Jameel Gardee explains why he uses IPS E.max and how it’s helping to produce amazing, natural restorations.
How important is zirconia as a material when it comes to your daily workflow?
I think zirconia is a lot more important, the material has developed for dentistry.
It’s great to have one more thing that you are able to use.
Don’t get me wrong, the ceramics that we have right now are really good, but some cases when we are doing longer bridge work and that kind of thing, the traditional IPS E.max, you don’t want to use it.
That’s why zirconia fits situations so well.
How do you take impressions? Do you use a digital scanner, or analogue?
In our clinic we are fully digital. We are an official Digital Smile Design clinic – one of only two in the UK currently.
All my workflow is digital. I don’t do anything analogue anymore.
Over a period of time, we’ve honed the workflows that we have so that they are super accurate, efficient and predictable.
We’ve got lots of case results and studies that we can use that shows the efficacy of the digital workflow.
Whilst we can still use analogue, and occasionally some members of our practice, our associates, will use impression materials, we do tend to lean fully digital.
In general, the only time I’d be using analogue is If something is wrong with the digital. That’s hardly the case today because you can get the scanner companies dialling in and fixing things remotely.
Over five/six years, we haven’t had any downtime where we haven’t been able to use the scanner.
I know some people have a little bit of a mental block when they apply intraoral for larger scans, and implant workflows. But to be honest if you utilise the proper techniques, you take your time and utilise the tools properly, then we’ve proved in many clinics around the world, that it is possible.
Which situations would you use IPS E.max (Lithium Disilicate) and which would you use IPS E.max Zircad Prime?
I’m really utilising IPS E.max Zircad Prime zirconia when I’ve got bridge work.
The problem with having the most popular ceramic in the world, IPS E.max is that when you want it to go for longer bridge work, then it wasn’t indicated for things that need a bit longer or a little bit more strength.
So, in this case, the addition to the IPS E.max family of Zircad Prime has really been a godsend. Especially because the manufacturer of IPS E.max is producing the zirconia, everything blends in. It’s not mixing different materials with different manufacturers, but utilising the same materials from the same manufacturer.
As a result, you have a similar shade, compatibility, blending together, which is really important when you’re doing these cases.
Otherwise, what will happen is that you’ll have a beautiful IPS E.max crown, but the colour won’t fit with other restorations. The shade is off – you can’t have that.
Here, everything blends in.
What about the strength of Prime?
I don’t think the strength is the issue with zirconia, I think the big bug bear is the bonding.
Bonding is the issue that people have and that is really the thing that people need to learn about and look at the research and studies and advice. For example, Professor Marcus Blacks from the University of Pennsylvania. He’s done a lot of studies on this and written a lot of papers – his paper, The ABC’s of bonding zirconia is a really excellent paper for anyone to read. It goes step by step on how to do it.
For me, I’ve used a variety of zirconia’s. With the bonding protocol Ivoclar Vivadent has, I’ve got no issues with cementing the zirconia veneers in the appropriate cases.
The age-old question: the aesthetics on zirconia is poor. Is this accurate anymore?
This is not accurate anymore.
There’s a whole range of different zirconia’s today from different manufacturers. Some of them are graded zirconia.
You would have zirconia that was just one monotone colour all the way through the block. Here now we have zirconia’s that are multiple colours through it.
Now, coupled with the fact that it’s IPS E.max and Ivoclar Vivadent are using it directly, this takes it to another level altogether.
I think some of the photos you can see show the beauty of the Zircad Prime material.
What we tend to do is monolithic restorations, so there’s no cut back. We don’t cut back or layer or press anything.
All we do is mill the Zircad Prime zirconia or the IPS E.max from monolithic blocks and then utilise staining glaze techniques as shown by Maxo Paulo Carno from Brazil to bring the staining techniques to life.
Would you recommend people try out Zircad Prime and E.max?
Absolutely, there’s a reason why IPS E.max is the world’s most popular ceramic. It works and it’s beautiful and it looks real.
The same thing with Empress as well. I wholeheartedly say that if you love IPS E.max and Empress, then you should try the Zircad Prime zirconia.
Obviously, the technician has got to be familiar with utilising it. This is always important to have the teamwork from the technician and the dentist.
Also, you have to make sure that the technician is utilising very good milling strategies to be able to produce texture morphology that rivals handmade restorations.
Again, Ivoclar Vivadent produces really amazing milling machines like the Programill PM7, that a few people in the UK utilise right now. These produce really amazing, natural restorations.
To find out more about IPS E.max Zircad Prime and how you can start implementing this zirconia in to your practice, please visit the website campaign.ivoclarvivadent.com/zircad_prime_dentist_ukie.
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