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NEW MATERIALS AND TECHNIQUES IN
PROSTHODONTICSAsbjørn Jokstad, Professor, Dr.Odont.
Department of Prosthodontics and Oral FunctionInstitute of Clinical Dentistry
University of Oslo, Norway
Turkish Dental Association, Istanbul, 24th June 2005
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Fixed Removable
Tooth
ImplantMucosa
Tooth + Mucosa
Turkish Dental Association, Istanbul, 24th June 2005
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New materials & methods
Dental implantsArticulatorsPrecision attachmentsRepairs (Ceram fracture, crown removal, post retrieval, etc.)
Denture fabrication: production, materials, lining & repairs
Laboratory: process & new materials
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New materials & methods–Fixed prostheses1. Rotating instrument
2. Root Post3. Gingival retraction
5. Bite & jaw registration4. Impression
6. Color shade7. Temporary construction
8. Restorative materials9. Production techniques
10. Cementation
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New materials & methods–Fixed prostheses
Axis• Acrylic Adjustment Kit• R.A.P.T.O.R. Resin Sculpting Set• R.A.P.T.O.R.
Brasseler• Acrylic Temporization Kit• Anterior Bur Box• Esthetic Inlay/Onlay• Nixon Inlay/Onlay II• Nixon Porcelain Veneer II Laminate
Veneer System• Ultra Denture Adjustment &
Polishing Kit
CosmedentTop Finisher System
Dentsply/CaulkEnhance Composite Finishing and Polishing System
Nobel BiocareProcera Preparation Kit
Preparation & finishing kits
Preparation & finishing kits
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New materials & methods–Fixed prosthesesRotating instrument
Root Post
1. Cast2. Prefabricated
– Metal– Non-metal
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1. Cast postsIndirect technique
• Impression
Direct technique: Post & resin• Wax• Resin
– Accuset– ExactaCast– Luminex– GC Pattern Resin
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2. Prefabricated posts1. Cast Posts
– Indirect– Direct: Post & resin
2. Prefabricated PostsAdditional core
Metal No YesNon-metal - Yes
> 30 products
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”Core”-materialsBis-core Bisco Dual co.Bisfil core Bisco Light co.Bisfil II Bisco Chem.CoBlue core Teledyne Chem.CoBuild-It! FR Jeneric Dual co.Ceracap Brasseler ceramicClearfil Core Kuraray Chem.Co“ “ PhotoCore Kuraray Light co.
Coradent Vivadent Chem.CoCore Paste Den-Mat Chem.Co
” ” Syringe Den-Mat Dual co.Core-Flo Bisco Chem.CoCoreRestore2 sds/Kerr Dual co.
” ” HDOC sds/Kerr Light co.CoreShade Shofu GIC
CuRay-support Sci-Pharm Dual co.Encore Centrix Chem.CoFluoroCore Dentsply Dual co.Fuji-II LC GC GIC-modif.HardCore Pulpdent Dual co.Infracore Temrex Dual co.Ketac silver 3M ESPE Ag-GICLight-Core Bisco Light co.LuxaCore Auto DMG Dual co.MagnaCore Bosworth Dual co.Microrest Core GC Chem.CoParapost Paracare Coltene Dual co.Rebilda VOCO Chem.CoTi-Core EDS Chem.CoVitremer 3M Espe GIC-modif.
