Metal free ceramic/ dental education in india
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METAL FREE CERAMICSMETAL FREE CERAMICS
Biologic Considerations & Laboratory Biologic Considerations & Laboratory Procedures.Procedures.
INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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IntroductionIntroduction
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General Biologic PreparationGeneral Biologic Preparation
Preservation of tooth structure.Preservation of tooth structure.Retention and resistance form.Retention and resistance form.Structural durability of the restoration.Structural durability of the restoration.Marginal integrity.Marginal integrity.Preservation of the periodontium.Preservation of the periodontium.
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Preservation of tooth structure.Preservation of tooth structure.
Judgment of the type of restoration to be Judgment of the type of restoration to be used.used.
Design.Design. Ill effects when excessively preparedIll effects when excessively prepared
1. Thermal hypersensitivity.1. Thermal hypersensitivity.
2. Pulpal inflammation.2. Pulpal inflammation.
3. Necrosis.3. Necrosis.
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Retention and resistance form.Retention and resistance form.
Retention: it is the ability of the preparation Retention: it is the ability of the preparation to impede the removal of the restoration to impede the removal of the restoration along its path of insertion.along its path of insertion.
Resistance: it is the ability of the Resistance: it is the ability of the preparation to prevent dislodgement of the preparation to prevent dislodgement of the restoration by forces directed in a apical, restoration by forces directed in a apical, oblique, or horizontal direction. oblique, or horizontal direction.
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The Design :The Design :
The preparation has to The preparation has to provide maximum provide maximum strength by establishing strength by establishing flat planes at right angles flat planes at right angles to the forces of to the forces of mastication and avoiding mastication and avoiding sharp line angles. A sharp line angles. A shoulder margin is also shoulder margin is also required because it offers required because it offers superior strength as superior strength as compared to chamfer. compared to chamfer.
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Retention and resistance form.Retention and resistance form.
Estimation.Estimation.Geometric form.Geometric form.Cement used to lute the restoration.Cement used to lute the restoration.Direction of the forces. Direction of the forces.
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Length of the preparation :Length of the preparation :
When a load is applied from a lingual direction, the labial When a load is applied from a lingual direction, the labial shoulder is placed under compression and only the length shoulder is placed under compression and only the length
of the preparation at the incisal lingual aspect provides of the preparation at the incisal lingual aspect provides significant resistance to this force. short preparations cause significant resistance to this force. short preparations cause
considerable stresses and may lead to fracture. of the considerable stresses and may lead to fracture. of the preparation preparation
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Factors affecting RetentionFactors affecting Retention
Degree of taper.Degree of taper.Total surface area of the cement film.Total surface area of the cement film.Area of cement under shear.Area of cement under shear.Roughness of the tooth surface.Roughness of the tooth surface.
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Taper :Taper :
Minimal taper is recommended for maximum surface area Minimal taper is recommended for maximum surface area and support of the preparation. Excessive taper of the and support of the preparation. Excessive taper of the preparation correlates with a reduction in breaking preparation correlates with a reduction in breaking strength and increase in stress concentration in the area strength and increase in stress concentration in the area where support is lacking. where support is lacking.
A 5`taper is ideal and would ensure maximum resistance A 5`taper is ideal and would ensure maximum resistance form with only one path of insertion of the crown but it is form with only one path of insertion of the crown but it is also difficult to achieve without producing undercuts.also difficult to achieve without producing undercuts.
The safest and most practical convergence angle of all-The safest and most practical convergence angle of all-ceramic preparations is 10`taper, which represents an ceramic preparations is 10`taper, which represents an acceptable compromise between taper and strength. acceptable compromise between taper and strength.
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Degree of taperDegree of taper
Jorgensenwww.indiandentalacademy.comwww.indiandentalacademy.com
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Surface area Surface area
Greater the surface area of the ecement film Greater the surface area of the ecement film greater is the retention.greater is the retention.
The size of the restoration is influenced by:The size of the restoration is influenced by:
1. size of the tooth.1. size of the tooth.
2. extent of coverage of the restoration.2. extent of coverage of the restoration.
3. additional preparations like grooves 3. additional preparations like grooves boxes.boxes.
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Area under shear.Area under shear.
The preparation must have opposing The preparation must have opposing walls.walls.
The opposing surfaces may be internal The opposing surfaces may be internal such as facial and lingual walls of a such as facial and lingual walls of a proximal box of an inlay.proximal box of an inlay.
Or may be external like axial walls of full Or may be external like axial walls of full veneer crown preparation.veneer crown preparation.
It can be also a sum of the both.It can be also a sum of the both.
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a. Internal retention in an a. Internal retention in an inlay.inlay.b. Slightly divergent internal b. Slightly divergent internal walls.walls.
a. External retention resists a. External retention resists removal.removal.b. Approximation of the b. Approximation of the restoration to the opposing restoration to the opposing external axial walls.external axial walls.
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Surface roughnessSurface roughness
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Resistance form Resistance form
Leverage and resistance.Leverage and resistance.Preparation length and resistance.Preparation length and resistance.Resistance and tooth width.Resistance and tooth width.Taper and resitance.Taper and resitance.Rotation around a vertical axis.Rotation around a vertical axis.Path of insertion.Path of insertion.
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Structural durability of the Structural durability of the restoration.restoration.
Occlusal reduction and functional cusp Occlusal reduction and functional cusp bevel.bevel.
Axial reduction.Axial reduction.Provision for reinforcing struts.Provision for reinforcing struts.
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Preparation for all Preparation for all ceramic restorationsceramic restorations
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Depth reduction index.Depth reduction index.
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Depth orientation groovesDepth orientation grooves
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Incisal / occlusal reductionIncisal / occlusal reduction
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Facial & Lingual reduction :Facial & Lingual reduction :
The minimal acceptable facial thickness of porcelain from The minimal acceptable facial thickness of porcelain from an esthetic standpoint is 1.0mm, and the ideal depth of an esthetic standpoint is 1.0mm, and the ideal depth of reduction on the midfacial aspect of a typical maxillary reduction on the midfacial aspect of a typical maxillary central incisor for an aluminous porcelain jacket crown central incisor for an aluminous porcelain jacket crown should be 1.3 mm. Facial depths of reduction up to should be 1.3 mm. Facial depths of reduction up to 1.5mm have also been recommended for molded, 1.5mm have also been recommended for molded, castable, and slip-cast ceramics. Lingual thickness castable, and slip-cast ceramics. Lingual thickness values of 1.5 mm are ideal but are difficult to achieve values of 1.5 mm are ideal but are difficult to achieve routinely. Practically lingual thickness should be in the 1 routinely. Practically lingual thickness should be in the 1 – 1.3 mm range, and the absolute minimum should be – 1.3 mm range, and the absolute minimum should be 0.8 mm. The lingual aspect of the preparation should be 0.8 mm. The lingual aspect of the preparation should be shaped to avoid uneven sections of the crowns and shaped to avoid uneven sections of the crowns and sharp line angles must be avoided. sharp line angles must be avoided.
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Facial reductionFacial reduction
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Lingual reductionLingual reduction
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Proximal reductionProximal reduction
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Shoulder :Shoulder :
A well defined shoulder with adequate width A well defined shoulder with adequate width improves the fracture resistance of the crown improves the fracture resistance of the crown because it provides additional bulk at the because it provides additional bulk at the margins that is placed at right angles to the margins that is placed at right angles to the direction of stressesdirection of stressesThe more the intimate the contact between The more the intimate the contact between the preparation and the ceramic crown higher the preparation and the ceramic crown higher the resistance to fracture on occlusal loading.the resistance to fracture on occlusal loading.
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Shoulder / Chamfer :Shoulder / Chamfer :
When the shoulder angle of the preparation to the When the shoulder angle of the preparation to the longitudinal axis of the tooth is greater than 90`, longitudinal axis of the tooth is greater than 90`, the risk if porcelain fracture increases. the risk if porcelain fracture increases.
The internal shoulder angle should be rounded to The internal shoulder angle should be rounded to reduce the stress concentration factor up to 50% reduce the stress concentration factor up to 50% and because sharp internal line angles cannot and because sharp internal line angles cannot be easily reproduced with porcelain. Similarly , be easily reproduced with porcelain. Similarly , the internal rounded shoulder is recommended the internal rounded shoulder is recommended for the In-Ceram* crown to facilitate the for the In-Ceram* crown to facilitate the adaptation of the aluminous oxide slip on the adaptation of the aluminous oxide slip on the die.die.
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Shoulder width :Shoulder width :A shoulder of uniform A shoulder of uniform
thickness may round the thickness may round the preparation excessively and preparation excessively and compromise resistance compromise resistance form. For a maxillary central form. For a maxillary central incisor, the lingual and incisor, the lingual and facial shoulder width should facial shoulder width should be I mm with a minimum of be I mm with a minimum of 0.8 mm, and the 0.8 mm, and the interproximal width should interproximal width should be 0.5 mm because the be 0.5 mm because the proximal walls of the crown proximal walls of the crown flare out and provide flare out and provide sufficient strength in the sufficient strength in the proximal area proximal area
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Axial reductionAxial reduction
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Axial reductionAxial reduction
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Shoulder curvature Shoulder curvature (interproximally) :(interproximally) :
The finish lines should follow a smooth The finish lines should follow a smooth curvature that it is not too steep inter-curvature that it is not too steep inter-proximally to avoid a potential v shaped proximally to avoid a potential v shaped notch that could split the labial off the notch that could split the labial off the lingual aspect of the crown.lingual aspect of the crown.www.indiandentalacademy.comwww.indiandentalacademy.com
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Prepared tooth schemaPrepared tooth schema
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Prepared tooth schemaPrepared tooth schema
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Why use metal free ceramics?Why use metal free ceramics?
TThere is an increase the depth of here is an increase the depth of translucency and light transmission in translucency and light transmission in the crown either deep into the crown the crown either deep into the crown or across the entire crown, which or across the entire crown, which increases the life like nature of the increases the life like nature of the restoration.restoration.
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Selection of restoration:Selection of restoration:
Strength.Strength. Simplicity of fabrication.Simplicity of fabrication. Marginal and internal fit.Marginal and internal fit. Cost-benefit analysis.Cost-benefit analysis. Skill of the operator.Skill of the operator. Esthetic performance.Esthetic performance. Potential for high volume production.Potential for high volume production.
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Indications :Indications :
Aesthetics.Aesthetics.Public figures, personalities, Public figures, personalities,
models, actresses and models, actresses and demanding patients. demanding patients.
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Contra-indications:Contra-indications:
parafunctional activity,e.g. bruxismparafunctional activity,e.g. bruxismUncorrected deflective malocclusions.Uncorrected deflective malocclusions.occlusal clearance less than 0.8 mm.occlusal clearance less than 0.8 mm. Insufficient tooth support.Insufficient tooth support.Molar teeth.Molar teeth.
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All Ceramic MaterialsAll Ceramic Materials
Conventional powder
Castable ceramics
Pressable ceramics
Machinable ceramics
Infiltrated ceramics
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Powder Slurry Ceramics :Powder Slurry Ceramics :
Supplied as: Powder and liquid. The powders are available Supplied as: Powder and liquid. The powders are available in different shades and translucencies, and are supplied in different shades and translucencies, and are supplied with characterizing stains and glazes. with characterizing stains and glazes.
Fabrication: Powder and liquid mixed to a slurry which is Fabrication: Powder and liquid mixed to a slurry which is build up in layers on a die material to form the contours build up in layers on a die material to form the contours of the restoration. of the restoration.
e.g. Vita Hi-Ceram (Vita Zahnfabrik) e.g. Vita Hi-Ceram (Vita Zahnfabrik) CERABIENCERABIEN (Noritake) (Noritake)OPTEC H.S.P (Jeneric/Pentron)OPTEC H.S.P (Jeneric/Pentron)DUCERAM L.F.C (Ducera Inc)DUCERAM L.F.C (Ducera Inc)
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Castable Ceramics :Castable Ceramics :
Supplied as: Supplied as:
solid ceramic ingots.solid ceramic ingots.
Fabrication: Cores or full contour Fabrication: Cores or full contour restorations are made using a lost wax restorations are made using a lost wax and centrifugal casting technique. and centrifugal casting technique.
e.g. DICOR (Dentsply).e.g. DICOR (Dentsply).
CERAPEARL (Bioceram, Kyocera)CERAPEARL (Bioceram, Kyocera)
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Pressable Ceramics :Pressable Ceramics :
Supplied as: Ingots Supplied as: Ingots Fabrication:Fabrication:Ingots melted at higher temperatures and pressed Ingots melted at higher temperatures and pressed
into a mould using a lost wax technique. These into a mould using a lost wax technique. These pressed form can be made into full contour, or pressed form can be made into full contour, or can be used as a substrate for conventional can be used as a substrate for conventional feldspathic porcelain buildup, or can be built up feldspathic porcelain buildup, or can be built up by layering technique.by layering technique.
e.g. IPS Empress I, II (Ivoclar vivadent)e.g. IPS Empress I, II (Ivoclar vivadent) OPC (Optec Pressable Ceramic)OPC (Optec Pressable Ceramic) ALCERAM (Cerestore, Innotek dental corp)ALCERAM (Cerestore, Innotek dental corp)
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Infiltrated Ceramics :Infiltrated Ceramics :
These are glass infiltrated core ceramics. These are glass infiltrated core ceramics. This involves slipcasting technique for This involves slipcasting technique for making the core, and the contours of the making the core, and the contours of the restoration are obtained by individual restoration are obtained by individual layering and staining techniques.layering and staining techniques.
e.g. In-CERAM (Vita Zahnfabrik)e.g. In-CERAM (Vita Zahnfabrik)Alumina infiltrationAlumina infiltrationZirconia infiltrationZirconia infiltrationSpinell infiltrationSpinell infiltration
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Machinable CeramicsMachinable Ceramics
Supplied as: ingots in various shades.Supplied as: ingots in various shades.Fabrication: Ingots are milled into desired form. Fabrication: Ingots are milled into desired form. They are of two types :They are of two types :1.CAD-CAM = 1.CAD-CAM = Computer Aided Designing – Computer Computer Aided Designing – Computer
Aided MillingAided Milling. e.g. . e.g. CEREC (Sirona)CEREC (Sirona)Ivoclar ProCAD (Ivoclar, Spring)Ivoclar ProCAD (Ivoclar, Spring)Dicor M.G.C (Dentsply)Dicor M.G.C (Dentsply)Procera (Nobel Biocare)Procera (Nobel Biocare)Lava (3M ESPE)Lava (3M ESPE)CERCON Dentsply Ceramco CERCON Dentsply Ceramco
2. Copy Milling = CELAY (Mikrona Technologies)2. Copy Milling = CELAY (Mikrona Technologies)
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CASTABLE CERAMICSCASTABLE CERAMICS
DICOR ( Dentsply)DICOR ( Dentsply)CERAPEARL( Kyocera)CERAPEARL( Kyocera)
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History :History :
The DICOR castable glass ceramic is one of the The DICOR castable glass ceramic is one of the pyoceram ceramics manufactured by Corning pyoceram ceramics manufactured by Corning glass ware.glass ware.
Founded in the year 1978, after 6 years of Founded in the year 1978, after 6 years of intensive research this ceramic system was intensive research this ceramic system was introduced to dentistry.introduced to dentistry.
The present system represents the cumulative The present system represents the cumulative efforts of Peter.J.Adair of BIOCOR Inc., David efforts of Peter.J.Adair of BIOCOR Inc., David Grossman Ph.D of the Corning Glass ware & Grossman Ph.D of the Corning Glass ware & Dentsply International.Dentsply International.
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Indications :Indications :
Anterior PJC.Anterior PJC. Inlays, onlays, three quarter crowns.Inlays, onlays, three quarter crowns. Partial veneers, especially in periodontally Partial veneers, especially in periodontally
compromised teethcompromised teeth
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Contraindications :Contraindications :
Clinical crown length is short.Clinical crown length is short. FPD.FPD.
