1. business and industrial
2. chemicals industry
3. adhesives

How to lute correctly our
restorations?
Dr. Tatiana Repetto-Bauckhage
Manager Professional Services Europe (N&S),
Turkey and Latin America
2
Topics of the day
•
Restoration & History
•
Classification materials & products Ivoclar Vivadent
•
Resume
What do we want to achieve?
4
In the past…
Nowadays a dentist have to consider…
Restoration
Metal/ Metalceramic
All Ceramics
6
Metal/ Metalceramic
• Basically the cementation can be done:
– Conventionally: Phosphate cement or glass ionomer Cement (i.e.
Vivaglass CEM)
– Adhesively: Resin Cement with an extra adhesive system (i.e.
Multilink or Multilink Automix)
• Pre-treatment in the Lab: sandblast inner surface
• (Optional) Pre-treatment in the office: Monobond Plus in the inner
surface (60 s)
Nowadays a dentist have to consider…
Restoration
Metal/ Metalceramic
All Ceramics
All-Ceramic Systems…
IPS
Empress Esthetic
Products for Permanent Cementation…
9
Indications…
INLAY
PARTIAL
CROWN
FULL
CROWN
VENEER
10
11
Position of preparation line and
isolation of working field
Position of preparation line
Type of
cement
subgingival
• conventional
• self-adhesive
possible
equigingival
• conventional
• Self-adhesive
• adhesive
supragingival
• conventional
• Self-adhesive
• adhesive
Type of isolation
12
Important is the right indication for cementation
Key Facts IPS Empress
Leucite glass ceramic
Maximum homogenity
Flexural strength of 160 MPa
Highly aesthetic
Characterization or Veneering
with IPS Empress Universal Stains and
IPS Empress Esthetic Veneer
Key Facts IPS Empress
Leucite glass ceramic
Maximum homogenity
Flexural strength of 160 MPa
Highly aesthetic
Characterization or Veneering
with IPS Empress Universal Stains and
IPS Empress Esthetic Veneer
16
IPS e.max
17
IPS e.max System
Lithium disilicate
glass ceramic
Zirconium
(Nano-) Fluor-Apatite
Glass ceramic
18
IPS e.max System
Lithium disilicate
glass ceramic
processing:
fully anatomic, cut-back and
framework
strength:
360-400 MPa
Zirconium
(Nano-) Fluor-Apatite
Glass ceramic
processing :
framework
processing:
press-on / layering ceramic
strength:
>900 MPa
strength:
90-120 MPa
19
IPS e.max System
The right material for every indication
Lithium disilicate (LS2) for single-unit restorations
and up to three-unit premolar bridges
High strength Zirconium IPS e.max ZirCAD (ZrO2) for wide-span bridges
up to 12 units
IPS e.max Press: All you need for the PRESS
technique
IPS e.max Press
Lithium Di - Silicate glass-ceramic ingot
High-strength, biocompatible glass-ceramic ingot for
the PRESS technique.
Available in three translucency/opacity levels
Choice of adhesive, self-adhesive or conventional
cementation.
21
Physical Properties
22
Preparation
Veneer Preparation (in mm)
23
24
IPS e.max Press – minimal invasive options
Veneer
Table Top
Onlay
Preparation
Crown Preparation ( in mm – the same stipulations apply for bridge abutments)
25
All you need for natural-looking restorations
The IPS Natural Die Material assortment now contains nine die shades –
three new shades for brighter and non-vital teeth.
26
IPS Natural Die Material
Colour
ND2
ND5
ND4
IPS e.max Ceram Veneer28
IPS Natural Die Material
Colour:
ND2
ND5
ND4
IPS e.max CAD: All you need for the
CAD/CAM technique in the future
IPS e.max CAD
Lithium Di - Silicate glass-ceramic block
High-strength glass-ceramic block for the CAD/CAM technique.