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2. Prefabricated posts, metal
SteelTitanium-alloyTitanium
”Active” – ”Inactive”ConicalParallelSteps
ThreadedSmoothStructured
FlatConicalOvoid
Slots & grooves
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2. Prefabricated post, non-metalFive main groups
1. Ceramic, prefabricated
2. Ceramic, made in thedental laboratory
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Posts made in ceramics
Prefabricated
Biopost (Incermed), ZrOx, D, ~ 1990Cerapost (Brasseler), 1995Cosmopost (Ivoclar), 1998Laboratory
+ ”Cosmopuck” (Ivoclar), 1998 In-Ceram (VITA), 1994
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1. Ceramic, prefabricated
2. Ceramic, made in laboratory
3. ”Black post”, Carbonfibresdispersed in resin
4. ”White post”, Quartsfibresdispersed in resin
5. ”Translucent post”
2. Prefabricated post, non-metalFive main groups:
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Non-metal, non-ceramic posts -many variants
Quarts compositeQuarts+Zirkonium ”resin”(Carbon) epoxiQuarts & Carbon polyester
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New materials & methods–Fixed prosthesesRotating instrument
Root Post
Gingival retraction1. Cord• Impregnated• Non-impregnated
2. Gel/paste3. Cotton4. Electrosurgery5. (Cobber-tube)
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Retraction cords, impregnatedProduct Producer Active substance TypeAltrac VOCO AlCl3Biopak SDI AlCl3 twinnedCrown-Pak Gingi-Pak dl-Adrenalin (4-ply) twinnedGingi-Aid Gingi-Pak Fe2(SO4)3 wovenGingi-Pak Gingi-Pak dl-Adrenalin (2ply- Soft-twist) twinnedGingi-Tract Den-Mat AlSO4, 0.5 mg/i twinnedGingibraid VanR AlKSO4/adrenalin + Aluminium braidedHemalin VOCO AdrenalinHemodent HAWE Premier AlCl3 21% twinnedPascord Pascal AlSO4 twinnedRacestyptin Septodont AlCl3+lignocain braidedRacord Pascal dl-Adren HCl +Znfenolsulfonat 0.3% twinnedRetracto Roeko AlCl3Sil-Trax Pascal AlSO4/dl-adrHCl/dl-adr+Znfenolsulfonat braidedRetreat/II Henry Schein AlSO4/adrenalin twin/braidSulpak Sultan AlK N.F/adrenalin HCl 4% twin/braidTraco VOCO AlCl3 6%Ultrax Sultan AlK N.F/adrenalinHCl 4% /AlK+adr braidedUnibraid VanR Adrenalin-alum braidedZ-twist Gingi-Pak dl-Adrenalin/ AlCl3 woven
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Retraction cord, non-impregnatedAstringedent (Ultradent), First Stop (Stevenson), Gingi-Aid (Gingi-Pak), Gingiva liquid (Roeko), Hemodent (HAWE Premier), Hemo-gin-L (Van R Dent Prod.), Hemo-stat (Henry Schein), Ocu Clear (Health Care Prod), Orostat(Gingi-Pak), Rastringent (Pascal Comp), Racemistat (Pascal Comp), Stasis (Gingi-Pak), Styptin (Van R Dent. Prod), Ultradent Alum Chlor. (Ultradent), ViscoStat (Ultradent), Visine (Pfizer Inc), Wet Pack (Van R Dent. Prod.)
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Expasyl (Kerr /Pierre Roland)
15% Al-Chlorid + Caolin
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Gel-Cord (Pascal)
Retrac
Comprecap (Roeko)
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New materials & methods–Fixed prosthesesRotating instrument
Gingival retraction
Impression
Root Post
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A perfect impression
1. Influence of theimpression material?
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Most commonly used materials in USA
Crowns Inlays
/bridges /onlays
Vinyl siloxane 81% 71%
Alginate 38% 20%
Polyeter 28% 22%
*Dental Products Report Survey, Nov 2000 n= 319 dentists.
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A perfect impression
2. Influence of theimpression technique?
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Method 1 - Dual-archSYN: Dual-arch impression,
Double-arch impression, Triple tray technique, Closed-biteimpression, Double arch single mix impression, Double arch double mix impression
•Occlusion?
•Patientcomfort•Maximumintercuspid•Easy for laboratory•Time
Dual-arch
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SYN: One phase technique, Single phase impression, Medium viscosity technique, Single mix technique, Single mix single impression, Monophase technique
Materials – ex.Aquasil Monophase DentsplyExamix Monophase GCImprint II 3M EspeImpregum F 3M EspeProvil Novo Monophase KulzerPresident System 75 Coltene
Method 2-One polymerisation phase- one viscosity
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Method 3-One polymerisation phase- two viscosities
SYN: Double mix technique, Double mix single impression, Express technique, One step putty wash technique, Sandwich impression, Simultaneous one-step technique, Two phase technique/ impression, Wet/Wet impression
Materials – ex.Aquasil Putty + Reprosil HF Light DentsplyExamix Putty + Examix Regular eller Inject GCExpress Putty + Express Medium 3M EspeImpregum F + Permadyne 3M EspeOptosil Comfort P Plus + Xantopren KulzerPresident Heavy + President (Jet) Light Coltene
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Method 4 –Two polymerisation phases-two viscosities
SYN: Correction impression, Double impression, Double mix double impression, Overlay impression, Putty-wash technique / impression, Two-step putty-wash technique, Wash technique, Wet/Dry impression
Materials – ex.Coltoflax + Coltex Xtrafine ColtenePanasil Heavy + Panasil Regular KettenbachPresident Putty Soft + President (Jet) Light ColteneExamix Putty + Examix Regular GCExpress Putty + Express Medium 3M EspeAquasil Putty + Reprosil HF Light Dentsply
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•Techniquesensitive•Hydraulic•Replacement
•Putty : washhardnesscompatibility?
