CASE GALLERY
Ceram·X® Global Case Contest
Best of 10 Years
CASE GALLERY
Ceram·X® Global Case Contest
Best of 10 Years
Content
I. Preface ......................................................................................................................................................... 3
II. One Material – Two shading concepts ............................................................................................................ 4
III. Clinical Practice ............................................................................................................................................. 5
IV. Clinical Cases from Ceram·X® Global Case Contest (GCC)
1. Ceram·X® GCC 2012/13
Bernd Van der Heyd
University of Göttingen, Germany ............................... 6
2. Ceram·X® GCC 2012/13
Rebecca Morgan
University of Central Lancashire, UK ............................ 7
3. Ceram·X® GCC 2011/12
Juri Beljakov
University of Tartu, Estonia .......................................... 8
4. Ceram·X® GCC 2010/11
Jekaterina Salabajeva
University of Tartu, Estonia .......................................... 9
5. Ceram·X® GCC 2010/11
Sofie Boeraeve
University of Gent, Belgium ....................................... 10
6. Ceram·X® GCC 2009/10
Nicolas Cazal
University of Nice-Sophia Antipolis, France .................11
7. Ceram·X® GCC 2008/09
Rudolf Semmler
University of Witten/Herdecke, Germany....................12
8. Ceram·X® GCC 2007/08
Daniela Illuminati
Università Politecnica Delle Marche, Italy ...................13
9. Ceram·X® GCC 2005/06
Luca Polonara
Università Politecnica Delle Marche, Italy ...................14
10. Ceram·X® GCC 2004/05 Patcha Angsuchotmetee Chiang Mai University, Thailand. ................................15
Dear Colleagues,
DENTSPLYʼs Ceram·X® Case Contest is a global dental-school talent competition, which honours outstanding
clinical results submitted by dental students. The case reports are presented in a standardised format as step-bystep photo-documentation and were judged by an independent international jury. Because of its innovative and
natural shade concept, Ceram·X®, the nano-ceramic restorative from DENTSPLY, encourages students of dentistry
to excel. It allows natural tooth structures to be mimicked visually and anatomically in virtually every clinical
case – matching the patientʼs age and individual needs. This innovative nano-ceramic composite resin by DENTSPLY with its extremely simple handling properties supports the work of the experienced practitioner while at the
same time inspiring excellent clinical treatment results - also in the hands of dental students.
The Ceram·X® Case Contest has been held annually since 2004 with growing interest from the international
professional community. Again, more than 230 dental students from 17 countries submitted their documented
clinical cases in the latest Ceram·X® Case Contest 2013.
The cases presented in this Case Gallery are a selection of Winner-cases over the last 10 years.
Please take a look and admire the exhibited skills of future dentists “unleashed” by a fascinating material.
Prof. Dr. med. dent. Rainer Seeman
Seemann
Senior Professional Service Manager, DENTSPLY
ONE MATERIAL — Two Shading Concepts
Ceram·X® is a restorative that allows users to choose
between two diﬀerent shading concepts.
Ceram·X® mono is based on a single shade concept, which
means users may choose from seven “everyday shades”
designed to fill the entire VITA®1 dental shade spectrum.
This concept is used primarily for clinical cases in which
perfect shade match is not absolutely critical, e.g. posterior
restorations.
Ceram·X® mono Shades Cover the Entire VITA®1 Shade
Range
The Ceram·X® mono shade system comprises only seven
shades (M1 to M7), which nevertheless cover all 16 tooth
shades of the VITA®1 Classic shade range. This approach
is practical, because numerous shades of the VITA®1 shade
guide are quite similar.
The seven Ceram·X® mono shades M1 to M7 can replace all
shades of the corresponding VITA®1 shade groups.
M1
M2
A2
M3
B2
A1 B1
M4
C2 C3
C1
D2
M5
D4
M6
A3.5 B3
A3 D3
The i-Shade Label shows users which Ceram·X® mono
shade corresponds to which VITA®1 shade.
Ceram·X® duo Dentin and Enamel Shades
The highly aesthetic Ceram·X® duo system comprises only
four dentin shades (D1 to D4) and three enamel shades (E1
to E3), imitating the shades of natural dentin and enamel.
It also includes a “Dentin Bleach” (DB) shade, which is
very light and opaque and designed for the restoration of
bleached teeth.
