Hybrid ceramic VITA ENAMIC successful in clinical endurance tests!

In 2013, VITA ENAMIC, the world's first dental hybrid ceramic for the digital workflow was launched. Since that time, the material has been a focus of attention for international science. This is because the product is not composed of a common composite formulation where ground filling materials are mixed with a polymer. The hybrid ceramic is constructed from a unique dual network that consists of a porous, presintered compact feldspar ceramic block (86 wt.%) that is then infiltrated with a polymer (14 wt.%) under pressure and heat. This innovative structure results in several processing advantages, as well as tooth-like properties.

But what do independent studies say about VITA ENAMIC in clinical use?
The following information demonstrates the positive effects of the hybrid ceramic material on the patient's mouth.

Find out what researchers have discovered about the clinical use of VITA ENAMIC and what conclusions they draw from it.
The study results have been organized and summarized for you according to the indication investigated.

Veneers

Veneers: 100% satisfaction and survival rate after one year

Researchers from Egypt have shown that the hybrid ceramic VITA ENAMIC can be used successfully in the esthetic zone. They provided six patients with a total of 54 veneers. In each case, two different preparation techniques were used. There were no new caries or sensory disturbances or inflammation of the dental pulp on the restored teeth. Cracks, debonding and major fractures were not detected either. Consequently, the survival rate and patient satisfaction were 100 percent after 12 months. [3]

Table tops

Robust, despite thinner layer thicknesses

In minimally invasive restoration procedures, tabletops or overlays are suitable for teeth that have been damaged by abrasion or erosion. They only include the occlusal surface and the cusp areas. Thin layers, thin tapering, precise marginal areas, a good adhesive bond and high robustness are necessary, particularly for total reconstructions of all teeth with a bite elevation. Clinical applications are often accompanied by increased muscle activity and strong masticatory forces, which presents a particular challenge for each material.

In a laboratory test on human teeth restored with hybrid ceramic tabletops, researchers from Germany and Saudi Arabia demonstrated that VITA ENAMIC is the right material to use for this purpose. These had a fissure/cusp layer thickness of only 0.5/0.8 mm. In a chewing simulation,VITA ENAMIC withstood forces significantly beyond the average occlusal force in the posterior region. The test specimens survived all 1.2 million chewing cycles. This means that hybrid ceramic is suitable for this type of restoration [4], which was further confirmed in the three clinical studies that followed.

Non-prep tabletops: therapeutic effect and 100% survival rate after two years

If the bite and the rest of the masticatory system no longer fit together, this can lead to what is called craniomandibular dysfunction. This often results in muscular pain in the facial and masticatory muscles, as well as in the neck and back area. A Belgian dentist treated three patients that had these complains, in addition to severely damaged teeth, with tabletops made of the hybrid ceramic VITA ENAMIC, some of which had wafer-thin layers of up to 0.2 mm. She also collaborated with a physiotherapist. After a short clinical try-in, they were immediately incorporated with full adhesion without preparation or provisional pretreatment. The restorations were still intact nearly two years after they were attached. Patients felt comfortable with their new bite and reported a noticeable decrease in neck and back pain. [5]

Non-prep tabletops and non-prep veneers: 100% clinical success rate after nearly four years

Researchers from Belgium restored the maxillary anterior teeth of patients who had functional impairment with palatal veneers without any preparation and without a prior long-term temporary restoration. If required, they also restored the premolars with occlusal tabletops made of the hybrid ceramic VITA ENAMIC. Orthodontic adjustments were then made to the posterior region after two months. The patients felt comfortable with the new hybrid ceramic restorations. The success rate after an observation period of nearly four years was 100%. For this reason, the two scientists rated the interdisciplinary reconstructive-orthodontic procedure using VITA ENAMIC and the hybrid ceramic material selection as positive. In their experience, the treatment concept proved to be predictable, efficient and patient- and tooth-friendly. [6]