•Occlusion?
•Hydraulic•Hydraulic•Fast•Patientcomfort•Maximumintercuspid•Easy for laboratory•Time
Two-phase -two stage
Two-phaseSingle-phase
Dual-arch
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Alternative method 5 -”Hydraulic principle”
For upper anterior abutments with fragile gingiva
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Alternativ method 6 -”Laminar” principle(Ref: G Schoenrock (1989)
For lower posterior abutments with dry work field problems
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Alternative method 7 – Tube-section
The safest techniquewhen abutments areperiodontally unstable
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1. Dual-arch1. Metall2. Plastic
2. Other1. Metall2. Plastic3. Individual
A perfect impression
3. Influence of theimpression tray?
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Trays – Dual-arch• Bite Relator (Temrex)• Bite Tray (Kerr)• Exacta• First Bite• Quad-Tray• Tri-Bite (Tri-Bite)• Triple Tray (Premier)
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Trays - metal
Platinated brassSteelTitaniumAluminium
PerforatedUperforated
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Trays – metal
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Trays – metal, for implant prosthodontics
KohlerMedizintechnik
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Trays - plastic
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Most used in USA
Percent used for impressionsCrowns Inlays
/bridges /onlaysVinyl siloxane 81% 71%Alginate 38% 20%Polyeter 28% 22%
Do you ever use individual tray? Yes 73% No 24%
*Dental Products Report Survey, Nov 2000 n= 319 dentists.
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Tray - individualCandulor C-plast Candulor Dental ChemicalCavex Shellac Cavex HeatCitotray Bayer AG LightComtray Schütz Dental LightEasy Tray Kerr HeatErkolen Erkodent Heat/VacuumExtoral Pro-Den LightFastray H Bosworth ChemicalFormatray Kerr ChemicalHygon Premier ChemicalIndivido/Lux VOCO Chemical/LightOstron 100 G-C Dental ChemicalPalatray/LC Hereaus Kulzer Chemical/LightPekatray Bayer ChemicalSpectra-Tray Ivoclar LightSR-Ivolen Ivoclar ChemicalT-LUX Scheu Dental LightTrayAcryl Schütz Dental ChemicalTriad Dentsply Light
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New materials & methods–Fixed prosthesesRotating instrument
Root PostGingival retraction
Bite & jaw registrationImpression
Turkish Dental Association, Istanbul, 24th June 2005
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Bite & jaw registration
Symmetry FacialPlane Relator
JAWS 3D
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New materials & methods–Fixed prosthesesRotating instrument
Root PostGingival retraction
Bite & jaw registrationImpression
Color shade
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• Dental Color Analyser (clearlight.com/~aei)
• Metalor-ikam system (metalor-ikam.com)
• Pocketspec(Pocketspec.com)
• ShadeVision /ShadeRite(X-Rite.com)
• Shadescan(Cynovad.com)
• Spectroshade(mhtint.com)
• ShadeEye NCC (Shofu.com)
• Dental Color Analyser (clearlight.com/~aei)
• Metalor-ikam system (metalor-ikam.com)
• Pocketspec(Pocketspec.com)
• ShadeVision /ShadeRite(X-Rite.com)
• Shadescan(Cynovad.com)
• Spectroshade(mhtint.com)
• ShadeEye NCC (Shofu.com)
Digital Shade SystemsDigital Shade Systems
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Hue
Chroma
Value
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New materials & methods–Fixed prosthesesRotating instrument
Root PostGingival retraction
Bite & jaw registration
Impression
Color shade
Temporary construction
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Bis-Acrylic composite Polymethyl metacrylatePolyethyl methylacrylate
Microfill light cured UDMA composite
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• ……. …………..