4 dentin
shades
3 enamel
shades
D1
D2
D3
E1
E2
E3
younger
From VITA¹ to Ceram·X® duo+
1
VITA® is a registered trademark of VITA Zahnfabrik Rauter GmbH & Co. KG.
older
B4
A4
From VITA®¹ to Ceram·X® mono+
Ceram·X® duo offers a restoration procedure based
on the natural configuration of dentin and enamel; this
is why the technique is also called a morphological or
anatomical layering concept. The Ceram·X® duo shades
closely imitate the translucencies and chromas of natural
enamel and dentin. Ceram·X® duo is thus the material of
choice when the aesthetic result is of major importance,
e.g. in Class IV restorations.
M7
D4
C4
CLINICAL PRACTICE
Principles of Shade Selection
Tooth cleaning with
prophylaxis paste
Shade
Sh
had
ade
de se
sel
selection
lect
le
cti
tio
ion
with VITA®1
Shade
Sh
had
de sel
selection
lecti
tion ffor
or
Ceram·X® duo in the
incisal and cervical
areas
Select
Selection
Sel
cti
tion
ion off ccorresponding
orre
or
resp
spon
ond
din
di
in
Ceram·X® shade with
i-Shade Label
S
Sh
Shade
had
ade sel
se
selection
lecti
tion
n ffor
orr
Ceram·X® duo Dentin
in the cavity
Final
FFiina
nall restoration
rest
stor
torat
ati
tion
ion
We recommend cleaning the tooth with a suitable
prophylaxis paste (e.g. Nupro Sensodyne®,
DENTSPLY) before shade selection. Regardless of
whether you wish to use Ceram·X® mono or duo, you
have two options for shade selection.
You can determine the matching shade using the
classic VITA®1 shade guide. The i-Shade Label will
then show you which Ceram·X® mono or duo shades
will provide the desired result.
Alternatively, you can select the shade with the
aid of shade tabs made of the original composite.
When using the anatomical layering concept (i.e.
Ceram·X® duo), try to select the enamel shade that
is most closely matched to the shade of the incisal
edge or the cusp tips, and the dentin shade that is
most closely matched to the cervical area, because
the shades of natural enamel and dentin are most
visible in these regions. The dentin shade may also
be selected using the natural dentin in the cavity, if
possible.
Tip:
Always select the shade while the tooth is hydrated
(i.e. prior to rubber dam application) and ensure
good light conditions.
Tip:
The following applies to both Ceram·X® mono
and Ceram·X® duo: If two shades appear similarly
suitable, the slightly darker shade will normally
provide a better aesthetic result.
(Prof. B. Klaiber)
2012-2013
BEFORE
cand. med. dent. Ztm.
Bernd van der Heyd
Tutor: Dr. Anne-Kathrin Schmidt
Department of Preventive Dentistry,
Periodontology and Cariology
University of Göttingen, Germany
Initial situation:
Changes in colour and
shape at tooth 21 with
increased translucency of
the mesial shoulder.
INTRODUCTION TO THE CASE
A 25 year old male patient asked for an aesthetic correction of tooth
21. The current restoration had been in situ for approximately 10 years
after traumatic injury in the anterior region (combined fractures grade
I and II according to Andreasen 1994). The settable pieces of the
fracture (mesial and distal shoulders) were fixed adhesively alio loco,
missing parts were completed with composite material. In addition
to a distal carious lesion, changes in luminosity, chroma, colour, and
shape occurred over the years.
Final situation:
Harmonious maxillary
anterior teeth with uniform
luminosity at teeth 11 and
21.
AFTER
Step 1
Colour determination by means of
polymerised Ceram·X®-samples
on adjacent tooth 11 for selecting
dentin and enamel shades.
Step 2
Functional build-up of incisal
edge at tooth 21 for the silicone
template, followed by reduction
of the oversized filling at tooth 31.
Step 3
Complete removal of filling and
caries in the distal-palatal region.
Tooth fragments which were fixed
after traumatic injury remained in
situ.
Step 4
Isolation of adjacent teeth with
teflon tape technique according to
Krüger-Janson
and
surface
conditioning with acid-etch technique.
Step 5
Design of mamelon structures and
halo effect after build-up of final
palatal structure.
Step 6
Finished filling with restored
function in dynamic occlusion.
Final Result 1
Countercheck 10 days after final
therapy (1). Final situation with
lip line.
