CERAMILL SINTRON. OFTEN IMITATED, BUT NEVER

PRESENTED BY AMANN GIRRBACH

B53466

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CERAMILL SINTRON. OFTEN IMITATED, BUT NEVER EQUALLED.Dipl. Ing. (FH) Axel Reichert

THE INTERNATIONAL JOURNAL OF DENTAL TECHNOLOGY WWW.DENTALDIALOGUE.DE

02 – dental dialogue VOLUME 19 – 1&2/18

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Retrospective on the 5th anniversary of the Ceramill Sintron CoCr sintering metal

A contribution by Dipl. Ing. (FH) Axel Reichert, Koblach/Austria

Since its market launch in 2012, over three million units have been fabricated from Ce-ramill Sintron. More than 2,000 laboratories worldwide process CoCr in green condition - and the trend is growing. According to the data available from five years of market surveillance, Ceramill Sintron has proven itself to be an established and safe material. This article presents the material, the processing chain and the technical innovations of the Argovent 2 sintering compartment. Based on case studies from dental practice, en-thusiastic Sintron users give insights into the variety of indications that can be realized with this combination of material and processing chain.

CERAMILL SINTRON. OFTEN IMITATED, BUT NEVER EQUALLED.

CONTACT■ Amann Girrbach AG

Herrschaftswiesen 1 6842 Koblach/Österreich Fon +43 5523 62333-0 [email protected] www.amanngirrbach.com

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HOMEPAGE

01 Continuous further developments, such as the Ceramill M-Gin software module, allow the efficient and precisely fitting fabrication of implant-supported Ceramill Reax bridges (with gingival section) from Ceramill Sintron

1&2/18 – dental dialogue VOLUME 19 – 03

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If you look at the current market situation, you might possibly come to the conclusion that zirconium oxide must quite literally be in every mouth. Particularly as the “white gold” dominates the current discussions on dental restoration materials. Whereby cobalt-chromium alloys (CoCr) still remain highly relevant as a dental material. Due to its mechanical properties, its processing, biocompatibility as well as stability, co-balt-chromium has proven to be a reliable material for a wide range of indications until today. However, the increasing use of CAD/CAM-based fabrication processes in dental laboratories has made it all the more important to find a safer and more efficient way of processing non-precious metals. This was achieved by the option of offering cobalt chromium in the form of an easily machinable milling blank with subsequent sintering. The Ceramill Sintron sintering material and the corresponding workflow have been widely used since then.Due to its properties, the CoCr sintering metal Ceramill Sintron can be classified as a typical CAD/CAM material. Above all, this is underscored by its processing features, such as easy milling in the green body state, high marginal stability and the stable sintering properties. Further processing has also proven to be straightforward and follows the usual handling patterns, since both polishing and veneering can be per-formed analog to conventional CoCr alloys.

However, Ceramill Sintron not only stands for the development of a material, but also for the corresponding processing chain. Add to this, the provision of matching hardware, which is constantly being fur-ther developed. This includes equipment such as a sintering furnaces and sintering compartments as well as CAD software solutions, which also enable the precisely fitted sintering of telescopes and wide-span restorations.Since the launch of Ceramill Sintron in 2012, more than three million Sintron units have been fabricated, which are now in clinical use. More than 650,000 units are now being fabricated annually with Ce-

ramill systems alone (surveillance period 09/2016 to 09/2017). Around 2,000 labo-ratories worldwide have integrated CoCr green body processing into their daily laboratory routine using CAD/CAM - and the trend is growing. And the complaint rate for the material in relation to the units fabricated is a mere 0.001 % (assessment period 09/2016 to 09/2017). It is worth em-phasizing here that there were no com-plaints whatsoever during applications to patients.According to the data now available after more than five years of market surveil-lance, Ceramill Sintron can be classified as an established and extremely safe materi-al. The same applies to the corresponding processing chain.

