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Full Dent. Sci. 2013; 4(14):1.
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Esta revista é indexada nas seguintes bases de dados:
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Full Dentistry in Science – Suplemento - (Jan/Fev/Mar. 2013)
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Full Dent. Sci. 2013; 4(14):2-8.
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Immediate high aesthetic performance oral rehabilitation with cad/cam
system vipi block trilux
Reabilitação oral imediata de alto desempenho estético com sistema cad/cam vipi block
trilux
Fábio Costa
Rony Rodrigues
Halim Nagem Filho
Jörg Erxleben
Abstract
During the last decades the concern with aesthetics in oral rehabilitation increased.
Patients demand on the aesthetic performance of the restoration and the time it takes
to get the permanent prosthesis installed raised. Patients shouldn´t spend this time interrupting social activities because of a aesthetically unacceptable temporary restoration.
The CAD/CAM systems have evolved enough to meet patient expectations in terms of
time but, prosthetic materials still need to be corrected to meet the aesthetic needs. If
all factors such as extent of rehabilitation, availability of CAD/CAM system, the office
hours, etc. are harmonized, with the system VIPI BLOCK TRILUX, the patient can leave
the office with a smile perfectly restored in one session.
Descriptors: CAD/CAM, Oral Rehabilitation, Aesthetics, Fixed Prosthodontics
Resumo
Durante as últimas décadas a preocupação com a estética na reabilitação oral aumentou muito. Os pacientes estão mais exigentes com o desempenho estético da restauração e com o tempo que leva para ter a prótese definitiva instalada. Os pacientes
passam este tempo sem precisar interromper as atividades sociais por causa de um
provisório esteticamente inaceitável. Os sistemas CAD/CAM evoluíram o suficiente para
atender a expectativa do paciente em termos de tempo mas, próteses dos materiais
ainda precisam ser esteticamente corrigidas para atender as necessidades. Se todos os
fatores como extensão da reabilitação, disponibilidade do sistema CAD/CAM, horário
no consultório, etc. são harmonizados, com o sistema VIPI BLOCK TRILUX, o paciente
pode sair do consultório com um sorriso perfeitamente restaurado em uma sessão.
Descritores: CAD/CAM, Reabilitação Oral, Estética, Prótese Fixa
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Full Dent. Sci. 2013; 4(14):2-8.
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Introduction
Oral rehabilitation formerly focused more pathological aspects such as pain, nutrition and gastrointestinal diseases. With the improvement of oral
health in all classes of the world population, the functional aspects such as phonetics and occlusion have
also become of immense importance to the health
of patients (AWAD et.al.1 2000). Today patients are
seeking an oral rehabilitation where they leave the
office with restorations nearly invisibles to society.
With increasing life expectancy, the elderly have an
active social life and their self-esteem needs to own a
high aesthetic performance smile (VERMYLEN et.al.11
2003). Professionals from various fields depend on
good appearance and, depending on the case, cannot work without an aesthetically acceptable rehabilitation treatment. This implies that even a temporary
long or short duration for these patients must have a
natural appearance (RAGAIN; JOHNSTON7 2000).
The confection of an immediate and functional
prosthesis after preparing the tooth, today usually
results in aesthetically unsatisfactory temporary res-
1A
torations. An acrylic resin for provisional crowns and
bridges is mixed with the self-curing liquid and the
prepared tooth is rebuilt with this monochrome resin
(Figure 1 B). Prosthesis without any aesthetic characteristics of a natural tooth is the result. The natural
tooth is composed of dentine, opaque and colored
characteristically to each individual. The dentin is covered by enamel layer, translucent, opalescent and in
relation to dentin nearly colorless. The combination of
the layers results in a gradient effect between cervical
and enamel region of the tooth (Figure 1 A) (VILLARROEL et.al.12 2011). The confection of a temporary
restoration from resin and monomer can affect the
health of the patient negatively due to the residual
monomers (VALLITTU9 1999). An alternative for long
term temporary restorations are pre-fabricated teeth,
prepared just-in-time by the professional and cemented with suitable cements. Depending on the case and
the functional abrasion of the tooth, the restoration
can be considered a definitive prosthesis (RODRIGUES
et.al.8 2008).
1B
1C
New techniques such as machining of fixed prostheses by a CAD / CAM (computer aided design /
computer aided manufacturing) system enable today the confection of crowns and bridges with high
satisfactory anatomy and functionality. The technology, developed in the 1980s and improved until
today, is based on scanning the oral situation, computer-aided prosthesis planning, design and machining of the prosthesis (MIYAZAKI et.al.5 2009). For
scanning is generally used a gypsum model obtained
by conventional molding (Figure 2). Recently develo-
ped intraoral scanners already permit the elimination
of molding and making of the model (FASBINDER2
2006). The digitized oral situation is transferred to a
specific software that plans the prosthesis and allows corrections to adjust margins, height of cusps,
occlusion, etc. (Figure 3). Once planned, the software calculates a machining program and a milling
center (Figure 4) prepares the prosthesis from a
blank of the chosen material (Figure 5). The shade
and any special characteristics are informed to the
technician to choose the appropriate color (VANINI;
Costa F, Rodrigues R, Nagem Fo H, Erxleben J.
Figure 1 - A) Natural Tooth; B) Temporary VIPI BLOCK Monochrome; C) Crown 21 with VIPI BLOCK TRILUX.
Full Dent. Sci. 2013; 4(14):2-8.
