innovation CLINICAL I V O C L A R V I V A D E N T QUARTER 1 // 1st January - 31st March 2017

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1 innovation QUARTER 1 // 1st January - 31st March 2017 CLINICAL I V O C L A R V I V A D E N T IPS Empress Direct CAD/CAM FREE CPD Plus SpeedCEM For more information on any featured Ivoclar Vivadent product please visit ICDE2017

2 NEW OFFER Quarter 1 Special Offers FitBit Charge 2 PurePulse Heart Rate All-Day Activity & Sleep Long Battery Life Smartphone Notifications Customisable Clock Faces Spend 1500 & get a FREE FitBit Charge 2! * PurePulse Heart Rate Music Control FitBit Blaze Smartphone Notifications All-Day Activity & Sleep Accessory Bands & Frames Long Battery Life Colour Touchscreen Workout Goals + Summaries Spend 2000 & get a FREE FitBit Blaze! * ipad Air 2 8 Megapixels Stereo Speakers imessage, , IM Triple-core 1.5ghz Typhoon Available in 3 Colours Long Battery Life Fingerprint Recognition 9.7 Screen (~264ppi) Spend 4000 & get a FREE 32gb ipad Air 2! * Spend 5000 & get a FREE 128gb ipad Air 2! * T&Cs Apply. Offers on this page cannot be used with new user offers. One gift per customer. Qualifying order must be placed on one invoice and cannot be accumulated. All free items will be sent on receipt of copy invoice, please allow 28 days for delivery. Offers end 31/03/2017, invoices must be received by 14/04/2017. E&EO 02 INNOVATION Q1 2017

3 CEMENTATION SpeedCEM Plus SpeedCEM Plus is a self-adhesive, selfcuring resin cement with optional lightcuring. This cement offers an ideal combination of performance and user-friendliness. Its formulation has been optimized to make it particularly suitable for use in conjunction with restorations made of zirconium oxide and metal-ceramics and for the cementation of restorations on implant abutments. Not every restoration can be completely and evenly cured with light. Strong self-curing capabilities offer an additional measure of reliability when seating opaque or nontranslucent restorations. User-friendly application Easy clean-up Fast removal of excess is one of the distinguishing features of SpeedCEM Plus. Given the optional light-curing activation, excess material can be tack-cured and then removed in large pieces using a scaler. Tolerant processing SpeedCEM Plus permits flexible use in different situations. It produces a reliable bond on moist and dry dentin - both when used in the selfcuring mode and when used in the lightcuring mode. Radiopacity With its especially high radiopacity, the resin cement is easy to distinguish from the dentin and enamel. This facilitates the differentiation between residual cement excess and secondary caries on future patient X-rays. Variolink Esthetic Variolink Esthetic is based on the aesthetic luting composites Variolink II and Variolink Veneer, which have proven their worth in clinical use for many years. Variolink Esthetic is available in these shades: Variolink Esthetic demonstrates exceptional shade stability. This is made possible by the patented, reactive light initiator Ivocerin, which is 100 % free of amine-based co-initiators. Variolink Esthetic forms the basis for long-lasting and reliable aesthetic results. Even if exposed to intensive light or a humid environment, Variolink Esthetic is not subject to visible shade changes. Multilink Automix The Multilink Automix System fulfils your expectations and those of your patients with regard to high bond strength and long-lasting adhesion of the restoration to the tooth structure due to the patented, hydrolytically stable phosphonic acid monomers contained in the product and the balanced performance initiator system. Multilink Automix is characterized by its outstanding and well-balanced adhesion, irrespective of whether it is light-cured or self-cured. LIG H T PATENTED Ivocerin INITIAT O R For more information on cements visit or scan the QR code. INNOVATION Q

