GC Get Connected 2020 02

14
2019
Contents
1. A full digital workflow with 3D-printed temporary restorations 4
By Dr Anthony Mak and Dr Andrew Chio, Australia
2. The composite injection technique with GRADIA PLUS 11

By MDT Lisa Johnson, United Kingdom, MDT Marijo Rezo, Croatia, CDT Jonas Spaenhoven from GC Europe
and MDT Roeland De Paepe from GC Benelux
3. Injection moulding for a predictable aesthetic outcome. 14

By Dr. Angel Andonovski, North Macedonia
4. Indirect Hybrid Nano-Ceramic Adhesive Restorations in the Posterior Region 18

A case report using the new CERASMART270
By Dr. Pierre Dimitrov, Dr. Assen Marinov and MDT Boyanka Vladimirova, Bulgaria
5. Smile rehabilitation with lithium disilicate veneers: a case report 24

By Prof. Joseph Sabbagh, Lebanon
6. Experiences gained with Experience™ mini Rhodium and Ortho Connect: 28

A Self-ligating bracket with a compelling design and convincing implementation process
By Dr. Marcus Holzmeier, Germany
7. Hybrid zirconia titanium abutments assembled with G-CEM LinkAce 34

can be autoclaved maintaining structural integrity.
By MDT Dieter Pils, Austria
8. Zirconia: Aesthetic, strong and predictable 36

By Patric Freudenthal IQDENT / DTG, Sweden
2 GC get connected
Dear readers
Welcome to the 14th edition
of GC’s Get Connected
newsletter.
GC develops dental products always having the convenience of the clinician in mind.
Among the cases of this fourteenth edition, you will find a full upper arch rehabilitation by means of a complete
digital workflow including a 3D printed temporary bridge.
With another CAD/CAM material, the nanohybrid ceramic CERASMART 270, it was possible to restore heavily
damaged teeth in the posterior region in a cost-efficient way, fully relying on adhesion and by using the
immediate dentin sealing technique.
Within direct restoratives, high-strength composites with optimized handling, such as G-ænial Universal
Injectable, open up entirely new possibilities. By using the injection moulding technique it was possible to
restore several defects in the anterior region in a fast and minimally-invasive manner and with a predictable
esthetic outcome.
These are only a few examples to illustrate that high-end dentistry is becoming more and more accessible
for dentists as well as patients – a benefit for all!
Please enjoy reading and do not hesitate to contact GC if you would like to join one of our courses in our
training centre or for any upcoming questions.
Dr. André Rumphorst

General Manager Marketing & Product Management
GC Europe NV
GC get connected 3
A full digital
workflow with
Dr Anthony Mak obtained his dental degree
at Sydney University (Australia) and then
went on to complete his post-graduate
3D-printed
temporary restorations
diploma in Oral Implantology. He graduated
with multiple awards and has worked with
some of Sydney’s most renowned practitioners.
His interests lie in dental technologies and
advances in materials and techniques. He
has a unique understanding in CAD/CAM
Digital dentistry and currently owns two By Dr Anthony Mak and Dr Andrew Chio,
practices in metropolitan Sydney focusing
on comprehensive and implant dentistry. Australia
Anthony has a thorough understanding of
direct vs indirect dental restorations and has
lectured internationally on the topics of
Aesthetic and Digital Dentistry. He is a
The evolution of digital technologies in dentistry has paved
sought after speaker and is a key opinion
leader for several global dental companies. the way for the development of simplified and predictable
protocols in field of restorative dentistry. Digital dental
technologies have allowed the seamless delivery of complex
treatments.
Proper treatment planning protocols printing or milling. The prosthetic design

are the foundation of any fixed resto- can be visualized, planned and even
rations in the arch involving dental designed prior to the patient even at-
implants. The data or information tending for the surgical phase of
from the CBCT scan and intraoral surface treatment.
scans (IOS) combined with the use of
CAD software allow the simplification An accurate and predictable outcome
Dr. Andrew Chio graduated as a dentist at of workflows including diagnostic facially of the implant surgery as well as the
the top of his year from the University of
driven mock-ups, restoration-driven restorative rehabilitation are realised
Melbourne (Australia) in 1995. On graduation
he then undertook his dental internship at implant treatment planning and the this way.
the Bendigo Base Hospital before spending design and fabrication of surgical
the next one and a half years working in a
rural hospital in Nepal. He is the principle
guides. The design of the temporary The following case study demon-
dentist of Arawatta Dental Centre in Carnegie and permanent prosthesis and the strates a scenario where a complete
and an active member of various dental design of the master die model can digital workflow was utilised with
associations. He is a lecturer and gives
advanced hands-on trainings to dentists in all be done on CAD software and two provisionalisation phases to reha-
specific areas of restorative dentistry. then manufactured either with 3D bilitate the full upper arch.
4 GC get connected
A full digital workflow
with 3D-printed
Case report
Fig. 1: Pre-operative smile and orthopanthomogram.
Diagnostic Record Collation 2

and Treatment Planning Phase
A 79-year old patient presented with

an unremarkable health history.
Chief complaint:
• mobile teeth
• occasional discomfort from the
areas around his existing upper Fig. 2: Occlusal and lateral view after periodontal treatment and extraction of tooth 16 and 28.
fixed partial denture
3
Examination (both clinical and
radiographic) indicated the following
(Fig. 1):
• moderate to advanced bone loss
affecting many of his upper and
lower teeth.
• secondary decay was diagnosed on
the abutments of his fixed dental
prosthesis. Fig. 3: The accuracy of image registration between the CBCT and IOS scans can be improved
• Teeth 15, 16 and 28 had a poor with radiographic markers (composite blobs). Removing sources of radiographic scatter (in this
case, the PFM bridge) also improves the accuracy.
prognosis and were planned for
extraction.
remaining dentition was periodontally • Intra-oral scans (IOS): digital impressions
The goal of the treatment was to treated (Fig. 2). before and after removal of the original
rehabilitate the upper arch with a PFM bridge were taken, as well as
combination of crowns and implant After the initial clinical examination and the patient’s occlusion (bite). Rough
retained restorations to provide the treatment, further information was preparation of the tooth abutments
patient with a fixed solution. collated. This included: were also completed prior to the
In the initial treatment phase, teeth 16 • 3D CBCT scanning for the presurgical acquisition of the subsequent IOS
and 28 were extracted and the planning. scan.
GC get connected 5
with 3D-printed
Tip: the accuracy of image registration 4

(superimposition of the IOS and CBCT
data) can be enhanced by (Fig. 3):
• the use of radiographic reference
markers: a composite such as
G-ænial Universal Injectable with
a radiopacity of 250% Al, does not
result in radiographic scattering
during CBCT scans.
• prior removal of the porcelain-
fused-to-metal (PFM) bridge:
reduction of radiographic scatter
caused by the metallic components
of the prosthesis
Treatment Plan
Following the collation of the Fig. 4: Intraoral surface scans (IOS) before and after removal of the original PFM bridge
information, the initial treatment plan superimposed on the CBCT scan: this facilitates the planning of implant placement from a
restorative perspective (restoration driven implant placement).
was formulated and involved:
• Guided surgical placement of 5

implant fixtures in the 16, 14, 11, 21
and 25 sites. A bone graft was also
planned in the 11 site due to bony
defects. A two-stage surgical protocol
was chosen for proper integration
of the implants in the 11 and 21 site.
• Immediate provisionalization with a
3D-printed temporary bridge
(GC Temp PRINT) from 15 to 24. The Fig. 5: Planning of implant placement. A surgical guide is designed based on the desired
implant position.
existing shape and contours of the
current failing bridge were copied
from the pre-operative IOS to create • It was planned to use lithium disilicate of the number, position, angulation
the temporary bridge. and monolithic zirconia for the and access position of the implant
• After implant integration, a second permanent restorations on both the fixtures following a restoratively
phase of provisionalization was natural teeth and implant abutments. driven protocol (Fig. 4).
foreseen with individual temporary
restorations (GC Temp PRINT) on Digital Implant Planning and Based on the planned implant
the implants and natural teeth. Surgical Guide Fabrication positioning (Fig. 5), a surgical guide
This allowed: was designed with the dedicated
• Verification of aesthetics and Digital data from the three scans – software. Master sleeves from the
occlusion the CBCT and the IOS before and after guided surgical system were placed
• Soft tissue management bridge removal - were accurately and fixed to the printed guide/
• Extraction of tooth 15. merged. This enabled virtual planning framework.
6 GC get connected
with 3D-printed
The design of the previous PFM was 6

also copied and replicated in the
digital planning of the temporary
bridge. It was then printed using the
Asiga Max UV and GC Temp PRINT
(medium shade) set at 50µm on the
3D printer.
Guided Implant Surgery and

First Provisionalization Phase Fig. 6: Five implant fixtures were placed using a fully guided surgical protocol.
The following clinical procedures

