2009

QDT
QUINTESSENCE OF DENTAL TECHNOLOGY

Sillas Duarte Jr, DDS, MS, PhD

Editor-in-Chief

© Naoki Aiba Photography

THE FIFTH ESSENCE
The elements of nature are also known as the elements of life or
the elements of survival, for without them life could not exist.
These elements are earth, water, air, fire, and ether. Aristotle in-
cluded ether in the classical elements of Ionic philosophy as the
“fifth essence” on the principle that the four terrestrial elements were subject to change, whereas no
change had been observed in the celestial regions. Interestingly, the word quintessence comes from the
15th century Middle French quinte essence, and from the Medieval Latin quinta essentia, and literally
means “fifth essence.” Quintessence is defined in the Merriam-Webster Dictionary as the essence of a
thing in its purest and most concentrated form. Technology, in contrast, refers to material objects of use
to humanity, such as machines, hardware, or utensils, but can also encompass broader motifs, including
systems, methods of organization, and techniques. This is the perfect combination for the profession we
embrace, not only because we need knowledge, skills, and good judgment, but also because we re-
quire multiple tools to carry out our tasks. The wise exercise of all of this knowledge leads to achieve-
ment of professional and personal satisfaction.
The Quintessence of Dental Technology (QDT) was introduced 32 years ago as a monthly journal in a
small format. It became a bimonthly journal and then finally an annual book. For all of these years, it has
been devoted to the most brilliant solutions to clinical cases and to new theories for esthetic and
technological dental rehabilitation. The ability and the freedom to assemble dentists, researchers, and
dental technicians who overturn established dogmas and who advance new concepts have made this
book unique.
I eagerly followed every issue since 1994. At that time I was finishing my graduate program in
operative dentistry, and during a dental meeting I got the QDT for the first time. I confess that I was
completely captivated. Living in a region of Brazil distant from the capital, surrounded by orange and
sugar-cane farms, it was not easy to find QDT every year. Thanks to the Internet this task became much
easier. Being appointed as editor-in-chief was daunting, but the gratification is proportional to the
book’s reputation.
Since the beginning of last year we have been working hard on this issue, and I was surprised by the
fierce (and healthy) competition for space in this book. Our challenge was to select the best manuscripts
that represent the philosophy of QDT. Judging contributions is difficult—described procedures had to
be innovative and at the same time scientifically relevant. We received a number of excellent
manuscripts; however, we focused on those that stand for improvement of oral health, technological
innovation, and superior esthetics, with outstanding craftwork. In this issue we have gathered
exceptional professionals from all over the world who recreate optical, mechanical, and esthetic
properties found in the natural tooth. And we constantly look toward contributors with a passion for our
profession and who are eager to join us in our explorations.

Sillas Duarte Jr, DDS, MS, PhD, is associate professor for the Depart-
ment of Comprehensive Care at Case Western Reserve University
School of Dental Medicine in Cleveland, Ohio, and maintains an intra-
Sillas Duarte Jr, DDS, MS, PhD mural practice limited to esthetic dentistry. He also has served as visit-
Editor-in-Chief ing professor at the University of Minnesota School of Dentistry in
sillas.duarte@case.edu Minneapolis, Minnesota, with a research focus on bonding to dental
structures, composites, and ceramics. Dr Duarte has served on the ed-
itorial boards of several journals and has published many journal arti-
cles and book chapters. He has performed hands-on courses and lec-
tured nationally and internationally on esthetic dentistry and adhesion.