Final Result 2
Countercheck 10 days after final
therapy (2). Direct comparison with
adjacent tooth.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
The restoration of the anterior tooth 21 was fabricated with Ceram·X
duo+. Prior to removal of the old restoration and caries excavation,
the tooth colour was determined. Then the incisal edge of tooth 21 was
built up, considering the functional front-cuspid protected occlusion,
the antagonistic tooth 31 was matched accordingly. This was the base
for the silicone template. After removal of the old restoration and
complete caries excavation, a bonding-drenched cord was inserted
in the sulcus. After surface conditioning, the adhesive material XP
BOND® (DENTSPLY) was applied. In order to build up the tooth
structures, dentin D1-D2 and enamel material E1-E1 were applied
according to the additive layering technique: Palatal final structure,
incisal edge, and mamelon structures with D1 and D2, labial surface
structure with enamel material E1-E3, and the incisal third using the
inlay technique. Finally, the restoration was recontoured and polished,
considering static and dynamic occlusion.
®
The present case report demonstrates a single tooth reconstruction
with the composite system Ceram·X® duo+. The aesthetic and
functional harmony of morphology of the anterior teeth by restoring
tooth 21 leads to a high level of patient satisfaction. The aesthetic and
functional result is impressive (final result 1 and 2) and supports the
field of applications for this material. The natural opalescence of the
material is outstanding and the handling of this nanohybrid composite
was rated comfortable. Finally, the alternative restoration with an
indirect ceramic restoration would have led to an increased loss of
tooth structure while resulting in an equal aesthetic outcome.
2012-2013
BEFORE
Rebecca Morgan
Professor: Lawrence Mair
Clinical Tutor: Mark Wallwork
University of Central Lancashire
Pre-operative frontal view.
Excessive non-carious tooth
surface loss.
INTRODUCTION TO THE CAS
CASE
SE
A 63 year old male attended our primary care clinic concerned about
the appearance of his anterior teeth due to excessive non carious
tooth surface loss. No medical history was of note. He had no molar
relationship but did not want dentures. No aetiology for the excessive
tooth surface loss could be established from questioning of the patient,
he was aware that it had progressively got worse over many years.
It was decided to restore the anterior teeth using Ceram·X® duo as it
would be a less destructive method of restoration and would be able
to be altered if needed, or poorly tolerated.
Step 1
Pre-operative retracted view – in
occlusion.
Step 2
Pre-operative
view.
Step 5
Pre-operative retracted view –
out of occlusion.
Step 6
Pre-operative lower occlusal view.
upper
occlusal
MATERIAL AND METHOD
Upper and lower anterior teeth were restored using Ceram·X
duo Enamel E2 and Dentin D3 to replicate VITA®1 Shade A3.5
using a free-hand staged build-up. No natural tooth material
was removed prior to the restorations. Canine guidance
was achieved on lateral excursions. Contouring and finishing was
achieved with diamond composite burs and Sof-Lex2 disks. Prior
to restorative work periodontal treatment was provided to ensure
periodontal health was established and maintained prior to the
restorations being undertaken.
2
VITA® is a registered trademark of VITA Zahnfabrik Rauter GmbH & Co. KG.
Not a registered trademark of DENTSPLY International, Inc.
AFTER
Step 3
Study models were articulated. The
occlusal relationship was reduced
to what was thought a suitable
amount for the restorations and
function.
Step 4
Post-operative retracted view in
occlusion.
Step 7
A wax-up of the desired outcome
was created to establish canine
guidance and for the production
of vacuum formed splints to aid
with the build-ups if needed.
Final Result
Vacuum formed splints were not used
as I found this difficult to achieve the
desired outcome. Canine guidance
was achieved. Most contact points
were established and all facilitated
interdental cleaning.
DISCUSSION AND CONCLUSION
®
1
Post-operative frontal view.
Much improved aesthetic
and natural looking
appearance of the patientʻs
smile.
By using this restorative material it allowed a non-destructive
restoration technique to be undertaken. The layering technique has
allowed a naturally aesthetic appearance to be achieved that the
patient was very pleased with. It has also allowed us to achieve a high
strength restoration without the destruction of natural tooth material.
2011-2012
Juri Beljakov
Superviser: Mare Saag
University of Tartu,
Department of Stomatology
INTRODUCTION TO THE CASE
The patient is a 53 year old man with a pronounced preventive and
restorative/aesthetic need for treatment due to dental caries and
dislocation of the teeth. He was not satisfied with the aesthetics of his
front teeth and wanted to get a good healthy looking smile. It was
decided to use a freehand technique without using a silicone index.
BEFORE
Pre-operative view.
Final result of the
performed restorative/
aesthetic treatment.
