Premise Indirect - przewodnik kliniczny - Kerr Hawe

Bio... what? 

Premise Indirect | Biomimetic nanotechnology 

Premise Indirect. The new biomimetic nanotechnology tempered composite 

programme which uniquely offers restorations that look, feel, mature and 

perform just like natural teeth... just as nature intended. 

For more information, log on to www.kerrhawe.com or call 00800 41 05 05 05 

©2008 Kerr Corporation 

Lab for life.

Press Release 

Biomimetic Story 

Product Presentation: The strength of Premise Indirect is the long history 

with belleGlass 

Historical and Provisional Studies 

Frequently Asked Questions

INDIRECTaddressesallthemodernrequirementsofprofessionalsseekingtheultimateinatempered compositeprogrammethatmostcloselyresemblesnaturaltoothstructurebothintermsofformand function. TheresultofsciencebornfromthesuccessofHerculiteXRV,belleGlassNGandPremise-newPREMISE 

Indirectwithanalmostceramiclikeappearancethankstoprovenoptimisedtriomodalpolymerisation butwithalltheadditionaladvantagesofKerr’suniqueheatandpressurecuringsystem;thepresenceof nitrogenreplacesairtouniquelyannihilatetheinhibitionlayerandproducewhatiseffectivelya98% Continuousimprovementsintermsofhandling,aestheticsandpolishabilityprovidesnewPremise 

totallypolymerisedrestoration.Marginalintegrityandcolourstabilityaremaximisedwithbothwear 

terminlay,onlay,crown,bridgeandveneerrestorations.WhenincorporatedwithCONSTRUCTfibre matrix,unprecedentedopportunitiesmayalsoberealised. andflexuralratesmimickingnaturaltoothstructureunsurpassedbyanycompetitivesystemforlong 

‘forgiving’proprioceptiverestorativealternativeispreferredandtimeisoftheessence. ThefulllineofKerrproductsisavailablefromauthorizeddentaldistributors.Formoredetailed NewPREMISEINDIRECTisespeciallysuitedforimmediateloadimplantpatientswhereamore 

www.KerrDental.com,contactyourlocalKerrrepresentative,orcallKerrInternationalFreephone informationonPREMISEINDIRECToranyotherKerrdentalproducts,pleasevisitourwebsiteat 

KERR (00800)41050505. 

ViaStrecce4 6934Bioggio Switzerland KerrHaweSA 

InternationalFreephone:(00800)41050505 

www.KerrDental.com www.KerrHawe.com

BIOMIMETICS 

Biomimeticsistheapplicationofbiologicalmethodsandsystemsfoundinnaturetothestudyand dentistandtechnicianwhoareconcernedwithproviding‘virtuallylife-longaestheticrestorations’. 

thatmostofuswouldreadilyappreciate. Twoeasilyrecognisedexamplesofthistransferfrombiologytotechnologyaretheintroductionof designofengineeringsystemsandmoderntechnology:‘life-like’wouldbeapopularinterpretation 

certainanimals(GeorgedeMestral,SwissEngineer,1948)andofcoursetheUK’sveryownPercy Shaw‘s‘cat’seye’reflectorfornighttimeroaddelineation:his1935inventionwasbasedonthefact thatthemakeupofacat’seyeincorporatesasystemofreflectingcells(tapetumlicidum)capable theVelcrofasteningfollowingresearchintothewayburrhooksfromsomeplantsclungtothefurof 

Nelumbolotusleafhasbeensimilarlymimickedbysomemanufacturersofself-cleaningpaints,roof tilesandevensheetglass,isanothercleveradaptationofman’sharbouringofnaturalphenomena ofreflectingthetiniestamountoflight.The‘Lotuseffect,’wherebytheselfcleaningnatureofthe 

Thebiomimeticprocessisofcourseatwowayaffairandtheflowofideasandsolutions,especially thosewithmedicalpositivesenhancingalongerandbetterqualityoflifeforushumans,bringsus forapplicationinatotallynovelway. 

hypeconcerningceramicrestorations,notablyCAD/CAMmilling,itisalltooeasytoforgetthegreat synergisticqualitiesthatalaboratorytemperedCOMPOSITEcrown,bridge,inlay,veneeroronlaycan provideforthepatient.Kerr’sbelleGlassNGsystem,constantlyratedNo1initsclassby’Reality’, neatlytodentistryingeneralandanextendedstorylinefromKerrinparticular.Withallthecurrent 

forindirectresinmaterial:itsuniqueformulaandspecialtri-modalcuringprocess(heat,pressure andlight)hashelpedsecureitsfavouredpositionwiththousandsofrestorationssuccessfullyplaced representswithoutdoubttheindustrystandardandhasstoodthetestoftimeasproductofchoice 

TheclinicalandtechnicalexcellenceofbelleGlassNGisbeyonddoubtwithcountlessin-vitroandinvivostudiessupportingitsheritagepositionstatus.Restorationsthathavealmostthesamewear 

overa13yearhistory. 

naturaldentitionisasadirectresultofbelleGlass‘uniqueandpatentedmaterialpropertiesand curingprocess.Kerr’sambitionistocontinuetoprovidepatientswithrestorationsthatwillgive countlessyearsofaestheticfunctionandanew,improvedbellleGlassunderthenamePREMISE rateashumanteethandcombinecoefficientofthermalexpansionresultswhichvirtuallymirror 

NewPremiseIndirectsharesalltheyears’ofheritagestatusgainedfrombelleGlass,HerculiteXRV INDIRECTisthecompany’swayofcontinuingtofulfilthisintention. 

evenbetterceramiclikeaesthetics,minimumplaqueattractionandsuperbplacementhandlingfor effortlessfabrication.AswithbelleGlassCONSTRUCTpolyethylenefibremayalsobeaddedto PremiseIndirectrestorationsespeciallyforbridgeworkorcrownswheretrulyexceptionalstrengthis andPremisechairsidecompositeswiththeaddedbonusoflongtermglossespeciallyintheanterior, 

required.Allinalllongtermcolourstabilitywithlowwaterabsorptioncombinetomakepossible 

MartinLindsayKerrLabProductManagerEuropediscussesanewperspectiveofinteresttoboth

thiswiththehugegrowthinimplantworksundertakenandthenecessitytouseamoreforgiving proprioceptiverestorativesuperstructurematerialotherthanceramic,thenthereareevenmore reasonstobeexcitedaboutnewPremiseIndirect.AddtothesefactstheuseofKerr’sawardwinning trulylife-likebiomimeticrestorationsthatwear,feel,lookandagejustlikenaturalteeth.Combine 

trulyharmonised,scientificallybalancedandlong-livedrestorativeapproach. NX3dualcureresincementthenwinningcombinationsarecertainlytheorderofthedaywitha 

toshowofftheirinnateartisticskillsbyprovidingbespokeandaestheticallypleasingyetalone FabricatingPremiseIndirectrestorationsextra-orallygivesbothtechniciansanddentistsachance 

oftime.Withmuchdentistryalsoconcernedwith‘repairandmaintenance’itiscomfortingtoknow thatintheunlikelyeventofchippingorfracture,PremiseIndirectrestorationscanbeswiftly repairedintra-orallywiththeminimumofstressfordentistorpatient. functionalandlonglivedpatientfriendlyrestorativesolutionssimplyandinarelativelyshortperiod 

contactyourlocalKerrrepresentativeorcallKerrInternationalFreephone(00800)41050505. TofindoutmoreregardingKerr’snewPREMISEINDIRECTbiomimeticnanotechnologyrestorative

Lab for Life. 

