1. Ivoclar Vivadent Direct Restoratives

2. Direct Restorative Procedure
Retraction
Adhesives
Composites
Composite Placement
Curing Lights
Polishing

3. Composites When to use composite? Why to use composites?
To replace decay or caries
To repair chipped, broken or worn teeth
To reshape healthy teeth for better esthetics
Why to use composites?
Esthetics: multiple shades can closely match natural tooth structure
Chemical bonding / Strength: composite chemically bonds to tooth structure; does not rely on a retentive prep
Retention of natural tooth structure: due to a non-retentive prep

4. Composite Terminology
Handling
Characteristics such as stickiness
Material should stick to the tooth, not the instrument
Low slumping
Material should be easy to adapt and hold its position once placed
General consensus is that micro-hybrids and nano-hybrids have better handling characteristics than nanofills or microfills

5. Composite Terminology
Depth of Cure
When a material fails to cure to 80%, mechanical and thermal properties are effected and this can lead to failure
Depth of cure can also affect the length of time it takes to prepare a deep posterior restoration
Depth of Cure is affected by:
The materials opacity
The density of filler particles
The shade (darker shades have a lower depth of cure)

6. Composite Terminology
Polymerization shrinkage
The unfilled resin matrix of all composites shrinks as much as 3% during setting
microhybrids and nanohybrids have the highest percentage of inorganic filler particles, and thus the lowest percentage of polymerization shrinkage
Effects of high polymerization shrinkage
Marginal leakage or white lines at the margin
De-bonding
Marginal staining
Secondary caries
Post-operative sensitivity

7. Composite terminology
Wear (Resistance to Abrasion)
Greatly affected by the size of the filler particles and the volume of filler particles in the material
The smaller the particle, the lower the wear
The more volume of fillers, the less wear
Flexural Strength
Measures the ability of the material to resist fracture when subjected to bending. It predicts a restoration's ability to resist occlusal load without cracking.
The higher the value the better

8. Composite Terminology
Fillers
Composites are classified according to the size, shape and distribution of their filler particles.
Microhybrids
Contain irregularly shaped particles of different materials and sizes to provide a combination of strength and polish (smooth surface). The smaller particles fill the spaces between the larger particles.
Filler content is 60 – 70% by volume, or 77-84% by weight.
Microfills
Contain silica with a particle size of 0.04 – 0.2 microns (or 40 nanometers to 200 nanometers)
Some microfills (and nanofills) contain prepolymers or clusters/agglomerated particles to increase the filler volume and strength. Prepolymers are made from a microfill composite, ground down and used as a filler in the final formulation. Prepolymers also reduce polymerization shrinkage.
Filler content is 32 – 50% by volume, or 50 – 60% by weight
Microfills take longer to cure do to the smaller particle size.
Microfills have lower compressive strength due to lower filler volume.
Nanofills / Nanohybrids
Nanofilled composites were recently introduced and they consist of nanomers (5 nm to 75 nm particles) and “nanocluster” agglomerates as the fillers. Nanoclusters are agglomerates (0.6 µm to 1.4 µm) of primary zirconia/silica nanoparticles (5 nm to 20 nm in size) fused together at points of contact, and the resulting porous structure is infiltrated with silane. The nanofilled composites present similar mechanical and physical properties to those of microhybrid composites, but when it comes to polish and gloss retention they perform significantly better.
Some manufactures have addeed nanomers to their formulations to create nanohybrid materials.

9. What’s about Tetric EvoCeram & IPS Empress Direct?
Unique
What’s about Tetric EvoCeram & IPS Empress Direct?
Nano-Optimized Technology
New types of nanoparticles, not used in other products to date, will result in greater benefits than simply focusing on “the usual“ nanofiller particles.
Nano-Fillers
Faster & easier polishability, lower wear
Nano-Pigments
Chameleon effect (the adjusting of shade to the surrounding teeth)
Nano-Modifiers
Stability of form, modeling & sculpting, reduced stickiness

10. Nano-Optimized Technology
Prepolymer
Ba-Al Silicate Glass 400 & 700 nm
Nano-Fillers
Faster & easier polishability
Lower wear for longer lasting restorations
Lower shrinkage & shrinkage stress for better marginal integrity
Ytterbiumtrifluoride
Mixed Oxide
Barium – Alumnium Silicate Glass

11. Ba-Al Silicate Glass Microhybrid (700 nm / 400 nm) BENEFITS:
The refractive index of these fillers match the monomer creating a high level of translucency.
radiopacity.
700 nm filler (mean particle size)
BENEFIT: strength
400 nm filler (mean particle size, down to 20 nm)
BENEFITS: polishability, smooth surface,
reduced wear
Tetric EvoCeram – Has a blend of both sizes
IPS Empress Direct – Specific to shade;
Enamel Shades (400 nm)
Dentin Shades (700 nm)

12. Prepolymer Pre-polymerized composite Monomer
Ba-Al silicate glass fillers (400 nm)
Ytterbium fluoride (200 nm)
BENEFITS: reduced shrinkage, reduced wear
Source: R&D Ivoclar Vivadent AG

