2 2014

Stay in touch with

innovative
the most
and trending topics

in dentistry.
 A whole new LEVEL
in Glass Ionomer
Technology
Over the last 5 years, the clinical performance of EQUIA has been
highly appreciated by clinicians worldwide. Together with various
ongoing studies worldwide, EQUIA is proving itself as a long lasting
restorative alternative for your daily, routine practice*. This is only one
of the impressive strengths of EQUIA. Find out more about the new
dimension in restorative dentistry on www.gceurope.com
*in the given indications

GC EUROPE N.V.
Head Office
Tel. +32.16.74.10.00
info@gceurope.com
http://www.gceurope.com
 Contents

4 Welcome
6 News
8 Fibres (un)limited
By Dr Filip Keulemans
15 Tips and strategies for restoring large cavities using fibre-
reinforced material
By Drs Stephane Browet and Javier Tapia Guadix
21 Clinical efficiency of one-step self-etch adhesives versus
etch-and-rinse systems
By Professor Jan van Dijken
26 Success with luting cements: material and technique tips
By Dr Frédéric Raux
32 10 years INITIAL: the birth and evolution of a highly
innovative ceramic class
By MDT Michael Brüsch
40 Step by step: Using everX Posterior

GC get connected 3
 Welcome to our second issue of GC Get Connected and thank you for
reading! Since we launched the publication last year, the response has
been overwhelmingly positive. We are proud to have this new channel
through which to reach out, and indeed connect with, our customers
around Europe. Be sure to share this with your friends and colleagues!
Highlights of 2013 for GC Europe so far include another excellent exhibition
at the IDS in Cologne in March, followed by the official opening of our new
administrative building at our headquarters in Leuven, as well as being a final-
ist in the European Excellence Award of the EFQM. These are all wonderful
achievements that demonstrate how we continuously strive for progress.

expanding our facilities

Our new building houses all the GC Europe headquarters departments,
namely Quality Assurance, Regulatory Affairs & Legal, IT, Sales & Marketing,
Product Management, Human Resources, Finance, and Management.
This 2-storey building has been designed to enhance communication
and productivity between the various departments. This state-of-the-art
facility incorporates elements of the architecture from its neighbouring GC
Campus building that have been strategically repeated and reinterpreted
as a way to illustrate harmony, synergy and looking into the future.
This continuum between the two buildings demonstrates GC
Europe’s role in making GC a global healthcare company – seamlessly
communicating within the company as well as outwards to customers
through the training hub.

international excellence Award

GC Europe is proud to have become one of the official 10 champions for
the 2013 EFQM Excellence Award. From 30 000 organisations implementing
the EFQM Excellence Model worldwide, GC Europe is the first dental
company in the world to reach the top 10 finalist status.
The EFQM assessors were particularly impressed by the main purpose
of GC: GC’s strong customer and end-user orientation, which is echoed
in our mission statement: “to improve the dental health of patients
around the world with high-quality dental products”. This mission has not
been changed in 92 years. GC Europe wants to reach more patients in

4 GC get connected
Welcome to GC ‘get connected’, GC Europe’s newsletter that showcases our
latest product innovations, techniques and trends in restorative dentistry.

Europe with innovative, high-quality and minimal-intervention products.

Furthermore, our ‘GC No Kokoro’ philosophy guarantees that profit and
growth will never overtake the original mission that is clearly focused on
the health of patients. This approach and the fact that GC is family-owned,
clearly distinguishes the company from its main competitors.
We are delighted to be recognised for our great efforts and we are
convinced it will inspire others. This award will give additional strength to
our resolve to continue on our journey to excellence.

About the eFQm excellence Award

The objective of the EFQM Excellence
Award is to recognise Europe’s best performing organisations, whether
private, public, or non-profit. It recognises industry leaders with an
indisputable track record of success in turning strategy into action and
continuously improving their organisation’s performance. To identify the
finalists, a team of 6 to 9 internationally experienced managers spend one
week on the applicants’ site, and an average of 500 hours per applicant;
reviewing documents, interviewing and analysing the organisation against
the EFQM Excellence Model.

I would like to invite you to read the rest of the articles in this issue
and feel free to contact us should you have any questions or comments.
Connect with us via marketing@gceurope.com

Best regards,

Eckhard Maedel
President, GC Europe
GC get connected 5
News

EQUIA announced as
material of choice at
international symposium
Italy: Key opinion leaders from around for its superior properties and clinical
Europe convened at a symposium held success. The symposium was presented
at the 46th meeting of the Continental by prominent dental researchers who
European Division of the IADR to shared their scientific data on EQUIA,
discuss and present evidence on the highlighting the evolution of glass
latest trends in glass ionomer science. ionomer materials in recent years,
GC’s EQUIA glass ionomer restorative paving the way for modern dentistry.
system was applauded and recognised Themes included glass ionomer

Glass ionomer technology symposium presenters (left to right)

Dr Uli Lobhauer, GC Europe President Mr Eckhard Maedel,
Professor Avijit Banerjee, Professor Servil Gurgan, GCI AG
Executive Vice President Mr Henri Lenn, Dr Thomas Klinke and
GC Europe product manager Dr Piyush Khandelwal.

6 GC get connected
 Let’s get social
As part of its continued dedication to connect with our
customers, GC Europe has implemented a social media
initiative as part of its marketing strategy. You can now follow
and interact with us on the following channels

and composite in perfect harmony

and practice-based research yielding
promising results with far-reaching
consequences.
The evidence presented on EQUIA’s
advantages included:
●● When coated with highly filled

resin coating, GIC shows improved

mechanical strength
●● A perfect seal of surface porosities,

cracks and improved acid resistance

is attainable with EQUIA Coat
●● 48 month clinical trial results show

EQUIA is a durable material for class I

and II restorations
●● Randomised control trial (RCT)

shows survival rate for EQUIA

restorations was 99.5% after 12
months and 96.3% after 24 months

For more information about

eQUiA, click here

Get in touch!
www.gceurope.com/products/
detail.php?id=127

Check our YouTube channel to watch

the interview with the different lecturers How did you find GC Connect?
and to see the complete presentations We want to hear from you! Please send your comments
http://www.youtube.com/user/ and feedback to marketing@gceurope.com
GCEuropeProducts
GC get connected 7
Fibres
(un)limited
By Dr Filip Keulemans

The use of glass fibres for the more accessible for dentists and dental
reinforcement of dental polymers was technicians and rapidly gained populari-
already proposed in the early 1960s. ty. This was not only because they blend
At that time, the response was that perfectly with contemporary treatment
the process to reinforce polymethyl approaches such as tooth tissue preser-
methacrylate dentures with weaves vation, metal-free and tooth-coloured
of glass cloths was far too slow for restorations, but also due to the versatile
everyday use. Although prefabricated fabrication procedure of FRC restora-
carbon and glass fibre-reinforced posts tions. They can be fabricated imme-
were introduced in the mid-1980s, diately into the mouth of the patient
a major breakthrough came with (direct approach) or chairside (semi-di-
the development and introduction rect approach) by the dentist and at the
of continuous, unidirectional pre- dental laboratory (indirect approach).
impregnated glass fibre-reinforced The resin matrix of most dental
composites (FRC prepregs) in the early composites and FRCs comprises a
1990s. Key features of this new group cross-linked polymer such as Bis-GMA,
of FRCs are: TEGDMA or UDMA. A special group
1. High fibre fraction (≥50 vol%) of FRCs polymer formulations are
2. Excellent wetting and impregnation those that form an Interpenetrating
of the fibres by the resin matrix Polymer Network (IPN). An IPN is a
3. Available as an uncured prepreg network formed by combining two
(a fibre reinforcement that is pre- or more polymers, which do not
impregnated with resin) merge by chemical reaction but by
From that moment on, FRCs became interpenetration. For dental FRCs only
8 GC get connected
 1a 2a