Leadership through innovation

In particular, the increased use of CAD/CAM technology and the associated de-sire to be able to realize as many types of restorations as possible with the aid of computers, requires continuous opti-mization and further development of the systems. Process safety and efficiency, longevity and low maintenance costs, as well as compatibility and ease of handling - all these associated aspects must also be taken into account when implementing follow-up products. Therefore the system solution relating to Ceramill Sintron is sub-ject to ongoing research and development (Fig. 1).Recent innovations are particularly notice-able in the area of furnace systems. The Ceramill Argotherm high-temperature fur-nace and the removable Ceramill Argovent sintering compartment provide two sophis-ticated system components that have been developed and manufactured exclusively for sintering restorations made of Ceramill Sintron. Their meticulous coordination with the specific material properties of Cera-mill Sintron guarantees distortion-free and precisely fitting sintering results. As part of the new generation of furnaces, Cera-mill Argotherm and Argovent have been matched in order to support an extended application field of the material (Fig. 2).

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The further development of the Argovent 2 is essentially based on an expansion of the useful space as well as the conversion to purely ceramic components. These brings a certain number of useful and positive properties with it. When compared to metal, ceramics offer the advantage of being very durable and dimensionally stable in specif-ic temperature ranges. In order to be able to offer components such as a compatible and easy-to-use sintering compartment for all existing Argotherm sintering furnaces, a complex design of the ceramic is necessary.

To achieve this objective, a production tech-nology was resorted to which starts where conventional fabrication reaches its limits: 3D printing. The additive fabrication process not only allows the realization of complex and individual structures, but also enables working with significantly finer wall thick-nesses, resulting in more lightweight and smaller components (Fig. 3). Even under-cuts and hollow sections which cannot be fabricated by milling and turning, or only to a limited extent, can be considered in the design process with 3D printing. For the first time, a technology that is currently unique

worldwide now enables the 3D printing of reaction-bound silicon-infiltrated silicon carbide (RBSiC) ceramics. Silicon carbide is used in furnace construction because of its excellent heat conduction, temperature resistance and dimensional stability in the high-temperature range, which qualify it as an extremely suitable material. Through processing with 3D printing, it was possible on the one hand to accommodate design optimization of the sintered components in a manner compatible with all Argotherm generations, and on the other hand, achieve shortened sintering times at a consistent consumption of argon gas due to the favor-able thermal properties and lower material consumption in the area of wall thickness.

When working with metals or metal alloys in a pure silicon carbide environment, it is important to prevent the objects to be sintered from coming into direct contact with the carbide ceramic. This eliminates any interactions among the materials. Otherwise, melting reactions of the CoCr alloy would occur, resulting in highly glossy surfaces. These fusions can, for example, cause rounding of delicate crown margins

as well as changes to the metal structure, which would have a negative effect on the shape and fit accuracy of the sintered object. This would interfere with the desired solid phase sintering at this point. Furthermore, the silicon carbide components such as, for example, the sintering bowls could be dam-aged through contact with the metal. For this reason, the Argovent 2 was developed as a “hybrid ceramic system” (Fig. 4). Components made of pure, inert aluminum oxide ensure encapsulation of the sintered material in the form of a protective sintering cover and in combination with an insert made of similar material.

The success of sintering powder metal al-loys depends on sufficient flushing with a protective gas such as argon. This eliminates scaling of the oxygen-affine CoCr material. In order to keep consumption of the noble gas to a comparably low quantity, as with the predecessor model, a sufficiently high impermeability of the system had to be en-sured. To this end, sealing concepts were developed for the mating surfaces of the ceramic sintering construction which had previously not been possible with conven-

02 The first and second generation of the system components Ceramill Argotherm and Argovent (from left to right). The system solutions relating to Ceramill Sintron are subject to permanent research and development work

1&2/18 – dental dialogue VOLUME 19– 05

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03 Novel materials and fabrication methods, such as 3D printing, open up new options for the processing of high-performance ceramics such as silicon-infiltrated silicon carbide (IntrinSiC, Schunk, 3D printed ceramic components)

05 Newly developed sealing and material concept to increase the efficiency of the Ceramill Argovent 2 sintering system

04 The Ceramill Argovent 2 sintering system consists of silicon carbide and oxide ceramic components. This results in an ideal combination of the two materials


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07 Perfect sintering results even at maximum dimensioned designs. Here is a Ceramill Reax bridge in the Argovent 2 sintering bowl

06 Even large-span bridge constructions with a gingival section (Ceramill Reax bridge) now fit into the sintering bowl. The useful space of the Argovent 2 could therefore be effectively enlarged compared to the Argovent

1&2/18 – dental dialogue VOLUME 19 – 07

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tionally manufactured SiC ceramics (Fig. 5).A thermally stable inlet seal on the sintering base and a removable weight of the retort increase the overall gas concentration in the interior and reliably ensure perfect sintering results.