EDITOR-IN-CHIEF
Sillas Duarte Jr, DDS, MS, PhD
Associate Professor
Department of Comprehensive Care
School of Dental Medicine
Case Western Reserve University
Cleveland, Ohio
ASSOCIATE EDITOR
Jin-Ho Phark, DDS, Dr Med Dent
Assistant Professor
Department of Comprehensive Care
School of Dental Medicine
Case Western Reserve University
Cleveland, Ohio
EDITORIAL REVIEW BOARD
Pinhas Adar, CDT, MDT
Atlanta, Georgia
Naoki Aiba, CDT
Monterey, California
Mike Bellerino, CDT
Metairie, Louisiana
Markus B. Blatz, DMD, PhD
Philadelphia, Pennsylvania
Karen Bruggers, DDS, MS
Cary, North Carolina
Gerard J. Chiche, DDS
Augusta, Georgia
Shiro Kamachi, DMD
Boston, Massachusetts
Edward A. McLaren, DDS
Los Angeles, California
Tom Peterson, MDT
Lynn, Massachusetts
Servando Ramos, DDS
US Army
Achim Renner, MDT
West Palm Beach, Florida
Avishai Sadan, DMD
Cleveland, Ohio
Fabiana Varjão, DDS, MS, PhD
Cleveland, Ohio
Aki Yoshida, CDT
Weston, Massachusetts
2009
Editorial: The Fifth Essence 2
Sillas Duarte Jr
In Memoriam: Adauto de Freitas Júnior 4
Avishai Sadan
Combining Lava Zirconia Copings and IPS e.max Ceram 9
for Anterior Crown Restorations
Renan Belli, DDS, MS/Jackeline Coutinho Guimarães, DDS, MS/
Wilmar Porfírio, MDT/Luiz Narciso Baratieri, DDS, MS, PhD
Conservative Adhesive Application of a 24
New Modified Zirconia Surface
Sillas Duarte Jr, DDS, MS, PhD/Jin-Ho Phark, DDS, Dr Med Dent/
Tomikazu Tada, MDT/Avishai Sadan, DMD
The Alveolar Model 39
Michel Magne, MDT/Panaghiotis Bazos, DDS/Pascal Magne, DMD, PhD
Immediate Protocols and Guided Surgery 47
for Esthetic Success with Full-Mouth Implant Rehabilitations
Iñaki Gamborena, DMD, MSD, FID/Markus B. Blatz, DMD, PhD
Clinical Application of Innovative Measurement Gauges 63
for Predictable Correction of Tooth Size/Proportion and
Gingival Architecture Discrepancies
Stephen J. Chu, DMD, MSD, CDT/Paul D. Fletcher, DDS/
Adam J. Mieleszko, CDT
Zirconia in the Esthetic Zone 77
Naoki Aiba, CDT
Vertical and Horizontal Ridge Defects in the Anterior Maxilla: 85
Prosthetic Solutions Using Custom CAD/CAM
Zirconia Superstructures on Implants
Stefan Holst, DMD, PhD/Hans Geiselhoeringer, CDT
 Volume 32

PUBLISHER
H.W. Haase
ASSOCIATE PUBLISHER
New Materials in Implantology 98 Tomoko Tsuchiya
Augusto Bruguera, CDT/Erika Téllez, DDS/Albert Vericat, DDS/ JOURNAL DIRECTOR
Javier Moreno, CDT/Xavi Balmes, CDT Lori A. Bateman
PRODUCTION EDITOR
Experimental Porcelain Veneers for an 111 Patrick Penney

Extreme Esthetic Rehabilitation EDITORIAL ASSISTANT

Patrick Schnider, CDT Colleen O’Keefe
ADVERTISING SALES
William G. Hartman
The Importance of the Substrate Characteristics in the 119
ADVERTISING/EDITORIAL/
Selection of a Ceramic System
SUBSCRIPTION OFFICE
Giovani Gambogi Parreira, MDT/Leandro Medeiros Santos, DDS, MS Quintessence Publishing Co, Inc
4350 Chandler Drive
Hanover Park, Illinois 60133
Phone: (630) 736-3600
Natura Magica: The Magic of Nature 133 Toll-free: (800) 621-0387
Sascha Hein, MDT Fax: (630) 736-3633
E-mail: service@quintbook.com
Website: http://www.quintpub.com
QDT is published once a year by
Tricks and Hints: Creating Irregularities 149 Quintessence Publishing Co, Inc,
Gérald Ubassy, MDT 4350 Chandler Drive, Hanover Park,
Illinois, 60133. Price per copy: $82.