1b
Figure 1: Three-unit onlay- 2b 2c
retained FRC-FDP (Fibre-
reinforced composite fixed
dental prosthesis) replacing
a missing molar in the upper 2d
jaw: (a) Onlay preparations on 1c
teeth 25 and 27, (b) FRC-FDP
before cementation, and (c)
intra oral view of FRC-FDP after
cementation.
3a 3b
Figure 2: A patient with a
missing upper first premolar (a)
presented himself at the Oral
Diagnostics Clinic of ACTA with
a Removable Partial Denture (b).
Due to the patients’ new job, he
requested a more comfortable
fixed solution. Since he refused 3c 3d
a conventional FDP and an
implant because of financial
implications, we provided him
with a cantilever FRC-RBFDP
(c and d).

Figure 3: Single-tooth
replacement of a missing upper
lateral incisor with three-unit
surface-retained FRC-RBFDP:
(a) pre-operative view, (b)
placement of unidirectional
fibre framework, (c) pontic
reinforced with everX Posterior,
(d) post-operative view.
GC get connected 9
 semi-IPNs are utilised, which means teeth, lingual retainers and tooth
that one or more polymers are cross- anchorage in orthodontics, space
linked and one or more polymers are maintainers in paediatric dentistry,
linear. In the case of a dental semi-IPN, repair and reinforcement of removable
the cross-linked part is formed by a dentures, fabrication of implant- and
thermoset polymer (dimethacrylate), tooth-borne restorations (permanent
while the linear part is formed by a and temporary crowns and bridges
thermoplastic polymer (monofunctional and resin-bonded bridges), repair of
methylmethacrylate). Commercially metal-ceramic restorations and post-
available examples of semi-IPN-based and-core restorations.
FRCs are everStick and everX Posterior Although I used FRCs occasionally
(GC), that contain a PMMA/Bis-GMA for the reinforcement of long-term
matrix. The semi-IPN resin matrix is used provisional and autologous tooth
in favour of cross-linked resin matrix replacement, my interest in FRCs was
because it exhibits increased toughness, sparked during my PhD. My research
improved handling properties and focused on the mechanical properties
superior bonding with other materials. and the use of FRCs for the design
and fabrication of resin-bonded fixed
Applications in dentistry dental prostheses (RBFDP) (Figure 1
Prepregs gradually expanded the a,b,c) in general and cantilever resin-
applications for FRCs in various dental bonded bridges (Figure 2a,b,c,d) in
fields. Some of these include the particular. During the spring of 2007
splinting of mobile or traumatised I spent several months at the Turku

Fiber-reinforced composites (FRCs) at a glance

everStick everX Posterior

Unidirectional fibre reinforcement Short fibre-reinforced composite
The material consists of The material is a composite that
unidirectional fibers embedded contains short fibres (1-2mm) that
into a resin matrix (IPN network). act as a reinforcement.
Indicated for C&B, orthodontic Indicated as a dentine-replacement
and periodontal splinting, posts. sub-structure for large cavities.

10 GC get connected
 4a 4b

4c 4d

4e 4f

4g 4h

Figure 4: Periodontal splinting

of mandibular anterior teeth.

Figure 5: Schematic
representation of a biomimetic 4i 5
composite restoration: lost
dentine is replaced by high
toughness SFRC (everX
Posterior) and covered by a
wear-resistant enamel-replacing
posterior hybrid composite.
GC get connected 11
 Clinical Biomaterials Centre in Finland composite restorations in stress-bearing
with Professor P. Vallittu and L. Lassila, situations was the driving force behind
where we addressed a frequently this exploration. We all know that resin
encountered clinical complication with composite restorations have shown
FRC-RBFDPs, namely delaminating good overall clinical performance in
and chipping of veneering composite. posterior restorations with annual failure
In order to overcome these kinds of rates between 1-3% and that secondary
failures, the FRC framework should be decay and fracture are among the most
modified to support the veneering important reasons for clinical failure.
composite. At that time we started In contrast, annual failure rates of
to use a short FRC, the precursor of endodontically treated teeth restored
everX Posterior, to eliminate those with resin composite restorations
complications (Figure 3 a,b,c,d). increased up to 2-12.4%. Not only
endodontically treated teeth, but also
Current limitations of composites in large multiple-surface restorations
large restorations showed to be more prone to fracture-
From when I first came in contact with related failures, including composite
it, this new FRC material fascinated me. bulk fracture and tooth fracture,
At the same time I became interested resulting in decreased longevity.
in biomimetic dentistry. Both topics It is clear that contemporary resin
started to amalgamate in my mind, composites still demonstrate
so I started to explore the clinical limitations due to their insufficient
possibilities of everX Posterior. Extending mechanical properties when used in
the indications and increasing the large restorations.
long-term performance of large resin From a biomimetic point of view,
we strive to replace lost tooth tissue
by biomaterials with similar physical

“Fibre-reinforced properties, especially with reference to

elastic modulus, strength and thermal

composites such as everX expansion coefficient. A well-accepted

biomimetic restorative approach

Posterior give me the advocates replacing dentine with

hybrid composites. Although such an

opportunity to replace approach seems more or less effective,

there are still relevant mechanical

missing tooth tissue in a properties, such as fracture toughness,

that are not taken into account.

more biomimetic way” The fracture toughness of hybrid

composite is still half that of dentine.
12 GC get connected
 6a 6b

6c 6d

7a 7b
Figure 6: Post-and-core
restoration of a maxillary
canine: (a) pre-operative view,
(b) cemented fibre post, (c)
dentine replaced by everX
Posterior, (d) post-operative
view. 7c 7d

Figure 7: An MOD composite

restoration of a mandibular
second premolar: (a)
pre-operative view; (b)
interproximal walls build-up
by conventional composite
according to a centripetal 8a 8b
filling technique, (c) dentine
replacement with everX
Posterior (notice protruding
fibres from the SFRC surface),
(d) post-operative view.