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Clinical Procedure :Clinical Procedure :
The tooth structure is sufficiently removed to The tooth structure is sufficiently removed to allow an adequate thickness of the material for allow an adequate thickness of the material for strength and color saturation.strength and color saturation.
For castable ceramics, the tooth reduction on all For castable ceramics, the tooth reduction on all surfaces must be no less than 1.2mm.surfaces must be no less than 1.2mm.
Heavy chamfer (135`)`or shoulder margin.Heavy chamfer (135`)`or shoulder margin. 6`- 8`taper and all line angles rounded.6`- 8`taper and all line angles rounded. Standard impression procedures are followed.Standard impression procedures are followed.
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Incisal or occlusal - 1.5 mm- 2.0 mm.Incisal or occlusal - 1.5 mm- 2.0 mm.
Facial or lingual - 1.0 mm – 1.5 mm.Facial or lingual - 1.0 mm – 1.5 mm.
Tooth preparation :Tooth preparation :
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Laboratory Procedures :Laboratory Procedures :
Die preparation.Die preparation.
Waxing & Spruing.Waxing & Spruing.
Investing & Mold conditioning.Investing & Mold conditioning.
Casting.Casting.
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Divesting.Divesting.
Sprue removal.Sprue removal.
Embedding.Embedding.
Ceramming & post ceram divesting.Ceramming & post ceram divesting.
Finishing, coloring.Finishing, coloring.www.indiandentalacademy.comwww.indiandentalacademy.com
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Die Preparation :Die Preparation :
Casts should be free of 0cclusal Casts should be free of 0cclusal artifacts,air bubbles and other artifacts,air bubbles and other inaccuracies. inaccuracies.
Dies must be prepared with Dies must be prepared with proper indexing. The dies proper indexing. The dies should be sectioned, trimmed should be sectioned, trimmed and refined with care. and refined with care.
Any existing undercuts must bu Any existing undercuts must bu blocked out to ensure wax blocked out to ensure wax pattern removal without pattern removal without distortion.distortion.
Die sealant should be used.Die sealant should be used.A die spacer of appropriate shade A die spacer of appropriate shade
is applied on evenly to the die is applied on evenly to the die to within 1 mm of margin.to within 1 mm of margin.
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Waxing :Waxing : Die lubricant is applied over Die lubricant is applied over
the die spacer to prevent the die spacer to prevent adherence of the wax to the adherence of the wax to the die.die.
All contours of the wax crown All contours of the wax crown should have a minimum should have a minimum thickness of at least 1mm to thickness of at least 1mm to ensure adequate strength of ensure adequate strength of the crown.the crown.
A smooth and completely A smooth and completely formed internal surface of the formed internal surface of the waxed crown is necessary.waxed crown is necessary.
A wild-Leitz stereomicroscope A wild-Leitz stereomicroscope with fibre optic light can be with fibre optic light can be used to avoid any over used to avoid any over extensions in the margins. extensions in the margins.
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Spruing :Spruing : One 8 or 10 gauge wax sprue, attached to the incisal One 8 or 10 gauge wax sprue, attached to the incisal
surface of the anterior patterns, provides an adequate surface of the anterior patterns, provides an adequate gate for the ingress of the ceramic material.gate for the ingress of the ceramic material.
Posterior patterns are usually require 10 gauge sprues Posterior patterns are usually require 10 gauge sprues attached to the lingual and buccal cusp tips.attached to the lingual and buccal cusp tips.
Sprue placement on molar patterns should be diagonally Sprue placement on molar patterns should be diagonally opposed for more uniform flow of the fluid ceramic.opposed for more uniform flow of the fluid ceramic.
A sprue design incorporating a perpendicular reservoir A sprue design incorporating a perpendicular reservoir has also produced adequate casting. Length must be has also produced adequate casting. Length must be approx 3 – 4 mm.approx 3 – 4 mm.
The pattern should be located so that its most distal The pattern should be located so that its most distal point is approx 6 – 7 mm from the open end of the point is approx 6 – 7 mm from the open end of the casting ring to allow adequate diffusion of the mold glass casting ring to allow adequate diffusion of the mold glass through the investment.through the investment.
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Spruing :Spruing :
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Investment :Investment : Wax pattern must be cleansed with a debublizing agent, Wax pattern must be cleansed with a debublizing agent,
any excess must be removed.any excess must be removed. Non-corroding casting rings that are resistant to Non-corroding casting rings that are resistant to
oxidation at high temperature must be used.oxidation at high temperature must be used. 2 layers of Kaoliner* a ring liner material (an asbestos 2 layers of Kaoliner* a ring liner material (an asbestos
liner)is placed inside the ring,to permit suffficient liner)is placed inside the ring,to permit suffficient expansion.expansion.
The ring liner is saturated eith water for about 10 sec The ring liner is saturated eith water for about 10 sec before ceating the ring on to the crucible former.before ceating the ring on to the crucible former.
A special phosphate bonded investment is used for A special phosphate bonded investment is used for casting process. casting process.
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This material exhibits no This material exhibits no setting expansion but setting expansion but produces approx 1.5% thermal produces approx 1.5% thermal expansion at high expansion at high temperatures.temperatures.
8 ml of distilled water must be 8 ml of distilled water must be mixed with 60 gm of mixed with 60 gm of investment powder for 30 sec investment powder for 30 sec under vacuum with power under vacuum with power spatulation.spatulation.
After spatulation additional After spatulation additional vibration under vacuum is vibration under vacuum is carried for 20 – 30 sec.carried for 20 – 30 sec.
The mixed investment should The mixed investment should be carefully applied on to the be carefully applied on to the wax pattern with a camel’s hair wax pattern with a camel’s hair brush.brush.
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Investment :Investment : After the wax pettern is After the wax pettern is
carefully filled and carefully filled and coated, the remaining coated, the remaining material should be material should be vibrated into the ring vibrated into the ring allowing an excess to allowing an excess to remain above the open remain above the open ends of the ring. ends of the ring.
After bench setting for 1 After bench setting for 1 hr the excess material hr the excess material should be trimmed even should be trimmed even with the top of the casting with the top of the casting flask.flask.
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Mold conditioning :Mold conditioning :
A two stage mold conditioning is employed.A two stage mold conditioning is employed. The invested pattern is placed in a cold furnace, The invested pattern is placed in a cold furnace,
the temperature is raised to 249`C, and the temperature is raised to 249`C, and maintained for 30 min (heat soak), 10 min of maintained for 30 min (heat soak), 10 min of additional time for each ring should be added if additional time for each ring should be added if more than three rings are placed at a time.more than three rings are placed at a time.
The temperature is raised to 899`C, and The temperature is raised to 899`C, and maintained for 2 hrs (heat soak), similarly 10 min maintained for 2 hrs (heat soak), similarly 10 min added for each ring.added for each ring.
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Casting :Casting :
A 4 gm ceramic ingot is loaded in the A 4 gm ceramic ingot is loaded in the ceramic crucible.ceramic crucible.
The amount of ceramic material required to The amount of ceramic material required to make a good casting can be determined make a good casting can be determined when multiplied by a conversion factor of when multiplied by a conversion factor of 2.6, the weight of the wax pattern, sprues 2.6, the weight of the wax pattern, sprues and button should not exceed 4gm .and button should not exceed 4gm .
Two patterns can be cast into one flask. Two patterns can be cast into one flask.
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Ceramic ingot Ceramic crucible:Ceramic ingot Ceramic crucible:
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Casting Machine :Casting Machine : The Dentsply DICOR The Dentsply DICOR
casting machine features casting machine features a platinum electric a platinum electric resistance-type muffle resistance-type muffle mounted on a electrically mounted on a electrically driven straight centrifugal driven straight centrifugal casting arm.casting arm.
The machine is fitted The machine is fitted with a special receptacle with a special receptacle to hold the Dicor to hold the Dicor crucible. crucible.
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Casting Procedure :Casting Procedure : An ideal temperature of 1100`C is maintained for An ideal temperature of 1100`C is maintained for
10 min to stabilize the muffle.10 min to stabilize the muffle. The crucible containing the ceramic ingot is The crucible containing the ceramic ingot is
inserted through the rear muffle door.inserted through the rear muffle door. The crucible is properly positioned in the muffle The crucible is properly positioned in the muffle
for melting the glass by the help if a special tool.for melting the glass by the help if a special tool. The rear door is closed, the melting temperature The rear door is closed, the melting temperature
is adjusted to 1360`C, and the melt switch is is adjusted to 1360`C, and the melt switch is turned on.turned on.
After reaching the determined temperature, this After reaching the determined temperature, this will be maintained for 6 min.will be maintained for 6 min.
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Casting Procedure :Casting Procedure : The rear muffle door is opened .The rear muffle door is opened . The casting ring is removed from the burnout furnace The casting ring is removed from the burnout furnace
and placed in the cradle with the crucible and gate facing and placed in the cradle with the crucible and gate facing the muffle.the muffle.
The front muffle door is opened and the muffle assembly The front muffle door is opened and the muffle assembly is slid forward towards the casting ring until it is seated.is slid forward towards the casting ring until it is seated.
The casting machine cover is shut and the casting switch The casting machine cover is shut and the casting switch is turned on. The casting arm spins automatically for 4 ½ is turned on. The casting arm spins automatically for 4 ½ min and then stops. By the end of the spin cycle the min and then stops. By the end of the spin cycle the casting will cool down casting will cool down
The casting ring is removed form the machine and The casting ring is removed form the machine and allowed to dool for 45 min before divestingallowed to dool for 45 min before divesting
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After castingAfter casting
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Divesting :
• After cooling, the investment is removed from arround the edges of the casting ring to a depth of approx 6 –8 mm. The investment mass can be forced out of the retaining ring by pushing with the fingers.
The bulk of the investment material can be broken away from the casting with finger pressure.
The remaining casting should be removed with an air abrasive tool using 25 micron aluminum oxide at 40 p.s.I.
The margin areas should be protected by covering with the finger to prevent chipping.
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Sprue removal :Sprue removal :
The cast crown is cut off at the junction of The cast crown is cut off at the junction of sprue and button using a suitable single or sprue and button using a suitable single or double side diamond disc.double side diamond disc.
The sprue is cut near the glass button to The sprue is cut near the glass button to avoid chipping.avoid chipping.
The remaining button must be dicsarde The remaining button must be dicsarde and cannot be reused because the glass and cannot be reused because the glass is altered during melting cycle.is altered during melting cycle.
The casting at this stage is non-crystalline.The casting at this stage is non-crystalline.
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Embedding :Embedding :
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Embedding :Embedding : The casting is embedded in the ceramic embedment The casting is embedded in the ceramic embedment
material, so that the ceramming process can take place.material, so that the ceramming process can take place. During this ceramming procedure the glass is concerted During this ceramming procedure the glass is concerted
into a 55% crystalline form.into a 55% crystalline form. The glass casting is embedded in a mixture of 18 ml The glass casting is embedded in a mixture of 18 ml
distilled water and 50gm of embedment powder. Hand distilled water and 50gm of embedment powder. Hand mixing is sufficient. mixing is sufficient.
The inside of the crown is carefully filled with the The inside of the crown is carefully filled with the embedment mix and then it is placed on a tray with a embedment mix and then it is placed on a tray with a concave receptacle in which additional material is concave receptacle in which additional material is placed.placed.
Additional embedment is used to cover and protect the Additional embedment is used to cover and protect the glass crown. The material should be allowed to set for 45 glass crown. The material should be allowed to set for 45 – 60 min.– 60 min.
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Ceramming :Ceramming : This process is accomplished by a precisely controlled This process is accomplished by a precisely controlled
ceramming furnace.ceramming furnace. The furnace temperature is gradually increased to The furnace temperature is gradually increased to
1075`C for 3 ½ hrs, this temperature should be 1075`C for 3 ½ hrs, this temperature should be maintained for 6 hrs. the furnace is cooled to 200`C and maintained for 6 hrs. the furnace is cooled to 200`C and the embedment tray is removed.the embedment tray is removed.
The ceramming process involves a two-stage heat The ceramming process involves a two-stage heat treatment. The first heat treatment is carried at the treatment. The first heat treatment is carried at the temperature for maximum nucleation of crystals, so temperature for maximum nucleation of crystals, so maximum no: of crystals are formed. The temperature is maximum no: of crystals are formed. The temperature is held for some time for the crystal growth to take place, to held for some time for the crystal growth to take place, to attain the maximum size.attain the maximum size.
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DICOR Ceramming Furnace :DICOR Ceramming Furnace :
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Ceramming tray Ceramming tray Pyrometric conePyrometric cone
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Postceram divesting :Postceram divesting :
The tray is allowed to cool to room The tray is allowed to cool to room temperature.temperature.
The embedment is broken.The embedment is broken.The crown is cleaned by air-blasting with The crown is cleaned by air-blasting with
25 micron aluminum oxide at 40 p.s.I at a 25 micron aluminum oxide at 40 p.s.I at a distance of approx 6inches. distance of approx 6inches.
The margins should be protected from The margins should be protected from chipping during air-blasting.chipping during air-blasting.
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Various phases undergone
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Crown finishing :Crown finishing :
Crystalline glass crown is inspected for internal Crystalline glass crown is inspected for internal nodules or irregularities, which may interfere nodules or irregularities, which may interfere with seating of the casting on the die. These with seating of the casting on the die. These irregularities csn be removed with extrafine irregularities csn be removed with extrafine diamond points.diamond points.
The crows is seated on to the die and examined The crows is seated on to the die and examined for marginal overextensions. If any, must be for marginal overextensions. If any, must be removed with fine white point or rubber wheel removed with fine white point or rubber wheel rotating at low speed. rotating at low speed.
The remaining sprue is removed with a double The remaining sprue is removed with a double sided diamond disc rotating at slow speed.sided diamond disc rotating at slow speed.
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Crown finishing :Crown finishing : The fine opaque white skin covering the crown must be The fine opaque white skin covering the crown must be
removed. The sprue is finished and the skin is lightly removed. The sprue is finished and the skin is lightly removed with a fine rubber abrasive wheel.removed with a fine rubber abrasive wheel.
After removal of the skin the crown is air blasted with 25 After removal of the skin the crown is air blasted with 25 microns aluminum oxide at 40 psi.microns aluminum oxide at 40 psi.
The primary and secondary occlusal anatomy can be The primary and secondary occlusal anatomy can be defined with small round and inverted cone T.C burs.defined with small round and inverted cone T.C burs.
Corrections can be done with an add-on material. The Corrections can be done with an add-on material. The casting is dried in front of the open muffle at 593`C and casting is dried in front of the open muffle at 593`C and introduced into muffle under vacuum to a temperature of introduced into muffle under vacuum to a temperature of 968`C for 1 min and can be shaped and adjusted to 968`C for 1 min and can be shaped and adjusted to desired contours. desired contours.
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Characterization & Glazing :Characterization & Glazing :
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Characterization & Glazing :Characterization & Glazing : After the ceramming process the casring is achromatic, After the ceramming process the casring is achromatic,
the desired hue is decided by the shading porcelains.the desired hue is decided by the shading porcelains. The blending of enamel and body colors must occur The blending of enamel and body colors must occur
while they are wet.while they are wet. The first and the second shading porcelains should be The first and the second shading porcelains should be
fired at a slightly lower temperature to prevent over fired at a slightly lower temperature to prevent over glazing and glassy appearance of the crown.glazing and glassy appearance of the crown.
Castable ceramics can be fired repeatedly in a Castable ceramics can be fired repeatedly in a conventional glazing oven without affecting the physical conventional glazing oven without affecting the physical properties or marginal integrity of the materialproperties or marginal integrity of the material
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Cementation :Cementation : The color value is modified by a The color value is modified by a
series od dentsply shaded series od dentsply shaded cements.these cements are color cements.these cements are color coordinated with the die spacers coordinated with the die spacers that are earlier used.that are earlier used.
