QDT - Quintessence · QDT2010 Editor-in-Chief SillasDua rte, DDS, MS, PhD QUINTESSENCEOFDENTALTECHNOLOGY. EDITOR-IN-CHIEF SillasDuarteJr,DDS,MS,PhD AssociateProfessor DepartmentofComprehensiveCare

QDT2010

Editor-in-ChiefSillas Duarte, DDS, MS, PhD

QUINTESSENCE OF DENTAL TECHNOLOGY

EDITOR-IN-CHIEFSillas Duarte Jr, DDS, MS, PhDAssociate ProfessorDepartment of Comprehensive CareSchool of Dental MedicineCase Western Reserve UniversityCleveland, Ohio

ASSOCIATE EDITORJin-Ho Phark, DDS, Dr Med DentAssistant ProfessorDepartment of Comprehensive CareSchool of Dental MedicineCase Western Reserve UniversityCleveland, Ohio

EDITORIAL REVIEW BOARDPinhas Adar, CDT, MDTAtlanta, Georgia

Naoki Aiba, CDTMonterey, California

Amir Avishai, PhDCleveland, Ohio

Mike Bellerino, CDTMetairie, Louisiana

Markus B. Blatz, DMD, PhDPhiladelphia, Pennsylvania

Karen Bruggers, DDS, MSCary, North Carolina

Gerard J. Chiche, DDSAugusta, Georgia

Shiro Kamachi, DMDBoston, Massachusetts

Edward A. McLaren, DDSLos Angeles, California

Servando Ramos, DDSUS Army

Avishai Sadan, DMDLos Angeles, California

Thomas J. Salinas, DDSRochester, Minnesota

Tomizaku Tada, CDTPasadena, California

Fabiana Varjão, DDS, MS, PhDCleveland, Ohio

Aki Yoshida, CDTWeston, Massachusetts

Editorial: The Art, the Science, and the Patient 2Sillas Duarte Jr, DDS, MS, PhD

A Tribute: Dr JohnW. McLean, OBE 8Gerard Chiche, DDS/David Winkler, DDS

Endosseous Implant Rehabilitation of Edentulism Using 11High-Strength Ceramics and Component Prosthesis DesignJuan José Gutierrez Riera, DDS, MSD/Albano R. Flores, DDS/Francisco Zarate Rivera, DDS, CDT/Thomas J. Salinas, DDS

Anterior Esthetics and Parafunction: 31A Comprehensive ApproachTyler Lasseigne, DDS, CDT/Hitoshi Aoshima, RDT/Gerard Chiche, DDS

BIOMATERIALS UPDATECeramic Systems: An Ultrastructural Study 42Sillas Duarte Jr, DDS, MS, PhD/Jin-Ho Phark, DDS, Dr Med Dent/Markus Blatz, DDS, PhD, Dr Med Dent Habil/Avishai Sadan, DMD

Minimally Invasive Reconstruction in Implant Therapy: 61The Prosthetic Gingival RestorationChristian Coachman, CCD, CDT/Eric Van Dooren, DDS/Galip Gurel, DDS, MS/Marcelo A. Calamita, DDS, MSc, PhD/Murilo Calgaro, CDT/Juvenal de Souza Neto, CDT

Appropriate Timing and Material Selection in an 76Esthetic RehabilitationMichel Magne, MDT, BS/Inge Magne, CDT, BS/Mamaly Reshad, DDS, MSc

Porcelain Jacket Crowns: Back to the Future Through Bonding 89Pascal Magne, PhD, DMD/Michel Magne, MDT, BS/Inge Magne, CDT

STATE OF THE ARTEsthetic Wax-up 98Tyler P. Lasseigne, DDS, CDT

A Step-by-Step Ultraconservative Esthetic Rehabilitation 114Using Lithium Disilicate CeramicOswaldo Scopin de Andrade, DDS, MSc, PhD/Gilberto A. Borges, DDS, MSc, PhD/Ariovaldo Stefani, DDS/Fábio Fujiy, DDS, CDT/Paulo Battistella, CDT