for the inLab System from Sirona
for the Everest System from KaVo
30
31
Physical Properties
Preparation
Veneer Preparation (in mm)
Preparation Lithium Disilicate (in mm)
Veneer
Thin Veneer
Table Top (occlusal Veneer)
Anterior Crown
33
Preparation Lithium Disilicate (in mm)
Inlay
Onlay
Partial Crown
Posterior Crown
34
35
Preparation Guidelines: Veneer
Starting situation
Incisal orientation grooves
Marginal orientation groove
Central and incisal orientation grooves
36
Preparation Guidelines: Veneer
Facial preparation in 3 levels
Initial proximal separation
Final proximal preparation
Finishing and smoothing of the preparation
Lithium Disilicate (IPS e.max Press) – high
translucency
Dr. R. Watzke, F. Perkon / IV Liechtenstein
37
Lithium Disilicate (IPS e.max Press) – high
opacity
J. Seger, IV/Liechtenstein
38
Lithium Disilicate (IPS e.max Press)
Combination with HT (high translucency) and HO (high opacity)
Dr. S. Andrews / S. Caxton, UK
39
Full contour LS2 restoration
Composition
mole%
SiO2 68 - 75
Li2O
12 - 16
K2O
2-5
Al2O3
1-4
2-5
P2O5
Lithiumdisilicate; Li2O2SiO2
+ SiO2: glass phase
nucleation
Additional components:
Oxide of the elements
Mg, Ce, V, Mn, Er, Tb, Zr
adjustment of
- color
- translucency
- brightness
- fluorescence
- opalescence
17
Manufacturing of LS2
temperature
Glass melt
1500 °C
crystallization
LS2 880 °C
crystallization
LS 650 °C
LS block
cooling
nucleation
550 °C
monolith
Quality control
time
Quality control
18
Processing of LS2
temperatur
CAD/CAM
Ostwald ripening:
T-t depending crystal growth of LS2,
840°C
Dissolution of LS
Crystallization of LS2
time
Speed Crystalllization Program
19 Minutes incl. Glaze/shades
19
Properties of LS2
precrystallized
e.max CAD, 840 °C
Approx. 40% lithiummetasilicate (LS)
embedded in glass
matrix
Approx. 65% lithiumdisilicate (LS2)
embedded in glass
matrix
LS etched (HF)
Glass matrix etched (HF)
20
IPS e.max ZirCAD: All you need for the
CAD/CAM technique
IPS e.max ZirCAD
Yttrium-stabilized zirconium oxide block
Zirconium oxide

Currently the most efficient all-ceramic for dental applications

Excellent biocompatibility and low heat conductivity

available as white or pre-coloured block

Delicate framework design

Self-adhesive or conventional cementation

Because of its excellent final strength, the material is capable of
fulfilling the clinical requirements in the posterior region (bridges),
by withstanding the high chewing forces in that area
45
IPS e.max ZirCAD
Yttrium-stabilized zirconium oxide block for the CAD/CAM technique
46
47
Physical Properties
48
Preparation
Dimensions in mm
 Using conventional cementation a small convergence angle and approx.
4 mm height must be observed
 Observe the minimum thickness of the ceramic
IPS e.max ZirCAD
Processing
Programat S1: Special high-temperature furnace for
sintering IPS e.max ZirCAD restorations at 1500°C.
