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EDITORIAL
Dear Readers,
We live in a disposable society. Its easier to throw things
out than to fix them. We even give it a name we call it
recycling. This is a quote attributed to the American film
director, screenwriter and playwright Neil LaBute. Indeed,
in our society where individuals are trying to upgrade all the
time, repair has gone out of style. This trend towards disposal of objects is supported by the fact that often, replacement is even more economically reasonable than repair.
CONTENT
into account that every restoration is more or less temporary, the factors that count are an extension of a restorations lifespan, a minimally invasive approach causing less
iatrogenic damage and a cost-reduction for the patient.
Useful information on the topic of repair, on decision criteria of when to select this treatment option and on appropriate repair techniques is provided in this issue of the
Espertise Magazine.
Enjoy reading!
In restorative dentistry, we also tend to opt for replacement
instead of repair very often and an economic incentive is
present at least for the dental practitioner: The fees chargeable for total replacement procedures are usually much
higher than those for fixing. However, especially against the
backdrop of demographic changes and due to the enhanced
performance of adhesive technologies, repair is becoming
a useful option in an increasing number of cases. Taking
Scientific Activities
Espertise Experts Conference
translucent effect.
Chairmen Prof. Dr. Jocelyne Feine and Prof. Dr. Reiner Biffar.
tics. In order to preserve natural teeth for a lifeWhat became evident in this context and was spe-
preparation and places indirect CAD/CAM restorations made of materials with a dentin-like modulus of elasticity (composite, 3M ESPE Lava
Ultimate CAD/CAM Restorative). The bonding
agent of choice is 3MESPE Scotchbond
Universal Adhesive.
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magazine
uate curriculum.
Comfortable solutions in
implantology
Due to an increased life expectancy, you will
have to deal with a growing number of partially
or completely edentulous patients. Especially in
individuals with no remaining teeth, difficult anatomical conditions often cause a low retention of
dentures. The concept of placing implant overdentures has proven its worth, however, the
Conclusion
cases.
approaches.
the computer.
nology.
What are the benefits of optical impression
taking for the dental practitioner?
To my mind, one of the most important advantages of optical impressions is that the scan can
be taken in increments. This contributes to an
increased patient comfort and reduces the pres-
Espertise
magazine
tice?
ridge properly. But I am sure that these limitations will soon be overcome.
design etc.
more cost-efficient.
References
van der Meer WJ, Andriessen FS, Wismeijer D, Ren
Y. (2012) Application of Intra-Oral Dental Scanners in the
Digital Workflow of Implantology. PLoS ONE 7(8): e43312.
doi:10.1371/journal.pone.0043312
Contact
Clinical Excellence
3M ESPE Filtek Supreme XTE Universal Restorative
Figure 3: Occlusal view of the anterior teeth after endodontic treatment and internal bleaching.
Patient case
lowing a trauma.
Treatment approach
Treatment plan
In the first step, the palatal area of the central incisors was built up (Fig. 7). For this purpose, a
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to be well-suited. The restorations were subseFor the build-up of the dentin core, a layer of Filtek
Conclusion
Contact
vancalcar@gmail.com
Figure 11: Result after nine months: The anterior teeth are symmetrically shaped.
Adhesive.
in Seefeld, Germany.
Espertise
magazine
S
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as
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et ec
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ia
on
um
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MPa
rc
50
45
40
35
30
25
20
15
10
5
0
Zi
Bond strength of 3M ESPE Scotchbond Universal Adhesive (blue) and a multi-bottle adhesive (purple) to different substrates. Source: C. Thalacker et al., Dent. Mater. Vol. 26, Suppl. 1, 2010, pp. e16-e17.
Adhesive is applied and rubbed in for 20 seconds, air-dried for 5 seconds and light-cured for
of repair procedures.
References
Thalacker C, Eckert AS, Loll H, Krueger DD, Guggenberger R: Bonding Mechanism of a Universal Adhesive to
Glass Ceramic, IADR 2013, #631.
[1]
Background
Repair versus replacement
10
Benefits of repair
Scientific evidence
tability.
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methacrylate-based resin composite and a siloranebased material, were used. In this study, the micro-
References
Loomans BA, Cardoso MV, Opdam NJ, Roeters FJ,
De Munck J, Huysmans MC, Van Meerbeek B. Surface
roughness of etched composite resin in light of composite
repair. J Dent. 2011 Jul; 39(7):499-505. doi: 10.1016/j.
jdent. 2011.04.007. Epub 2011 May 6.
[1]
Palasuk J, Platt JA, Cho SD, Levon JA, Brown DT, and
Hovijitra ST. Effect of Surface Treatments on Microtensile Bond
Strength of Repaired Aged Silorane Resin Composite. Operative
Dentistry: January/February 2013, Vol. 38, No. 1, pp. 91-99.
[5]
Conclusion
Contact
b.loomans@dent.umcn.nl
Micro-hybrid composite
Nano-composite
120
TBS [MPa]
80
40
Di
HF
3%
am
o
3 % nd
bu
H
r
3% F 2
0
HF se
9.