Natural location of the
central line has been also
achieved.
AFTER
Step 1
Initial status. Patientʼs every day
smile.
Step 2
Teeth
11
and
21
were
endodontically
treated
and
strenghtened
with
Radix®
(DENTSPLY) fibre posts in order
to secure a long–term stability of
the composite restoration.
Step 3
Initially restored teeth 11, 21 and
prepared teeth 12, 22. For the
dentin layer D3, D2 shades were
used and E3, E2 for the enamel
layer accordingly.
Step 4
Initial restorations of the teeth
12, 22. D3, D2 dentin and E3,
E2, E1 enamel shades were
used, combining them in order
to achieve a more aesthetic and
natural result.
Final result. Left side
Teeth 13 and 23 were restored
using D4, D3 dentin and E3,
E2 enamel shades in order to
achieve natural opacity of the
canines.
Final result. Right side
A slightly tranclucent incisal edge
of the restored teeth can be
observed.
Final result. Front view
The positive smile line and
dominating
central
incisors
provide the patient with a younger
and aesthetic appearance.
Final result.
1 month recall:
Natural and good looking smile.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
Professional teeth cleaning was carried out (scaling, air-flow,
polishing). Infiltration anesthesia with Ubistesin 4% was performed.
Radix® (DENTSPLY) Fiber Posts were used to strengthen teeth 11,
21. Enamel surface was roughened with fine diamond burs, etched
with 36% phosphoric acid and bonded with XP BOND® (DENTSPLY).
For free-handed direct restoration of the upper anterior teeth using
Ceram·X® duo nanohybrid composite (dentin shades D4, D3, D2,
enamel shades E3, E2, E1), transparent interdental strips and wedges
were used. Final shaping, finishing and polishing were performed
with fine finishing diamonds, Arkansas stones and PoGo® (DENTSPLY)
micro-polishers.
Using Ceram·X® duo for direct anterior restorations resulted in
a good colour match and a satisfactory result. Ceram·X® duo has
demonstrated excellent properties concerning handling, polishability
and aesthetics. The opportunity to use direct restorations instead of
indirect fixed restorations in this case made it possible for the patient
to afford such a treatment. From my point of view, Ceram·X® duo is a
material which is easy to handle and use. Without a doubt I will use it
in my future practice to achieve the most reliable and aesthetic results.
2010-2011
Jekaterina Salabajeva
Superviser: Mare Saag
University of Tartu,
Department of Stomatology
BEFORE
Pre-operative view.
INTRODUCTION TO THE CASE
A 15 year old non-smoking female patient presented at the consultation
due to the malformed maxillary lateral incisors and canines. The
mesio-distal diameter of the teeth was reduced and the shape was
altered. Good oral hygiene and low caries risk existed. The patient
was dissatisfied with her smile and wanted to improve the aesthetics.
Treatment plan: to restore the missing tooth structure of teeth No 13,
12, 22 and 23 by direct composite restoration using Ceram·X® duo.
Final result providing good
aesthetics and restored
function. The patient was
happy with the result.
AFTER
Step 1
Pre-operative right lateral view,
presenting an altered form and
size of teeth 13 and 12 with
interdental spaces.
Step 2
Due to the conical shape of right
lateral incisor teeth 13 and 12
were isolated partly with rubber
dam and the gingival retraction
cords to minimise the flow of
crevicular fluid. The tooth surfaces
were roughened with a diamond
bur to clean the enamel surface
and improve adhesion.
Step 3
Lateral view after building an
enamel base layer against the
silicone index and approximal
walls using transparent plastic
strips and dental wedges. It is a
surface on which dentin layers
will be applied and mamelons
contoured.
Step 4
Lateral view of the teeth 13 and
12 after the final enamel layer
was applied.
Left side
Pre-operative left lateral view
demonstrating an altered form
and size of teeth 22 and 23 with
interdental spaces. The form of
the teeth was recontoured in the
same way as in the case of 12
and 13.
Final result. Right side
A final aspect of the composite
resin restoration of the teeth 22
and 23.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
A wax-up was prepared to settle the occlusal parameters and to
fabricate a silicone matrix. The teeth were cleaned with Nupro®
(DENTSPLY) prophylaxis paste. Shade was selected with Ceram·X®
duo shade guide: E2, D1 and D2. Following isolation with rubber
dam, gingival retraction cords were applied around teeth 12 and 13.
