Dental Asia May/June 2018

Behind the Scenes
As a pilot
u s e r ,
I have
already
b e e n
using the Vita’s
Enamic hybrid ceramic
(Panadent), launched
i n 2 0 1 3 , s i n c e 2 0 1 1
(Fig. 1). Although I tend
to be sceptical on principles regarding
anything new, the special properties of this
innovative material attracted my interest. In
the meantime, the product has successfully
proven its worth in chairside treatments in
my practice. In this respect, the particularly
easy and fast processing that it oers has
turned out to be of enormous benefit.
However, in order to achieve perfect
shade results, some experience is certainly
required initially.
Fig. 1: Vita Enamic is a hybrid ceramic that
represents a new generation of materials.
Initial situation
During a routine check-up of a 21-yearold
male patient, who regularly visits
our dental practice for check-ups and
undergoes dental cleaning once every year,
caries was noted in his UL6 tooth (Fig. 2).
Following a comprehensive consultation,
including presentation of the Vita Enamic
h y b r i d c e r a m i c , t h e p a t i e n t c h o s e a
CAD/CAM chairside restoration, with an
inlay comprised of this innovative material.
Fig. 2: Initial situation – caries in tooth UL6
ELASTIC,
AESTHETIC CERAMICS
In this article, Dr. Otmar Rauscher uses a patient’s case as
an example to explain the entire treatment workflow
utilising Vita Enamic for inlays.
by Dr. Otmar Rauscher
Material properties
P r o f . R u s s e l l A . G i o r d a n o f r o m
Boston University (USA) had already begun
working on the idea of elastic aesthetic
ceramics in 1996. In his collaboration
with Vita, it was finally possible for the
new generation of materials to reach
m a rket m a tu ri ty . Th ey a re b a sed o n a du a l
ceramic-polymer network structure, in
which the silicate ceramic content (86%)
forms a three-dimensional framework
similar to a grid. The polymer content (14%)
is added to this open structure as part of
a special industrial production process,
creating an interpenetrating adhesive bond
with the ceramic.
In itself, the polymer also forms a
cohesive 3D grid structure, which in
turn penetrates the ceramic in a fully
homogenous and isotropic fashion. The
material bond results in a hybrid ceramic
with an elastic modulus of 30 GPa, which is
in the range of the elastic values of human
dentine.
At the same time, the exural strength
of Vita Enamic is 150-160 MPa. Load tests
c a r r i e d o u t a t t h e U n i v e r s i t y o f F r e i b u r g
(Dr. Petra Güß, associate professor)
(Bilkhair and Güß), demonstrate that
adhesively cemented crowns fabricated
using Vita Enamic have significant loadbearing
capacity, even in cases of reduced
wall thickness. Regarding processing
with the Cerec MC XL unit (Sirona Dental,
Salzburg, Austria), the special material
properties favour a chipping-free milling
of restorations with a wall thickness that
can, in the case of veneers, be reduced
to 0.2 mm in the marginal area. Further
investigations by Vita Zahnfabrik conrm
m y o w n e x p e r i e n c e r e g a r d i n g f a s t e r
CAD/CAM processing using Cerec MC XL
in comparison with conventional ceramics
both in fast and normal
mode.
Commercially
speaking, it is also relevant
that compared with other
ceramics, Vita Enamic
achieves the longest
service life with the
diamond milling tools used
with the Cerec MC XL unit.
Moreover, material tests carried out
by the University of Zurich (Switzerland)
u n d e r P r o f . W e r n e r H . M ö r m a n n
(Mörmann W et al, 2013) have also
demonstrated that the hybrid ceramic
results in less abrasion of the tooth enamel
of natural antagonists than conventional
silicate ceramics, and that its own occlusal
wear is within the range of natural enamel.
Accordingly, with regards to attrition
of the occlusal surfaces, differences in
height between the tooth substance and
restoration generally do not occur in my
experience. Hybrid ceramics otherwise
require regular intraoral adaptive measures
in the case of materials that oer greater
abrasion resistance.
Fig. 3: Results in two translucency levels
Fig. 4: Vita Toothguide 3D-Master shade scale
Preparation and finishing
The planned treatment began as
usual with shade-taking. Vita Enamic is
provided in two levels of translucency,
H T ( H T = h i g h l y t r a n s l u c e n t ) a n d
T (T = translucent), each of which is available
54
DENTAL ASIA
MAY / JUNE 2018