7
were then completed on the day of
implant surgery:
• All five implant fixtures were placed

following a fully guided surgical
protocol with the surgical guide
(Fig. 6) and primary stability was
confirmed.
Fig. 7: A flap was raised in the 11 region as buccal bone grafting was required due to a bony
• A flap was raised in the 11-21 region, defect.
a bone graft with bovine cancellous
particulate was placed and covered • The 3D-printed temporary bridge tooth 24 (upper left first premolar)
with a porcine collagen membrane. was then cemented with GC Fuji developed signs and symptoms of
Cover screws were placed and TEMP LT on the remaining natural pulpal necrosis. Hence, it was
primary closure was established teeth (Fig. 8). endodontically treated (Fig. 9).
after a relieving incision and closed
with PTFE sutures. At the other A healing period of 16 weeks allowed
implant sites (16, 14 and 25), healing complete osseointegration of the
abutments were placed (Fig. 7). implant fixtures. During this period,
8 9
Fig. 8: Immediate post-operative following guided implant surgery and temporary Fig. 9: During the healing phase, tooth 24
cementation of the provisional fixed bridge printed from GC Temp PRINT (medium shade) developed pulpal necrosis and was
endodontically treated.
GC get connected 7
with 3D-printed
Second Provisionalization 10
Phase after Implant Integration.
Once the 16-week healing phase was

completed and the fixtures were
integrated, the restorative phase
could be initiated. The patient
confirmed that he was happy with
the shape and occlusion of the initial
temporary bridge (Fig. 10). The Fig. 10: View at 10 days after implant surgery.
aesthetic and occlusal scheme could
therefore be replicated in the second
11
phase of provisionalization.
A pre-preparation IOS was taken with

the healing abutment and temporary
bridge in situ (Fig. 11).
The temporary bridge was then

removed and preparation of the
abutment teeth finalized and re- Fig. 11: Pre-operative surface scan
margined to the healed gingival tissue
levels.
12
Stage 2 implant surgery on the 11 and
21 sites was completed using a soft
tissue diode laser. The implants were
exposed and cover screws removed.
An emergence profile scan was taken

immediately after the healing
abutments were removed to record
Fig. 12: Periapical radiographs to verify the seat of the digital scan bodies.
gingival contours around the implant
before any collapse of the tissues.
Next, the full upper arch was scanned
with digital scan bodies in place to
capture the implant position “Mak optimised scan strategy” (MOSS), All the digital data was then sent to
accurately (Fig. 12). allowing accurate stitching of IOS the ceramist for the fabrication the
images. In soft tissue “pink” areas, the second set of provisional restorations.
All other prosthodontic records availability of landmarks is often limited;
including the bite registration and the MOSS uses a specific scan path with Provisional restorations were printed
opposing arch were also captured or without markers for an enhanced with GC Temp PRINT and characterised
with the intra-oral scanner before scan accuracy and was especially with OPTIGLAZE color (GC).
placing the temporary bridge back. designed for cases with few teeth to Temporary abutment cylinders were
All IOS were taken following the correlate to. utilised for the implant-retained
8 GC get connected
with 3D-printed
13 restorations. The contours of the 11

and 21 implant-retained provisionals
as well as the pontic of 15 were
designed and fabricated to shape the
soft tissues for optimal support and
(Figs. 13-15).
Following removal of the temporary

bridge, all the abutments were
Fig. 13: Second set of provisional restorations printed with GC Temp PRINT (medium shade) cleaned and the tooth 15 was
using the Asiga Max UV 3D printer. extracted (Fig. 16). The provisional
implant restorations, fabricated with
14 direct screw access were torqued to
the manufacturer’s recommendation.
All other temporary printed
restorations were cemented with
FujiTemp (GC) (Figs. 17-19).
The soft tissues were prosthetically

shaped and allowed to heal for a
period of 3 months before the
Fig. 14: Completed provisional crowns, implant retained crowns and bridge, characterised with finalisation of the rehabilitation with
OPTIGLAZE color (GC) – Dental technician: Brad Groblar, Oral Dynamics, New Zealand.
the definitive restorations.
15 16a 17a
16b 17b
Fig. 15: Completed provisionals fitted onto Fig. 16: (a) After removal of the temporary Fig. 17: (a) Healing abutments were removed
the printed models to allow the refinement of bridge from the first provisionalization phase. and (b) the second set of temporary
the contact points and occlusal contacts. (b) Tooth 15 was extracted. restorations was placed.
GC get connected 9
with 3D-printed
18 Conclusion
The case presented illustrates how

advances in digital technologies can
provide clinicians with the tools for
diagnosis, treatment planning, the
execution and provision of dental
restorative procedures in a truly
transformative way.
Fig. 18: Periapical radiographs to verify the seat of the implant-retained provisional restorations.
Simplification of clinical protocols,
increased accuracy over conventional
19 analogue techniques and improved
patient comfort and outcomes are
compelling reasons of the benefits of
a full digital workflow in the field of
restorative and implant dentistry.
Fig. 19: Immediate post-operative view of the inserted provisionals.
10 GC get connected
The
composite
MDT Lisa Johnson from VIVID Dental
Laboratory in Leeds is one of the UK’s top
aesthetic technicians with twenty years’ of
experience using composite systems and
specialised in large implant frameworks.
injection
Lisa was involved with the development of
the new GC GRADIA® PLUS composite resin
C&B system since the early trials. Lisa has
layered many frameworks using injectable
techniques with the GC GRADIA® PLUS One
Body System.
technique
MDT Marijo Rezo became a dental
technician in 1996 in Zagreb, Croatia. Since
with
GRADIA PLUS
then, he has worked in several private
laboratories in Zagreb. Since 2004, he has is
own dental lab, Kati Dental d.o.o. He actively
participated in various congresses and has
given many workshops in the country and
abroad.
Interview with
MDT Lisa Johnson, United Kingdom
MDT Marijo Rezo, Croatia
CDT Jonas Spaenhoven from GC Europe
MDT Roeland De Paepe from GC Benelux
CDT Jonas Spaenhoven is Product
Manager at GC Europe.
Using the proper composite, the injection technique
is a very convenient approach to get a convincing,
aesthetic result with minimum effort. We spoke with
four dental technicians about their experiences with

MDT Roeland De Paepe is Product
Manager and Demonstrator at GC Benelux. GRADIA PLUS in using this technique.
GC get connected 11
The composite
injection technique
with GRADIA PLUS
How would you explain the wax-ups, but also temporaries, injection technique, making it very
injection technique? denture try-ins or the existing predictable.
dentition can be copied.
Jonas Spaenhoven: The injection Moreover, composites are ideal for
technique follows a clear procedure, What are the main advantages intra-oral corrections, small adjustments
with maximum control over each step. of this technique? or even repairs.
It basically consists of duplicating a
wax-up by making a transparent Marijo Rezo: The main advantage of What are the indications for
mould. A flowable composite is the injection technique is the speed the injection technique?
injected into this mould and light-cured. of production of the final workpiece,
This versatile technique can be used the high precision of this Lisa Johnson: Whether you want to
for very basic restorations – e.g. using reproduction in the flask and the reproduce a try-in, a temporary or
only a dentine and an enamel simplicity of the process itself. convert a wax-up to a final bridge
composite as well as very complicated - the injection technique is ideal. It
and highly aesthetic restorations. Lisa Johnson: The process is quick, can also be used to repair to existing
Because the injection technique allows simple and extremely accurate, giving restorations.
the technician to have control over predictable results. Technicians who
each step, it’s very easy to learn have minimal ceramic or layering Jonas Spaenhoven: Cases where
allowing even young, inexperienced experience can effectively produce there is a high demand for predictability
technicians to have very aesthetical natural looking restorations. are very much indicated.
end-results.
Jonas Spaenhoven: It also fits Also, whenever there is a high risk of
And besides indirect restorations, a perfectly in a digital workflow: the chipping, ceramics would be less
similar approach can be used for wax-up can be digitally designed and suitable. Composite restorations with
direct restorations. GC has introduced milled or printed. A temporary the injection technique are then more
a special injection moulding kit for restoration can also be printed from indicated.
this purpose. GC Temp PRINT and characterised
with OPTIGLAZE color. This way the Roeland De Paepe: Absolutely,
Lisa Johnson: The injection end result is visualised in an early because the nano-filled composite is
technique is a simple way of stage and adaptations can still be made an excellent stress absorber. In this
producing composite restorations during this entire phase. When the regard, for me, the main indication is
especially when you want to create patient is satisfied, the shape can full-arch implant work because the
an accurate reproduction. Not just exactly be reproduced with the gain of time is huge.
12 GC get connected
The composite
injection technique
with GRADIA PLUS
Marijo Rezo: I would also use it mostly Roeland De Paepe: GRADIA PLUS
for major implant reconstructions and offers different modules were
telescope work. But glass-fibre- especially the LB One Body colors and
supported bridges, provisional crowns the LB colors form the Layer Pro set
and bridges and all normal indications have the perfect solutions for
for indirect composite are also possible. injection techniques.
Why is GRADIA PLUS the The Gum set makes the picture
preferred composite for this complete.
technique?
Jonas Spaenhoven: There are also
Lisa Johnson: I choose to use the Lustre Paints that can be used to
GRADIA PLUS as I feel this material paint your aesthetics externally or
gives me the best possible aesthetic used internally . For very aesthetical
results – and the Light Body flowable restorations, a cut-back with internal Jonas Spaenhoven: Yes, but the
composite is perfect for this technique. characterisations using the Lustre colours can be mixed to obtain an
The material is strong and very easy Paints or Light Body effects can be individualised effect, so you have
to work with. Having used many other performed. A variety of enamel endless combination options.
composite systems over the years, shades can then be injected to cover
GRADIA PLUS is my choice for any the dentine base. Especially dental technicians who are
composite work. used to working with ceramics, will
Thanks to the modularity of the GC immediately like this system because
Marijo Rezo: The consistency of the GRADIA PLUS system, every mixing colours is basically what they
material itself is excellent. The One technician can choose his level of do in their daily work.
body material is extremely lightly finishing, depending on the case!
injected into the flask itself because it Lisa Johnson: I think this kit differs
is very fluid and does not need to be What makes GRADIA PLUS so from others as it is the first kit I’ve found
heated. different from other that contains everything you need to
composite systems on the fabricate natural looking restorations,
Jonas Spaenhoven: As the injection market? from the heavy body material that
technique is ideal for the easy can be hand-layered to the light body
reproduction of complete arches, you Marijo Rezo: It offers a wide range of that can be injected. The range of pink
need a strong and wear resistant colours that can handle even the most composites for the gingiva can also
composite. With a flexural strength of demanding aesthetic reconstructions, be either layered or injected. The kit
160 MPa, GRADIA PLUS is particularly and an innovative glazing system is also has Lustre Paints and a glazing
suitable for high-wear, high-pressure put at the top of the range. fluid that can be used for
restorations. And because you inject a characterisation - it’s a complete kit
big volume of highly filled composite, Roeland De Paepe: In the GRADIA and all you need!!
you obtain a very dense and strong arch. PLUS system every lab can choose
which modules are interesting for the
Besides the outstanding physical preferred composite indications.
properties, GC GRADIA PLUS is also
very friendly to the antagonists The number of syringes was brought
because of the ultra-fine filler back from 150 in the old GRADIA
technology. system to 65 in the new GRADIA PLUS.
GC get connected 13
Injection
moulding for
a predictable
aesthetic
outcome.
By Dr. Angel Andonovski, North Macedonia
Dr. Angel Andonovski became a dental
technician in 2012. In 2017, he graduated as
Extensive treatment planning can be time-consuming.
a dentist at the University of St. Kiril and However, this time is often saved at the actual
Metodij in Skopje, Macedonia. Thereafter,
he started his ‘Master in Prosthetic Dentistry’ execution of the treatment plan. Meanwhile, the
at the same university. In 2018, he received
his license for general dentistry. That same
aesthetic outcome will be more predictable and the
year, he won the second price in the total procedure is less stressful, as part of the treatment
post-graduate category of the Essentia
Academic Exellence Contest. Since 2012, he can be done outside the mouth, in absence of the
has been working as a dental technician
and since 2018, he is working in one of the
patient.
biggest dental clinics in Macedonia.
A 35-year-old woman consulted the 1

