CLINICAL TIPS FOR POLISHING CERAMICS: E.MAX AND ZIRCONIA

Adjusting occlusal contacts is frequently required at the time of try-in and/or post-insertion. If there is a minor occlusal adjustment needed, my suggestion is to use only a rubber abrasive polishing wheel and not a diamond. A diamond is needed only if there is a significant adjustment to be made.

If a diamond is used in this process, proper polishing of the surface is necessary to achieve a smooth surface. A polished ceramic surface is less abrasive than one that is glazed, so there should be no need for re-glazing of the restoration. The larger the diameter of the polishing wheel used, the more efficient and effective the process. A point may be necessary to get into the depth of the anatomy, however it is the least effective because of its size.

The three key points for this procedure are:

1. Diamond: Use a fine grit diamond in a friction grip slow speed handpiece. An electric handpiece is more effective than one that is air driven. Run the handpiece at 20,000 RPM with water spray. Avoid a high-speed handpiece because it will create excessive heat and trauma in the ceramic. A light touch is required to avoid excessive heat and vibration. You will then need to use a rubber Polishing Wheel. (Left: Fine Diamond.)

2. Rubber Polishers: I use Brasseler’s Dialite LD (lithium disilicate) and ZR (zirconia) series. Each have a medium and a high shine wheel. An electric handpiece should run at 10,000 RPM to a maximum of 15,000 RPM, with only light pressure used. Electric handpieces have constant torque even at a slow speed, so they are more effective than air driven handpieces. Begin the process with the medium shine wheel. This step should take approximately 30 seconds. Next use the high luster rubber wheel with the same technique as described above. (Right: Medium Dialite LD.)

3. If you use Polishing Paste: Polishing paste should be used with a bristle brush wheel in a slow speed latch handpiece. The product I use is the Dental Ventures of America Zircon-Brite ‘G.’ This is very effective for polishing the grooves in the posterior anatomy. (Left: High Shine Dialite LD.)

Happy polishing!

This Article was first posted on Spear Education. http://www.speareducation.com/spear-review/2012/08/clinical-tips-for-polishing-ceramics-e-max-and-zirconia/

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The One-Two (Three) Punch!

Although it has been on the market for several years, I want to start first by pointing out the exceptional design on the VivaPen.  ExciTE F in the VivaPen allows exceptional control with ideal chemistries in the material since it eliminates the problems with leaving the cap off or accidentally dispensing 10 drops instead of one.  While that isn’t an issue with something like water, we all know that the adhesive agents are some of the most expensive things per gallon on the planet – so the last thing we want to do is accidentally waste it!  With the VivaPen delivery of ExciTE F, the adhesive can be placed precisely where it is needed and massaged into the dentin or on the enamel, and it is assured to be fresh and delivered in a controlled fashion.  A perfect method of preparing the tooth for the adhesive process!

The next ‘punch’ is Variolink Veneer.  This is an exceptional material that has some unique advantages over other alternatives available.  To start, this material is designed to be used under veneers and so in aesthetic cases.  It goes without saying that it is only logical to use the material developed by the same company that designed the world leading veneer materials, Empress and e.Max.  in addition to the common sense involved, there is the issue of color instability in most conventional adhesive cements.

Every base/catalyst system has amines in it that creates this color instability – resulting in the material turning dark over the first few years after delivering the new smile.  Imagine the frustration of having a beautiful translucent porcelain restoring your smile to your ideal goal, only to have it turn dark under the veneers a couple

years later!  The solution is in an adhesive resin that is designed to be color stable and that would be a light cure only system.  Since the problem was in both the base and catalyst in the dual cure systems, it needed to be completely re-engineered.  Fortunately it also includes a fantastic advantage to boot!

In the Variolink Veneer system there is a range of choices, not based on color, but based on the value.  When delivering a smile it is very often the case that in looking at the smile in the mouth it is just a little too stark and lifeless or it needs a bit of a punch to add that spark or pizzazz the patient is looking for.  In either case, the Variolink Veneer has you covered.  It is offered in a +1, +2, and +3 value or a -1, -2, and -3 value as well as a neutral.  The effect this can have in warming up that smile that is a little too stark or adding that sparkle to that smile that is just a little bit short of what the patient wants.  If you deliver beautiful smiles to your patients, this belongs on your tray setup!

The third punch is the power of the bluephase light.  Cordless lights have been plagued with ergonomic issues and power issues and battery issues and have lacked versatility.  The bluephase has addressed all of those issues and is a dramatic improvement in curing over many of the lights available.  The power it delivers allows you to rapidly cure the restorative material and progress through the procedure with confidence that your resins are as completely cured as they can be!  The concerns about rapid curing being detrimental turn out to be clinically irrelevant and in direct resin placement, the current materials have addressed the shrinkage issue anyway.  When bonding through Empress or e.Max, the power and ergonomics of the bluephase light make it a clear choice winner!