If a natural colored tooth If a natural colored tooth preparation exists, a translucent preparation exists, a translucent glass ionomer cement is indicated. glass ionomer cement is indicated. In those cases the tooth structure In those cases the tooth structure or a metal core is present, the use or a metal core is present, the use of properly colored cement can be of properly colored cement can be of good esthetic value.of good esthetic value.
During cementation process, During cementation process, controlled, positive finger pressure controlled, positive finger pressure should be used to seat the crown should be used to seat the crown onto the prepared tooth. Excess onto the prepared tooth. Excess cement is completely removed cement is completely removed after the setting is complete.after the setting is complete.
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POWDER SLURRY POWDER SLURRY CERAMICSCERAMICS
Vita Hi-CeramVita Hi-Ceram (Vita Zahnfabrik) (Vita Zahnfabrik)
CERABIENCERABIEN (Noritake) (Noritake)
OPTEC H.S.P (Jeneric/Pentron)OPTEC H.S.P (Jeneric/Pentron)
DUCERAM L.F.C (Ducera Inc)DUCERAM L.F.C (Ducera Inc)
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Lab Procedures :Lab Procedures :
Preparing the refractory die.Preparing the refractory die.Hard core porcelain framework.Hard core porcelain framework.Crown buildup.Crown buildup.
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Refractory Die :Refractory Die :
Apply Vita interspace varnish on to the die in 2 or 3 Apply Vita interspace varnish on to the die in 2 or 3 coatings.coatings.
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DuplicationDuplication
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In the In the Vita Vacumat Vita Vacumat 200200 : prog 5.5, end : prog 5.5, end temp 1,000`C, pre-temp 1,000`C, pre-drying time 10 min, drying time 10 min, heating time 10 min, heating time 10 min, hold time 3 min. In the hold time 3 min. In the Vita Vacumat 100Vita Vacumat 100 : : prog 5, end temp prog 5, end temp 1000`C, pre-drying time 1000`C, pre-drying time 10 min, heating time 10 10 min, heating time 10 min, hold time 3 min.min, hold time 3 min.
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Constructing the hard core Constructing the hard core porcelainporcelain
The Hi-Ceram hard core The Hi-Ceram hard core porcelain has to be applied porcelain has to be applied and fired in three layers and fired in three layers altogether : 1. The wash altogether : 1. The wash firing.; 2. Half of the required firing.; 2. Half of the required thickness with protuberances thickness with protuberances for later checking on the for later checking on the thickness of the porcelain.; 3. thickness of the porcelain.; 3. Full build-up as a smaller Full build-up as a smaller version of the crown it is to version of the crown it is to become. Minimum thickness-become. Minimum thickness-0.5mm.0.5mm.
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The thickness of hard The thickness of hard core porcelain core porcelain framework should not framework should not be less than 0.5 mm.be less than 0.5 mm.
For additional For additional stability, a collar in Hi-stability, a collar in Hi-Ceram hard core Ceram hard core porcelain can be porcelain can be added palatally or added palatally or lingually. lingually.
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The refractory die The refractory die should be blasted should be blasted away using glass away using glass beads at a pressure beads at a pressure of 1- 2 bar.of 1- 2 bar.
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The build up of the crownThe build up of the crown : : The crown should be The crown should be
built up to its desired built up to its desired shape using Vitadur-shape using Vitadur-N dentin porcelain, N dentin porcelain, although to although to compensate firing compensate firing shrinkage it must be shrinkage it must be built longer incisally. built longer incisally. The cervix of the hard The cervix of the hard core framework can core framework can be coated before be coated before hand using Vitadur-N hand using Vitadur-N opacous porcelain.opacous porcelain.
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A little Vitadur-N A little Vitadur-N opacous dentin opacous dentin can also be can also be applied palatally, applied palatally, so that even in so that even in cases where cases where there is a deeper there is a deeper than normal bite than normal bite by the occluding by the occluding teeth, any shining teeth, any shining through of the Hi-through of the Hi-Ceram hard core Ceram hard core porcelain will be porcelain will be completely completely avoided. avoided. www.indiandentalacademy.comwww.indiandentalacademy.com
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To create the To create the necessary space for necessary space for the enamel the enamel porcelain, the dentin porcelain, the dentin should have a should have a crescent carved crescent carved away incisally and away incisally and for the smooth for the smooth transition between transition between the dentin and the dentin and enamel, then also enamel, then also be smoothened be smoothened using a flattened using a flattened brush. brush.
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For individual For individual shading and shading and characterization, characterization, there are 5 there are 5 Vitadur-N Vitadur-N opacous dentin, 6 opacous dentin, 6 dentin effect, 2 dentin effect, 2 enamel effect enamel effect and 7 COLOR and 7 COLOR porcelains porcelains available.available.
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The shape of the The shape of the crown is now built crown is now built up in Vitadur-N up in Vitadur-N enamel porcelain. enamel porcelain. It should be It should be somewhat over somewhat over dimensioned to dimensioned to compensate firing compensate firing shrinkage.shrinkage.
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The crown is fired as The crown is fired as follows: either by follows: either by placing it onto a placing it onto a fibrous pad firing fibrous pad firing support (in which support (in which case raise the case raise the temperature by temperature by 10`C), or by wrapping 10`C), or by wrapping a normal crown stand a normal crown stand in the fibrous pad in the fibrous pad material and then material and then placing the crown placing the crown loosely onto it: loosely onto it:
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The fired Hi-Ceram crown should be ground The fired Hi-Ceram crown should be ground all over in the normal way, using a diamond or all over in the normal way, using a diamond or a green silicon carbide bur. For corrections, a green silicon carbide bur. For corrections, clean without using any cleansing agent but clean without using any cleansing agent but with a clean brush under running water, or a with a clean brush under running water, or a steam jet blaster.steam jet blaster.
Then reapply the Then reapply the appropriate appropriate porcelain and fire porcelain and fire as for the main as for the main vacuum firing, vacuum firing, except with the except with the temperature temperature reduced by 10`C.reduced by 10`C.
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The cervical The cervical porcelain should porcelain should be mixed with Vita be mixed with Vita modeling liquid, modeling liquid, applied onto the applied onto the cervical margin, cervical margin, condensed and condensed and then bottled. then bottled. Excess cervical Excess cervical porcelains should porcelains should then be removed then be removed using either a using either a clean finger or a clean finger or a dry brush. dry brush. www.indiandentalacademy.comwww.indiandentalacademy.com
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Glaze firing :Glaze firing :
Applying the Applying the Vitachrom ”L” Vitachrom ”L” glaze No. 725 glaze No. 725 allows the allows the temperature for the temperature for the glaze firing to be glaze firing to be lowered, thereby lowered, thereby guarantying that guarantying that the cervical the cervical margins retain its margins retain its accurate fit.accurate fit.
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MACHINABLE CERAMICSMACHINABLE CERAMICS
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Classification:Classification:
CAD CAM CERAMICS
COPY MILLED
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CAD – CAM CeramicsCAD – CAM Ceramics
CERECCEREC CEREC SCANCEREC SCANCEREC 2CEREC 2 CEREC InLABCEREC InLABCEREC 3CEREC 3 IVOCLAR PROCAD (IVOCLAR, SPRING)IVOCLAR PROCAD (IVOCLAR, SPRING)DICOR M.G.C (DENTSPLY)DICOR M.G.C (DENTSPLY)PROCERA (NOBEL BIOCARE)PROCERA (NOBEL BIOCARE)LAVA (3M ESPE)LAVA (3M ESPE)
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Introduction:Introduction:
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Types of CAD – CAM Devices:Types of CAD – CAM Devices:
DIRECT: DIRECT: Fully integrated CAD – CAM devices for Fully integrated CAD – CAM devices for
chair side restorative approach. CAD & chair side restorative approach. CAD & CAM stations are located at the dental CAM stations are located at the dental office. office.
INDIRECT: INDIRECT: System that consists of several modules System that consists of several modules
with at least, distinctive CAD & CAM with at least, distinctive CAD & CAM stations.stations.
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Direct CAD - CAMDirect CAD - CAM
CEREC, CEREC 2, CEREC 3CEREC, CEREC 2, CEREC 3
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INTRODUCTION CEREC VIDEOINTRODUCTION CEREC VIDEO
CEREC
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CCEERREE
C C SSYYSSTTEEMM
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EquipmentEquipment
a computer integrated imaging and milling a computer integrated imaging and milling system, with the restorations designed on system, with the restorations designed on the computer screenthe computer screen
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Ingots usedIngots used
Dicor MGC*(Dicor MGC*(Machinable Glass CeramicMachinable Glass Ceramic)(Dentsply):)(Dentsply):
This is a mica based machinable glass ceramic This is a mica based machinable glass ceramic containing 70% vol of crystalline phase. The containing 70% vol of crystalline phase. The unique “House of Cards” microstructure found in unique “House of Cards” microstructure found in Dicor MGC is due to the inter locking of the Dicor MGC is due to the inter locking of the small platelet shaped mica-crystals with an small platelet shaped mica-crystals with an average size of 1 – 2 microns. This particular average size of 1 – 2 microns. This particular structure leads to multiple crack deflections and structure leads to multiple crack deflections and ensures greater strength than leucite containing ensures greater strength than leucite containing ceramics.ceramics.
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Vita Mark II (Vident):Vita Mark II (Vident):These contain sanidine (KALSiThese contain sanidine (KALSi33OO88) as a ) as a major crystalline phase within a glassy major crystalline phase within a glassy
matrix.matrix.
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ProCad (Ivoclar):ProCad (Ivoclar):ProCAD is reinforced with tiny leucite particles, ProCAD is reinforced with tiny leucite particles,
and has been referred to as: "Empress on a stick".and has been referred to as: "Empress on a stick".
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Vita IN-Ceram Blanks (Vita Zhanfabrik):Vita IN-Ceram Blanks (Vita Zhanfabrik):
These are third generation blanks from Vita. These are third generation blanks from Vita.
The Spinell MgAlThe Spinell MgAl22OO44..The Alumina AlThe Alumina Al22OO33..The Zirconia ZrOThe Zirconia ZrO2.2.
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The Spinell Blanks:The Spinell Blanks:
The fine chemical and The fine chemical and mechanical properties mechanical properties of the highly pure of the highly pure synthetic spinell are synthetic spinell are used with the aim to used with the aim to obtain an esthetically obtain an esthetically appealing, translucent appealing, translucent ceramic structures.ceramic structures.
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Alumina Blanks:Alumina Blanks:
These uses the advantages of the These uses the advantages of the synthetic corundum that is prepared from synthetic corundum that is prepared from bauxite prepared in electric melting bauxite prepared in electric melting furnace. furnace.
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Zirconia Blanks:Zirconia Blanks:This combines the fracture toughness of This combines the fracture toughness of
the meta-stable tetragonal zirconium oxide the meta-stable tetragonal zirconium oxide which is also referred to as “ceramic which is also referred to as “ceramic steel”.steel”.
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Clinical Procedure:Clinical Procedure:
Preparation design.Preparation design.
Optical impression.Optical impression.
Computer generated restoration design.Computer generated restoration design.
Milling procedure.Milling procedure.
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Tooth Preparation Design:Tooth Preparation Design:Tooth preparation follows typical all-Tooth preparation follows typical all-
ceramic guidelines.ceramic guidelines.
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Optical impressionOptical impression The surface of the prepared teeth often lacks sufficient The surface of the prepared teeth often lacks sufficient
reflectivity or it may have facets that give an uneven reflectivity or it may have facets that give an uneven glaze to the computer screen.glaze to the computer screen.
It is therefore necessary to coat the preparation with a It is therefore necessary to coat the preparation with a special powder (titanium dioxide) that has proper light special powder (titanium dioxide) that has proper light reflectivity.reflectivity.
Rubber dam must be placed to prevent fogging of the Rubber dam must be placed to prevent fogging of the camera lens and to aid in isolation.camera lens and to aid in isolation.
Cerec is the first system that makes intra-oral scanned Cerec is the first system that makes intra-oral scanned impressions a reality. This is done through a small hand impressions a reality. This is done through a small hand held camera.held camera. The camera, which resembles a wand, The camera, which resembles a wand, illuminates the prepared tooth and the 2 adjacent teeth illuminates the prepared tooth and the 2 adjacent teeth with its light source and processes the image with the 3-with its light source and processes the image with the 3-D measuring camera.D measuring camera.
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The operator actually feels the wand vibrate as The operator actually feels the wand vibrate as the camera oscillates to scan the teeth at slightly the camera oscillates to scan the teeth at slightly different angles.different angles. The Cerec software then The Cerec software then blends these images to create its 3D map of the blends these images to create its 3D map of the topography.topography. This optical scanning system could This optical scanning system could well be the precursor of much expanded use of well be the precursor of much expanded use of optical scanning in dentistry.optical scanning in dentistry. However, the However, the inability to scan sub gingival margin areas and inability to scan sub gingival margin areas and some interproximal areas must (but probably some interproximal areas must (but probably will) be overcome before optical scanning will) be overcome before optical scanning becomes mainstream.becomes mainstream.
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Optical impression:Optical impression:
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Design Phase:Design Phase: With the With the
help of the help of the CEREC 3 CEREC 3 Software Software we can we can choose the choose the basis basis software software for the for the designing designing of of inlays/onlainlays/onlays or ys or crowns or crowns or veneers.veneers.
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Shaping of the surfaces:Shaping of the surfaces:
1.1. FunctionFunction
2.2. CorrelationCorrelation
3.3. ExtrapolationExtrapolation
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Function:Function:This design programme takes This design programme takes design of the antagonist.design of the antagonist.CorrelationCorrelationThis design programme allows to This design programme allows to copy intact occlusal surfaces.copy intact occlusal surfaces.ExtrapolationExtrapolationThis programme calculates the This programme calculates the dimensions of the restoration with dimensions of the restoration with reference to a tooth database and reference to a tooth database and as well as with the adjacent teeth.as well as with the adjacent teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
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With using With using all the all the programmeprogrammes the s the operator operator can digitally can digitally design the design the restoration restoration by moving by moving the cursor the cursor along the along the boundaries.boundaries. www.indiandentalacademy.comwww.indiandentalacademy.com
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The procedure can be stopped at any The procedure can be stopped at any time and can override the computer and time and can override the computer and allow the operator to correct, the digitally allow the operator to correct, the digitally generated features.generated features.Once the restoration has been designed, Once the restoration has been designed, the computer develops a 3-D model on the computer develops a 3-D model on the screen.the screen.All the information is stored.All the information is stored.The design phase usually takes 2 – 8 The design phase usually takes 2 – 8 min.min.
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CEREC VIDEOCEREC VIDEO
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Milling Phase:Milling Phase:
After all the data has been supplied, the After all the data has been supplied, the computer selects the size of the ceramic computer selects the size of the ceramic block to be used in the milling process.block to be used in the milling process.
There are wide range :There are wide range :Composition.Composition.Shade.Shade.Size.Size.
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These blanks are factory fabricated and These blanks are factory fabricated and thus are more homogenous and less thus are more homogenous and less porous than materials that are made in the porous than materials that are made in the lab.lab.
These materials also produce “chameleon These materials also produce “chameleon effect”.effect”.
The material is mounted on the metal stud, The material is mounted on the metal stud, which allows it to be inserted in to the which allows it to be inserted in to the milling hub.milling hub.
Once the material is inserted. The window Once the material is inserted. The window is closed an the milling process is is closed an the milling process is activatedactivated..
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Advantages of CEREC System:Advantages of CEREC System:
One or two appointments.One or two appointments. Optical impression, max time required is 5 sec.Optical impression, max time required is 5 sec. Wear hardness similar to enamel.Wear hardness similar to enamel. Less fracture due to single homogenous block.Less fracture due to single homogenous block. Excellent polish.Excellent polish. Improved esthetics.Improved esthetics. Time saving.Time saving. Good occlusal morphology in relation to Good occlusal morphology in relation to
antagonist.antagonist.
