E x p r e s s 2 VPS Impression Material Clinical case 1: Anterior all-ceramic Lava Zirconia Bridge using Express 2 Penta Putty Soft in combination with Express 2 Regular Body VPS Impression Material in the 1-step technique Dr. Gunnar Reich, Munich, Germany Clinical Cases Initial situation: The patient appeared in the office with an aesthetically insufficient anterior PFM bridge (teeth 11 13) (Fig. 1). She agreed to replace the PFM bridge with an all-ceramic Lava Zirconia Bridge to avoid visible crown margins and dark appearance of the gingiva in the future. Treatment: After removal of the insufficient PFM bridge, the abutment teeth were cleaned and prepared to support the Zirconia bridge (Fig. 2) and retraction cords were placed (Fig. 3). For the 1-step precision impression, Express 2 Penta Putty Soft and Express 2 Regular Body VPS Impression Material were chosen, since this combination offers high resistance upon mouth insertion and good detail reproduction without being displaced. After removal of the first retraction cord, Express 2 Regular Body material was syringed around the prepared teeth (Fig. 4). In parallel, Express 2 Penta Putty Soft material was automatically mixed and dispensed with the 3M ESPE Pentamix 3 Automatic Mixing Unit (Fig. 5) and shaped into the tray (Fig. 6). The resulting impression showed a very accurate reproduction of the preparation margins and a nice colour contrast (Fig. 7). After two weeks with a temporary bridge made with Protemp 4 Temporisation Material, the final all-ceramic Lava Restoration was placed into the patient s mouth (Fig. 8) using RelyX Unicem Self-Adhesive Universal Resin Cement (all 3M ESPE). Fig.1: Initial situation: Aesthetically insufficient 3-unit PFM bridge in anterior region (teeth 11 13). Fig. 2: Front teeth prepared to receive a 3-unit full-ceramic Lava Zirconia Bridge. Fig. 3: Prepared teeth with retraction cords in situ. Fig. 4: Express 2 Regular Body VPS Impression Material syringed around prepared teeth. Fig. 5: Simultaneous filling of the impression tray with Express 2 Penta Putty Soft VPS Material from the Pentamix 3 Mixing Unit. Fig. 6: Shaping of Express 2 Penta Putty Soft Material in the tray using latex-free gloves. Fig. 7: Detail of prepared teeth in 1-step impression with Express 2 Regular Body and Express 2 Penta Putty Soft VPS Material. Fig. 8: Final situation: 3-unit all-ceramic Lava Zirconia Bridge seated in the patient s mouth.
Clinical case 2: Posterior Lava Zirconia Crown using Express 2 Penta Putty Soft in combination with Express 2 Light Body Flow VPS Impression Material in the 1-step technique Dr. Dr. Andreas Syrek, Munich, Germany Initial situation: Large cavity in endodontically treated lower first molar, temporarily filled with a glass ionomer (Fig. 1). Occlusal relations were insufficient (infraocclusion, Fig. 2). Treatment: To stabilize the tooth it was decided to place an all-ceramic Lava Zirconia Crown from 3M ESPE. The tooth was prepared with a chamfer margin to support the Zirconia crown (Fig. 3). For the impression, Express 2 Light Body Flow VPS Impression Material was syringed around the preparation and onto the occlusal surfaces of the neighbouring and opposite teeth (Fig. 4). The wash material was chosen for its excellent flow behaviour and the good detail reproduction experienced. For good insertion pressure, it was combined with automatically mixed Express 2 Penta Putty Soft VPS Impression Material using the 3M ESPE Pentamix 3 Automatic Mixing Unit (Fig. 5). The good colour contrast and the nice flow behaviour of the wash material make the details of the preparation easily visible (Figs. 6, 7). While waiting for the final restoration to be milled and veneered, the patient carries a temporary crown made of Protemp 4 Temporisation Material (Fig. 8), cemented with RelyX Temp NE Temporary Cement (both 3M ESPE). Figs. 1, 2: Initial situation: Infraocclusion in combination with insufficient temporary glass ionomer restoration of endodontically treated lower first molar. Fig. 3: Tooth prepared to receive an all-ceramic Lava Zirconia Crown. Fig. 4: Express 2 Light Body Flow Material syringed around prepared tooth. Nice flow of wash material to tooth and soft tissue. Fig. 5: Simultaneous filling of the impression tray with Express 2 Penta Putty Soft Material from the Pentamix 3 Mixing Unit. Fig. 6: 1-step impression with Express 2 Light Body Flow and Express 2 Penta Putty Soft VPS Impression Material. Fig. 7: Detail of prepared lower first molar in 1-step impression with Express 2 Light Body Flow and Express 2 Penta Putty Soft VPS Material. Fig. 8: Final situation: Temporary restoration using Protemp 4 Temporisation Material.
