e.

max Ceram
®

IPS
special e.dition
Oliver Brix, Germany
 e.maximize

CAD/CAM-manufactured zirconium oxide frameworks As laboratory technicians, we are continually seeking a vital appearance of IPS e.max Ceram restorations. Because
are becoming increasingly integrated into the daily veneering material that can be optimally processed in the veneering ceramic is ideally coordinated with all the
routine of dental laboratories and the fabrication of combination with the framework material. At the same time, other components of the IPS e.max system, it offers me a
aesthetic tooth restorations. The material’s biocompati- it should be consistent with our personal philosophies and high degree of flexibility. In addition to veneering zirconium
bility and high strength make it particularly suitable for preferred working techniques. Very often, veneering oxide frameworks, I can also use it for the glass-ceramic
use in dentistry. Because its precision and productivity materials are used that are not specifically intended for the frameworks from the IPS e.max range (PRESS and CAD).
have been continually optimized, the material is capable purpose, because their range of tolerance, i.e. their CTE,
of meeting even the highest expectations today. matches that of zirconium oxide frameworks. In most cases, Today, more and more patients desire an improvement of
however, this leads to aesthetic outcomes that are not their overall appearance, apart from having their teeth
In the fabrication of frameworks for all-ceramic restorations, altogether satisfactory. restored to function. Therefore, aesthetic tooth restorations
IPS e.max ZirCAD, an yttrium-stabilized zirconium oxide typically involve an adjustment of the tooth shape to create
block, can be used for example. Today, laboratories that do With IPS e.max Ceram I have finally found a layering ceramic a more harmonious smile line. Moreover, a shade lighter
not dispose of a CAD/CAM unit to design and mill zirconium that meets my needs. This low-fusing glass-ceramic contains than that of the existing dentition is chosen in most cases.
oxide frameworks in-house can choose from a broad range nano-fluorapatite crystals, which impart it with a structure In the patient cases presented below, the natural aesthetic
of options to outsource the manufacturing process, which similar to that of vital teeth. Its fluorescence and lifelike light appearance was re-created with all-ceramic restorations.
deliver quality results. I make use of this opportunity myself, scattering are additional features that support me in my daily The major impact this type of restoration may have on the
as this enables me to put my full concentration into creating work. In addition, a unique combination of freely adjustable patient’s appearance should be kept in mind during the
high-quality ceramic veneers. brightness and excellent chroma enhance the aesthetic and entire procedure.

Pre-operative situation – Pictures of the final result can be found at the end of this Special Edition

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 e.max Ceram
®

– Step-by-step procedure
IPS

Milled and sintered single tooth coping made IPS e.max Ceram ZirLiner 1 is applied to the Deep Dentin A2 and Dentin A2 are applied
of zirconium oxide coping and the shade is modified with
IPS e.max Ceram Shades

The incisal area is built up using TI 1, TI 3, OE 1 Crown right after conducting the first firing Low shrinkage and a homogeneous surface
and T o-g. Mamelon structures are created cycle in the ceramic furnace. The result is
with MM materials. OE 3 is used to enhance impressive, even without further adjustments
the brightness value in selected areas. or finishing. |3
4|
First Patient Case

The steps involved in the fabrication of a zirconium oxide-

based restoration with the nano-fluorapatite glass-ceramic
IPS e.max Ceram are outlined below based on a patient case.
The old, defective crowns had to be replaced by new ones as
gingival irritation was present and the exposed crown mar-
gins had a negative effect on the overall appearance of the
young patient.

After removing the old restorations, whose palatal aspects

showed extensive metal coverage, the teeth were re-
prepared. In the process, particular attention was paid to the
biological and functional aspects, so that a sound foundation Defective crowns compromise the aesthetic appearance of the smile
for successful restorative results was laid.

Pre-operative situation – labial aspect Pre-operative situation – palatal aspect Lab-fabricated temporary

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 Apart from using the inLab® system from Sirona, a
multitude of other procedures are available for milling
zirconium oxide frameworks (e.g. KaVo Everest®), or
having them manufactured externally. The frameworks
used in this case show high accuracy of fit and a uniform
wall thickness. In the course of the finishing procedure,
the copings were reduced cervically and thinned to a layer
thickness of approx. 0.3 mm labially. The crown margins
were reduced to fabricate a porcelain shoulder.

Milled ZrO2 frameworks Crown margins that have been shortened to accommodate the shoulder porcelain

The basic shade is established using IPS e.max Ceram

ZirLiner 2.
The primary basic shade will show after applying a coat of
ZirLiner and characterizing it with IPS e.max Ceram
Shades. Subsequently, the Margin materials are applied
and fired as usual.

ZirLiner and Margin material after firing The ZirLiner technique enables the precise reproduction of shades and provides enhanced
light reflection.

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IPS e.max Ceram Occlusal Dentin orange and Deep Dentin Subsequently, the framework is masked with a mixture of To enhance the chroma in the cervical region and reduce the
are applied in the proximal region. This enables me to create Deep Dentin and Dentin A3. brightness value, a mixture of 50 % Dentin and 50 %
a basis for the desired depth of colour in spite of the high Cervical Transpa orange is applied.
brightness value exhibited by the framework.