4 SPECIAL OFFER CAD/CAM Block Offer BUY 17 GET 5 FREE On all blocks * BUY 8 GET 2 FREE On all blocks * A14 S & L CAD Blocks now available in LT: A1, A2, A3, A3.5, B1, B2, C1, C2 & D2 BUY 5 GET 1 FREE On all blocks * Blocks include, IPS e.max, Telio CAD and IPS Empress CAD. Cheapest block packs will be FREE. Offer only available when all placed as one order. 2) - for tooth SPECIAL OFFER Bluephase Style Bluephase Style is on an ergonomic mission. Whilst it is grounded in the proven technologies of the Bluephase range, it incorporates optimised features. It offers a new light output of 1,200 mw/cm2, which is comparable to that of the existing Bluephase light which was 1,100 mw/cm2. Additionally, the new Bluephase Style features a compact and ergonomic shape that fits the hands of women and men even more comfortably Bluephase Style with 10% more power: 1,200 mw/cm2 Available February 2017 NEW COMING SOON PURCHASE A BLUEPHASE CURING LIGHT AND RECEIVE 250RRP OF IVOCLAR VIVADENT PRODUCT FREE * 04 INNOVATION Q1 2017

5 ARTICLE Proven aesthetics: six years of success with IPS Empress Direct After having successfully used the nano-hybrid composite IPS Empress Direct in clinical practice for six years, the author draws a balance. The teeth of the first patient he restored with this material are still in an excellent condition. Based on this first patient case with IPS Empress Direct a new product at the time the author explains how he successfully uses the material in direct restorative procedures. Figs 1a and b: Preoperative situation: Defective amalgam and composite fillings in the upper and lower arch. Case report The author describes the restoration of an entire fourth quadrant, involving IPS Empress Direct as the restorative material. At the time, the rehabilitation comprised both dental arches. The patient requested the treatment because of his postoperative sensitivity. Moreover, the existing restorations were defective and aesthetically unpleasing (Figs 1a and b). The proximal contact surface between tooth 46 and tooth 47 seemed to be incorrectly shaped, as after each meal, food particles got trapped in the interdental space. Moreover, there were no occlusal contacts, and a functional occlusal surface was not present. Fig 2: Rubber dam placement to isolate the treatment field. A rubber dam was placed in the area of the quadrant in question to create a completely dry treatment field (Fig. 2). The rubberdam technique results in an ideal treatment field. Excellent visibility is ensured and any unintended swallowing of materials by the patient is prevented. The old fillings were removed and the underlying carious tissue was excavated using a round bur. Subsequently, the cavities were finished with fine-grit diamond grinders and diamond-coated tips in an ultrasonic handpiece. In general, care should be taken to provide the cavities with an appropriate shape. The aim is to maintain as much contact enamel and underlying supportive dentin as possible. The cavity should feature a continuous outer boundary line (Fig. 3). Fig 3: After the old filling and the carious tissue had been removed, the cavity was prepared according to the principles of the adhesive technique. Conditioning A multiple-step total-etch adhesive (SyntacR) was used as the bonding agent. The author had already used this bonding agent for nearly 15 years at the time. Three positive outcomes underscore the clinical strength of this adhesive: i) There was no postoperative sensitivity, ii) the restorations demonstrated optimum adhesion to the underlying tooth structure and iii) they showed exceptional marginal integrity. When the total-etch technique is used, the enamel and dentin surfaces are etched for different lengths of time (enamel = 30 seconds, dentin = 15 seconds) (Fig. 4). After the etching process, Syntac Primer was slightly rubbed into the tooth structure, left to react for 20 seconds and then carefully dispersed with air until complete evaporation. The same procedure was repeated with Syntac Adhesive. The subsequently applied bonding agent (Heliobond) should remain on the etched tooth surface for at least 10 seconds. Only in this way can the material completely Fig 4: Phosphoric acid was applied and left to react for 15 seconds on dentin and 30 seconds on the enamel. penetrate the collagen fibres and the partly demineralized dentin layer. After the bonding agent had taken effect, the material was carefully removed by suction and dispersed with air. After curing, the dentin surface should have a slightly glossy appearance. This shows that the adhesive has penetrated thoroughly and there are no areas with an unduly thick coating of adhesive. INNOVATION Q