6 % 12 c
0
H
s
Sa F 1 ec
nd 20
37 bla sec
%
s
H ting
3 P
...
O
Co 4 20
C o jet se
c
he
(
si 3 0
m
ve
9.
6 % stre )
H F ng t
12 h
0
se
c
r
12 ol
0
am sec
3 % ond
HF bur
Co 20
j
s
9. et ( ec
6 % 30
37 HF m )
12
%
0
H
C o 3 P O se
c
he 4
si 2 0
ve
se
s
c
9.
6 % tre
ng
HF
th
20
se
c
nt
co
(5
tiv
ga
Sa
Ne
tin
as
bl
40
0
nd
80
Di
TBS [MPa]
120
Results achieved for a micro-hybrid composite (containing barium glass fillers) using
different repair procedures.
Results achieved for a nano-composite (containing zirconia clusters) using different repair procedures.
11
Background
Repair or replacement?
Literature review
Marginal defects
Other failures
material.
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magazine
Repair or replacement?
References
[1]
Conclusion
Dent Mater. 2013 Jan; 29(1): 28-50. doi: 10.1016/j.dental.2012.07.006. Epub 2012 Aug 3.
repair.
[2]
259-72.
[3]
decision-taking [1].
failure.
Clinical problems
Contact
Prof. Dr. Reinhard Hickel
hickel@dent.med.uni-muenchen.de
Repair
Replacement
Marginal staining
Marginal adaptation
1. Marginal problems
Severe marginal demineralization or caries with cavitation and suspected undermining caries but localized and accessible
Surface lustre
Voids or rough surface, cannot be masked by saliva film, simple polishing is not sufficient
Contact point too weak and possible damage due to food impaction or Contact point too weak and/or clear damage due to food impaction
inadequate contour
and repair not feasible/possible
- Chip fractures which damage marginal quality or proximal contact or (Partial or) complete loss of restoration and/or multiple fractures
contour
2. Surface problems
- Bulk fractures with partial loss (less than half) of the restoration
Tooth integrity (enamel cracks, tooth fractures)
13
Background
When to repair and when to replace
14
Direct restorations
Category
Rating
Characteristic
Marginal Integrity
Alpha
No visible evidence of a crevice along the margin into which an explorer will catch
Bravo
The explorer catches a crevice along the margin, but there is no exposure of dentin or base
Charlie
Delta
Alpha
Bravo
Charlie
Alpha
Bravo
Alpha
Bravo
Presence of discolouration at the margins between the restoration and the tooth structure;
discolouration does not penetrate along the margins of the restoration toward the pulp
Charlie
The discolouration penetrated along the margins of the restoration in a pulpal direction
Oscar
Alpha
The restoration is visible, but there is no mismatch in colour, shade and/or translucency
between the restoration and the adjacent tooth structure
Bravo
There is a mismatch in colour, shade or translucency, but not outside the normal range of
tooth colour, shade and/or translucency
Charlie
The mismatch is outside the normal range of tooth colour, shade and/or translucency
Romeo
Sierra
Tango
Surface is deeply pitted or shows irregular grooves, which were not related to the natural
anatomy and could not be refinished
Victor
Anatomic Form
Secondary Caries
Marginal
Discolouration
dental practice, however, seems to depend on different factors: Firstly, repair is carried out more
often in some countries than in others, which might
Colour Match
lum). Secondly, factors such as the size of the restoration and its position in the patients mouth have
an impact on the decision. Also, the original dentist
is more likely to choose for repair than a practitioner
that did not place the restoration. For many dental
practitioners, the lack of objective guidelines for
quality evaluation and the fact that the repair procedure is different depending on the substrate, is
rather confusing. Since dentists are usually paid by
the number of restorations they deliver, every
Surface
Espertise
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Indirect restorations
Metal and glass ceramic restorations can be
alone or polished.
[1]
mance.
References
composite
aging
conditions.
Dent
Mater.
2007;23:1276-282.
[2]
after
[3]
2011;36:563-566.
fluoric acid.
[4]
Conclusion
Chipping of glass ceramic restoration.
[6]
236.
Contact
What is also needed is a simplification of sur-
mutluozcan@hotmail.com
15
16
restorative.
posite resins and glass ceramics in themLava Ultimate blocks for processing with the CEREC system.
Adjustments with light-curable composite mateDuring the CEREC Winter Opening we (the GCZ)
dental practitioners.
Espertise
magazine
17
E-Modulus (GPa)
45
40
35
30
25
20
15
10
0
Leucite-reinforced
glass ceramic
Hybrid ceramic
Resin nano
ceramic
Dentin acc. to
Kinney et al.,
1950-2003 review
Dentin acc. to
Arola et al.,
2006
Dentin acc. to
Plotino et al.,
2007
3M ESPE Internal data measured according to ISO 6872; Dentin: literature data
The elastic modulus of the resin nano ceramic material is similar to that of dentin.
Lava Ultimate
conversation.
References
Koller, M; Arnetzl, GV; Holly, L; Arnetzl, G. Lava
ultimate resin nano ceramic for CAD/ CAM: customization
case study. Int J Comput Dent. 2012; 15(2):159-164.
