SPECIAL REPRINT c Light and Shadow by Haristos Girinis, Nagold B 2129 E. Die ganze Welt der Zahntechnik.

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1 B 2129 E Die ganze Welt der Zahntechnik SPECIAL REPRINT c by Haristos Girinis, Nagold WIELAND Dental +Technik GmbH & Co. KG Schwenninger Straße 13, Pforzheim, Germany Fon / , Fax / Mai Jahrgang 5

2 Special Reprint dental labor, Heft 5/2010, Verlag Neuer Merkur GmbH, München The new NEM Airbag There are countless NEM frame materials, which can be difficult to layer due to their composition and resulting physical properties. Haristos Girinis has found a safe solution for a high level of adhesion in Reflex NP safe. Author: Ztm. Haristos Girinis (master dental technician), Nagold, Germany Indexes Adhesion Conditioner NEM Layering Reflex NP safe by Wieland is applied in a wafer-thin layer to the NEM frame and finished as a thin wash firing. This saves an additional work step, the oxidation firing. This provides you with a high level of adhesion and all the frame materials can be layered without long-term cooling. A major advantage. Starting Situation A patient arrived at the dental practice because he was no longer satisfied with his current solution in the anterior tooth region. After a precise anamnesis and discussion, a suggestion for an aesthetic restoration could be made, which did, however, require surgical crown lengthening. After the surgical intervention, the tooth was prepared and a temporary solution (Fig. 1) was provided. The impression was taken state-of-the-art and a master model (Fig. 2) was created. The relevant measures to manufacture a sawn model were taken (Fig. 3). A perfect die is of major significance for the subsequent ceramic shoulder. The functionally supported frame is prepared in wax (Fig. 4) and then cast. das dental labor LVIII 5/2010

3 The transfer of wax into metal is an established practice and further reference will not be made to it here (Fig. 5). Fig. 1 The reduction with a carbide dental bur for the ceramic shoulder is carried out in a targeted manner (Fig. 6 and 7) and ground back deep into the approximal space. This measure is an important region in order to transport light into the gingival with the ceramic shoulder to support the naturalness of the restoration. Preparative Steps After preparation, the frame is blasted with 110 µm alumina (Fig. 8), the cap is steam cleaned, dried off and then covered with a thin layer of Reflex NP safe (Fig. 9). Oxide firing is not carried out because the manufacturer says that this is not necessary this saves time in the work chain. NP safe is the buffer between the ceramic and the NE frame and also prevents subsequent oxidation. After firing, the cap looks whitish (Fig. 10) and we begin the first opaque firing (Fig. 11). The firing result produces a matt surface (Fig. 12), which is prepared with the second opaque application, i.e. the last application (Fig. 13) and then powdered with fluorescent shoulder porcelain (Fig. 14). After the excess has been blown off (Fig. 15), this is fired. This firing result produces (Fig. 16) a crystalline, rough and fluorescent, light-diffusing surface, which counteracts the shading. The Ceramic Shoulder A ceramic shoulder is a state-of-theart development in anterior tooth restoration (Fig. 17). The first result after firing (Fig. 18) produces the familiar shrinkage. After correcting the shoulder and the second firing, there is a considerably improved result (Fig. 19 and 20). e Fig. 1 Starting situation, tooth 21 with temporary solution f Fig. 2 Situation after impression f Fig. 3 Sawn model f Fig. 4 Cervical wax-up Fig. 2 Fig. 3 Fig. 4 das dental labor LVIII 5/2010

4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 e Fig. 5 After casting: Perfect margin fit e Fig. 6 Refined: Reduction of the shoulder region e Fig. 7 Detailed view e Fig. 8 Frame blasted with 110 µm, no oxide firing! e Fig. 9 Wafer-thin application of NP safe e Fig. 10 After firing: slightly whitish surface e Fig. 11 First opaque wash application Ceramic layering When layering the ceramic mass, attention is paid to controlling the colour saturation from the very beginning. Consequently, the fitting masses are set in the cervical area, whereby the die geometry and the vestibular anatomical form must be taken into considera- das dental labor LVIII 5/2010