The enamel surface was roughened with a fine diamond bur, etched
with 36% phosphoric acid, and finally bonded with XP BOND®
(DENTSPLY). Ceram·X® duo was used in the layering technique using
silicone index, transparent strips and dental wedges. Finishing and
polishing were performed with fine diamond burs, abrasive strips,
series of flexible abrasive discs and PoGo® (DENTSPLY) micropolishers.
My patient was suffering psychologically due to dental defects, which
affected her appearance. For the correction of this problem, I chose
Ceram·X® duo for its simplicity of use, sculptability and the clarity of
shading concept. The material exceeded my expectations in all these
areas. As a beginner, I also found Ceram·X® duo surprisingly easy to
work with. As the material is easy to handle and is easily polished, the
restoration allows to significantly reduce patient chair time and increase
satisfaction from the process for both parties. Ceram·X® helped me to
achieve a good aesthetic and functional outcome in the correction of
the defects in question. I find Ceram·X® duo the most efficient composite
dental material and it will be my first choice in future practice.
2010-2011
Sofie Boeraeve
Professor:
Prof. Dr. De Moor
University:
Universiteit Gent
BEFORE
In the first consultation a lot
of toothwear was visible.
The amalgamic restored
tooth was extracted during
the treatment.
INTRODUCTION TO THE CASE
This patient is a 35-year-old man, who presents erosion problems
caused by the frequent use of soft drinks. He is a heavy smoker. The
patient wasnʼt satisfied with the yellow discolourations and erosion of
his teeth.
His wish was a functional and aesthetic rehabilitation. This case shows
the followed steps during the treatment of the part of the lower jaw
and upper jaw.
The patient was satisfied
with the restorative
procedure because the
teeth discolourations were
not present anymore.
AFTER
Step 1
Buccal view of the lower frontal
teeth before treatment. Due to
crowding, tooth 41 is located in
a more buccal position.
Step 2
Before the composite build-up
was done, a roughening of the
tooth surface was necessary for a
better adhesion.
Step 3
Application
of
phosphoric
acid gel, primer and bonding.
Contour-strips were used to
create a natural and aesthetic
shape of the teeth.
Step 4
The
result
after
checking
occlusion. This finishing step was
completed by the use of Enhance®
Finishing and Polishing system
(DENTSPLY). The teeth are now in
a more equal position without an
orthodontic treatment.
Step 5
Frontal view of the upper and
lower premolar zone before
treatment.
Step 6
The upper premolars were built
up in the same way as the lower
incisors.
Step 7
A buccal view of the composite
build-ups before finishing the
shape.
Final Result
The shape of the premolars is
adjusted to the lower premolars.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
By using Ceram·X mono for the lower frontal teeth it was easy to
achieve aesthetic results. The Ceram·X® duo was used as well through
a multi layering technique.
The patient asked for healthier looking teeth. Qualitative restoration
materials as Ceram·X® can achieve a stable and functional smile
without the usage of expensive and time-consuming porcelain crowns
or orthodontic treatments as seen in this case.
®
2009-2010
Nicolas Cazal
Professor: Dr Eric Leforestier,
Pr Michèle Muller-Bolla
University: Université Nice-Sophia
Antipolis, France
INTRODUCTION TO THE CASE
A 12 year-old female patient presented at the consultation 2 weeks
after the trauma, with large fractures of her maxillary right and left
central incisors. The fractured fragment of the 21 was bonded on the
emergency date.
BEFORE
Smile, function and
phonation are disturbed
because of this post
traumatic situation which
has affected the anterior
maxillary teeth. The vitality
of these teeth will be kept.
The layering technique
using Ceram·X® composite
allowed the achievement
of two anterior fillings in
only one sequence, while
providing aesthetics,
function and phonation.
AFTER
Step 1 – Initial clinical situation
A 12 year-old female patient
presented at the consultation
2 weeks after the trauma, with
large fractures of her maxillary
right and left central incisors. The
fractured fragment on the 21 was
bonded on the emergency date.
The restorative Ceram·X® duo
system was chosen for aesthetic
and functional reasons.
Step 2 – Silicon Guide
The teeth were cleaned with
Nupro® (DENSTPLY) prophylaxis
paste. Shade was selected prior
to isolation, to avoid possible
interference in chroma and
opacity evaluation due to tissue
dehydration. Using the Ceram·X®
shade guide in natural light, E2
(enamel) and D3 (dentin) were
chosen. A rubber dam was placed
from 14 to 24. A large bevel was
prepared on the enamel surfaces.