practice because she was dissatisfied
with the appearance of her frontal
teeth. At the clinical assessment old
restorations with marginal discolouration,
a devitalised, darkened tooth #11 with
a noticeable crack on the incisal surface
and rotations of the lateral incisors and Figure 1: Pre-operative intraoral view. Old
right canine were found. (Fig. 1). restorations, cracks and discolourations are
visible
14 GC get connected
Injection moulding
for a predictable aesthetic outcome.
2 3a 3b
Figure 2: After internal bleaching of tooth #11 3c Figure 3: After removal of the old
restorations
Treatment options were discussed aesthetic result and is cost- and teeth (Fig. 2). In the next session, the
including the need for shape correction time-effective. G-ænial Universal old restorations were replaced;
as well as slight colour adjustments. Injectable has excellent physical simultaneously, the shape of the rotated
The patient refused the use of ceramics properties and wear resistance: these teeth was corrected to achieve an
because of the treatment cost. are important properties to consider ideal integration of the future veneers,
for the long-term outcome. which then could be made of uniform
It was decided to treat the teeth with thickness with a predictable result
G-ænial Universal Injectable composite After internal bleaching of tooth #11 (Figs. 3 and 4). Essentia Dark Dentin
veneers using an injection moulding with sodium perborate, the tooth and Medium Enamel were used.
technique: it renders a predictable shade was similar to the adjacent Thereafter, impressions were made.
A wax-up was prepared on the model
4 5 (Fig. 5). This allows to focus on proper
shape and symmetry outside the
mouth, which is always more practical.
It also gives an indication of how thick
the applied composite layer will be; in
this case, only a thin enamel
replacement layer was needed. As an
Figure 4: Smile after replacement of the old Figure 5: Wax-up of the frontal teeth additional benefit, the patient needs
restorations
to spend less time in the dental chair.
Based on this wax-up, a transparent
6 7 silicone key was prepared with
EXACLEAR (Fig. 6). Injection channels
were created (Fig. 7), ending at the
incisal edge, so the sprue could be
easily removed without altering the
shape of the restoration.
Figure 6: Transparent mould from Figure 7: Creation of the injection channels

EXACLEAR with the tip of the syringe
GC get connected 15
Injection moulding
8 9
Figure 8: Frontal teeth were cleaned and Figure 9: Frontal teeth were etched with
slightly roughened phosphoric acid
10 11
Figure 10: Frosty appearance of the teeth Figure 11: Teflon tape was applied on the
after etching adjacent teeth
The day after the first treatment session, phosphoric acid (Fig. 9), leaving the
the patient returned. The teeth were typical frosty surface (Fig. 10). One by
cleaned and the frontal teeth in need one, the teeth were isolated by
of restoration were slightly roughened separating them from the adjacent
(Fig. 8). Next, they were etched with teeth using Teflon tape (Fig. 11).
12a 12b G-Premio BOND was applied, left

undisturbed and then strongly
air-blown before polymerisation (Fig.
12a). The silicone key was seated into
the mouth and G-ænial Universal
Injectable (shade A2) was injected
(Fig. 12b) and light-cured through it
12c 12d (Fig. 12c). After removing the silicone
key (Fig. 12d), composite excesses
could be easily removed with a sharp
blade.
Figure 12: a) Bonding with G-Premio BOND; b) Injection of G-ænial Universal Injectable (Shade
A2); c) Light-curing through the EXACLEAR mould d) After removal of the mould. Excess could
be easily removed.
16 GC get connected
Injection moulding
13 The EXACLEAR impression is very precise, so all the texture

that was being put in the wax-up could be replicated in
the final restorations (Fig. 13). The finishing procedure is
simplified in this technique; since shape and texture are
already established and there is no sticky oxygen inhibition
layer. All that was needed was some polishing with a goat
hair wheel and a felt wheel with DiaPolisher Paste (Fig. 14).
The results were predictable (Fig. 15), corresponding to the
wax-up model and the rotations and colour differences
were corrected. The smile line gently followed the lower
lip line and a good aesthetic result was obtained.
Figure 13: Intraoral view before polishing
14a 15a
14b 15b
Figure 14: Polishing with soft brushes Figure 15: After treatment. a) Intraoral view; b) Smile
GC get connected 17
Dr. Pierre Dimitrov graduated from the
Medical University of Sofia (Bulgaria), Faculty Indirect Hybrid
Nano-Ceramic
of Dental Medicine in 2016. He is working in
the dental clinic DentaConsult in Sofia. His
interests are in restorative dentistry of posterior
teeth, endodontics, digital dentistry and dental
technology. Dr. Dimitrov has attended
postgraduate courses in the fields of e.g.
composite restorations, indirect ceramic Adhesive Restorations in
the Posterior Region
restorations, endodontic treatment and
digital workflow in restorative dentistry.
A case report using

the new CERASMART270
Dr Assen Marinov graduated from the By Dr. Pierre Dimitrov, Dr. Assen Marinov
Medical University of Sofia (Bulgaria), Faculty
of Dental Medicine. He is practicing in the
fields of dental implantology, functional
and MDT Boyanka Vladimirova, Bulgaria
and aesthetic dentistry. Dr. Marinov has
finished the Basic Curriculum at the Vienna
Interdisciplinary School of Dentistry (VieSID) Indirect composite and ceramic restorations are a
(Austria), implementing the protocol of Prof.
Rudolf Slavicek in his practice. He also finished
the complete course in functional diagnostic
valid solution in restoring medium to heavily damaged
wax-up of DTG Stephan Provancher and
attended the Master Program in digital and teeth in the posterior region, providing strength,
aesthetic dentistry with Paulo Kano.”
Together with the team of DentaConsult, Dr. longevity and aesthetics. With the advancement of
Marinov is developing a growing practice in
Sofia. He is combining digital and analogue CAD/CAM technologies and intraoral scanners we
workflow in treatment planning and execution.
can produce and deliver these kinds of restorations
in one visit or a few days, minimising the chance of
sensitivity, maintaining tooth vitality and protecting
the damaged tooth structures from cracks and
fractures. Using contemporary adhesive systems
MDT Boyanka Vladimirova became a
dental technician in 1994. She got her training
and Dental Council’s registration at the Medical
and composite materials we are able to bond indirect
Collage in Varna (Bulgaria). She is a member
of the Dental Technologists Association (DTA). restorations with little to no retention in the
She has been working at various laboratories
and owns her own company since the preparation, without unnecessary sacrifice of tooth
beginning of 2018. She is also a ceramist at
the team of DentaConsult. Her focus is on structures and still be able to guarantee a predictable
aesthetic crowns and bridges, with a strong
attention to design, detail and quality. long term success to our patients.
18 GC get connected
Indirect Hybrid Nano-Ceramic
Adhesive Restorations
in the Posterior Region
1 premolar. A mixed analog-digital premolar and two molars with full