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Indirect CAD - CAMIndirect CAD - CAM
CEREC* SCAN,CEREC* SCAN, CEREC* In-LABCEREC* In-LAB PROCERA* SYSTEMPROCERA* SYSTEM LAVA 3M ESPE LAVA 3M ESPE Cercon® Zirconia (Dentsply)Cercon® Zirconia (Dentsply)
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CEREC SCAN:CEREC SCAN:
Tooth preparation.Tooth preparation.Conventional impressions.Conventional impressions.Die preparation.Die preparation.Controlled by one of the practice pc’s.Controlled by one of the practice pc’s.Can be upgrade to CEREC 3.Can be upgrade to CEREC 3.Works upon CEREC 3 software.Works upon CEREC 3 software. Intra oral scanning device is not present.Intra oral scanning device is not present.
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CEREC SCAN (inclusive of both scanning CEREC SCAN (inclusive of both scanning and milling device)with lap top(imaging and milling device)with lap top(imaging device).device). www.indiandentalacademy.comwww.indiandentalacademy.com
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Scanning device.Scanning device.
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CEREC In-LAB:CEREC In-LAB:
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Controlled Scanning:Controlled Scanning:
Consists of a compact milling unit with a Consists of a compact milling unit with a in-built scanner.in-built scanner.
This consists of non contact scanning for This consists of non contact scanning for utmost precision.utmost precision.
Software runs on Windows* 98.Software runs on Windows* 98.
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Controlled Design:Controlled Design: Offers a complete spectrum of design options for Offers a complete spectrum of design options for
crowns and bridge framework.crowns and bridge framework. All relevant parameters can be adjusted All relevant parameters can be adjusted
individually …for example, the occlusal and individually …for example, the occlusal and radial wall thickness and the cross sectional radial wall thickness and the cross sectional area of the bridge connectors.area of the bridge connectors.
This system gives a visual thickness if operator This system gives a visual thickness if operator falls short of the minimum material specific wall falls short of the minimum material specific wall thickness.thickness.
Thus the operator exerts complete control over Thus the operator exerts complete control over the design process ay all times. the design process ay all times.
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Controlled milling:Controlled milling:
Prior to each milling jib CEREC In-Lab Prior to each milling jib CEREC In-Lab automatically checks the dimensional automatically checks the dimensional accuracy of the milling tools.accuracy of the milling tools.
The integrated soft touch control monitors The integrated soft touch control monitors the calibration of the tools throughout the the calibration of the tools throughout the milling process and compensates for any milling process and compensates for any wear-related inaccuracies.wear-related inaccuracies.
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Parallel milling with two tools:
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High speed milling of copings and bridge frame work.
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Processing times:Processing times:
Process stepProcess step Coping Coping Bridge Bridge frameworkframework
Scanning Scanning (automatic)(automatic)
Approx. 10 minApprox. 10 min Approx. 20minApprox. 20min
DesignDesign Approx. 2 minApprox. 2 min Approx. 6 minApprox. 6 min
Milling Milling (automatic)(automatic)
Approx. 15 minApprox. 15 min Approx. 50 minApprox. 50 min
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Procera* All-CeramProcera* All-Ceram
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Fabrication Procedures:Fabrication Procedures:
Tooth preparation.Tooth preparation.
Die preparation.Die preparation.
Scanning.Scanning.
Data transfer.Data transfer.
Central milling.Central milling.
Application of conventional porcelains.Application of conventional porcelains.
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Tooth preparation:Tooth preparation: Since the Since the
scanner's tip is scanner's tip is rounded, the rounded, the finish line should finish line should be a chamfer be a chamfer placed sub-placed sub-gingivally at 0.5 gingivally at 0.5 mm to 0.7mm. A mm to 0.7mm. A rounded shoulder rounded shoulder may be also an may be also an appropriate appropriate design.design. www.indiandentalacademy.comwww.indiandentalacademy.com
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A relatively A relatively level level topography topography should be should be accomplisheaccomplished during d during preparation preparation of the of the occlusal occlusal surface of surface of posterior posterior dentition. dentition.
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The occlusal surface of a The occlusal surface of a posterior tooth is posterior tooth is shaped, eliminating shaped, eliminating undercuts and sharp undercuts and sharp edges. Steep slopes edges. Steep slopes and sharp groves are and sharp groves are avoided to enable the avoided to enable the scanner to recognize all scanner to recognize all of the information of the information through the tip.through the tip.
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For anterior For anterior dentition, dentition, preparation of the preparation of the lingual surface lingual surface requires shaping requires shaping with diamond bur with diamond bur to eliminate to eliminate debris. debris.
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Fine finish lines on Fine finish lines on the prepared tooth the prepared tooth enable the scanner enable the scanner to precisely register to precisely register all aspects of the die all aspects of the die models, which models, which directly affects the directly affects the marginal fit of the marginal fit of the definitive definitive restoration. restoration.
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Preparation Preparation depths should be depths should be between 1.0 mm between 1.0 mm and 1.5 mm, and 1.5 mm, while the while the occlusal occlusal reduction should reduction should be at least 2.0 be at least 2.0 mm.mm.
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Lab Procedures:Lab Procedures:
The cast is made in the conventional The cast is made in the conventional way, the die is ditched to make the way, the die is ditched to make the margin easier to identify during margin easier to identify during scanning.scanning.
The die is then taken to the The die is then taken to the PROCERA* design station for PROCERA* design station for scanning and designing.scanning and designing.
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A technician using the special A technician using the special Procera design station scans the die Procera design station scans the die and designs the coping to be and designs the coping to be fabricated. This station consists of a fabricated. This station consists of a computer, a modem and the Procera computer, a modem and the Procera scanner. Once positioned on the scanner. Once positioned on the scanner, a probe lightly touches the scanner, a probe lightly touches the die as it is rotated. A 3D map is die as it is rotated. A 3D map is produced from this "tactile scan" that produced from this "tactile scan" that consists of approximately 50,000 data consists of approximately 50,000 data points from around the die. points from around the die.
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The technician then marks the margin The technician then marks the margin or finish line and selects an or finish line and selects an emergence profile for the coping, emergence profile for the coping, using the computer and its’ Procera using the computer and its’ Procera design software. This information is design software. This information is then modemed to the manufacturing then modemed to the manufacturing facility in Fairlawn, New Jersey. In facility in Fairlawn, New Jersey. In about 4 days the Procera coping about 4 days the Procera coping is returned to the laboratory for further is returned to the laboratory for further veneering. veneering.
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The production starts with milling an The production starts with milling an enlarged die to compensate for the enlarged die to compensate for the sintering shrinkage.sintering shrinkage.
An enlarged high-alumina coping is An enlarged high-alumina coping is milled that shrinks to the desired shape milled that shrinks to the desired shape after sintering.after sintering.
The coping is returned to the laboratory, The coping is returned to the laboratory, and body and incisal porcelains are and body and incisal porcelains are added in the conventional manner.added in the conventional manner.
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Lava from 3M ESPELava from 3M ESPE
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EquipmentEquipment
Lava™ Scanner Lava™ Scanner Lava™ Milling Unit Lava™ Milling Unit Lava Therm furnace (sintering Lava Therm furnace (sintering
unit).unit).
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PreparationPreparation
Anterior Crown • 1.5 – 2.0 mm incisal reduction • 1.0 – 1.5 mm lingual reduction • 1.0 – 1.5 mm lingual reduction • Round the internal line angles
Posterior Crown • 1.5 – 2.0 mm occlusal/incisal reduction • 1.0 – 2.0 mm axial reduction
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The optimal preparation is a shoulder or chamfered preparation with a circumferential step or chamfer which must be applied at an angle of >5° (horizontal). The angle of the preparation (vertical) should be 4° or larger. The inside angle of the shoulder preparation must be given a rounded contour.
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Laboratory Preparation Laboratory Preparation A light colored type IV or V die stone (white, A light colored type IV or V die stone (white,
beige, buff, or green) without plastic additives is beige, buff, or green) without plastic additives is recommended. A light, dull (non-reflective) recommended. A light, dull (non-reflective) surface works best for the scanning procedure. surface works best for the scanning procedure.
Model bases should be removable from the Model bases should be removable from the plaster that is used to attach the model to the plaster that is used to attach the model to the articulator. The model bases should be flat, articulator. The model bases should be flat, have minimal thickness and size, in order to have minimal thickness and size, in order to ensure optical accessibility. ensure optical accessibility.
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A common split-cast system is recommended. Attention A common split-cast system is recommended. Attention should be paid to ensure that the base of the model is should be paid to ensure that the base of the model is smooth and flat, without split-cast guides, metal plates smooth and flat, without split-cast guides, metal plates or magnets. or magnets.
Overlapping areas should be blocked out with light Overlapping areas should be blocked out with light colored wax after consultation with a dentist, as should colored wax after consultation with a dentist, as should defects. All segments of the saw-cut model must be defects. All segments of the saw-cut model must be removable from the base with double, triple, or block removable from the base with double, triple, or block pin die system to prevent rotation or movement of the pin die system to prevent rotation or movement of the die(s) and tissue (pontic) areas.die(s) and tissue (pontic) areas.
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Vertical walls and sharp line angles Vertical walls and sharp line angles are difficult for the scanning process are difficult for the scanning process to decipher. Avoid preparations with to decipher. Avoid preparations with these situations (see Ideal Die these situations (see Ideal Die Preparation). Copings or frameworks Preparation). Copings or frameworks for implant abutment posts should for implant abutment posts should also be pinned, removable, and in die also be pinned, removable, and in die stone or acceptable resin die stone or acceptable resin die material. Margins should be ditched material. Margins should be ditched according to Ideal Die Preparation according to Ideal Die Preparation example. example.
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1. 1. Dies should be Dies should be ditched directly below the margin ditched directly below the margin – – DO NOT DO NOT mark the margins, or use die spacer, or mark the margins, or use die spacer, or hardener on the die preparation area.hardener on the die preparation area.This will create a reflective surface on the die that This will create a reflective surface on the die that will compromise the scanned data of the die will compromise the scanned data of the die surface. (Note proper angulation of prep area). surface. (Note proper angulation of prep area).
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Undercuts, occlusal holes, surface defects should be blocked or based-out with a resin block-out material, or a light colored wax. Nodules, stone-tags should be flicked, or scraped off.
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Severely prepped teeth with missing proximal, buccal, lingual walls should be built-up to adequate or desired clinical prep design with a resin block-out material or light colored wax. The model is now ready to be scanned.
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MATERIAL USEDMATERIAL USEDLava™ Frame Zirconia Lava™ Frame Zirconia
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Lava™ Scanner Lava™ Scanner
Consists of a non-contact optical scan system, a PC with a monitor, and the Lava CAD Windows™ based software, which displays the model as a three-dimensional object. www.indiandentalacademy.comwww.indiandentalacademy.com
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Lava™ Milling Unit Lava™ Milling Unit
This computer-controlled precision milling unit can mill out 21 copings or bridge frameworks without supervision or manual intervention.
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Lava™ Therm Furnace Lava™ Therm Furnace
Bridges and crown frameworks undergo sintering and attain their exact dimensions, density, and final strength
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3M ESPE Lava Cementation 3M ESPE Lava Cementation
Cementation of Lava All Ceramic Cementation of Lava All Ceramic restorations can be accomplished with restorations can be accomplished with proven, conventional techniques using any proven, conventional techniques using any of the following cements:of the following cements:3M ESPE RelyX Unicem Self-Adhesive 3M ESPE RelyX Unicem Self-Adhesive Universal Resin CementUniversal Resin Cement3M ESPE RelyX Luting Cement3M ESPE RelyX Luting Cement3M ESPE Ketac-Cem Glass Ionomer 3M ESPE Ketac-Cem Glass Ionomer CementCement
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Cercon® ZirconiaCercon® ZirconiaDentsply CeramcoDentsply Ceramco
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Material: Yttria-stabilized zirconia. Material: Yttria-stabilized zirconia.
Recommended Use: Anterior or Recommended Use: Anterior or posterior single crowns and multi-unit posterior single crowns and multi-unit bridges.bridges.
Lab Processing: Computer Aided Lab Processing: Computer Aided Manufacturing (CAM) of pre-sintered Manufacturing (CAM) of pre-sintered zirconia. zirconia.
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PropertiesProperties: Flexural Strength>900MPa, : Flexural Strength>900MPa, Fracture Toughness=9.0MPa.m0.5, Fracture Toughness=9.0MPa.m0.5, VHN~1200, CTE~10.5 m/m/oC, at 500oC.VHN~1200, CTE~10.5 m/m/oC, at 500oC.
Esthetics:Esthetics: Inherently translucent, metal- Inherently translucent, metal-free restorative solutions for the entire free restorative solutions for the entire mouth. mouth.
Veneering:Veneering: Optimally matched to Optimally matched to Cercon® Ceram S veneering porcelain.Cercon® Ceram S veneering porcelain.
Placement:Placement: Conventional cementation or Conventional cementation or adhesive bonding adhesive bonding
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Cercon units and frameworks are Cercon units and frameworks are fabricated using a CAM (computer fabricated using a CAM (computer aided manufacture) process. The aided manufacture) process. The restoration is first designed in wax restoration is first designed in wax on the model. The waxed on the model. The waxed restoration is then placed in the restoration is then placed in the Cercon Brain for scanning where Cercon Brain for scanning where a confocal laser takes precise a confocal laser takes precise measurements of the pattern. measurements of the pattern.
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The data is then enlarged by the The data is then enlarged by the Cercon Brain by approximately Cercon Brain by approximately 50% to allow for shrinkage that 50% to allow for shrinkage that will take place during the final will take place during the final sintering. The block is then milled sintering. The block is then milled to replicate the expanded pattern to replicate the expanded pattern and is placed in specialized and is placed in specialized sintering furnace where final sintering furnace where final sintering takes place. sintering takes place.
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Technique Technique
1.1. Framework waxup Framework waxup
2.2. Waxup is scanned and milled in the Waxup is scanned and milled in the Cercon Brain Cercon Brain
3.3. Milled pattern ready for sintering Milled pattern ready for sintering
4.4. Pattern is sintered using Cercon Heat Pattern is sintered using Cercon Heat
5.5. Sintered pattern is seated and prepared Sintered pattern is seated and prepared for ceramic layering for ceramic layering
6.6. Completed Cercon Bridge Completed Cercon Bridge www.indiandentalacademy.comwww.indiandentalacademy.com
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Framework waxup Framework waxup
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Waxup is scanned and milled in the Waxup is scanned and milled in the Cercon Brain Cercon Brain
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Milled pattern ready for sintering Milled pattern ready for sintering
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Pattern is sintered using Cercon Pattern is sintered using Cercon Heat Heat
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Sintered pattern is seated and Sintered pattern is seated and prepared for ceramic layering prepared for ceramic layering
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Completed Cercon Bridge Completed Cercon Bridge
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COPY MILLED COPY MILLED RESTORATIONSRESTORATIONS
CELAY* SystemCELAY* System
Mikrona TechnologiesMikrona Technologies
Switzerland.Switzerland.
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Material usedMaterial used
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Procedure:Procedure:
Preparation: Preparation: shoulder with shoulder with rounded rounded axio-cervical axio-cervical line angle.line angle.
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Resin coping:Resin coping:
A prototype composite A prototype composite resin coping is modeled resin coping is modeled on the die.on the die.
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The resin coping modeled with The resin coping modeled with CELAY – TECH is transferred on to CELAY – TECH is transferred on to the scanning / milling platform. the scanning / milling platform.
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Scanning of the prototype resin with Scanning of the prototype resin with simultaneous of the copy milled simultaneous of the copy milled crown substructure.crown substructure.