Non-prep tabletops: 100% survival rate with high-risk patients after two years

A total of seven patients [2] with severe grinding issues and massive loss of tooth structure underwent complete reconstruction with VITA ENAMIC hybrid ceramic. The restorations were done by researchers from Belgium without a prior provisional phase. The bite was elevated with tabletops and palatal anterior veneers. Restorations with a layer thickness of just 0.11 mm were also used. he therapy was accompanied by physiotherapeutic treatment. After two years, the survival rate was 100%. Minimal chipping and remediable debonding or major fractures resulted in a success rate of 93.5%. The authors, therefore, assessed the use of non-prep restorations made of VITA ENAMIC in patients at high risk of grinding issues with massive loss of tooth structure, as a simple, adaptable and reliable solution that can be successfully implemented without a provisional phase. [7]

Inlays/onlays

Inlays and partial crowns: 97.4% survival rate after three years

Researchers from Germany recruited a total of 47 patients at different locations for a clinical study and provided them with a total of 103 inlays and partial crowns made of the hybrid ceramic VITA ENAMIC, according to predefined criteria. After an observation period of three years, the survival rate of the inlays was 97.4%, and for the partial crowns it was 95.6%. No debonding at all could be observed. The researchers particularly emphasized the shade stability and the preservation of the anatomical shape through the minimally invasive restoration option with the hybrid ceramic. Overall, they rated the restorations made from VITA ENAMIC as positive after three years. [8]

Onlays on severely weakened teeth: 97% survival rate after three years

Teeth that have undergone root canal treatment are often so severely damaged and weakened by caries that permanent restoration frequently proves challenging. Often, there are higher bite forces, as sensitivity is greatly reduced, due to the removal of the nerves. For the clinical study, researchers from China provided 93 subjects that had previously undergone root canal treatment with 101 onlays on posterior teeth. For two groups, they either used VITA ENAMIC or VITABLOCS Mark II. After three years, the survival rate of onlays made of VITA ENAMIC was an impressive 97%, while that of VITABLOCS Mark II was as high as 90.7%. As a result of their findings, the researchers described the restoration of teeth with root canal treatment in the posterior region with VITA ENAMIC as promising. [9]

Crowns

Crowns: 97% survival rate after two years in practical test

Researchers from the U.S. wanted to know how well crown restorations with VITA ENAMIC perform in everyday practice. In a dental practice, 35 patients were treated with 45 CAD/CAM-supported hybrid ceramic crowns and observed over a period of two years. The results: Crowns that had been cemented with adhesive according to the manufacturer's instructions showed a survival rate of approximately 97%. [10]

Crowns with reduced layer thickness: success rate of 92.7% after three years

In a clinical study involving 34 patients, researchers from Germany wanted to know what the success rate was for hybrid ceramic crowns with a low layer thickness between 1 millimeter and 1.5 millimeters. After a minimally invasive preparation, a total of 76 monolithic single crowns were fabricated in the digital workflow and adhesively incorporated. The results after an observation period of three years: The clinical success rate was 92.7%, which is considered positive, particularly considering the low layer thickness. [11]

Implant prosthetics: immediate restoration with 90% survival rate after two years

Researchers from Belgium wanted to know whether implantation and restoration with VITA ENAMIC would work in one single session. For this purpose, they performed a definitive restoration on ten implants in full occlusion with crowns made of hybrid ceramic immediately after the surgical procedure. The survival rate of the implants was 100% after two years. The bone remained stable after the initial remodeling of the bone. Due to debonding, the crowns made of the hybrid ceramic VITA ENAMIC achieved a survival rate of 90% after two years. Chipping or fractures did not occur despite the immediate restoration in full occlusion. Overall, the researchers rate the procedure as a success in terms of patient satisfaction, noting that the right patient selection is also crucial. [12]

Summary:

Clinical performance summary: 99.2% survival rate after two years

In summary, VITA ENAMIC shows promising results. A research group from Australia came to the same conclusion. They summarized the clinical data and findings on full and partial restorations made from the hybrid ceramic. A total of five clinical studies were included. The clinical survival rate of VITA ENAMIC was 99.6% overall after one year and 99.2% after two years, according to the data analysis. [1]
In clinically challenging situations with bruxism [2], bite elevation, immediate loading and high degree of destruction, the hybrid ceramic showed promising performance, even with reduced layer thicknesses. This suggests high clinical long-term stability, especially for clinical situations without special circumstances.

