Information provided by Ivoclar Vivadent Inc.

	The use of prefabricated implant abutments offers dental laboratories, their dentists and their patients many benefits. These include the availability of a variety of prefabricated abutment sizes and angulations, as well as the convenience of prepackaged impression analogs and copings.

	Recently introduced prefabricated abutments, such as the Straumann® Anatomic IPS e.max® Abutment, which was developed through a partnership between Ivoclar Vivadent and Straumann, provide exceptional esthetics and performance. The anatomically shaped, bone-level Straumann Anatomic IPS e.max zirconium oxide abutment demonstrates high strength and an exceptional fit that requires little adjustment. As a result, users can deliver the best possible esthetic outcomes to their patients.

	A horizontal offset, a significant design feature of the Straumann Anatomic IPS e.max Abutment, keeps the micro-gap away from the bone. The SLActive surface of the abutment creates osseoconductivity, and the cross-fit connection of the implant ensures a precise and secure fit. Additionally, the cross-fit connection of the Straumann bone level implant provides stability through deep conical connections and proprietary grooves. As a result, there is a clear path of insertion for a consistently predictable fit.

	At the dentist’s office, tooth Nos. 6 through 9 and tooth No. 11 were prepared for IPS e.max lithium disilicate crowns and veneers. A closed tray impression post (Straumann RC) was hand tightened to implant No. 7 (Straumann RC) using the SCS screwdriver. A full-arch impression was taken (

 A soft-tissue model of the implant site was fabricated by applying a soft-tissue material (Gingitech, Ivoclar Vivadent) around the impression post (

). Care was taken to extend the tissue material just past the impression post/analog interface while keeping the material away from margins of adjacent preparations. The impression was poured with ­resin-fortified die stone (ResinRock Ivory, Whip Mix).

 The model was sectioned, trimmed and mounted on an articulator (Stratos 200, Ivoclar Vivadent) for the crown and implant abutment fabrication process (

). Plastic abutments from the Straumann CrossFit PLAN set were tried on the model to determine the correct diameter, gingival height, abutment height and angulation of the Straumann Anatomic IPS e.max Abutment (

). The many options available made the selection process fast and easy, with minimal ­adjustments to the final abutment.

 In this case, a gingival height of 3.5 mm and 15° angled abutment was ordered from the manufacturer (

). The abutment received ­required very little adjustment to proceed with the case. However, any adjustment to a Straumann Anatomic IPS e.max Abutment must be performed with careful consideration to not overheat the abutment. A diamond bur (Zir-Cut, Axis Dental) was used with a highspeed (300,000 rpm) handpiece (NSK Presto Aqua), light pressure, and plenty of water irrigation to keep the abutment cool (

). After minor adjustments to the abutment, the case was ready for full-contour waxup.

The case was waxed up to full final contours with gray sculpturing wax (Yeti Thowax), and the margins were sealed with bordeaux wax (Yeti Thowax Underlining Wax) (

). The full-contour waxup was then invested and pressed in lithium disilicate. The canines Nos. 6 and 11 were pressed with an HTB1 ingot, while incisors Nos. 7 through 10 were pressed with LTB1. The pressed units were divested and placed in an ultrasonic cleaner submersed in IPS e.max Press Invex Liquid for 20 minutes. Each unit was then sandblasted with 50-micron aluminous oxide at 2-bar pressure to remove the reaction layer.

 The sprues were ground off, and each unit was individually seated on the working model (

). The incisal third of the incisors was then cut back for internal staining and porcelain application. Internal staining was achieved using a combination of IPS e.max Ceram shade paste I2, IPS Empress Universal Stain grey, and IPS Empress Universal Stain vanilla (

 Once the stain was fired, an internal mammelon porcelain buildup was completed using IPS e.max Ceram porcelains MM light and OE4 (

). The porcelain was fired at 750°C. The final contours of the incisors were then built in IPS e.max Ceram ­translucent porcelains TI 1 and OE 1 (

 The restorations were fired again at 750°C. Each restoration was adjusted to final contours in the bisque stage, with the proper proportions, line angles and anatomy evaluated (

). Canines Nos. 6 and 11 were stained using IPS Empress Universal Stain shade B1 to match the incisors (

 The restorations were glazed using IPS e.max Ceram Fluorescent Glaze Paste (

). The monolithic canines were fired at 770°C, while the layered incisors were fired at 725°C. The glazed surfaces were polished with first a Pink Dialite Wheel (Brasseler USA), then with Diashine “fine” polishing paste (VH Technologies).

 The restorations were cleaned, dried and acid etched with IPS Ceramic Etching Gel. The final restorations exhibited lifelike contours, translucency and texture (

	The Straumann Anatomic IPS e.max Abutment is a new and convenient tool for dental laboratory technicians to add to their armamentarium. With a combination of features that enable the creation of lifelike esthetic results and soft-tissue contouring that can be appreciated by dentists and patients alike, the IPS e.max Abutment rivals the shape and esthetic value of a custom abutment, without the need for costly equipment. 

Articles

 The use of prefabricated implant abutments offers dental laboratories, their dentists and their patients many benefits. These include the availability of a variety of prefabricated abutment sizes and angulations, as well as the convenience of prepackaged impression analogs and copings.

