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Practice Solutions: Ivoclar Vivadent by Jason Olitsky, DMD, AAACD

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by Jason Olitsky, DMD, AAACD
Dr. Jason Olitsky is the past president of the Florida Academy of Cosmetic Dentistry and an accredited member of the American Academy of Cosmetic Dentistry. He is also an accredited Digital Smile Design Master and director of esthetics and photography with the Clinical Mastery Series. Olitsky teaches portrait and clinical photography and over-the-shoulder anterior esthetics courses with The Clinical Mastery Series. He is clinical adjunct faculty with Arizona School of Dentistry and Oral Health and a clinical consultant with Dental Advisor. Olitsky also owns WallSmiles.com, a photography business that sells clinical before and after images, and portrait wall art for dentists. Olitsky is co-author of "The Naked Tooth: What Cosmetic Dentists Don't Want You to Know," published for the general consumer. He publishes on various topics of cosmetic dentistry, has appeared in numerous national beauty and health magazines and serves as product consultant for dental product companies. He maintains a private practice in Ponte Vedra Beach, Florida.

Ensuring a harmonious shade match among restorations and adjacent natural teeth can sometimes be challenging, particularly when a combination of restorative materials (e.g., direct composite, all-ceramic) is used. Adding to inherent shade matching challenges is the need for composite core buildups underneath planned all-ceramic restorations.

Fortunately, a light- and dual-curing adhesive luting composite (Variolink Esthetic, Ivoclar Vivadent) with color-neutral shades is available to promote esthetic cementation and shade matching across a variety of restorations and with natural tooth structure. Indicated for the permanent cementation of ceramic and composite restorations,

Variolink Esthetic facilitates precise shade matching of restorations through its "Effect" shade system, an approach that features five different shades for color-neutral cementation, but still enables brightening or darkening of restorations, as needed. Variolink Esthetic's reactive and patented Ivocerin light initiator, which ensures fast and reliable curing of the material during subsequent light polymerization, contributes to the material's exceptional shade stability. This unique combination of light initiator and light sensitivity filter in Variolink Esthetic also enables easy cleanup of excess cement after pre-polymerization using a curing light. Additionally, the cement's viscosity controller imparts good flow properties and stability, allowing the material to be easily extruded from the syringe.

Case presentation
A 34-year-old woman in good health but with high caries risk presented with an occlusal cavity in tooth #17, recurrent caries under existing amalgam restorations on teeth #18 and #19, and a defective amalgam restoration on tooth #20 (Fig. 1). Treatment options (e.g., direct or indirect restorations) and associated risks were discussed with the patient, and the decision was made to restore teeth #17 and #20 using a nanohybrid bulk fill composite (Tetric EvoCeram Bulk Fill), and perform a core buildup (Tetric EvoCeram Bulk Fill) on teeth #18 and #19 to ultimately support lithium disilicate (IPS e.max) crown restorations. The existing amalgam restorations and occlusal cavity in tooth #17 were removed, in addition to the recurrent caries in teeth #18 and #19.

Bulk fill core buildup and restoration
Teeth #18 and #19 were prepared .5mm subgingival to accommodate full-coverage lithium disilicate (IPS e.max) crown restorations. A size 1 retraction cord (Ultrapack) was placed in the gingival sulcus of teeth #18 and #19 to achieve ideal isolation while placing the composite buildups. A traditional Toffelmire matrix band was placed on tooth #20 (Figs. 2 & 3). Typically the operator uses Isodry isolation when performing subgingival crown procedures; however, Isodry requires removal when photographing cases.

The remaining dentin and enamel for all prepared teeth were conditioned with 2 percent chlorhexidine gluconate solution, and the enamel was selectively etched using a 37 percent phosphoric acid (Total Etch). The teeth were lightly dried with an air dryer (A-dec) to remove excess moisture yet leave the dentin slightly moist. A universal adhesive bonding agent (Adhese Universal) that enables the option of leaving the dentin dry or moist, thereby eliminating potential errors, was applied to the preparations for 20 seconds and light-cured for 10 seconds per tooth.

A nanohybrid bulk fill composite (Tetric EvoCeram Bulk Fill) was selected for all direct restorations. Since all cavity preparations and build-ups were less than 4mm in depth, the composite was placed in one increment, sculpted, and light-cured for 10 seconds which was sufficient to ensure a complete depth of cure. Designed for fast and efficient placement, Tetric EvoCeram Bulk Fill can be placed in increments up to 4mm. The material's low shrinkage and low stress facilitate superior margin integrity for predictable results, while the nanofill technology enhances, high-gloss polish, and low wear.

The matrix band was removed from tooth #20, and the tooth was again cured for an additional 10 seconds to ensure light penetration. The direct composite fillings and buildups were adjusted and polished, occlusion was checked, and the retraction cord pulled for the quadrant impression (Fig. 4). A VPS impression (Virtual) of the entire quadrant was then taken using a double-sided impression tray to ensure that optimal detail was captured for the laboratory technician (Fig. 5). Provisional restorations were placed on teeth #18 and #19, and the patient was dismissed.

Esthetic cementation of IPS e.max crowns
When the lithium disilicate restorations were returned from the laboratory (Gold Dust Dental Lab), the patient presented for delivery of the final restorations. The provisional restorations were removed, and the IPS e.max crowns were tried in to verify fit and complete seating, which was confirmed radiographically. To ensure a predictable and long-lasting bond between the all-ceramic material and core buildup, the crowns were first cleaned with Ivoclean and then chemically conditioned using a silanating agent (Monobond Plus) (Fig. 6).

The patient was isolated with dry angles and cotton while seating the final restorations. A size 1 cord was placed with Viscostat Clear to maintain an isolated field for cementation. Teeth #18 and #19 were cleaned with 2 percent chlorhexidine solution and rinsed, after which the enamel was selectively etched with 37 percent phosphoric acid (Total Etch). The etchant was rinsed and the teeth dried with the A-dec air drier.

Then, to enhance efficiency without sacrificing bond strength, a single-component, light-cured universal adhesive (Adhese Universal) was placed onto the preparations for 20 seconds with a scrubbing motion to ensure adequate coating of all preparation surfaces, then air dried thoroughly with the air drier (Figs. 7 & 8). The preparations were then light cured for 10 seconds each with the LED curing light (Bluephase Style) (Fig. 9).

The restorations were loaded with Variolink Esthetic dual-cure cement and seated onto the preparations. The cement was then light-cured for three seconds per quarter, which enabled excess to be easily removed with an explorer (Fig. 10). The restorations were flossed, after which they were coated with a water soluble glycerin (Liquid Skip) to prevent an oxygen inhibition layer before final curing of 20 seconds per surface. The occlusion was then checked, adjusted, and the restorations polished (Fig. 11).

Conclusion
When placing IPS e.max lithium disilicate restorations on composite core buildups that are also adjacent to natural teeth and direct composite restorations, Variolink Esthetic can be used to facilitate seamless shade matching, exceptional shade stability, fast and reliable curing, and easy cleanup of excess cement. The cement's ideal flow and handling characteristics, as well as its durable and long-lasting bond strength, contribute to simplicity and predictability when providing a combination of restorations in the posterior region.


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September 2025
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