How ENAMIC IS is being utilized by CAD/CAM dentists to replicate natural tooth characteristics.

When the team at VITA first began developing ENAMIC CAD/CAM blocks, they set out to create the most tooth-like material possible.

They wanted to provide dentists and their patients with a material that mimics natural dentition-in both strength, elasticity and esthetics. That was no easy task, but after more than a decade of research and development, ENAMIC® was finally ready for prime time in 2013.

The product was so successful that VITA released another option a few years later in 2016: ENAMIC IS (Implant Solutions). This was a natural extension of the product line, giving CAD/CAM dentists the ability to provide their patients with a material that replicates natural tooth characteristics and is both force absorbing and beautiful in just a few hours, said Jim McGuire, CDT, and director of education and technical support for VITA North America.

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Dr. Daniel Butterman of Colorado has been using ENAMIC IS since it was first launched, and said it offers more resiliency than other products on the market-which is key to successful implant dentistry.

“I’ve been placing implants for 18 years, so I’ve seen the evolution of the materials,” Dr. Butterman says. “You used to see fractures and failures because a screw would get loose or too much force would cause the porcelain on a PFM crown to fracture. So we made the screws more rigid and started turning to stronger materials like zirconia. The problem is when people bite too hard the force has to go somewhere. Because the materials are so strong now, more force is placed on the bone, and that could lead to bone loss and failure. The ideal material is more resilient and takes on some of that force to protect the bone.”

VITA ENAMIC and now VITA ENAMIC IS provide doctors and patients with the tooth-inspired, durable restorative options they’re after. Here’s a closer look at the material and why you might want to consider incorporating it into your practice.

Why it works

ENAMIC is comprised of a structured ceramic matrix that combines the positive characteristics of a ceramic with the resiliency of a polymer, McGuire says, making it look and act more like a natural tooth. The ceramic structure gives the material the stiffness, wear resistance and load bearing properties it needs, while the polymer provides force distribution for heavy loads in both posterior and anterior natural tooth or implant supported indications. The dual-network structure also allows for a less invasive technique and can be milled out as thin as 1 mm for posteriors.

The team at VITA was the first to develop this type of matrix structure, which presented some challenges. They had to achieve a matrix that allowed the polymer to be introduced and interconnected with the ceramic, create a homogenous material, and then determine a way to predictably reproduce the matrix and the ENAMIC material in a production facility.

What they came up with is a material that’s about 86 percent ceramic and 14 percent polymer, making it the only truly structured ceramic with polymer on the market, McGuire says. He describes the creation as similar to a DNA strand, with polymer interwoven between the ceramic scaffolding.

“The ceramic reinforces the polymer and the polymer absorbs the energy from patients chewing before it overloads the ceramic structure,” McGuire says. “Plastic deformation occurs, helping to prevent catastrophic failure that is often observed in traditional glass-ceramic restorations.”

ENAMIC’s resiliency, or force absorbing properties, makes it an ideal solution for implants, which is why VITA created the IS version. The IS block features a pre-drilled hole so it easily connects to the implant’s abutment adapter base, McGuire said. Clinicians can use ENAMIC IS as a single screw-retained restoration or to fabricate a custom implant abutment with more traditional cement-retained restorative material to be bonded to the ENAMIC abutment.

“There’s no built-in resiliency with implants because they’re static,” McGuire says. “ENAMIC is uniquely suited to be an implant material because of its resiliency, force distribution, load bearing capability and toughness.”
ENAMIC is an especially attractive option when clinicians feel there is more potential for an implant to become overloaded, Dr. Butterman said. This might be the case when a patient has a strong bite or is a heavy bruxer. The material absorbs the force in these situations, protecting the implant and the bone surrounding it.

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Same-day dentistry

ENAMIC IS gives clinicians the ability to deliver a high-quality implant restoration in a single appointment, which is another quality that attracted Dr. Butterman to the material. Before, patients would come in for impressions and then have to return a week later when the crown was ready. Now, because ENAMIC mills so quickly, he can use his CAD/CAM system the way he always intended: to provide patients with same-day dentistry.

“For the dentist, it’s easy to say I want to see the patient for a 15- to 20-minute appointment for imaging, but it’s very different for the patient,” Dr. Butterman says. “For that short appointment, our patients might have to take off an entire day of work or hire a babysitter. There are so many issues that come into play that make this easy appointment very difficult for our patients. If we can eliminate that extra step and take one appointment away so they don’t have to use vacation time, patients are thrilled with that. Nobody wants to wait, and nobody needs to wait anymore because the workflow has improved so much.”

More control

Using materials like ENAMIC IS in the digital workflow also gives clinicians more control over how much pressure is put on the tissue and how deep the margins are, Dr. Butterman says. One problem dentists and patients have dealt with in the past is excess cement. The margins in these restorations are often deep and difficult to see, and that makes it common for harmful cement to be left behind. The fact that Dr. Butterman can control the process digitally and see the margins better makes cement cleanup much easier.

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“The total control that we have over every aspect of it really makes for a much better restoration,” Dr. Butterman says. “And we’re much less likely to cause damage to the implant because extra cement was left behind.”
The material is also easy to adjust if contacts are too tight, Dr. Butterman says. That isn’t the case with other materials; he has to start over if his contacts are off. Enamic has a resin component, so he can always add material if he needs to. It’s also possible to add any necessary color changes right in the patient’s mouth-even years later.

Other benefits

Patients love ENAMIC IS because it feels and acts like a natural tooth, McGuire said. It can also be milled very thin, 1 mm within the occlusion and 0.3 mm facially for anterior veneers in support of less invasive tooth preparation that help reduce patient sensitivity and chair time.

“It’s truly a tooth replacement material,” McGuire says. “Dentists like that when they mill the material the definition of the margins is dead on. It mills beautifully at very thin cross sections without losing its marginal integrity. The milling properties provide for very sharp and defined marginal edges in support of esthetic blending into the tooth structure. It’s easy to work with and because of its unique structure it mills very quickly.”

And once it’s milled, unlike other machineable materials, there’s no post processing other than polishing, McGuire says. There’s no need to put the restoration in the furnace, enabling dentists to focus more on patient care. Though for best esthetic results, Dr. Butterman does recommend taking a few minutes to stain and glaze the restoration.
Overall, ENAMIC  IS gives Dr. Butterman another option for implants, and one with the ability to absorb pressure to prevent bone loss. It also saves him time, usually 20 to 30 minutes per restoration.

“Now we have a material that absorbs forces better. That makes me sleep better at night,” Dr. Butterman says. “And the fast processing time and the fact we can deliver the restoration in a single appointment makes my patients sleep better. It’s another material in the tool belt that adds some nice advantages that weren’t there before. The resiliency and processing time are the two big ones for me.”

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