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The finished The finished sintered sintered substructure substructure after firing after firing onto the die.onto the die.
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GLASS INFILTRATED GLASS INFILTRATED CERAMICSCERAMICS
In-Ceram* AluminaIn-Ceram* AluminaIn-Ceram* SpinellIn-Ceram* SpinellIn-Ceram* ZirconiaIn-Ceram* Zirconiawww.indiandentalacademy.comwww.indiandentalacademy.com
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Introduction:Introduction:
This system use a slip casting (a procedure by This system use a slip casting (a procedure by which a fine particle ceramic, dispersed in an which a fine particle ceramic, dispersed in an aqueous liquid medium (low viscosity slurry) is aqueous liquid medium (low viscosity slurry) is applied on to a porous mold, which rapidly applied on to a porous mold, which rapidly extracts the liquid causing the formation of a extracts the liquid causing the formation of a close packed but a weak ceramic particle close packed but a weak ceramic particle structure.) procedure. Then the slip-casting is structure.) procedure. Then the slip-casting is sinter fired.sinter fired.
The combination of these procedures gives the The combination of these procedures gives the material its outstanding properties.material its outstanding properties.
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Classification:Classification:Reinforcing Reinforcing crystalscrystals
Clinical SystemClinical System Charestrestics Charestrestics
AluminaAlumina In-Ceram In-Ceram Alumina (Vita)Alumina (Vita)
High alumina High alumina coping infused coping infused with a low fusing with a low fusing glassglass
ZirconiaZirconia In-Ceram In-Ceram Zirconia (Vita)Zirconia (Vita)
High Zirconia High Zirconia coping infused coping infused with a low fusing with a low fusing glassglass
Magnesium Magnesium oxide spinelloxide spinell
In-Ceram In-Ceram Spinell (Vita)Spinell (Vita)
High Spinell High Spinell coping infused coping infused with a low fusing with a low fusing glassglass
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Clinical procedureClinical procedure
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Armamentarium:Armamentarium:
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Divide the unprepared labial surface if Divide the unprepared labial surface if the tooth crown into three equal thirds.the tooth crown into three equal thirds.www.indiandentalacademy.comwww.indiandentalacademy.com
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Prepare two depth orientation grooves Prepare two depth orientation grooves on the labial surface of the tooth with a on the labial surface of the tooth with a dual-guided groove cutter.dual-guided groove cutter.www.indiandentalacademy.comwww.indiandentalacademy.com
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Prepare palatal depth orientation Prepare palatal depth orientation grooves.grooves. www.indiandentalacademy.comwww.indiandentalacademy.com
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Prepare two incisal depth orientation Prepare two incisal depth orientation grooves.grooves. www.indiandentalacademy.comwww.indiandentalacademy.com
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Condition after milling of all depth Condition after milling of all depth orientation grooves.orientation grooves.
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Reduction of the hard tooth substance Reduction of the hard tooth substance parallel to the incisal third of the labial parallel to the incisal third of the labial surface between the second and the third surface between the second and the third milled groove.milled groove.www.indiandentalacademy.comwww.indiandentalacademy.com
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Reduction in the area of the labial surface Reduction in the area of the labial surface between the first and the second milled between the first and the second milled groove and thus almost parallel to the path groove and thus almost parallel to the path of insertion.of insertion. www.indiandentalacademy.comwww.indiandentalacademy.com
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Correct preparation of the tooth in two Correct preparation of the tooth in two planes.planes.
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Incorrect preparation; in one plane, Incorrect preparation; in one plane, therefore insufficient reduction of therefore insufficient reduction of substance. Due to that insufficient wall substance. Due to that insufficient wall thickness of crown, crown mat fracture. thickness of crown, crown mat fracture. www.indiandentalacademy.comwww.indiandentalacademy.com
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Incorrect preparation of the tooth Incorrect preparation of the tooth surface lead to the risk of damaging of surface lead to the risk of damaging of the pulp.the pulp. www.indiandentalacademy.comwww.indiandentalacademy.com
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Application area of the proximal cutter.Application area of the proximal cutter.www.indiandentalacademy.comwww.indiandentalacademy.com
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Use of the step cutter with depth stops: Use of the step cutter with depth stops: this cutting tool is to optimize the this cutting tool is to optimize the position and quality of the prepared position and quality of the prepared step.step.
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Palatal side is prepared with a foot ball Palatal side is prepared with a foot ball diamond.diamond.
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Smoothening of the sharp angles using Smoothening of the sharp angles using a bud shaped diamond.a bud shaped diamond.
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Defined marginal Defined marginal reduction of 0.6 – 1.2 reduction of 0.6 – 1.2 mm.mm.
Incisal or occlusal depth Incisal or occlusal depth 1.5 – 2 mm.1.5 – 2 mm.
Shoulder with rounded Shoulder with rounded axio-cervical line angle / axio-cervical line angle / chamfer is indicated in chamfer is indicated in reduced tooth reduced tooth substance.substance.
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Laboratory Working Laboratory Working Procedure Procedure In-Ceram*In-Ceram*
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Model FabricationModel Fabrication
Blocking OutBlocking Out
Applying the interspace varnishApplying the interspace varnish
Waxing up the propWaxing up the prop
DuplicationDuplicationwww.indiandentalacademy.comwww.indiandentalacademy.com
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DeflaskingDeflasking
Stirring VITA INCERAM special plasterStirring VITA INCERAM special plaster
DeflaskingDeflasking
Trimming the plaster modelTrimming the plaster model
Separating the special plaster modelSeparating the special plaster model
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Sectioning the bridge unitsSectioning the bridge units
Preparation marginsPreparation margins
Preparing the slipPreparing the slip
Pouring the slip into a plastic mixing cupPouring the slip into a plastic mixing cup
Applying the slipApplying the slip
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Applying VITA In Ceram StabilizerApplying VITA In Ceram Stabilizer
11stst sintering firing sintering firing
22ndnd sintering firing sintering firing
Checking on the master modelChecking on the master model
Material testingMaterial testing
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Application of glassApplication of glass
Glass infiltration firing of Glass infiltration firing of bridges in VITA INCERAMATbridges in VITA INCERAMAT
Remove excess glassRemove excess glass
Glass control firingGlass control firing
CompletionCompletion
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Model FabricationModel Fabrication
A A working modelworking model with removable dies with removable dies from a high-quality, dimensionally stable from a high-quality, dimensionally stable model stone is prepared.model stone is prepared.www.indiandentalacademy.comwww.indiandentalacademy.com
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A A master modelmaster model that has not been that has not been sectioned is fabricated, for positioning, sectioned is fabricated, for positioning, transferring and checking the crowns transferring and checking the crowns and bridges.and bridges. www.indiandentalacademy.comwww.indiandentalacademy.com
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Preparation for DuplicationPreparation for Duplication
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Check the sawed die carefully for Check the sawed die carefully for undercuts and block out them.undercuts and block out them.
Blocking Out:Blocking Out:
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Applying the interspace Applying the interspace varnish:varnish:
The varnish must be applied to the The varnish must be applied to the plaster diesplaster dies in 2 – 3 coats approx. 45 in 2 – 3 coats approx. 45 microns.microns. www.indiandentalacademy.comwww.indiandentalacademy.com
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Applying the interspace varnish:Applying the interspace varnish:
Epoxy or galvanized dies require 4 Epoxy or galvanized dies require 4 coats approx. 60 microns.coats approx. 60 microns.
! Wait for at least 5 min after each ! Wait for at least 5 min after each application of the varnish. After application of the varnish. After applying the last coat wait for 20 min applying the last coat wait for 20 min to ensure complete drying.to ensure complete drying.
! Do not extend the interspace varnish ! Do not extend the interspace varnish over the shoulder. over the shoulder.
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Waxing up the prop:Waxing up the prop:
For the fabrication of bridgework, a prop For the fabrication of bridgework, a prop must be waxed up palatally in the area of must be waxed up palatally in the area of the pontic.the pontic. www.indiandentalacademy.comwww.indiandentalacademy.com
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The prop facilitates the application of The prop facilitates the application of the slip material and allows increased the slip material and allows increased absorption of liquid and quicker absorption of liquid and quicker extraction during the application of the extraction during the application of the slip.slip.
! The waxed up prop must not have any ! The waxed up prop must not have any under cuts.under cuts.
Waxing up the prop:Waxing up the prop:
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Duplication:Duplication:
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Duplicate with an addition polymerizing Duplicate with an addition polymerizing silicone in a ratio of 1 : 1 using the dual silicone in a ratio of 1 : 1 using the dual impression technique or……impression technique or……www.indiandentalacademy.comwww.indiandentalacademy.com
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Duplicate using the pouring method Duplicate using the pouring method with the help of a duplicating mold.with the help of a duplicating mold.www.indiandentalacademy.comwww.indiandentalacademy.com
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Deflasking:Deflasking:
After deflasking allow the impression to After deflasking allow the impression to harden for approx. 30 min(according to harden for approx. 30 min(according to manufacturer).manufacturer). www.indiandentalacademy.comwww.indiandentalacademy.com
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Spray a wetting agent on to the Spray a wetting agent on to the impression and allow the agent to dry.impression and allow the agent to dry.www.indiandentalacademy.comwww.indiandentalacademy.com
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Stirring the Stirring the VITA In-Ceram* VITA In-Ceram* Special PlasterSpecial Plaster
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Mixing:Mixing:
VITA In-Ceram special plaster 20g : 4.6 VITA In-Ceram special plaster 20g : 4.6 ml distilled water.ml distilled water.www.indiandentalacademy.comwww.indiandentalacademy.com
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Mixing:Mixing:
Pour 4.6 ml of distilled water into the Pour 4.6 ml of distilled water into the mixing beaker, then min the content of mixing beaker, then min the content of the sachet of VITA In-Ceram special the sachet of VITA In-Ceram special plaster by hand. Then mix under plaster by hand. Then mix under vacuum for 20 sec.vacuum for 20 sec.
! Make sure the mixing unit is clean and ! Make sure the mixing unit is clean and dry. The processing time can be dry. The processing time can be lengthened by adding chilled distilled lengthened by adding chilled distilled water. water. www.indiandentalacademy.comwww.indiandentalacademy.com
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Pouring:Pouring:
Pour the plaster in to the mould slowly in Pour the plaster in to the mould slowly in small increments without the formation of air small increments without the formation of air bubbles.bubbles. www.indiandentalacademy.comwww.indiandentalacademy.com
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Preparation for the Preparation for the application of the application of the
SLIPSLIP
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Deflasking:Deflasking:
After filling the special plaster into the After filling the special plaster into the special plaster mold, deflask after 2 hrs.special plaster mold, deflask after 2 hrs.www.indiandentalacademy.comwww.indiandentalacademy.com
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Grinding the special die:Grinding the special die:
After deflasking the base must be ground flat. After deflasking the base must be ground flat. During this, the models must be kept dry.During this, the models must be kept dry.
! Any absorption of water of water on the hardened ! Any absorption of water of water on the hardened special die has a negative effect on the expansion special die has a negative effect on the expansion behavior.behavior.
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Separating the bridge model:Separating the bridge model:
Partly section the special plaster model Partly section the special plaster model from beneath using a separating disc.from beneath using a separating disc.www.indiandentalacademy.comwww.indiandentalacademy.com
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Attaching the bridge model:Attaching the bridge model:
Glue the special plaster bridge model onto a Glue the special plaster bridge model onto a VITA In-Ceram firing tray using cyanoacrylate VITA In-Ceram firing tray using cyanoacrylate adhesive.adhesive. www.indiandentalacademy.comwww.indiandentalacademy.com
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Sectioning the bridge unit:Sectioning the bridge unit:
After approx.10 min, section the plaster model After approx.10 min, section the plaster model between the abutment teeth with a sharp saw between the abutment teeth with a sharp saw blade, in order to prevent damage to the blade, in order to prevent damage to the bridge substructure due to the shrinkage in bridge substructure due to the shrinkage in the plaster during sintering firing.the plaster during sintering firing.
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Margin preparation:Margin preparation:
Mark the margins with a super polymer Mark the margins with a super polymer color cartridge.color cartridge.
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Manufacturing the Manufacturing the SLIP:SLIP:
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Weigh out exactly 38 g of VITA In-Weigh out exactly 38 g of VITA In-Ceram alumina powder.Ceram alumina powder.www.indiandentalacademy.comwww.indiandentalacademy.com
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Pour the contents of 1 ampoule of ZITA In-Pour the contents of 1 ampoule of ZITA In-Ceram alumina mixing liquid and 1 drop of Ceram alumina mixing liquid and 1 drop of VITA In-Ceram Alumina additive into a glass VITA In-Ceram Alumina additive into a glass beaker and mix briefly in the VITASONIC.beaker and mix briefly in the VITASONIC.
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Place the glass beaker on a vibrator Place the glass beaker on a vibrator and spatulate the 38 g of VITA In-and spatulate the 38 g of VITA In-Ceram Alumina powder slowly into the Ceram Alumina powder slowly into the liquid in several small portions.liquid in several small portions.www.indiandentalacademy.comwww.indiandentalacademy.com
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After the entire powder is added, place the After the entire powder is added, place the glass beaker in the VITASONIC for 7 min.glass beaker in the VITASONIC for 7 min.
! After mixing, the slip must be homogenous.! After mixing, the slip must be homogenous.
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The mixture must be evacuated for 1 min. The mixture must be evacuated for 1 min. (e.g. with a vacuum investment unit).(e.g. with a vacuum investment unit).
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Pour the slip from the glass beaker into Pour the slip from the glass beaker into the enclosed plastic mixing cup. the enclosed plastic mixing cup.
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Applying the SLIPApplying the SLIP
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Start to apply the slip in the area of the Start to apply the slip in the area of the pontic.pontic.
Build up to half of the height of the pontic.Build up to half of the height of the pontic.Then coat the abutment dies fully and Then coat the abutment dies fully and
connect them to the pontic. connect them to the pontic. www.indiandentalacademy.comwww.indiandentalacademy.com
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! Proceed rapidly when building up the ! Proceed rapidly when building up the remaining slip.remaining slip.
! Do not interrupt this process, so that drying ! Do not interrupt this process, so that drying out the layers is that have already been built out the layers is that have already been built up is prevented (onion-skin effect). up is prevented (onion-skin effect). www.indiandentalacademy.comwww.indiandentalacademy.com
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Since fine reworking is always required after Since fine reworking is always required after sintering, the slip should be applied more sintering, the slip should be applied more richly prior to sintering firing.richly prior to sintering firing.
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Carefully expose the preparation margin Carefully expose the preparation margin with a scalpel until the marking can be seen.with a scalpel until the marking can be seen.
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Final shaping of the substructure is only Final shaping of the substructure is only carried out after sintering.carried out after sintering.
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Sintering firing:Sintering firing:
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After firing allow the substructures to cool After firing allow the substructures to cool down to 400`C in the closed firing down to 400`C in the closed firing temperature, and then to the room temperature, and then to the room temperature with the furnace opened.temperature with the furnace opened.www.indiandentalacademy.comwww.indiandentalacademy.com
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Sintered substructure:Sintered substructure:
Since the plaster model has contracted Since the plaster model has contracted during firing, the sintered substructure can during firing, the sintered substructure can be easily removed from it.be easily removed from it.
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Checking the fit of the coping on Checking the fit of the coping on the working model:the working model:
Before continuing the work on the Before continuing the work on the working model, remove the interspace working model, remove the interspace varnish.varnish.
In order to check the accuracy of the In order to check the accuracy of the fit, carefully place the sintered fit, carefully place the sintered substructure on the working model substructure on the working model again.again.
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Do not exert pressure Do not exert pressure when placing. when placing.
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Due to dust formation when grinding Due to dust formation when grinding sintered dental ceramic products, always sintered dental ceramic products, always wear a face mask. Work behind a shield wear a face mask. Work behind a shield and use a suction unit.and use a suction unit.