The best of both worlds

	Telio is a comprehensive, fully integrated product system for temporary restorations designed for dentists, CAD/CAM users and dental technicians. All Telio materials are well suited for the manufacture of conventional and implant-borne temporaries. The materials are compatible with each other and their shades are optimally coordinated.

	Part of the Telio family, Telio Lab is a PMMA-based two-component powder/liquid system for cold polymerization in A-D shades. It is used for fabricating temporary crowns and bridges.
	Telio Lab exhibits optimal polishing properties, resulting in a smooth surface. Stains and/or layering materials can be used to apply final esthetic optimizations. It can be used in conjunction with the casting technique, the injection technique and the fabrication of temporary veneers in conjunction with artificial teeth.

	The technique described here represents a step-by-step for fabricating temporaries using Telio Lab and the casting technique.

 The tooth shape and function are designed with the help of a wax-up (Fig. A) and replicated with a silicone key (Fig. B). The restoration design is key to the temporary’s success.

 Remove the silicone key from the model once it is set and clean off any wax residue from the model. Block out undercuts and cuts between model segments.

 Immerse the model in water for 5 minutes. Then, apply two layers of Separating Fluid. After each layer, wait until the surface is no longer shiny.

 Pour the desired amount of Telio Lab Cold Liquid into a clear mixing beaker. Dispense the same amount of powder into a separate beaker. Add the powder to the Cold Liquid. Use a modeling spatula to mix without creating air bubbles.

 Cover the beaker and allow a dough time of about 2 minutes (Fig. C). Fill the silicone key with Telio Lab Dentin without causing any air bubbles (Fig. D).

 Apply Telio Lab Dentin on the isolated model avoiding air bubbles (Fig. E).

 Place the silicone key on the model in the correct position (Fig. F).

 Once Telio Lab has reached its plastic phase, polymerize the material under pressure in a water bath for 15 minutes at a pressure of 2-6 bar/29-87 psi and a temperature of 104-122°C.

 After polymerization is complete and the restoration has been removed from the silicone key, reduce the Telio Lab restoration’s incisal area with cross-cut burs.

 Check the reduction (cut-back) with the silicone key (Fig. G).

 Blast the surface with aluminum oxide at 2 bar/ 20 psi pressure or roughen with a bur.

 Apply Telio Lab Cold Liquid on the clean surface. Then, condition the surface with SR Composiv to ensure a sound bond between the restoration and Telio Stains (Fig. H). The layer thickness of SR Composiv must be between 0.2 and 0.5 mm. Process for 3 minutes.

 Cure the material in a light-polymerization device and then individualize the incisal area using Telio Stains (Fig. I).

 Use a sponge to remove the inhibition layer (Fig. J).

 Replace the reduced and stained restoration in the silicone key and position it on the wetted and isolated model. Repeat the casting process using Telio Lab incisal materials.

 Use cross-cut tungsten carbide burs to finish the restorations (Fig. K). Avoid overheating the materials.

 The restoration should be tried in on the die and carefully finished. Check proximal and occlusal contact points and make sure the minimum thicknesses are maintained even after minor adjustments.

 Next, polish. When polishing, pay special attention to crown margins, interdental areas, occlusal surfaces and the basal rest area of pontics.

 Polish to a high gloss with a goat hair brush, cotton or leather buffing wheels as well as Universal Polishing Paste (Fig. L).

 Use low speed and limited pressure for high-gloss polishing. Adjust the pressure with the handpiece, not the polishing motor.

 To optimally polish interdental areas and occlusal surfaces, try modifying the goat hair brushes to become star shaped so only the desired areas can be polished.

 Depending on the type of high gloss desired, leather buffing wheels can be used to achieve a high shine, while cotton buffs are used to achieve a lower degree of lustre (Fig. M).

 Telio is a comprehensive, fully integrated product system for temporary restorations designed for dentists, CAD/CAM users and dental technicians. All Telio materials are well suited for the manufacture of conventional and implant-borne temporaries. The materials are compatible with each other and their shades are optimally coordinated.

Find the right system

	Laboratory ceramists and their dentists often are faced with restorative cases that demand the use of a singular material capable of simultaneously providing conservative esthetics and sufficient functional strength. Lithium disilicate is increasingly being used in clinical situations demanding the highest physical and optical characteristics.

	Unlike conventional PFM restorations, lithium disilicate ­restorations are uniformly strong and esthetic and allow dental professionals to provide highly cosmetic restorations in a conservative manner. Additionally, the enhanced strength and presence of a glassy matrix allows dentists to either conventionally cement or adhesively bond lithium disilicate restorations.

 line of ingots expands the restorative possibilities for smile design and is ideal for enamel replacement with minimally invasive preparations. The new Impulse ingots include three Value shaded ingots in an intermediate translucency and two Opal ingots that provide dental professionals with a high level of natural opalescence to beautifully mimic the look of ­natural dentition.

	Created to meet the demands of dental professionals around the world, IPS e.max Press Impulse ingots can be used in single tooth restorations, bridges in the anterior, implant super structures, veneers and thin veneers. With a strength of 400 MPa, IPS e.max Press Impulse ingots demonstrate the same flexural strength of the original IPS e.max Press ingots and can be reliably pressed to as thin as 0.3 mm for veneers.