Figure 8: Cusp-replacing 8c 8d
composite restoration of a
mandibular first molar: (a)
pre-operative view; (b) cavity
outline, (c) dentine replacement
with everX Posterior, (d) post-
operative view.
GC get connected 13
 Opening new restorative options In the past few years I have noticed
As a short fibre reinforced composite that the interest for and the use
(SFRC), everX Posterior exhibits im- of FRCs has started to decrease
proved mechanical properties not only with general practitioners, but I’m
relating to strength, elastic modulus convinced that everX Posterior will
and polymerisation shrinkage in com- be able to revive the interest in
parison to hybrid composites, but es- FRCs. Today I use FRCs not only for
pecially regarding fracture toughness. the fabrication of post-and-core
We now have a dentine replacement restorations, periodontal splints
material that is tougher than dentine (Figures 4a to 4i) and resin-bonded
and able to arrest crack propagation bridges, but also for the fabrication
in a similar way to dentine. Therefore, of adhesive restorations. FRCs such as
everX Posterior can be beneficial in everStick and everX Posterior give me
large stress-bearing restorations as a the opportunity to replace missing
dentine replacing biomaterial, eventu- tooth tissue in a more biomimetic
ally resulting in less fracture-related way. It is particularly the design
failures and improving the overall lon- and properties of everX Posterior
gevity of large direct resin composite that make this material suitable as
restorations. dentine replacement in biomimetic
restorations (Figure 5). In my opinion,
About the author: everX Posterior can be used for direct
Dr Filip Keulemans is an Assistant and indirect biomimetic composite
Professor in Restorative Dentistry and restorations, which are indicated for:
Endodontology, at Ghent University, 1. Restoration of endodontically
Belgium, where he is responsible treated teeth, including core build-
for Dental Material Sciences course ups, post-and-core restorations
and pre-clinical training in Restorative Dentistry. (Figure 6) and endocrowns
His research interest are mainly Dental Materials 2. Medium to large Class I and II
(characterisation, evaluation and development of restorations (Figure 7)
fibre-reinforced composites) and Adhesive Dentistry 3. Cusp-protecting and cusp-replacing
(biomimetic restoration of natural teeth).He received restorations (Figure 8)
his PhD in 2010 from the University of Amsterdam 4. Crown build-ups
with the thesis entitled “Exploring the limitations of 5. FRC-RBFDPs
fibre-reinforced composite fixed dental prostheses”
(promoter: Professor Albert Feilzer). From 2000 until
2012, he worked in part-time private practice with a
special interest in adhesive and restorative dentistry.
From 2000 until 2004, he was a part-time Assistant in
Restorative Dentistry and Crown & Bridge work at the
VUB. From 2005 until 2009 he was a researcher at the
Dental Materials department of the ACTA.

14 GC get connected
Tips and strategies
for restoring large
cavities using fibre-
reinforced material
By Drs Stephane Browet and Javier Tapia Guadix

Evidence has shown that one of the upon as a durable restorative material.
biggest challenges facing dentists But what value is a restoration itself
today is restoring severely damaged that lasts for 20 years if the tooth
teeth. In order for these restorations to fails? The final objective should
be long lasting, certain biomechanical be preservation of the tooth and
and biochemical criteria need to be not necessarily preservation of the
met. restoration.
Even the smallest of cavities can
result in dramatic failure due to Cavity design
poor material choice and incorrect When it comes to restorations of this
biomechanical interaction between nature there are two goals: to stop
the tooth and the material. We often crack propagation and stopping new
see cases where a small cavity was cracks from forming. To achieve this
restored with amalgam a few years you will need a good material and a
prior. The amalgam itself meets the sound approach. When it comes to
material criteria but the biomechanical cavity preparation, the sharper the
issues are clearly evident and cause angles, the higher the stress created
severe cracks to develop. These cracks in the cavity. The difficulty today
could lead to complete failure of the is that as dentists we often have
restoration with loss of vitality of the to redo restorations with existing
tooth, and possibly even loss of the cavity designs for amalgam but
tooth. Amalgam has long been relied restore those cavities with another
GC get connected 15
 material. In addition, the tooth will cusp tips, as references for occlusal
also be damaged to some extent. Our morphology and to preserve as much
challenge is to minimise this damage tooth tissue as possible. Because the
by making good choices in cavity walls are clearly not thick enough the
design and material. load bearing forces will create fatigue
The principles of cavity design within the cusps. Even with a bonded
are well established: the width of restoration, this fatigue will eventually
the cavity should not exceed half of cause the wall to fracture.
the intercuspal width. This means
the surrounding tooth structure Restorative guidelines
is strong enough to function with The following clinical situations call for
the restorative material inside. It cuspal coverage:
is recommended that you need 1. A wide isthmus and thin walls
between 2 -2.5 mm of wall thickness 2. If there is no dentinal support and
in order to maintain good intrinsic cusps are undermined - blocking
strength. It is clear that if we don’t out the unsupported enamel will
respect these criteria and the not solve the problem because
cavity ends up with very thin and curing a composite inside a shell will
undermined walls, biomechanical fracture it
failure will occur. 3. A horizontal crack in the
Our biggest problem here is that undermined base of the cusp
we get cavities like this to start with. 4. A longitudinal MOD crack
It’s not necessarily our choice to drill a 5. Any crack inside the pulp chamber
cavity like this for caries removal. Often 6. An endodontically treated tooth
times an old amalgam restoration with MOD restoration requires
can lead to this type of cavity and the coverage for all cusps
temptation is to keep the remaining 7. An endodontically treated tooth
tooth structure to enable a direct with a crack in the pulpal floor
restoration. The requires all cusps to be covered
tendency is to
keep those everX posterior
What is needed for these
restorations is a material that
will bond to the tooth. This
is not a guarantee that
the restoration will work,
but some sort of adhesion
is required that is not
mechanically retained like
16 GC get connected
amalgam. What is needed is a material
that behaves like tooth structure,
“When it comes to
something that resists fatigue and also
increases the load bearing capacity of
restorations of this nature
the total restorative complex of the
tooth with the restoration.
there are two goals: to
everX Posterior (GC) fibre-reinforced
composite material offers many
stop crack propagation
solutions to the type of problems we
have discussed in this article. everX
and stopping new cracks
Posterior is made up of three sections:
an interpenetrating polymer network
from forming”
(IPN) resin matrix, e-glass fibres and
fillers, initiators and inhibitors. What is by using a very strong material. In
really important in a material like this, actual fact, when using such a strong
is the way in which the e-glass fibres material, the tooth inadvertently
and the IPN matrix interact with each becomes the weaker part of the
other because this makes it possible to restorative complex. This means that
absorb the loading forces. This transfer if failure occurs, the tooth will be lost.
of pressure from the matrix to the With this everX Posterior, in the case of
fibres on a microscopic scale means failure, the damage can be contained.
that crack propagation can be stopped Cracks can be deviated along the
while at the same time giving the material inside the tooth, resulting in
restoration the capacity to resist very fractures which are more above gum
high loading forces. level, instead of running through the
The maximum bite force for humans entire tooth leading to catastrophic
is about 1000 N. A conventional failure. It will still lead to failure, but will
composite has a similar resistance. allow for further restoration because
However, if you compare a the fracture line is still visible and
combination of everX Posterior, which accessible.
is a base material that should be Fracture toughness is another
covered with an overlaying composite, physical property which is twice
the total load bearing capacity is much as high in everX Posterior than in
higher than with composite alone, conventional composites. The flexural
even “almost double”. modulus is closer to that of natural
dentine, so it behaves like natural
Fracture prevention tooth structure.
Some dentists are misguided when While the build-up procedure of the
they think that a tooth can be saved material allows for a well-functioning
GC get connected 17
Restoration of a restorative complex, it’s how the
posterior cavity material shrinks that matters. The
using everX volumetric change and shrinkage
stress of the material after and
Posterior as a during setting is similar to that of
dentine replacement conventional composite, but a very
1: Preoperatory big difference is the presence of the
fibres. By placing the material in the
cavity and by pushing it down you
are able to align the fibres into a
more longitudinal direction which
reduces linear shrinkage. With the
vertical shrinkage you can expect
the entire restoration to shrink down,
2: Preparation 3: Bonding but this won’t create the same stress
as a regular composite. The linear
stress and shrinkage on the walls is
lower, giving you a more predictable
outcome and minimised damage.
By using everX Posterior as
dentine replacement and layering it
with a regular composite, the total
4: Enamel wall 5: everX build up load bearing capacity of the tooth
complex will increase significantly.
Therefore it makes sense in both
direct and indirect approaches
to have the support from a fibre-
reinforced composite underneath.