MANUSCRIPT SUBMISSION
Functional, Esthetic, and Morphologic Adjustment 153 QDT publishes original articles covering
dental laboratory techniques and methods.
Procedures for Anterior Teeth See Guidelines for Authors at
www.quintpub.com for submission informa-
Dario Adolfi, DDS, CDT tion.
Copyright © 2009 by Quintessence Pub-
lishing Co, Inc. All rights reserved. No part
Beauty 169 of this publication may be reproduced or
transmitted in any form or by any means,
Naoki Hayashi, RDT electronic or mechanical, including photo-
copying, recording, or any information
and retrieval system, without permission in
writing from the publisher. The publisher
Ceramic Restorations in Anterior Dentition: 179 assumes no responsibility for unsolicited
manuscripts. All opinions are those of the
A Solution for Discolored Endodontically Treated Teeth authors. Reprints of articles published in
Luís Henrique Schlichting, DDS, MS/Kathryn Klemz Schlichting, DDS/ QDT can be obtained from the authors.
Lessandro Machry, DDS, MS/Paulo Kano, DDS, CDT/ Permission to photocopy items solely for
internal or personal use and for the inter-
Luiz Narciso Baratieri, DDS, MS, PhD nal or personal use of specific clients is
granted by Quintessence Publishing Co,
Inc, for libraries and other users registered
with the Copyright Clearance Center
The California Smile 195 (CCC) Transaction Reporting Service, pro-
vided that the base fee of $5 per article
Samuel C. Lee, CDT, MDC plus $.10 per page is paid directly to the
CCC, 222 Rosewood Drive, Danvers, MA
01923 (www.copyright.com). Identify this
publication by including with your pay-
ment the fee code:
0-86715-459-4/09 $5 + $.10.
Printed in Canada
Cover photograph by Naoki Aiba. ISSN 0896-6532 / ISBN 978-0-86715-419-1
 BELLI ET AL
33 34
36 37
Fig 33 After the dentin buildup, the copings were fired.
Fig 34 Layering of the enamel body. Opal Effect and Transpa Blue were applied at the proximal incisal edges.
Figs 35 and 36 Application of the outer enamel layer. Alternate layers of Transpa TI1, TI2, and T Neutral were
applied on the buccal surface.
Figs 37 and 38 Completed crowns ready for firing.
Fig 39 The surface texture was refined prior to glazing.
for approximately 13 minutes at 403°C to 750°C
(Fig 33). For the enamel buildup, e.max Ceram
Dentin A1 and BL1 were used, followed by appli-
cation of Opal Effect, Transpa Blue, Transpa Incisal
TI1 and TI2, Transpa T Neutral, and Incisal Edge
(Figs 34 to 36). The crowns were removed from
the working cast so that the contact areas could
be completed and then fired for approximately 13
minutes (Figs 37 and 38). After firing the enamel,
a correction was made with e.max Ceram Impulse
18 QDT 2009
35
38 39
Cervical Transpa, followed by another firing for
approximately 7 minutes. The crowns were then
glazed using the e.max Ceram Glaze FLUO and
fired for 40 seconds at 730°C. The surface texture
was achieved using the appropriate burs and pol-
ishing systems (Fig 39). The definitive crowns are
shown in Figs 40 to 46.
Before adhesive cementation, the adaptation
was checked (Figs 47 and 48) and the internal
crown surfaces were sandblasted with 50-µm alu-
 Lava Zirconia Copings and IPS e.max Ceram for Anterior Crown Restorations

40

41 42 43

44

45 46

Figs 40 to 46 Definitive all-ceramic crowns made with Lava zirconia copings and IPS e.max Ceram veneering
porcelain.

QDT 2009 19
 SCHLICHTING ET AL

11a 11b 11c

11d

Figs 11a to 11d A 1.5-mm round-ended cylinder diamond bur (no. 6681.314.016, Komet, Schaumburg, IL,
USA) is applied to the cervical, middle, and incisal thirds. Grooves are made to a depth equal to half the diam-
eter of the bur to respect the anatomic shape of the tooth. The grooves are carried out on different planes. In-
cisal grooves connect with the facial grooves and act as a reference for incisal edge reduction. Even so, the
use of silicone guides is recommended.

186 QDT 2009

 Ceramic Restorations for Discolored Endodontically Treated Teeth

12a

Figs 12a and 12b (a) Due to the concavity of

the palatal region, reference holes instead of
grooves are made with round diamond burs.
(b) After the partial facial preparation is carried
out, a uniform tooth reduction is evident.

Figs 13a and 13b (a) A round-ended slightly

tapered bur (no. 4137F, KG Sorensen, São
Paulo, Brazil) is used to finish the facial reduc-
tion, because its shape facilitates the prepara-
tion of convergence angles. (b) Completed fa-
cial reduction. 12b

13a 13b

Fig 14 The same bur is used in the preparation

of a shoulder with rounded inner edges or a
chamfer. In this case, because of the discoloration
of the root, intrasulcular margins are mandatory.
How far the restorative margins go into the sulcus
depends on the crestal relationship.22

Fig 15 The final check of the tooth prepara-

tion is carried out with a vertically sectioned sil-
icone guide. At this time, final adjustments can
still be made before the impression procedures
are carried out.

14 15

QDT 2009 187