Abstract This Q&A article details Dr. John Pasicznyk’s

clinical experience working with Celtra® Duo (ZLS), a high-strength zirconia-reinforced lithium silicate (ZLS) material made specifically for use with CEREC®. The article also features a case study in which a decaying amalgam restoration is replaced with a full-coverage Celtra Duo (ZLS) crown.

As the owner of four busy dental practices throughout the Indianapolis area, Dr. John Pasicznyk is receptive of ways to help streamline everything from workflow to inventory control. With CEREC single-visit dentistry at the core of each practice, material management is essential to keep things running smoothly and efficiently. An original beta tester for Celtra Duo (ZLS), a high-strength zirconia-reinforced lithium silicate (ZLS) material made specifically for use with CEREC, Dr. Pasicznyk found Celtra Duo (ZLS) to be well suited for the majority of bread-and-butter restorative cases performed at each of his four dental practices. cerecdoctors.com spoke with Dr. Pasicznyk, who shared his experience with Celtra Duo (ZLS) as well as an example of a routine case he performed, in which Celtra Duo (ZLS) is used to restore a fractured tooth that was previously treated with amalgam.

Dr. Fleming: When did you begin using Celtra Duo (ZLS), and more importantly, what were the motivating factors involved in your decision to use the material?

Dr. Pasicznyk: I started using Celtra Duo (ZLS) in my practice in 2016. My reason for initially choosing the material is unusual. I own four dental practices, all with CEREC, and all with a different doctor. Understandably, that created a significant inventory management issue, with each provider having different material preferences. At any given time, we could have upward of 10 different materials and translucencies in each clinic. By integrating Celtra Duo (ZLS) I can limit the number of different materials we keep on hand at

any given time.Dr. Fleming: Approximately how many Celtra Duo

(ZLS) restorations have you produced and placed to date?Dr. Pasicznyk: At this point in my career, I would

estimate I have placed more than 300 Celtra Duo (ZLS) restorations, with my associate doctors accounting for another 200.

Dr. Fleming: What aspects/characteristics of Celtra Duo (ZLS) make it an improvement (or different) over other CEREC materials you’ve used in the past, and why?

Dr. Pasicznyk: The multiple processing pathways are a key differentiator to me. In any clinical case, we are making material selection decisions based on a number

46 cerecdoctors.com | Q4 | 2018

Fig. 1: Fractured tooth #14 with failing amalgam

Fig. 2: Preparation and core buildup

The Benefits of Incorporating Celtra® Duo (ZLS) into Practice from Both a Clinical and Business Management Perspective A Q&A with John Pasicznyk, D.D.S., with accompanying full-contour crown case study by Mark Fleming, D.D.S.

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of factors, with esthetics and strength as the two most critical to most dentists. Celtra Duo (ZLS) provides the best of all worlds: a strong material that can be characterized when fired, or a polish-only material that can be efficiently and quickly delivered when the material’s inherent esthetics need no modifications.

Dr. Fleming: Are there any cases where a material other than Celtra Duo (ZLS) is advisable, and if so, what are the reasons?

Dr. Pasicznyk: There are always situations where a different material is indicated. I truly don’t see any material on the market as a “one size fits all.” When a patient has a history of breaking previous ceramic or metallic restorations, or if the tooth preparation does not lend itself well to an adhesive bonding protocol, I would lean toward using a material like zirconia that can be cemented and still retain the highest strength possible. In cases where the patient exhibits a high decay rate, a repairable material such as some of the hybrid resin-ceramics would certainly be in my consideration. Overall, though, Celtra Duo (ZLS) is an excellent choice for the “bread-and-butter” cases that dentists deal with every day.

Dr. Fleming: Celtra Duo (ZLS) is a unique CEREC material as it gives the clinician a choice of several processing pathways, such as mill and polish only, or mill and fire. Can you tell us a little about the merits of using a material that provides multiple processing pathways, and also discuss which clinical indications are more suitable for the mill and polish pathway vs. the mill and fire option?

