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I industry report _ i ndi rect techni que

cosmetic
dentistry 1_2008
_The demand for aesthetic results in prosthetic
restoration is constantly increasing in our laboratories.
More and more patients are coming to the dental office,
desiring and expecting their restorations and even their
fillings to look natural. The aspect of laboratory costs of
aesthetic restorations also plays an increasingly impor-
tant role.
In recent years, dental companies have produced
materials that allow the dentists to better satisfy these
needs. These materials, called composites, consist of in-
organic fillers and are surrounded by an organic matrix.
Research has made progress in the following areas:
more resistant substances are being used in the mixture,
improving the texture, ie, smoothness and density.
Compared to traditional composites, the new micro-
hybrid composite materials used in preservative den-
tistry enable direct restorations with improved abrasion
resistance and accuracy.
These light-curing composite materials contain
75% inorganic fillers with different particle sizes, en-
abling great aesthetic results in combination with very
strong mechanical abrasion resistance (Enamel plus
HFO, mechanical characteristics; see Tables 1 and 2).
For these reasons our labs use micro-hybrid com-
posite materials for inlays and onlays. Composites are
increasingly replacing ceramics in aesthetic quadrant
restorations because inlays can be done much faster,
therefore saving time and costs for both the laboratory
and the practice.
Dentists quickly realize the excellent accuracy and
durability of these indirect restorations, as well as the
applications in extended occlusal surfaces, particularly
when they and their laboratories have developed and
established a standardized method for their technical
implementation. This applies even more so since dental
offices use light-curing materials for direct fillings be-
cause they permit easy regulation even during cemen-
tation of indirect restorations.
_Technique
Even though we are aware of the functional quali-
ties and, above all, the accuracy of gold, we now prefer
to use a micro-hybrid composite material (Enamel Plus
HFO, by Micerium S.p.a., Italy). This especially applies in
cases where old amalgam fillings or infiltrated ceramic
inlays have to be replaced (Figs. 13).
A broad utilization has shown that the material is
very accurate. Additionally, it is easily processed in any
laboratory, a simple cast is sufficient (Fig. 4).
After the model has been mounted in the traditional
method with a class IV cast, it has to be verified that all
details and edges are perfectly visible. It is important to
pay attention to the correct preparation method with
low friction. Additionally, the thinnest pointeg, in the
Posterior aesthetic inlays:
indirect technique
Author_Daniele Rondoni, Italy
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]
Tetric
Ceram
Coltene
Miris
Dentsply
Esthet X
Kerr Point
4
HFO Sinfony
140
120
100
80
60
40
20
0
200
150
100
50
Table 2
flexibility > 140 MPa
pressure resistance 450 490 MPa
elasticity module > 10.000 MPa
Vickers hardness 75 kg
2
/mm
2
transparency < 35%
Enamel plus HFO
* measured at 63 C, for 13 min. (at 75 C hardness + 20 %)
Table 1
By kind permission of Cosmetic Dentistry
International Edition n.1, 2008
I 37
industry report _ i ndi rect techni que I
cosmetic
dentistry 1_2008
occlusal central partwith a minimum of 1.5 mm, is re-
quired to avoid risk of fracture during cementation.
Once closing preparation borders have been deter-
mined, they are marked with a wax marker. Thereafter
the preparation area is sealed with a cyano-acrylate
based varnish (Margidur Benzer, Switzerland).
Before proceeding with the composite coating, it is
necessary to block out an area on the bottom of the cav-
ity with a neutral wax to facilitate the drainage of the
bonding composite during cementation and to allow
correct placement of the inlay (Fig. 5). After isolating the
affected surfaces with a ceramic separator (Temp Sep,
Micerium S.p.a., Italy), it should then be prepared for the
subsequent anatomical coating (Fig. 6).
The Enamel Plus HFO composite is a highly fluores-
cent dentine with various color saturation for the
restoration of the inner (dentin) zones. Additionally,
there are age-based enamels (generic enamel) with dif-
ferent luminosity degrees depending on the age of the
patient and the type of restoration (Fig. 7).