49
3Y-TZP for dental applications –
process for making zirconia based restorations
blocks
CAD/CAM based restoration
coloring of zirconia
 3 different methods:
1. Zirliner
2. Infiltrationliquids
3. Precolored Blocks
 colours should be adjusted to the veneering
 deeply coloured frameworks might influence the
final optical appearance of the restoration
 too high concentration of colouring ions can have a
negative influence on the material properties, the
fatigue behaviour and the aging
52
Adhesive cementation of
IPS e.max ZirPress/ZirCAD
Clinical case by:
Dr. Dr. Andreas Rathke & Achim Kuster
(Liechtenstein)
Preparation
Images: Dr. Dr. Andreas Rathke / Achim Kuster
(Liechtenstein)
Images: Dr. Dr. Andreas Rathke / Achim Kuster
(Liechtenstein)
Pressed crown
Images: Dr. Dr. Andreas Rathke / Achim Kuster
(Liechtenstein)
Pre-treat the crown with the Monobond Plus and dry
Images: Dr. Dr. Andreas Rathke / Achim Kuster
(Liechtenstein)
Fill the crown with Mulilink Automix
Images: Dr. Dr. Andreas Rathke / Achim Kuster
(Liechtenstein)
Insertion of the crown and removal of composite excess
Images: Dr. Dr. Andreas Rathke / Achim Kuster
(Liechtenstein)
IPS e.max ZirPress/ZirCAD crown adhesively luted with
Mulilink
Images: Dr. Dr. Andreas Rathke / Achim Kuster
(Liechtenstein)
IPS e.max ZirPress: All you need for the
PRESS technique
IPS e.max ZirPress
Fluorapatite glass-ceramic ingot
Fluorapatite glass-ceramic ingots for the press-on technique in
conjunction with zirconium oxide (IPS e.max ZirCAD)
61
62
IPS e.max ZirPress – Overall concept
Available in 4 levels of translucency and in 1 size:
 HT – High Translucency (16 A-D and 4 Bleach BL shades)
 LT – Low Translucency (16 A-D and 4 Bleach BL shades)
 MO – Medium Opacity (9 A-D shades and 4 Bleach BL shades)
 G – Gingiva (2 shades)
63
Physical Properties
Preparation
Dimensions in mm
Same preparation guidelines as for IPS e.max ZirCAD
64
IPS e.max Ceram: All you need to achieve
consistent aesthetics and shading
65
IPS e.max Ceram
Nano-fluorapatite layering ceramic
 Nano-fluorapatite glass-ceramic for veneering and
characterizing all-ceramic frameworks
66
Physical Properties
History
Classification according to History - Cements -
1880→
1970→
Zincphosphate
Harvard®
- Polycarboxylate
Durelon™
- Silicate
Speiko®
Glassionomer (GIC)
Ketac®Cem
- Resinmodified-GIC
Fuji®Plus
- Compomer
PermaCem®
Resin Cements
Variolink®
with Adhesive (etch&rinse)
1985→
- Resin Cements
Panavia®
with Adhesive (self-etch)
- Resin Cements
Self-adhesive
RelyX™Unicem
69
Topics of the day
•
Restoration & History
•
Classification materials & products Ivoclar Vivadent
•
Resume
Classification according to Materials - Cements -
Adhesive Resin Cements
- Polymer-type Resin Composite
4)
Etch&rinse
+ Adhesive
5)
Self-etch
Adhesive
Conventional Cements
- Acid-Base-type 1) Zincphosphate
2) Glassionomer (GIC)
3) Resinmodified GIC
(RMGIC)
Classification according to Materials - Cements Adhesive Resin Cements
- Polymer-type Resin Composite
4)
Etch&rinse
+ Adhesive
5)
Self-etch
Adhesive
Conventional Cements
- Acid-Base-type 1) Zincphosphate
2) Glassionomer (GIC)
3) Resinmodified GIC
(RMGIC)
6) Self-adhesive Resin Cements
- Polymer-type with Acidic Monomer -
IPS e.max: all you need for cementation
 glass ceramics are generally etched (IPS Ceramic
Etching Gel)
 glass ceramics are generally silanized (Monobond Plus)
only when followed by conventional cementation (glass
ionomer) conditioning is not needed
 Oxide ceramics are being silanized (Monobond-Plus)
when followed by adhesive cementation.
 Oxide ceramics don‘t need conditioning when they are
self-adhesively or conventionally cemented.