6: Enamel build up 7: Staining final

8: Polishing 9: Final
18 GC get connected
Additional tips for using everX About the authors
Posterior Stephane Browet attended dental school
●● everX Posterior should be at the Free University of Brussels in
completely enclosed by the other 1995 and completed the Post Graduate
material programme Aesthetic Dentistry.
●● First close the proximal, then the From 1999 he has taught rubber dam
occlusal techniques and adhesive dentistry.
●● Use a ball plugger or microbrush to From 2002 till 2005 he was active in the
adapt the material to the floor and Scientific Board Conservative Dentistry
take your time at the Institute for Continued Education of the Society of
●● Light-cure in layers of 2mm Flemish dentists. He also is a past board member of the
thickness Belgian Academy of Esthetic Dentistry and the Academy
●● When adding the final layer of of Microscope Dentistry, as well as a member of the
regular composite, use air block European Society of Microscope Dentistry. Nationally
during the final light-cure to create and internationally he lectures on rubber dam isolation,
a surface with a good finish and microscope dentistry, posterior and anterior composites,
without an oxygen inhibited layer indirect restorations. He combines this with a private
●● Always respect manufacturer practice focused on microscope aided restorative dentistry.
guidelines for maximum rotation
speed for polishing points - avoid Javier Tapia Guadix obtained a Bachelor
heating because it will change the of Dental Surgery from the European
properties of the material University of Madrid (UEM). He became
●● For final lustre a goat hair brush with an Associate Professor at Department
diamond paste will create a glossy of Prosthetics at UEM in 2004. He is the
result for surface polishing Co-founder of Bio-Emulation group and
founder of Juice - Dental Media Design.
He is a member of the GC Restorative
Advisory Board. In addition, he is a professional CG Artist,
specialising in medical - dental animations and illustra-
tions. He was the Collaborator of the Spanish Dental Coun-
cil and the Spanish Dental Foundation between 2007-
2009. In 2005 he was awarded the Collegiate Merit Award
by the Spanish College of Dentists from the 1st Region. He
currently owns a private practice in Prosthetic and Restor-
ative Dentistry in Madrid, Spain and frequently presents
lectures on topics such as Composite Stratification Tech-
niques, Dental Photography and Computers in Dentistry.
He is widely published in Restorative Dentistry, Dental
Photography and Computers in Dentistry.
GC get connected 19
DiReCt RestoRAtion 1 2

1. Pre-operative view

2. Occlusion and articulation

should be considered, they
guide the layering for final
morphology. Isolation with 3 4
rubber dam is recommended
for a controlled protocol,
optimal view and access

3. Cavity after removal of the

old restoration shows decay
5 6
4. Another view of the decay
under the old amalgam
restoration

5. Caries removal and cavity

preparation finalized
7 8
6. Cavity after bonding procedure

7. Sectional matrix placement

and separation ring, a wedge
adapts the matrix to the tooth
in the cervical area
9 10
8. Build-up of the mesial wall
in two consecutive, separately
light cured layer

9. Internal buil-up with Ever-X

Posterior
11 12
10. Finalized occlusal morphology

11. Final result

12. Follow-up
20 GC get connected
Clinical efficiency of
one-step self-etch
adhesives versus etch-
and-rinse systems
By Professor Jan van Dijken

The rise of self-etch bonding agents which causes differences in their

In recent years, the trend with bonding effectiveness. One example of
agents has been one of simplification, this is whether a system contains
as evidenced by the development HEMA or not. In fact, HEMA
of one-bottle self-etch adhesives (2-hydroxyethylmethacrylate) is a
(SEA, 7th generation) that combine well-known allergenic substance, but
etching, priming and bonding in a is widely used in dental adhesives to
single clinical step. The ultimate aim of reduce viscosity, enhance the bond
these modifications was to reduce the strength to dentine and prevent phase
number of steps needed, as well as the separation. Therefore, the launch
technique sensitivity of the process [6]. of HEMA-free adhesives (G-Bond
Nowadays, self-etching adhesives and G-ænial Bond) has triggered
are recognised for their quick considerable interest. At the same
application and are considered to time, the clinical reliability of these new
be more user-friendly than their HEMA-free bonding systems has been
multi-step counterparts [3]. However, challenged by some universities and is
-3-step etch-and-rinse systems (4th currently under debate.
generation) are often still considered to
be the gold standard in bonding. Long-term clinical data
Moreover, not all self-etch adhesive The problem today is that many new
systems have the same composition, systems have no independent clinical
GC get connected 21
 evaluations, and many lack long-term now compete with traditional bonding
studies. The majority of bond strength agents.
tests are performed immediately When choosing a bonding system,
after bonding and only a few studies it is important to see which products
mimic, and then only partially, the are supported by good clinical
chemical and physical stress factors results rather than to simply rely on a
occurring within the oral environment. particular generation of adhesives. In
In vitro tests tend to indicate that fact, the clinical failure rates of products
etch-and-rinse systems have a better within the same generation of
performance than SEAs [1] and are adhesives can vary dramatically (Table
less technique-sensitive [6]. However, 1). In any given generation, some
recent clinical trials [1-4] show that products will have very high success
the annual failure rates of SEAs have rates while others will lead to many
been constantly improving and can failures.