6 EDITORIAL Fig 5: After lining the cavity with Tetric EvoFlow (to create an even cavity floor), sectional matrices were placed. Fig 6: IPS Empress Direct Dentin was used to successively rebuild the cusp slopes. Filling In an initial step, flowable composite (Tetric EvoFlowR) was applied to the entire dentin surface in a layer of approx. 0.5 mm thickness and to the enamel in a thin layer. The composite material was cured twice for 10 seconds using a curing light with a light intensity of at least 1000 mw/cm2. Subsequently, the restoration was built up using the sculptable IPS Empress Direct. The objective was to turn the class II cavity into a class I cavity. This required the proximal cavity walls to be reconstructed (Figs 6 and 7). Unlike matrix bands, sectional matrices enable the composite build-up to be given the convex shape typical of proximal surfaces. As far as matrix systems were concerned, we had to completely rethink our way of using them. In amalgam fillings, matrices served the purpose of keeping the material in place during condensing. They also prevented the amalgam from slipping into the interdental spaces, which may result in damage to the soft tissue. By contrast, the application of composites may be compared to the injection moulding procedure employed in the manufacture of plastics. In order to achieve a smooth, shiny surface, the soft plastic is injected into a metal mould. The resulting product normally does not require any further finishing. The sectional matrices used in the case presented here serve a similar purpose as the metal moulds: They define the final shape when the proximal walls are reconstructed. IPS Empress Direct enamel material was adapted appropriately and then light-cured. Due to the smooth surface, hardly any finishing was required. Fig 7: Creating a functional, anatomically correct occlusal surface texture. Fig 8: View immediately after finishing and polishing. The restorations blend seamlessly with the surrounding dentition. Fig 9: The same situation six years later. The fillings are still intact. No marginal leakage is observed. The cavity was filled up with a series of first horizontal and then oblique layers of IPS Empress Direct Dentin. As a basis for the occlusal surface topography, triangular cusp slopes were shaped (Fig. 8). The occlusal surface was completed with oblique layers of IPS Empress Direct Enamel (Fig. 9). After the matrices had been removed, the occlusal surfaces were moulded according to gnathological principles. The occlusion was verified and any premature contacts eliminated. Finishing of the occlusal surface was performed with tungsten carbide grinding instruments (H390F, Komet). Only few fine finishing and polishing steps were required. Finishing was achieved with a three-step polishing system (AstropolR) (Fig. 10). For the finishing of convex areas, we recommend using single-bladed grinding discs with decreasing grit-size (OptiDiscR, Kerr-Hawe). Conclusion By consistently adhering to the protocol shown, even complex direct restorations can be fabricated in a fairly uncomplicated manner. In the case presented, the three basic criteria for a satisfactory outcome could be met: appropriate shade, shape and function. Even six years after the treatment, the patient s restorations are still intact and aesthetically pleasing. Contact Details: Dr Sandro Pradella Via Lussemburgo, Eremo di Curtatone, Italy sanprad@tin.it Scan here to complete the questionnaire regarding this article to receive 1 hour CPD. All you have to do is sign up using the code IVQRT117. Once completed you CDP will be automatically issued. Visit today for you FREE CPD 06 INNOVATION Q1 2017