To start, small composite portions that correspond
to the occlusal plane are fixed with pre-curings using a
light-curing unit (Laborlux Micerium S.p.a., Italy) for 20
seconds. In cervical areas a UD2 dentine is used, while in
the incisal areas thinner layers (about 0.5 mm) of GE3
(generic enamel) with a high luminous value (Figs. 810)
are applied until both the vestibular and the proximal
walls have been rebuilt, while the contact point is care-
fully molded (Fig. 11).
Composite coatings along an edge are especially im-
portant to assure absolute precision of the restoration.
Therefore, it is advisable to use optical magnification de-
Fig. 1 Fig. 2 Fig. 3
Fig. 4 Fig. 5 Fig. 6
Fig. 7 Fig. 8 Fig. 9
Fig. 10 Fig. 11 Fig. 12
38 I
I industry report _ i ndi rect techni que
vices. Now, the internal parts of the restoration can be
coated.
The dentine coating should allow a natural desatu-
ration of the chromaticity through a horizontal appli-
cation without losing the translucent and luminous as-
pects. Thanks to the HFO Universal-Dentines, that allow
a gradually controlled internal chromaticity towards
occlusal areas, this can easily be accomplished. In the
deepest composite coat a high saturated dentin, in this
case UD3, is applied and pre-cured for 20 seconds. At-
tention needs to be paid to the correct composite solid-
ification in order to avoid creating cavities within the
restoration and cavities respectively.
For cusp inclinations, or triangular occlusal ridges re-
spectively, an UD2 dentine is used, while it needs to be
controlled that the alignment of these elements is in
harmony with correct functional dynamic occlusion
(Fig. 12).
After the last dentine layer has been pre-cured, ad-
ditional cusps are modeled with white Opalescent
White (OW), using a silicone brush (T-Pen No. 2,
Micerium S.p.a., Italy) (Figs. 13, 14).
When anatomical coating is finished, final polymer-
ization is done using light-curing for four minutes.
When light polymerization is completed, prior the re-
moval of the restoration from the work model, possible
functional inaccuracies can be corrected in the articu-
lator using diamond burs (Figs. 15, 16).
Due to the final density and consistency of the ma-
terial the finishing can be done as it would be with ce-
ramics (Table 2): using a small tungsten bur the occlusal
cosmetic
dentistry 1_2008
Fig. 13 Fig. 14 Fig. 15
Fig. 16 Fig. 17 Fig. 18
Fig. 19 Fig. 20 Fig. 21
Fig. 22 Fig. 23 Fig. 24
industry report _ i ndi rect techni que I
fissures are then finalized (Fig. 17). The more regular
surfaces (both proximal and vestibular) are homoge-
neously smoothed with abrasive paper cones (Fig. 18).
Final polishing is performed in a simple manner without
light-curing varnishes, using three polishing pastes
(Shiny System, Micerium S.p.a., Italy) (Figs. 19, 20).
When polishing is finished (Figs. 21, 22) the inlays are
removed from the work model and thoroughly checked
and cleaned.
Prior to delivery to the dental practice in adequate
packaging, all cemented areas have to be sandblasted
with low pressure to facilitate easy fitting of the com-
posite inlays (Figs. 23, 24). It is important to remember
that during cementation, the dentist will be able to use
the same composite that he normally uses for direct fill-
ings.
_Conclusion
Looking back at many years of experience, we can as-
sess that todays adhesive systems, in combination with
modern micro-hybrid composites, allow us to make
restorations that go beyond posterior aesthetic inlays.
We are now also able to achieve outstanding aesthetic
and durable results with veneers and extended restora-
tions in the anterior regions.
The anatomical coating technique in combination
with Enamel Plus HFO allows us to manufacture
restorations in our laboratory that are routinely being
manufactured in the dental practice using the same
technique. These indirect restorations are cheaper,
faster and achieve better aesthetic results._
Dr Daniele Rondoni has
worked since 1981 in the
dental laboratory Savona,
Italy. There, he became ac-
quainted with aesthetic
restoration with a specialty
in blending technique with
composites. He aided in the
development of Enamel
plus HFO Tender blending systems, gives interna-
tional lectures, and regularly teaches continuing
education courses for technicians and dentists at
home and abroad.
cosmetic
dentistry
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