Step 3 – Tooth conditioning /
Adhesive application
An ortho-phosphoric acid was
applied for 15 seconds. The teeth
were washed with air-water spray.
An etch and rinse adhesive system
(XP BOND® (DENTSPLY)) was
carefully applied.
Step 4 – Placement of
Ceram·X® duo Enamel
Enamel increments of Ceram·X®
duo were applied into the silicone
guide for the reconstruction of the
palatal surface of the teeth.
Step 5 – Placement of
Ceram·X® duo Dentin
Dentin increments of Ceram·X®
duo were applied on palatine
wall and on the residual tissues.
Step 6 – Shaping restorations
The restorations were shaped and
surface texture was achieved by
fine finishing diamond bur.
Step 7 – Finishing and polishing
The final polishing was then obtained
with Enhance® Multi (DENTSPLY),
1μm and 0.3 μm aluminia oxide
and
Prisma™Gloss®
pastes
(DENTSPLY).
Final Result
Final result carried out with the
Ceram·X® duo. It is possible to
obtain an aesthetic restoration
with only two shades and a simple
protocol.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
This post traumatic situation required the use of the composite resin
Ceram·X® duo utilising the layering technique (dentin shade D3 and
enamel shade E1). The realisation of a wax up provides insight into
the occlusal parameters (particularly anterior guide) which will be
clinically reported by the use of a silicon key. The final surface state is
obtained with aluminia oxide points and Enhance® Multi (DENTSPLY)
system.
These teeth will not be endodontically treated. In fact, the Ceram·X®
composite allows the practitioner to respond favourably and quickly to
the aesthetic and functional expectations of patients. Itʻs extraordinary
properties in terms of sculptability, shade and ease of implementation
avoids prosthetics realisation.
2008-2009
Rudolf Semmler
Professor: OA Dr. Jordan,
OA Dr. Markovic
University: Witten/Herdecke
BEFORE
Clinical image of pulpitis
chronica ulcerosa aperta,
Teeth 11 and 21.
INTRODUCTION TO THE CASE
This case shows a clinical example of a carious upper jaw-front
of a 21-year-old patient. The patient came to the dental clinic
Poliklinischen Ambulanz of Witten/Herdecke University suffering from
strong toothache at the upper incisors; caries at both incisors were
diagnosed. With the help of the adhesive technique with composite
filling materials, this case proves that a satisfying cosmetic oral
rehabilitation can be realised even in the event of extensive decay.
Final image one week after
direct dentin-adhesive
restoration with Ceram·X®
duo.
AFTER
Step 1
Dental polishing using a fluoridefree polishing paste (Nupro®,
(DENTSPLY)).
Step 2
Determining the proper tooth
shade by using the i-Shade label
Ceram·X® duo.
Step 3
Absolute dry conditions after
excavation of the caries and
complete root canal treatment.
Step 4
Wax-Up used for producing
a silicone key to simplify
reconstructing the tooth
anatomy.
Step 5
Distal cavity reconstruction of
tooth 11 with X-Flow® (DENTSPLY)
by using a modified approximal
Teflon
tape.
D3
coloured
composite was previously applied
into the dentin bodies.
Step 6
Placement of a two centimetre
long metal strip into the silicone
key, held in place with a wooden
wedge.
Step 7
Finished composite reconstruction
and final curing; following this,
the extra material is removed with
a scalpel.
Final Result
Completed restoration immediately
after polishing with the PoGo®
(DENTSPLY) system.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
The clinical image above shows asymptomatic pulpis with pulp
exposure. After polishing the surface and determining the colour,
the anterior segment is isolated; then a pulpectomy, endodontic
treatment, and lateral condensation are performed. Next, a transfer
key based upon a wax-up is created enabling reconstruction of the
palatinal wall. With a strip of Teflon tape on the adjacent incisor, there
is now an ideal contact site for the reconstruction. After applying the
Ceram·X® duo E3 enamel shade to the surface layer the reconstruction is completed.
By using the incremental-adaptation technique with the multi-coloured
DENTSPLY Ceram·X® duo system, large tooth defects can be
reconstructed in a natural way. Accented by dynamic colour variance,
malleable consistency, and life-like translucent qualities; Ceram·X®
duo allows for a completely individual design and offers excellent
cosmetic results.