Premise Indirect | Biomimetic nanotechnolgy

History 

• 1891, Kerr Brothers founded Detroit Dental Manufacturing 

Company Only Product, Gas Fired Porcelain Furnace 

• 1920’s, Impression Compounds & Waxes 

• 1950’s Investments, Denture Base Material 

• ‘60s & 80’s, Division of Sybron Corporation, market leader in 

alloys, endo, impression material, composite, bonding 

& amalgamators. 

• 1993 - Sybron Dental Specialties, acquisitions; Demetron, 

Metrex, E&D, belle de st. Claire, Precision Rotary 

Instruments 

• 2000 SDS spins off from Sybron International 

.06% Camphoroquinone + .01% Aromatic or .04% 

Aliphatic Tertiary Amine + 450 nm Light Source = 

Higher Conversion

Benzoyl Peroxide + Heat = FREE RADICALS 

Allows higher curing temperature 

= higher conversion - 98.5%

Chemistry 

Conversion of Heat and Pressure Cured Composite 

Bennet ME, Puckett AD, Parsall DE, Roberts SB, J Dent Res 1996: 

75-291. Abstr #2188 

5 min 10 min 15 min 20 min 

Hardness (V) 69.5 (6.8) 79.7 (4.4) 81.6 (4.4) 90.7 (2.4) 

Diametral 

Tensile 34.7 (7.3) 53.9 (10.9) 62.5 (11.2) 65.8 (4.9) 

Strength 

% Conversion 86.5 92.8 96.2 98.5 

Eliminate The 

oxygen-inhibited 

layer = conversion to 

the surface and 

any voids that may 

remain after 

pressure curing.

Features 

Result: 

Heat & Pressure Processed Polymer-Glass Restorative 

• Increased Productivity 

• Improved Aesthetics 

• Physical properties more closely matching that of human dentin 

Features 

History: 

• Based on 19 Years of HerculiteXRV Technology 

• Leader in Resin & Composite Technology (Herculite, Prodigy, Point 4)

Indications 

Anterior Veneers 

Opalescent particles 

within enamel layer 

exhibits a natural vitality 

Indications 

Opalescence 

Definition: 

Opalescence is the 

reflection of an iridescent 

light.

Indications 

Single Crowns 

• Metal Understructure or 

• Construct 

Polyethylene 

Reinforcement 

Indications 

Implant Restorations 

• Kind and forgiving to 

opposing dentin 

• Simulation of lost 

periodontal ligament

Indications 

Metal Free Bonded Bridges & 

Perio Splints 

• Connect / Construct Polyethylene Fiber Reinforcement 

Features 

Premise Indirect / Biomimetics 

“Clinicians now have a restorative material available that alleviates 

our concerns about abrasion to opposing dentition, and one that 

matches if not surpasses the aesthetic level of porcelain.” 

Gregg A. Helvey, DDS

Features 

Advantages of Indirect 

Composites over Ceramics 

• Simple Fabrication 

• Margins when finished are impeccable 

• Restoration/Luting Cement: same type of material 

• Less than 1% Shrinkage 

• Can be repaired at Chairside 

• Kind to the opposing teeth 

Features 

Vs. Porcelain 

belleGlass Intra-oral Repair: 

· Freshen restoration 

· Silane surface 

· Apply modeling resin 

· Repair w/ Kerr resin 

· Trim & Polish 

· Dismiss patient 

· 1 Hour 

Porcelain Intra-oral Repair: 

· Remove restoration 

· Re-appoint patient 

· Mail restoration to 

lab 

· Wait 7 to 10 days 

· Anesthetize patient 

· Re-cement 

restoration 

· 10 Days

Developments 

Coefficient of Thermal Expansion of 

Restorative Materials 

MATERIAL 

CTE (ppm/°C) 

AMALGAM 25 

PORCELAIN 7.8 

GOLD 14.4 

BG OPACEOUS DENTIN 13.1 

Natural Enamel 12 

Natural Dentin 11.4 

COMPOSITE RESIN 30 

GLASS IONOMER CEMENT 5.7* 

Skinner, E.W. and Phillips, R.W. The Science of Dental Materials; W.B. 

Saunders, Co. Phil. 1967. 

* Puckett, A.D. et al, Quint. Int. 26 (8), p577-581, 1996. 


Biomimetic refers to human-made processes, 

substances, devices or systems that imitate nature. 

Burs on a dog’s coat 

led to the invention of 

Velcro.


The art and science of designing and building 

biomimetic apparatus is called biomimetics. 

Replicating the water 

repellant nature of 

certain leaves in the 

manufacturing of paint. 

Picture Courtesy of David Zielinski RDT, USA

Premise Indirect / Nanotechnology 

Nanotechnology involves the creation and 

manipulation of complex structures on the scale of 

nanometers – something organisms have done for 

about 3.8 billion years. 

The ideal nanohybrid 

restorative that ages, 

feels, wears, functions 

and looks like a natural 

tooth. 

Picture Courtesy of Ronnie van Eeden RDT, South Africa

Picture Courtesy of Gabriel Palazzi RDT, Switzerland 

Premise Indirect / Features 

The result of science born from the 

success of Heruculite XRV, 

belleGlassNG and Premise. 

Premise Indirect utilizes the same 

optimized trimodal polymerization as 

belleGlass NG, the most respected 

indirect restorative of its kind. 

Indications: Inlays, onlays, crowns, 

veneers, bridges, splints and ideal for 

implant restorations with proprioceptive 

tooth-like response.

Premise Indirect / Features 

Natural look and wear. Closely matches 

natural dentition in wear characteristics, 

as well as an opalescent appearance that 

virtually replicates natural enamel like no 

other restorative material. 

Performance. Trimodal curing (light, heat 

and pressure) achieves over 98% material 

conversion, as compared to 60 – 70% 

achieved with light-cure only materials. 

Proven History. Twelve years of positive 

clinical history, and tens of thousands of 

successful restorations placed since 1996. 

Premise Indirect / Research 

Nanohybrid technology. The combination of large prepolymerized filler 

(PPF) particles, 0.4 micron structural filler and small silica nanoparticles 

allows higher filler loading, improved physical properties, optimal handling, 

higher surface gloss and reduced polymerization shrinkage. 

Prepolymerized filler 

Point 4 filler 

Silica nanoparticles


High gloss retention. The particle size of fillers in PPF particles is below 

the wavelength of visible light and light-scattering effects are minimal. 

Plucking of PPF particles is reduced because mechanical properties are 

more similar to the cured paste number rather than ceramic particles. 

Cured traditional composites wear 

unevenly causing a loss of luster and 

gloss. 