	The IPS e.max Press ingot product line, originally available in four translucencies (High Translucency, Low Translucency, Medium Opacity, High Opacity) and two sizes, has been greatly expanded with the introduction of IPS e.max Impulse ingots. By providing translucencies and new shades with the same exceptional strength of the original IPS e.max Press ingots, Impulse ingots enable dental professionals to provide their patients with the most functional and life-like esthetics possible in restorations requiring the use of lithium disilicate glass-ceramics.

	Developed with the same quality of Ivoclar Vivadent materials, IPS e.max Ceram Impulse veneering materials are specially developed to create individual characterization. Pressable lithium disilicate restorations (IPS e.max Press, Ivoclar Vivadent) are fabricated utilizing a hot wax press technique, and due to crystal size and length, the flexural strength of pressable lithium disilicate is 400 MPa.

	A healthy 61-year-old woman presented with the intention of replacing the bridge spanning tooth Nos. 10-12 for cosmetic reasons, but didn’t want her otherwise healthy tooth Nos. 6-9 prepared (Fig. A). The right-hand bicuspids (Nos. 4 and 5) previously had been treated with titanium post and cores, but at the time of presentation, the patient was uninterested in post build-ups and desired only composite build-ups.

	However, during a discussion of treatment options, the patient was informed that it would be possible to create a uniform appearance to her smile (i.e., including Nos. 6-9) by keeping tooth preparation to a minimum (e.g., only 0.3 mm). After demonstrating the proposed changes using intraoral mock-ups, she accepted the proposed treatment plan.

	The need to provide patients with minimal preparations while simultaneously addressing esthetic and color blocking issues (e.g., old dark tooth structure from root canal therapy) can require a combination of restorations that range from thin, for esthetics and conservation of tooth structure, to thick, for adequate strength. In this case, the restorative material of choice was lithium disilicate (IPS e.max), and in particular the recently introduced Opal ingot.

	Based on the diagnostic wax-up (Fig. B) and final impressions of the provisional restorations, the laboratory ceramist followed the following protocol to fabricate the lithium disilicate (IPS e.max Press Opal) veneer and bridge restorations:

 A wax-up for pressing was created using a matrix of the provisional model, which was trimmed to remove any areas without clear tissue detail, leaving a small piece of the palatal area to stabilize the matrix during injection.

 The matrix was placed on the model, wax was injected, and the wax was allowed to set for 3 minutes, after which the matrix was removed from the model.

 Using a scaler (Hollenbeck, Kerr Corporation), the margins were exposed, wax removed from the gingival area and any flash from waxing removed.

 After observing the clinical photographs, the midline of the provisional model was marked, along with the incisal edge positions of all teeth, and the width was checked with an electronic caliper (6425A Caliper, Central Tools Inc.).

 The stick-bite photograph then was studied to ensure the midline was in the proper position, and wax was added to create lobes to work with and reinforce the dominant line angle.

 The mesial and distal line angles were built-up with hot wax, followed by the emergence lobes. The middle was then filled, allowing the wax to flow to the newly established areas, ensuring that the middle lobe was high and that the mesial reflected more forward.

 Surface morphology was refined using a wax carving instrument (Premier Dental). After shaping the facial areas, the mesial and middle lobes were refined and their boundaries established.

 The incisal embrasures were worked and opened. Utilizing the back side of the carving instrument, the mesial lobe symmetry was refined. The emergence profile was controlled by building out just enough to set the facial plane and vertical axis.

 At this time, the contacts were checked to ensure they ran all the way to the papilla. To prevent the formation of black triangles, the interproximal areas were extended.

 To separate the embrasures, the contact was melted with the waxing instrument and cut through with a thin porcelain slicing blade (Tanaka Dental Products). The wax was then cut back to allow room for layering ceramic on the facial incisal aspect. Margins were resealed and the ­restorations were sprued for pressing. 

	After the interproximal embrasures were complete, the wax model (Figs. C and D) was sprued, invested and pressed with the appropriate shade of IPS e.max Press Impulse ingot. Then, the following ceramic layering protocol was followed:

 The midline was marked, the incisal edges were refined using a diamond bur (854 Bur, Brasseler USA), and the sprues were removed.

 Utilizing a sharp diamond (Brasseler USA) with light pressure and high speed, a rough reduction was completed to remove any scale layer left from investment. Every surface area of the restorations was freshened with the diamond, since lithium disilicate cannot be sandblasted, as per manufacturer instruction.

 A football-shaped diamond (Brasseler USA) was used to set up the dentin lobes and remove the reaction layer up to the contacts. With a diamond bur (863 Bur, Brasseler USA), the emergence profile and surface was worked to remove any remaining reaction layer and reestablish the desired morphology.

 Once the desired surface morphology was achieved, the color of the restorations was modified using a ceramic stain (IPS e.max Stain, Ivoclar Vivadent) and brush (Tanaka Dental Products), and color was added from the gingival to incisal. A ceramic glaze (Ivoclar Vivadent) was then applied to the restorations, which were fired at 770°F (Fig. E).

 To begin esthetic development, it was necessary to separate the lobes and extend slightly past the cut-back (Fig. F).