13. Ytterbium Trifluoride
Ytterbium trifluoride (200 nm)
BENEFITS: radiopacity, fluoride release
Source: R&D Ivoclar Vivadent AG
Source: R&D Ivoclar Vivadent AG

14. Spherical Mixed Oxide Spherical Mixed Oxide (120 – 160 nm) BENEFITS:
1. Refraction corresponds to the polymer refraction index → no reduction in translucency
→ increases the "chameleon effect" of the material providing the opportunity for “single shade”
applications
2. Spherical shape ideal for low thickening effect. Less resin is required leading to less shrinkage.
3. The combination of individual particles and agglomerated particles produce an ideal consistency & improved handling properties.
Source: R&D Ivoclar Vivadent AG

15. Nano-Optimized Technology
Nano-Pigments
Intensified color nuances
More natural shade appearance
Shade adjusts to match surrounding tooth structure  Chameleon Effect

16. Nano-Optimized Technology
Nano-Modifiers
Stability of form, non-slumping
Easy to model and sculpt anatomy
Non-sticky handling
Easy to spread, brush, etc.
monomer
Nano-plates

17. Variances in Chemistries
Manufacturers will modify filler chemistries and monomers to adjust product attributes such as handling and other physical properties.
The Tetric EvoCeram Family of composites all feature the same basic chemistry.
Tetric EvoCeram represents the primary chemistry
Tetric EvoFlow contains less filler and more monomer (resin) resulting in a flowable version of Tetric EvoCeram
Tetric EvoCeram Bulk Fill features an additional initiator (Ivocerin) to increase polymerization depth and curing efficiencies. The material is slightly more translucent and has slightly less filler allowing it to adapt better to cavity walls.

18. Criteria important to dentists
Handling
Subjective but often most important criteria
Working time
How long can the material be manipulated before it starts to set up
Polishability
How quickly does the material polish to a high gloss
Gloss retention
How long will it maintain the polish
Radiopacity
How clearly can the material be distinguished on an x-ray
Shade match and shade stability
How close do the shades match the patients natural tooth structure and will that match be maintained over time

19. Composite Procedure – Tetric EvoCeram Clinical Case by Dr Arnd Peschke, Schaan, Liechtenstein
Initial situation: Leaking restoration
margins and secondary cervical
caries.
After isolation and application of a
matrix, the cavity is conditioned
and coated with an adhesive
The adhesive is light-cured
The proximal wall of the restoration is built up with Tetric EvoCeram. In the process, the Class II cavity turns into a Class I cavity.
After light-curing the proximal increment, the first section of the occlusal surface is reconstructed, while the characteristics of the natural morphology are taken into account.
The first occlusal increment is light cured to minimize the shrinkage stress and facilitate anatomically correct contouring.
A second occlusal increment is applied to complete the design of the occlusal surface.
After an occlusal check, the restoration is polished.

20. Tetric EvoCeram Tetric EvoCeram Bulk Fill Tetric EvoFlow
Composite Portfolio
Esthetics
IPS
Empress Direct
Tetric EvoCeram Tetric EvoCeram Bulk Fill Tetric EvoFlow
Performance
Convenience
Economy
Tetric

21. Tetric® Light-curing, micro-hybrid composite
Time tested, cost effective material
10 shades; 3 translucencies
Basic White for posterior:
sold in bulk quantities
Can be bulk filled
Sculptable / non-sticky formula
High radiopacity

22. Tetric EvoCeram Tetric EvoCeram Bulk Fill Tetric EvoFlow
Composite Portfolio
Esthetics
IPS
Empress Direct
Tetric EvoCeram Tetric EvoCeram Bulk Fill Tetric EvoFlow
Performance
Convenience
Economy
Tetric

23. IPS Empress® Direct The only composite to be esthetic enough to be call Empress®!
Highly esthetic nano-hybrid composite
Simple placement technique
32 shades; 5 translucencies
Two formulas
Dentin shades mimic natural dentin properties
Enamel shades mimic natural enamel properties
Unique Trans Opal shade creates opalescence on the incisal edge

24. Advantages of IPS Empress Direct
Wide range of indications for anterior and posterior teeth
True universal composite
32 shades and 5 levels of translucency
Arguably the best esthetic composite on the market
New opalescent shade
Simplifies anterior cases where patient has opal incisal edge
No need to use a specific layering technique
Simple to use with outstanding results
High surface gloss
Mimics gloss of natural teeth or all-ceramics
Lifelike fluorescence associated with Empress materials
Required for a true esthetic material
Long working time
Dentist is in control of the procedure
High radiopacity
Material is easily detected on x-rays

25. Consistent Advantages Over Competitors
IPS Empress Direct offers more Dentin and Enamel shades for better esthetics
IPS Empress Direct has a longer working time
IPS Empress Direct offers a higher radiopacity
IPS Empress Direct has lower shrinkage
IPS Empress Direct has lower shrinkage stress
Please refer to the Competitive Comparison Booklet for specifics