Clinical case 3: Posterior all-ceramic Lava Zirconia Bridge using Express 2 Penta Putty in combination with Express 2 Ultra-Light Body Quick VPS Impression Material in the 2-step technique Dr. Gunnar Reich, Munich, Germany Initial situation: The patient carried an 8-year old posterior PFM bridge (teeth 45 47). Due to poor fit (large marginal gap of > 500 µm) an extended carious lesion was diagnosed mesiobuccally at mesial abutment tooth 45. This tooth had received endodontic treatment before. The patient consented to have the old bridge replaced with an all-ceramic Lava Zirconia Bridge from 3M ESPE. Treatment: The old bridge (Fig. 1) was removed and the caries completely excavated. X-ray and visual control displayed that revision of the endodontic treatment was not necessary. Tooth 45 was reinforced with a RelyX Fiber Post followed by a core build-up with Filtek Z250 Universal Restorative System. Then both bridge abutment teeth were prepared for the subsequent Lava Restoration with chamfer margins (Fig. 2). After retraction (Fig. 3), a precision impression using the 2-step technique was taken with Express 2 Penta Putty and Express 2 Ultra-Light Body Quick VPS Impression Material a perfect combination for this impression technique (Figs. 4 6). Express 2 Ultra-Light Body Quick material was very agreeable to syringe and stayed nicely at the tooth, but created very thin layers in the impression and flew deeply into the sulcus, demonstrating its high structural viscosity (thixotropic behaviour) (Fig. 7). After an interim period of 10 days with a temporary restoration (3M ESPE Protemp 3 Garant ) the final Lava Restoration was seated with RelyX Unicem Self-Adhesive Universal Resin Cement. It showed an excellent marginal and approximal fit and required only very minor occlusal adjustments (Fig. 8). Fig. 1: Initial situation: PFM bridge with insufficient marginal sealing and underlying caries. Fig. 2: Prepared teeth. Fig. 3: Prepared teeth with retraction cords in situ (double cord technique). Fig. 4: Filling of the impression tray with automatically mixed Express 2 Penta Putty VPS Material from the Pentamix 3 Mixing Unit. Fig. 5: Carved primary impression. Fig. 6: 2-step impression with Express 2 Ultra-Light Body Quick and Express 2 Penta Putty VPS Material. Fig. 7: Detail of impression made with Express 2 Ultra-Light Body Quick and Express 2 Penta Putty VPS Material. Express 2 Ultra-Light Body Quick Material penetrates deep into the sulcus and flows in very thin layers. Fig. 8: Final all-ceramic Lava Zirconia Bridge shortly after placement. Gingiva is recovering.
Clinical case 4: Replacement of an insufficient PFM crown by an all-ceramic Lava Crown Dr. Gunnar Reich, Munich, Germany Initial situation: Insufficient 2-year old PFM crown with large destruction of tooth 36 on its lingual aspect. Tooth 36 underwent endodontical treatment 1½ years ago. The insufficient crown was replaced by an all-ceramic Lava Crown. Treatment: The insufficient crown was removed and the caries was completely excavated (Fig. 1). Revision of the endodontical treatment was considered as not necessary based on X-ray examination and visual control. Two RelyX Fiber Posts were inserted in tooth 36 (Fig. 2) to stabilize the following core build-up with Filtek Z 250 Universal Restorative System (Fig. 3). A precision impression using the 2-step impression technique was taken with Express 2 Penta H Universal Quick and Express 2 Light Body Flow Quick VPS Impression Material (blue, Figs. 4 7). A second 2-step impression was taken with the somewhat thicker Express 2 Light Body Standard Quick Wash Material (pink, Figs. 8 10). A temporary crown was fabricated using Protemp 3 Garant and cemented with RelyX Temp NE Temporary Cement (both 3M ESPE). The final Lava Restoration (Fig. 11) was permanently cemented with RelyX Unicem Self-Adhesive Universal Resin Cement (Fig. 12). Fig. 1: Initial situation: Insufficient PFM crown with large carious lesion at lingual aspect of tooth 36. Fig. 2: Tooth 36 reinforced with two RelyX Fiber Posts, occlusal view. Fig. 3: Tooth 36 after core build-up and circular chamfer preparation for Lava Crown, occlusal view. Fig. 4: Initial impression made with Express 2 Penta H Uni versal Quick Material after carving. Fig. 5: Intra-oral syringing with Express 2 Fig. 6: 2-step impression made with Express 2 Penta H Universal Quick and Express 2 Fig. 7: Detail of 2-step impression made with Express 2 Penta H Universal Quick and Express 2 Light Body Flow Quick. Fig. 8: Intra-oral syringing of Express 2 Light Body Standard Quick. Fig. 9: 2-step impression using Express 2 Penta H Universal Quick and Express 2 Light Body Standard Quick VPS Material. Fig. 10: Detail of 2-step impression made with Express 2 Penta H Universal Quick and Express 2 Light Body Standard Quick. Fig. 11: Final Lava Crown on die model, occlusal view. Fig. 12: Final Lava Crown in patient s mouth, occlusal view.