Table 1 – Published annual failure rates of adhesive systems tested in Umea in similar dentin-only cervical non-
carious lesion studies after 5-year follow-up periods. AFR= Annual Failure Rate. For most etch-and-rinse systems,
35-37% phosphoric acid has been used, while in other cases the acid is given between brackets. JWV van Dijken.
A randomized controlled 5-year prospective study of two HEMA-free adhesives, a 1-step self etching and a 3-step
etch-andrinse, in non-carious cervical lesions. Dental Materials 2013; 29: e271-e280
22 GC get connected
 For this reason, clinical trials are
vital to evaluate each product’s “New clinical studies
performance, rather than to argue the
superiority of a certain generation of
bonding agents.
show that one-step
self-etch adhesives
Can a one-step self-etch adhesive
have the same clinical performance
as a traditional etch-and-rinse
clinically perform as
system?
The most recent clinical study on class well as etch-and-rinse
bonding systems after
V non-carious lesions [1] compares the
clinical bonding durability of a 1-step
HEMA-free SEA (G-Bond, GC), a 3-step
HEMA/TEGDMA free etch-and-rinse
(cfm, Saremco) and a 2-step HEMA-
five years.”
containing etch-and-rinse adhesive
(XP Bond, Dentsply). All adhesive
restorations were done on non-carious
cervical lesions, as they are considered
to be the ultimate performance proof
for adhesive systems. Moreover, no
enamel bevel was created in order
to specifically focus on the bond
strength to dentine. The restorations
were evaluated at baseline 6, 12, 18,
24 months and then annually for five
years, by both the operator and the
examiners.
The results at five years show that
the clinical success of both HEMA-free
adhesives was significantly higher
than for the HEMA-containing 2-step
etch-and-rinse adhesive. Another study
carried out at the Catholic University
of Leuven, Belgium (KU Leuven) [5],
showed equally favourable clinical
effectiveness at three years for a HEMA-
GC get connected 23
 free adhesive (G-Bond, GC) and a study by KU Leuven in non-carious
HEMA-rich adhesive (Clearfil Tri-S Bond, cervical lesions corroborates these
Kuraray). findings by concluding that a similar
Excluding HEMA from the clinical success rate was observed for
composition of bonding agents G-Bond and the ’gold standard’ etch-
could also lead to other advantages, and-rinse Optibond FL, both after three
such as lower allergenic risk, [3] and five [4] years. Significantly more
improved mechanical strength and incisal marginal defects were observed
lower hydrolytic degeneration. The with the SEA than with the etch-and-
conclusion of my study [1] was that rinse adhesives, but these could be
the durability in non-carious cervical easily removed with polishing. The
lesions of the HEMA-free adhesives performance of G-Bond was clinically
(G-Bond and cfm) was successful after acceptable after five years.
five years. In addition, G-Bond was
one of the most clinically effective in What are the conclusions from these
dentine bonding. clinical studies?
Additional clinical results in Class II Etch-and-rinse systems are always
cavities [2] showed that the durability described as the top performers when
of G-Bond in Class II cavities was compared to self-etch adhesives in
successful after 6 years. This research laboratory tests. However, the results
also clearly indicated that the clinical obtained during the recent clinical
effectiveness of G-Bond was highly trials clearly show that the SEAs
acceptable and in line with the etch- perform well clinically.
and-rinse adhesives. Another clinical Overall, there is a consensus that

References
1 JWV van Dijken. A randomized Three-year clinical performance 5 SG Moretto, EMA Russo, RCR
controlled 5-year prospective study of a HEMA-free one-step self-etch Carvalho, J De Munck, K Van Landuyt,
of two HEMA-free adhesives, a 1-step adhesive in non-carious cervical M Peumans, B Van Meerbeek, MV
self etching and a 3-step etch-and- lesions. Eur J Oral Sci 2011; 119: 511- Cardoso. 3-year clinical effectiveness
rinse, in non-carious cervical lesions. 516. of one-step adhesives in non-
Dental Materials 2013; 29: e271-e280. 4 KL Van Landuyt, J De Munck, B Banu carious cervical lesions. J Dent 2013
2 JWV van Dijken. A 6-year prospective Ermis , M Peumans, B Van Meerbeek. Aug;41:675-682.
evaluation of a one-step HEMA- Five-year clinical performance of 6 MF. Burrow & MJ. Tyas. Comparison
free self etching adhesive in Class II a HEMA-free one-step self-etch of two all-in-one adhesives bonded
restorations. Dental Materials 2013; adhesive in non-carious cervical to non-carious cervical lesions -
29: 1116-1122. lesions. Clin Oral Invest DOI 10.1007/ results at 3 years. Clin Oral Investig.
3 KL Van Landuyt, M Peumans, J De s00784-013-1061-9 , published ahead 2012;16:1089-1094
Munck, MV Cardoso, B Ermis, B Van of print 2013
Meerbeek.
24 GC get connected
self-etch systems have advanced About the author
significantly in the past few years Professor Jan van Dijken is Professor
and can achieve clinical success rates in Cariology at the University
similar to those of the gold standard of Umeå in the northern part of
3-step etch-and-rinse adhesives such Sweden. He has been working at
as Optibond FL [3-4]. Burrow & Tyas [6] the Dental School in Umeå for the
conclude that “the restoration of non- last forty years educating both post
carious cervical lesions with the newer graduate students and dentist, dental
all-in-one adhesives appears to be a technician and dental hygienist
viable alternative technique to more students in Cariology and restorative dentistry. His
complicated adhesive materials.” research interests are mainly Dental Materials and
The clinical studies mentioned [1-5] Adhesive Dentistry. Long term clinical evaluation of
imply that the absence of HEMA has no resin composites, ceramics and adhesive systems
negative effect on the failure rate of the and biocompatibility evaluation in vivo are the main
restorations. This is echoed by Burrow issues of the research in Umeå. He became dentist
& Tyas [6], who state that “it seems at the University of Amsterdam (ACTA) in 1973. After
that the absence of HEMA has not working as private dentist and school dentist he
had any adverse effect on restoration moved to Sweden and received his PhD in 1987 from
retention or marginal staining”, in a the University of Umeå studying in his thesis longevity
study comparing G-Bond (GC) and of resin composites in vivo. Part of this research was
S3 Bond (Kuraray). According to the performed at NIOM, the Scandinavian Material Institute
class V study conclusions, there could in Oslo. Collaboration research with Umeå has been
even be a positive effect on the bond performed with several other universities in the world
strength to dentine, due to reduced like Copenhagen, Turku, Nijmegen, Amsterdam,
water uptake and gradual hydrolytic Helsinki, Oslo, etc, and also with many PDHS clinics in
polymer degradation. However, Sweden. From 2000 he has been head of the Biomaterial
more long-term clinical studies are Research group Umeå and the Dental Hygienist
needed to investigate whether the Education Umeå.
HEMA-free adhesives could enable
a better bonding durability. Finally,
we concluded that the durability in
non-carious cervical lesions of the
HEMA-free adhesives was successful
after 5 years. Despite concerns which
have been raised, the 1-step SEA
(G-Bond, GC) demonstrated one of the
best clinical effectiveness in dentine
bonding.

GC get connected 25
Success with luting
cements: material
and technique tips
GC Get Connected recently spoke with Dr Frédéric Raux, a dentist
based in France, about the use of luting cements in his practice.

As a clinician, what are the most For example, if I am cementing a

important features that you look for metal-based crown, the cementation
in a luting cement? margins are not visible and my
Dr Frédéric Raux: In my opinion, there preparation is retentive enough, I do
are three important criteria that I use not need to use a resin-based luting
to guide my choice for the best luting cement. In this case, I’d rather opt for
cement in every clinical situation: a glass-ionomer or resin-modified
• Retention: Is my preparation glass ionomer luting cement which is
retentive enough? Do I need to economical, easy to use and moisture
bond the restoration or simply lute tolerant, besides providing excellent
it? marginal sealing, significant fluoride
• Aesthetic requirements: Will the release and reliable clinical results.
luting cement influence the final On the other hand, whenever the
aesthetic result of the restoration? preparation is not retentive enough
• User-friendliness: Is the cement and/or aesthetics is a key factor, resin
fast and easy to use, saving chair- cements are required. Classic adhesive
time and avoiding varied and resin cements present separate
complicated steps? bonding agents, requiring several
26 GC get connected
 1

1. No need to keep the

G-CEM LinkAce syringes in the
refrigerator. 2 4

2. Preparations on the 11
and 21 after the removal of
temporary restorations.

3. Cleaning with nylon

microbrushes under spray. 3

4. Etching of the inside of the

e.Max crowns with hydrofluoric
acid (5%) and rinsing with
a water/air spray. For the
luting to be successful, any
contamination of the surface 5 6
should be avoided after
etching.