5 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig. 18 Fig. 19 Fig. 20 e Fig. 12 After the wash firing e Fig. 13 Second and last opaque application, covering e Fig. 14 Powdered with shoulder porcelain e Fig. 15 Excess is dusted before firing e Fig. 16 After firing: Crystalline rough surface e Fig. 17 Applied shoulder porcelain for the initial ceramic stage firing e Fig. 18 After firing e Fig. 19 Correction for second shoulder firing e Fig. 20 After the second shoulder firing das dental labor LVIII 5/2010

6 Fig. 21 Fig. 22 Fig. 23 e Fig. 21 Regulating the colour saturation, die geometry and anatomical form e Fig. 22 Approximal view, wedge-shaped anatomical form c Fig. 23 After the first firing tion. Using dentine modifiers and Chromatix, the colour saturation of the crown is regulated (Fig. 21). Attention must be paid to the wedge-shaped anatomical form of the restoration in the approximal view (Fig. 22). You must have a good control view in order to copy nature as exactly as possible. The first firing procedure produces the desired result (Fig. 23). Concentration Firing 1 You should concentrate on just two work stages. Firstly the dentine firing, i.e. concentration firing 1 and secondly, the enamel firing, concentration firing 2. Work begins with the dentine application from the cervical position round to incisal (Fig. 24). From the palatal position, work begins with the build-up of the incisal plate (Fig. 25) in the desired anatomical form and size in order to perfectly create the ratio c Fig. 24 Dentine application to the enamel loss, from cervical to incisal c Fig. 25 and 26 Build-up of the incisal plate from palatal to the desired anatomical size c Fig. 27 The incisal plate is protruding, cut-back to hard substance (Chromatix) c Fig. 28 and 29 Targeted submersion of incisal dentine structure between dentine and edge (Fig. 26). If the incisal plate is protruding, then it is cut back to the hard substance (Chromatix) (Fig. 27). Then the incisal dentine structure (mamelons) is carried out according to the colour analysis (Fig. 28 and 29). This dentine das dental labor LVIII 5/2010

7 Fig. 24 Fig. 25 Fig. 26 Fig. 27 Fig. 28 Fig. 29 structure is packed with transparent and neutral mass in order to ascertain the enamel-dentine junction (Fig. 30 and 31). A blue filament with bluish incisal mass is positioned to expand the transparent cladding towards the approximal space and the incisal region (Fig. 32). The side view is another outstanding chance to check and really evaluate the lengthening of the approximal space, the supra-curvature, the vestibular shrinkage, the palatal scoop and the entire morphology (Fig. 33). After this work step, the actual dentine firing procedure occurs. The firing result produces concentration step 1, the dentine firing (Fig. 34), which is concluded as a result. das dental labor LVIII 5/2010

8 Fig. 30 cf Fig. 30 and 31 Packing of dentine into transparent mass as enamel-dentine junction Fig. 31 Fig. 32 Fig. 33 Fig. 34 e Fig. 32 and 33 Extension into the approximal space, supra-curvature, vestibular shrinkage, palatal scoop c Fig. 34 After the actual dentine firing, dentine concentration step is completed Concentration Firing 2 Concentration firing 2 begins with the enamel mass. The approximal space, the contour and the anatomical width to the neighbouring tooth is filled (fig. 35). In Figure 36, it is clear to see that the contact point is two-dimensional, rather than point-shaped (Fig. 36). The finishing of the tooth form is carried out with the mesial and distal enamel crest, which specifies the limits of the external tooth contour (Fig. 37). With the targeted, individual filling of the limits using enamel mass, the restoration is given the desired anatomical form (Fig. 38). Again, the side view is observed, which demonstrates very well the anatomical crest form. The function provides us with the form (Fig. 39). After this second firing, concentration step 2 is completed (Fig. 40). das dental labor LVIII 5/2010

