{"id":2501,"date":"2018-04-05T08:24:05","date_gmt":"2018-04-05T08:24:05","guid":{"rendered":"http:\/\/www.cerecdigest.net\/?p=2501"},"modified":"2018-04-05T14:26:38","modified_gmt":"2018-04-05T14:26:38","slug":"is-choice-burden-or-freedom","status":"publish","type":"post","link":"https:\/\/www.cerecdigest.net\/2018\/04\/05\/is-choice-burden-or-freedom\/","title":{"rendered":"Is Choice a Burden or Freedom?
A brief look at CAD\/CAM material selection<\/div>"},"content":{"rendered":"
As you venture into the world of chairside CAD\/CAM restorations, one thing will invariably (and painfully) become quite clear: you now have to deal with material selection<\/em>. Remember that chapter back in dental school, the one about feldspathic, leucite, and something or another? No? You’re not alone.<\/p>\n
In our workshops and seminars, we try to work with as large a diversity of ceramic blocks as we can, just as we do in our supporting clinic. Due to regional issues in Asia, there is some limitation on materials approved by government policies. Despite this, the available selection can still be quite daunting to the uninitiated. Naturally, one of the most popular questions that we hear is this:<\/p>\n
“I don’t want to stockpile so many different kinds of blocks at my clinic. If you had to choose one, which one would it be?”<\/p><\/blockquote>\n
Pick your poison: one of our drawers of CAD\/CAM blocks at the clinic. Source: Bonnie Huang.<\/figcaption><\/figure>\n
Imagine that you’re packing for some plein air painting in the Rockies. Which color would you pack? Green is probably a safe bet, if you are only going to paint leaves and bushes. What about the glaciers and the occasional maple tree? The answer of course, is that you wouldn’t bring just one color with you.<\/p>\n
Bob Ross teaches plein air painting. Except no Bob Ross and no plein air. Source: Deadpool 2 promo.<\/figcaption><\/figure>\n
When we isolate our choice to an arbitrary parameter, it’s easy to lose sight of the overall perspective. For instance, material vendors love to talk about stuff like flexural strength, marginal integrity, and translucency. A quick check with google scholar will reveal that, of the three commonly used glass ceramics, feldspathics have substantially lower strength than those of lithium disilicates and zirconia-reinfored lithium silicates (ZLS). The following table lists some of the data, in MPa.<\/p>\n\n
\n\n
\n\t
Source<\/th>
Feldspar<\/th>
Lithium \nDisilicate<\/th>
ZLS<\/th>\n<\/tr>\n<\/thead>\n
\n
\n\t
Manufacturer<\/td>
154<\/td>
360<\/td>
370<\/td>\n<\/tr>\n
\n\t
Coldea et al, 2013<\/td>
138<\/td>
344<\/td>
<\/td>\n<\/tr>\n
\n\t
Vichi et al, 2013<\/td>
103<\/td>
-<\/td>
-<\/td>\n<\/tr>\n
\n\t
Lauvahutanon, 2014<\/td>
127<\/td>
-<\/td>
-<\/td>\n<\/tr>\n
\n\t
Stawarczyk, 2015<\/td>
-<\/td>
356<\/td>
<\/td>\n<\/tr>\n
\n\t
Lawson, 2016<\/td>
-<\/td>
377<\/td>
451<\/td>\n<\/tr>\n
\n\t
Elsaka, 2016<\/td>
-<\/td>
348<\/td>
444<\/td>\n<\/tr>\n
\n\t
Peteren, 2016<\/td>
104<\/td>
-<\/td>
-<\/td>\n<\/tr>\n
\n\t
Goujat, 2017<\/td>
-<\/td>
210<\/td>
-<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n
So… we should never choose feldspar if we want long-lasting restorations, right? Or does each category of materials have its own advantages and disadvantages beyond just some numbers on paper? In the following clinical cases, I will focus on anterior restorations and discuss one very important factor in material selection (especially for single-visit restorations without cutback and layering): shade<\/em><\/strong>.<\/p>\n
Howdy Neighbor<\/h1>\n
When restoring only a few units of dentition, you are at the mercy of the quality of their neighbors. For most patients that want their false teeth to remain as inconspicuous as possible, the shade and texture of the neighbors play a vital role in the material selection. In this first case, we used the Triluxe Forte, a feldspathic ceramic from VITA.<\/p>\n