Premise Indirect PPF particles wear 

more uniformly, wear resistance is 

improved and surface remains 

smoother and glossier with time. 


In-vivo measurements of wear over a 

In-vivo measurements of wear over a 

five year period shows an average of 

1.2 microns a year – closer to the wear 

of natural teeth than any other material 

tested.


Premise Indirect more closely 

matches the coefficient of 

thermal expansion (CTE) of 

natural dentin – resulting in a 

material that looks and acts 

virtually the same as natural 

tooth structure. 

Premise Indirect / Systems 

Intro System 

Starter system offering everything 

needed for Inlays and Onlays. 

Master System 

Complete system offering 

everything needed for Inlays to 

full bridges.

Premise Indirect / Materials 

Primary Dentins are used for foundation 

and coping layers and improve strength. 

Facial Dentins cover all foundation and 

coping layers to produce a stable long 

lived polished surface. 

Incisals are placed onto the incisal / 

cuspal area and are designed to match the 

vitality of tooth enamel. 

Premise Indirect / Materials 

Modeling Resin is an unfilled 

universal wetting agent used for 

sculpturing. 

Rubber Sep is a removable 

latex release agent and spacer 

applied to all dies and contact 

areas creating a 20 micron 

space. 

Opaques are applied after metal 

prep and block out any 

underlying metal color. 

Silane Primer is applied to the 

fitting surface of any metal free 

restoration prior to bonding. 

Cervicals simulate root and 

cervical color, 

Kolor Plus is applied 

internally to add effect on 

occlusal and interproximal 

surfaces.

Premise Indirect / Inlays & Onlays 

When layering note that maximum Facial Dentin 

thickness should not exceed 1.5 mm. 

Primary Facial Incisal 


If desired, duplicate the working die and 

articulate. Isolate adjacent tooth contact 

points and opposing dentition with Rubber 

Sep. 

Prepare the model and working die. Block 

out all undercuts. 

Apply a thin layer of Primary Dentin into 

the floor and axial walls and adapt to the 

desired contour. Finish slightly short of the 

marginal periphery. Apply Kolor Plus to 

modify the occlusal color if needed. Light 

cure all aspects for 20 seconds.


Adapt Facial Dentin in small increments to 

desired contour. Continuously verify 

occlusal clearance. Work one cusp at a 

time. Apply Kolor Plus modifier to simulate 

occlusal staining. Light cure each 

increment for 10 seconds. 

Finalize the occlusal scheme with Cuspal / 

Incisal to desired contour. Remove the die 

from the working model. Add contact areas 

if needed. Light cure all aspects for 20 

seconds. Polymerize for 20 minutes in the 

curing unit. Remove the restoration from 

the die as soon as possible after full 

polymerization. 


The completed restoration after polishing.

Premise Indirect / Crowns & Veneers 

When layering note that maximum Facial Dentin 

thickness should not exceed 1.5 mm. 

Primary Facial Incisal 


If desired, duplicate the working die and 

articulate. Isolate adjacent tooth contact 

points with Rubber Sep. 

Prepare the model and working die. 

Apply Primary Dentin and contour to the 

desired shape. Finish slightly short of the 

marginal periphery. Light cure each aspect 

for 20 seconds.


Adapt Facial Dentin onto the margin for 

precision fit. 

Adapt Facial Dentin to the desired contour. 

Repeat on all aspects. Light cure at 

frequent intervals. Once final contour has 

been achieved, light cure all aspects for 20 

seconds. 


Adapt Incisal material in small increments. 

Light cure each increment for 10 seconds. 

Finalize contour at the incisal edge. Create 

a restoration that is slightly longer than the 

tooth being replicated. (This allows for 

correct morphology after polishing 

procedures). Remove the die from the 

working model. Add contact areas. Light 

cure all aspects for 20 seconds.


Polymerize for 20 minutes in the curing unit. 

Remove the restoration from the die as 

soon as possible after full polymerization. 

The completed restoration after polishing. 

Premise Indirect / Metal Restorations 

Premise Indirect can be incorporated onto 

any recommended dental alloy. Use of 

mechanical retention is recommended. 

Metal frameworks should incorporate 

smooth rounded edges especially for incisal 

and occlusal areas. Produce a framework 

thickness of 0.3 – 0.5 mm. For bridges, 

design the framework for correct placement 

of pontics and connectors. Ensure adequate 

space for veneering material. 

Primary Facial Incisal Metal Opaque


Wax to full contour. 

Remove waxed crown. 

Assess available space. 

Trim framework to desired shape. 


Ideal margin space. 

Rounded and smoothed. 

Trim and polish backings 

before applying material. 

Rounded and smoothed.


To achieve maximum bond strength, it is 

essential to ensure cleanliness of the metal. 

Sandblast all veneering areas with 50 micron 

Aluminum Oxide at no more than 2 bar (30 

PSI) pressure. 

After cleaning, apply Metal Prep with an 

applicator brush or directly from the bottle. 


All veneering areas are covered with Metal 

Prep. Allow to fully dry approximately 1 

minute. Blast excess metal prep off with 

compressed air at 1 bar (15 PSI) pressure. 

Apply Opaque to a final thickness of 0.1 – 

0.2 mm. Ensure that there are no visible grey 

areas. This may require 2 – 3 applications. 

Light cure each opaque layer for 40 seconds 

per surface. Create a first wash Opaque. If 

desired, mix a small amount of Modeling 

Resin with Opaque.


If desired, modify Opaque shades with Kolor 

Plus. 

Orange modifier is ideal for cervical areas or 

for producing a warmer color. 


Wash application of Opaque with cervical 

area completed. Light cure each layer for 40 

seconds. 

Complete masking of the underlying metal 

framework. Note a slight surface shine.

Premise Indirect / Construct 

Construct reinforcing braid is the ideal 

“building block”. It has a patented weave 

designed for more complete resin wetting. 

• Delivers superior strength and toughness 

• Made from polyethylene fiber 

• Cold gas plasma treated 

• Three widths available 

• Three times stronger than steel 

• Impregnated with Silane and Resin 

• Available in three shades, one neutral 

and two opaque shades designed to 

eliminate “shine through”. 


Indications 

• Single-unit posterior crowns 

• Posterior bridges 

• Anterior bridges 

• Selected anterior single crowns 

• Selected Inlays and Onlays 

Guidelines 

• Assess all prescribed cases to ensure a successful outcome. 

• Always use the largest width of Construct fiber available. 

• Ensure complete wetting of the fiber with Construct Resin. 

• Keep the design of frameworks as simple as possible.


Prepare the model and working die. 

Asses size and area of the preparation. 

Forma a flat disc of Primary Dentin 0.5 – 0.6 

mm thick. 


Apply the disc to the occlusal surface and adapt 

excess material over the axial walls to form a 

coping. Finish short of the margin periphery. 

Light cure each aspect for 20 seconds. The 

ideal coping thickness is 0.2 mm. 

Construct needs to be wrapped around the 

periphery of the preparation. Apply to the 

occlusal surface if space permits. Follow the 

preparations contour for optimal placement. 