2010

PUBLISHERH.W. Haase

EXECUTIVE VICE-PRESIDENTWilliam G. Hartman

JOURNAL DIRECTORLori A. Bateman

PRODUCTION EDITORPatrick Penney

ADVERTISING SALESWilliam G. Hartman

ADVERTISING/EDITORIAL/SUBSCRIPTION OFFICEQuintessence Publishing Co, Inc4350 Chandler DriveHanover Park, Illinois 60133Phone: (630) 736-3600Toll-free: (800) 621-0387Fax: (630) 736-3633E-mail: [email protected]: http://www.quintpub.com

QDT is published once a year byQuintessence Publishing Co, Inc,4350 Chandler Drive, Hanover Park,Illinois, 60133. Price per copy: $84.

MANUSCRIPT SUBMISSIONQDT publishes original articles coveringdental laboratory techniques and methods.See Guidelines for Authors atwww.quintpub.com for submission informa-tion.

Copyright © 2010 by Quintessence Pub-lishing Co, Inc. All rights reserved. No partof this publication may be reproduced ortransmitted in any form or by any means,electronic or mechanical, including photo-copying, recording, or any informationand retrieval system, without permission inwriting from the publisher. The publisherassumes no responsibility for unsolicitedmanuscripts. All opinions are those of theauthors. Reprints of articles published inQDT can be obtained from the authors.

Permission to photocopy items solely forinternal or personal use and for the inter-nal or personal use of specific clients isgranted by Quintessence Publishing Co,Inc, for libraries and other users registeredwith the Copyright Clearance Center(CCC) Transaction Reporting Service, pro-vided that the base fee of $5 per articleplus $.10 per page is paid directly to theCCC, 222 Rosewood Drive, Danvers, MA01923 (www.copyright.com). Identify thispublication by including with your pay-ment the fee code:0-86715-375-0/10 $5 + $.10.

Printed in CanadaISSN 0896-6532 / ISBN 978-0-86715-375-0

Basics of Face Photography for Esthetic Dental Treatment 132Dudu Medeiros, BFA, MBA/Oswaldo Scopin de Andrade, DDS, MS, PhD/Fabiana Varjão, DDS, MS, PhD

SnowWhite and Transparence, Part 2 143Hiro Tokutomi, RDT

On the Brittleness of Dental Ceramics: Why Do They Fail? 152Renan Belli, DDS, MS/Jackeline Coutinho Guimaraes, DDS, MS, PhD/Ulrich Lohbauer, MS, PhD, FADM/Luiz Narciso Baratieri, DDS, MS, PhD

Opacity, Part 1: The Color Management of Porcelain Laminate 163Veneers Based on the Color of Abutment TeethHiroki Goto, RDT

Opacity Control of Zirconia Restorations 173Aki Yoshida, RDT/Shigemi Ishikawa-Nagai, DDS, MSD, PhD/John D. Da Silva, DMD, MPH, ScM

All-Ceramic Restoration: A Case of Refined Surface Characterization 186Shin Nakamura, RDT

Previsualization: A Useful System for Truly Informed Consent to 189Esthetic Treatment and an Aid in Conservative Dental PreparationFrancesco Mintrone, DDS/Shigeo Kataoka, CDT

Ceramic Restorations: Updates and Concepts for 199Esthetic RehabilitationPaulo Kano, DDS, CDT/Luiz Narciso Baratieri, DDS, MS, PhD/Renata Gondo, DDS, MS

Light and Shade: A Challenge to Natural Teeth 210Naoki Hayashi, RDT

A Novel Approach for Noninvasive Pontic Site Development 218Domenico Cascione, CDT, BS/Mamaly Reshad, DDS, MSc/Tae Kim, DDS

Cover photograph by Dudu Medeiros.

