Artistry in Motion
All ceramics, all techniques, all philosophies
By Lee Culp, CDT
Throughout the years, restorative trends and techniques have come and gone. Some material developments have transformed the face of esthetic dentistry, while other initial concepts have phased out and died. Several options exist for the hand layering of ceramics: a more traditional coping framework, using a full array of dentin, incisal, and modifiers; micro-layering techniques that combine minimal ceramic layering with surface shading; or artistically applying stains and glazes to a full-contour ceramic restoration. Regardless of whether the ceramist is using traditional techniques, the lost wax technique and pressing technology, or the newest digital techniques to create beautiful restorations through a combination of digital design and the final handmade artistic process, the final human touch must always be present with the touch of a brush. As Jack Marrano, CDT, says, “Once you design it, you still have to sign it.”
Over the years, technicians have struggled to predictably reproduce natural esthetics in their restorations using ceramic materials. In the 1970s and ’80s, the goal was to overcome the higher opacity and higher brightness value inherent in a metal ceramic restoration. As we moved into the 1990s and 2000s, a new array of all-ceramic materials were offered. For the first time these new materials, such as IPS Empress and IPS e.max (Ivoclar Vivadent, ivoclarvivadent. com) offered technicians a way to more easily reproduce the color, value, and translucency of natural dentition. However, even though re-creating natural dentition through ceramics became easier, additional ceramic technology was needed as the options for layering techniques and substructures multiplied.
In the lithium disilicate and zirconia categories, we now have several choices with regard to opacity-translucency and brightness. However, to match natural dentition on a consistent basis, we need a system of layering ceramics that can be used predictably on the different substructures and with the layering techniques that are being used today.
The development of more translucent all-ceramic framework materials over the past few years has greatly affected the way ceramists approach the layering of all-ceramic restorations. Also, the general trend toward restorations with an increased brightness value has played an important role in the development of new ceramic systems. The modern translucent substructures reflect less light, which reduces the brightness of the fabricated restoration. To counteract this effect, IPS e.max Ceram Power Dentin and Power Incisal materials (Ivoclar Vivadent) were developed. Without changing familiar layering techniques, this material can be used to achieve a lifelike brightness on translucent frameworks. Additionally, restorations that clearly exhibit greater brightness can be achieved on more opaque frameworks with these specially shaded materials. IPS e.max Ceram Power Dentins are available in all A-D shades, as well as for the four bleach shades.
To demonstrate the esthetic effects of the products, the author fabricated frameworks using traditional buildup techniques with IPS e.max Ceram (Figure 1) and IPS e.max Ceram Power (Figure 2), the latter of which exhibits increased brightness. The author then compared the two products, respectively, using micro-layering techniques (Figure 3 and Figure 4).
Even though creating artistically influenced, esthetic-functional restorations is where the author’s passion lies as a ceramist, predictability is still necessary in achieving the final outcome. While ceramic technology has come a long way in the last several years, something still was missing until now: a stain and shade system that was multifunctional, meaning a technician could use only one stain and shade system on all ceramics, both internally and externally, as well as have the ability to mix in powdered ceramics to achieve the desired color and effects necessary to achieve the esthetic goals. IPS e.max Ceram Power Dentin and Power Incisal, used with the new IPS Ivocolor Universal system (Ivoclar Vivadent), allow the ceramist the ability to achieve infinite color and shading effects from one simple system. With its lower fusing temperature, the system eliminates the worry about overfiring layered ceramics while trying to achieve desired results even when that restoration requires several applications of color to create the desired appearance.
In courses and lectures over the last 20 years, the author has always espoused the philosophy that a comprehensive knowledge of natural esthetics and proper function are most important. Next, in the fabrication stage, we must always combine the passion of artistry with a logical thought process that includes predictability and efficiency to achieve the ultimate goal, of a happy ceramist, dentist, and patient.
Lee Culp, CDT, is CEO of Sculpture Studios in Cary, North Carolina.
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