Due to the new fitting of sintering furnaces with the Argovent 2 made of silicon carbide, the most important aspects for successful and extended material processing were ensured:■ More available space due to an enlarged

sintering bowl at consistent low protective gas consumption.

■ Reduced sintering times due to reduced wall thicknesses at optimum thermal con-ductivity

■ Perfect support of the material and main-tenance-free, easy-to-replace components without the need to invest in a new fur-nace system

With the accustomed high material quality, users benefit from new options and greater convenience in the fabrication of Ceramill Sintron structures without having to change the established workflows. The available space has been increased significantly, which not only allows accommodating up to 25 % more units, but also means that there are no longer any limitations in terms of processing large-span bridge constructions, even with a gingival section (Figs. 6 and 7).

Ceramill Sintron – market feedback from practices

Five years ago, Amann Girrbach entered new dental territories with the dry-millable CoCr Ceramill Sintron sintering metal. A world revolution which promised a more process-safe and precise alternative to con-ventional cobalt-chromium alloys such as, for example, those used in the field of cast-ing. The development of the material, which was also accompanied by the Fraunhofer Institute IFAM in Dresden, proved equally complex and intensive. Finally, the innova-tive material was tested for its usability in numerous studies at renowned universities and institutes before being launched on the

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market at the end of 2012. However, whether a new product actually works in everyday laboratory routines, can only be proven in practice. Here, it needs to meet the require-ments of technicians, clinicians and patients and contribute to the satisfaction of every-one involved in the long term. Testimonials from users who have integrated Ceramill Sintron into their daily laboratory routines for many years give insights into their work with the materials, furnaces and sintering compartments.

Ceramill Sintron and Zolid FX Multilayer – a perfect symbiosis!

Ztm. Rosa Winterhalter und Ztm. David May (Fig. 8): “We manage the laboratory “Lindau-er Zahntechnik GmbH“. Together with three other employees, we cover all the require-ments and the entire range of prosthetic restorations. Ceramill Sintron has been an integral part of our daily practice for about three years. Initially, we mainly fabricated primary telescopes, monolithic crowns and frameworks for temporary restorations. Digitization has made it easier to fabricate CoCr restorations in everyday dental rou-tines. The fit is excellent and, in contrast to conventional casting, always consistent. As a result, our workflows have become more efficient and we have seen a significant in-crease in the cost-effectiveness of our lab-oratory. Meanwhile, we have specialized in wide-span bridges made of Sintron. For the bridge shown here as an example (Figs. 9 to 11), we used Ceramill Sintron as frame-work material. For the monolithic crowns, we chose the super highly translucent Ceramill Zolid FX Multilayer zirconium oxide with in-tegrated color shade gradient. With these two materials, Ceramill Sintron and Ceramill Zolid FX Multilayer, we can optimally combine stability and esthetics as well as benefit from a simple and process-safe workflow.

The preparation of the framework and the correct bonding of the zirconium oxide crowns are crucial for restorations of this type. The framework is covered with an opaque layer to achieve an optimal starting

position for the highly translucent crowns. To condition the Zolid FX multilayer crowns, we use Monobond Plus (Ivoclar Vivadent) and Multilink Automix (Ivoclar Vivadent) for bonding. Then, the gingiva is applied indi-vidually with resin and polished. From our point of view, Ceramill Sintron is the ideal framework material for this purpose as it ensures a tension-free fit and an optimal bond for the resin layering of the gingiva. In case of age-related changes of the gingiva, the resin ratio as well as the zirconium oxide crowns can be replicated and replaced easily. Our dentists were also enthusiastic about this type of restoration, as they received a safe dental prosthesis without esthetic limitations.