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MANGANI10 2001). Some materials still need post-treatment to achieve desired functionality. Among
them, zirconia needs to be sintered for 9 hours. While available in various shades, zirconia and ceramic
materials require a supplement with ceramics and
other materials to obtain an aesthetically satisfactory
prosthesis (HERRGUTH et.al.4 2005). Despite being a
very quickly and efficiently technology, the patient
depends on a temporary restoration until a permanent prosthesis is ready.
Aim of this work is to show the aesthetic results
of the VIPI BLOCK TRILUX system. The works were
carried out with the S50 Implant scanner and milling
center ZENOTEC mini from WIELAND.
Figure 2 - Scanner with gypsum model ready for scanning.
Figure 3 - Prosthesis planning software.
Figure 4 - Milling Center with Zirconia blank
Figure 5 - Box VIPIBLOCK TRILUX.
System VIPI BLOCK TRILUX
VIPI Ltda. recently launched acrylic blanks for
CAD / CAM systems with a VITA® shade color gradient (Figure 6 A and B).
From the blanks were milled several clinical cases and photographed before installation (Figures 7
to 14).
6A
6B
Figure 6 - A)VIPIBLOCK TRILUX; B) amplifying the gradient.
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Full Dent. Sci. 2013; 4(14):2-8.
7A
5
7B
Figure 7 - A) Milled elements by cervical view B) elements by incisal view.
9A
Costa F, Rodrigues R, Nagem Fo H, Erxleben J.
Figure 8 - Clinical case with restoration VIPI BLOCK TRILUX Shade A3.
Full Dent. Sci. 2013; 4(14):2-8.
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9B
Figure 9 - A) Elements 21-23 in VIPI BLOCK monochrome and B) VIPI BLOCK TRILUX Shade A3.
Figure 10 - Elements 21-23 in VIPI BLOCK TRILUX lingual view.
Figure 11 - Element 16 in VIPI TRILUX BLOCK A3 lingual view.
Figure 12 - Element 16 incisal view.
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Full Dent. Sci. 2013; 4(14):2-8.
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Figure 13 - Another clinical case report with 6 anteriors in VIPI BLOCK TRILUX A3.
also consider the translucency and opacity as optical
properties intermediate between bodies completely
transparent and completely opaque (VILLARROEL et.
al.132005). Therefore the characteristics of tooth enamel are fundamental to the aesthetics of the tooth.
Therefore, what defines the color gradient is the
thickness and the area of the enamel layer. While the
thickness of the enamel layer increases (Figure 15 A)
the passage of light increases (Figure 15 B) and the
intense shade will lighten as showed in Figure 15 C.
Figure 14 - The same case by another view.
In optics, it is noteworthy that translucency and
opacity are essential factors in the dental case analysis. VILLARROEL122011 states that the presence or
absence of thickness, enamel shade, degree of translucency and surface texture are key components in
optical perception of color. The natural incident light
has an important role in determining the amount of
light transmission or reflection, and how an object is
perceived depends on the nature of the light source.
The dental enamel is a tissue which is not easily
reproduced in his optical characteristics, by not being
completely transparent or completely opaque. Its optical properties in relation to dynamic light reflected
by the surface vary from translucent to opalescent.
It is being understood as translucency the property
of a material or tissue that allows light to pass through, transmitting the incident light, disordering the
rays and re-directing them in all directions. We could
Figure 15 - A) Schematic tooth B) arrows indicate the translucency and
color and C) observed color.
Known since the year 1911, and frequently studied is the fluorescence of natural teeth (HARTLES,
LEAVER3 1953). Fluorescence is the characteristic of
a material transforming invisible light (generally ultraviolet light) into light waves visible for the human eye.
Costa F, Rodrigues R, Nagem Fo H, Erxleben J.
Discussion
Full Dent. Sci. 2013; 4(14):2-8.
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Therefore the tooth appears light emitting because
it reflects more visible light than it receives from ambient lighting. Although known for a century, this fact
must be taken into consideration during development
of a high aesthetic performance material.
Another feature of enamel not easy to copy
from nature is the opalescence (YONG-KEUN; BIN14
2007). The opalescence is the scattering of light in
macrostructures of particles smaller than light waves (600nm). For real reproduction of the opalescent
effect several biphasic glass and ceramics systems
were studied (PRIMUS et. Al.6 2002). Incorporating
this new technology into the gradient blank allows
excellent reproduction of the tooth with high aesthetic performance.
With the new gradient pigmentation technology with opalescence is it possible to assign a color to
every individual tooth. The elements may be positioned inside the blank in various ways (Figure 16). If the
tooth is positioned at the top it will receive a darker
shade. If at the bottom the shade is lightened. Most
systems also allow an inclination of the teeth, thus
smoothing the gradient if necessary.
1.
2.
3.
4.
5.
6.
7.
8.
9.
12.
13.
14.
All the facts discussed above were studied, tested
and matched to create the product VIPI BLOCK TRILUX. The images of the work show a high aesthetic
prostheses performed with the system VIPI BLOCK
TRILUX. With the growth of the CAD / CAM industry,
scanner systems with machining center, milling tools
and mainly the materials become economically viable
and attractive to patients. If all factors such as extent
of rehabilitation, availability of CAD / CAM system,
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References
11.
Conclusion
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the office hours, etc. are harmonized, the patient can
leave the office with a smile perfectly restored in just
one session (Figure 1 C).
10.
Figure 16 - Schematic drawing of the influence of the position of the tooth
within the VIPI BLOCK TRILUX in color.
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