In this “blue” phase, the restorations can be manually adjusted or cut-back in a fast and efficient fashion. IPS e.max CAD acquires its final strength of 360 MPa and the desired esthetic characteristics, such as tooth color, translucency and brightness, during a simple and quick crystallization process at 850 °C. Subsequently, the crowns can be stained and glazed or veneered with IPS e.max Ceram.
PREPARATION GUIDELINES AND MINIMUM THICKNESSES
Successful results can only be achieved with IPS e.max CAD if the guidelines and framework thicknesses are strictly observed.
Veneer
If possible, the preparation should be entirely located in the enamel. The incisal preparation margins should not be located in the area of the abrasion surfaces or dynamic occlusal surfaces. By preparing orientation grooves using a depth marker, controlled enamel reduction can be achieved. Dissolution of the proximal contacts is not required. For preparation without involving reduction of the incisal edge (only labial reduction), the preparation depth in the labial area should be at least 0.6 mm. For preparation involving reduction of the incisal edge (labial/incisal reduction), the preparation depth in the cervical and labial area should be at least 0.6 mm. The incisal edge must be reduced by 0.7 mm. The extent of the incisal reduction depends on the desired translucency of the incisal area to be built up. The more transparent the incisal edge of
the intended veneer, the more pronounced the reduction should be. Discoloured teeth may require more preparation.
Partial crown
Provide at least 1.5 mm of space in the cusp areas. Partial crowns are indicated if the preparation margin is less than approx. 0.5 mm away from the cusp tip, or if the enamel is severely undermined. The shoulder should be prepared without a chamfer, i.e. in a 90° angle to the residual tooth structure.
Anterior and posterior crowns
The anatomic shape is evenly reduced while observing the given minimum framework thickness. A circular shoulder is prepared with rounded inner edges or a chamfer at an angle of 10-30ยบ: The width of the circular shoulder/chamfer is approx. 1.0 mm. Reduction incisal or occlusal by approx. 1.5 mm. The vestibular or lingual reduction is approximately 1.2 mm for anterior teeth and approximately 1.5 mm for posterior teeth. The incisal edge of the preparation should be at
least 1.0 mm (milling tool geometry) in order to permit optimum milling of the incisal edge during CAD/CAM processing.
Shade Determination
The correct tooth shade is the basis for a restoration with a life-like appearance. After tooth cleaning, the tooth shade of the non-prepared tooth and/or the adjacent teeth is determined. Individual characteristics have to be taken into consideration when determining the tooth shade. If a crown preparation is planned, for example, the cervical shade should also be
determined. In order to achieve true-to-nature results, shade determination should be carried out at daylight. Furthermore, the patient should not wear clothes of intensive colours and/or lipstick. Basically, it has to be kept in mind that the final shade of the restoration is the result of the following individual shades:
– Die shade
– Shade of the ceramic block
– Shade of the layering ceramic
– Shade of the cementation material
IPS e.max Press/CAD LT Materials Shade Guide
Since the IPS e.max CAD blocks demonstrate a bluish shade prior to crystallization, they cannot be used for the selection of the block shades. For that purpose, the materials shade guide is
used, which shows the shade of all the available IPS e.max CAD blocks after crystallization, as well as all the IPS e.max Press ingots.
IPS Natural Die Material
In order to facilitate the reproduction of the tooth shade, the shade of the prepared tooth can be determined with the help of the IPS Natural Die Material shade guide. With the help of the die shade and the desired tooth shade, the corresponding block can be selected. Further information regarding the influence of the die shade on the final shade of the restoration can be found on the combination tables.
Cementation
For the cementation of IPS e.max restorations, you may choose between the tried-and-tested cementation materials from the coordinated assortment of Ivoclar Vivadent.
Variolink® II / Variolink Veneer
The dual-curing, highly aesthetic luting composite Variolink II has been successfully used for more than 10 years and offers excellent clinical results. The light-curing Variolink Veneer is especially indicated for the adhesive cementation of veneers to achieve enhanced shade and translucency effects.
