1. table of contents 1.high strength ceramics 2.solutions 3.provisional 4.solutions

2. what are modern high strength ceramics? –lithium disilicate (e.Max) –zirconia “ A factor critical to the strength and abrasiveness of ceramic materials is how the clinician adjusts, grinds, and polishes the ceramic restoration on delivery and cementation.” – John A. Sorensen, DMD, PhD, FACP

3. modern ceramics “…there is no correlation between the hardness of a ceramic and the potential abrasion of natural tooth structure.” – Sorensen – microscopic surface roughness of the ceramic = abrasion – finer the grain structure = lower the wear – finer the grain structure = the more polishable zr/ld = Finest Grain Structure

4. zirconia ~1200MPa pressed or milled strongest opaque substructure or monolithic lithium disilicate ~400MPa pressed, milled or layered second strongest translucent can be pressed within 2/10ths mm for anterior restorations (veneers)

5. zirconia ~1200MPa BruxZir (Glidewell) Lava Zirconia (3M ESPE) Cercon (Dentsply) In-Ceram (Vita) Zirlux (Zahn) lithium disilicate ~400MPa e.Max (Ivoclar Vivadent)

6. solutions occlusal –low RPM, low pressure 100K RPM anatomy –low RPM, low Pressure 100K RPM

7. solutions heat = micro fractures heatless grinder for adjustment (Max 240°F)

8. solutions –LD Grinders pink medium recommended for Lithium Disilicate Green Coarse recommended for Zirconia –Dialite Diamonds –adjust/removal – removal, provided copious amounts of water, 100K rpm and light, steady touch

9. ZR LD

10. provisional Tips and techniques tips & techniques

11. composite provsional BisAcryil Protemp (3M ESPE) Luxatemp (DMG-America) Venus (Heraeus) acrylic provisonal methayl/methacrylate Snap (Lang Dental) Jet (Parkell)

12. problem: messy pumice + ragwheel

13. solution: 2-step polish – no rag wheel minimal heat no pastes or compounds needed #1: medium pre polish #2 fine high shine

14. other uses Night guards Splints Flippers Dentures Orthodontic Retainers