workflow was used for this case. The coverage CERASMART270 overlays in
treatment was completed in two visits 2 visits - one for preparation and
in the span of 3 days. Each step from impressions and another one for
the preoperative situation until the bonding the restorations.
finishing, including the laboratory
phase will be shortly explained. After isolation with rubber dam, the
old restorations and underlying caries
Fig. 1: CERASMART270 overlay, milled with The patient initially presented with a were removed with a round diamond
Sirona Cerec 4.
few direct restorations in the left bur on high speed with plenty of
lower jaw (3rd quadrant) (Fig. 2). water cooling, followed by final cleaning
The new CERASMART270 is a great Complaints of the patient were of the decayed dentine with a steel
addition to GC’s growing CAD/CAM increased sensitivity to thermal stimuli manual excavator and gentle
solutions providing increased strength in this region and food impaction. The sandblasting with 27 micron aluminum
while keeping everything great about second premolar was endodontically oxide particles. A small portion of the
the original CERASMART blocks - flexibility, treated and without radiologic or mesiolingual pulp horn was exposed.
possibility of abrasion and repairability symptomatic signs of apical The undermined and unsupported
at a reasonable price (Fig. 1). Our periodontitis; the buccal and lingual cusps and walls were reduced to
preparation, production and luting walls and the mesial marginal ridge ensure stable dentinal support of the
procedures remain basically the same were thin and undermined; the shade tooth structures and provide restorative
without the need to change or adapt of the tooth was visibly different. The material space of 1.5 - 2mm. A buccal
our clinical and laboratory protocols. first molar was vital with a big direct chamfer preparation was chosen for
The CERASMART270 blocks are a perfect composite restoration of the mesial, the second premolar out of aesthetic
choice for in-office milled indirect occlusal and distal surfaces with residual considerations. (Fig. 3)
restorations as the finishing, staining caries on the distal; the buccal and
and glazing steps can be easily carried lingual wall were thin and suspected An immediate dentine sealing procedure
out in the dental office using GC to crack or fracture at any time. The was carried out to ensure optimal
OPTIGLAZE and OPTIGLAZE color. second molar was vital with a faulty adhesion to the freshly prepared
direct restoration, showing degradation dentine and to create a hermetically
I would like to share a case from our of the bond between restorative sealed biological system, protecting
daily practice, restoring three material and tooth, uncovered dentine, the tooth structures from contamination.
posterior teeth in a quadrant where suboptimal proximal contacts and A deep margin elevation was performed
CERASMART270 blocks in two thing buccal and lingual walls. The for the distal margin of the second
translucencies were used - A3 HT for soft tissues were inflamed. The decided premolar. Enamel margins were left
the molars and A3 LT for the treatment plan with consent of the uncovered to be available as an
endodontically treated, darker shaded patient was to restore the second adhesion substrate in the cementation
2 3a 3b
Fig. 2: Preoperative photograph, occlusal view. Fig. 3: Intraoperative view - restoration and caries removal, cusp reduction.
GC get connected 19
4 5 A one-step VPS impression of the

lower jaw, an alginate impression of
the upper jaw, a bite registration and
a face bow were transferred from the
patient to the laboratory. In the lab,
stone models were fabricated from
GC FujiRock. The models of the jaws
Fig. 4: Immediate dentine sealing and deep Fig. 5: Stone models mounted in the were mounted in a semi-adjustable
margin elevation. articulator.
articulator using average settings
using the bite registration and the
6 face bow. The preparation model was
cut into separate stone dies for optimal
scanning and access to the margins. A
check model of the prepared teeth was
also poured from GC FujiRock. (Fig. 5)
The models and the separate

preparation dies were scanned using
Medit Identica T500 laboratory scanner.
The restorations were then designed
in ExoCAD according to the static
occlusion and the dynamic relationship
of the teeth in protrusion and lateral
movements using the virtual articulator
function. (Fig. 6)
The restorations were milled from

Fig. 6: Digital design of the restorations. CERASMART270 with a Roland
DWX-4W milling machine using a
milling strategy for hybrid ceramics.
step. The pulp exposure was only of G-Premio BOND was applied and The second premolar restoration was
sealed using adhesive and flowable rubbed for 20 seconds onto the dentine. milled from CERASMART270 A2 LT
composite. After thinning of the adhesive with air and the two molars were milled from
it was cured for 20 seconds using the CERASMART270 A2 HT. (Fig. 7)
The tooth structures were gently High Power Mode of D-Light Pro. A
sandblasted for 10-15 seconds with layer of G-ænial Universal Injectable,
27 micron aluminum oxide particles shade A2, was applied over the dentine, 7
under pressure with plenty of water sealing it and removing all uneven
cooling. Dentine was then etched with surfaces and undercuts of the preparation.
37% phosphoric acid for 15 seconds With a diamond bur the enamel
and generously rinsed afterwards, margins were prepared once again to
followed by gentle drying of the ensure to adhesive or composite has
dentinal structure with a 3-in-1 syringe been left. Preparation and marginal
to prevent desiccation of the tooth finishing were done after the removal Fig. 7: Milled restorations straight from the
milling machine.
structures. With a microbrush, a coating of the rubber dam. (Fig 4)
20 GC get connected
The restorations were cut from the 8

sprues, finished with a rubber point,
sandblasted with 27 micron aluminum
oxide and cleaned with a steam cleaner.
A coating of CERAMIC PRIMER II was
applied and was set to dry.
Characterization was done using
OPTIGLAZE color and OPTIGLAZE
Clear. Each layer of the stains was
polymerised for 20 seconds using
D-Light Pro in High Power Mode. The
restorations were finally polished with
diamond paste and a goat-hair brush.
(Fig. 8)
Fig. 8: The finished restorations on the check model.

On the day of the cementation, the
restorations’ inner surfaces were
sandblasted with 27 micron aliminum 9
oxide particles and subsequently
cleaned using phosphoric acid for 30
seconds. With a microbrush, a coating
of CERAMIC PRIMER II was applied to
the clean surface and let to evaporate.
G-ænial Universal Injectable A2 was
used as the cementing composite. It Fig. 9: Inner surface treatment before adhesive cementation of the restorations.
was applied right before the
cementation (Fig. 9).
The preparations were isolated with a optimal adhesion between the treating the tooth surface. Enamel
rubber dam and were sandblasted restorations and the teeth. (Fig. 10) and composite were etched with 37%
with 27 micron aluminum oxide phosphoric acid for 30 seconds,
particles under pressure with plenty The cementation of the restorations followed by generous rinsing with
of water cooling in order to achieve a was carried out one by one for each water. The preparation surface was air
clean and rough surface, ensuring tooth following the same protocol for dried with air. G-Premio BOND was
10
Fig. 10: Isolated and sandblasted preparations,

prepared for adhesive cementation.
GC get connected 21
11
Fig. 11: Adhesive cementation of the restorations

using G-Premio Bond & G-ænial Universal
Injectable.
applied to the preparation surfaces in was achieved. Everything was

accordance with the manufacturer’s polymerised after complete cleaning
instructions.The restoration was put on each surface of the tooth (buccal,
and held in place by hand. All lingual and occlusal) for 20 seconds
composite excess was removed using on each surface with D-Light Pro in
a probe and a brush until visual control High Power Mode. (Fig. 11)
of the sealed preparation’s margins
12
Fig. 12: Final view of the cemented restorations after rubber dam removal, inspection for
excess cement with D-Light Pro in DT Mode.
22 GC get connected
Finishing and polishing of the margins In conclusion, the new CERASMART270 simplified adhesive systems, different
of the restorations was done using is a great addition to GC’s CAD/CAM kinds of clinical and laboratory composite
abrasive metal and polishing plastic solutions. Compared to its original materials, highly aesthetic and durable
strips, rubber points and a polishing predecessor, it offers increased strength, ceramics and other equipment, we
brush with diamond paste. Using the while maintaining flexibility, simplified are confident to offer our patients a
Detection Mode of GC’s D-Light Pro laboratory steps and maintaining the long term solution and provide them
we were able to inspect the margins same clinical protocols in preparation with functional and aesthetic
of the restoration and tooth structures and cementation procedures. Thanks restorations with a minimised risk of
for excess cement. A good overall to the great line and wide selection of procedural mistakes and
integrity of the tooth-restoration GC’s restorative materials - flexible and complications.
complex was achieved. (Fig. 12)
13
A bitewing radiograph of the cemented
overlays was taken in order to assure
proper restoration adaptation and
visualise composite excess. The small
excess of composite viewed at the
distal margin of the second molar was
removed subsequently and the margin
was polished using rubber points and
polishing brush. (Fig. 13) A checkup of Fig. 13: Bitewing radiograph after cementation of the CERASMART270
restorations
the restorations 2 months after
cementation showed good aesthetic
and functional integration. The patient 14
was comfortable and satisfied with
the treatment. No complains of
sensitivity, food impaction or any
discomfort have been reported. The
restorations displayed a pleasant
aesthetic integration, including the
second premolar which had a
Fig. 14: Two months recall of the cemented CERASMART270
significantly darker shade before the
restorations.
treatment. (Fig. 14)
GC get connected 23
Smile rehabilitation
with lithium
disilicate veneers:
a case report
There is an increasing demand of patients for a
beautiful smile, combining perfect teeth alignment to
a natural shade. Different materials and techniques
are available on the market, but in terms of longevity
and patient satisfaction, the results are not similar.
When compared to indirect porcelain veneers, direct
composite veneers, and prefabricated veneers,
showed a lower survival rate, with several shortcomings
and high risk failures such as veneers debonding
and overcontouring1.
Porcelain laminate veneers made with lithium disilicate
remain the gold standard technique in terms of longevity
and survival rate2. The main advantages of pressed
porcelain are that the resulting veneers have a high
Prof. Joseph Sabbagh graduated from
Saint-Joseph University in Beirut (Lebanon)
level of accuracy and minimal internal structural defects3.
and in 2004, he obtained his PhD in
Biomaterials at the Catholic University of
Louvain (UCL), Belgium. In 2000 he obtained
a Master in Operative Dentistry (Restorative
By Prof. Joseph Sabbagh, Lebanon
dentistry and Endodontics) at UCL.
Currently, he is an associate Professor at the
Department of Restorative and Aesthetic The following paper reports the case
dentistry in the Lebanese university and the of Serena, a 25-year-old patient that
director of the Master program as well as
guiding several research projects. His private
complains about her unpleasing smile
practice is restricted to aesthetic dentistry due to wear and erosions on the upper
and endodontics.
laterals and incisors (Fig. 1). After a
He has published many papers in
international peer-reviewed dental journals thorough clinical examination and
and has lectured locally and internationally. smile analysis, in order to optimise
He is a member of the Academy of Operative
Dentistry USA, the editorial board of the result, it was agreed to place four
Reality-Journal, USA, the International laminate veneers made with lithium Fig. 1: Preoperative view of the patient smile
Association of Dental Research, and a fellow (upper anterior teeth)
of the International College of Dentists. disilicate (Initial LiSi Press, GC).
24 GC get connected
Smile rehabilitation with
lithium disilicate veneers:
a case report
An alginate impression was taken,