 Effect enamels (IPS e.max Ceram) were placed, beginning with Opal (OE 1) to create a silhouette, while translucency was reduced with a translucent incisal (TI 1) ceramic. Keeping the midline straight, the silhouette shape was built with incisal ceramic enamel. To create the mammelon effects, a light-colored ceramic (MM Light) was feathered on the tips of the dentin lobes. Salmon effect enamel (MM Salmon) also was used and carried to the incisal edge (Fig. G).

 Prior to firing, shape, color and value were evaluated and corrections made. The restorations then underwent the first bake (Fig. H).

 After baking, the lithium disilicate restorations underwent full contouring with an Opal enamel ceramic (OE 1) to replace what was cut-back during waxing (Fig. I). The lobe structures were filled and rebuilt to final anatomy prior to the second bake, after which any deficient areas were corrected, beginning at the midline and working out. The incisal embrasures were then reopened and the restorations fired a third time.

 After baking, the lithium disilicate restorations underwent a corrective procedure utilizing adjusting diamonds (Brasseler USA) to modify the contacts at the midline, based on the stick-bite. Excess ceramic was removed from the surfaces, and the incisal was blended into the surface morphology and embrasure form with an 863 diamond bur. Lines from the gingival two-third were extended into the incisal, without over-grinding the stained and glazed pressed ceramic (Fig. J).

 After smoothing the lingual incisal, functional movements were checked with an articulator and articulator paper. Once occlusion was verified, the distal line angle was softened, the lobes began to take form, and a natural flowing contour was created, with incisal spacing smallest at the midline and the dental lobes flowing into the incisal edge. The lobes were smoothed and shaped with soft angles to achieve ideal esthetics (Fig. K).

 Excess material was removed, the restorations were glazed (IPS e.max Glaze, Ivoclar Vivadent), and a final firing was completed at 725°F (Fig. L).

 After firing, excess glaze was removed from the surface with a diamond bur (850-016 Bur, Brasseler USA), beginning at the midline and working out. Minimal adjustments to the contacts were made to ensure a proper seal from the tip of the papilla to the incisal embrasure (Fig. M).

 A polishing wheel (Brasseler Gray, Brasseler USA) and light rubber wheel were used to smooth the surface of the restorations. A diamond strip was used to adjust the interproximal contacts, without pulling it all the way through, which would damage the restorations (Fig. N).

 To achieve a natural appearance, a rubber wheel was used to polish and smooth any high points in the restorations, which were then placed back on the articulator for assessment of functional movements. A diamond paste (Diashine, VH Technologies Ltd.) and a soft bristle brush (Robinson Brush, Bolton Dental Manufacturing Inc.) brought the surface to high luster, making the restorations ready for final cementation (Fig. O).

	Lithium disilicate restorations (IPS e.max) can be conventionally cemented or adhesively bonded. The patient was anesthetized, the provisionals removed, and the preparations thoroughly cleaned. After try-in of the restorations, the internal aspects were conditions with a single-component bonding agent (Excite F single), after which the selected shade of resin cement (Variolink Veneer +3) was applied. Proper isolation and gingival retraction was accomplished, and the preparations were conditioned with the single-component bonding agent (Excite F), desensitized (Gluma, Heraeus Kulzer), and cured. The restorations were seated individually, cured into place, and cleaned with glycerin and dental floss.

	Lithium disilicate restorations (IPS e.max Press) enable dentists to offer patients a conservative alternative for replacing previously placed PFM restorations and transforming the appearance of their smiles. In the case presented here, the patient was very pleased with the function and esthetics of the IPS e.max Press restorations (Fig. P), as well as the fact that only minimal tooth reduction was required.

	For a video of this technique, visit the Team Aesthetics and CMR Dental website at 

 Laboratory ceramists and their dentists often are faced with restorative cases that demand the use of a singular material capable of simultaneously providing conservative esthetics and sufficient functional strength. Lithium disilicate is increasingly being used in clinical situations demanding the highest physical and optical characteristics.

Step-By-Step: IPS e.max Press Impulse

	This case demonstrates placement of highly esthetic indirect restorations using an efficient and reliable adhesive cementation technique. Reducing the risk of debonding, fracture and restorative failure, the all-ceramic and adhesive materials selected provided a stable, durable and long-lasting bond. By carefully considering material such as Ivoclar Vivadent’s Multilink Automix and technique selection, the patient benefited from restorations that demonstrated ideal fit, function and esthetics.

	Demonstrating excellent reliability and durability in the anterior and posterior, Multilink Automix is an innovative and universal, self-cure with an optional light cure luting cement indicated for inlays, onlays, crowns, bridges and posts. Multilink Automix allows cementation of a range of restorative materials including metal and metal ceramics, oxide ceramics, fiber-reinforced composites, precious alloys, and all-ceramics.

	Used with a one-step primer (Multilink A&B, Ivoclar Vivadent) that self-etches, self-cures and seals dentin in 15 seconds, excellent marginal adaption and high immediate bond strengths are achievable. The hydrolytically stable acidic monomers ensure durable adhesion and immediate bonding and reaches complete polymerization in 5-6 minutes without using a curing light.