2007-2008
BEFORE
Daniela Illuminati
Professor: Prof. Angelo Putignano
University: Università Politecnica
Delle Marche,
School of Dentistry,
Restorative Dentistry
INTRODUCTION TO THE CASE
The case reported is on an 8 year old patient with a trauma on tooth
21 with a mesial angle fracture without pulpar compromission and
vitality preservation. The final restoration, following rehydration,
demonstrates the satisfying integration of shape, texture and colour.
AFTER
Step 1
Two dental impressions were
taken for a wax up. A silicone
key was built to obtain an
anatomic and functional guide for
composite stratification.
Step 1
After polishing the surfaceof the
teeth with pumice and water to
prevent dehydration of dental
elements, dental and enamel
shades were taken.
Step 3
Given the low eruption of
central
incisors
and
the
lack of lateral elements, the
rubber dam is loosely applied
and ligautres are made to ensure
a dry operative field.
Step 4
Following preparation, enamel
and dentin are simultaneously
etched for 20 seconds with 35%
phosphoric acid.
Step 5
After the acid is rinsed for 30
seconds, XP BOND® (DENTSPLY)
is applied the palatal surface mass
is applied with Ceram·X® duo E1
shade utilising the silicone key.
Step 6
Each mamelon is built up, taking
special care to follow the axis
of tooth, using the Ceram·X® D2
shade and leaving little spaces to
maximise translucency between
and around the mamelons.
Step 7
Because of the strong white
component observed on all
surfaces we use an intensive
white tint applied with a specillum
and a brush.
Final Result
Final aspect of the restoration,
after finishing and polishing with
a diamond drill and the Enhance®
and PoGo® system (DENTSPLY), a
lower value of the colour is shown
due to dehydration of the teeth
under rubber dam.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
For this case Ceram·X® duo composite was used in D2 and E1
shades, characterisation was achieved with Tetric Colour1 White. The
finishing has been carried out with the 40 micron intensive drill, the
PoGo® (DENTSPLY) rubber drill and pastes of aluminium oxide of the
Enhance® system (DENTSPLY) in differentiated granulometry.
Following a rigorous protocol, in anterior tooth trauma, not even
in experienced hands is it possible with Ceram·X® duo to obtain
restorations that answer to the greatest aesthetic demands of the
patients. Obviously the study of shape, of inner anatomy and of
surface texture play an important role even when the restoration is
chromatically improvable.
1
Not a registered trademark of DENTSPLY International, Inc.
2005-2006
BEFORE
Luca Polonara
Professor: Prof. Angelo Putignano
University: Università Politecnica
Delle Marche,
School of Dentistry,
Restorative Dentistry
INTRODUCTION TO THE CASE
The case report is on a 34 year old patient with an incongruous restoration on tooth 26 with loss of the contact area and absence of correct
anatomy. The treatment plan includes the restorationʼs rebuilding, the
finishing and polishing of the distal surface of tooth 25 that shows
cracks imputable to the realisation of the previous restoration.
AFTER
Step 1
The tooth after the removal of the
restoration under rubber dam and
before the definitive preparation.
Step 2
Palodent® (DENTSPLY) matrix
correctly placed for a better
adaptation of separatory ring.
Step 3
Acid etching with orthophosphoric
acid for 20 seconds simultaneously
on enamel and dentin.
Step 4
After the application of 5 layers
of Prime&Bond® NT (DENTSPLY),
the interproximal wall is then built
up with the E1 shade of Ceram·X®
duo following the application of a
thin layer of X-Flow® (DENTSPLY)
in A3 shade.
Step 5
Building of the vestibular side
with the D3 shade of Ceram·X®
duo taking care to leave sufficient
space for the enamel mass.
Step 6
Realization of the palatal side
with the same technique and
characterisation of pit and fissures
with intensive Orange and Dark
Brown tints.
Step 7
Apposition of the last layer of
enamel mass E1 on all surface.
Aspect before finishing and
polishing.
Final Result
Restoration ended with the
obvious signs of the dehydration
of the enamel under rubber dam
and the clamp on the gingival
edge.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
Ceram·X® duo shades D2 and E1 were used with a thin layer of X-Flow®
(DENTSPLY) A3. The finishing has been carried out with abrasive
diamond, rubber drill PoGo® (DENTSPLY) and pastes of aluminium
oxide from the Enhance® system (DENTSPLY) in differentiated
granulometry.
The case clearly shows how respecting anatomy and
controlling the thickness of composite masses, with a
simple, but rigorous protocol, it is possible with Ceram·X®
duo to obtain restorations that fulfill the greatest aesthetic
demands of the patients.