5. Application of GC Ceramic
Primer.

6. Extrusion of G-CEM LinkAce

inside the crown. Always check
the opening of the two barrels
of the syringe before placing
the mixing tip, to ensure that
both pastes are at the same
level. Bleed the syringe if 7
needed. Always discard the first
mixed paste extruded from the
mixing tip (the size of a pea
is enough) to ensure that the
correct proportioning of pastes
A and B is delivered.

7. Cementation of crown on
tooth 21.
GC get connected 27
 adhesive steps before the cementation What results have you had since
itself. With the new generation of self- using the material?
adhesive resin cements (SARCs), both Dr Frédéric Raux: Absolutely no
aesthetic and adhesive requirements problem! The colour match is always
are fulfilled without the need for time- perfect and for the first year of follow-
consuming and complicated steps. For up, I haven’t seen any change of colour.
me, this is the easiest way for luting my G-CEM LinkAce is HEMA-free and
indirect restorations! shows very low water uptake, therefore
delivering very good colour stability.
When did you first start to use I have not experienced any loss of
G-CEM LinkAce and what were your retention or complaints from patients
initial thoughts about it? in terms of post-operative sensitivity.
Dr Frédéric Raux: I started using For the moment, I am 100% satisfied!
it about 8 months ago, because I
wanted to try a different self-adhesive What do you enjoy most about
resin cement than the one I was using G-CEM LinkAce?
using. Technology has evolved quickly Dr Frédéric Raux: G-CEM LinkAce is
and I knew I could expect better easy to use, ergonomic and aesthetic.
properties with the newest generation It has a very good working time,
in this category. G-CEM LinkAce allowing it to be used even for
firstly attracted me for its properties, extensive bridges or simultaneous
combined with the tradition that GC cementation of several crowns. The
pursues in the area of luting cements. fact that I do not need to store it in the
And immediately, I found it easy to refrigerator is also a great advantage.
use, ergonomic and aesthetic. So, my The disadvantage of refrigeration is
choice was for the better one: G-CEM that the dentist has to remove the
LinkAce is a very good SARC! syringe from the refrigerator way
before the treatment itself, so that it
can reach room temperature. Studies
have shown that the use of a cement
at lower than room temperature leads
to a considerable decrease in physical
“G-CEM LinkAce is in my properties(1). G-CEM LinkAce is in my
drawer and always ready to be used.
drawer and always ready Moreover, its non-runny viscosity
and low film thickness are ideal. It is

to be used.” important for me to know that such

a low film thickness will provide me
with an excellent fit of my restoration
28 GC get connected
 8

9 10

8. Tack-cure with a light-

curing device for 1 second
before removal of excesses.
Alternatively, wait between 1
and 2 minutes until the cement
feels rubbery.
11 12
9. Removal of excess with a
probe. Removal of excess in the
proximal area can be done with
floss. Care should be taken all
time to avoid movement of the
crown in this early stage.

10. Cementation of the second

crown on tooth 11. 13a 13b 13c

11. Final light-cure of 40

seconds per face (here in
vestibular face) with a light-
curing unit in high-intensity
mode.

12. Final result immediately

after cementation.

13 a-b-c. Ergonomic and very

thin tips for post cementation.
GC get connected 29
 without the need for further occlusal observe the golden rule for all cements:
adjustments after cementation. wait for 4 minutes before making any
Recent studies support my view: its occlusal adjustments. When removing
mechanical and optical properties are the excess, you have to make sure that
very good, compared to other SARCs. the crown doesn’t move.
When cementing zirconia-based
About the author crowns the main concern is how to Do you have any advice for dentists
Dr Frédéric Raux is ensure good retention. Bonding to who want to start using G-CEM
a dentist based in zirconia is a real challenge nowadays. LinkAce?
France. He is also With specific phosphate monomers, Dr Frédéric Raux: Try it. Trust me,
a lecturer in the G-CEM LinkAce seems to provide a you will like it! Don’t forget that you
area of Restorative stable bond to zirconia without the can never bond on dirty surfaces.
Dentistry and need for additional primers(2). So always ensure that the tooth
current President of Its good wear resistance is also an and restoration surfaces are clean
the French Academy interesting point, especially in cases of before cementing any crown. This
of Adhesive inlays and onlays with the margins locat- can be achieved with simple clean-
Dentistry. The ed on the occlusal aspect of the tooth. up procedures using a brush and
dental technicians A cement with poor wear resistance will pumice slurry on a low speed. Etching
that he collaborated cause marginal gaps. The clinical con- solutions, conditioners and solutions
with on the cases sequences are plaque accumulation, like alcohol and hydrogen peroxide
presented in marginal discolouration and chipping are not recommended as they can
this article are of the ceramic margins. G-CEM LinkAce negatively influence the adhesion of
Hélène and Didier presents high wear resistance(3). SARCs to the tooth. Finally, make sure
Crescenzo, owners Finally, the other potential source that you follow the indicated surface
of Esthetic Oral in of failure for dual-cure luting cements treatment on your prosthesis.
Cogolin, France. lies in a poor self-curing mode. Light-
curing is important, but studies have References
shown that light may not reach the 1 Effect of pre-cure temperature on the
bonding potential of self-etch and self-
cement line, even in ceramic and
adhesive resin cements, Cantoro et al., Dent
zirconia-based crowns. Therefore, it Mater 24(5):577-83, 2008.
is essential that the cement has an 2 Shear Bond Strength of Auto-mixing
efficient self-curing mode to ensure Self-adhesive Resin Cements to Zirconia,
adequate polymerisation, even in Yoshida et al.,J Dent Res 91 (Spec Issue B):
Abstract 242, 2012.
places where the light cannot reach
3 In Vitro Wear of Five Cements Against
the cement line. The self-curing ability Enamel, Suyama et al.,J Dent Res 92 (Spec
of G-CEM LinkAce seems to be faster Issue A): Abstract 1686, 2013.
and higher(4) than other SARCs, which 4 Conversion and acid-base reaction in
gives me confidence and peace of modern self-adhesive cements, Kournetas
et al., J Dent Res, in press.
mind. However, every clinician should
30 GC get connected
 aces :
A quartet of

Innovation, Simplicity,
Versatility and Reliability

New
G-CEM LinkAce™
from GC

...with new innovative

technology bringing
reliable solutions for
a broad range of indications.
10 years INITIAL: the
birth and evolution of a
highly innovative class
By MDT Michael Brüsch

The Initial Ceramic line is celebrating its was already more predatory than a
10 year existence this year, with success growth market, so a highly exceptional
by the millions and, above all, countless concept was called for.
enthusiastic devotees. Meticulous analysis of the
The idea of such a ceramic range veneering ceramics market revealed
was obviously born much earlier. In a shortcoming of all the ceramic
late 2001 a very small team of experts, materials hitherto developed: they
comprising five representatives from were not suitable for universal use.
industry and dental technology, came There was no ceramics manufacturer at
together with the aim of gauging the that time providing dental technicians
possibilities for a new, all-embracing with a system for all possible
ceramic system. At the time, the framework materials (MC,AL,ZR,LF,TI,
prevailing European dental market etc.) that was cohesive, practical and,
above all, user-friendly.