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Cool Temp ColteneIntegrity DentsplyLuxatemp Automix DMGProtemp 3 Garant 3M ESPEStructur 2 VOCO GmbHTempofit DetaxTrim II H Bosworth
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Eugenol -containing E.g.Temp-Bond og IRM
Non-eugenol-containingE.g. Nogenol og Dycal
Light & chemical curedE.g. Provilink
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New materials & methods–Fixed prosthesesRotating instrument
Root PostGingival retraction
Bite & jaw registrationImpression
Color shadeTemporary construction
Restorative materials
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Restorative
In-Ceram
LFC-Hi-Au
Procera
Galvano/AGC
Empress
Metal-ceram
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Most used in USA – full ceramics
1. Pressed 63%
(e.g., Empress, OPC)
2. Aluminium-oxide 46%
(e.g., Procera)
3. Lithium disilicate 36%
(e.g., Empress 2)
*Dental Products Report Survey, Nov 2000 n= 319 dentists.
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Fibre-reinforced CompositeLaboratory• FibreKor & Sculpture• Vectris & TargisClinic• Connect & BelleGlass• Fiber-splint• FibreSpan NSI & Nulite• GlasSpan• Ribbond & Revolution• Ribbond Triaxial & Revolution• Splint-it! & Flow-It! & Protect-It!• Stick / Sticknet / Everstick
Glass
Kevlar
Polyethylene
Mesh
Parallel
Twinned
Pre-Impregnated
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New materials & methods–Fixed prosthesesRotating instrument
Root PostGingival retraction
Bite & jaw registrationImpression
Color shadeTemporary construction
Restorative materials
Production techniques
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Production techniques-CAD-CAM (CADCAD--CAM)CAM)
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BEGO Medifacturing BEGO Medical (D)CAD/CAM System etkon (D) CELAY Mikrona Technologie (CH)Cercon® Dentsply/Degudent/Degussa Dental (D)CEREC3/CEREC Inlab Sirona Dental Systems (D)CICERO® Cicero Dental Systems (NL)DCS Precident DCS Dental (CH)DECIM DECIM (S)DENT. CAD/CAM GN-1 GC Corporation (J)digiDENT® Girrbach Dental (D)Everest KaVo Elektrotechnisches (D)Lava® 3M ESPE Dental (D)PRO 50 CYNOVADSM (Can)Procera® Nobel Biocare (S)WOL-CERAM WDT-Wolz-Dental-Technik (D)Xawex Arnold Wohlend (D)
Production techniques- CAD-CAM
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1. Development of materials, e.g Ceramics
0
200
400
600
800
1000
1200
1400
Carrara Core Optec OPC Empress Empress2Vitadur Alfa Carrara Dentin Vintage
Synspar VMK95 Duceram LFCCreation LF InCeram Alum InCeram ZirconiaInCeram Spinell Cerec Mark 2 ZiOxideLava 3M
(Tensile strength, Mpa)
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2. Development of software
CEREC 1 CEREC 2
Time - precision
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3. Development of production units
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New materials & methods–Fixed prosthesesRotating instrument
Root PostGingival retraction
Bite & jaw registrationImpression
Color shadeTemporary construction
Restorative materialsProduction techniques
Cementation
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Water-based - conventional
Zinc-phosphatePolycarboxyla
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Water-based:Glassionomer
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Resinmodified GIC & polyacrylate modified resin
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Light-Cured/Dual-Cure1. Insure/Insure Lite
Cosmedent2. Variolink II
Ivoclar Vivadent3a. Nexus2
sds/Kerr3b. RelyX Veneer Cement
3M ESPE4a. Choice
Bisco4b. Illusion
Bisco5. Calibra
Dentsply/Caulk
Resin CementsResin CementsDual-Cure-Only1. Panavia F
Kuraray2. RelyX ARC
3M ESPE3. Bistite II DC
Tokuyama Soda/J. Morita USA
4. Duo-LinkBisco
5a. Cement-It! Universal C & BPentron
5b. PermaFlo DC Indirect Luting/Restorative ResinUltradent
Self-Cure1. Panavia 21
Kuraray2. Post Cement HI-X
Bisco3a. C & B Metabond
Parkell3b. M-Bond
Tokuyama Soda/J. Morita USA
4. C&B Cement Luting CompositeBisco
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1. Clean surface with H2O2, wash, dry 2. Mix powder and liquid3. Apply cement in crown4. Place crown on prepared tooth5. Wait6. Remove surplus with probe7. Inspect crown margin
Zinkphosphate cement
Thank you for yourkind attention