The Scottsdale Center for Dentistry

1
Welcome

• The Scottsdale Center for Dentistry
• Nothing comes closeand Ive seen them all
• CEO Deans VISION
• Unbiased
• Comprehensive
• Pragmatic
• A home for Continuing Education
• Instructors who support unconditionally
• Develop new relationships
• Where experiences take shape
• A unique learning experience
• State of the Art lecture
• lab facilities
• Fully-functional
• on-site practice

Tonight!
2
Dr. Sameer Puri

• Private Practice in General and
• Esthetic Dentistry, Tarzana California
• CEREC Leadership
• Founder OTS Advanced
• Education Seminars
• Founder Cerec Doctors
• Advanced Cerec Training
• Founder www.CERECDoctors.com
• Online Education
• Meeting Architect Sirona 20th Anniversary CEREC
  Celebration
• 2000 person users meeting in Las Vegas, NV
• Teaches 1000s of doctors each year how to love
  their CEREC.

3
IPS e.max CAD HT coming in October!
4
Emax CAD Indications
5
IPS e.max CAD HT

• Lithium disilicate like LT and MO
• Same physical properties like LT and MO (360
  MPa)
• 9 A-D, 4 Bleach BL shades and 2 sizes (I12, C14)
• 2 fabrication techniques (staining and cut-back
  technique)
• Adhesive, self-adhesive and conventional
  cementation
• Labside and chairside processing

6
IPS e.max CAD Blocks

• Comparison IPS e.max CAD LT before and after
  crystallization

7
Indications

• Veneers
• Anterior and Posterior Crowns

8
IPS e.max CAD Overall concept

• Available in 3 levels of translucency and in 2
  sizes
• HT High Translucency (9 A-D and 4 Bleach BL
  shades)
• LT Low Translucency (9 A-D and 4 Bleach BL
  shades)
• MO Medium Opacity (5 shade groups)

9
IPS e.max CAD Indications

• Inlays
• Onlays
• Veneers
• Partial crowns
• Anterior and posterior crowns
• Primary telescope crowns
• Implant superstructures

10
IPS e.max CAD Block Selection
11
Cementation vs. Strength
12
Aesthetic vs. Strength
13
IPS e.max Press and CADClinical Studies
14
IPS e.max CAD - MO

• Crowns (MO)
• Mörmann, Zurich, CH (3year) 60
• Kelly, UConn, USA 51
• Nathanson, Boston, USA 30
• Sorensen, Portland, USA 20

15
IPS e.max CAD LT crowns

• Reich, Leipzig e.max CAD LT for CEREC
• 41 posterior crowns
• Beuer, München e.max CAD LT for Everest
• 30 crowns (mainly anterior)
• Bindl, Zürich e.max CAD LT for CEREC
• 30 crowns
• Fasbinder, Ann Arbor e.max CAD LT for CEREC
• 61 crowns

16
(No Transcript)
17
(No Transcript)
18
IPS e.max Press and CADEsthetics
19
Translucency Summary
e.max
Empress Esthetic
Empress CAD
HT
LT
HO MO LT HT
20
IPS e.max Translucency Overview
21
CEREC Connect Opening New Opportunities
22
CEREC Connect Digital Dentistry is NOW!
23
(No Transcript)
24
Emax Cad Success
Emax Cad Return Rate 5.4 Emax Cad Remake
Rate 2.3 PFM Single Unit Return Rate 39
higher than Emax Cad LT All Ceramic Single Unit
return rate 49 higher than Emax Cad LT
25
(No Transcript)
26
Factors affecting strength

• Crystallization procedure
• Bulk of material
• Bonding vs. cementation

27
Crystallization of e.max CAD
28

Effect of Heat Treatment on Strength of Dental
Glass-Ceramic Discs
29
Question asked

• What happens if the firing parameters of the
  standard crystallization program are changed?
• Objective
• To examine the effect on biaxial flexure strength
  by altering the heat treatment of the e.max CAD
  by changing the closing time, heating rate and
  long term cooling.

30
Common shortcuts

• Four groups were used for this study
• (1) Control manufacturers instructions
• (2) Rapid Closing - manufacturers instructions
  but the closing time is reduced from 6 min to 18
  s
• (3) Increased Heating Rate - manufacturers
  instructions except the initial heating rate is
  changed from 30ºC/min to 90ºC/min and
• (4) No long term cooling - manufacturers
  instructions except no long term cooling is used.

