressure (35 psi) to

enhance resin bonds while minimizing surface damage.*

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Prior to Try-in

The internal surfaces should be coated

with a ceramic/metal primer that

contains adhesive monomers that

chemically bond to metal oxides.*

MDP has been shown to offer the most

consistent bonds to zirconia

Silanes

Universal Adhesives (w/MDP)

Silane Primer + MDP

Organo-Phosphate Monomer (MDP)

Silane Primers

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MDP Monomer

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

BONDS WITH OR WITHOUT HF

ACID ETCHING

THE “NO-WATER” SILANE w/ MDP

INSTANT ACTIVATION

LESS DEGRADATION

(More Stable 2 Year Shelf-Life)

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Silanes


Silane Primer + MDP


Silane Primers

A disadvantage of many other silane products is that they are pre-

hydrolyzed.

Another disadvantage is some require the use of Hydrofluric Acid

etching and sometimes in addition to Micro-Etching. The new

Monobond Plus requires HF and Micro-Etching as well as 60 minute

activation time period.

Zirconia CleaningIvoclean (Ivoclar)ZirClean (Bisco) Try-in contaminates the

surface more than if a ceramic primer is not present.

Salvia contains phosphates so they compete for the same receptor sites as the ceramic primers

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Zirconia Ceramic Primers

Z Prime Plus(Bisco)

G-Multi Primer & Ceramic Primer II (GC America)

Peak ZM (Ultradent)

Z Bond (Danville Zest)

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REVIEW: Ceramic Try-in

Make sure it is sand blasted properly from lab

Use a Ceramic Primer prior to try-in (unless using Calcium Aluminate Cement)

Ultrasonic with ethanol after try-in

No additional MDP Ceramic Primer needs to be used.

Or

Sandblast after try-in and use a MDP Ceramic Primer then follow cementation protocols

Enamel & Variable Dentin Bonding

NEXT Problem:Varying tooth substrates

Maintain good retention and resistance preparation design

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Cementation

Adhesion

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Adhesion

Class I or II

:Tooth Preparation

3x Tubule Density Equals Higher Fluid &

Increased Difficulty for Bonding 30% Decrease in

Bond Strengths with most bonding systems.**

What substrate are we treating?

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When bonding to enamel, an etch & rinse approach is definitely preferred, indicating that simple micro-mechanical interaction appearssufficient to achieve a durable bond to enamel. When bonding to dentin, a mild self-etch approach is superior, as it {MDP} 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

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

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Cementation Material Options

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

Ceramic Primer on Restorations

Cement Selection

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TRADITIONAL GLASS IONOMER

CEMENTATION OPTIONS

Resin Modified Glass Ionomer Cements

Use Ceramic Primer prior to try-in

Clean with ethanol after try-in

Keep tooth slightly moist and place RMGI cement

as it will chemically cure to the tooth and the Ceramic Primer

Still want to always have good prep design

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Resin Modified Glass Ionomer

Cement and a Ceramic Primer Lab sandblasts @ 30psi w/ 50 micron aluminum-oxide

particles

G-Multi Primer (MDP) prior to tryin

Ultrasonic clean with ethanol

Place FujiCEM2 RMGI cement in restoration

Cementation

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Cementation

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Alkaline pH 8.5

Moisture Tolerant

Self Sealing

Apatite Formation

Insoluble/No Degredation

Stronger with time

Semi / Translucent

Biocompatibility-Excellent

Bioactivity-Apatite formation

No silane, conditioning, bonding

Calcium Aluminate/Glass Ionomer Hybrid Cement**

TIP

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Ceramir Crown & Bridge is indicated for permanent cementation of:

• Porcelain fused to metal crowns and bridges

• Metal (gold, etc.) crowns and bridges

• Gold inlays and onlays

• Cast or prefabricated metal posts

• Strengthened core all-zirconia or all-alumina

ceramic crowns and bridges

• Lithium Disilicate (eMax)