and a diagnostic wax up was made
on the four anterior teeth (Fig. 2). A
silicone tray was made on the
wax-up using Exafast (GC), a polyvinyl
siloxane (PVS) and left during three
minutes for setting. Then the mock up
was made using Tempsmart DC
(Shade A1), a dual-cure resin based Fig. 2: Wax up of the four upper incisors Fig. 3: Mock up on the upper incisors made
using Tempsmart DC (A1)
composite (Fig. 3).
In the following session, the teeth gingival limits (Fig. 4a). The preparation 1.5-2 mm. Palatally, the teeth were
were minimally prepared using phase consisted of three steps : buccal, finished with an overlap, for a better
diamond burs from the SKIV Kit incisal and proximal reduction. seating of the veneers (Fig. 4b), and
(Simple Kit for Inlay and Veneers, The incisal preparation was carried an enhanced translucency of the
Komet, Fig. 4) ensuring finishing over the incisal edge from buccal to incisal edge4.
contour within enamel with equi- palatal, with an incisal reduction of
Fig. 4: Simple Kit for Inlay and Veneers, for Fig. 4a: Minimal teeth preparation for Fig. 4b: Palatal view of the prepared teeth
veneers preparation Porcelain Laminate Veneers : buccal view
Fig. 5a: Lithium disilicate veneers (Initial LiSi Fig. 5b: Application of hydrofluoric acid (9%) Fig. 5c: Application of silane (Ceramic Primer II)
Press) during 20 sec during 2 min
The second session was dedicated to rubber dam, and ligatures were made the lab), then conditioning using
veneers placement. After removal of around the teeth with waxed dental hydrofluoric acid (9%) for 20 seconds
the temporaries and cleaning of the floss, to avoid any gingival fluid (Fig. 5b), then thorough rinsing, and
teeth, the four veneers received from contamination. finally a layer of silane, the Ceramic
the laboratory were tried in (Fig. 5a). The inner parts of the veneers were Primer II, was applied and left
For an optimal adhesive procedure, prepared as follows; sandblasting using undisturbed for 2 minutes (Fig. 5c), than
the working field was isolated using a alumina oxide, (usually carried out by dried to remove any existing excess.
GC get connected 25
a case report
Teeth preparation consisted of etching teeth were thoroughly rinsed and dried and air thinned, then
all the surfaces with orthophosphoric gently dried, and the universal adhesive polymerised for 20 seconds (Fig. 6c).
acid with a concentration of 37% G-Premio BOND (GC) was applied
during 20 seconds (Fig. 6a). Then, the with a microbrush (Fig. 6b), gently
Fig. 6a: Application of orthophosphoric acid Fig. 6b: Application of G-Premio Bond Fig. 6c: Light curing of the bonding during
37% during 20s on the prepared teeth adhesive 20 sec
After applying G-CEM Veneer cement gently removed using dental floss.
at the inner side of the porcelain Polymerisation was completed
restorations, the two centrals were during 40 seconds from each side
seated first (Fig. 7), then the two using the same light-curing unit.
laterals. Excesses of cement were Careful removal of excesses reduces
removed using a brush, then tack- the finishing procedure and ensures
cured for 3 seconds out using a LED a better finishing and polishing of the
unit, and interproximal excess were porcelain veneers.
Fig. 7: Application of the G-Cem Veneer
(Translucent shade)
Light-curing resin cements are preferred