Multilink® Automix
The universal, dual-curing luting composite offers a wide range of indications. Furthermore, it generates a very strong bond on all material surfaces.
Vivaglass® CEM
Vivaglass CEM is an aesthetic glass ionomer cement for the conventional cementation of high-strength all-ceramic restorations (zirconium oxide and lithium disilicate ceramics). Vivaglass CEM contains a particularly transparent glass filler for achieving aesthetic results. LED lights of the bluephase® family are used for the polymerization of light-curing and dual-curing adhesive composites. The high light intensity achieved with bluephase permits comparatively short polymerization times with simultaneous good polymerization depth. Especially for the demanding polymerization of adhesively cemented all-ceramic restorations, bluephase 16i is used. In the process, the entire strength of the high performance LED is utilized. All-ceramic restorations are incorporated as quickly as possible.
Staining/Glazing
IPS e.max CAD Crystall./Glaze Paste
To apply individual characterizations and glaze, please observe the following procedure:
– The extended surface of the restoration must be free of auxiliary firing paste and dry before the IPS e.max CAD Crystall./Shades, Stains, and Glaze are applied.
– Extrude IPS e.max CAD Crystall./Glaze paste from the syringe and mix thoroughly.
– If a slight thinning is desired, the Glaze can be mixed with a little IPS e.max CAD Crystall./Glaze Liquid. Do not thin the material too much, since this will cause the Glaze Paste to run uncontrollably.
– Hold the restoration by the firing pin and apply IPS e.max CAD Crystall./Glaze paste evenly on the entire restoration using a brush.
– Avoid to apply too thick a glaze layer. Avoid pooling, especially on the occlusal surface.
– Too thin a glaze layer may lead to an unsatisfactory gloss.
– If characterizations are desired, the restorations can be individualized using IPS e.max CAD Crystall./Shades and/or IPS e.max CAD Crystall./Stains before crystallization firing.
– Extrude Shades and Stains from the syringe and mix thoroughly.
– The Shades and Stains can be thinned to the desired consistency using IPS e.max CAD Crystall./Glaze Liquid. Do not thin too much, since this will cause the Shades and Stains to run uncontrollably.
– Apply mixed Shades and Stains directly into the unfired glaze layer using a fine brush (2-in-1 technique).
After glazing and staining, the combination firing (Crystallization/Glaze) is conducted in a compatible ceramic furnace (e.g. Programat CS). When placing the objects into the furnace and setting the firing parameters, please observe the following points:
– Place the restoration including the pin into the center of the IPS e.max CAD Crystallization Tray.
– A maximum of 6 restorations can be positioned on the firing tray and crystallized using the combination firing with IPS e.max CAD Crystall./Glaze paste.
Place the glazed and stained restoration including the pin into the center of the IPS e.max CAD Crystallization Tray. Do not use a honey-comb firing tray for crystallization. If additional characterizations or adjustments are required after crystallization, a corrective firing using IPS e.max CAD Crystall./Shades and Stains and Glaze can be conducted. Conduct the combination firing (Crystallization/Glaze) using the following parameters:
Combination Crystallization/Glaze:
Furnace: Programat CS
Program: 1
Stand-by temperature B: 403°C 757°F
Closing time S: 6:00 min
Heating rate t1: 90°C/min 162°F/min
Firing temperature T1: 820°C 1508°F
Holding time H1: 0:10 min
Heating rate t2: 30°C/min 54°F/min
Firing temperature T2: 840°C 1544°F
Holding time H2: 7:00 min
Vacuum 1
11: 550/820°C
12: 1022/1508°F
Vacuum 2
21: 820/840°C
22: 1508/1544°F
Longterm cooling L: 700°C 1292°F
Cooling rate tl: 20°C/min 36°F/min
Correction Firing:
Furnace: Programat CS
Program: 2
Stand-by temperature B: 403°C 757°F
Closing time S: 6:00 min
Heating rate t1: 60°C/min 108°F/min
Firing temperature T1: 840°C 1544°F
Holding time H1: 3:00 min
Heating rate t2: -
Firing temperature T2: –
Holding time H2: –
Vacuum 1:
11: 450°C
12: 842°F
Vacuum 2:
21: 839°C
22: 1542°F
Longterm cooling L: –
Cooling rate tl: –
Please note: these firing parameters are not suitable for the crystallization of IPS e.max CAD MO!