In future, we will increasingly offer wide-span implant-supported restorations as well as telescopic work and frameworks for temporary restorations made of Ceramill Sintron. We also regard Sintron as being an indispensable material in our laboratory in the future.”

Five years of Sintron - a major benefit for our laboratory!

Ztm. Matthias Klinger (Fig. 12): As the owner of “Zahntechnik Klingner” with ten employees, it is important for me to remain innovative and to keep all technicians and customers on board. As such, we can look back on 13 years of CAD/CAM-supported fabrication. This technology supports us in numerous areas, from crown and bridge technology to telescopic and bar work (Fig. 13) to splint therapy and full dentures.

In November 2012, we opted for the Ceramill Sintron sintering metal, which had just been launched on the market. Being the first ma-terial of its kind, there existed neither many years of experience in the laboratory nor were there comparable materials in terms of processing. However, the possibility of processing CoCr alloys computer-aided, in-house and with our existing milling machines was extremely interesting. So we became “users of the first hour”.

At the time of the market launch, designs up to a maximum length of 5 cm were ap-proved. And despite the still limited range of indications, no one wanted to opt for casting any more at that time. Instead, we received more and more orders for milling, also from other laboratories and even from non-industry sectors.

For us it was extremely exciting to cooperate closely with Amann Girrbach’s developers on the implementation of this wide-span resto-ration. With the introduction of the Ceramill Evolution Kit, the Float Sintering Disc and the adaptation of the software for variable sintering stabilizers, the sintering of large-span works became reproducible (Fig. 14).

However, really large structures still had to be separated as there was not enough space in the sintering bowl. Our desire for a larger and more stable sintering bowl turned reality after the IDS 2017 with the introduction of the Ceramill Argovent 2. With the Argov-ent 2, the sintering time as well as argon gas consumption were reduced. Even after meanwhile about 200 sintering processes, the sintering compartment shows no signs of wear due to the new materials.

Our decision taken in 2012 in favor of Cera-mill Sintron was the right one. Large second-ary constructions with milling times of about 120 minutes with the finest fissures are no magic at all. Fantastic material properties such as a homogeneous, shrink hole-free structures, excellent veneering, milling and polishing properties complement the reliable process chain. With a milling cutter wear of virtually zero at constantly improved milling strategies, we are able to keep up with the quality of our competitors at all times and are put into a comparatively better position in terms of economic efficiency. Ceramill Sintron has made a positive change to our daily laboratory routine. These have been exciting years, and - I’m sure - the coming ones will remain exciting.”


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09 Wide-span bridge framework made of Ceramill Sintron. The crowns were fabricated from Ceramill Zolid FX Multilayer

10 The Ceramill Zolid FX Multilayer crowns were bonded to the opaqued framework and the gingiva was modeled individually with resin

11 Highly esthetic denture which perfectly combines the properties of Ceramill Sintron and Ceramill Zolid FX Multilayer

“Ceramill Sintron and Zolid FX Multilayer – a perfect symbiosis!”■ DMT Rosa Winterhalter and DMT David May managing directors of the

Lindauer Zahntechnik GmbH [email protected], www.lindauer-zahntechnik.de


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Ceramill Sintron has maximized the cost-efficiencyof my laboratory

Łukasz Sopałowicz (Fig. 15): “10,000 - that is roughly the number of units I have made from Ceramill Sintron in my laboratory with nine employees since the material was intro-duced. I think this number leaves no doubt about my being an enthusiastic user of Sin-tron. And of course, I am also a proponent of state-of-the-art materials such as zirconium

oxide or glass ceramics. However, there are a number of indications, for example, bars or combination work, (Figs. 16 and 17), where I gladly resort to the dry millable CoCr sintering metal from Amann Girrbach due to its exceptional material properties. The material is distinguished by an extremely homogeneous structure and a perfect fit of restorations. I would never be able to achieve the same high quality at such consistency with a casting method.