	Using the Automix delivery system (Ivoclar Vivadent), a consistent mix is achieved without activation capsules or application tools and devices. The “Easy Clean-up” formula allows excess cement to be pre-cured into a gel-like consistency for simpler and more efficient removal.

	The patient presented for functional and esthetic restorations in the posterior and was given a comprehensive esthetic and functional exam. All diagnostic information was gathered and a definitive treatment plan developed. Due to masticatory forces under where the proposed restorations would function, an esthetic lithium disilicate material with high monolithic strength (IPS e.max CAD) that would be fabricated using CAD/CAM technology .

	The teeth were prepared following the manufacturer’s guide for adhesive cementation of CAD/CAM fabricated posterior lithium disilicate crowns. For proper preparation, 1.5 mm to 2.0 mm of occlusal reduction was completed, along with 1.5 mm of axial reduction and 1.0 mm reduction at the gingival margins. The internal line angles were rounded, and a flat-ended tapered diamond bur established a butt-joint margin.

 Prior to seating, the lithium disilicate crowns (Fig. 1) were tried-in to ensure proper fit, function and esthetics. Critical to the success of cementation, a fluid-free field was established using self-supporting cheek-retractors, cotton rolls and dry-angles in the anterior. A latex-free lip and cheek retractor (OptraGate, Ivoclar Vivadent) also was placed to ensure improved visibility and accessibility. For a patient who salivates excessively, place the patient on nasal decongestants (Claritin D/Chlor-Trimeton, Merck & Co.), for one to two days prior to treatment to reduce the risk of salivary contamination.

After achieving complete isolation, the preparations were cleaned with a slurry of water and pumice. If bacterial contamination is a concern, a slurry of pumice and 2% chlorhexidine rinse (Consepsis, Ultradent Products,) may be used based on its antimicrobial effect. The preparations were blot-dried or lightly dried so they remained moist.

Prior to applying the bonding agent, the preparations were checked for moisture and debris. The gingival tissues were examined using a prophylactic angle and micro-tip scrubbing for bleeding, which would contaminate the adhesive cement. After confirming healthy tissue, individual preparation margins were cleaned manually with micro-tip brush scrubbing and the water/pumice slurry. To remove contaminants and the remaining slurry solution, the preparations were irrigated with water and air-dried.

After preparing the dentition, the lithium disilicate crowns were etched with 5% hydrofluoric acid gel (IPS Ceramic Etching Gel, Ivoclar Vivadent) for 20 seconds to remove any remaining contaminants and achieve the manufacturer’s recommended etch pattern (Fig. 2). The crowns were thoroughly rinsed with water and air-dried (Fig. 3).

A silane coupler (Monobond Plus, Ivoclar Vivadent) was placed on the internal crown surfaces and allowed to set for 1 minute (Figs. 4 & 5). Air was used to remove excess material. Then the crowns were ready to be filled with adhesive cement (Multilink Automix) and seated (Fig. 6).

To facilitate a high immediate bond strength, seal the dentin and achieve ideal marginal adaptation, a self-etching and self-curing primer (Multilink A&B) was mixed and applied to prepared dentition. Three drops (1 per restoration) of Multilink A were mixed with 3 drops (1 per restoration) of Multilink B in the provided mixing tray (Figs. 7-9). Using the micro-tip brush, primer solution was scrubbed into each preparation to ensure sufficient coverage (15 seconds on dentition; 30 seconds on enamel).

After applying primer, air was used to remove excess solution and thoroughly dry the surface (Fig. 10).

Immediately following, the self-cure with optional light cure universal adhesive cement (Multilink Automix) was extruded from the automix tip into the first lithium disilicate crown (Fig. 11). The crown was seated on the preparation and firm pressure applied. The remaining restorations were filled and seated consecutively in the same manner (Fig. 12).

The Wave Technique was used to facilitate proper curing and seating. Holding the curing light 2 mm from the crowns and slightly waving it in a single direction from one interproximal area to the next, the cervical and/or buccal surfaces of each crown were cured for 3-4 seconds each. Excess cement was removed from the buccal and interproximal areas with a scaler (Fig. 13). After removing all excess, the cervical aspect of the buccal surfaces of each crown was cured for 5-10 seconds. The lingual were then cured for 3-4 seconds each, and excessive cement removed with the scaler.

	Upon completion, the interproximal areas of all restorations were cleaned with dental floss. The seated crowns were cured for 20 seconds on high power (approximately 1,200 mW/cm2) on both the buccal and lingual surfaces.

	The patient was very pleased with the final lithium disilicate CAD fabricated crowns (IPS e.max CAD) seated intraorally with the universal dual-cure adhesive cement (Multilink Automix).The restorations ultimately provided the function and strength required, along with the esthetics the patient desired (Fig. 14).

 This case demonstrates placement of highly esthetic indirect restorations using an efficient and reliable adhesive cementation technique. Reducing the risk of debonding, fracture and restorative failure, the all-ceramic and adhesive materials selected provided a stable, durable and long-lasting bond. By carefully considering material such as Ivoclar Vivadent’s Multilink Automix and technique selection, the patient benefited from restorations that demonstrated ideal fit, function and esthetics.  About the material

How to seat posterior all-ceramic crowns

	LabShop is a new logistic support tool from Ivoclar Vivadent that includes a scanner option that enables dental laboratories to easily order all of their Ivoclar Vivadent products. This new logistical approach to product ordering combines the simplicity of Web commerce with the information and tools laboratories need for selecting the best in materials-all in just a few clicks.