72
Cementation portfolio
Variolink® II
Variolink® Veneer
IPS
Empress® Syntac
Syntac or
ExciTE DSC
or ExciTE
Adhesive
Cementation
Universal
Luting composites
(for all materials)
Multilink® Automix
Self-etching
Multilink
Primer A/B
IPS
Esthetic
Luting composites
(for glass ceramics)
SpeedCEM
e.max®
No adhesive
Self- Adhesive
Cementation
Cementation portfolio
Esthetic
Luting composites
(for glass ceramics)
Variolink® II
Syntac or
ExciTE DSC
Adhesive
Cementation
Variolink® Veneer
Universal
Luting composites
(for all materials)
Multilink® Automix
SpeedCEM
Variolink® II
Product Highlights
 Since 1991
 Worldwide > 20 million applications
 Light-cure with dual-cure option
 6 shades
 2 consistencies
 Numerous awards
 Clinical long-term studies > 10 years
77
Variolink® II
78
Catalyst paste
yellow (210/A3)
high viscosity
yellow (210/A3)
low viscosity
transparent
high viscosity
transparent
low viscosity
Variolink® II
Isolation and Etching
Total Etch:
enamel 30 s
dentin 10 s
79
Influence of etching time
Increase
ofof
etching
time
Increment
etching
time
An increase of etching time…
Dentin
Surface
Dentin
surface
.
Increase
of micro
leakage
Increase
of micro
leakage
means an increase of
penetration time or contact
time. By an increased time
we got micro leakage.
Cementation portfolio
Esthetic
Luting composites
(for glass ceramics)
Variolink® II
Variolink® Veneer
Syntac
or ExciTE
Adhesive
Cementation
Universal
Luting composites
(for all materials)
Multilink® Automix
SpeedCEM
Variolink® Veneer
Product Highlights
 Value Shade Concept
ideally suitable for Veneers
 Optimum Shade Stability
light-cure only
 Optimized Consistency
less sticky
 Easy Excess Removal
Microfillers
Variolink® Veneer
Value shade concept
With increasing Value (+1
+3 or -1
-3)
the shade effect increases and the translucency decreases
(increasing share of colour pigment in the luting composite).
HV+3
HV+2
HV+1
Brightening
Translucency
MV 0
Neutral
LV-1
LV-2
LV-3
Darkening
Translucency
84
Shade simulation with Variolink Veneer Try-In
 The Variolink Veneer Try-In pastes feature the
same optical properties as the subsequently
used luting composite Variolink Veneer.
 Thus, the aesthetic effect of the luting
composite on the restoration can be checked
prior to adhesive cementation.
85
Variolink® Veneer
Value shade concept
Restorations on the model
Try-in and shade simulation with the
Variolink Veneer Try-In shades
HV+3
High Value +3
Try-In shade
HV-3
Low Value -3
Try-In shade
86
Cementation portfolio
Esthetic
Luting composites
(for glass ceramics)
Variolink® II
Variolink® Veneer
Universal
Luting composites
(for all materials)
Multilink® Automix
Self-etching
Primer A/B
Adhesive
Cementation
SpeedCEM
88
Multilink® Automix
Product Highlights
 Self-etching Multilink Primer A/B
time saving application
 High Bond Strengths & Flexural Strength
clinical safety
 Direct Application
no handmix, no capsules, no accessories
 For all Indications (except Veneers)
economic and time-saving
90
Multilink® Automix Product at a glance
Multilink® Automix is a dual-curing
luting composite system for the universal
cementation of indirect restorations made of
 metal
 metal-ceramics
 all-ceramics
 composite / FRC
Multilink Automix is applied
with the self-etching and self-curing
Multilink Primer A/B:
91
Multilink® Automix
92
Self-etching Multilink Primer A/B
Enamel Etching Pattern
Enamel surface (SEM) after etching with
self-etching Primers:
Multilink Primer A/B
after 15 sec
ED-Primer AB (Kuraray)
after 60 sec
Picture by courtesy of Prof. J. Perdigao,
Univ. Minnesota/Minneapolis (USA)
Multilink®
Automix
Shear Bond Strengths (after 24h)
Force
90
cured
cement sample
o
surface
25
[MPa]
Enamel
Dentin
20
15
10
Method according to
US-patent 6324916 (2001)
all materials self-cured,
R&D, Ivoclar Vivadent AG
5
0
Multilink Automix
Panavia 21
RelyX Unicem
Multilink® Automix
Direct Application
 No handmixing
 No additional equipment needed
i.e. RelyX Unicem 1. Capsule activator
2. Mixing device
3. Capsule injector
 Consistent mixing results
 Time-saving
 Individual proportioning
94
Multilink®
Automix
Step-by-step
Flowcharts
Each System Pack contains 4 Flowcharts:
Multilink Automix
for Ceramic
Multilink Automix
for Composite
Multilink Automix
for Metal
Multilink Automix
for Root Posts
The excellence gets even better…
Multilink Automix
2s
3
4
2s
3
4
new „quarter – technique“
– 4 quarters
– Light exposure
in „LOP“ Mode
[650 mW/cm2]
97
Uncomplicated
1. Quarter
2. Quarter
3. Quarter
4. Quarter
Easy handling due to…
… one-step primer : mix  apply  finished.