2004-2005
BEFORE
Patcha Angsuchotmetee
Professor: Dr. Montri
Chantaramungkorn
University:Chiang Mai University,
Chiang Mai, Thailand
INTRODUCTION TO THE CASE
The direct restoration of a Class IV fracture is often regarded as the
most challenging in aesthetic dentistry presumably due to the extent of
natural tooth structure that must be re-created. This case presentation
discusses easy application techniques and finishing & polishing tips
for a new nano-composite restorative with natural shading system
(Ceram·X® duo) by restoring the tooth with both dentin and enamel
shades to transform the Class IV fracture into a final restoration that
mimics nature.
AFTER
Step 3 – Thickness of Dentin Core
Ceram·X® duo dentin shade
replaces dentin with an opacity
and high chroma that replicates
the propoerties of natural dentin.
Clinical tip: The thickness of
dentin shade layer depends on
opacity of the restoring tooth;
use thicker layer of dentin shade
if tooth being restored appeared
less translucent.
Step 4 – Enamel Layer
A
layer
of
corresponding
Ceram·X® duo enamel shade
E2 (according to i-Shade label)
replaces enamel with enamel-like
translucency.
Step 5 – Final Enamel Layer
Contouring
A flat–end artistʻs brush helps
to smoothen surface and blend
the restoration nicely into the
surrounding tooth structure prior
to light curing, thus making
finishing and polishing more
efficient, faster and easier.
Step 6 – Finishing & Polishing
A flame shaped fine diamond is
used to create primary anatomy,
natural texture and optical effects
on the facial surface Embrasure
form is corrected as necessary
utilizing polishing discs. PoGo®
(DENTSPLY) can be used to give
the acceptable final polishing
surface smoothness.
Step 7A – Fine diamond ﬁnishing
Appearance of Ceram·X® duo
restoration after finishing with
fine diamond.
Step 7B – After PoGo® polishing
Postoperative appearance of
Ceram·X® duo restoration after
final polishing with PoGo®
(DENTSPLY).
Final Result
Ceram·X® duo restoration at 1
month recall. The restoration is
harmoniously integrated with the
adjacent tooth and the gingival
architecture. The original
fracture line is imperceptible.
MATERIAL AND METHOD
DISCUSSION AND CONCLUSION
Materials: Ceram·X® duo shades D2 and E2, Prime&Bond® NT
(DENTSPLY), PoGo® (DENTSPLY). Method: Direct adhesive bonding
technique using Prime&Bond® NT (DENTSPLY) then by layering
technique using Ceram·X® duo shade D2 and shade E2. Final polishing
with PoGo® (DENTSPLY) to give the excellent surface smoothness.
With increasing patient demands for anterior aesthetic restorations,
composite resin restorations enjoy great popularity due to excellent
aesthetics, acceptable longevity, and relative low costs. Innovative
techniques together with new nano – ceramic restoratives like
Ceram·X® duo will help put a smile on both patient and dentistʻs faces,
as it surely helps make life easier and enjoyable.
VITA® is a registered trademark of VITA Zahnfabrik Rauter GmbH & Co. KG.
Not a registered trademark of DENTSPLY International, Inc.
Clinical tip: Avoid too much pressure in using PoGo® (DENTSPLY) to prevent unrealistic flat labial surface, intermittent
buffing medium pressure is recommended to achieve more natural appearance like the adjacent tooth surface.
1
Step 2 – Dentin Core
Ceram·X® duo dentin shade D2
was placed first on the palatal
side of the cavity to act as a
support and also to replace
dentin at the same time. Clinical
tip: #8A Plastic instrument (HuFriedly2) and proper transparent
matrix placement will help contour
this important first layer of dentin
core.
2
Step 1 – Shade Matching
Shade matching with VITA®1 shade
guide
prior
to
restorative
procedures can easily be cross
referenced to the i-Shade label
for proper Ceram·X® shade
selection. In this case, A2 VITA®1
shade was the closest match,
equivalent to Ceram·X® duo
shade D2 and E2.
Simple
Only 7 shades cover full VITA®1 range
Natural
Low monomer release
Aesthetic
UKXL791
Date of publication: 08/2014
“Perfect“ long term aesthetics2
DENTSPLY LTD
Building 3, The Heights
Weybridge
KT13 0NY
UNITED KINGDOM
www.dentsplymea.com
Phone +44 1932 853422
1
2
VITA® is a registered trademark of VITA Zahnfabrik Rauter GmbH & Co. KG.
Klaiber B, University of Wurzburg, Germany.