	Available 24/7, LabShop eliminates time constraints for orders because they can be placed online whenever and wherever laboratories prefer. All actualized information about products and prices is just a click away. Additional information also is available for all products, including direct links to instructions for use, MSDS, commercials and advertisements.

	LabShop features a personalized login that stores order and invoice history, as well as a quick order function that can be completed using only the product number and quantity desired. Additionally, when researching new products, LabShop provides user-friendly, guided product allocation tools that make finding ­products simple.

, you will land on the LabShop homepage as a Guest and can browse the catalog.

 To register or sign in, click the Sign In section (Fig. A).

 After clicking the Sign In button, you can choose from three options:

		Register for a user ID and password. If you choose Please Register, you’ll be directed to a Registration page where you’ll be required to complete all applicable information related to your existing Ivoclar Vivadent customer account. Once submitted, you’ll be advised that you’ll receive your credentials within one business day.

		Sign in as a returning customer (Fig. B). If you’ve already registered, you’ll type in your user ID (e-mail address) and password in the Returning Customer area of the Sign In screen.

		Contact the Customer Support Team by e-mail or phone.

 Once signed in, you’ll land on your personalized homepage (Fig. C), which is interfaced with Ivoclar Vivadent’s Order Entry and Customer Master Data system. This provides your Customer Earned Discount Pricing Structure and Sold To and Ship To accounts.

	In addition to shopping and ordering, you’ll be able to access additional tools and links, including the Corporate Website, Additional Resources, Special Offers, Favorites and Recent History. There also are a number of options for purchasing.

 To shop and order, select a Product Category (Fig. D) on the navigation menu or browse the product category in the main selection area.

 Navigation continues by clicking through the product hierarchy one page at a time.

 Once you’ve arrived at your final product selection (Fig. E), you can complete the ordering process (example: type, shade and quantity) and can quickly add the product selection to your shopping cart (Figs. F and G).

	Another quick option for purchasing is the new easy to use scanner, which provides simple operation and increased capacity. To use this option, scan the product you’d like to buy, plug in and the browser opens LabShop. Log in and all scanned items are already in the quick order selection.

	You also can go to the Quick Order section, which is where all scanned products are immediately populated. Additionally, if you know the Product ID Code, you can search and select the item and simply enter the quantity.

 After the product is added to the cart, it is immediately viewable in the shopping cart area. There is an overview of the product selection listed, with the ability to view all items placed in the cart. You can change quantities or remove product from your cart at this point.

 When you’re finished ordering, you can proceed to Continue Shopping or Check Out Now.

 Once you’ve finished shopping and have clicked the Check Out Now button, you’ll be directed to the Check Out page. A Purchase Order Number (PO#) can be entered and a Shipping Method must be selected at this time. Additionally, you may submit additional information in the Comment Box for special instructions.

 After you’ve selected a Shipping Method all of the items and price details of your order will be displayed, along with the Shipping and Tax amounts, together with your Order Total (Fig. H).

 Finally, based on your earned discount, a savings sticker will be displayed with your current savings on the order. You’ll then be able to click the Confirm Order button, after which you’ll immediately receive a Thank You message and an Order Number. At this point, you can either Logout or Continue to Shop. Your order confirmation is now visible in the order history section or for download.

	On the customer homepage, LabShop provides several Additional Resource links (Fig. I), all of which can be changed as needed: Alloy Configurator; Intercom Case Planner; Reflect Magazine; Education Courses. A Favorites area enables LabShop users to quickly and easily manage favorite products that can be reordered regularly. Additionally, a Recent History area allows easy navigation back to product areas just visited. A Special Offer area changes often and features different promotions.

	LabShop continues Ivoclar Vivadent’s commitment to delivering innovative products and services to its laboratory customers. LabShop users have access to additional benefits, including specials like free/reduced shipping and promotions for LabShop customers only.

 LabShop is a new logistic support tool from Ivoclar Vivadent that includes a scanner option that enables dental laboratories to easily order all of their Ivoclar Vivadent products. This new logistical approach to product ordering combines the simplicity of Web commerce with the information and tools laboratories need for selecting the best in materials-all in just a few clicks.

Shopping made simple

 The lasers’ flexible, ergonomic handpiece, unit-dose tips and procedure-specific programs provide dental professionals with the 

 Equipped with easy-to-use-technology, the battery operated Odyssey Navigator features an 

beneficial for several soft-tissue indications

, including repairing gingival hyperplastic tissue, debriding pockets, second-stage implant surgery and frenectomies.

 Using the Odyssey Navigator for soft-tissue treatments leads to 

significant reduction in periodontal pathogens

as well as improved bleeding on probing and a significant change in periodontal indices.

 after periodontal surgery because these lasers, which are safe for oral tissue structures, result in less post-operative pain and tissue edema

	The Lana Loupe Fit Over Telescope Glasses from Vision USA (visionusa.biz) can be worn over your laser glasses for enhanced vision. They are available in 2.5X and 3.5X magnifications.


