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Available since 2013, VITA ENAMIC is the first hybrid dental ceramic in the world with a dual-network structure. This material represents a pioneering new generation of innovative materials for esthetic CAD/CAM dentistry.
As well as providing insights on what this revolutionary CAD/CAM material has to offer, this newsletter also explains what you need to take into consideration during processing, particularly with regard to shade characterization, polishing and bonding. It also includes useful tips and tricks that you can use right away when working with the new hybrid ceramic.
With VITA ENAMIC, Sirona CEREC and inLab users have access to a pioneering new material that has been designed solely with CAD/CAM technology in mind. In developing ENAMIC, VITA adopted an entirely new approach, creating a hybrid ceramic where a polymer network reinforces the dominant ceramic network. Both networks are fully integrated with one another, resulting in a composite material that combines the benefits of conventional ceramics and of composite materials. Thanks to properties similar to those of natural dentition, it offers patients an excellent level of oral comfort.
As the owner of a CEREC / inLab MC XL system that uses software version 4.0 or later, VITA ENAMIC is initially available to you in five shades and two levels of translucency in the block geometry size EM-14 (12 x 14 x 18), see Fig. 1. You can use VITA ENAMIC for single-tooth restorations such as inlays, onlays, veneers and crowns.
Fig. 1: A new class of materials: the hybrid ceramic VITA ENAMIC with its dual-network structure.
As ENAMIC blocks are supplied at full strength for processing, none of the firing procedures required in the case of conventional ceramics are necessary. Shade characterization and customization are performed by way of polymerization.
Tras seleccionar VITA ENAMIC en el menú de materiales, deberá dibujar el límite de preparación —como de costumbre—, definir el eje de inserción y editar la propuesta inicial de forma virtual, antes de fresar la restauración a partir de un bloque de VITA ENAMIC.
First use a diamond tool to remove the sprue, and then fit the restoration to the model and verify or correct the proximal and occlusal contacts.
To perform contouring as well as pre-polishing and high-gloss polishing, dental technicians can use the VITA ENAMIC Polishing Set technical, a product line for two-phase polishing in extra-oral applications (Fig. 2)
Fig. 2: VITA ENAMIC Polishing Set technical: polishing instrument set for simple pre-polishing and high-gloss polishing of VITA ENAMIC in the laboratory.
Important: Only diamond-coated milling tools or special polishing instruments may be used for reworking VITA ENAMIC restorations. Make sure only to apply slight pressure and, wherever possible, to only carry out wet milling.
Tip: If Sof-Lex polishing discs are used for pre-polishing, make sure that only the medium grain (M), fine grain (F) and very fine grain (SF) models are used.
When characterizing ENAMIC restorations, all options are covered by the VITA ENAMIC STAINS KIT, a set of light-curing stains (Fig. 3) that includes six stains together with accessories for the reproduction of natural shade nuances.
Fig. 3: VITA ENAMIC STAINS KIT
For greater coverage and shade retention, the surface of the ENAMIC restoration must be roughened and free from grease. You have two options in this case:
In both cases, you must clean the conditioned surfaces thoroughly after treatment (ultrasonic or steam jet equipment).
Tip: Do not use a brush for cleaning as this results in contaminations on the surface.
Important: Following subsequent silanization (e.g. using VITASIL), you should no longer touch the roughened surface.
Mix the corresponding shade powder using a glass or plastic spatula on the porcelain mixing plate with VITA ENAMIC STAINS LIQUID (Fig. 4). Once mixing has been completed, you have approximately ten minutes to perform processing.
Fig. 4: Mixing the shade powder on the porcelain mixing plate.
Important: In order to prevent inadvertent thinning of the applied shade layer prior to sealing the surface using VITA ENAMIC GLAZE, intermediate polymerization must be performed after application of the shade.
Perform shade polymerization using a combination of two adapted curing systems: first, mixing the shade powder and liquid triggers a process of autopolymerization. Final polymerization is then achieved using light at a wavelength of 350-500 nm.
Observe the following minimum intervals for polymerizing the shade layer and VITA ENAMIC GLAZE using selected dental polymerization devices:
Sealing the surface is a mandatory step that increases the durability of the restoration as well as shade brilliance in the oral environment. It is performed on a chemical basis using VITA ENAMIC GLAZE.
Apply a thin, even layer of VITA ENAMIC GLAZE across the entire restoration. Do not allow pools of excess material to develop (Fig. 5).
Fig. 5: Quickly apply a single coat of VITA ENAMIC GLAZE to create a thin and even layer.
Perform final polymerization as described. Ensure that all surfaces to which a layer of material has been applied are fully polymerized.
In addition to shade characterization using stains, subsequent customization of VITA ENAMIC restorations is also possible. For smaller adjustments to the shape, e.g. the addition of contact points, light-curing methacrylate-based composites, special low-viscosity filling composites, and veneering composites such as VITA VM LC can be used.
Recommendation: Condition the surface of VITA ENAMIC restorations before performing customization using an appropriate bonding agent (PDF: VITA ENAMIC individualization).
Unlike other composite materials such as Lava Ultimate (3M ESPE), VITA ENAMIC restorations support etching using hydrofluoric acid gel, and can be adhesively bonded in accordance with the same clinical protocol as silicate ceramics. Light-curing or dual-curing fine hybrid composites can be used for bonding together with adhesive systems. In addition, crowns can be bonded using the self-adhesive composite RelyX Unicem (3M ESPE).
As a hybrid ceramic, VITA ENAMIC is distinguished by the fact that it offers both stability and elasticity, as well as other properties. Why might it be necessary in this respect to redefine the conventional understanding of the term "strength" when it comes to ceramic materials?
Dr. Andres Baltzer:
"The problem to date ‒ influenced by industry ‒ was the often one-sided focus of users on flexural strength. The message was: the higher the MPa value, the better. The flexural strength test setup, however, has little to do with the real-life conditions in situ. More attention should be given to the overall constellation of physical parameters. The goal should be to obtain materials which, in terms of the interaction of their properties, correspond to natural teeth. With VITA ENAMIC, a crucial step has now been taken in this direction."
In your personal experience, what are the benefits of VITA ENAMIC for users of CAD/CAM technology?
Dr. Andres Baltzer:
"VITA ENAMIC is easy to process. First, it supports highly effective polishing using the corresponding polishing set, and second, the material – which, as it happens, is also distinguished by unusually natural light transmission properties – can also be easily characterized using acrylic shades where required. Of course, a further benefit is that generally, firing is not required with this hybrid ceramic."
Fig. 6: Initial situation / © Dr. Andres Baltzer
Fig. 7: Preparation / © Dr. Andres Baltzer
Fig. 8: Final result / © Dr. Andres Baltzer