Clinical case 5: Aesthetics: Two 3-unit PFM bridges in the upper anterior region Dr. Christoph Zawta, Meran, Italy Initial situation: Poor aesthetics in the upper anterior region due to old insufficient PFM bridges 13 11 and 21 23 with recurrent caries and partly exposed crown margins (Figs. 1, 2). The patient was very unsatisfied with this situation. In order to re-establish the aesthetic aspect in the anterior region the old restorations were replaced by new PFM bridges and tooth 24 was restored with an IPS Empress inlay. Treatment: After removal of the insufficient restorations and restorative pre-treatment a direct bridge temporary (3M ESPE Protemp 3 Garant ) was inserted (Fig. 3). Subsequently, periodontal pre-treatment was performed. After a healing period of 3 months a chamfer preparation was carried out for the abutment teeth 13, 11, 21, 23. Ultrapak cords have been placed for retraction of the gingival tissue in two-cord technique (Fig. 4). The precision impression using the 1-step impression technique was made with Express 2 Penta H and Express 2 Light Body Flow VPS Impression Material (Fig. 5). Tray and wash material offer a very good colour contrast allowing an excellent readability of all relevant details. Fig. 6 exhibits a detailed view of the upper central incisors showing that the preparation margins for both abutment teeth are entirely captured. Neither tears nor voids occurred at the preparation margins or at other relevant areas. A master model has been created (Fig. 7). Fig. 8 shows the precise fit of the high-gold alloy frameworks on the master model. The intra-oral try-in of the frameworks showed an excellent precision of fit (Fig. 9). After try-in of the firstly fired frameworks the PFM bridges with ceramic shoulders were glaze fired and finalized (Fig. 10). The bridge restorations were permanently cemented with RelyX Unicem Self-Adhesive Universal Resin Cement (Figs. 11, 12). Fig. 1: Initial situation: Insufficient PFM bridges. Fig. 2: Close-up initial situa tion. Fig. 3: Close-up of temporary made with Protemp 3 Garant. Fig. 4: Prepared teeth 13, 11, 21, 23 with retraction cords in place. Fig. 5: Precision impression made with Express 2 Penta H and Express 2 Light Body Flow VPS Material. Fig. 6: Detail of precision impression made with Express 2 Penta H and Express 2 Light Body Flow (teeth 11, 21). Fig. 7: Master model sawed, prepared teeth, Fig. 8: Bridge frameworks on master model, Fig. 9: Bridge frameworks in patient s mouth, Fig. 10: Final bridge restoration on master model, Fig. 11: Final restoration inserted in mouth, Fig. 12: Patient with final restoration.
Clinical case 6: All-ceramic Lava Crown restoration Dr. med. dent. Vivien Porsfeld, Munich, Germany Initial situation: Endodontically treated tooth 26 temporarily restored with Filtek Supreme XT Flowable Restorative (Fig. 1). Tooth 26 required full crown restoration due to large occlusal defect and advanced crack at its mesial aspect. The patient chose to have an all-ceramic restoration. Treatment: After removal of the temporary restoration, tooth 26 has been build-up with Filtek Z 250 Universal Restorative System followed by a circular chamfer preparation for the Lava Crown (Fig. 2). A precision impression was made using Express 2 Penta H Quick and Express 2 Light Body Flow Quick VPS Impression Material (blue, Figs. 3, 4, 5). A second impression was taken with the somewhat thicker Express 2 Light Body Standard Quick Wash Material (pink, Fig. 6). Both new wash material consistencies showed great flow characteristics they perfectly flowed into the deep sulcus, far below the preparation margins. For both impressions the colour contrast between tray and wash material was very good, allowing an excellent readability of all relevant details. Both impressions entirely captured the preparation margins of the prepared teeth (Figs. 5, 6). Neither tears nor voids occurred at the preparation margins or at other relevant areas. The preliminary impression for the temporary restoration was made with 3M ESPE Position Penta VPS Alginate Replacement and the Position Tray. A temporary crown was fabricated using Protemp 3 Garant and cemented with RelyX Temp NE Temporary Cement (both 3M ESPE). The final Lava Restoration (Figs. 7, 8) was permanently cemented with RelyX Unicem Self-Adhesive Universal Resin Cement. Fig. 1: Initial situation: Tooth 26 temporarily restored with Filtek Supreme XT. Fig. 2: Tooth 26 prepared, with retraction cords in place, occlusal view. Fig. 3: Intra-oral syringing with Express 2 Fig. 4: Precision impression made with Express 2 Penta H Quick and Express 2 Fig. 5: Detail of Express 2 Penta H Quick Express 2 Light Body Flow Quick impression. Fig. 6: Detail of Express 2 Penta H Quick Express 2 Light Body Standard Quick impression. Fig. 7: Final Lava Crown on die model, Fig. 8: Final Lava Restoration in patient s mouth, occlusal view. 3M ESPE AG ESPE Platz 82229 Seefeld Germany E-Mail: info3mespe@mmm.com Internet: www.3mespe.com 3M, ESPE, Express, Filtek, Garant, Lava, Penta, Pentamix, Position, Protemp and RelyX are trademarks of 3M or 3M ESPE AG. Empress and Ultrapak are not trademarks of 3M or 3M ESPE AG. 3M 2009. All rights reserved. 02 (6.2009)