… Automix syringe which allows time-saving direct dispensing
of the material with less waste.
… easy clean-up of excess material.
Monobond Plus - 1 Primer
1 Primer for all restoration materials
+
3 functional groups for a strong
and durable bond
– Silane methacrylate
Ceramics
– Phosphoric acid
methacrylate
+
Non-precious metal & zirconia
– Sulphide methacrylate
Precious metal
Monobond Plus can be stored
at room temperature.
Cementation portfolio
Esthetic
Luting composites
(for glass ceramics)
Variolink® II
Variolink® Veneer
Universal
Luting composites
(for all materials)
Multilink® Automix
SpeedCEM
No adhesive
Self- Adhesive
Cementation
100
Self-adhesive universal resin cement
101
SpeedCEM
Fast
SpeedCEM stands for fast cementation of indirect restorations:
•
No separate phosphoric acid etching
•
No enamel or dentin bonding agents required
•
No additional accessories such as mixing units or capsule
activators required
•
No manual mixing
•
SpeedCEM is applied directly into the restoration –
finished!
102
SpeedCEM
Easy
SpeedCEM combines the easy processing technique of a
conventional cement with the advantages of a luting
composite:
•
Self-curing with optional light-curing
•
Increased strength
•
High bond strength values
•
High translucency
•
Low solubility in water
•
High radiopacity
103
SpeedCEM
Self-adhesive – How does it work?
MDP = 10 methacryl oyl
Oxydecyl dihydrogen phosphates
O
OH
P
O
O
OH
O
Methacrylate
Acidic group
The integrated bonding
agent (MDP monomer)
establishes a chemical bond
to
• dentin and enamel,
• metals and
• zirconium oxide.
Therefore, no additional
adhesives or bonding agents
are required.
104
SpeedCEM
Excellent shear bond strength
[after self-curing]
[MPa]
Enamel
Dentin
10.5
Shear bond test
ISO TS-11405
R&D, Ivoclar Vivadent AG
December 2008
8.3
SpeedCEM
5.6
3.9
RelyX™ Unicem¹
6.4
1.9
Maxcem Elite™
4.9
3.3
G-Cem™ ¹
¹ Capsule-Version
RelyX™ Unicem, G-Cem™ and Maxcem Elite™ are not registered trademarks of Ivoclar Vivadent.
105
SpeedCEM
High strength
[Flexural strength after light-curing]
[MPa]
Test method according to
ISO-4049:2000,
R&D, Ivoclar Vivadent AG
December 2008
79.0
58.7
88.7
51.9
SpeedCEM
RelyX™ Unicem¹
Maxcem Elite™
G-Cem™ ¹
¹ Capsule-Version
RelyX™ Unicem, G-Cem™ and Maxcem Elite™ are not registered trademarks of Ivoclar Vivadent.
106
SpeedCEM
Radiopacity
[% Al]
Test method according to
ISO 4049:2000,
R&D, Ivoclar Vivadent AG
December 2008
336
270
220
210
SpeedCEM
RelyX™ Unicem¹
Maxcem Elite™
G-Cem™ ¹
¹ Capsule-Version
RelyX™ Unicem, G-Cem™ and Maxcem Elite™ are not registered trademarks of Ivoclar Vivadent.