for veneers cementation as they have
a longer working time, allowing the
placement of several veneers. The
setting time is controlled by the
operator. Additionally, G-CEM Veneer
cement has an optimal consistency
that avoids excess displacement in
the interproximal areas, making their Fig. 8: After veneers placement, a layer of Fig. 9: Silicone point used for final polishing
glycerin is applied for a better polymerisation.
removal much easier. The final
polymerisation is achieved through a
layer of glycerin gel placed on all the occlusion followed by excursive and The use of diamond burs on the buccal
veneers, in order to avoid the formation laterality movements. Rugby-shaped surface of the veneers, is not
of an oxygen inhibited layer (Fig. 8). fine diamonds were used with water recommended, in order to preserve the
spray to adjust the occlusion; then surface gloss. Buccal excesses can be
The occlusion was carefully checked rubber points were used to polish removed using a blade N° 12. A silicone
using articulating paper in centric the surfaces. cup was used for polishing (Fig. 9)
26 GC get connected
a case report
and finally a small quantity of Porcelain laminate veneers are respected, the survival rate of
diamond paste was used on a low considered a very conservative porcelain laminate veneers at 15
speed for the final lustre and technique in aesthetic dentistry. Their years, is close to 85%6. Layton and
polishing using a goat brush wheel. longevity depends on many factors Walton reported the longevity of
that can be summarised into a feldspathic porcelain veneers as up
Figures 10 a and b show the careful case selection, a healthy to 12 years; at 5 years, the survival
postoperative buccal and palatal gingival tissue and periodontal rate was 96%, dropping to 93% at 10
views of the veneers 6 months after environment and an excellent years and to 91% at 12 years7 (Layton
their placement in the mouth. laboratory. When those criteria are and Walton, 2007).
Fig. 10a and 10b: Postoperative buccal and palatal views of the veneers after 6 months
References
1. Shetty A, et al., Survival rates of porcelain laminate restoration based on different incisal
preparation designs: An analysis. J Conserv Dent. 2011 ;14 (1):10-5.
2. Arif R et al., Retrospective evaluation of the clinical performance and longevity of
porcelain laminate veneers 7 to 14 years after cementation. J Prosthet Dent, 2019 : 122 (1) :
31-37.
3. Mormann WH. The evolution of CEREC system. JADA. 2006; 137 (Suppl) : 7S–13S.
4. Magne P, Belser U. Bonded porcelain restorations in the anterior dentition: A Biomimetic
Approach. Germany: Quintessence, 2003.
5. Gresnigt MM et al., Randomized clinical trial on indirect resin composite and ceramic
laminate veneers: Up to 10-year findings. J Dent, 2019; 86 : 102-109.
6. Morimoto S et al., Main Clinical Outcomes of Feldspathic Porcelain and Glass-Ceramic
Laminate Veneers: A Systematic Review and Meta-Analysis of Survival and Complication
Rates. Int J Prosthodont 2016 ; 29 (1) : 38-49.
7. Layton D and Walton T. An up to 16-year prospective study of 304 porcelain veneers. Int J
Prosthodont. 2007;20:389–396.
GC get connected 27
Experiences gained with Experience™
mini Rhodium and Ortho Connect:
A Self-ligating
bracket with a
compelling design
and convincing
implementation process
By Dr. Marcus Holzmeier, Germany
Dr. Marcus Holzmeier worked as a
freelance dentist from 1999-2000 after his
Self-ligating brackets are an integral part of modern
studies at the University of Erlangen. During
his time as a product manager and clinical orthodontics, as they are associated with significantly
research associate at Heraeus Kulzer
(2000-2004), he obtained his doctorate at shorter treatment times than conventional brackets
the University of Mainz in 2002. Prior to
obtaining the recognition as a specialist in among other things. In practice, the various systems
orthodontics in 2007, he worked as a
research assistant at the University of do indeed have quite different handling characteristics,
Erlangen from 2004-2007. Since 2007, he has
been working as an orthodontist in the so that the changeover to another or new system is
practice of Dr. Windsheimer & Partner in
Crailsheim. He specialises in early treatment,
functional orthodontics as well as adhesive
associated with a period of familiarisation. If this is
technology. Parallel to his work in the
practice, Dr. Holzmeier regularly works as facilitated by training and if a new system convinces
an author and speaker and has been a
lecturer at the Department of Orthodontics by its clinical handling, efficiency and aesthetics, the
at the University of Würzburg since 2008. He
is a member of the WFO and DGKFO. decision to change products is worthwhile. Dr. Marcus
Holzmeier is convinced of this. In this context, he
reports on his positive experiences in using the
self-ligating Experience™ mini Rhodium bracket
(GC Orthodontics) on the basis of a case study.
28 GC get connected
A Self-ligating bracket with
a compelling design and convincing
Bracket systems are usually indicated from the previous system in terms of improved aesthetics compared to the
in modern orthodontics as soon as handling in order to keep the predecessor bracket we used and can
complex, physical tooth movements familiarisation time for the team as also be employed as a passive or
have to be made, e. g. in the case of short as possible, and on the other active system, depending on the size
pronounced rotations, displacements hand, the points that had previously of the archwire and deflection.
or gap closure or gap opening.1 led to irritation had to be solved
Usually, a lack of oral hygiene or the better by the new bracket. Experiences
express wish of the patient not to use
fixed appliances are arguments against I also need an aesthetically pleasing, The carefully considered switch to
a fixed treatment method. In this case, relatively small bracket in order to meet Experience mini Rhodium has proven
other solutions need to be found. Once the patients’ demands. This basic its value. We have no more fractures
the indication for bracket treatment requirement is fulfilled by the of the closure clip and hardly any
has been established, this can be Experience mini Rhodium (GC detached brackets: Due to the low
performed with a variety of different Orthodontics), which we have been depth, contact with the front of the
systems and the appropriate specialist using successfully since autumn 2016 lower jaw is rare and the micro-etched
knowledge. In general, it is essential to in all new cases with self-ligating mesh pad base of the bracket appears
know “one’s” system used in practice, brackets. In our opinion, other to produce excellent bonding to the
its values and behaviour during tooth requirements for a bracket include an composite (in our case Transbond XT
movements. We prefer using self- as flat as possible profile, e.g. to avoid (3M Unitek) or Ortho Connect (GC
ligating brackets in our practice, as interfering with the occlusion in case Orthodontics)).
there is less friction from the beginning of deep bites and without affecting
of the levelling phase. As a result, the patient’s cheeks and lips if possible. As is generally known, orthodontics
tooth movements are executed with The bracket should have a sufficient tend to be more of a long-term
minimal forces, which increases the mesio-distal width to provide good treatment, and therefore it is not
patient’s wearing comfort due to guidance and rotation control. The possible to completely replace a
reduced pain and simultaneously moves surface must allow the best possible predecessor product at a fixed point
the teeth quickly and effectively – the sliding movement, i.e. friction, binding in time; rather, it is a matter of phasing
treatment time can therefore often be and notching effects should be as out and introducing bracket types.
shortened. In addition, the absence of small as possible in the area influenced Since the introduction of Experience
elastics reduces plaque retention by the bracket material per se. We mini Rhodium into our practice, all
around the brackets and makes it also place great emphasis on a sturdy new patients receive these as self-
easier to clean the patient’s teeth.2 clip that can be opened and closed ligating brackets and all previously
easily and a bracket, the base of which started treatments are completed
As long-time users of self-ligating provides a secure bond. It is annoying with the predecessor product. As a
brackets, we had already been looking if the closure clip breaks or “wears out” result, we worked with both bracket
for a better alternative to our used during treatment and can no longer types over a transitional period of
system for several years and have retain the archwire in the slot. Equally approx. 2 years. In view of this additional
tested different self-ligating bracket advantageous is the overall small size logistical effort and the constant
systems during this time. It was of the bracket, which despite its mental change between the systems,
important to us to find a bracket miniaturisation integrates wings in it is understandable that it was not an
suitable for the MBT. 022” slot system order to be able to place a ligature or easy decision to switch to another
generally used in the practice and to attach rubber chains if required. We bracket. Rather, this decision was
be able to work conceptually in one chose Experience mini Rhodium, as it preceded by collecting extensive
system. On one hand, the new meets all the clinical requirements information and discussions with
bracket should not differ too much here. In addition, it benefits from colleagues.
GC get connected 29
The changeover was facilitated by a is quickly practiced and works well. In practice are usually combined with the
team training course conducted by addition, I also enjoy working with GC aesthetic Initialloy RC and BioActive RC
one of the manufacturer’s employees Ortho Connect because the brackets– (GC Orthodontics) archwires. In our
in our practice at the time the bracket despite the low viscosity of Ortho experience, a defined break occurs
was introduced. The team learned Connect, which allows penetration between the base and the composite
how to handle the new bracket in its into the etched enamel profile – remain material during removal of the bracket,
original size as well as on an oversized in a stable position before polymerisation so that the composite residues can be
demonstration model and how to and excess material is easy to be polished from the tooth surface as
open, close, etc. using a typodont. removed. To date, the material has usual. We have not observed any
From the outset, we therefore avoided demonstrated high adhesive strength, chipping of enamel during removal to
any anxieties with regard to the new which is clinically comparable to the date. Overall, we like using self-ligating
system or faulty handling when orthodontic gold standard Transbond brackets and in particular Experience™
changing archwires. The assistants XT (etching gel/ primer/composite), mini Rhodium, as they make work
appreciate the reduced effort required which is also used in the practice. considerably easier, for example, when
for clips compared to ligatures. opening and closing with the EM
Derotation, particularly in the initial We appreciate the option that the instrument, they accelerate some
phase, works excellently due to the brackets can be ordered both treatment steps (especially in the
bracket width (rotation control) and individually or in pre-sorted trays per levelling phase at the beginning of
the secure hold of the closed clip. case. Another big advantage is the the treatment) and are comfortable to
option of choosing between open wear and clean for the patient. In
In combination with GC Ortho Connect, and closed brackets. We prefer the open addition, the teeth move quickly and
the practice also benefits from the bracket as this allows good position effectively due to the lower friction
easy application of the system for control with the height gauge (see compared to conventional brackets,
bracket bonding: This one-component Fig. 13 further on) as well as alignment i. e. the total treatment time can often
3
system does not require bonding, so with the Heidemann spatula (see Fig. 11 be reduced. Furthermore, the
that the bracket can be placed directly further on). All brackets for the posterior Experience mini Rhodium is bevelled
on the etched and dried enamel region can be supplied with hooks so at the edges of the slot, so that binding
surface after application of GC Ortho that we are flexible when placing effects are also reduced during
Connect. Dosage of the correct amount elastic bands. The brackets in our translational movement.4
Case report
The following clinical case shows the The then ten and a half year old patient OPG, FRS and photo analysis, exhibited
incorporation of a multibracket presented herself for orthodontic a skeletal class III tendency. An alveolar
appliance with self-ligating brackets. treatment at the end of 2016. The midline shift of 1 mm to the right was
The banding of the 6’s is not discussed extensive diagnostic measures, such visible in the maxilla. The maxillary
in the following. as clinical examination, model analysis, arch exhibited a narrowing of the gap
1 2 3
Figs. 1-3: Intraoral images in occlusion before the start of treatment with a fixed appliance
30 GC get connected
in region 13 with an elevated and 4 5

protruding position of tooth 13. The
first quadrant showed a pre-migration
of 1.5 mm. In addition, tooth 12 had a
cross bite and a misaligned position of
the anterior teeth (Figs. 1-5).
Treatment was initially initiated in

March 2017 with plates, in the maxilla
with protrusion segment from 12-22. Figs. 4-5: Narrow positions and misaligned teeth
This enabled us to use the phase of
second dentition and protrude the Due to this fact and also for reasons of intensively with a fluoride-free polishing
maxillary front by about 5 degrees. cost, this alternative was excluded, as paste. Fine pumice powder is also
The aim of the multi-bracket phase, aligner treatment is to be paid for in full suitable for preparatory cleaning. The
which followed six and a half months privately. After informing about the tooth enamel was then conditioned
later, is to adjust the teeth physically: various treatment options, we therefore for 30 seconds with 37% phosphoric
rotation, tip and torque are precisely decided together with the patient and acid gel (Ortho Etching Gel; GC) in the
controlled and adjusted; the correction her mother to opt for multibracket area where the bracket bases were to
of the cross bite is performed including treatment with the self-ligating Experience be bonded (Fig. 6). After spraying the
the correctly adjusted oral-vestibular mini Rhodium brackets, based on the gel and drying the etched tooth surfaces,
root inclination. With the aid of the above-mentioned advantages of the the typical chalky white enamel surface
self-ligating brackets to be inserted, system. Initially, the teeth were cleaned was clearly visible (Fig. 7).
tooth 13 is quickly guided to the occlusal
plane with as little friction as possible 6 7
and thus accelerated movement,
while at the same time being moved
into a distally neutral position. Teeth
16 and 26 should be held in position.
An alternative would have been

orthodontic treatment using removable
appliances exclusively. However, plate
Fig. 6: Etching of the tooth enamel with Fig. 7: The etched tooth surfaces impress
apparatuses would have made it
phosphoric acid gel in the area of the with chalky white.
difficult to adjust both tooth 13 and brackets to be bonded
physically shift tooth 12, as well as the
correct adjustment of tip and torque.
8 9 10
A further therapy option might have
been an aligner treatment, whereby
the treatment would have required at
least one case refinement due to the
not yet present teeth 15 and 25. In
addition, 100% compliance is a
prerequisite here for achieving difficult Fig. 8: Experience mini Rhodium Bracket Tray Figs. 9-10: GC Ortho Connect light-cured
extrusion movements with aligners, opened for the patient orthodontic adhesive applied directly to the
bracket base
such as those required for tooth 13.
GC get connected 31
11 12 according to MBT system specifications.