IPS e.max CAD Crystall./Glaze Spray:
Instead of the IPS e.max CAD Crystall./Glaze Paste, IPS e.max CAD Crystall./Glaze Spray may also be used.
Follow the procedure below for this purpose:
– Secure the restoration on a suitable IPS e.max CAD Crystallization Pin as described above.
– Make sure that the auxiliary firing paste (IPS e.max CAD Object Fix Putty or Flow) is flush with the crown margin.
– Before characterization and glazing, the outer surface of the restoration must be dry and free of auxiliary firing paste.
– If characterizations are desired, the restoration may be individualized using IPS e.max CAD Crystall./Shades and IPS e.max CAD Crystall./Stains before the crystallization firing.
– Extrude Shades and Stains from the syringe and mix thoroughly.
– The Shades and Stains can be thinned to the desired consistency using IPS e.max CAD Crystall./Glaze Liquid. Do not thin too much, since this will cause the Shades and Stains to run uncontrollably.
– Apply the mixed Shades and Stains directly on the blue restoration using a brush.
– Observe the Characterization Guide (see page 20) for the application of the Shades and Stains.
Hold the restoration by the IPS e.max CAD Crystallization Pin Spray the IPS e.max CAD Crystall./Glaze Spray directly on the unfired IPS e.max CAD Crystall./Shades and Stains. Spray the restoration from all sides while simultaneously rotating it.
Shake the spray can well between individual bursts. Spray an even layer onto the restoration.
Please observe the following procedure for the application of the IPS e.max CAD Crystall./Glaze Spray:
– Hold the restoration by the IPS e.max CAD Crystallization Pin.
– Shake the spray can well immediately before use until the mixing ball in the container is moving freely (approximately 20 seconds). If the spray is not sufficiently shaken, mainly the propellant is discharged with a spraying burst. This, in turn, results in the glazing powder in the spray not being entirely used up and a residue remaining in the can.
– Observe a distance of 10 cm between the nozzle and the surface to be sprayed.
– Hold the spray can as upright as possible during spraying.
– Spray the restoration from all sides with short bursts while simultaneously rotating the restoration so that an even, covering layer is created. Shake the spray can again between individual bursts.
– Spray the restoration a second time from all sides with short bursts while simultaneously rotating the restoration. Shake the spray can again between individual bursts.
– Wait until the glaze layer is dry and has assumed a whitish colour.
– Areas that do not show an even layer have to be sprayed again.
– Place the restoration in the center of the IPS e.max CAD Crystallization Tray.
– Conduct the combination firing using the stipulated firing parameters (Crystallization/Glaze).
Allow the IPS e.max CAD Crystall./Glaze Spray to dry briefly until a whitish layer has formed.
If required, spray the restoration again to achieve an even Glaze Spray layer on the IPS e.max
CAD restoration. Place the restoration on the IPS e.max CAD Crystallization Tray in the furnace and fire using the stipulated parameters. If additional characterizations or adjustments are required after crystallization, a corrective firing using IPS e.max CAD Crystall./Shades and Stains and Glaze can be conducted.