7 FOCUS PRODUCTS Tetric EvoCeram Tetric EvoCeram is the universal composite for anterior and posterior restorations that delivers outstanding aesthetics. Tetric EvoFlow Tetric EvoFlow is the top-selling flowable radiopaque composite in Europe, it is flowable when desired and stable as required. Tetric EvoCeram Bulk Fill Tetric EvoCeram Bulk Fill offers excellent handling and allows large increments of up to 4mm to be polymerised in just 10 seconds with a lifelike dentin appearance. Tetric EvoFlow Bulk Fill Tetric EvoFlow Bulk Fill can be cured in increments of up to 4mm with an excellent affinity to cavity walls and self-levelling consistency as additional benefits. Tetric Classic Tetric is a classic among the universal composites. An outstanding radio-opacity of 400% Al BUY 3 GET 1 FREE* NEW USER OFFERS AVAILABLE IPS Empress Direct IPS Empress Direct is a lightcuring, highly aesthetic nanohybrid composite filling material for direct restorative procedures in the anterior and posterior region. Multilink Automix Multilink Automix is an adhesive luting system for the cementation of indirect restorations made of silicate and oxide ceramics, metal and metal-ceramics & composites. This offer is only available on the products shown here. Mix and match between products is not applicable. (i.e. buy 3x OptraGate packs to get an OptraGate pack free) Variolink Esthetic Variolink Esthetic is an amine free, aesthetic light- and dualcuring luting composite for the permanent cementation of ceramic and composite restorations. ExciTE F ExciTE F is a light-curing, fluoride releasing, singlecomponent total-etch adhesive for the placement of direct restorations. Monobond Etch & Prime The first single-component ceramic primer in the world, allowing you to etch and silanate glass-ceramic surfaces in one easy step & improves bond strength. Fluor Protector S The protective fluoride varnish that is colophony & latex free which provides superior protection against dental caries and erosion, allowing your patients to consume food after 1 hour. Adhese Universal Adhese Universal is a singlecomponent, light-cured adhesive for direct and indirect bonding procedures that is compatible with all etching techniques. OptraGate OptraGate is a latex free device that retracts the lips & cheeks evenly and gently, allowing more effective, relative isolation of the treatment field. OptraSculpt Pad OptraSculpt Pad is a contouring instrument with special foam pad attachments, which is designed for the efficient, nonstick forming and shaping of composite fillings.. SpeedCem Plus SpeedCEM Plus is optimised to make it particularly suitable for use in conjunction with restorations made of zirconium oxide and metal-ceramics and for the cementation of restorations on implant abutments. INNOVATION Q

8 LEE CULP FRIDAY 10.30am pm LIDA SWANN PETR MYSICKA Digital, Aesthetics and Efficiency, these three cornerstones of modern dentistry will be the focus of our 5th annual ICDE event, following on from the sell-out successes of 2010 to Bringing together renowned dental professionals to present their opinion and case studies, ICDE2017 is the perfect opportunity to explore the constantly evolving dental landscape, with a focus on Digital, Aesthetics and Efficiency. JAMES RUSSELL IAN SMITH NILESH PARMAR SATURDAY 10.00am pm Daytime: Curve Theatre Evening: King Power Stadium CARL FENWICK VICKEN HATSAKORDZIAN For more information please visit: Alternatively you can contact Sarah Rees on: Tel: or sarah.rees@ivoclarvivadent.com NEW COURSE Direct Restoratives Masterclass with Dr Christopher Orr ATTIQ RAHMAN More speakers to be announced. This one day course applies a systematic anatomical approach to composite layering replicating natural tooth colour with Empress Direct using a multi-shade layering technique. Shade matching and mapping of internal effect colours to plan the restoration reflects the classification of composite resins by physical and optical properties. London 17th March :00am - 5:00pm Advanced Dental Seminars 11a Bell Yard Mews, Bermondsey Street, London SE1 3TN Leicester 22nd April :00am - 5:00pm ICDE UK & Ireland Compass Building, Feldspar Close, Leicester LE19 4SD Wakefield 15th September :00am - 5:00pm Wakefield Academy, 13 Navigation Court, Calder Park, Wakefield, West Yorkshire, WF2 7BJ Manchester 8th December :00am - 5:00pm MANDEC, 3rd Floor, University Dental Hospital, Higher Cambridge Street, Manchester, M15 6FH ONLY 250 +vat 7 Hours CPD For more information on any featured Ivoclar Vivadent product please @IvoclarVivadentUK *T&C s Apply. Offers only available through Ivoclar Vivadent Product Specialists. All free items will be sent on receipt of copy invoice, please allow 28 days for delivery. Offers cannot be combined or used in conjunction with any other offer. Offers end 31/03/2017. E&EO