And it is the latter which is the most crucial factor for me, and this is why Sintron has become firmly established in my laboratory routine. Sintron promises 100 % reproduc-ibility. By processing with the CAD/CAM technique, CoCr restorations can finally be manufactured as often as you like and always in the same quality. Due to the soft quality of the material, the milling tools as well as the drive system of my machine are hardly tasked. In combination with the milling strategies matched to the material,

13 Bar work made of Ceramill Sintron with MK1 bars on titanium bases

14 A 14-pontic tertiary framework made of Ceramill Sintron with veneer

“Five years of Sintron - a major benefit for our laboratory!”■ DMT Matthias Klingner, owner of Zahntechnik Klingner

[email protected], www.zahntechnik-klingner.de


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the milling results always fascinate me time and again. The subsequent sintering pro-cess is equally uncomplicated and precise. Meanwhile I have switched from the first version of the Ceramill Argovent sintering compartment to the successor model. And my laboratory benefits significantly from the optimization realized by Amann Girrbach for the Argovent 2. The larger sintering bowl now offers considerably more room for a larger number of units and the change to metal-free ceramic components lends the

Argovent 2 high resistance and long-term stability. The results are without fault and can be veneered subsequently with any conventional layer ceramic on the market. The final results are high quality as well as esthetically convincing restorations.”

Ceramill Sintron is indispensable in our laboratory!

Jörg Schönthal (Fig. 18): “I have been the lab-oratory manager of Dentaltechnik Dr. Lerner

GmbH since 2010. We are a smallish labo-ratory with four employees. For 15 years I have specialized in the field of telescopic technology with a host of different materials and am therefore a fully fledged telescopic technician. In 2013, a decision for a CAD/CAM system had to be taken; and the reason why I finally decided in favor of the complete in-house system from Amann Girrbach was mainly due to the Ceramill Sintron sintering metal. To begin with, I started with single crowns and smaller bridges. The fit con-

16 Prepared framework made of Ceramill Sintron with terminal sliding male part

17 The finished combination work made from Ceramill Sintron with sliding sections

“Ceramill Sintron has maximized the cost-efficiency of my laboratory”■ ZT Łukasz Sopałowicz, Managing Director of the Lider-Tech Laboratory

[email protected], www.lider-tech.pl


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19 Scanned primary telescopes on the master model. Now the secondary structure is “designed”. The friction can be controlled individually by changing the radial value

20 Inserted primary telescopes in the patient’s mouth after nearly six months of wearing time. The extremely homogeneous surface promotes healing, which is noticeable at the gingival margin

21 Final restoration: The telescope restoration was veneered and completed with the Signum composite and Signum matrix from Kulzer

“Ceramill Sintron is indispensable in our laboratory!”■ Jörg Schönthal, Laboratory Manager at Dentaltechnik Dr. Lerner, speaker and course

leader for the topic Telescope Technique with Ceramill Sintron [email protected], www.dental-center-bretten.de


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vinced me, which is why I quickly became more courageous and started to test and work far beyond the indications applicable at that time.

Due to the continuous further development of the Ceramill Argotherm sintering furnace, the software and the integration of a new workflow using the Float Sintering Disc, the indication range was expanded significantly and even wide-span bridges were able to be realized.

Owing to the intensive cooperation with the research and development department of Amann Girrbach as well as my many years of experience with the fabrication of tele-scopic work, we have created a workflow that enables us to fabricate complete tele-scopic work with a time saving of up to 50 % (Figs. 19 to 21). In addition, we benefit from a high level of system security, a perfect fit and easy-to-process surfaces. Whereas the patient benefits particularly from the high level of biocompatibility, the absence of tension and plaque resistance provided by this material in its polished state. And of course, all these advantages inspire our treating dentists.