Volume 33

Aclear definition of art is quite complex. It is said that art is the method of deliberately arranging elements in away that appeals to the senses or emotions. The meaning of art is explored in the branch of philosophy knownas esthetics, which deals with new ways of seeing and perceiving the world. However, to produce art and define

a standard of esthetics, it is necessary to understand the nature, behavior, and performance of the elements that com-pose a particular piece of art. The systematic knowledge that is capable of predicting outcomes is science.This issue of Quintessence of Dental Technology attempts to balance art and science with the addition of two new

sections to our regular article line-up: “State of the Art” and “Biomaterials Update.” The state-of-the-art section fo-cuses on innovation of laboratory and clinical techniques by novel approaches. The biomaterials update section pro-vides a scientific review that discusses new aspects, properties (physical, mechanical, optical, bonding), as well as ad-vantages and limitations of upcoming restorative materials. Both sections are presented to inform and inspire cliniciansand technicians to a new level of exceptional service for their patients.Ultraconservative oral rehabilitation is clearly the ultimate goal of esthetic restorations. The opportunity to preserve

and protect oral tissues by using enhanced biomaterials—with their capacity to bond any type of surface, promotefaster osseointegration, or mechanically and optically restore oral tissues, at the same time being biocompatible—yielded a new era in dentistry. Ideally, any clinical situation can be conservatively or minimally invasively treated. Themore we can preserve dental tissues in their pristine condition, the better. But are there any limitations on how conser-vatively a treatment can be performed? The answer to this question truly depends on numerous factors, some of whichare beyond the clinicians’ control. The degree of salivary flow, risk of caries, periodontal involvement, age, compliance,among other factors must be assessed before initiating a minimally invasive treatment plan. Perhaps the most impor-tant consideration is that our patients understand and want a comprehensive, but conservative, treatment plan. It is ex-citing that we are now able to offer a wide assortment of dental treatments ranging from conservative to invasive. It alldepends on the patient’s needs. Stress and lack of compliance are still the main causes of restorative failures, more sothan anything inherent in dental restorative materials themselves.Fortunately, the future of restorative dentistry is bright. Upcoming technologies as well as “smart materials” will help

us to identify the benefits and limitations of a given treatment, and all boundaries will be expanded. The aforemen-tioned technologies combined with art will permit superb esthetic oral rehabilitations. But one aspect will neverchange: The patient is the one who will judge the success of the treatment. Therefore, esthetic restorations must stillbe patient-driven, not materials-driven.

Sillas Duarte Jr, DDS, MS, [email protected]

QDT 20102

Editorial

The Art,the Science,and the Patient

QDT 2010 11

A59-year-old male presented to the clinic withmaxillary and mandibular edentulism and in-ability to wear conventional prosthetics (Fig

1). His chief complaint was difficulty in chewing. He re-quested a long-term solution with functional and es-thetic prostheses. His medical history was noncontrib-utory with the exception of hypertension.

CLINICAL PLANNING PHASEClinical examination revealed that both arches exhib-ited atrophy with mobile tissue and limited vestibularform. Further analysis revealed compromised supportas a result of extensive residual ridge resorption ofboth arches.

A panoramic radiograph revealed an edentulous at-rophic maxilla with pneumatized posterior segmentsand an edentulous mandible with a limited amount ofsupracanal bone height in the posterior areas (Fig 2).

Study casts were mounted on a SAM 3 (SAM,Münich, Germany) fully adjustable articulator, and theinterarch distance was determined. A diagnostic set ofmaxillary and mandibular complete dentures were com-pleted with a trial tooth arrangement (Fig 3). Based onthe patient’s edentulous situation and medical history,several treatment plans were composed. The patient

1Private Practice, Monterrey, Nuevo León, Mexico.2Reproducciòn Ceramica Avanzada, Monterrey, Nuevo León,Mexico.

3Associate Professor, Department of Dental Specialties, MayoClinic, Rochester, Minnesota, USA.