• Stainless steel crowns

• Ortho bands and appliances

Bioactivity

A reactive bioactive system that contributes to hydroxyapatite mineralization of hard tissue through ion release and alkaline

pH.**


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Cementation Technique

Mix for 8-10 seconds

.17ml vs single cap .10ml

3-4 restorations


Ceramir C&B Comparison to other

cement classes

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Lithium Disillicate (eMax)• Cleaning

w/phosphate scavengers is not necessary

• Silane is

contraindicated

• Tooth etching or

conditioning is not necessary

• Bonding agent is not needed

CEMENTATION TECHNIQUE

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Zirconia Restorations- Cleaning w/ phosphate

scavengers is not necessary

- Silane is contraindicated

- Tooth etching or conditioning

is not necessary- No bonding agent necessary

Cement Selection

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Crown RetentionResults 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

Three year recall data yielded no loss of retention, no secondary caries, no marginal discoloration, and no

subjective sensitivity. All restorations rated excellent for marginal integrity.

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Cement SelectionJournal of Esthetic & Restorative Dentistry March 2015

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Simplify Cementation

-Silane is contraindicated

-Restoration does not have to be cleaned after tryin

-Tooth etching or

conditioning is not necessary

-Bonding agent is not needed

Technique Research/Literature**

Moisture Tolerant

No Sensitivity

Alkaline pH

Apatite Forming

Insoluble

Stronger With Time

Self Sealing

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Missing Canine

Zirconia abutment and Empress crown

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What do you cement with?

Weigh the benefit

of a bioactive

cement vs. a bonding agent &

adhesive cement.

Evaluate the preparation design

& moisture control.

Bonded Adhesion

Increasing strength demands

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ResinCement Options

Self Adhesive 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

Bonding Agent w/ Resin 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

SE Resin Cements

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

• Acid Neutralization

• Prolonged Gel State

• Convenience

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All Ceramic Crown Microleakage

Bonded 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.

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Results & Conclusions

Activa (Pulpdent)

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Activa (Pulpdent)

Theracem (Bisco)

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Theracem (Bisco)

New “Universal” Systems

Simple & easy to use

Direct & indirect techniques

Use as Total, Selective or Self Etch

Low sensitivity

Lots of MDP Based Products*

MUST use manufacturers bonding

agent and their dual cure resin

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MDP Penta-P MDP MDP

Adhesive Functional Monomers

MDP GPDM

MDP Modified

Phosphates

LITHIUM DISILICATE & SILICATE, LEUCITE AND FELDSPATHIC

RESTORATIONS

IS AN ADHESIVE CEMENTATION

SYSTEM THAT IS EASY-TO-USE,

EFFICIENT AND HIGHLY

EFFECTIVE

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148178/

(RFA-DE-10-004) “Tooth-colored resin restorations have an

average replacement time of 5.7 years due to secondary caries precipitated by bond failure.”

Factors that compromise bond durability in restorative dentistry

We challenged that current dentin adhesive designs that incorporate increasing concentrations of hydrophilic monomers are going in the wrong

direction

Water sorptionPolymer swelling

Decline in mechanical propertiesLeaching of hydrolyzed resin components

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BOND LOCATION& DEGRADATION

• 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.


Increased Difficulty for Bonding

%30 Degrease in Bond Strengths with most

bonding systems.


Intact hybrid layers created by a simplified etch-and-rinse adhesive in caries-affected primary dentin partially

disappeared after 6 months of intraoral function

Instability of hybrid layersproblem may be more severe than we realize


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MMP-8MMP-2MMP-9

Demineralizing dentin is like openingthe Pandora’s box, releasing

endogenous enzymes (Matrix Metalloproteinases - MMPs)

that were trapped withinthe mineralized dentin matrix.

In the presence of water (such as thatderived from water sorption or from

adhesives, MMPs (2,8 & 9) can breakdowncollagen fibrils that are not protected

by intrafibrillar minerals

Sukala et al. (2007)Mazzoni et al. (2007)


Courtesy Pacific University (Dr Marc Geissberger)

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InstroN Ultra Tester (Ultradent)

Ultra Jig (Ultadent)

Maximum/Minimum Shear Bond Strength

per Bonding Material

Shear Bond Test Results - 2012

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Zirconia Try-in Questions??? The lab should have sandblasted the restoration at 30-50psi w/

50 micron aluminum oxide.