Conduct the Combination firing (Crystallization/Glaze) in a furnace using the following parameters:
Firing parameters for the Combination firing Crystallization/Glaze
Furnace: Programat CS
Program: 1
Stand-by temperature B: 403°C 757°F
Closing time S: 6:00 min
Heating rate t1: 90°C/min 162°F/min
Firing temperature T1: 820°C 1508°F
Holding time H1: 0:10 min
Heating rate t2: 30°C/min 54°F/min
Firing temperature T2: 840°C 1544°F
Holding time H2: 7:00 min
Vacuum 1:
11: 550/820°C
12: 1022/1508°F
Vacuum 2:
21: 820/840°C
22: 1508/1544°F
Longterm cooling L: 700°C 1292°F
Cooling rate tl: 20°C/min 36°F/min
Correction Firing:
Furnace: Programat CS
Program: 2
Stand-by temperature B: 403°C 757°F
Closing time S: 6:00 min
Heating rate t1: 60°C/min 108°F/min
Firing temperature T1: 840°C 1544°F
Holding time H1: 3:00 min
Heating rate t2: –
Firing temperature T2: –
Holding time H2: –
Vacuum 1:
11: 450°C
12: 842°F
Vacuum 2:
21: 839°C
22: 1542°F
Longterm cooling L: –
Cooling rate tl: –
Etching and Silanating:
Etching of the IPS e.max CAD restoration for 20 seconds using IPS Ceramic Etching Gel Apply Monobond-S on the etched surface, let it react for 60 seconds and blow dry. Irrespective of the cementation method and material used, the IPS e.max CAD restoration is prepared as follows:
– Apply IPS Ceramic Etching Gel on the surface to be etched using a plastic spatula or disposable brush. Prevent the Etching Gel from contacting surfaces that do not have to be etched.
– Allow the IPS Ceramic Etching Gel to react for 20 seconds. A longer etching time does not result in enhanced bonding strength with the cementation material.
– After the reaction time, rinse off Etching Gel under running water into a cup (polyethylene, approx. 250 ml). For neutralization, please observe the Instructions for Use of the IPS Ceramic Etching Gel.
– Thoroughly dry the restoration.
– If the restoration should be adhesively cemented, subsequently apply Monobond-S on the etched surfaces and allow to react for 60 seconds.
– After the reaction time, dry the remaining residue with water- and oil-free air.
Preparing for Cementation
Once the IPS e.max CAD restoration has cooled to room temperature, proceed with the following steps:
– Remove the restoration from the hardened IPS Object Fix Putty / Flow.
– Remove any residue with ultrasound in a water bath and/or with steam
– Do not remove residue with Al2O3 or glass polishing beads.
– Finally, try-in the restoration before permanent cementation.
– Adjustments by grinding of the crystallized restoration are to be avoided whenever possible due to the high final strength of the material. Shape adjustments and occlusal/proximal contact points should have been carried out already in the blue state.
– If adjustments by grinding of the restoration are required, make sure that no overheating of the ceramic occurs.
– Use fine-grained diamonds (<60>
Cementation:
For the cementation of IPS e.max CAD restorations, you may basically choose between the tried-and-tested cementation materials from Ivoclar Vivadent.
Cementation of IPS e.max CAD restorations with Multilink® Automix
For the cementation of IPS e.max CAD restorations with Multilink Automix please proceed as follows:
– Clean the preparation, rinse with water and dry with air.
– Apply Multilink Primer A and B on enamel and dentin.
– Apply Multilink Automix directly into the etched and silanized restoration.
– Place the restoration and remove excess cementation material.
Cementation of IPS e.max CAD restorations with Vivaglass® CEM:
For the cementation of IPS e.max CAD restorations with Vivaglass CEM please proceed as follows:
– Clean the preparation, rinse with water and dry with air.
– Apply mixed Vivaglass CEM into the restoration.
– Place the restoration and remove excess cementation material.
Please observe the detailed processing steps of the respective cementation material:
-Clean preparation, rinse with water and blow dry with air.
-Depending on the cementation material used, subsequently apply the bonding system.
-Apply Multilink Automix directly in the etched and silanated restoration. Set the restoration and remove excess.
-Completed IPS e.max CAD restoration in situ, occlusal and buccal view.
CARE INSTRUCTIONS:
Proxyt® – Professional care
Like natural teeth, high-quality IPS e.max CAD restorations require regular professional care. This is not only beneficial to the health of the gingiva and teeth but also to the overall aesthetic appearance. You can care for valuable surfaces without abrasion using the pumice-free polishing paste Proxyt pink. The low RDA* value = 7 gives you peace of mind of cleaning with a low-abrasion paste. Scientific investigations and longstanding practical experience confirm the gentle effect compared to other pastes.
*Relative Dentin Abrasion
No comments:
Post a Comment