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[1] Banh W, Hughes J, Sia A, Chien DCH, Tadakamadla SK, Figueredo CM, Ahmed KE. Longevity of Polymer-Infiltrated Ceramic Network and Zirconia-Reinforced Lithium Silicate Restorations: A Systematic Review and Meta-Analysis. Materials (Basel) 2021 Sep 3; 14(17): 5058.
[2] VITA ENAMIC is not approved by the manufacturer for parafunctions such as bruxism. The user accepts full responsibility for contraindications when using VITA products.
[3] Attia YS, Sherif RM, Zaghloul HH. Survival of Hybrid Laminate Veneers using two different tooth preparation techniques: Randomized Clinical Trial. Braz Dent J 2021 Nov-Dec; 32(6): 36-53.
[4] Al-Akhali M, Chaar MS, Elsayed A, Samran A, Kern M. Fracture resistance of ceramic and polymer-based occlusal veneer restorations. J Mech Behav Biomed Mater 2017 Oct; 74: 245-250.
[5] Mainjot AKJ. The "one-step, no-prep" technique: A straightforward and minimally invasive approach for full-mouth rehabilitation of worn dentition using polymer-infiltrated ceramic network (PICN) CAD-CAM prostheses. J Esthet Restor Dent 2020 Mar; 32(2): 141-149.
[6] Mainjot AKJ, Charavet C. Orthodontic-assisted "one-step, no- prep" technique: A straightforward and minimally-invasive approach for localized tooth wear treatment using polymer-infiltrated ceramic network CAD-CAM prostheses. J Esthet Restor Dent 2020 Oct; 32(7): 645-661.
[7] Oudkerk J, Eldafrawy M, Bekaert S, Grenade C, Vanheusden A, Mainjot A. The one-step, no-prep approach for full-mouth rehabilitation of worn dentition using PICN CAD-CAM restorations: 2-yr results of a prospective clinical study. J Dent 2020 Jan; 92:103245.
[8] Spitznagel FA, Scholz KJ, Strub JR, Vach K, Gierthmuehlen PC. Polymer-infiltrated ceramic CAD/CAM inlays and partial coverage restorations: three-year results of a prospective clinical study over five years. Clin Oral Investig 2018 Jun; 22(5): 1973-1983.
[9] Lu T, Peng L, Xiong F, Lin XY, Zhang P, Lin ZT, Wu BL. A three-year clinical evaluation of endodontically treated posterior teeth restored with two different materials using the CEREC AC chair-side system. J Prosthet Dent 2018 Mar; 119(3): 363-368.
[10] Chirumamilla G, Goldstein CE, Lawson NC. A two-year Retrospective Clinical study of Enamic Crowns Performed in a Private Practice Setting. J Esthet Restor Dent. 2016 Jul; 28(4): 231-7.
[11] Spitznagel FA, Scholz KJ, Vach K, Gierthmuehlen PC. Monolithic Polymer-Infiltrated Ceramic Network CAD/CAM Single Crowns: Three-Year Mid-Term Results of a Prospective Clinical Study. Int J Prosthodont 2020 Mar/Apr; 33(2): 160-168.
[12] Lambert F, Eldafrawy M, Bekaert S, Mainjot A. One-tooth one-time (1T1T), immediate loading of posterior single implants with the final crown: 2-year results of a case series. Int J Oral Implantol (Berl) 2020; 13(4): 369-383.