After try-in:

Ivoclean and silanate?

Ultrasonic with ethanol after try-in or steam clean then silanate?

Sand blast then ultrasonic and ethanol?

Zirconia silanate prior to try-in

(Ultrasonic with ethanol after try-in)

Sandblast after try-in and use a MDP based cement

Silanes


Silane Primer + MDP


Silane Primers A disadvantage of many other silane products is that they are pre-hydrolyzed. Another disadvantage is some require the use of Hydrofluric Acid etching and sometimes in addition to Micro-Etching. The new Monobond Plus requires

HF and Micro-Etching as well as 60 minute activation time period.

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What substrate are we treating?

Class I or II

:Composite Preparation


Increased Difficulty for Bonding

30% Decrease in Bond Strengths with most

bonding systems.

FULL COVERAGE CERAMICS AND ZIRCONIA

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Blatz MB et al. JPD 2003

Al-Amleh B et al. J Oral Rehabil 2010

Wolfart M et al. Dent Mater 2007

Edelhoff D, Ozcan M. Clin Oral Implants Res

2007.

Papia E et al. J Biomed Mater Res 2013

Zirconia Ceramic Conditioning

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• 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

ZrPrime

r

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 solutionBond： Same BondComposite： Same

Micro tensile bond strength to Dentin

(MPa

)

“MDP”s perform differently

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MDP-containing material bonds to Zirconia

CLEARFIL™ CERAMIC PRIMER

MDP

γ-MPS

Ethanol

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Zirconia Cementation Review➢ Silanate with Clearfil Ceramic Primer prior to tryin**

➢ Clean with Ivoclean, ethanol or steam clean then reapply Clearfil Ceramic Primer

➢ Difficult Isolation use:

➢ Resin modified glass ionomer (Use silane)

➢ **Ceramir (Do not silanate)

➢ Good isolation with moderate to good resistance & retention

➢ Silane

➢ SE Resin cement such as Panavia SA Plus Or GC LinkAce

➢ Good isolation with poor to moderate resistance & retention➢ Silane

➢ Resin adhesive and bonding agent

Sand Blaster

Ceramic Primer (MDP)

Resin

Universal

Zirconia

Etched/Self Etch

1. Prepare Restoration SurfaceSand Blaster 30um @35psi

2. Ceramic Primer (MDP)

3. Etch Enamel 15-30 secs. Etch Dentin 10-15 secs

4. Apply Adhesive. Apply into preparation X secs. Thin with air X secs. Light Cure.

5. Seat Restoration. Load cement into restoration. Seat & remove Most excess.(Air inhibiting liquid) Light cure.

Bonded Adhesion

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Bonded Adhesion

• More efficient than Halogens

• Halogen produces light from 370 to 800 nm then filters out all

but blue light in 400-500 nm range

• Longer lasting / Cordless / Batteries

• Faster curing (5 seconds)

• Smaller in size/lighter

• Less heat

Benefits of LED Lights

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VALO delivers

Access to the curing site = Energy to the resin

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Machined from Aerospace Aluminum

Bonded Adhesion

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Bonded Adhesion

Review Air abrasion by lab

Use a Ceramic Primer prior to try in of ceramics

Pick from the Zirconia Cleaning Steps

Cementation

High bonds to enamel and dentin with an adhesive and dual cure resin cement

Use Glass Ionomer or Calcium Aluminate in Moisture Challenged areas and or high caries risk when adequate tooth retention is available

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Thank YOU!

[email protected]

www.LEGIONpride.com

TODD C. SNYDER, DDS, FAACD, FIADFE, ASDA

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http://www.instagram.com/Toddsnyderdds/

http://www.facebook.com/todd.snyder.dds

http://twitter.com/tcsaesthetics

http://www.instagram.com/Toddsnyder1/

powerpoint presentation...6/27/2019 3 retention form 2.5 -8 resistance form prepared tooth 4mm+ tall...

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