In my opinion, Ceramill Sintron will deter-mine the market for non-precious alloys in the future, particularly in the area of tele-

scopic technology. I enjoy the advantages of processing Sintron daily and it brings new ideas into our laboratory. One can rely on this system, and especially on Ceramill Sin-tron. I am already looking forward to the next developments.” ■

CERAMILL SINTRON OVERVIEW

INDICATIONS■ Crowns and bridges, fully anatomically

and anatomically reduced■ Telescopes■ Multi-pontic screw-retained construc-

tions on Ti bases■ Individual abutments on Ti-bases■ Anatomically reduced and fully anatom-

ical crown and bridge frameworks in the anterior and posterior regions

TECHNICAL DATA ■ Tensile strength (Rm): 900 MPa■ E-modulus (E): 200 GPa■ Density: 7.9 g/cm3■ Vickers hardness: 270 HV 10■ CTE 25 - 500 °C: 14.5 *10-6/K■ Elongation at break: 30 %■ Open porosity: 0 %■ Color: silver■ Oxide color: gray-green■ Yield strength (Rp 0.2 %): 450 MPa

CHEMICAL COMPOSITION (WT %)■ Co: 66■ Cr: 28■ Mo: 5■ Si: < 1■ Fe: < 1■ Mn: <1■ Other elements (C) < 0.1■ Organic binders (for blanks in green

state)■ The alloy is free of nickel, beryllium,

gallium and cadmium in accordance with DIN EN ISO 22674.

PROFESSIONAL CAREER

After his training and successful career as a dental technician (Dentallabor Nikolaus & Sperlich, Dingolfing) Axel Reichert obtained the title of Dipl.-Ing. of Dental Technology at the University of Applied Sciences Osnabrück. At Amann Girrbach, he has now been applying his practical and tech-nical knowledge in research and development for the past ten years, particularly in the areas of materials development and CAD/CAM. Axel Reichert was involved in many of the development steps with sintering technologies in the powder metal and high-performance ceramics sector and was the responsible project leader for the development of the Ceramill Argotherm and Argovent furnace systems. Meanwhile, Axel Reichert is team leader of materials development in the Research and Development Department at Amann Girrbach.

INTEGRATED, DIVERSE, EFFICIENT, OPEN.

Model management articulator and masticatory loading simulator

Fabricate a precision model quickly and cost-effectively

Loss-free transfer of patient data into the Ceramill Map400

The “function scanner” with Splitex-Integration

PRECISION MODEL PRECISION TRANSFER

Ceramill PMMACeramill Splintec Ceramill Splintec Standard

Ceramill WaxCeramill Wax White

Ceramill Sintron Ceramill TI-Forms

Zolid FX Preshades Zolid FX White

Zolid FX Multilayer Zolid HT+ Preshades Zolid HT+ White

Zolid Preshades Zolid White

ZI White

CERAMICS

ACRYLICS/WAX METAL

Dental Dialogue_ET1803_Sonderdruck Sintron_A4 Doppelseite_4c_AG6597_EN_v01.indd 1 08.03.18 14:47

INTEGRATED, DIVERSE, EFFICIENT, OPEN.

Model management articulator and masticatory loading simulator

Fabricate a precision model quickly and cost-effectively

Loss-free transfer of patient data into the Ceramill Map400

The “function scanner” with Splitex-Integration

PRECISION MODEL PRECISION TRANSFER

Ceramill PMMACeramill Splintec Ceramill Splintec Standard

Ceramill WaxCeramill Wax White

Ceramill Sintron Ceramill TI-Forms

Zolid FX Preshades Zolid FX White

Zolid FX Multilayer Zolid HT+ Preshades Zolid HT+ White

Zolid Preshades Zolid White

ZI White

CERAMICS

ACRYLICS/WAX METAL


Amann Girrbach AG | Fon +49 7231 957-100Fon International: +43 5523 62333-390 www.amanngirrbach.com

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AUSTRIA (HEADQUARTERS) Amann Girrbach AG

Koblach, Austria Fon +43 5523 62333-105

[email protected]

GERMANY Amann Girrbach GmbH

Pforzheim, Germany Fon +49 7231 957-100

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NORTH AMERICA Amann Girrbach North America, LP

Charlotte, NC, U.S.A. Fon +1 704 837 1404

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BRAZIL Amann Girrbach Brasil LTDA

Curitiba, Brasil Fon +55 41 3287 0897

[email protected]

ASIA Amann Girrbach Asia PTE LTD.

Singapore, Asia Fon +65 6592 5190

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CERAMILL SINTRON. OFTEN IMITATED, BUT NEVER