32 GC get connected
 Ceramists were often compelled to
process materials from a wide variety
of suppliers which each needed to be
handled differently. The expenditure
in terms of time, money and failure still is today a unique selling point of the
management was correspondingly Initial ceramic range. At the time it was a
high. The aim and the necessity was very brave decision and, with hindsight,
to change this very situation as a it was the correct decision by GC to
matter of urgency. The time when implement my proposal.
practitioners needed to rethink and In theory it was a very forward-
switch products constantly for the looking, visionary project. In practice
purposes of handling, layering, colour, we were brought back down to earth
fluorescence and opalescence was very quickly. Despite this or precisely
finally to be brought to an end. because of this – we were all obsessed
by this vision of Initial by then. For us
The idea is born there was simply no alternative, there
The vision for Initial was to be a was no turning back!
ceramic system that offers ceramists
the possibility of applying a consistent, The problem-solving stage
uniform layering and colour strategy The synchronisation of the vastly
regardless of what substructure is different ceramics posed by far the
being veneered. Everything – literally greatest problems for us. Colour,
everything – was to be achieved with handling, shrinkage, opalescence,
Initial. Starting from a conventional 2-3 fluorescence, etc. everything had to be
layering technique, through to a lifelike, the same in the system of all six types
bio-aesthetic build-up, Initial, while of ceramic. Ceramists needed to be
working across systems was to meet able to rely on achieving an absolutely
every requirement! comparable result with a metal-
The bio-aesthetic layering method, ceramic, for example, as with a zircon-
analogous to the make-up of a natural ceramic by using an almost identical
tooth, should be highlighted. It was and layering technique. However, there
GC get connected 33
 were secondary concerns, the ‘side- outside jeopardised the already tight
shows’ around the main attraction, schedule. This meant that a very small
which took up a huge amount of time. team of experts (5 people!) for a project
The bio-aesthetic layering method of this magnitude constantly had to
had to be easy to understand, re-organise and rediscover itself. At all
standardised and reliable, yet be costs we wanted to meet the planned
matched individually to the natural launch deadline of the end of March
tooth, prepared and processed for the 2003 at IDS.
user. Somehow we had to square the
circle. Testing and troubleshooting
Simply to establish the colour By the end of 2002 all the variables had
foundations of the bio-aesthetic been finalised or at least decided and
layering technique (the Inside commissioned. The manufacturer had
materials), over 2500 tooth shades managed to produce and deliver all
identified in patients were evaluated the materials required in the desired
and the essence of these was excellent quality (material science
transferred to the Inside ceramics. We properties). Nevertheless, how would
also engaged enthusiastically in the the Initial system prove its worth in
never-ending skirmishes about size/ everyday use in what can sometimes
scope, packaging and container design be harsh reality?
of such a range. Naturally opinions All six types of ceramic were pushed
differed considerably on these points. to their limits and beyond based on
Simply put: a previously established, complex
The trade and manufacturers ‘stress programme’. Every conceivable
wanted as little as possible, leaving us handling error in the laboratory was
with a rather sparse kit! taken into consideration so that, after
While the users wanted as much market launch, users could be offered
as possible, making it a rather expert support as quickly as possible.
representative kit! We felt sure we had thought of
In addition, a great deal of our own everything, but reality caught up with
mistakes and imponderables from us time and again, bringing us back

34 GC get connected
down to earth with a bump. Initial
Ceramic therefore continued to be “The vision for Initial was
to be a ceramic system
put under enormous pressure, while
at the same time marketing strategies,
product brochures and especially
the directions for use still had to be that offers ceramists the
designed, written and illustrated for
all six ceramics. One team member
took charge of these jobs and was
possibility of applying
released from all other responsibilities
concerning Initial.
a consistent, uniform
It is well known that euphoria can
move mountains. I cannot remember layering and colour
how many mountains we all had to
move in those 14 months in the run-up strategy regardless of
to IDS 2003, but what suddenly stood
in our way in January 2003 seemed what substructure is
insurmountable. The team member
appointed to deal with the directions
for use disclosed to the other team
being veneered”
members in early January 2003 that
he could not finalise the six directions It was high-risk, but I said goodbye
for use in time for IDS. This threatened to my wife, my laboratory, my business
to burst our grand dream like a soap partner, my lab team, my dentists
bubble. and friends for two months to take
The market launch at IDS had advantage of the slight chance that
effectively become impossible. we might still be able to finish the
Everything we had worked on day and manuals.
night seemed to have been in vain. All the other remaining team
Suddenly all hopes were concentrated members divided the outstanding jobs
on me. After the colleague gave up, I between them as best they could. Our
was the only dental technician in the mood had plunged to an absolute
team and hence the only one who depth, but we continually psyched
could still rescue things. I did not have each other up and that feeling ‘when
long to think about it. Action was the going gets tough, the tough get
needed quickly. We absolutely wanted going’ gave us wings. And we achieved
to launch Initial at IDS 2003. But how the almost impossible! By mid-March
on earth could we – or could I – do it in 2003 (nearly) everything was ready.
the short amount of time left?
GC get connected 35
 The vision becomes reality negative and the small team gained
The launch at IDS far exceeded all our renewed energy time and time again
expectations. We were able to proudly in order to tackle the maintenance and
present to amazed and astounded necessary expansion of the system.
trade fair visitors our unique ceramic The US market launch in May 2005 saw
concept with utmost conviction. the Initial line expanded with a new
Without much publicity, yet very bleaching set for MC, LF, TI, AL, ZR. The
successfully (which is always an small founding team was gradually
indication of a very good system) Initial expanded, which greatly relieved
was launched gradually after 2003, everyone’s workload and enabled
first in Europe, then the USA. Since us to turn our attention again to
then, Initial has also been marketed implementing new Initial projects.
throughout Asia.
It was the right decision to Continual evolution
concentrate the European In November 2006 a Gum Shades
launch initially on the Set for MC / ZR was presented and
Benelux countries, brought onto the market. This set –
Austria, Switzerland very important for implant techniques
and Germany. – was developed in close cooperation
In the first two with the newly formed Inner Circle,
years post-launch a dental technology working group
we first became centred on Initial.
painfully aware Four years post-launch we realised
how important that we had set new standards in the
and especially how high-end veneer sector, but, looking at
time-consuming the system as a whole, we were rather
good and fast support too complex for the world market
is, how important immediate with its different trends and demands.
troubleshooting is to users. This kept Commercially, Initial was a great
the small team more than busy and success for GC. This made it even more
often enough pushed the team to its important to address the question of
limits. At the same time, lectures in 3D whether Initial should position itself
imaging were being prepared, articles more broadly in order to cover the
were being written and naturally sector below high-end as well.
practical workshops and seminars were Pricing pressures increasingly
being held, as well as training sessions dominated the market and people
for trade technical advisers. were seeking alternatives. It was
Fortunately, the positive experiences important to provide laboratories
with Initial far outweighed the under time and cost pressures with a
36 GC get connected
fabrication method that would enable
them to produce high-quality and “It is well known that
euphoria can move
aesthetically convincing restoration
work without major investment and at
an attractive price for patients.
Whenever GC wants to bring
something new onto the market, it
mountains. I cannot
is also expected to be something
special. The ONE BODY System-IQ
remember how many
was developed and first introduced
in 2007 as PRESS-over Metal / Zircon:
mountains we all had to
a very small system with a few special
features and great potential. move in those 14 months
Like the two products launched
later – One Body LAYERING over Metal in the run-up to IDS 2003”
(May 2009) and One Body LAYERING
over Zircon (February 2011) – the been developed, e.g. the Reflective
base materials have a certain degree Liner for IQ Layering Zircon, Special
of light dynamics and can therefore Liquids, Fluo Crystals, which are
be used even for the anterior teeth integrated into a special working
without additional layering, a unique system. It is not possible here to name
selling point, just like the ingenious everything. Of course, improvements
Lustre Paste also launched in 2007 in the system should be highlighted,
with IQ-One-Body. This unique three- such as the ZR-FS zircon veneering
dimensional ceramic stain made it ceramic launched in 2008. The much
possible to produce restorations with higher feldspar content than the ‘old’
just one glaze firing. In 2007 there were ZR provides far higher depth effect and
still two Lustre Paste Sets, one for high- brilliance when veneering and is rightly
CTE and for low-CTE ceramics. seen as the benchmark in the field of
This situation was changed in 2010 zircon veneering.
and the new IQ-One-Body, Lustre Paste For now, the last measure to make
NF was launched in June of that year. Initial accessible on a broader basis was
Now there was just one paste for all presented at IDS 2013 with the Initial
ceramics. The Lustre Paste is extremely Classic Line. This range is mainly aimed
popular and is also used by many non- at production laboratories which
users of Initial every day for refining predominantly employ the 2 to 3-layer
aesthetics. technique but on no account want to
In the past ten years, a great number compromise on material quality. As
of different innovative materials have the worldwide market works over 70%
GC get connected 37
 About the author with non-precious alloys in this sector,
Michael Brüsch trained as a dental the Classic Line was provided – a Paste
technician from 1976-1979, after which Opaque CL specially adapted to non-
he was employed as a dental technician precious metals.
working mainly with gold and ceramics. The Initial System has always
In 1986 he completed his Master dental kept moving and will continue this
technician degree in Düsseldorf and in the future. Cautiously, without
then became a laboratory director distorting the character of the system,
focusing on all-ceramic restoration work. In 1989 it is constantly being adapted to the
he set up his own, privately based dental laboratory current prevailing market needs.
specialising in functional and aesthetic prosthetics with a New projects for Initial are planned
focus on multichromatic-additive veneering techniques to ensure that this innovative classic
for composite and porcelain, precision fabrication always remains relevant.
methods for crowns, inlays, onlays and veneers made
from composite and all-ceramic materials. Brüsch is an Postscript
international adviser and course presenter for workshops Having consciously omitted to
on system-coordinating all-ceramic restorations. He has mention anybody by name in this
become well-known for his exceptional 3D presentations. article, I would like to take this
He is an active member of the German Association for opportunity here to thank all my
Aesthetic Dentistry (DGÄZ) and the Dental Excellence- companions on this journey for their
International Laboratory Group and has been a specialist endless patience, commitment,
in Dental Techniques at EDA since 2008. He is considered support and devotion that enabled us
to be an authority on the subject of all-ceramic and to create something quite wonderful
biomaterials and functional restoration work and and real out of our shared vision of
regularly presents workshops and publishes papers. Initial. Vision requires courage and we
certainly had courage.
I would also like to thank the many,
many users. Through your enthusiasm
and your input, you have made a huge
contribution towards Initial being what
it is today.
And last but not least, my thanks
of course go to GC, who for ten years
have put extraordinary trust in me,
opened up lots of new avenues and
smoothed the way for me.
In conclusion, I would do it all over
again!!!