Using Construct scissors, cut a length of 

fiber. Wet one end of the fiber with Construct 

Resin. Apply to the proximal axial walls into 

its desired position. After full adaptation and 

saturation, light cure for 3 – 5 seconds.


Apply Construct Resin in small increments 1 

– 2 mm at a time. Wrap around the 

periphery. After each adaptation and 

saturation of the fiber, light cure for 3 – 5 

seconds. 

Wrap around the entire periphery. Light cure 

little and often. 


After full adaptation overlay by 0.1 – 0.2 mm 

and cut the fiber. Light cure 3 – 5 seconds. 

Measure a length of Construct for the 

occlusal surface.


Apply Construct as before and light cure 3 – 

5 seconds. Once completed light cure all 

aspects for 20 seconds. 

Continue layering of the crown to final 

completed restoration. 

Premise Indirect 

Continued improvements over the years 

with our indirect restorative line has resulted 

in superior handling characteristics as well 

as exceptional polishability. 

Please refer to the complete Directions for 

Use for more information. 

Visit www.kerrlab.com for more information.

Historical and Provisional 

Studies

Primary research information courtesy of 

Prof. D Watts, 

Dr. Nick Silikas (BSc, MPhil, PhD, FADM), 

The University of Manchester 

Higher Cambridge Street 

Manchester M15 6FH

Dental Materials 19 (2003) 393–398 

www.elsevier.com/locate/dental 

In vitro characterization of two laboratory-processed resin composites 

A. Kakaboura a, *, C. Rahiotis a , S. Zinelis b , Y.A. Al-Dhamadi c , N. Silikas c , D.C. Watts c 

a Department of Operative Dentistry, University of Athens, Thivon 2, 115 27, Goudi, Athens, Greece 

b Biomaterials Laboratory, University of Athens, Greece 

c Dental School, University of Manchester, Manchester, UK 

Received 15 January 2002; revised 20 May 2002; accepted 11 June 2002 

Abstract 

Purpose. To compare various characteristics of two new-generation laboratory-processed resin composites (BelleGlass HP/SDS-Kerr and 

Sinfony/3M-ESPE). The properties evaluated were degree of CyC conversion, microhardness, roughness, biaxial flexural strength and 

polymerization shrinkage-strain. 

Materials and methods. All specimens were subjected to a first and a second polymerization cycle according to the manufacturers’ 

instructions. The degree of CyC conversion (DC) was recorded on rectangular (3 £ 2 £ 0.5 mm 3 ) specimens (n ¼ 3) by FT-IR 

micromultiple internal reflectance spectroscopy immediately after each of the two polymerization cycles. Twenty cylindrical specimens 

(10 £ 2mm 2 ) of each material were prepared for surface microhardness (n ¼ 10, VHN, 200 g load, 20 s) and surface roughness (n ¼ 10, Ra) 

measurements. The biaxial flexural strength and stiffness were determined on disk-shaped (n ¼ 8, 15 £ 0.7 mm 2 ) specimens loaded to 

fracture at 1 mm/min crosshead speed. The polymerization shrinkage-strain was calculated with the bonded-disk method. All values were 

statistically analyzed by Student’s unpaired t-test ( p , 0.05). 

Results. The second polymerization cycle significantly increased the degree of CyC conversion for both materials ( p , 0.05). BelleGlass 

HP exhibited significantly higher degree of CyC conversion, surface microhardness, surface roughness, biaxial flexural strength and stiffness 

values compared to Sinfony ( p , 0.05). 

Significance. Several differences exist between the materials although both products are recommended for the same clinical applications. 

q 2003 Academy of Dental Materials. Published by Elsevier Science Ltd. All rights reserved. 

Keywords: Belleglass HP; Sinfony; Degree of cure; Microhardness; Roughness; Biaxial flexural strength; Shrinkage-strain; Load-to-failure rates 

1. Introduction 

Although porcelain is a well-accepted esthetic material 

for prosthodontic applications, the metal–ceramic and allceramic 

restorations show some undesirable characteristics. 

The opaque nature of metal substructure does not simulate 

natural translucency; fabrication is time-consuming and 

technically demanding and the abrasiveness of porcelain is 

destructive to the opposing natural tooth structure [1]. 

Moreover, in all ceramic restorations, the absence of a metal 

framework gives the potential for low fracture resistance, 

limiting the clinical application in high stress areas. 

In an effort to overcome some of these disadvantages, the 

manufacturers, even in the early 1980s, introduced numerous 

products of laboratory-processed resin composites [2]. 

These materials provided alternative ways for clinicians to 

* Corresponding author. Tel.: þ30-317788575; fax: þ30-31-8033129. 

E-mail address: afrodite1@otenet.gr (A. Kakaboura). 

overcome some inherent deficiencies of direct composites 

restorations, including polymerization shrinkage, 

inadequate polymerization in deep interproximal areas and 

restoration of proximal contacts and contour [3]. 

However, these resin composites were microfill materials 

which demonstrated poor clinical performance due to low 

flexural strength and wear characteristics attributed to the 

low inorganic filler content [4]. In the early 1990s a second 

generation of laboratory-processed resin composites was 

developed, advocated for a wide range of fixed prosthodontic 

applications such as inlays, onlays, veneering, metal-free 

single unit crowns and short span anterior bridges [4]. A 

variety of materials with remarkable differences in composition, 

polymerization modes and curing conditions comprise 

the second generation of the laboratory-processed 

resin composites. Ultra-small filler particles and polyfunctional 

methacrylate monomers are used in these composites. 

They are processed by different laboratory techniques based 

on combinations of heat, pressure, vacuum and light 

0109-5641/03/$ - see front matter q 2003 Academy of Dental Materials. Published by Elsevier Science Ltd. All rights reserved. 

doi:10.1016/S0109-5641(02)00082-9

394 

A. Kakaboura et al. / Dental Materials 19 (2003) 393–398 

Table 1 

Composition and polymerization modes of the materials tested 

Materials Batch number # Composition Polymerization mode 

First cycle: photopolymerization (Light 

Teklite) 650 mW/cm 2 ,40s; 

Second cycle: heat 140 8C, pressure 60 psi, N 2 

(BelleGlass HP curing unit), 20 min 

BelleGlass HP shade: enamel natural 808B93 Aliphatic urethane dimethacrylate, aliphatic 

dimethacrylate oligomers, fillers: 74 wt% barium 

silicate glasses and SiO 2 , mean size: 0.6 mm 

First cycle: photopolymerization (Visio 

Alpha), 400 mW/cm 2 ,15s; 

Second cycle: photopolymerization 

(Visio Beta) up to 40 8C, vacuum, 15 min 

Sinfony shade: enamel natural FW0059863 Aliphatic and cycloaliphatic monomers, 

fillers: 50 wt% aluminum glass and SiO2 

mean size: 0.6 mm 

polymerization. Although, second generation products 

became available in 1995, their characteristics and clinical 

performance have not been adequately investigated [2, 

5–10]. Additional products, such as Sinfony (3M-ESPE 

Dental AG, Germany), were introduced claiming improved 

performance and esthetics. The purpose of this study was to 

evaluate the in vitro performance of two second-generation 

laboratory-processed resin composites. Properties to be 

examined include: the degree of CyC conversion, surface 

microhardness, surface roughness, biaxial flexural strength 

and polymerization shrinkage-strain which are acknowledged 

to be related to the clinical performance of composite 

restorations. 