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Due to dust formation when grinding sintered Due to dust formation when grinding sintered dental ceramic products, always wear a face dental ceramic products, always wear a face mask. Work behind a shield and use a mask. Work behind a shield and use a suction unit.suction unit. www.indiandentalacademy.comwww.indiandentalacademy.com
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Adjust contours and functioning by grinding Adjust contours and functioning by grinding slightly(fine diamond, low speeds, minimum slightly(fine diamond, low speeds, minimum pressure). pressure).
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Be cautious in the marginal area, use very Be cautious in the marginal area, use very fine grained diamond or rubber disc at low fine grained diamond or rubber disc at low speed with minimum pressure.speed with minimum pressure.
Contours and functioning must be controlled Contours and functioning must be controlled now, if required adjusted, because no further now, if required adjusted, because no further adjustments can be performed after the glass adjustments can be performed after the glass infiltration firing.infiltration firing.
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Completed substructure:Completed substructure:
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Defect repairDefect repair
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The VITA-In-Ceram Optimizer is a mixture The VITA-In-Ceram Optimizer is a mixture of Aluminum oxide powder and wax and is of Aluminum oxide powder and wax and is used to fill up small defects in ground or used to fill up small defects in ground or slip-coated or sintered In-Ceram crown and slip-coated or sintered In-Ceram crown and bridge substructures.bridge substructures.www.indiandentalacademy.comwww.indiandentalacademy.com
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Separating agent is added onto the die and Separating agent is added onto the die and blow completely dry.blow completely dry.
Take up Vita In-Ceram Alumina Optimizer Take up Vita In-Ceram Alumina Optimizer with an electric wax knife and apply to the with an electric wax knife and apply to the crown margin. crown margin.
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Remove the excess with a paper Remove the excess with a paper napkin and the hot wax knife.napkin and the hot wax knife.
Remove the substructure from the Remove the substructure from the die.die.
Place the substructure on the model Place the substructure on the model again and check the optimizer that again and check the optimizer that has been applied.has been applied.
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Sintering:Sintering:
Fix the substructure on a platinum rod or Fix the substructure on a platinum rod or place it on a fibrous pad firing support co place it on a fibrous pad firing support co that the so that the optimizer will not come that the so that the optimizer will not come into contact with it.into contact with it.www.indiandentalacademy.comwww.indiandentalacademy.com
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Firing chart.Firing chart.
Use ceramic furnaces in which no alloys are fired.Check the fit on the working model.www.indiandentalacademy.comwww.indiandentalacademy.com
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Material testing:Material testing:
To check the sintered substructures for To check the sintered substructures for possible micro-cracks using the Vita In-possible micro-cracks using the Vita In-Ceram testing liquid.Ceram testing liquid.www.indiandentalacademy.comwww.indiandentalacademy.com
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The crown on the left is ok.The crown on the left is ok.The crown on the right must be The crown on the right must be
manufactured once again.manufactured once again.www.indiandentalacademy.comwww.indiandentalacademy.com
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Application of the glass powder:Application of the glass powder:
Mix Vita In-Ceram Alumina glass Mix Vita In-Ceram Alumina glass powder with distilled water to obtain a powder with distilled water to obtain a thin consistency.thin consistency.
Apply 1 – 2 rich coats with a thickness Apply 1 – 2 rich coats with a thickness of 1 – 2 mm only on the outer surface of 1 – 2 mm only on the outer surface of the sintered substructure using a of the sintered substructure using a brush.brush.
The margin of the crown must not be The margin of the crown must not be coated. coated. www.indiandentalacademy.comwww.indiandentalacademy.com
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! During the glass infiltration of ! During the glass infiltration of bridge substructures on platinum bridge substructures on platinum foil, the basal surface of the foil, the basal surface of the pontic must not be covered with pontic must not be covered with glass powder. This can cause air glass powder. This can cause air in the sintered pontic to escape, in the sintered pontic to escape, otherwise complete glass otherwise complete glass infiltration will not take place.infiltration will not take place.
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Glass infiltration firing in Glass infiltration firing in INCERAMAT:INCERAMAT:
Place the crown copings on platinum Place the crown copings on platinum pins in the firing tray, so that the crown pins in the firing tray, so that the crown margins do not come in to contact with margins do not come in to contact with the platinum pin in order to prevent the the platinum pin in order to prevent the glass from penetrating into the interior glass from penetrating into the interior of the crown.of the crown.
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Place the coated crown copings onto a Place the coated crown copings onto a piece of platinum foil (Pt = 95%, Au = piece of platinum foil (Pt = 95%, Au = %5) in order to carry out the glass %5) in order to carry out the glass infiltration firing and preheat shortly.infiltration firing and preheat shortly.www.indiandentalacademy.comwww.indiandentalacademy.com
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Firing chart:Firing chart:
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Glass infiltration firing in the Glass infiltration firing in the VACUMAT:VACUMAT:
The glass infiltration of crown copings can The glass infiltration of crown copings can also be carried out in the dental ceramic also be carried out in the dental ceramic furnace under vacuum.furnace under vacuum.www.indiandentalacademy.comwww.indiandentalacademy.com
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Firing chart:Firing chart:
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Glass infiltration firing of bridge Glass infiltration firing of bridge substructures in INCERAMAT:substructures in INCERAMAT:
Place the coated bridge substructure for the Place the coated bridge substructure for the glass infiltration firing on a piece of platinum glass infiltration firing on a piece of platinum foil of 0.1 mm thick.foil of 0.1 mm thick.www.indiandentalacademy.comwww.indiandentalacademy.com
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Firing chart :Firing chart :
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! In the case of incomplete infiltration – if ! In the case of incomplete infiltration – if there are chalk-like areas – the there are chalk-like areas – the infiltration process should be repeated. infiltration process should be repeated. www.indiandentalacademy.comwww.indiandentalacademy.com
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Remove the excess glass with a coarse Remove the excess glass with a coarse grained diamond instrument or heatless grained diamond instrument or heatless abrasive almost down to the abrasive almost down to the substructure. substructure. www.indiandentalacademy.comwww.indiandentalacademy.com
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Sandblast residual material with 50 microns Sandblast residual material with 50 microns aluminum oxide at a maximum pressure of aluminum oxide at a maximum pressure of approx. 3.0 bar.approx. 3.0 bar.
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Glass control firing:Glass control firing:
Place the substructure on a fibrous pad Place the substructure on a fibrous pad supporting on a Vita firing support W .supporting on a Vita firing support W .
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Firing chart:Firing chart:
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Finishing:Finishing:
After the glass control firing sandblast the After the glass control firing sandblast the crown with 50 microns aluminum oxide at a crown with 50 microns aluminum oxide at a maximum pressure of 3 bar. maximum pressure of 3 bar. www.indiandentalacademy.comwww.indiandentalacademy.com
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Finished substructures:Finished substructures:
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Possible Errors:Possible Errors:
Inadequate fit:Inadequate fit: Insufficiently or incorrectly blocked out.Insufficiently or incorrectly blocked out.
Interspace varnish applied to shoulder.Interspace varnish applied to shoulder.Dies were not repositioned correctly after the Dies were not repositioned correctly after the
application of interspace varnish.application of interspace varnish.Recovery time of silicone not followed.Recovery time of silicone not followed. Distorted impressions.Distorted impressions.Mixing ratios not followedMixing ratios not followed
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Setting time not followed.Setting time not followed. Improper firing temperatures.Improper firing temperatures.Preparation margin not exposed exactly Preparation margin not exposed exactly
after the application of the slip.after the application of the slip. Improperly sandblasted glass.Improperly sandblasted glass.Marginal areas were sandblasted using Marginal areas were sandblasted using
excessive pressure.excessive pressure.
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Fractured bridges:Fractured bridges:
Prop was not waxed up correctly.Prop was not waxed up correctly.Prop has undercuts.Prop has undercuts.Special plaster model was not sawed.Special plaster model was not sawed. Insufficient exposure of prop after Insufficient exposure of prop after
application of slip, slip coated application of slip, slip coated substructures feature micro-cracks. substructures feature micro-cracks.
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Sintering problems:Sintering problems:
Loose flakes in the crown after sintering firing:Loose flakes in the crown after sintering firing:Die was not wetted sufficiently during the Die was not wetted sufficiently during the
application of the first.application of the first.Slip coat (rapid drying-up, consequence: Slip coat (rapid drying-up, consequence:
onion skin effect)onion skin effect)
Glazing, greenish discolorations in the crown:Glazing, greenish discolorations in the crown:Furnace temperature too high.Furnace temperature too high.
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Veneering With Veneering With VITADUR*ALPHAVITADUR*ALPHA
LAYERING TECHNIQUELAYERING TECHNIQUE
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VITA In-Ceram Alumina crown VITA In-Ceram Alumina crown and bridge substructures:and bridge substructures:
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VITA In-Ceram Alumina crown and bridge VITA In-Ceram Alumina crown and bridge substructures ready for veneering.substructures ready for veneering.
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Opaque dentin:Opaque dentin:
Apply the opaque dentin in the required Apply the opaque dentin in the required shade, beginning at the cervical area, to shade, beginning at the cervical area, to cover the entire surface of the substructure.cover the entire surface of the substructure.www.indiandentalacademy.comwww.indiandentalacademy.com
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Completed opaque dentin.Completed opaque dentin.
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Dentin:Dentin:
Dentin is applied and built up to the final Dentin is applied and built up to the final shape of the crown. At this stage the shape of the crown. At this stage the occlusion, laterotrusion and protrusion occlusion, laterotrusion and protrusion should be checked in the articulator.should be checked in the articulator.
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To make enough space for the enamel, it is To make enough space for the enamel, it is necessary to reduce the volume of the necessary to reduce the volume of the dentin accordingly.dentin accordingly.www.indiandentalacademy.comwww.indiandentalacademy.com
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Applying enamel in several small portions to Applying enamel in several small portions to complete the shape of the crown or the complete the shape of the crown or the occlusal surface. The crown should be occlusal surface. The crown should be modeled slightly larger than the actual tooth modeled slightly larger than the actual tooth size to compensate for firing shrinkage. size to compensate for firing shrinkage. www.indiandentalacademy.comwww.indiandentalacademy.com
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In the case of bridges separate the teeth In the case of bridges separate the teeth down to the substructure before the first down to the substructure before the first firing.firing. www.indiandentalacademy.comwww.indiandentalacademy.com
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The finished build up ready for the first The finished build up ready for the first firing.firing. www.indiandentalacademy.comwww.indiandentalacademy.com
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Firing chart:Firing chart:
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302302Bridge after first firingBridge after first firingwww.indiandentalacademy.comwww.indiandentalacademy.com
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Correction layering:Correction layering:
Build up the inter-dental areas and the basal Build up the inter-dental areas and the basal surface of the pontic with Opaque dentin.surface of the pontic with Opaque dentin.
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Complete the contour corrections with Complete the contour corrections with Dentin in the body of the tooth and enamel Dentin in the body of the tooth and enamel in the incisal area.in the incisal area.www.indiandentalacademy.comwww.indiandentalacademy.com
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Firing chart:Firing chart:
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Crown and bridge after correction firing.Crown and bridge after correction firing.www.indiandentalacademy.comwww.indiandentalacademy.com
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Finishing:Finishing:
Trim the bridge or crown. Polish to obtain Trim the bridge or crown. Polish to obtain an even, homogenous surface for the glaze an even, homogenous surface for the glaze firing.firing.
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To guarantee perfect articulation check the To guarantee perfect articulation check the occlusion, protrusion and laterotrusion occlusion, protrusion and laterotrusion once more in the articulator.once more in the articulator.www.indiandentalacademy.comwww.indiandentalacademy.com
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Glaze and stains applied.Glaze and stains applied.www.indiandentalacademy.comwww.indiandentalacademy.com
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Firing Chart:Firing Chart:
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The finished restoration on the model. The finished restoration on the model. Afterwards the interior surfaces of the Afterwards the interior surfaces of the finished restoration must be sandblasted finished restoration must be sandblasted once again with 50 microns aluminum oxide once again with 50 microns aluminum oxide at a maximum pressure of 3 bar.at a maximum pressure of 3 bar.www.indiandentalacademy.comwww.indiandentalacademy.com
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Finished restoration:Finished restoration:
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VITA Individual Layering VITA Individual Layering Technique:Technique:
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Opaque dentin / luminaries:Opaque dentin / luminaries:
Apply the individually shaded opaque Apply the individually shaded opaque dentine and luminaries to the entire labial dentine and luminaries to the entire labial surface.surface.
Enhancing the shade of the crown using Enhancing the shade of the crown using the Vitadur Alpha Luminaries.the Vitadur Alpha Luminaries.
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Washing or mixing in Luminaries, e.g. LM 5 Washing or mixing in Luminaries, e.g. LM 5 in the cervical areas, LM 1 in the middle in the cervical areas, LM 1 in the middle third and LM 3 in the incisal area. Applied in third and LM 3 in the incisal area. Applied in the gingival or incisal area, these dental the gingival or incisal area, these dental ceramics enhance the distribution of light in ceramics enhance the distribution of light in the restoration.the restoration. www.indiandentalacademy.comwww.indiandentalacademy.com
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Applying the DENTINE:Applying the DENTINE:
The dentin is applied in the required The dentin is applied in the required shade . The mamelons can be lightened shade . The mamelons can be lightened mesially and distally with a lighter dentine.mesially and distally with a lighter dentine.www.indiandentalacademy.comwww.indiandentalacademy.com
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Incisal Mirror build-up:Incisal Mirror build-up:
The incisal area is built up to the desired The incisal area is built up to the desired height with T4 (translucent).height with T4 (translucent).www.indiandentalacademy.comwww.indiandentalacademy.com
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Applying Intensive:Applying Intensive:
Intensives can be applied to add individual Intensives can be applied to add individual shading and characterizations.shading and characterizations.
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First intermediate firing:First intermediate firing:
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322322Crown after the first firing.Crown after the first firing.www.indiandentalacademy.comwww.indiandentalacademy.com
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Mainly light shaded Translucent and Cervical Mainly light shaded Translucent and Cervical porcelains are applied for correction.porcelains are applied for correction.
Correction:Correction:
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Correction firing:Correction firing:
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Finishing:Finishing:
After the correction firing, trim and After the correction firing, trim and polish the crown as usual.polish the crown as usual.www.indiandentalacademy.comwww.indiandentalacademy.com
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Glazing:Glazing:
Cover the entire surface of the crown Cover the entire surface of the crown with the glaze material.with the glaze material.www.indiandentalacademy.comwww.indiandentalacademy.com
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Glaze Firing:Glaze Firing:
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Finished restoration:Finished restoration:
Before insertion, the inner surface of the Before insertion, the inner surface of the finished restoration should be sandblasted finished restoration should be sandblasted once more with 50 micron aluminum oxide at once more with 50 micron aluminum oxide at a maximum pressure of approx. 3 bar. a maximum pressure of approx. 3 bar. www.indiandentalacademy.comwww.indiandentalacademy.com
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INJECTION MOLDED / INJECTION MOLDED / PRESSABLE CERAMICSPRESSABLE CERAMICS
IPS EMPRESS* I, IIIPS EMPRESS* I, II
CERESTORE* (ALCERAM)CERESTORE* (ALCERAM)
Summary
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Material:Material:
This is a glass ceramic material that is This is a glass ceramic material that is made up of a glass phase and a leucite made up of a glass phase and a leucite phase. The growth of the leucite crystals phase. The growth of the leucite crystals starts at the grain edges of a ground starts at the grain edges of a ground starting glass. These leucite crystals grow starting glass. These leucite crystals grow in a multi-step fabrication process up to a in a multi-step fabrication process up to a size of few microns. size of few microns.
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Material: ………Material: ………
This semi-finished product in powder form This semi-finished product in powder form is then pressed to ingots and fired. is then pressed to ingots and fired.