	
	1. V.I. Haraszthy et al., "Microbiological Effects of Diode Laser Treatment of Periodontal Pockets" J Dent Res 85(Spec Iss A): 1163, 2006.
	2. J. Sanz et al., "A Diode Laser as an Adjunct to Periodontal Surgery" J Dent Res 88(Spec Iss A): 847, 2009.
	3. S.G. Ciancio et al., "Clinical Effects of Diode Laser Treatment onWound Healing" J Dent Res 85(Spec Iss A): 2183, 2006.

 1. The lasers’ flexible, ergonomic handpiece, unit-dose tips and procedure-specific programs provide dental professionals with the convenience they need in their busy practices.  2. Equipped with easy-to-use-technology, the battery operated Odyssey Navigator features an advanced design and a wireless foot pedal.

5 reasons to buy: Enhanced patient care

In today’s challenging economic climate, more people are experiencing or are at-risk of job loss. Confronted with the growing difficulty of providing basic necessities for themselves and their families, they want every shrinking dollar to count.

While many patients seek cosmetic dental restoration work, these procedures typically aren’t covered by dental insurance, and people may find themselves with more limited financial resources and greater spending restrictions. Yet they still desire-even expect and demand-enhanced esthetics from their dentists. Additionally, patients are concerned about minimally invasive and “reversible” treatments that don’t harm tooth structure.


	To help dentists achieve these patient demands, veneer restorations are well suited for conservative and esthetic enhancement, particularly on anterior dentition. Porcelain veneer restorations provide optimal natural-looking esthetics, are extremely stain-resistant and last for up to 15 years. However, they are expensive at $1,000 to $2,000 per tooth and are a permanent, irreversible solution that may require multiple lengthy office visits for treatment completion, as well as sedation for pain. Additionally, once damaged, porcelain veneers cannot be repaired; they must be replaced.

While there are disadvantages associated with direct composite bonding (e.g., the most technique sensitive dental veneers), the process offers superior control over coloring and contouring for the experienced practitioner, especially on single, anterior dentition. They also are relatively affordable at $350 to $650 per tooth.

Direct/indirect composite resin veneers feature both direct and indirect techniques in reconstruction of restorations with improved physical properties. Current composite materials on the market have enhanced material and optical properties for esthetics and durability. 

 Numerous studies examining factors such as marginal integrity, bond strength, adhesive layer thickness, discoloration and shrinkage of restoration also indicate acceptable results for composite resin restorations. 

 Additionally, many composites can be applied with little or no preparation of tooth structure.

When esthetic concerns are of utmost importance-such as when restorative work is performed on the upper and lower anterior teeth-dentists can achieve superior esthetics, fit and function by combining direct and indirect techniques. The direct/indirect combined procedure is fast, simple and affordable. The efficient process typically requires just 5-to-7-minutes to complete the mock-up, 5-to-7-minutes to polish, and then 5-to-7-minutes to seat, frequently without the need for an anesthetic. Fractural strength and durability also have been found to be satisfactory 

 and clinically acceptable in restorations achieved through a direct/indirect composite method. While composite restorations do demonstrate some degree of degradation (i.e., discoloration, marginal degradation and color mismatching) over time, studies have shown that they provide a relatively stable and effective span of lifetime (i.e., up to 7 years) before requiring touch-ups and/or replacement. 

Repairing, rather than replacing, the restoration has a significantly lower impact on chairside time and discomfort of the procedure. When weighed against its relatively shorter durability compared to other types of restorations, a direct/indirect combination restoration touch-up still remains the more desirable option to many patients. 

It’s also worth noting that bleaching may lead to a negative influence (i.e., degradation of physical properties, marginal integrity, color, and enamel and dentin bond strength) on restorations and restorative materials. Rather than bleaching, periodic touch-ups are recommended for maintenance of satisfactory esthetics and function. 

When maintaining marginal integrity to restore a proper smile line is more of a consideration, the recommended method is the use of adhesive restorations (e.g., primarily direct composite buildups). In cases presenting more extensive tissue loss, discoloration and/or facial morphology, the dentist may suggest veneers and crowns. 

The direct/indirect composite method, also referred to as semi-direct, is ideally suited and indicated for patients with diastemas.

Making direct composite veneers employing a combination of a direct composite technique with indirect shaping and cementing techniques has been discussed and demonstrated by others,

and isn’t unique to the author. However, this technique article demonstrates how the author has modified the indirect/direct technique to best accommodate his patients’ specific needs.


	A college-age female patient presented with diastema. Her before smile depicted post-orthodontic, smaller-size teeth with noticeable gaps between the teeth (Figs. 1 and 2). After a thorough examination of her oral condition and a detailed discussion, it was determined that the patient desired improved esthetic results. However, while at a later date she looked forward to treatment with more comprehensive all-ceramic restorations, at the time, her family budget was limited. In collaborative consultation that took cost into careful account, the author and the patient selected a modified direct/indirect composite resin veneer as the treatment of choice.

Using the IPS Empress Direct Kit composite (Ivoclar Vivadent), the diastema was closed at the midline, and some shape changes were made to the distal of tooth Nos. 8 and 9. In addition, a mock-up was made for tooth Nos. 7 and 10 to achieve a more ideal shape. This was accomplished on a dry tooth without the use of an etch or a bond (Fig. 3). The mock-up was cured (Fig. 4).
	