26. Sales Tools Competitive Comparison Brochure Trade In Program
Clinical Guide

27. Additional Resources
IFU
Scientific Documentation
Samples

28. Tetric EvoCeram Tetric EvoCeram Bulk Fill Tetric EvoFlow
Composite Portfolio
Esthetics
IPS
Empress Direct
Tetric EvoCeram Tetric EvoCeram Bulk Fill Tetric EvoFlow
Performance
Convenience
Economy
Tetric

29. The Tetric EvoCeram Family
Products for all composite indications!
SCULPTABLE
FLOWABLE
2 mm layering
4 mm bulk filling
Tetric EvoCeram®
The composite
Tetric EvoCeram® Bulk Fill The bulk-fill composite
Tetric EvoFlow® The flowable composite
22 shades Universal Proven performance and longevity with 100 million restorations world wide
3 shades Posterior A 4-mm bulk-fill
composite for posterior
restorations with 3 unique and patented features
14 shades (3 NEW!) All flowable indications The time-tested flowable
composite with high radiopacity
2 mm flowable layering
Tetric EvoFlow is a component of the Tetric line of products. Whether you are in need of a sculptable or a flowable composite, this line offers you a suitable option for any indication.

30. Tetric EvoCeram® Clinically proven with over 100 million restorations
True universal composite:
Esthetics enhanced by refractive index technology
Well-balanced properties
Sculptable, non-slumping, non-sticky handling
Low shrinkage
Low wear
High polish / sustained gloss
22 shades; 3 translucencies

31. Advantages of Tetric EvoCeram
A long working time, combined with a short curing time
Leaves dentist in control of procedure; no need to rush the placement
Natural shade blend: Coordinated light refraction indexes of fillers, monomer matrix and nano-color pigments
Great esthetics with a single shade solution for faster placement
Proven clinical performance
Over 100 Million restorations have been placed worldwide!
5+ years of clinical success in recalls

32. Consistent Advantages Over Competitors
Tetric EvoCeram offers a longer working time
Tetric EvoCeram offers lower shrinkage
Tetric EvoCeram offers higher radiopacity
Tetric EvoCeram offers more “body shades” for a more accurate shade match on single shade restorations
Please refer to the Competitive Comparison Booklet for specifics

33. Sales Tools Competitive Comparison Brochure
TDA 5-Year Clinical Performance
Trade In Program
Flow Chart

34. Additional Resources IFU Scientific Documentation FAQs Samples
Ed Lowe Oral Health Article Reprint

35. Tetric EvoCeram® Bulk Fill The posterior composite without compromise!
Based on Tetric EvoCeram’s proven formula
Three patents to make it the best posterior composite
Ivocerin® - photo initiator
Shrinkage Stress Relievers reduce Shrinkage Stress
Light sensitivity filter
Can be filled in 1mm – 4mm increments – you decide
3 shades with refractive index technology

36. Advantages of Tetric EvoCeram Bulk Fill
Faster Cure for all increments up to 4mm in just 10 seconds!
Saves up to 60% of placement time!
Easier placement due to non-sticky, sculptable consistency and extended working time.
No need for a capping layer
No need for expensive placement equipment
Over 3 minutes of working time to leave the dentist in control
Better Performance due to lower shrinkage stress at 4mm than the leading composite at 2mm
Less stress on the margin leads to long term clinical success

37. Consistent Advantages Over Competitors
Lower shrinkage stress
Better, faster polish
Lower wear
No capping layer or expensive placement instruments
Higher filler content for lower shrinkage
More natural level of translucency
Longer working time
Please refer to the Competitive Comparison Booklet for specifics

38. Sales Tools Lehnard Special Edition Report Competitive Comparison
Brochure
Trade In Program
TDA 1-Yr Recall
Clinical Casebook
DZW Clinical Editorial

39. Additional Resources IFU Scientific Documentation
Ivocerin Special Report
VivaLearning Module
FAQs
ADA Report Response
Dr. David Watts Expert Letter
Samples

40. Tetric EvoFlow® Flowable when desired. Stable when required.
Based on Tetric EvoCeram’s proven formula
The ideal consistency for all flowable indications
High radiopacity
Expanded shade range with 3 translucencies, including 3 dentin shades
Smaller tip design for more precise placement

41. Advantages of Tetric EvoFlow
The IDEAL consistency for ALL flowable indications
Flowable but stays in place without running out of the prep
Expanded SHADE RANGE with multiple translucencies
Only flowable system with 3 dentin shades which can be used to mask slight defects
New SMALLER tip design for more precise placement
More control for the dentist when placing a flowable

42. Consistent Advantages Over Competitors
Tetric EvoFlow is available in 3 dentin shades
Tetric EvoFlow offers a higher radiopacity than most flowables
Tetric EvoFlow has fluorescence making it a more esthetic option
Tetric EvoFlow is recommended for ALL flowable indications
Tetric EvoFlow comes in both syringe and cavifil delivery forms

43. Sales Tools
Brochure
Trade In Program

44. Additional Resources
IFU
Scientific Documentation
FAQs
Samples

45. Thank You!