The compressive strain resulting from the The compressive strain resulting from the leucite crystal structure in a silicate glass leucite crystal structure in a silicate glass matrix provides increased stability.matrix provides increased stability.
This material is based on a system of…..This material is based on a system of…..SiOSiO22 – Al2O – Al2O33 – K – K22O and complies with ISO O and complies with ISO
6872 ‘Dental Ceramic’.6872 ‘Dental Ceramic’.
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Layering ceramic:Layering ceramic:
This is a sintered glass ceramic which is This is a sintered glass ceramic which is coated upon the lithium disilicate glass coated upon the lithium disilicate glass ceramic framework. This is supplied in ceramic framework. This is supplied in powder form. They have been developed powder form. They have been developed in various versions called ‘Dentin’, ‘Incisal’, in various versions called ‘Dentin’, ‘Incisal’, ‘Impulse, Transpa’, Effect.‘Impulse, Transpa’, Effect.
Their crystalline phase consists of apatite Their crystalline phase consists of apatite (flourapatite). (flourapatite).
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Clinical procedure:Clinical procedure:
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Shade selection:Shade selection:
Tooth cleaning is necessary before shade Tooth cleaning is necessary before shade selection. Do not over dry the tooth.selection. Do not over dry the tooth.
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Tooth preparation:Tooth preparation:
A chamfer / A chamfer / shoulder shoulder preparation (10 preparation (10 – 30`) with – 30`) with rounded inner rounded inner angles.the angles.the width of the width of the circular margin circular margin should be should be approx.1 mm.approx.1 mm.www.indiandentalacademy.comwww.indiandentalacademy.com
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Reduce the axial Reduce the axial walls of the tooth on walls of the tooth on the incisal third of the the incisal third of the crown by approx. 1.5 crown by approx. 1.5 mm.mm.
The incisal or The incisal or occlusal reduction occlusal reduction should be approx. should be approx. 1.5 – 2 mm.1.5 – 2 mm.
Anterior crowns, the Anterior crowns, the labial or palatal labial or palatal reduction should be reduction should be approx. 1 – 1.5 mm. approx. 1 – 1.5 mm.
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Die shade selection:Die shade selection:
The shade of the prepared die is determined using The shade of the prepared die is determined using the Die material shade guide. With the appropriate the Die material shade guide. With the appropriate shade we can fabricate esthetically appealing, true-shade we can fabricate esthetically appealing, true-to-nature restorations. To achieve optimum results, to-nature restorations. To achieve optimum results, the dentin should be moist when the shade is the dentin should be moist when the shade is determined. determined. www.indiandentalacademy.comwww.indiandentalacademy.com
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Impression making:Impression making:
An addition curing silicone or any other An addition curing silicone or any other suitable impression material can be used. suitable impression material can be used.
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Processing procedureProcessing procedure
1. Fabricating the model.
2. Applying the spacer.
3. Connectors.
4. Contouring.
5. Spruing.
6. Investing. www.indiandentalacademy.comwww.indiandentalacademy.com
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7.Furnace calibration.
8.Pressing.
9.Divesting.
10.Control dieing.
11.Foundation firing.
12.Layering, staining, glazing.
13.Etching and cementation.
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Fabricating the model:Fabricating the model:
Fabricate a type IV stone model with Fabricate a type IV stone model with detachable segments according to the detachable segments according to the impression.impression.www.indiandentalacademy.comwww.indiandentalacademy.com
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Applying the spacer:Applying the spacer:
It is advisable to apply a sealer to It is advisable to apply a sealer to harden the surface and to protect the harden the surface and to protect the die. This sealer must not cause any die. This sealer must not cause any changes in the dimensions of the die.changes in the dimensions of the die.
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For single crowns, apply two layers of For single crowns, apply two layers of spacer up to maximum 1 micron spacer up to maximum 1 micron thickness.thickness. www.indiandentalacademy.comwww.indiandentalacademy.com
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Bridge restorations also require two layers Bridge restorations also require two layers of spacer. Apply an additional layer of of spacer. Apply an additional layer of spacer to the intercoronal surfaces of the spacer to the intercoronal surfaces of the abutments (the area facing the pontic). This abutments (the area facing the pontic). This measure helps prevent undesired friction.measure helps prevent undesired friction.www.indiandentalacademy.comwww.indiandentalacademy.com
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IPS Bridge Connectors:IPS Bridge Connectors:
These are prefabricated anatomically These are prefabricated anatomically shaped plastic connectors in six different shaped plastic connectors in six different shapes.shapes.
Used to contour three unit bridges and Used to contour three unit bridges and ensure adequate size of the connector ensure adequate size of the connector between the pontic and bridge abutment.between the pontic and bridge abutment.
IPS connectors C1 – C6 are designed to IPS connectors C1 – C6 are designed to achieve the correct connector dimensions. achieve the correct connector dimensions.
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Areas of application:Areas of application:
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Areas of application:Areas of application:
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Procedure:Procedure:
Select the connector recommended for the Select the connector recommended for the region for which the fabricated bridge is region for which the fabricated bridge is intended and remove it from the harness.intended and remove it from the harness.
Once the bridge abutment has been Once the bridge abutment has been modeled with wax, attach the selected modeled with wax, attach the selected connector to the connecter area between connector to the connecter area between the pontic and the bridge abutment.the pontic and the bridge abutment.
After that, complete modeling the full wax-up After that, complete modeling the full wax-up and secure it with a silicone key.and secure it with a silicone key.
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The modeled bridge is now reduced in a The modeled bridge is now reduced in a targeted fashion. In other words, the area targeted fashion. In other words, the area that will be built up using layering material that will be built up using layering material after the press cycle has to be carefully after the press cycle has to be carefully reduced so that the framework thickness reduced so that the framework thickness measures at least 0.8 mm.measures at least 0.8 mm.
The plastic connector ensures that the The plastic connector ensures that the minimum connector thickness between the minimum connector thickness between the pontic and bridge abutment is automatically pontic and bridge abutment is automatically observed during the reduction process.observed during the reduction process.
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If the labio-lingual portion of the If the labio-lingual portion of the connector reduced, the portion of the connector reduced, the portion of the incisal to the cervical has to be enlarged.incisal to the cervical has to be enlarged.
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The connector area should measure at The connector area should measure at least 16 mmleast 16 mm2.2. 4x4 mm. 4x4 mm.www.indiandentalacademy.comwww.indiandentalacademy.com
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Framework : layering material Framework : layering material thickness:thickness:
In order to achieve the best possible In order to achieve the best possible surface stability by creating ample surface stability by creating ample working parameters and to design working parameters and to design adequate frameworks.adequate frameworks.
The framework must be thicker than The framework must be thicker than the layering materialthe layering material
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Correct : the framework design supports the cusps. Correct : the framework design supports the cusps. The wall thickness of the framework is at least 0.8 The wall thickness of the framework is at least 0.8 mm. Only this design ensures adequate stability.mm. Only this design ensures adequate stability.
•Incorrect : the relationship between the framework and the total space available is not proportional.
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Framework-pontic design:Framework-pontic design:
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Contour:Contour:
Framework design depending upon the Framework design depending upon the space availablespace available
Full Wax-up:Full Wax-up:
Fabricate a full wax-up of the restoration. Use the IPS connectors to ensure the adequate size of the connector area between the pontic and the bridge abutment.
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Wax-up with connector in place:Wax-up with connector in place:
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Wax–up from buccal:Wax–up from buccal:
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Wax-up from palatal:Wax-up from palatal:
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Version A:adequate space Version A:adequate space available:available:
After full wax up, the buccal and the After full wax up, the buccal and the lingual portion of the modeled lingual portion of the modeled framework is reduced in a targeted framework is reduced in a targeted fashion.fashion.
Subsequently reduce the the wax-up Subsequently reduce the the wax-up by the space required for the layering by the space required for the layering material applied after pressing.material applied after pressing.
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The labial viewThe labial view
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The palatal viewThe palatal view
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Final wax framework for Final wax framework for layering:layering:
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Version B: Only limited space Version B: Only limited space available(reduced layering available(reduced layering
technique)technique) If only limited space is available, only the If only limited space is available, only the
buccal and incisal portion of the waxed-up buccal and incisal portion of the waxed-up framework are reduced in a targeted framework are reduced in a targeted fashion. fashion.
The palatal – lingual portion is waxed-up to The palatal – lingual portion is waxed-up to its full contour(anatomical shape).its full contour(anatomical shape).
Minimum thickness between the pontic and Minimum thickness between the pontic and the bridge abutment is the bridge abutment is maintained(connector).maintained(connector).www.indiandentalacademy.comwww.indiandentalacademy.com
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Reduced buccal-incisal portion:Reduced buccal-incisal portion:
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Palatal-lingual portion in its full Palatal-lingual portion in its full contour (anatomical shape):contour (anatomical shape):
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Areas to be built up with Areas to be built up with layering material:layering material:
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Spruing of the framework Spruing of the framework pattern:pattern:
Single crowns:Single crowns:
For single crowns depending on the size For single crowns depending on the size and volume of the wax pattern, attach an and volume of the wax pattern, attach an axial sprue in the direction of flow of the axial sprue in the direction of flow of the ceramic material.ceramic material.
Use round profile 2.5 – 3 mm / 8 gauge: Use round profile 2.5 – 3 mm / 8 gauge: length 3 mm – max 8 mm. length 3 mm – max 8 mm.
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Bridges:Bridges:For 3 unit bridges, attach an 8 gauge round
profile axial wax sprue directly into the abutment teeth at an angle of 45 – 60àpprox.
The attachment points of the sprue to the object and the sprue former must be rounded and smooth. Avoid sharp edges.
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Wax pattern-sprue attachment:Wax pattern-sprue attachment:
-- Pattern angled at 45 60`.
-- The distance between the paper ring and the patter must be at least 10 mm.
-- All sprue attachments are flared and smooth.www.indiandentalacademy.comwww.indiandentalacademy.com
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Correct spruing:Correct spruing:
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Incorrect spruing:Incorrect spruing:
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Incorrect spruing:Incorrect spruing:
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Correct spruing:Correct spruing:
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Correct spruing:Correct spruing:
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Incorrect spruing:Incorrect spruing:
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Correct spruing:Correct spruing:
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Incorrect spruing:Incorrect spruing:
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Incorrect spruing:Incorrect spruing:
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Correct spruing:Correct spruing:
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Incorrect spruing:Incorrect spruing:
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Incorrect spruing:Incorrect spruing:
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Correct spruing:Correct spruing:
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Incorrect spruing:Incorrect spruing:
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Incorrect spruing:Incorrect spruing:
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Ideal spruing:Ideal spruing:
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Investing:Investing:
Investment is carried out with the IPS Investment is carried out with the IPS Empress 2 special investment material.Empress 2 special investment material.
Weigh the ring base (seal the opening Weigh the ring base (seal the opening of the ring base with wax ).of the ring base with wax ).
Position the objects to be pressed on Position the objects to be pressed on the ring base and attach them with wax, the ring base and attach them with wax, weigh again.weigh again.
The difference between the two values The difference between the two values is the weight of the wax used. is the weight of the wax used.
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Large investment ring :Large investment ring :
Up to 1.3g wax weight requires one large Up to 1.3g wax weight requires one large ingot.ingot.
Small investment ring:Small investment ring:
Up to max 0.5 g wax weight requires one Up to max 0.5 g wax weight requires one small ingot.small ingot.
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Remove the protective tape from the new 2-Remove the protective tape from the new 2-in-1 IPS Empress paper ring, form a cylinder in-1 IPS Empress paper ring, form a cylinder exactly along the marked line and press the exactly along the marked line and press the two end together.two end together.www.indiandentalacademy.comwww.indiandentalacademy.com
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Set the paper ring on the base of the Set the paper ring on the base of the investment ring and check it for correct fit. investment ring and check it for correct fit. Use the ring stabilizer to stabilize the paper Use the ring stabilizer to stabilize the paper ring.ring. www.indiandentalacademy.comwww.indiandentalacademy.com
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Mix the special investment material under Mix the special investment material under vacuum according to the instructions. vacuum according to the instructions.
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Fill the paper ring slightly below the Fill the paper ring slightly below the stabilizing ring.stabilizing ring.www.indiandentalacademy.comwww.indiandentalacademy.com
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Remove the stabilizing ring and slowly Remove the stabilizing ring and slowly place the ring gauge on the investment place the ring gauge on the investment with a hinged movement.with a hinged movement.www.indiandentalacademy.comwww.indiandentalacademy.com
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After the setting time, remove the ring gauge After the setting time, remove the ring gauge and the ring base with a turning movement. and the ring base with a turning movement. Remove the paper ring. Remove the rough Remove the paper ring. Remove the rough spots on the bottom surface of the spots on the bottom surface of the investment ring with a plaster knife. investment ring with a plaster knife. www.indiandentalacademy.comwww.indiandentalacademy.com
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Check for 90`angle.Check for 90`angle.www.indiandentalacademy.comwww.indiandentalacademy.com
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Preheating:Preheating:
If several investment rings are preheated If several investment rings are preheated simultaneously, mark them, either with wax simultaneously, mark them, either with wax on the ring base before investing or with a on the ring base before investing or with a fireproof pen after investing.fireproof pen after investing.www.indiandentalacademy.comwww.indiandentalacademy.com
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The ingot support and the aluminum oxide The ingot support and the aluminum oxide plunger is placed in the cold furnace.plunger is placed in the cold furnace.www.indiandentalacademy.comwww.indiandentalacademy.com
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The ingot support and the aluminum The ingot support and the aluminum oxide plunger are placed in the cold oxide plunger are placed in the cold furnace, while the speed investment ring furnace, while the speed investment ring is only placed in the furnace once the is only placed in the furnace once the final temperature has been reached.final temperature has been reached.
When placing the investment ring into When placing the investment ring into the furnace, make sure that the furnace the furnace, make sure that the furnace temperature does not drop down.temperature does not drop down.
But the special investment ring is placed But the special investment ring is placed in the clod furnace with the aluminum in the clod furnace with the aluminum oxide plunger and the ingot support.oxide plunger and the ingot support.
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Do not preheat the Empress investing with Do not preheat the Empress investing with other investment and casting objects (e.g. other investment and casting objects (e.g. soldering models, metal casting rings, etc).soldering models, metal casting rings, etc).
Clean and calibrate the preheat furnace.Clean and calibrate the preheat furnace.www.indiandentalacademy.comwww.indiandentalacademy.com
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Pressing:Pressing:
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Press parameters for EP-500:Press parameters for EP-500:
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Pressing in the EP-600:Pressing in the EP-600:
Programme selection Programme selection for the IPS empress 2 for the IPS empress 2 layering technique by layering technique by pressing F3.pressing F3.
And select the ring And select the ring size.size.
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Placing the ingots:Placing the ingots:
Large investment ring:Large investment ring:
Single restorations: maximum 1 large ingot or 1 Single restorations: maximum 1 large ingot or 1 small ingot.small ingot.
Bridges: Bridges: maximum 1 large ingot. maximum 1 large ingot. Small investment ring:Small investment ring:
Maximum 1 small ingot per pressing cycle.Maximum 1 small ingot per pressing cycle.
Do not use 2 small ingots. Do not use 2 small ingots.
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Remove the ring from the preheating furnace Remove the ring from the preheating furnace immediately after the completion of the immediately after the completion of the preheating cycle. Place the corresponding preheating cycle. Place the corresponding cold ingots for the layering technique in the cold ingots for the layering technique in the investment ring.investment ring. www.indiandentalacademy.comwww.indiandentalacademy.com
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Placement of a large ingot (several Placement of a large ingot (several crowns or bridge)crowns or bridge)www.indiandentalacademy.comwww.indiandentalacademy.com
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After selecting the exact press parameters, After selecting the exact press parameters, Place the investment ring with the ingot, in Place the investment ring with the ingot, in the press furnace and start the process by the press furnace and start the process by closing the head.closing the head.www.indiandentalacademy.comwww.indiandentalacademy.com
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The press cycle runs automatically. A beep The press cycle runs automatically. A beep sound indicates the end of the press cycle.sound indicates the end of the press cycle.www.indiandentalacademy.comwww.indiandentalacademy.com
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Remove the investment ring from the Remove the investment ring from the furnace immediately after the program is furnace immediately after the program is completed and close the furnace. completed and close the furnace.