Application
108
SpeedCEM
Application
109
SpeedCEM
Anwendung
Cementation of a 3-unit bridge made of
IPS e.max Press
110
SpeedCEM
Anwendung
The restoration is etched with hydrofluoric acid
SpeedCEM – Clinical case
Monobond Plus is applied
111
SpeedCEM – Clinical case
The prepared tooth is cleaned prior to cementation
112
SpeedCEM – Clinical case
SpeedCEM is applied directly into the restoration
113
SpeedCEM – Clinical case
The restoration is seated in place
114
SpeedCEM – Clinical case
Excess is removed by means of the “Quarter” technique:
Cement is light-activated per aspect for 1 sec
115
SpeedCEM – Clinical case
Excess is removed in the visco-plastic state
116
SpeedCEM – Clinical case
Proximal excess is removed (Superfloss)
117
SpeedCEM – Clinical case
The cement joint is covered with
glycerin gel (Liquid Strip)
118
SpeedCEM – Clinical case
Final polymerization of the cement joint
(20 sec with bluephase in the HIP mode, approx. 1,200 mW/cm2)
119
SpeedCEM – Clinical case
The cement joint is finished
120
SpeedCEM – Clinical case
Postoperative view
121
Why to develop a new implant cement?
Multilink Automix
was only
a compromise,
Multilink
Implant
enables: if it‘s used for
cementation on implant abutments:
• the optimum removal of excess material
• difficult excess• removal
appropriate setting time of about 2 minutes.
• setting time without Multilink Primer is too long,
up to 5 min
123
Multilink® Implant
Self-curing luting composite with lightcuring option for the adhesive cementation
of indirect restorations made of metal,
metal-ceramic, glass-ceramic and oxideceramic on implant abutments.
Multilink® Implant
Optimum removal of excess material
due to Multilink Implant‘s special formulation an the “quarter
technique”
1. quarter
4. quarter
2. quarter
3. quarter
Multilink® Implant
Shade range adjusted to the indication
– based on the shades of current ceramic abutments
– invisible cement joints even if the restoration margin is visible
– Due to the opaque shades any remaining excess cement is easily
identified.
transparent
MO 0
MO1
128
Topics of the day
•
Restoration & History
•
Classification materials & products Ivoclar Vivadent
•
Resume
IPS e.max: all you need for cementation
 glass ceramics are generally etched (IPS Ceramic
Etching Gel)
 glass ceramics are generally silanized (Monobond Plus)
only when followed by conventional cementation (glass
ionomer) conditioning is not needed
 Oxide ceramics are being silanized (Monobond-Plus)
when followed by adhesive cementation.
 Oxide ceramics don‘t need conditioning when they are
self-adhesively or conventionally cemented.
129
Lightcuring, dualcuring, selfcuring …
lightcuring
Variolink
Veneer
dualcuring
Variolink II
selfcuring
Multilink
Automix
SpeedCEM
Multilink
Which adhesives system can I use?
lightcuring
Variolink
Veneer
Total Etch
dualcuring
Variolink II
Total Etch
selfcuring
Multilink
Multilink
Automix
Selfetch
Syntac/ Excite Syntac/ Excite DSC/ AdheSE DC*
Multilink Primer
A&B
* Except veneers
Variolink® II
Variolink® Veneer
Multilink® Automix
SpeedCEM
Ceramics & Cements
Ceramic
Glass-Ceramics
High Strength
Glass-Ceramics
Examples
IPS Empress CAD
IPS Empress Esthetic
Vita Mark II
IPS e.max CAD
IPS e.max ZirCAD
IPS e.max Press
InCeram Cubes
IPS e.max CAD LT Procera
Type
Silicate (Leucit, …)
K2O-Al2O3-SiO2
Lithiumdisilicate
Li2Si2O5
Zr/Al-Oxide
(ZrO2)x or (Al2O3)x
Flexural
Strength
110 - 160 MPa
350 - 400 MPa
600 - 1200 MPa
Cementation
Resin Cements with
separate Adhesive
a) Resin Cements with separate Adhesive
b) Self-adhesive Resin Cements
c) Conventional Cements
Recommended
Product
Variolink II, V. Veneer
Multilink Automix
Oxide Ceramics
Multilink Automix
SpeedCEM
Vivaglass CEM
Questions?
- Press <ESC> to exit the presentation -