The null hypothesis to be tested, was that no significant 

differences would be found in the properties examined, 

between the two materials. 

2. Materials and methods 

The resin composites examined were BelleGlass HP 

(SDS-Kerr, Orange, CA, USA) and Sinfony (3M-ESPE 

Seefeld, Germany). The composition of each material and 

their required polymerization mode are shown in Table 1. 

The degree of CyC conversion (DC) was evaluated after the 

first and second polymerization cycles with a reflectance 

FT-IR spectroscopy (Perkin–Elmer, Norwalk, CT, USA). 

Three rectangular specimens (3 £ 2 £ 0.5 mm 3 ) were prepared 

per material. Spectra of the original pastes and of the 

directly irradiated surfaces were acquired after the first and 

second polymerization cycle under the following conditions: 

4000–400 cm 21 range, 4 cm 21 resolution, 458 para 

edge KRS-5 minicrystal of seven internal reflections, 40 

scans coaddition at 35 ^ 1 8C. The quantitative measurements 

of DC were performed based on the two-frequency 

method [11,12]. 

For surface microhardness measurements, the resin 

composite pastes were packed into disk-shaped Teflon 

molds (10 mm diameter, 2 mm height), pressed against 

transparent polyester matrix strips and subjected to the two 

polymerization cycles. Ten specimens per material were 

prepared. After the second polymerization cycle the specimens 

were stored in water under dark conditions at 37 8C for 

24 h, the flat surfaces were ground slightly with 1000 grit 

size wet silicon carbide (SiC) papers and the microhardness 

values were obtained after application of 200 g load for 20 s 

using a Microhardness instrument (HMV 2000, Shimadzu 

Corp., Tokyo, Japan) equipped with a Vickers diamond 

indenter. 

For surface roughness measurements, 10 disk-shaped 

specimens per material were prepared, as described above. 

Mean roughness values (Ra) were measured using an 

electronic profilometer (Diavite DH-5, Asmeto AG, Richterswill, 

Germany) operated with a 5 mm diamond stylus, 

908 reading angle and 0.80 mm cut-off length. Six 

recordings per specimen surface were recorded.

A. Kakaboura et al. / Dental Materials 19 (2003) 393–398 395 

Fig. 1. Schematic representation of the biaxial flexural method of fracture. 

Eight disk-shaped specimens (15 mm diameter, 

0.7 mm height) per material were prepared for the 

biaxial flexural strength test, which were subjected to the 

two individual polymerization cycles. The specimens 

were ground, as described earlier and were immersed in 

water at 37 ^ 1 8C for 24 h. Then, each specimen was 

transferred on a biaxial flexure device consisting of three 

stainless steel balls (3.2 mm in diameter) equally spaced 

along the periphery of 10 mm diameter supporting circle 

(Fig. 1). The specimens of each group were loaded at 

the center with a stainless steel ball of 3.2 mm diameter 

until fracture, in a universal testing machine (Model 

6022, Instron Corp, Canton MA, USA) operating in 

compression at 1 mm/min crosshead speed. The biaxial 

flexural strength was calculated according to the 

equation [13] 

BS ¼ AP=h 2 and 

A ¼ð3=4pÞ½2ð1 þ nÞlnða=r p 0Þþð1 þ nÞð2a 2 2 r p2 

0 Þ=2b 2 

þð1 þ nÞŠ 

r p 0 ¼ð1:6r 2 0 þ h 2 Þ 1=2 2 0:675h 

where BS is the biaxial flexural strength, P the load at 

failure, n the Poisson’s ratio (0.24) [14], a the radius of 

supporting circle, b the radius of the specimen disk, h 

the thickness of the sample and r 0 the ball radius. 

The load-to-failure rate was determined directly from the 

load versus time graphs plotted as the ratio of the fractured 

load to the failure time. 

The polymerization shrinkage-strain during the primary 

cure cycle was measured with the bonded-disk 

method [15,16]. 

Statistical analysis was performed by unpaired Student’s 

t-test to define any significant differences in the properties 

tested between the two resin composites for each testing 

condition. A 95% confidence level was chosen ( p ¼ 0.05). 

3. Results 

The mean values of all the properties are shown in 

Table 2. The second polymerization cycle significantly 

improved the percentage degree of CyC conversion (DC) in 

both materials ( p , 0.05). BelleGlass HP showed significantly 

higher final DC values, higher surface microhardness 

and higher roughness (Ra) values, compared to Sinfony 

( p , 0.05). BelleGlass HP exhibited lower final shrinkagestrain 

values compared to Sinfony during the primary cure 

cycle, and also had remarkably lower shrinkage-strain 

values in the early stages of the polymerization, 10–40 s 

(Tables 3 and 4). No statistically significant differences 

were detected between the two materials regarding the 

biaxial flexural strength. Nevertheless, BelleGlass HP

396 


Table 2 

Results (mean ^ SD) of all characteristics evaluated. The properties were measured after the second cure cycle 

Material 

Degree of CyC 

conversion, first cycle 

Degree of CyC 

conversion, second cycle 

Micro-hardness 

(VHN) 

Roughness 

(Ra, mm) 

Biaxial flexural strength 

(MPa) 

Load-to-failure rate 

(MPa/s) 

BelleGlass HP 60 (7.2) 80 (10.4) 174 (22.1) 0.31 (0.05) 49.4 (9.4) 5.5 (0.4) 

Sinfony 50 (5.1) 66 (6.8) 77.8 (16.5) 0.16 (0.03) 53.4 (8.1) 2.6 (0.3) 

exhibited a significantly higher load-to-failure rate compared 

to Sinfony ( p , 0.05), an indication of higher 

material stiffness. 

4. Discussion 

The null hypothesis was rejected. The two materials 

exhibited significant differences in most of the properties 

studied. The degree of CyC conversion for direct resin 

composites has been reported to vary from 50 to 75% [17, 

18]. The results of the present study indicate that after the 

second polymerization, Sinfony reached a value within this 

range, whereas BelleGlass HP demonstrated an even higher 

degree of CyC conversion (80%), which is in accordance 

with the results reported by Knobloch et al. [2]. Differences 

in monomer composition and polymerization conditions 

may explain the higher degree of CyC conversion provided 

by BelleGlass HP. BelleGlass HP contains aliphatic 

urethane monomers, which are known to provide an 

increased degree of CyC conversion [18]. However, the 

main differences are expected to arise from the temperatures 

used in the second cure cycle. The polymerization of 

BelleGlass HP during the second cycle was performed at a 

higher temperature (140 8C) than for Sinfony (40 8C). 