The dentin core is layered to full size with various dentin materials and subsequently reduced according to its natural form, The inclination of the incisal plane creates an effect of depth
so that it represents around two thirds of the total layer thickness. and sufficient space for natural effects and the incisal layer.
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 I lengthen the incisal area, which consists of various Incisal Subsequently, I wash in expressive and natural effects with The palatal view shows the build-up, its dimensions and the
and Transpa materials, by approx. 1 mm. My selection of the IPS e.max Ceram Impulse materials. To cover the labial integrated framework. The transition between the frame-
materials as well as the way in which I layer them is closely aspect, I exclusively use Transpa Incisal and Transpa materials work and the ceramic is softened with IPS e.max Deep
guided by the structure of the adjacent teeth, to which I (Transpa Incisal TI 1-TI 3, Tanspa clear and Cervical Transpa Dentin and small amounts of Essence material.
continuously refer during the build-up procedure. orange) in layers of approx. 0.2 mm thickness.

The Essence materials are ideally suited for this purpose. Even After firing, the restoration shows subtle, in-depth Shade modification with IPS e.max Ceram ZirLiner ensures
very thin layers suffice to achieve the desired result. Next, shading. The characteristics that have been incorporated that the basic shade and chroma of the restoration are ideally
Dentin (A2 and A3) and Transpa Incisal (TI 1 and TI 2) are are clearly visible but harmoniously blend into the natural supported by the zirconium oxide framework.
added to the palatal aspect. surroundings and enhance the overall appearance.
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Following corrective firing, I adjust the shape of the restora- structure is still intact and no porosities are present. The
tion and create surface texture. After glaze firing, the surface desired degree of lustre is achieved by mechanical polishing
of the restoration exhibits a slight lustre. Nevertheless, the with rubber polishers after finishing all convex areas.

The post-operative view after incorporation of the restorations using a conventional cementation protocol (PD Dr. Daniel Edelhoff, Aachen/Germany) shows that oral harmony has been
optimally restored, thanks to the perfect symbiosis of two trendsetting materials. The natural-looking appearance produced by the shape and morphology of the restorations is further
enhanced by the perfectly coordinated pink and white aesthetics. Transmitted light illumination shows the potential of the all-ceramic materials used.

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10 |
Second patient case

In the case shown below, aesthetic restoration of the anterior

teeth of a middle-aged patient was accomplished despite the
presence of severely discoloured tooth stumps and metal core
build-up by placing all-ceramic restorations.

The completed IPS e.max PRESS crowns were tried in using

the Variolink II Try-in Paste (opaque white). Next, they were
conventionally cemented.

Complete masking of the discoloured tooth stumps was

achieved even without using an opaque metal framework.
By using an IPS e.max HO ingot in conjunction with
IPS e.max Ceram, a reduction of the brightness value of
the restoration was avoided.

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 Age-specific layering technique with IPS e.max Ceram

ZirLiner and Margin firing Cervical Dentin – 50/50-mixture of Dentin A2 and CT orange Coverage with Dentin A2 – around two thirds of the original tooth form

A 50/50 mixture of Dentin A2 and Transpa neutral is applied to finalize the anatomical Cut back and mamelon design Personalization of the incisal third with Impulse materials, e.g. MM light, T blue, OE 1,2
form.

12 |
Enhancement of the brightness value with OE 4 Transpa Incisal and a 50/50 mixture of OE 1 and T neutral is added to the labial aspect A halo effect is achieved by lengthening the incisal edge with Incisal Edge material.

MM materials are applied as light blockers at the transition between coping and ceramic The completed crown shows internal characteristics as well as a balanced shade effect and Complete masking of the white zirconium oxide framework can be accomplished even if
build-up. Next, the build-up is finalized with Dentin and Transpa Incisal 1. natural brightness. little space is available in the palatal region.

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 Third patient case

In the patient case shown below, the main focus was placed
on an attractive overall appearance in addition to restoring
tooth function, and thus on highly aesthetic restorations that
blended harmoniously into the oral environment.

The prepared teeth showed slight discoloration. With

IPS e.max ZirLiner, which is applied to the framework, this
type of discolorations can be effectively masked without
completely blocking light transmission.

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By using zirconium oxide in conjunction with the IPS e.max
Ceram veneering ceramic, the high-quality all-ceramic
restoration desired by the patient could be provided with
ease. To see the happy smile on the patient’s face is a most
gratifying experience.

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 e.maximize your smile

My experience has shown that from an aesthetic point of

view, zirconium oxide-based crowns deliver convincing
results, because they blend in perfectly with the adjacent
natural teeth. Particular importance should be placed on
selecting a veneering ceramic that is well-coordinated with
the framework material.

The nano-fluorapatite glass-ceramic IPS e.max Ceram enables

me to translate my perceptions of shape and shade into
concrete form on a one-to-one basis. This allows me to
create restorations that exhibit high light transmission and
impressive shade effects.

The final pictures of the first

patient case presented
clearly show that the wide
array of ceramic materials
provided by the IPS e.max
system offers me creative Incorporated zirconium oxide-crowns in the oral environment. The curvature of the incisal line
freedom and a versatile and the incisogingival length produce a harmonious impression.
range of options to
accurately match the
individual characteristics of
the patient. Thus a natural,
harmonious appearance is
achieved.

Brix Innovative Dental Design

Oliver Brix
Hallwielweg 9
65779 Kelkheim
Germany
Tel. ++49 / 6195-902 984
[email protected]

16 |
| 17
Poster IP
S e.max
Please co Oliver B
ntact Ivo rix
clar Vivad
ent AG,
9494 Sch
aan / Liec
htenstei
n to ord
er this p
oster.

Descriptions and data constitute no warranty of

attributes.
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