Place the investment ring on a wide-Place the investment ring on a wide-meshed grid (IPS Empress cooling rack) meshed grid (IPS Empress cooling rack) and allow it to cool to room temperature.and allow it to cool to room temperature.
The grid ensures quick and even cooling of The grid ensures quick and even cooling of the investment ring and prevents undesired the investment ring and prevents undesired heat accumulation.heat accumulation.
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Divesting:Divesting:
After approx. 60 minutes, after cooling, the After approx. 60 minutes, after cooling, the investment ring may shoe cracks. These investment ring may shoe cracks. These cracks are developed during cooling as a cracks are developed during cooling as a result of the different CTE’s of the various result of the different CTE’s of the various materials (the ingot, pressed material, materials (the ingot, pressed material, investment material). investment material).
But do not compromise the result of the But do not compromise the result of the pressing cycle.pressing cycle.
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Mark the length of the plunger on the Mark the length of the plunger on the cooled investment ring.cooled investment ring.www.indiandentalacademy.comwww.indiandentalacademy.com
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Separate the investment ring using a Separate the investment ring using a separating disc. This predetermined separating disc. This predetermined breaking point enables reliable separation of breaking point enables reliable separation of the ingot and the ceramic material.the ingot and the ceramic material.www.indiandentalacademy.comwww.indiandentalacademy.com
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Break the investment ring at the Break the investment ring at the predetermined breaking point using a predetermined breaking point using a plaster knife.plaster knife.www.indiandentalacademy.comwww.indiandentalacademy.com
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Rough divestment is carried carried out with Rough divestment is carried carried out with polishing jet medium at 60 psi pressure.polishing jet medium at 60 psi pressure.www.indiandentalacademy.comwww.indiandentalacademy.com
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For fine divestment, only 2 bar (30 psi) For fine divestment, only 2 bar (30 psi) pressure is applied. pressure is applied. www.indiandentalacademy.comwww.indiandentalacademy.com
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Remove the reaction layer from the Remove the reaction layer from the pressed framework using the invex liquid.pressed framework using the invex liquid.
Immerse the object in invex liquid for Immerse the object in invex liquid for max. 30 min, and thoruoghly rinse the max. 30 min, and thoruoghly rinse the framework with water and blast it with framework with water and blast it with aluminum oxide powder of 100 microns aluminum oxide powder of 100 microns size at 15 psi pressure.size at 15 psi pressure.
If the reaction later is not completely If the reaction later is not completely removed, bubbles may form, which removed, bubbles may form, which subsequently lead to bonding problems subsequently lead to bonding problems and crack in the layering ceramic. and crack in the layering ceramic.
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When When divesting divesting the object, the object, blast from blast from the direction the direction indicated in indicated in the the schematic schematic diagram. diagram.
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Press result after pressing at too low Press result after pressing at too low temperature.temperature.www.indiandentalacademy.comwww.indiandentalacademy.com
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If the temperature of the furnace has If the temperature of the furnace has been set correctly, the pressed objects been set correctly, the pressed objects exhibit only a thin reaction layer that can exhibit only a thin reaction layer that can be easily removed.be easily removed.www.indiandentalacademy.comwww.indiandentalacademy.com
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If the object is pressed at too high If the object is pressed at too high temperature a substantial reaction layer is temperature a substantial reaction layer is forms that is difficult to remove. If the forms that is difficult to remove. If the reaction layer is not completely removed, reaction layer is not completely removed, the bond to the layering material is impaired.the bond to the layering material is impaired.www.indiandentalacademy.comwww.indiandentalacademy.com
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Removing and finishing:Removing and finishing:
Excessive grinding results in local Excessive grinding results in local overheating of the ceramic framework and overheating of the ceramic framework and may lead to micro-crack formation.may lead to micro-crack formation.
Therefore keep grinding to minimum.Therefore keep grinding to minimum.Avoid inhalation of grinding dust.Avoid inhalation of grinding dust.
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Use a fine diamond disk to cut the sprues. Guide Use a fine diamond disk to cut the sprues. Guide the diamond disk through a wet sponge during the diamond disk through a wet sponge during cutting to ensure permanent wetting of the area to cutting to ensure permanent wetting of the area to be ground. In this way, overheating of the ceramic be ground. In this way, overheating of the ceramic framework is avoided. Use ceramic burs to process framework is avoided. Use ceramic burs to process the attachment points of the sprues.the attachment points of the sprues.
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Make sure that the material Make sure that the material thickness is of at least 0.8 mm thickness is of at least 0.8 mm throughout, and never prepare the throughout, and never prepare the framework less than 0.8 mm.framework less than 0.8 mm.
Avoid excessive heating of the Avoid excessive heating of the pressed material.pressed material.
Never use rotary instruments to Never use rotary instruments to clean the framework. Only blast clean the framework. Only blast with aluminum oxide powder (100 with aluminum oxide powder (100 microns at 15 psi). microns at 15 psi).
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Fitting the framework to the die:Fitting the framework to the die:
Remove the spacer prior to fitting the Remove the spacer prior to fitting the pressed framework on the die.pressed framework on the die.
Fine irregularities are carefully removed Fine irregularities are carefully removed with a fine diamond. with a fine diamond.
Margins can be adjusted using diamonds Margins can be adjusted using diamonds or fine emery disks.or fine emery disks.
Always work with cooling. Always work with cooling.
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424424
Control die:Control die:
According to the shade selection, the According to the shade selection, the IPS die material kit is used to enhance IPS die material kit is used to enhance the shading of the restorations.the shading of the restorations.www.indiandentalacademy.comwww.indiandentalacademy.com
425425
Coat the inner surface of the ceramic Coat the inner surface of the ceramic framework with the IPS Empress die framework with the IPS Empress die material isolating liquid. material isolating liquid. www.indiandentalacademy.comwww.indiandentalacademy.com
426426
Apply the corresponding die material to Apply the corresponding die material to the inner surface of the restoration, the inner surface of the restoration, using the die material condenser.using the die material condenser.www.indiandentalacademy.comwww.indiandentalacademy.com
427427
Insert a die holder in to the die material.Insert a die holder in to the die material.Die material is cured with a light Die material is cured with a light
polymerization device.polymerization device.www.indiandentalacademy.comwww.indiandentalacademy.com
428428
Foundation firing:Foundation firing:
Carefully blast the framework with special Carefully blast the framework with special jet medium aluminum oxide powder (100 jet medium aluminum oxide powder (100 microns at 15 psi) prior to foundation firing.microns at 15 psi) prior to foundation firing.
Clean with steam and dry with oil-free air. Clean with steam and dry with oil-free air. Avoid contamination.Avoid contamination.
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429429
The foundation The foundation material(the material(the desired dentin) desired dentin) is applied is applied thinly on the thinly on the entire entire framework.framework.
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430430
Firing chart for foundation firing:Firing chart for foundation firing:
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431431
Framework after firing.Framework after firing.
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432432
Layering diagram:Layering diagram:
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433433Dentin layeringDentin layeringwww.indiandentalacademy.comwww.indiandentalacademy.com
434434And completed with incisal layering.And completed with incisal layering.www.indiandentalacademy.comwww.indiandentalacademy.com
435435
Similar procedure Similar procedure is used for single is used for single crowns.crowns.
Occlusal view of Occlusal view of the completed the completed layering.layering.
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436436
Firing chart for layering material:Firing chart for layering material:
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437437
The temperature for firing this crown The temperature for firing this crown has been set too low. The crown shows has been set too low. The crown shows clear signs of insufficient firing.clear signs of insufficient firing.www.indiandentalacademy.comwww.indiandentalacademy.com
438438
If the restoration exhibits a shining, true-If the restoration exhibits a shining, true-to-nature appearance, it has been fired to-nature appearance, it has been fired with all the firing parameters set correctly. with all the firing parameters set correctly.
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439439
The firing temperature was set too high, the The firing temperature was set too high, the restoration exhibits too much of shining.restoration exhibits too much of shining.
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440440
Staining & characterization:Staining & characterization:
Before starting the staining procedure, Before starting the staining procedure, make sure the restoration is free of dirt and make sure the restoration is free of dirt and grease. A roughened surface is favorable.grease. A roughened surface is favorable.www.indiandentalacademy.comwww.indiandentalacademy.com
441441
Apply the stains as thinly as possible, Apply the stains as thinly as possible, avoid pooling and too thick layers.avoid pooling and too thick layers.www.indiandentalacademy.comwww.indiandentalacademy.com
442442
Firing chart for stains:Firing chart for stains:
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443443
Glazing:Glazing:
Apply the glaze material in the usual Apply the glaze material in the usual manner using a brush. Make sure not to manner using a brush. Make sure not to apply the glaze material either too thick apply the glaze material either too thick or too thin layers.or too thin layers.www.indiandentalacademy.comwww.indiandentalacademy.com
444444
Glaze firing chart:Glaze firing chart:
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445445
Corrective firing:Corrective firing:
This is a low sintering add-on material with medium This is a low sintering add-on material with medium incisal opacity for any necessary corrections. This incisal opacity for any necessary corrections. This material can be used alone or mixed with dentin or material can be used alone or mixed with dentin or incisal powders in the ratio of 50:50.incisal powders in the ratio of 50:50.
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446446
Finished FPD:Finished FPD:palatal viewpalatal view
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447447
Finished FPD:Finished FPD:buccal viewbuccal view
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448448
Finished Finished crown:crown:
buccal/occlusal viewbuccal/occlusal view
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449449
Etching:Etching:
Etching the internal surface is necessary for all IPS Empress restorations, since this procedure increases the shear bond strength between the ceramic material and the composite cement. The fracture resistance is also increased.
Etch the internal surfaces of the restoration for 20 sec using the ceramic etching gel.
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450450
Cementation:Cementation:Generally adhesive cementation is Generally adhesive cementation is
recommended for metal free ceramic recommended for metal free ceramic restorations.restorations.
Conventional GI Cement can also be used, Conventional GI Cement can also be used, if clinical conditions are unsuitable for if clinical conditions are unsuitable for adhesive bonding and if there is sufficient adhesive bonding and if there is sufficient retention is available.retention is available.
The adhesive bonding must be used for the The adhesive bonding must be used for the cementation of restorations made of the cementation of restorations made of the IPS Empress staining technique.IPS Empress staining technique.
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451451
CERESTORE / ALCERAM*CERESTORE / ALCERAM*“Shrink Free Ceramic”“Shrink Free Ceramic”
COORS BIO-MEDICALCOORS BIO-MEDICAL
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Tooth preparation:Tooth preparation:Labial, lingual and interproximal reduction of Labial, lingual and interproximal reduction of
1.25 mm to 1.5 mm: incisal and occlusal 1.25 mm to 1.5 mm: incisal and occlusal reduction of 1.5 mm to 2 mm.reduction of 1.5 mm to 2 mm.
The preferred margin design is a 90`full The preferred margin design is a 90`full shoulder with a rounded gingival axial line shoulder with a rounded gingival axial line angle with a width. of 1mm to 1.5 mm.angle with a width. of 1mm to 1.5 mm.
Feather edge and beveled preparations are Feather edge and beveled preparations are contraindicated.contraindicated.
Conventional impressions are accepted.Conventional impressions are accepted.
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453453
Laboratory technique:Laboratory technique:
The non shrink property of the material The non shrink property of the material encourages a direct approach rather than encourages a direct approach rather than indirect casting. indirect casting.
There is no solidification shrinkage, nor There is no solidification shrinkage, nor the need for control investment expansion.the need for control investment expansion.
Coping are formed by transfer molding the Coping are formed by transfer molding the ceramic directly on to the non shrinking ceramic directly on to the non shrinking heat stable epoxy master die.heat stable epoxy master die.
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Epoxy die material.Epoxy die material.
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Epoxy die kit:Epoxy die kit:
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Investing the epoxy master die Investing the epoxy master die ::
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457457www.indiandentalacademy.comwww.indiandentalacademy.com
458458
Investing with dental plaster in flask:Investing with dental plaster in flask:
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459459www.indiandentalacademy.comwww.indiandentalacademy.com
460460www.indiandentalacademy.comwww.indiandentalacademy.com
461461
Completed flasking:Completed flasking:
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462462
Wax boil out:Wax boil out:
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463463www.indiandentalacademy.comwww.indiandentalacademy.com
464464www.indiandentalacademy.comwww.indiandentalacademy.com
465465www.indiandentalacademy.comwww.indiandentalacademy.com
466466www.indiandentalacademy.comwww.indiandentalacademy.com
467467www.indiandentalacademy.comwww.indiandentalacademy.com
468468www.indiandentalacademy.comwww.indiandentalacademy.com
469469www.indiandentalacademy.comwww.indiandentalacademy.com
470470www.indiandentalacademy.comwww.indiandentalacademy.com
471471www.indiandentalacademy.comwww.indiandentalacademy.com
472472www.indiandentalacademy.comwww.indiandentalacademy.com
473473www.indiandentalacademy.comwww.indiandentalacademy.com
474474
Microprocessor controlled Microprocessor controlled furnace:furnace:
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475475
Finished coping:Finished coping:
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476476
Advantages:Advantages:Marginal integrity generated by direct Marginal integrity generated by direct
molding without distortion during veneer molding without distortion during veneer applications.applications.
Esthetics – depth of color without metal.Esthetics – depth of color without metal.Biocompatible – totally inert core with Biocompatible – totally inert core with
glazed porcelain veneer that is more glazed porcelain veneer that is more resistant to plaque accumulation.resistant to plaque accumulation.
Low thermal conductivity.Low thermal conductivity.Low coefficient of thermal expansion and Low coefficient of thermal expansion and
high modulus of elasticity; protection of high modulus of elasticity; protection of cement seal.cement seal.www.indiandentalacademy.comwww.indiandentalacademy.com
477477
Disadvantages:Disadvantages:
Specialized lab equipment required.Specialized lab equipment required.Tooth preparation requires close attention Tooth preparation requires close attention
to detail.to detail.Not recommended in patients with bruxism Not recommended in patients with bruxism
or inadequate clearance.or inadequate clearance.Contraindicated in long span FPD.Contraindicated in long span FPD.
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478478
Common causes of failure of a Common causes of failure of a Cerestore crown:Cerestore crown:
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479479
Laboratory:Laboratory:
Inadequate coping design. Thin copings Inadequate coping design. Thin copings less than 0.5mm thick, especially on less than 0.5mm thick, especially on occlusal surface of posterior teeth.occlusal surface of posterior teeth.
Failure to die check copings for flaws Failure to die check copings for flaws before veneering.before veneering.
Poor technique in veneer placement.Poor technique in veneer placement. Inappropriate firing temperatures Inappropriate firing temperatures
creating over expansion of the epoxy creating over expansion of the epoxy die or ceramic coping leading to a loose die or ceramic coping leading to a loose fit. fit. www.indiandentalacademy.comwww.indiandentalacademy.com
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Clinical:Clinical:
Unsuitable preparations. Insufficient tooth Unsuitable preparations. Insufficient tooth reduction, sharp line angles causing reduction, sharp line angles causing stress, large undercuts resulting in large stress, large undercuts resulting in large block outs on the master die.block outs on the master die.
Forcing a binding crown to seat, as using Forcing a binding crown to seat, as using a bite stick.a bite stick.
Malocclusions prior to placement.Malocclusions prior to placement.
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481481
SummarySummary
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BibliographyBibliography
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BibliographyBibliography
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