31
Strength was studied

• An ISO 6782 sized disc (1.2 mm in thickness and
  15.5 mm in diameter) was scanned using the Cerec
  InLab (Sirona). Twenty specimens were milled for
  each group in four shades (five in each of A3,
  A3.5, B1 and BL2) using standard milling. The
  specimens were fired and glazed in one firing
  according to the firing parameters of each group
  in a P500 Programat oven (Ivoclar Vivadent).
  Specimens were tested using a universal testing
  machine (Instron Corporation) at a crosshead
  speed of 0.5 mm/min using a pin on three ball
  configuration.

32
Effect of Treatments
33

Conclusion
Though no statistical difference between the heat
treatment groups due to a large standard
deviation. It was noted that a strength
reduction of 10 to 20 was observed when
deviating from the manufacturers instructions
for firing.
34
Rapid Firing Cycle

• Change close time from 6 minutes to 18 seconds
• Rate of rise from 30-90 seconds
• Cooling rate from 30 to 50
• Will change the cycle from 2740 to 1610
• will result in approximately 20-30 loss of
  strength

35
Restoration Design
The following material thicknesses must be
observed to produce the desired tooth color and
provide adequate strrength
36

Bonding and Thickness Effect on Fracture Load of
CAD/CAM Crowns
37
Question asked

• How does thickness and cementation affect the
  load that a e.max CAD restoration can take?
• Objective
• To measure the fracture load of CAD/CAM lithium
  disilicate glass-ceramic crowns (e.maxCAD,
  Ivoclar Vivadent, Inc.) milled with two
  thicknesses and cemented either conventionally
  (Vivaglass CEM, Ivoclar Vivadent, Inc.) or
  adhesively (Multilink Automix, Ivoclar Vivadent,
  Inc.).

38
Thickness and Cementation Groups

• Four groups were used for this study
• Standard thickness and conventional cementation
• Reduced thickness and conventional cementation
• Standard thickness and adhesive cementation
• Reduced thickness and adhesive cementation.

39
Load to Failure was measured

• Fifteen specimens were produced for each group. A
  standardized molar crown was scanned using the
  Cerec InLab (Sirona). Thirty crowns were designed
  with thicknesses exceeding the minimal dimensions
  for e.maxCAD material (Standard thickness).
  Thirty more crowns were milled with the thickness
  reduced internally by 0.6 mm. The occlusal
  morphology was the same for all the crowns. The
  specimens were then fired and glazed in one
  firing according to the manufacturers
  instructions in a P500 Programat oven (Ivoclar
  Vivadent, Inc.).

Standard Thickness
Reduced Thickness
40
Load to Failure was measured

• The crowns were cemented to composite
  (Heliomolar, Ivoclar Vivadent) preparations which
  were formed from the internal surface of each
  crown using either a conventional cement
  (VivaglassCEM) or an adhesive cement (Multilink
  Automix) and stored in water for 24 h at 37C.
  The crowns were loaded using a 15 mm diameter
  steel ball at a crosshead speed of 0.5 mm/min
  with an Instron Universal Testing machine until a
  crack was produced.

41
Effect of Thickness and Cement Type
42

Conclusion
Within this study, increased thickness and
adhesive cementation greatly increased the
failure load of CAD/CAM lithium disilicate crowns.
43
Lithium Biocompatibility
44
Summary

• ..tended towards increasing cytotoxicity,
  however were less cytotoxic than several commonly
  used composites and comparable to several alloys
  and glass ionomers.

45
CEREC 3D

• Pioneer of single visit CAD/CAM dentistry!
• Over 20 years of unrivaled success!
• Used by 8 of dentists in the US. More dentists
  joining every day!!!

46
CEREC Connect
The Worlds only Network for Digital Dentistry!
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
(No Transcript)
52
(No Transcript)
53
(No Transcript)
54
(No Transcript)
55
(No Transcript)
56
(No Transcript)
57
(No Transcript)
58
(No Transcript)
59
(No Transcript)
60
(No Transcript)
61
(No Transcript)
62
(No Transcript)
63
(No Transcript)
64
(No Transcript)
65
(No Transcript)
66
(No Transcript)