	After being removed, the mock-up was prepared for chairside adjustments and changes to overall shape (Fig. 5).

The composite restoration that was shaped intraorally was then adjusted, polished and finished outside of the mouth (i.e., indirectly) chairside. Note: At this time, the restoration may be highly polished for optimal smoothness, fit and overall refinement (Fig. 6).

The restoration was then cemented using adhesive with a similar protocol when seating an indirect restoration.

Upon completion, the final smile exhibited superior esthetics. Note the improved arch form and general symmetry. The patient was prescribed a recall visit during her college break for follow-up examination and polish (Figs. 7-10).


	In an unrelated case completed in 2006, the patient was so satisfied with the results that in preparation for her upcoming wedding, she returned for follow-up work. In September of 2011, a touch-up of the facial-incisal of tooth No. 9 was completed. (Figs. 11-12). Thanks to the minor additional touch-up, five years later in 2011, the author was able to give his patient the gift of a radiant smile on her wedding day (Fig. 13). The cost of the touch-up may have been economical, but the confidence gained by the patient on her special day when all eyes were on her could be considered priceless.

As this case illustrates, the direct/indirect resin composite veneer approach is an affordable and time-efficient (between 15 and 30 minutes) alternative for economically stressed patients seeking superior esthetic restorations. Dentists can charge a fair fee and patients can be ensured of a conservative and minimally invasive procedure for smile enhancements that exhibit outstanding results.  
	
	

References
	1. Fahl Júnior N. The direct/indirect composite resin veneers: a case report. Pract Periodontics Aesthet Dent. 1996 Sep;8(7):627-38; quiz 640.
	2. Dietschi D, Devigus A. Prefabricated composite veneers: historical perspectives, indications and clinical application. Eur J Esthet Dent. 2011 Summer;6(2):178-87.
	3. Zorba YO, Bayindir YZ, Barutcugil C. Direct laminate veneers with resin composites: two case reports with five-year follow-ups. J Contemp Dent Pract. 2010 Jul 1;11(4):E056-62.
	4. Cox CF, Tarim B, Kopel H, Gürel G, Hafez A. Technique sensitivity: biological factors contributing to clinical success with various restorative materials. Adv Dent Res. 2001 Aug;15:85-90. Review.
	5. Heintze SD. Systematic reviews: I. The correlation between laboratory tests on marginal quality and bond strength. II. The correlation between marginal quality and clinical outcome. J Adhes Dent. 2007;9 Suppl 1:77-106. Review Erratum in: J Adhes Dent. 2007 Dec;9(6):546.
	6. Pazinatto FB, Atta MT. Influence of differently oriented dentin surfaces and the regional variation of specimens on adhesive layer thickness and bond strength. J Esthet Restor Dent. 2008;20(2):119-28; discussion 129.
	7. Heintze SD, Ruffieux C, Rousson V. Clinical performance of cervical presentations-a meta-analysis. Dent Mater. 2010 Oct;26(10):993-1000. Epub 2010 Jul 16.
	8. Takahashi H, Finger WJ, Wegner K, Utterodt A, Komatsu M, Wöstmann B, Balkenhol M. Factors influencing marginal cavity adaptation of nanofiller containing resin composite restorations. Dent Mater. 2010 Dec;26(12):1166-75. Epub 2010 Sep 29.
	9. Ozcan M, Mese A. Fracture strength of indirect resin composite laminates to teeth with existing restorations: an evaluation of conditioning protocols. J Adhes Dent. 2009 Oct;11(5):391-7.
	10. Gresnigt NM, Ozcan M. Fracture strength of direct versus indirect laminates with and without fiber application at the cementation interface. Dent Mater. 2007 Aug;23(8):927-33. Epub 2006 Oct 6.
	11. Mendonça JS, Neto RG, Santiago, SL, Lauris JR, Navarro ME, de Carvalho, RM. Direct resin composite restorations versus indirect composite inlays: one-year results. J Contemp Dent Pract. 2010 May 1;11(3):025-32.
	12. Gordan VV, Garvan CW, Blaser PK, Mondragon E, Mijör IA. A long-term evaluation of alternative treatments to replacement of resin-based composite restorations: results of a seven-year study. J Am Dent Assoc. 2009 Dec;140(12):1476-84.
	13. Sharif MO, Catleugh M, Merry A, Tickle M, Dunne SM, Brunton P, Aggarwal VR. Replacement versus repair of defective restorations in adults: resin composite. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD005971.
	14. Attin T, Hannig C, Wiegand A, Attin R. Effect of bleaching on restorative materials and restorations-a systematic review. Dent Mater. 2004 Nov;20(9):852-61.
	15. Dietschi D, Argente A. A comprehensive and conservative approach for the restoration of abrasion and erosion. Part II: clinical procedures and case report. Eur J Esthet Dent. 2011 Summer;6(2):142-59.
	16. King KA, Powell L. Quick and easy: Indirect fabrication of composite veneers. J Tenn Dent Assoc. 2010 Spring;90(2):32-4; quiz 34-5.
	17. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent. 2010 Spring;5(1):102-24