If you aren’t already using these materials and products, you owe it to yourself and your patients to get your hands on them – you will be glad you did!

What a great time to be a dentist!

If you have any questions contact your local Oklahoma Ivoclar Vivadent representative, Nate Smith.

Best in Business,

Dr. Mark Duncan DDS, FAGD, DICOI, LVIF

In 2007 Dr. Duncan was invited to join the full time faculty at the Las Vegas Institute and has moved to Las Vegas where he teaches with the Institute and maintains a faculty practice. Together with the faculty at the Las Vegas Institute, he is involved in teaching advanced esthetic and occlusal concepts along with practice management concepts to students from around the world.
http://www.lviglobal.com

STRENGTH, ESTHETICS, CERAMICS? MAX OUT YOUR POTENTIAL!

A new day has dawned upon us… did you notice it?

A few years ago Ivoclar introduced a revolution in dentistry and radically improved our ability to correctly treat our patients.  Even though the ADA no longer defines our profession as the ‘Art and Science’ of dentistry, what Ivoclar has done is allow us to continue that approach under the new definition of Dentistry!

This is interesting and important to what we are doing in our practices because it specifically guides us to provide treatment and consider the impact of that treatment on our patients.  In the world of fixed restorative, one of the major frustrations has been to find a solution for significant destruction of the tooth that would not create additional destruction – or more simply, to create a fix that doesn’t cause more problems.  The new material e.Max does exactly that!  Combine the wear characteristics of e.Max being in the same range as natural tooth structure with the advanced protocols that can eliminate bruxism, and we are now talking about treating the disease and considering their impact on the human body!

e.Max has wear rates over two years that are within the range of enamel!  So many of our choices cannot claim this and we were forced to accept progressive deterioration of the mouth because the materials did not function as natural tooth structure.  The e.Max is also significantly stronger than pressed ceramics – some 250% stronger when bonded in place.  It is strong enough that you can actually conventionally cement it though I am hard pressed to understand why you would.  The advantages of adhesively places restorations are too numerous to not become expertly proficient at using adhesively retained restorations as your primary, or perhaps sole, treatment.  The ideal combination of the restorative material e.Max and the bonding resin Variolink II and the power of the bluephase light and there is little that can’t be accomplished!

Although it is not widely appreciated or understood yet, the emerging approach of Neuromuscular dentistry cannot be ignored.  It offers the benefits of conventional occlusal perspectives and has the additional advantage that we can create physiologic muscle harmony by intent.  Finally we have the ability to objectively measure where the muscles are comfortable and design a functional envelop for the patient that allows muscle harmony along with joint balance and proper articulation of the teeth.  Astonishingly, when this occurs the parafunctional habit of bruxism can be totally eliminated!  If bruxism is eliminated, and the patient is given the benefit of a material like e.Max with ideal wear characteristics, it is finally possible to offer our patients conservative restorations that will replace and restore the broken, missing, or diseased tooth while maintaining the healthy and strong natural tooth structure – and perhaps keep that restoration for life!

It is painfully apparent that we are enjoying one of the most rapidly advancing times in the history of dentistry.  In the arena of materials, we now enjoy beautiful esthetics with great bondability and strength characteristics that don’t create their own problems.  Predictable and tooth conserving adhesive dentistry is truly an option!  There is diagnostic equipment that allows us to see and understand so much more in our patients!  From 3D imaging technology to objective measurement tools to allow us to evolve into the next level as a profession; we are in a time of unparalleled change and growth.  In the world of occlusion we once thought the teeth were the only important structure – then evolved out thinking to include the bones and proper alignment of the joints.  The next evolution in understanding simply incorporates the muscle and soft tissue in the diagnosis, and when that is included, we can maximize the properties of materials like e.Max.

What a great time to be a dentist! Check it out at http://www.ivoclarvivadent.us/emaxchangeseverything!

If you have any questions contact your local Oklahoma Ivoclar Vivadent representative, Nate Smith.

Best in Business,

Dr. Mark Duncan DDS, FAGD, DICOI, LVIF

In 2007 Dr. Duncan was invited to join the full time faculty at the Las Vegas Institute and has moved to Las Vegas where he teaches with the Institute and maintains a faculty practice. Together with the faculty at the Las Vegas Institute, he is involved in teaching advanced esthetic and occlusal concepts along with practice management concepts to students from around the world.
http://www.lviglobal.com