In general, the additional cure-cycle and photothermal 

annealing enhance the DC of the resin composites. Thus, the 

physicomechanical properties of the materials can be 

improved [19,20] and an increase in polymerization rate 

can be achieved which yields and promotes an annealing 

effect in the polymer. The high pressure (60 psi) applied 

during BelleGlass HP polymerization may also increase the 

extent of polymerization. 

The positive influence of the additional cure on DC found 

in this study has been noted in previous studies [21–23]. 

The second polymerization cycle will increase the molecular 

mobility of the residual monomer and the chain segments 

after initial photopolymerization. However, an inherent 

drawback of the increased CyC conversion may be the 

reduction of remaining CyC bonds available for copolymerization 

with the resin luting cements. Jordan [24] 

reported that the lack of air-inhibited layer and the limited 

unsaturation of the laboratory-processed resins negatively 

affect the composite-luting cement interfacial strength. 

The proportional increase in DC after the second 

polymerization cycle was found to be essentially equivalent 

for both materials. 

The volume fraction and type of inorganic fillers as well as 

the DC of the organic matrix are important contributory 

factors to the microhardness of composite materials [19,25, 

26]. The higher inorganic volume fraction of BelleGlass HP, 

the harder type of glasses contained [27] and the higher density 

of the organic matrix, as a result of the enhanced conversion, 

can explain the higher microhardness values obtained. Surface 

microhardness is considered as an indicative factor of the 

mechanical strength of a resin [28]. A positive correlation 

between the hardness of a resin material and the wear 

resistance has been reported [7,28,29] although such a 

correlation has not been confirmed in other studies [30,31]. 

Resin composite restorations with smooth outer surfaces 

lead to reduced plaque retention, surface staining and 

secondary caries incidence [32,33]. The higher roughness 

value obtained for BelleGlass HP may be partly explained 

by the higher filler volume loading and the harder type of 

fillers incorporated into the material. Moreover, curing of 

BelleGlass HP under nitrogen pressure may provide 

nitrogen entrapment, which may increase the porosity at 

the surface region. On the other hand, polymerization of 

Sinfony under vacuum eliminates such surface porosity. 

Nevertheless, both materials investigated showed initial 

roughness lower than the roughness values of 

0.64 ^ 0.25 mm reported for enamel. Enamel roughness 

of 0.64 mm at enamel-to-enamel occlusal contact areas is 

considered as a standard for roughness measurements of 

resin composites [34]. Plaque accumulation preferentially 

occurs on composite surfaces with a roughness range of 

Table 3 

Mean shrinkage-strain values for Sinfony, at three different temperatures during the first cure cycle, SD in parentheses (n ¼ 5) 

Temperature (8C) 

Sinfony 

10 s 20 s 40 s 30 min 60 min 

23 2.60 (0.15) 3.30 (0.04) 3.50 (0.03) 4.30 (0.05) 4.34 (0.06) 

37 2.90 (0.10) 3.55 (0.16) 3.80 (0.16) 4.40 (0.19) 4.44 (0.20) 

60 3.34 (0.30) 3.94 (0.35) 4.10 (0.39) 4.66 (0.47) 4.73 (0.46)

A. Kakaboura et al. / Dental Materials 19 (2003) 393–398 397 

Table 4 

Mean shrinkage-strain values for BelleGlass HP, at three different temperatures during the first cure cycle, SD in parentheses (n ¼ 5) 

Temperature (8C) 

BelleGlass HP 

10 s 20 s 40 s 30 min 60 min 

23 0.28 (0.11) 0.96 (0.10) 1.85 (0.10) 2.67 (0.12) 2.90 (0.10) 

37 0.24 (0.03) 1.27 (0.08) 2.30 (0.08) 3.18 (0.10) 3.28 (0.10) 

60 0.34 (0.10) 1.96 (0.34) 2.93 (0.32) 3.56 (0.35) 3.70 (0.40) 

0.7–1.4 mm [32]. The lower roughness of Sinfony compared 

to BelleGlass HP may be a contributory factor to the 

higher reported color stability of Sinfony [6]. The roughness 

of BelleGlass HP recorded by Soeno et al. [35] cannot be 

compared with the results of the present study since a 

different polishing procedure of the specimens was used. 

Mechanical strength is an important factor in the 

clinical success of a restoration. Resin composites are 

much weaker in tension than in compression. Therefore, 

tensile strength is generally considered as a more 

meaningful property for assessment of the clinical failure 

potential of resin materials [36]. The traditional tensile 

test has rarely been used for resins because of the 

difficulty associated with gripping and aligning of the 

specimens. Recently, the biaxial flexural test has been 

used to determine the tensile strength of composite 

materials [36]. In the present study, although BelleGlass 

HP exhibited a higher DC and a higher filler volume 

than Sinfony, similar biaxial flexural strength values were 

recorded from both materials. It is well recognized that 

several structural parameters, such as inclusions of voids, 

cracks, flaws and stress gradients influence the fracture 

strength of brittle materials [36]. A value of n ¼ 0.24 

was taken as a selected value of Poisson’s ratio which is 

consistent with previous measurements [14]. Other 

restorative materials, such as glass-ionomer cements, 

exhibited higher values of 0.30 [37]. If such a larger 

value had been selected it would have enhanced the 

values by 4.7%. Hence, even if the values for the 

materials varied widely 0.24–0.30, this would not have 

produced a very significant effect on the resultant 

strength values. It is not known whether nitrogen 

entrapment into BelleGlass HP during the second 

polymerization cycle may induce flaws, which in 

sequence may affect the material strength. So, despite 

the fact BelleGlass HP presented a higher DC than 

Sinfony, this cannot predict their relative strengths. 

The load-to-failure rates measured show that Sinfony 

is a more flexible material than BelleGlass HP. The 

lower DC in Sinfony may generate a less stiff organic 

network, which along with the lower filler volume 

content may explain the more flexible nature of Sinfony. 

The latter may permit higher energy absorption capacity 

under loading, which may appear as plastic deformation. 

This effectively blunts the crack tip, which then requires 

more energy to propagate. 

The polymerization shrinkage-strain during the primary 

cure cycle showed that Sinfony had consistently higher 

shrinkage values compared to Belleglass HP, despite its 

lower DC. This could be attributed to the higher filler 

percentage of Belleglass HP (74%), compared to that of 

Sinfony (50%). The slower shrinkage response of Belleglass 

HP is consistent with a lower concentration of the 

photosensitizer. The rate of propagation R p is proportional 

to the photosensitizer concentration C s [38]. This probably 

accounts for the slower start in the polymerization of 

Belleglass HP. 

In conclusion, significant differences were determined 

between the two second-generation laboratory-processed 

resin composites evaluated in terms of DC, surface 

microhardness, surface roughness, biaxial flexural strength 

and stiffness, which may affect the clinical behavior of each 

material. Nevertheless, controlled long-term clinical studies 

are needed to confirm the clinical significance of these 

differences. It is not known whether the greater compliance 

of Sinfony may provide a better stress distribution pattern 

and more efficiently preserve adjacent tissue integrity in 

intracoronal restorations. However, the mechanical properties 

of these materials may be modified when veneering 

metal frameworks, as the bonding capacity of the composite-metal 

interface may strongly influence the mechanical 

performance of the complex. Consequently, although the in 

vitro characterization of material properties cannot yet 

establish sound criteria for the prediction of their clinical 

efficacy, it provides a basis for understanding the laboratory 

and clinical performance of these materials and for the 

development of new materials. 