The composite was then cured (Fig. 14)
for 20 seconds (depending on the
treatment room Bluephase Style; Ivoclar
Vivadent or SmartLite Focus; Dentsply
Sirona). Here, it is important to work
with as high a light output as possible
(for LED devices from 1,200 mW/cm2
upwards) that reaches well below the
Fig. 11: The bracket can be aligned with the Fig. 12: After applying the bracket, excess bracket base.
Heidemann spatula. composite is removed with the Heidemann
spatula.
Finally, any excess material remaining
after polymerisation must be removed
Now the brackets from the GC Tray syringe (Figs. 9 and 10). The brackets using a scaler or finisher. This was
(Fig. 8), which had previously been were then placed on the teeth, followed by the application of a
opened for the patient, could be positioned and the excess material fluoride-releasing, light-curing sealant
clamped sequentially into the bracket was removed immediately with the to the buccal and labial surfaces
forceps and the composite material Heidemann spatula (Figs. 11 and 12). respectively (Pro Seal; ODS/
applied directly from the GC Ortho polymerisation for 20 seconds). Finally,
Connect syringe to the bracket base Figure 13 shows the alignment of a the first archwire could be inserted
by means of the attached disposable bracket using a height gauge exactly (Fig. 15). A 0.014” nickel-titanium (NiTi)
was used as archwire material, which
13 14 had previously been adapted on the
model and was now inserted with
the Weingart forceps.
The ends of the archwire were

annealed and bent. Ligating proved
very easy as the brackets were already
open when delivered in the tray and
the EM instruments for opening and
Fig. 13: Alignment of the bracket using a Fig. 14: Light polymerisation for a total of 20 closing the brackets were included
height gauge seconds per tooth with the initial order by GC.
13 14 Alternatively, it is also possible to very

easily open or close the clip with a
Heidemann spatula, by placing it on
the opening groove and opening the
clip with a twisting movement. Finally,
the brackets were closed with the EM
instrument, which again, is also
possible with the Heidemann spatula
or with the finger. The colour coding
Fig. 15: The ligated archwire with closed Fig. 16: Condition without colour coding disappeared after the first brushing of
bracket clips after the first brushing of the teeth the teeth (Fig. 16).
32 GC get connected
13 14 14
Fig. 17: Very fast levelling is already evident Fig. 18: A further 5 weeks later: marked tooth Fig. 19: Condition after changing the arch
5 weeks after insertion. This is particularly movement has taken place.
evident during the onset of alignment for
tooth 13. Unfortunately, oral hygiene is
inadequate at this time. Oral hygiene instructions
were repeated together with giving remotivation.
The very fast onset of alignment for With appropriate treatment progress, follow-ups and the associated change
tooth 13 (Fig. 17) was already apparent I expect a good and fast adjustment of archwires can be learned quickly by
at the first change of the archwire of teeth 12 and 13 as well as a the team and implemented without
after five weeks. correction of the midline shift in the errors.
maxilla. At this point in time, I expect
The aesthetic archwire InitialloyTM to achieve neutral dentition within References
Rhodium, Medium, Form C, 0.018” (GC 12-15 months.
Orthodontics) was now used as 1. Papageorgiou SN, Keilig L, Hasan I, Jäger A,
Bourauel C: Effect of material variation on
archwire, which, in combination with Conclusion the biomechanical behaviour of
the brackets, creates a relatively orthodontic fixed appliances: a finite
element analysis. Eur J Orthod. 2016 Jun; 38
inconspicuous apparatus. Experience mini Rhodium is a very (3): 300-307
Unfortunately, oral hygiene was not comfortable bracket for the dentist 2. Bock F, Goldbecher H, Stolze A: Klinische
Erfahrungen mit verschiedenen
sufficient at this time due to the and the patient: the markings and selbstligierenden Bracketsystemen.
naturally occurring hindrance by the shape enable good positioning, the Kieferorthopädie 2007; 21 (3): 157-167
3. Burrow S.J: Friction and resistance to Sliding
brackets, so that oral hygiene robust closing clip and the flat in orthodontics: A critical review. American
instructions were repeated as well as construction height with good width Journal of Orthodontics and Dentofacial
Orthopedics. April 2009, Volume 135 (4):
giving renewed motivation and (rotation control) are convincing from 442-447
recommending the use of Tooth the material side, as are the good MPa 4. GC Orthodontics brochure at www.
gcorthodontics.eu
Mousse (GC). A further five weeks values for enamel adhesion in
later, the distinct tooth movement combination with GC Ortho Connect.
was impressive and oral hygiene was In my opinion, another application
also improved (Figs. 18 and 19). advantage is that the handling during
GC get connected 33
Hybrid zirconia
titanium abutments
assembled with
G-CEM LinkAce
can be autoclaved maintaining
structural integrity.
By MDT Dieter Pils, Austria
Dieter Pils (Austria) graduated as a dental
technician in 1988. He passed the Instructor
Implant abutments are classified as semi-critical
Examination and Entrepreneur Examination
and obtained the title of ‘Master dental
technician’ in 1995. In 2018, he obtained the medical devices. Regulator authorities in the EU as
‘Master of Science’ degree in dental
technology at the Donau Universität Krems
(Austria). Since 1996, he is the CEO of Pils well as in the US therefore recommend to sterilise
Zahntechnik GmbH.
them after each use and possible contamination.
Sterilisation is not harmful for titanium, but little
information can be found regarding the effect on
resin cements and ceramics. Therefore, we tested in
collaboration with the Danube Private University in
Austria and Uni-Saarland in Germany whether or not
autoclaving could harm the structural integrity of
two-piece abutments.
34 GC get connected
Hybrid zirconia titanium abutments assembled
with G-CEM LinkAce can be autoclaved
maintaining structural integrity.
We cemented 24 CAD/CAM-generated zirconia abutments A high stability of the hybrid abutments was found in both
with G-CEM LinkAce on prefabricated titanium bases. We groups, demonstrating high retention force. Steam
split the abutments into two groups; one group was autoclaving did not seem to have a weakening effect on
autoclaved and the other group remained untreated. All G-CEM LinkAce; in contrast, we found a significantly higher
specimens were mechanically aged in a chewing simulator number of specimens reaching the pre-set maximum
and thermocycler. Thereafter, all abutments were force of 1000 N after the sterilisation process. Possibly, the
subjected to a pull-off test, limited to a maximum force of heat had a similar effect as post-polymerisation methods
1000 N, which is higher than the force reached by most used in the lab that also make use of heat to increase the
cements. With this test we tried to detach the abutment cross-linking density of resin polymers.
from its titanium base.
G-CEM LinkAce is my preferred luting option in the lab for
hybrid abutments, as it’s strong, self-adhesive and can lute
ceramics, zirconia, metal as well as composites. As such it
has become indispensable for my daily work!
Do you want more details on how to cement hybrid abutments

with G-CEM LinkAce? Take a look at this interesting article from
Roland Verhoeven, published in GC get connected 3.
Source: Pils D et al. Application of a standard autoclaving protocol does not harm structural integrity of two-piece zirconia abutments under
detachment force testing. Clin Oral Investig. 2019 May 10. doi: 10.1007/s00784-019-02926-9.
GC get connected 35
Zirconia:
Aesthetic,
strong and
predictable
By Patric Freudenthal IQDENT / DTG,
Sweden
Patric Freudenthal graduated as a dental

technician in 1989 at the University of Malmö,
Sweden. Before that he worked as a dental
assistant between 1984-1986. After graduating,
he worked as a technician for 10 years before
starting his own lab with Björn Stoltz.
IQDENT has worked with implants, CAD-CAM
and aesthetics during all this time, with focus
on bioinert materials. Since 2004, Patric has
been lecturing on different topics, such as:
implants, CAD-CAM, aesthetics, full ceramic
etc. Function & aesthetics with technology
is the key-instrument in his everyday work.
He is a member (and board member) of
The Dental Technicians Guild.
Aesthetics and economy
When zirconia hit the dental market in the late 90’s, it was expensive for the labs
and clinics, and only provided by big milling-centers and companies.
The system had very few options on design and the amount of units that could
be made. In the beginning, it were only single units and after a few years small
36 GC get connected
Zirconia:
Aesthetic, strong and predictable
bridges. Slowly it started to take over

Moment PFM Time Zirconia Time
the porcelain-fused-to-metal (PFM)
crowns, mostly for the improved Model 20 20
aesthetics and ease of use. In the Spacer 3 6
Nordic countries, the production costs Applying casting channels 2 0
are high (high taxes on labor and Invest 2 0
means) so the dental labs are always Prepare alloy 5 0
looking for more cost-effective ways to Cut casting channels 3 0

Adjustments 5 0
make their workpieces.
Polishing 4 3
From the moment the prices enabled Margins 5 5
in-house milling at a lower cost, a small Wax-up 15 0
revolution happened in the dental labs! Investment material 3 0
Now we could mill more or less Burn-out 4 0
everything and milling zirconia became Devest, sandblasting etc. 6 0
a daily business. Soon the design Try-in 3 1
software improved and we could design Porcelain 40 40
more freely and for more indications. Total time 120 75
Today there is almost no limitation for