38 GC get connected
 Master all your challenges.
The all-round ceramic system.
flexibility

c l a s s i c

individuality

e x p e r t

productivity

IQ one

Whether flexibility, individuality or productivity is your biggest challenge at work,

with Initial we provide a system that enables everything. If you want to work in
a very fast economical way or for a perfect harmony of aesthetics and individuality:
Initial from GC is the all-round ceramic system for each and every indication.

GC EUROPE N.V.
Tel. + 32.16.74.10.00
info@gceurope.com
http://www.gceurope.com
everX
Step by step:

Posterior
Discover the power of fibres with a conventional composite
Evidence shows that fracture of such as G-ænial Posterior as the
restorations is one of the main causes enamel replacement layer. Using the
of restoration replacement. Modern combination of both materials enables
composites offer perfect features a biomimetic restoration of teeth.
for enamel replacement: high wear everX Posterior reinforces large
resistance and aesthetics. However, posterior restorations.
they are not able to equal dentine The short fibres used in everX
when it comes to resistance to fracture. Posterior provide a fracture toughness
everX Posterior is a fibre-reinforced equal to collagen-containing
composite designed to replace dentine and almost double that
dentine and to be used in conjunction of a conventional composite. This
makes everX Posterior the strongest
possible sub-structure to reinforce
any composite restoration in large
preparations

40 GC get connected
 ClAss i CAvities ClAss ii AnD lARge CAvities
1 1

2 2

3a

3b 3b

BeneFit FRom An eAsy

4 mm lAyeR AppliCAtion

1. Prepare cavity. 4 4

2. Bond and light-cure.

3a. Build first the missing wall(s)

with composite.

3b. Apply everX Posterior in 5 5

layer up to 4mm.

4. Light-cure 10-20 seconds.

5. Cover with composite.

GC get connected 41
 Fibres prevent crack propagation everX Posterior the ideal dentine
Cracks are a common issue, often replacement, especially in large
starting as a result of thousands of preparations.
repetitive bites, at the surface of the
material and propagating through the Optimal bonding
filling and the teeth. The short fibres Bonding different materials is a key
prevent and arrest crack propagation factor in the layering technique. Since
that often starts from the surface of everX Posterior is used in the sandwich
the composite material and slowly technique, the bonding between
propagates through the filling and the the 2 composites will be important
tooth structure. to ensure the homogeneity of the
Fracture toughness equivalent to whole restoration. On top of chemical
dentine and almost double that of adhesion, fibres will bring mechanical
other composites shows that the retention to ensure a perfect bond to
cross-linked fibres bring unsurpassed any overlaying composite and to the
strength to the restoration. This makes tooth structure.

Watch the technique in action here

42 GC get connected
 Discover
the power of fibres

everX
Posterior
from GC
The strongest*
composite sub-structure.
everX Posterior from GC is the first
fiber reinforced composite designed
to be used as dentin replacement
in large size cavities.

Extending the limits

of direct restorations.
* data on file

GC EUROPE N.V.
Head Office
Tel. +32.16.74.10.00
info@gceurope.com
http://www.gceurope.com
 Product Family
Product Family

everStick ®
everStick
from GC
®

fibre reinforcements
from GC
fibre
for dailyreinforcements
for daily
dentistry
dentistry
• Reliable • Easy to use • Minimally invasive • Extra strong
• Aesthetic • Scientifically proven • Cost effective
• Reliable • Easy to use • Minimally invasive • Extra strong
• Aesthetic • Scientifically proven • Cost effective

GC trademarks: everX Posterior, G-ænial Bond, G-CEM LinkAce, G-ænial Posterior, EQUIA

158491-GC-OPERATORY STICK-adv-165x235.indd 1 19/08/13 11:22