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resistance and degree of conversion of laboratory processed 

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comparison of the wear resistance and hardness of indirect composite 

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systems on resin bonding to laboratory-processed indirect resin 

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Hanbook of analysis of synthetic polymers and plastics. Chichester, 

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Am Ceram Soc Bull 1980;59:551–3. 

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[16] Watts DC, Marouf AS. Optimal specimen geometry in bonded-disk 

shrinkage-strain measurements on light-cured biomaterials. Dent 

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1985. p. 109–35. 

[18] Ferracane JL, Greener EH. The effect of resin formulation on the 

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compressive strength and marginal dimensional stability. II. Wear, 

hardness and color stability. Quint Int 1987;18:265–71. 

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material following post curing. Br Dent J 1991;171:246–8. 

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additionally heat-cured composites. J Prosthet Dent 1996;76:613–8. 

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ed. St Louis: Mosby; 1993. p. 23–33. 

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associated with hardness measurements of composites. Dent Mater 

1992;8:218–23. 

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(Como), Italy by Erredue G; 1999. p. 3–29. 

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1997;76:1508–16. 

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209–58.

KERR - PROJECT 

1) GLOSS

Material 

Premise Indirect - Facial 

Dentin 

(3 steps cure) 

Premise Indirect - Primary 

Dentin 


Premise Direct - Dentin 

Light-cure – 40 sec 

Premise Direct - Enamel 


24 h – After 

cure 

24 h – 

Ethanol 

100% 

% of Gloss 

retention 

Δ Gloss 

75.6 (1.1) 65.1 (3.9) 86.1 (4.2) 10.5 (3.0) 

33.7 (9.3) 17.1 (4.9) 50.7 (0.8) 16.5 (4.3) 

45.9 (2.9) 27.9 (14.0) 59.8 (0.8) 18.0 (11.7) 

66.6 (2.0) 55.5 (10.4) 83.1 (13.3) 11.1 (8.6)

2) KNOOP HARDNESS NUMBER

Material 

Premise Indirect - Facial Dentin 


Premise Indirect - Primary Dentin 






24 h – After cure 

24 h – Ethanol 

100% 

% KHN 

51.8 (6.4) 34.2 (6.6) 34.4 (5.4) 

54.7 (4.7) 39.2 (5.3) 28.1 (9.3) 

44.8 (2.3) 28.3 (0.8) 36.8 (4.7) 

43.6 (2.6) 24.2 (1.9) 44.4 (3.0)

3) COLOUR STABILITY 

Material 

Premise Indirect - Facial Dentin 


Premise Indirect - Primary Dentin 






ΔE 

0.89 (0.08) 

2.15 (0.60) 

1.88 (0.49) 

1.01 (0.18)

(InternalData) PHYSICALPROPERTIESINDIRECTCOMPOSITERESINS(Ref.139AK74) 

Dia.Tens. Comp. Flex.Str. Flex.Mod. Rockwell X-RayOp. Wt.%Filler Vol% CTE K1C Str.,MPa(sd)Str.,MPa(sd) MPa(sd) MPa(sd) 15THard. (%Al) (Vol.%) shrink.(sd)ppm/Deg.C.(sd)MPam1/2(sd) BelleGlassHP TranslucentDentin 63(4) 417(34) 142(10)13100(700) 87(1.0) 78(56) 3.0(0.1) 30.2(0.8) 1.04(0.04) Product 

56(4) 370(28) 158(11)21,000(1400) 89.1(1.0) 300 87.1(72.5) 0.94(0.1) 13.1(0.7) 1.48(0.09) Enamels 63(2) 460(50) 167(21)10,700(200) 89.6(0.4) 100 72.9(59.5) 3.1(0.03) 26.4(0.3) 0.96(0.07) BelleglassNG Trans.Dent.306-167,131-192 450(60) 150(30)11,100(200) 84.0(0.7 2.3(0.2) 28.6(1.4) OpaceousDentin 

50(10) 510(10) 150(10)10,900(300) 87(0.8) 100 77(70) 2.3(0.3) 33.9(0.8) MetalPlus,Op.Dent. 63(5) 450(40) 130(14)11,500(300) 82(0.5) 200 78(63) 1.9(0.1) 25.1(1.7) 1.1(0.1) PremiseIndirect Enamel313-79,329-5 

56(4) 370(28) 158(11)21,000(1400) 89.1(1.0) 300 87.1(72.5) 0.94(0.1) 13.1(0.7) 1.48(0.09) FacialDentin 450(60) 150(30)11,100(200) 84.0(0.7 200 78(63) 2.3(0.2) 28.6(1.4) Incisal 50(10) 510(10) 150(10)10,900(300) 87(0.8) 100 77(70) 2.3(0.3) 33.9(0.8) 1.1(0.1) Artglass PrimaryDentin 

67(4) 351(28) 109(10)8,300(400) 80(1.0) 69 3.4(0.1) 33.3(1.0) 1.17(0.05) Enamel 67(2) 365(14) 114(10)7,800(400) 79(1.0) 500 67 Targis Dentin 58(8) 415(25) 142(23)10,300(600) 84.6(1) 74 3.0(0.1) 28.2(0.6) 0.77(0.09) Dentin 

107(16)6,300(460) Sculpture Dentin 48(8) 395(20) 136(9)12,700(400) 84.6(1) 78.7 2.62(1.4) 24.0(1.4) 1.13(0.16) Enamel 

126(21)10,500(300) Cristobal+ OpaceousDentin 49(6) 450(38) 179(11)13,000(400) 87.8(0.2) 216 75.1 3.26(0.3) 27.0(1.0) 1.14(0.27) Incisal 66(10) 473(19) 156(20)12,000(200) 86.4(1.0) 200 73 2.91(0.10) 1.22(0.09) Enamel 

Dentin 60(9) 441(60) 155(13)16,129(601) 93(0.4) 86.8(72.4) 1.55(0.15) 15.3(2.8) 1.27(0.2) Enamel 66(4) >500 136(18)17,980(715) 93.9(0.2) 300 88.2 1.62(0.07) 13.7(1.1) 1.19(0.09) Sinfony Estenia 

63(3) 430(18) 89(8)3,557(338) 51.5(1.3) 83 4.53(0.04) 62.6(3.0) 1.12(0.05) Enamel 63(4) 457(43) 89(3)3,219(228) 56.6(1.2) 100 44.7 4.62(0.3) 68.6(1.5) 1.31(0.08) Dentin 

Dentin 54(8) 420(34) 128(17)9,700(460) 83.5(1.5) 77.9 2.4(0.2) 34.3(0.3) Enamel 59(6) 409(27) 140(8) 9700(500) 83.1(0.7) 73.5 3.2(0.2) 33.5(0.3) Ceramics DiamondCrown 

Feldspathic 80 In-Ceram 450 Nature 70 393 45 600

elleGlassNGTM2003TECHNICALSUMMARY 2. Eight-yearclinicalperformanceofheatandpressurecuredindirectcomposite.D.A.Givan,S.J. O’NEALandS.SUZUKI.(Univ.ofAlabamaSchoolofDentistry,Birmingham,Alabama,USA) 1. 