Correspondence to: Thomas J. Salinas, Mayo Clinic, Departmentof Dental Specialties, 200 1st Street SW, Rochester, MN 55905, USA.Fax: (507) 284-8082. Email: [email protected]

Juan José Gutierrez Riera, DDS, MSD1

Albano R. Flores, DDS1

Francisco Zarate Rivera, DDS, CDT2

Thomas J. Salinas, DDS3

Endosseous ImplantRehabilitation ofEdentulism UsingHigh-Strength Ceramicsand ComponentProsthesis Design

The restorations were prepared for cementation bysteam cleaning. To effectively seal the cementationmargins, the recipient cementation sites were pre-pared by hydrofluoric acid etching of the gingival ce-ramic for 30 seconds. The entire zirconia surface wasetched with phosphoric acid for cleaning. For themandibular prostheses, all restorations not coveringaccess openings were cemented extraorally (Figs 27ato 27f). The crown restorations were prepared bychairside treatment with CoJet (3M ESPE).19,20 Resincement (Unicem, 3M ESPE) was used to bond the

restorations to the framework. The rest of themandibular restorations were cemented after securingthe mandibular prosthesis with abutment screws tothe manufacturer’s suggested torque. After torque ap-plication was completed, closure of the accesses wasaccomplished using compacted polytetrafluoroethy-lene tape, and a bis-GMA zirconium silicate–filled gin-giva-colored composite resin (Ceramage GingivalShade, Shofu, Tokyo, Japan). For maximum microleak-age protection and resistance, the rest of the restora-tions were then bonded using resin cement.21

QDT 201026

GUTIERREZ ET AL

27a 27b

27c 27d

27e 27f

Figs 27a to 27f (a and b) Components of maxillary and mandibular prostheses prior to assembly. (c) Hydro-fluoric acid etching of gingival ceramic. (d) Phosphoric acid cleaning of zirconia surfaces. (e) Cementation ofpontics in the laboratory. (f) Securing abutment screws with torque application.

INTRAORAL SEQUENTIAL LUTING OFTHE MAXILLARY PROSTHESISFor the maxillary restoration, all abutments weretransferred to the mouth and secured using an abut-ment placement jig after radiographic verification(Figs 28a to 28e).

Cementation and bonding of each maxillarycrown was likewise accomplished using CoJet andUnicem cement. Intentional crimping of the metallicinsert of each abutment facilitated retrieval of theframework without impedance of each insert’s rela-tive divergence angle after sequential cementation(Fig 29).

QDT 2010 27

High-Strength Ceramics and Component Prosthesis Design

Figs 28a to 28e (a) Light-cured urethanedimethacrylate placement jig on master cast. (b)Transfering of abutment to mouth with placementjig and securing with torque application. (c) Com-puter-aided design/computer-assisted manufac-ture–generated zirconia abutments ready for se-quential luting. (d and e) Intaglio and occlusalsurfaces of the maxillary restoration prior to se-quential luting.

Fig 29 Zirconia custom abutment with anodized ti-tanium insert. The abutment is bonded to the pros-thesis with the sequential luting technique whilethe insert facilitates positioning and remains de-tachable.

28a 28b

28c 28d

28e

29

S t a t e o f t h e A r t

ESTHETIC WAX-UP

Tyler P. Lasseigne, DDS, CDT1

Mimicking the tooth’s natural morphology andinternal characterization is challenging. It be-comes even more difficult when color is added

to the equation. An accurate esthetic wax-up not onlyserves as a diagnostic tool, but it can also be used to in-form and even impress the patient.

1Private Practice, Baton Rouge, Louisiana; Assistant Clinical Profes-sor, Department of Prosthodontics, LSU School of Dentistry, NewOrleans, Louisiana, USA.

Correspondence to: Dr Tyler P. Lasseigne, Esthetic Associates,LLC, 16645 Highland Road, Suite J, Baton Rouge, LA 70810, USA.Email: [email protected]

E s t h e t i c W a x - u p

Figs 37 to 39 Final esthetic wax-up.

F i n a l C e r a m i c s

Figs 40 and 41 Ceramics by Hiro Tokutomi, MDT.