9 Fig. 35 Fig. 36 d Fig. 35 Concentration step two: Enamel contour, anatomical width d Fig. 36 Approximal view, contact surface, no selective application Fig. 37 Fig. 38 Fig. 39 Fig. 40 e Fig. 37 and 38 Completion of form, mesial and distal enamel crest, external tooth contour d Fig. 39 Anatomical form, palatal scoop d Fig. 40 After the second dentine firing, concentration step 2 is completed Refinement Now, I begin to copy the characteristics of the neighbouring tooth from the natural dentition to the restoration. Enamel-dentine junction and light strips (Fig. 41), mesial and distal grooving, periphery surfaces, surface details and surface finishes are marked out (Fig. 42). The surface is very specifically refined using different stones (Fig. 43) and this is how we create it step-by-step (Fig. 44). Then, a modified final firing is carried out (Fig. 45), which preserves the surface structure. It goes without saying that manual polishing is essential. This gives it that little something extra in order to simulate the abrasions which are identical to natural dentine (Fig. 46 and 47). Finale As previously mentioned, the function simulates the form, which can be very das dental labor LVIII 5/2010

10 Fig. 41 Fig. 42 Fig. 43 Fig. 44 e Fig. 41 and 42 Copying of information from natural dentition to the restoration e Fig. 43 Roughed-up surface after processing with stones e Fig. 44 Before the modified final firing Fig. 45 Fig. 46 e Fig. 45 After the final firing, the surface structure is preserved e Fig. 46 After manual polishing c Fig. 47 Side view Fig. 47 das dental labor LVIII 5/2010

11 Fig. 48 Fig. 49 Fig. 50 Fig. 51 Fig. 52 well seen in Figure 48. Of course, attention must be given to the blending from ceramic to alloy in order to define the transitional flow cleanly and exactly (Fig. 49). The final inspection takes place in the mouth (Fig. 50 to 52) the last instance for any dental work. Success is the unison of red and white aesthetics! Summary By using Reflex NP safe, together with the corresponding ceramic Reflex under compliance of the processing parameters, the highest level of safety is given to the aesthetically functional cerametallic reconstruction for the dental technician, the dental practitioner and, most of all, for the patient. Acknowledgement Many thanks to the patient patients and the team at the Dr. Peter Drescher dental practice, Stuttgart. Correspondence Address: Ztm, Haristos Girinis (master dental technician) Marktstr Nagold Germany Telephone +49 (0) Material Conditioner: Reflex NP Safe, Wieland Ceramics: Reflex, Wieland Alloy: Remanium Star, Dentaurum Ceramic stones: MTC 4, Shofu Cast: Fujirock White, GC Embedding compound: Sherafina 2000, Shera e Fig. 48 Continuous function e Fig. 49 and 50 Internal view: Metal and ceramic are harmoniously fused e Fig. 51 Directly after attachment, the gingival is still slightly anaemic e Fig. 52 Detailed view of natural tooth and reconstruction das dental labor LVIII 5/2010

12 REFLEX NP SAFE THE NEW NP METAL AIRBAG There are many NP metal framework materials and some of these are difficult to veneer because of the physical properties determined by their composition. The new REFLEX NP safe conditioner is the solution to this problem. Using REFLEX NP safe together with REFLEX gives you a success rate of nearly 100 % when veneering non-precious metal alloys. REFLEX NP safe is applied to the non-precious metal framework in a thin layer and fired as a wash. There is no need for an oxide bake. Then the framework is veneered with REFLEX as usual. All framework materials can be veneered without the need for slow cooling Very strong bond No need for oxide bake (which saves time) More reliable veneering of laser sintered and milled framework materials A single firing program can be used for all non-precious framework materials Try it for yourself. EXPECT THE DIFFERENCE! BY WIELAND. > ZENOTEC CAD/CAM > Dental alloys > AGC Electroforming > X-Type ceramics >