[1]
Country Insights
Dentistry in ...
18
ment is necessary.
vately.
Denmark.
Practicing dentistry in
Denmark
Insurance system
portion.
general taxation. The cost of dental care is subsidized by the health care system, but the major
cities.
socio-economic status.
tions.
Espertise
Scientific Activities
magazine
a lecturer. While there was a separate German event in the beginning, the contest is
Clinical cases
case. In both the scientific and the clinical categories, the participants have the prospect of winning a
sponsorship for further development of their skills:
The person with the best scientific presentation
situation. In his lecture, he presented a corresponding patient case that is published in this
issue of the Espertise Magazine. The second-
Scientific studies
Conclusion
While the members of the jury agreed that the quality of the lectures was exceptionally high, the par-
19
Clinical Excellence
Digital Rehabilitation Concept
Figure 4: A minimally invasive tooth preparation was necessary in this case due to the high increase in the vertical
dimension of occlusion, the parafunctional habit of the
patient and the high number of existing restorations.
These aspects are combined in the digital rehabilitation concept that was developed by me at the
University of Groningen in collaboration with Prof.
Dr. M. S. Cune, Dr. A. W. J. van Pelt and Dr. U.
Schepke. It is specifically suited for the treatment
of patients with severe tooth wear and includes
technologies for optical impression taking as well
as computer-aided design and manufacturing of
indirect restorations. In this way, a time-efficient
production process is ensured.
The material used in this approach is 3MESPE
Lava Ultimate CAD/CAM Restorative, a highstrength material that is elastic at the same time.
In this way, chewing forces are absorbed by the
material and fractures are unlikely to occur. Due to
a monolithic design, the risk of chipping is eliminated. However, repair is always possible with
light-curing direct composite material. In the following, the Digital Rehabilitation Concept is
explained using a patient case.
Espertise
magazine
21
Figure 15: The patient is very satisfied with the function and
appearance of his restorations. His formerly toothless
appearance has changed significantly.
Contact
Erik-Jan Muts
info@erikjanmuts.nl
Scientific Activities
Lunch and Learn CED-IADR 2013
22
cementation?
Espertise
magazine
conditions.
regarded as uncomplicated.
add?
The latter was also very low for RelyX Unicem. The
cess of a restoration.
conversation.
Main indication
Primary benefits
RelyX Unicem
Main indication
The "all-rounder"
Primary benefits
RelyX Ultimate
Yes, within the PREP Panel (Product Research and
Main indication
Primary benefits
23
Espertise
General Information
magazine
E D I T O R I A L Information
Date
Event
Location
Website
20.02.2014
22.02.2014
Chicago,
USA
www.cds.org/Midwinter_Meeting/
Midwinter_Meeting.aspx
Chicago Dental Society
Gerhard Kultermann
28.02.2014
01.03.2014
Birmingham, United
Kingdom
www.thedentistryshow.co.uk
CloserStill Media Healthcare Ltd
Nicole Jaganosch
06.03.2014
09.03.2014
Guangzhou,
China
www.dentalsouthchina.com/En
Department of Science & Technology
of Guangdong Province
Thorsten-Simon Eickholt
13.03.2014
15.03.2014
Madrid,
Spain
www.ifema.es/expodental_01
IFEMA
Production:
21.03.2014
23.03.2014
Sydney,
Australia
www.adx.org.au
Australian Dental Industry Asscociation
02.04.2014
04.04.2014
Scandefa
Copen
hagen,
Denmark
www.scandefa.dk
Bellacenter
Editor:
Editorial team:
Manuel Meier-Staude
Eva-Maria Popp
Frdric van Vliet
www.eberl.de Immenstadt/Germany
03.04.2014
06.04.2014
Istanbul,
Turkey
www.cnridex.com/en_anasayfa.aspx
CNR EXPO
04.04.2014
06.04.2014
IDEM Singapur
Singapore,
Republic of
Singapore
www.idem-singapore.com
Koelnmesse
21.04.2014
24.04.2014
Moscow,
Russia
www.dental-expo.com/eng/dentalsalon.html
Dental Expo Ltd
16.05.2014
17.05.2014
Vienna,
Austria
www.wid-dental.at/index_EN.htm
sterreichischer Dentalverband
22.05.2014
24.05.2014
Rimini, Italy
www.amicidibrugg.it/
Associazione Amici di Brugg
22.05.2014
24.05.2014
Dental Bern
Bern,
Switzerland
www.dentalbern.ch/index.php?l=en
Swiss Dental Events
3M Deutschland GmbH
09.06.2014
12.06.2014
Sinodental
Beijing,
China
cnc.sinodent.com.cn/en/index.aspx
IHEC
17.06.2014
19.06.2014
3M Deutschland GmbH
Location Seefeld
3M ESPE ESPE Platz
82229 Seefeld Germany
info3mespe@mmm.com
www.3mespe.com
Published by:
Location Seefeld
82229 Seefeld Germany
info3mespe@mmm.com
Dubai
Kenes Asia (Thailand Office)
www.3mespe.com