what a dental lab can produce in-house. Fig. 1: Production time comparison chart between the traditional PFM-crown and the
present-day layered zirconia crown.
It became possible to have your own
industrial production on a small scale
and by adapting the workflow and product portfolio accordingly, it became an economic business.
In our lab we have always been interested in production optimisation, how much time it takes to reach the end result,
how much time a remake would take, which way would be the most cost-effective (Fig. 1)...
The difference in production time says it all! Obviously, we always have to keep the required quality and level of aesthetics
in mind. Different customers may have different demands.
We believe that today, our lab has reached a good balance between the economical aspect and our production process,
offering a high quality meeting all our customers’ requirements.
The aesthetical veneering material should meet the production time, the quality and aesthetical outcome. After testing a
wide range of materials, we ended up with the system of GC Initial. Here we found a full range of ceramic solutions. From
painting solutions with GC Initial Spectrum Stains (2D) or GC Initial Lustre Pastes NF (3D), to layering solutions with GC
Initial MC / Zr-FS / LiSi / Ti. This range of ceramics offered us all we needed to deliver the desired quality.
Zirconium dioxide is a strong material (some call it ‘the white metal’) but at the same time it is brittle, like all ceramic
materials. If you don’t pay attention, it is easily damaged, all it takes is a diamond disc in the wrong place.
Another important thing is the design of the framework, especially the connectors in bridges. The connector is the weakest
point in a bridge framework. In a single crown, the thickness of the coping and the tooth preparation design are the most
important factors.
To control all the manufacturing steps (design, milling, cleaning, colouring with infiltration liquids, sintering) is of utmost
importance. Therefore, choose a qualitative zirconia and strictly follow the manufacturer’s instructions during the
production process. Use high quality milling machines and a sintering furnace that can go up to at least 1650° for better and
more predictable results.
GC get connected 37
Zirconia:
My recommendation would be to take your time to read through the existing literature on zirconia and all the steps
needed to have control from design to sintering.
Our workflow
In our lab we have three main techniques in zirconia:
1 Layered | 2 Semi layered - also called micro-layering or buccal veneering | 3 Monolithic or One Body
These can be either tooth-supported or implant-supported.
Below, examples of a 0.3 mm layering design (Fig. 2) and an 0.8 mm layering design (Fig. 3) are shown. Highly aesthetical
results can be obtained with both techniques. The technique selection depends on the appearance of the surrounding
teeth that need to be replicated. For the case shown in Fig. 3, a very translucent incisal edge needed was needed;
therefore, a more traditional layering from dentine to enamel was used.
Fig. 2a: 0.3 mm layering design Fig. 2b: The staining technique with a base Fig. 2 c: The final bake is Enamel and Enamel
of Initial Lustre Pastes NF and a sprinkle of Opal Booster from Zr-FS (or LiSi). This is what
CL-F and a second bake with Spectrum Stains. we can call our basic product.
Fig. 3a: 0.8 mm layering design Fig. 3b: For a 0.8 mm buccal cut-back, more Fig. 3c After final dentine bake
work is needed on the layered part. First step
is a foundation with Initial Lustre Pastes NF,
sprinkled with CL-F or shoulder material and
fired at 900°C.
All ceramic materials

will fail if you don’t
follow the rules;
if you try to cheat
the system,
Fig. 3d Try-in Fig. 3e: Final result. it will beat you.
38 GC get connected
Zirconia:
Clinical case reports
Case 1
In most cases we start with clinical picture taking followed by the impression
taking (digital or analog). Next step is to decide on the treatment plan.
We always aim to have the final product, form and function finished before we
start with the final work.
The digital plan is made with a standard dental CAD program and after liaising
Fig. 4: Intraoral image of the initial situation
with the dentist and patient, a mock-up (Fig. 5) is designed and printed.
After mock-up and a provisional phase, we start up the creation of the final
restoration – a zirconia bridge - following our standard protocol: Zirconia Disk
HT, Initial Zr-FS, Initial Lustre Pastes NF, Initial Spectrum Stains.
First step is to ensure that your framework is close to the desired colour
(Figs. 7 and 8). We are currently using Initial Zirconia Disk which we infiltrate
with colouring liquids.
Fig. 5: Digital mock-up
Fig. 6: Intraoral mock-up Fig. 7: Shade selection on the oral scan
GC get connected 39
Zirconia:
Shade matching of the framework (Fig. 9)

is an optional step and not really required
in our case as we apply a foundation
layer with Initial Lustre Pastes NF in
order to secure the colour.
A layer of Initial Lustre Pastes NF is

applied and fired (Fig. 9) after which
Dentin, Enamel and Effect colours are
added to the framework. At this point Fig. 8: Initial zirconia framework Fig. 9: Shade matching
we want to reach a slightly darker/
warmer colour than the final level.
(Fig. 10).
If required we can apply a second

layer or adjust it with Initial Spectrum
Stains in a later phase. If the desired
result is achieved, we continue with
the layering using Initial Zr-FS.
For the first layer we applied INside

Fig. 10: After application of Initial Lustre Fig.11 First ceramic layer with different
IN-46 in the approximal areas, Dentin
Pastes NF powders for cervical and incisal area
D-A3 and a touch of A3.5 at the cervical
area. For the incisal part we applied
TM-01, -05 and some CT-22., on top of
that some thin areas for discrete
mamelons were made with Inside 44
(Fig. 11).. We always fire this first, with the
normal dentine program. Why we do
this is simple: If we are not happy with
the outcome we can go for an internal
Fig. 13 (a and b) After the final colour
staining with Initial Spectrum Stains
check and cleaning, the restoration is ready
to reach the desired result. to be sent to the dentist.
Fig. 12: Shade check
When we have obtained the required

colour, we cover the first build-up
with CL-F and enamel, maybe some
CT-22/24 at the cervical area (Fig. 12).
The final steps are managing shape

and surface structure, glazing and
polishing.
Fig. 14: End result seated in the mouth of the
patient
40 GC get connected
Zirconia:
Case 2
As always, the case started with

clinical picture taking (Fig. 15)
followed by the impression taking
The treatment plan is always based
on the initial assessment.
After preparation of the teeth, the

temporary restorations were made Fig. 15a Initial oral situation Fig. 15b Initial oral situation
using CAD/CAM; (Fig. 16);
in this stage, only the upper jaw was
done (Figs. 17 and 18).
Fig. 16: Digital wax-up to create a plan and temporary constructions.
Fig. 17: Preparations Fig. 18: Temporaries – upper jaw only.
The lab stages:

The first step was designing the
framework after the decided plan.
Fig. 19: Framework design based upon Fig. 19: Reduced framework design
digital wax-up
GC get connected 41
Zirconia:
Fig. 20: The framework milled from Zr disk, Fig. 21: Framework with Lustre Pastes and Fig. 22: Fired at 900°.
infiltrated with colouring liquids and sintered sprinkled with Initial Zr-FS CL-F just before firing
Fig. 23: INside and Fluo Dentin Fig. 24: Dentin, Translucent Modifier and CL-F. Fig. 25: The internal staining with Initial
Spectrum Stains can be clearly seen.
Then, the framework is milled, coloured

and sintered to a colour matching as
closely as possible (Fig. 20). This is not
the most important step; we do a final
colouring before layering with the
Initial Lustre Pastes NF (Figs. 21 and 22).
This is followed by usual protocol:
application of Initial Zr-FS, Inside, Fluo
Figure 26: First layer of enamel and Enamel Fig. 27: Second layer of Enamel and Enamel Dentin, Dentin, Translucent Modifier,
Opal Booster Booster. Surface, shape and structure are
CL-F, CT and Enamels (Figs. 23-27),
defined in this step.
polishing and glazing (Fig. 28).
High aesthetic results can be reached
with different approaches, the chosen
technique is always related to the specific
case and the demands of patient and
dentist. A well considered and proven
workflow is of utmost importance.
Acknowledgements:
Clinical work by:
- Dr. Kaspar Hermansen
Fig. 28: Glazed and polished - Dr. Henrik Hjelte
- Dr. Niclas Berggren
- Dr. Henrik Annerud
- Dr. Sofie Rix
Dental lab work by IQDENT AB Ystad/Sweden.
42 GC get connected
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14

2. The composite injection technique with GRADIA PLUS 11

3. Injection moulding for a predictable aesthetic outcome. 14

4. Indirect Hybrid Nano-Ceramic Adhesive Restorations in the Posterior Region 18

5. Smile rehabilitation with lithium disilicate veneers: a case report 24

6. Experiences gained with Experience™ mini Rhodium and Ortho Connect: 28

7. Hybrid zirconia titanium abutments assembled with G-CEM LinkAce 34

8. Zirconia: Aesthetic, strong and predictable 36

Dr. André Rumphorst

protocols in field of restorative dentistry. Digital dental

technologies have allowed the seamless delivery of complex

Proper treatment planning protocols printing or milling. The prosthetic design

Fig. 1: Pre-operative smile and orthopanthomogram.

Diagnostic Record Collation 2

A 79-year old patient presented with

Tip: the accuracy of image registration 4

• Guided surgical placement of 5

The design of the previous PFM was 6

Guided Implant Surgery and

The following clinical procedures

• All five implant fixtures were placed

Once the 16-week healing phase was

A pre-preparation IOS was taken with

The temporary bridge was then

An emergence profile scan was taken

13 restorations. The contours of the 11

Following removal of the temporary

The soft tissues were prosthetically

The case presented illustrates how

Fig. 19: Immediate post-operative view of the inserted provisionals.

is a very convenient approach to get a convincing,

aesthetic result with minimum effort. We spoke with

four dental technicians about their experiences with

A 35-year-old woman consulted the 1

Figure 6: Transparent mould from Figure 7: Creation of the injection channels

12a 12b G-Premio BOND was applied, left

13 The EXACLEAR impression is very precise, so all the texture

A case report using

1 premolar. A mixed analog-digital premolar and two molars with full

4 5 A one-step VPS impression of the

The models and the separate

The restorations were milled from

The restorations were cut from the 8

Fig. 8: The finished restorations on the check model.

Fig. 10: Isolated and sandblasted preparations,

Fig. 11: Adhesive cementation of the restorations

applied to the preparation surfaces in was achieved. Everything was

An alginate impression was taken,

Light-curing resin cements are preferred

in region 13 with an elevated and 4 5

Treatment was initially initiated in

An alternative would have been

11 12 according to MBT system specifications.

The ends of the archwire were

13 14 Alternatively, it is also possible to very

them after each use and possible contamination.

Sterilisation is not harmful for titanium, but little

information can be found regarding the effect on

resin cements and ceramics. Therefore, we tested in

collaboration with the Danube Private University in