Dr. Pasicznyk: In cases where esthetic modifications are not necessary, i.e., a restoration that blends perfectly with the natural dentition, and in cases where the restoration is not subjected to the highest forces possible, a polish-only pathway is ideal. It’s fast, efficient, and very esthetic. When a patient requires the absolute highest esthetics or will subject the restoration to higher masticatory forces, firing the material, with or without characterization, is necessary.

Dr. Fleming: What types of cases do you prefer to

use Celtra Duo (ZLS) with and why?Dr. Pasicznyk: I prefer using this material for

all of my full-coverage crown cases. I am comfortable with the shade matching, the processing, and the manufacturing characteristics of the material.

Dr. Fleming: Speaking of cases, please walk us through one of your exemplary Celtra Duo (ZLS) cases.

Dr. Pasicznyk: This full-coverage crown case is a fairly routine situation that I see in my practices: The patient presented with a fractured tooth #14 and an existing amalgam restoration in place (Fig. 1). The decay had progressed quite far and compromised the nerve of the tooth. The tooth was endodontically treated and built up with resin composite prior to full-coverage preparation (Fig. 2). Due to the damage sustained, a traditional full-coverage crown preparation was executed.

All CEREC materials have specifications that must be followed by the manufacturer. In the case of Celtra Duo (ZLS), the specification within the CEREC software that must be followed to a rule is fissure thickness of >1.5 mm. This can be easily illustrated by setting your occlusal minimal thickness parameter to 1,500 microns, and can be further confirmed through the use of “Cursor Details” within the software.

A butt joint/shoulder margin is indicated for Celtra Duo (ZLS) restorations. Once a satisfactory design has been established, we can begin manufacturing

Fig. 3: Celtra Duo (ZLS) full-contour crown restoration (occlusal view)

Celtra Duo (ZLS) provides excellent fracturestrength, esthetics, and longevity.

the restoration. When milling Celtra Duo (ZLS) restorations, “fast mill” is not an option; not using “fast mill” allows for absolutely fl awless margins.

After being milled, the material was characterized and glazed using the Celtra Duo (ZLS) universal overglaze and fi red in the CEREC SpeedFire oven, per the manufacturer’s program. One of the benefi ts of using the SpeedFire oven is that by being completely computer controlled, we can ensure the restoration is reaching the appropriate temperature for clinical success.

After the restoration cooled, it was tried in, and fi nally cemented in place using Prime and Bond elect adhesive with Calibra Ceram resin cement (Figs. 3-4).

Dr. Fleming: Have you experienced any restoration failures using Celtra Duo (ZLS)? If so, what kinds of failures and what was the likely causes? What steps can be taken to help prevent problems from happening with Celtra Duo (ZLS) restorations?

Dr. Pasicznyk: I have experienced failures with a number of materials during my career using CEREC. Celtra Duo (ZLS) is no different. When we say “failure” we are typically referring to a crack or fracture of the material. I have seen three failed Celtra Duo (ZLS) restorations during my use of the material, and each one of those can be traced back to me failing to follow the manufacturer’s recommendation of minimal thickness.

To avoid complications, there are a few things we

can do: 1. Prep appropriately to allow for 1.5 mm of material thickness; 2. If polishing the material without fi ring, follow the polishing protocol, making sure not to simply make it look “shiny”; and 3. If fi ring in the oven to achieve maximal strength, do not use any putty or pins; simply place the restoration on the fi ring pad and fi re the material according to the manufacturer’s program, which is unique from other materials.

Dr. Fleming: Overall, you’ve experienced excellent outcomes with Celtra Duo (ZLS). What are your clinical observations with this material in respect to the strength, esthetics, and longevity?

Dr. Pasicznyk: In my experience, Celtra Duo (ZLS) provides excellent fracture strength, esthetics, and longevity to the point that I would not hesitate to use it for any restoration in my own mouth.

Dr. Fleming: If a colleague were to try this material for the fi rst time, what would you tell him/her to help ensure successful results? Are there any particular “dos and don’ts” about the processing technique that contributes to its success?

Dr. Pasicznyk: As outlined above, to help ensure optimal restorative outcomes, follow the manufacturer’s recommendations for processing the material.

For questions and additional information, Dr. Pasicznyk can be reached at info@nvdkeystone.com.

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Fig. 4: Celtra Duo (ZLS) full-contour crown restoration (buccal view)