Simplfied Restorations

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step-by-step IPS e.max system
Simplified
restorations
IPS e.max System
• All-ceramic system
Ivoclar Vivadent’s IPS e.max System provides strength with esthetics
• Indicated for cases from thin veneers to 12-unit bridges
• 4-uni posterior bridges can be fabricated
By Matt Roberts, AAACD, CMR Dental Lab, Idaho Falls, ID. Clinical images by Dr.
Chris W. Campbell, DMD, Palmetto Dental Associates, Pa, Lexington, S.C.
• High quality esthetics
The design of this case was com-
The IPS e.max concept comprises
on technique now enables the fabri-
• Lithium disilicate glass ceramic for single-tooth
restorations
plex. By using digital design it was
lithium disilicate glass-ceramic (LS2)
cation of 4-unit posterior bridges that
• Zirconium oxide for long-span bridges
possible to design the implant abut-
– suitable mainly for single-tooth res-
feature outstanding overall strength
ments at the same time as the final
torations – and a high-strength zirco-
and high esthetics.
restorations.
nium oxide for long-span bridges. One
• Exceptional overall strength
Ivoclar Vivadent, Inc.
single layering ceramic for the entire
Case presentation
the IPS e.max System
system enables a uniform layering
A fully retracted pre-op photo was
Ivoclar Vivadent’s IPS e.max Sys-
diagram and precise shade match.
provided by the clinician to assist to
tem is an all-ceramic system that
The combination of IPS e.max
the ceramist in creating a diagnostic
covers all indications ranging from
CAD (LS2) and IPS e.max ZirCAD (ZrO2)
waxup with proper midline position
thin veneers to 12-unit bridges.
used in the innovative IPS e.max CAD-
and avoiding a maxillary cant (Fig.
ivoclarvivadent.com
800-533-6825
U.S.
175 Pineview Drive
Amherst, NY 14228
Canada
1-6600 Dixie Road
Mississauga, Ontario L5T
2Y2
Fig. A Preoperative view.
Fig. B Diagnostic wax-up.
Fig. C Digital scan of the restoration.
Fig. D Full contour design.
Fig. E Implant abutment design.
Fig. F Virtual articulator.
Fig. G Abutments in place on master model.
Fig. H Restorations fitted on master model.
Fig. I Zirliner applied to bridges.
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step-by-step IPS e.max Press
Fig. J Full contour IPS e.max
Ceram buildup of the bridges.
Fig. K IPS e.max Ceram effect powders
are in place on the crystallized restorations.
Fig. L Completed case on the master model.
Coloring is done after milling but before sintering.
ders are in place on the crystallized restorations. The color
04
Hybrid titanium zirconia implant abutments were
ducing the need for layering ceramic. Monolithic posteriors
designed within the full contour design, allowing
are possible with acceptable esthetic results and minimal
control in the HT zirconia provides nice esthetics while re-
proper shape and position of the abutments relative to final tooth position (Fig. E). The ovate pontic preparation
for the cantilevered pontic is visible in the No. 11 position.
05
Fig. M The completed restoration.
areas requiring implant treatment.
01
11
The completed restoration shows excellent shade
transition from IPS e.max to Zenostar from laterals to
The virtual articulator is used to check excursive
cuspid, even with minimal cutback of zirconia (Fig. L). Note the
and protrusive movements (Fig. F). The mandibular
ideal incisal edge position following contours of lower lip (Fig. M).
model is turned off to allow the viewer to see the collision areas in the design. These were adjusted to allow anterior guidance without posterior working or balancing interferences.
A). The preoperative photo also shows the edentious
layering produces exceptional results.
06
Conclusion
The combination of good restorative treatment planning,
good clinical execution, gathering appropriate models, bites
The master model with the zirconia abutments in
and photos and having a systematic, sequential approach
place (Fig. G). Titanium sleeves support the zirconia
to the final outcome of the case is what‘s really important.
A diagnostic waxup was completed idealizing form
and provide metal seats for the screws, greatly increasing
All of the technology and great material in the world won’t
and function and formed from Zenotec wax to be
the overall strength and reliability of the abutments without
result in a successful result for the patient if the restorative
pressed out of the IPS e.max system (Fig. B). A silicone
matrix of this waxup was used to fabricate provisional
restorations. Note the tissue discrepancy in the edentious
areas, the need to replace the space occupied by gingivia
was part of the material selection and planning process.
02
sacrificing the trans-illumination potential of the zirconia.
07
Digital design for the anterior lithium disilicate
crowns was outsourced to Wieland Precision
Abutment design and zirconia bridge fabrication provided
milled in-house on a Wieland Zenotec mini mill. All restora-
by Brad Lyman and Tracy Egbert.
The provisional restorations were photographed and
tions were fit to the master model. Contacts, occlusion
and surface morphology were verified on the IPS e.max
mouth . The model was digitally scanned with 3Shape 3D
CAD Design software at the same time as the prepared tooth
model and the mandibular models were scanned (Fig. C). All 3
models can be used interactively. The provisional restorations
are represented in blue superimposed on a preliminary design
of the definitive restorations. The cross hairs can be oriented
restorations prior to crystalizing.
08
09
About the author
Zirliner was applied to the bridges in areas where
IPS e.max ceram layering was planned (Fig. I).
The full contour IPS e.max ceram buildup of the
bridges was completed (Fig. J). The degree of
with a full-face photograph to aid with facial orientation. The
transillumination possible with zirconia abutments and trans-
design was then refined to more closely follow the shape and
lucent zirconia bridges is visible. The bridges were only cut
position of the provisional restorations.
back 0.6mm on the facial for esthetic layering. All occlusal,
03
A full-contour design was completed with 3Shape
the higher translucency exhibited by Wieland’s new zirconia,
software (Fig. D). The Zenostar full-contour zrico-
very minimal layering is needed for esthetics. A much stron-
nia bridges are shown in white and the IPS e.max lithium
ger final restoration than more conventional substructure
lingual and gingival surfaces were left in zirconia. With the
disilicate restorations are blue. The zirconia comes in 6
design is acheived. The strength gained by minimal layering
shades of translucent and one more opaque white shade
vastly increases the use of zirconia as a restorative material.
that we use for abutments to prevent show through of the
screw or titanium chimney within the abutment. Both the
translucent and opaque zirconia are shaded with Wieland
coloring liquids to create color gradient within the zirconia.
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by-step to provide the final result the patient desires. lab
Technology for milling (Fig. H). The Zirconia bridges were
impressed to provide models to the lab that showed
the shape and position of the temporary restorations in the
process isn’t completely visualized and preplanned prior
to starting the case, and then the plan is followed, step-
10
Prior to crystallizing, the IPS e.max HT restorations
were cut back 0.2mm-0.4mm for incisal effect
Mat t Rober ts, A A ACD, began fabricating
esthetic reconstructive restorations more
than 3 0 years ago and est ablished CMR
Dental Lab in 1978, where he still pursues
his passion for excellence in esthetics and
function. A member of the American Academy of Esthetic Dentistry and the American
Academy of Cosmetic Dentistry, he is one
of only 35 accredited dental technicians.
Roberts founded the Team Aesthetic Education program to provide hands-on training
for dentists and technicians. A member of
the L.D. Pankey Institute faculty, he helps
teach the Aesthetic Solutions Program for
dentists and technicians. A member of the
editorial team for many dental journals, he
also speaks nationally and internationally. He
may be reached at www.teamaesthic.com.
layering (Fig. K). The initial IPS e.max Ceram effect pow-
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