David S. Hornbrook, DDS, FAACD
The use of lithium disilicate (e.Max) has become increasingly more popular the last few years for both anterior and posterior restorations. Confusion, however, still exists in how these restorations should be cemented to provide optimal aesthetics, retention, and fracture resistance. Although most of us may have different bonding agents and cements already in our office that we could use, Bisco has made it very easy to predictably cement these restorations by developing a lithium disilicate cementation kit, named appropriately “eCement”.
This kit is very comprehensive and includes the adhesive agent, porcelain etch, dentin and enamel etch, silane, and both anterior light-cure only cement and posterior dual-cure cement.
The nice thing about this kit is that the quality of each of the components is top notch. So many times when a manufacturer puts a cementation kit together, I throw out some of the included components and replace them with ones that I feel are better. This is not the case with the eCement kit.
The porcelain etch is a 4 % buffered Hydrofluoric acid that is used to either re-etch a lithium disilicate restoration after it is returned from the lab, or to etch a CAD:CAM designed and milled in-office restoration using Cerec. The consistency and handling is very easy to use compared to other HF acids. The dentin and enamel etch is by far my favorite etch on the market. Bisco named it “Select Etch” because the consistency and viscosity is such that it can easily be limited to enamel only for those that are using a self-etching adhesive and want to increase the bond to enamel by etching, yet do not want to get any of the etchant on the dentin. It also contains Benzalkonium Chloride which is an anti-microbial agent that has been shown to improve the long term durability of the dentinal hybrid layer.
The adhesive agent in this kit is Bisco’s new “All-Bond Universal”. This is an alcohol-based single bottle system that can be used with either the total-etch or self-etching techniques. It is much different than any of the other One bottle systems on the market. As a proponent of Total-etch, I use this adhesive agent in conjunction with etching both the enamel and dentin.
The dual–cure resin cement in the kit is one of the very best on the market. It works excellent with a “Tack & Wave” technique and the excess easily peels away from the restoration margins after waving. The anterior light-cure only cement comes in two shades: Translucent and Milky Bright. This is the same cement that Bisco uses in their Choice 2 resin kit, and handles great and is easily removed from the margins after using the Tack & Wave technique as well. This kit does not include the water-soluble try-in gels that would normally come in an anterior cement kit, but if you like the way this cement handles and cleans up, you could order the try-in gels from the Choice 2 kit.
Overall, this is an excellent system. It includes everything you need to bond in a lithium disilicate restoration including microbrush tips, mixing wells, and all syringe tips. The instructions are easy to follow with photos and describe the use as a self-etch or a total etch system. Expiration dates are located on the bottles and syringes and remained even after multiple wipes with a surface sterilization solution.
(Would have been 5 stars if try-in gels were included)
For David Hornbrook, IPS e.max is a restorative material that he can use for virtually everything.
What are your goals when you place an indirect restorative material?
My primary goals when placing an indirect restoration depend on where it is being placed in the mouth and why. In summary, esthetics, bondability, strength and versatility are the most important decision criteria.
Does IPS e.max satisfy your esthetic requirements for a restorative material?
Yes, absolutely. Due to the availability of many translucency levels and the different fabrication options, e.max is a material that satisfies my esthetic needs in the anterior and my functional needs in the posterior region.
In what way do you feel IPS e.max enables you to provide your patients with state-of-the-art treatments?
I would consider any material that offers my patient optimal esthetics, conservative treatment, high strength, wear compatibility and excellent fit “state-of-the-art”. Just like IPS e.max: Unlike gold or feldspathic ceramic, it offers the requirements necessary to meet almost all scenarios.
What impresses you most about the IPS e.max system?
Its versatility. No longer do I feel limited by the material nor do I have to develop treatment plans based on the limitations of the restorative materials available.
What has been your most memorable experience with IPS e.max?
It was the comment of my dental assistant, with whom I have been working together for 17 years. For her to comment that this is the best restorative material she has ever worked with should be enough for even the most astute and sceptical clinician and ceramist to take a closer look.
About David Hornbrook
David Hornbrook graduated from UCLA School of dentistry and currently practices in San Diego, CA. He has been a guest faculty member of the post-graduate programs in Cosmetic Dentistry at Baylor, Tufts, SUNY at Buffalo, UMKC, and the UCLA Center of Cosmetic Dentistry.
He has consulted with numerous manufacturers in product development and refinement and is on the editorial board of Practical Procedures & Aesthetic Dentistry, Contemporary Esthetics, Signature, and is the past editor of the Journal of the American Academy of Cosmetic Dentistry. He is also the current clinical editor of the Dental Practice Report, as well as a member of the Esthetic Dentistry Research Group, which publishes REALITY and REALITY NOW.
He is an accredited member and Fellow of the American Academy of Cosmetic Dentistry. He was the founder and past director of P.A.C.~live, and is now the director of “The Hornbrook Group Aesthetic Seminars”. He has lectured internationally on all facets of esthetic dentistry and has published articles in most of the leading dental journals.
Second is the ergonomics. I want a light that is light, comfortable in my hands and also that access to the off-on button is convenient if I am holding it or if my dental assistant is using it. The other thing I look at it is if it allows me accessibility to all area of the mouth. Often times, I am placing bonded restorations on second molars and access to these teeth is mandatory. Curing tip sizes available for the light also comes under this category. It is mandatory in my practice to have a 2.0 mm tacking tip as well as a broad 8.0-10.0 mm tip to cure larger surfaces areas. The Bluephase Style is one of the lightest curing lights on the market and LED eliminates the need for a noisy fan to cool the bulb that we have traditionally seen in curing lights of the past.
Third is the actual wavelength of the light that is emitted from the curing tip. Since manufacturers utilize different photo initiators in our current array of resin cements and restorative resins, we must have a curing light that emits light to polymerize all the materials we use. The halogen lights always had the upper hand over the LED lights because they emitted the correct light to meet all our needs. Unfortunately, the halogen lights were bulky, heavy, noisy, and needed to be plugged in. For the past 10 years, I used two different lights in my office: the bulky halogen to be my “cure all” workhorse, and then an LED as a convenient portable light that I could use when I knew what photo initiator was used in the material I was placing. The Bluephase Style, unlike many other LED lights on the market actually uses a multi-diode format where it has one of the broadest output ranges on the market of any curing light, Halogen or LED, and thus truly can be a “do all” curing light that I can use with all my restorative dentistry. The big, bulky, noisy halogens that were once plugged into the counter of all my operatories are now gone and in their place in the sleek, light LED.
Lastly, I want durability. It doesn’t benefit me to have a fancy new light, if it won’t hold up to daily clinical use. One of the major drawbacks of LED light technology was the need for a battery that had external conductors that allowed for the transfer of the re-charge form the base charger. This may work great for cameras and cell phones, but with the harsh environment in clinical dentistry where we are using chemical disinfectants and work in a moist environment, these types of batteries and chargers are just not effective. Every LED user will tell you that they have had battery problems because of corrosion of the connectors between the battery and charger. With the Bluephase, Ivoclar incorporated inductive charging, similar to what we have seen in electric toothbrushes in the past. This eliminates the metal, corrodible connections and also creates a very smooth and sleek contour that is easily wiped down and cleaned after patient use.
Overall, this is a great light and one that I am very impressed with. Many of the LED lights available the last few years have had their pitfalls and problems. With the Bluephase Style, I just haven’t found any yet.
Dr David S. Hornbrook