TEAM DAY – sharing is caring
EADT eV launched TEAM-DAY under the credo “sharing is caring”. The event took place for the first time on July 7, 2018. Dentists, dental technicians, dental technologists and scientists experienced a successful opening event at the LMU Munich. In focus: zirconium oxide.
Bringing together what belongs together – dentists, dental technicians, dental technologists and scientists come together in EADT eV. The aim is a profitable exchange and practice-oriented knowledge transfer. The idea of TEAM DAY is based on this intention. The popular focus topic “zirconium oxide” attracted more than 70 participants to Munich. Nomen est omen – TEAM-DAY lived up to its name not only through the mixed audience from practice, laboratory and science. The speaker teams also consisted of different professions and highlighted the material zirconium oxide in all its facets.
Zirconium oxide: practice, laboratory, dental technology
It started with the President of EADT eV ZTM Andreas Kunz (Berlin) together with Dr. Insa Herklotz (Charité Berlin). The two discussed the interaction between practice and laboratory and explained their approach to dealing with zirconium oxide based on the scientific clinical data and their own patient cases. The team considers zirconium oxide to be the material of choice, particularly in implant prosthetics. Tissue compatibility, mechanical and light-optical properties – the various requirements for zirconium oxide were examined and a conclusion was drawn. Both consider it an aesthetic advantage that tooth-colored material has advantages in the area of the gingiva (depending on the degree of transparency). In terms of tissue compatibility, they consider zirconium oxide to be equivalent to the gold standard titanium. Technical complications are prevented by material-appropriate processing. In principle, the speakers advocate including the choice of material in the patient-dependent treatment concept, which is discussed together. Dental technologist and head of development Falko Noack (Koblach) showed how much know-how there really is in the small white blank. He discussed the production of zirconium oxide blanks and listed a number of quality standards that manufacturers must take into account. Zirconium oxide is not only defined by strength and biocompatibility; these are normative values. More relevant for the user are application-related properties (e.g. millability, edge stability, colorability, blendability) and knowledge of the material.
“You are wanted” – that was the title of the lecture by Tom Weinert (Munich), who stimulated thought with his amusing remarks. The police inspector and cybercrime expert discussed digital identity on the Internet. The focus of his remarks was the Darknet, social networks, data security, cybercrime and many everyday things from all of our digital lives. He urgently raised awareness about the careful and considered handling of personal data on the Internet.
Zirconia: tooth color, science and the generations
Nina Lümkemann (LMU Munich) and ZTM Bastian Wagner (Munich) also gave a special lecture. The materials scientist and the dental technician had a little exchange of blows and argued why the dental technician should concern himself with science and why science needs the dental technician. They impressively visualized the topic of tooth color and in particular the brightness value using a patient case. What influences e.g. B. the effect of light in zirconium oxide? Nina Lümkemann explained the principle of scattering and grain size and their influence on translucency. Bastian Wagner showed his procedure for veneering a front tooth. He works according to the color values within the Lab value and mixes his dentin materials himself based on the respective brightness value. Both advocated that the interpretation of the patient's individual tooth color based on specific values must be incorporated into the choice of material.
PD Dr. also had a home game. Bogna Stawarczyk and Dr. Anja Liebermann (both LMU Munich). Her task was to shed light on zirconium oxide from the perspective of in-vitro and in-vivo science. First, Bogna Stawarczyk explained the differences between the various manufactured zirconium oxide blanks, e.g. B. in terms of strength, Weibull modulus and grain size. Anja Liebermann gave a detailed overview of the scientific clinical studies. She concluded that there were hardly any fractures of the framework, but that chipping within the veneer was the problem. She cited a recent study with 10-year data that found cumulative survival rates for zirconia bridges were 91,3%. She attributed the complications to the very young material at the time and the lack of user experience. Bogna Stawarczyk explained what chipping is and how chipping can occur. Correct design, adherence to the firing parameters, little rework on the sintered framework and ceramic-appropriate rework after grinding on contact surfaces can minimize the risk of these fractures! Or you can forego the delusion. The various monolithic zirconium oxide generations from 1 – 4 were presented and it was pointed out that the scientific data, especially for the new materials (3rd and 4th generations), were still sparse. Anja Liebermann added that initial clinical studies on the 2nd generation of zirconium oxide for monolithic restorations show good prognosis. Clinical studies on the 3rd or 4th generation are currently unknown.
Zirconia: Implant prosthetics and fixation
The speaker team Dr. Peter Gehrke (Ludwigshafen) and ZT Carsten Fischer (Frankfurt) have been demonstrating for years how enriching teamwork can be. In their presentation, the two dealt with zirconium oxide in implant prosthetics and specifically addressed two-part ceramic CAD/CAM abutments. Among other things, the “attractiveness” of zirconium oxide for soft tissue suggests that the material should also be used in the area of temporary implant tooth replacements. They raised awareness of the fact that the biocompatible zirconium oxide will only fully exploit its advantages if all parameters within the entire manufacturing process are correct. This includes, among other things, abutment hygiene (cleaning protocol) and adequate surface topography (0,2 - 0,5 µm) in the basal area. Your message: We need a precise definition that describes and differentiates the respective manufacturing process. Because, says Peter Gehrke, CAD/CAM abutments show system- and manufacturing-related quality differences.
The attachment of zirconium oxide restorations in the mouth is a controversial topic and is inextricably linked to materials science. Prof. Dr. Matthias Kern (University of Kiel) presented the current scientific data and stated that the cementation of zirconium oxide restorations (crowns, bridges) is state of the art. Prof. Kern emphasized several times that the prerequisite for long-term stable fixation with cements is sufficient retention and resistance of the abutment tooth. He always recommends an adhesive bond if the attachment is to be done in the enamel. Using the example of the adhesive bridge, he explained his procedure for bonding. The speaker emphasized that the framework should be carefully blasted with corundum before it is inserted in practice in order to prevent the risk of contamination. An adhesive system or a luting composite with phosphate monomer (high reactivity) should always be used for fixing.
from left: Bastian Wagner, Nina Lümkemann, Carsten Fischer, Peter Gehrke, Anja Liebermann, Siegbert Witkowski, Falco Noack, Bogna Stawarczyk, Matthias Kern, Annett Kieschnick, Andreas Kunz
Conclusion
The good news: Zirconia is one of the most versatile dental materials! The bad news: There is no such thing as one size fits all! The appropriate material must be selected for each indication and not the material must be adapted to the indication. It is important for the user to have in-depth knowledge of material selection, processing (practice, laboratory) and studies. Sharing is caring – that was the motto of TEAM-DAY and the speakers did a wonderful job of exemplifying the union of professions. Not least due to the attentive questions of the moderator ZTM Siegbert Witkowski (University of Freiburg), the discussion groups after each lecture block were also an enrichment and gave the TEAM-DAY a charismatic format.
Text and images: Annett Kieschnick
The next TEAM DAY will take place on March 21, 2020 at the LMU Munich.