IndirectPosteriorCompositeResins;KarlFLeinfelderDDS,MS,July2005 AdjunctProfessor,UniversityofNorthCarolina,ChapelHill,NorthCarolina ProfessorEmeritus,UniversityofAlabama,Birmingham,Alabama 3. 

IndirectComposites:Dentistry'sBestKeptSecret,DamonC.Adams,DDS,May6,2007,Spring ScientificSession 4. 

AnteriorApplicationofanIndirectComposite,aDoctor/TechnicianLiaison’sPerspective,Dr. DamonC.Adams,DDS;DentistryToday,April2005 6. Wearofcompositeresinveneeringmaterialsandenamelinachewingsimulator 5. 

andDentalMaterials,DentalSchool,Christian-Albrechts-UniversityatKiel,Germany SoerenScheibnerb,PrivatePractice,Neuburg,Germany Publishedondentalmaterials23(2007) ChristianMehla,KlausLudwiga,MatthiasKerna,DepartmentofProsthodontics,Propaedeutics 

SuccesswithbelleGlass–StepbyStep-CompositeisProgress ByAxelMühlhäuser(DT),Germany,publishedondental-labinternational,Vol.3,No.1/2007 7. 

ClinicalPerformanceofBondedCeramicandResin-BasedCompositeInlaysandOnlaysUsinga Self-EtchBondingSystem:a51-MonthReport Jose-LuisRuiz,DDS;GordonJ.Christensen,DDS,MSD,PhD;AbdiSameni,DDS;LuisVargas,DDS PublishedonINSIDEDENTISTRY—MAY2007 8. 

SupplementalOneAppointmentInlay/OnlayProcedure(ForDentists) 10. Protocol–ConservativeOneAppointmentBelleglassNGOnlayProcedure–MAY2007 9. 

10-yearClinicalEvaluationofaSelf-etchingAdhesiveSystem-ClinicalResearch NAkimoto,MTakamizu,YMomoi 11. 

12. EvaluationofClinicalandInVitroWearforResinComposites. ShiroSuzuki,KarlLeinfelder,UniversityofAlabamaatBirmingham OperativeDentistry,2007,32-1,3-10 

AlvinKobashigawa,EdwardShellard-Sybron/Kerr

A.I.KobashigawaandE.Shellard;“CrackArrestingPropertiesofaFiberReinforcedComposite ResinLaminate.”;J.Dent.Res.V.79SpecialIssueAbst.#289,Apr.2000 14. EffectOfFiberReinforcementOnTheBreakingStrengthOfCrowns,C.A.Munoz-Viveros,etal., 13. 

15. CrackArrestingPropertiesOfafiberReinforcedCompositeResinLaminateA.I.Kobashigawaand E.Shellard,KERRCorporation,Orange,California,USA Abst.#1177J.Dent.Res.77SpecialIssueB,June,1998. 

ClinicalEvaluationofaDentinAdhesiveSystem:13YearResults;A.A.BoghosianandJ.L. DrummondandE.P.Lautenschlager,NorthwesternUniversityFeinbergSchoolofMedicine 16. 

W.D.Roe*,M.H.Ramp:“WearofenamelOpposingThreeEstheticMaterialsandOneAlloy”.;J. Dent.Res.V.79SpecialIssueAbst.#1090,Apr.2000 18. ALL-IN-ONEADHESIVE-NEXUS3DENTINBONDSTRENGTH:INDIRECTPROCEDURE 17.

BGNG-belleGlassNGNextGeneration BGHP-belleGlassHPHeatandPressure 

• 

PI–PremiseIndirect 

Newcompositenames? 

• 

belleGlassNGEnamelsNOWPremiseIndirectIncisal belleGlassNGOpaceousDentineNOWPremiseIndirectPrimaryDentine belleGlassNGTranslucentDentineNOWPremiseIndirectFacialDentin 

Yes-thenewovenisexactlythesameastheoldoneexceptithasamoremodernfasciaand CantheoldBGNGovenbeusedtocurePremiseIndirect? 

• 

Isnitrogenabsolutelynecessary? CuringrestorationsinthePIovenwithoutnitrogenmeanstheywillbecoveredinthesticky touchcontrolpanel. 

finalrestorationwheneitherusingornotusingnitrogenbutourpreferenceisofcourseto useit. airinhibitedlayer.Thiscanbeeasilyremoved.Thereisverylittleclinicaldifferenceinthe 

WhatarethemajorimprovementswiththenewPIcomposite? – Evenbetterhandling(nonstickytexture,easytocarveandcondensewithminimum 

anterior. 

Closershadematchtotheshadeguide. 

EvenmoretoothlikeappearanceespeciallywiththeIncisal. slump)withsuperbceramic-likeappearanceandlongerlivedglossespeciallyinthe 

AbilitytobuilduptheentirerestorationwithpolishablePIFacialifspacedoesnot permitforPrimary,FacialandIncisal. – FacialcontainsahigherchromavaluethanbelleGlassOpaciousDentinsoismore effectiveatmaskingmetalworkssoidealforimplantsuperstructureandothermetal 

work.

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Simplythetransferoftechnologytobiologyorbiologytotechnologyandtheenhancement ofeitherbyboth.Thecat’seyeinthemiddleoftheroadclearlyvisibleatnightreflecting Explainbiomimetic 

bornwithwhichhelpsthemseebetteratnight.PIisatransferoftechnologytobiology wherebyvirtuallytoothlikerestorationsinallsensesofthewordarefabricated. surroundinglightisanearexactcopyoftheinternalsightstructuremechanismthatcatsare 

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manufacture. Isitpossibletomixbotholdandnewmaterials? Yeabutcareshouldbetakentoestablishfinalshadematchespriortorestoration 

OursuggestionistouseMetalPrepfromGCintheinterimperiod. Nothisproducthasbeendiscontinuedandwearecurrentlyworkingonanewformulation. IsKerrMetalPrepavailable? 

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highsmilelinecases.Thecervicalred/brownshaderemainsavailable. Whataboutawiderrangeofshadesforcervicalcolouring? Thisisinhandtomanufactureabroaderrangeofpinkcoloursespeciallyforimplantand 

-TheFacialDentinbuildupshouldbenomorethan1.5mminthickness. Howtoachieveoptimumaesthetics? -UseA-1PrimarydentinforalloftheshadesexceptB-1forextralightshades. -Properincisalshadeselectionisimportant.Monochromaticlayeringdoesnotwork. 

-Usethe40secondruletomakesurethattheCQinbleached. -ProperuseofthePrimaryDentinbuildupwilldecreasethechromaonthickbuildups. -Carrytheincisalbuilduptonomorethan1/4ofthefacialbuildup.

Premise Indirect - przewodnik kliniczny - Kerr Hawe

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