[A short term clinical evaluation of IPS e.max Press all-ceramic crowns]
Purpose: The aim of this study was to evaluate the clinical effect of IPS e.max Press crowns.
Methods: A total of 127 IPS e.max Press crowns was placed in forty-one patients from 2007 to 2009. The crowns were evaluated with a modified USPHS criteria for color match, marginal discoloration, fracture, secondary caries, marginal adaptation and gingival health for a period of 12 to 42 months, with a mean of 28 months after insertion. A,B,C and D ratings were assigned.
Results: 94.49% of the crowns were rated as A and 5.51% rated as B for color match and marginal adaptation. 1.57% of the crowns was detected with marginal discoloration and one crown(0.79%) was detected with veneer chipping. No secondary caries was detected, and 93.70% of the crowns were rated as A, 4.72% rated as B and 1.58% rated as C for gingival health.
Conclusion: IPS e.max Press crowns exhibit excellent clinical performance over a mean evaluation period of 28 months.
DDS Lab Blog
IPS e.max is a versatile, metal-free, high-strength material. It offers superior aesthetics, providing excellent restorations that help increase patient satisfaction. This material is suitable for fabricating single-unit crowns of many varieties: inlays, onlays, veneers, and screw-retained implant crowns. It may also be used to construct three-unit anterior bridges and for cases with minimum preparation dimensions. Other advantages for this material include a precision-fit and nearly-perfect contact between adjacent and opposite teeth. Restorations created using IPS e.max may be conventionally cemented using resin ionomer cement or, when necessary, can be bonded for maximum retention.
When using the press technique, there are two different kinds of ingots that may be used. IPS e.max Press is a high-strength glass ceramic while IPS e.max ZirPress is a highly aesthetic glass ceramic that may be pressed onto the zirconium oxide.
IPS e.max Press Ingots
These are made from lithium disilicate, a biocompatible glass-ceramic material providing the excellent form, function, and fit that make ceramics so renowned. These ingots provide a flexural strength of 500 MPa and are available in seven different ingots.
IPS e.max Press HT
These high-translucency ingots provide characteristics similar to enamel and are suitable for small restorations such as inlays and veneers. Restorations can be customized with the staining technique.
IPS e.max Press MT
Optimal for anterior crowns, these medium-translucency ingots are best for cases requiring a material brighter than HT but more translucent than LT ingots. Restorations made from these ingots are ideal for the cutback technique and for staining.
IPS e.max Press LT
These low translucency ingots are ideal for larger restorations such as posterior crowns with a translucency similar to dentin. Aesthetics can be enhanced using the cutback technique.
IPS e.max Press Multi
These ingots are poly-translucent and polychromatic, providing a natural shade progression from the margin to the edges of the front teeth. They are ideal for creating a strong and highly aesthetic restoration, and although they can be stained or cut back and layered, they can also be finished by simple glazing.
IPS e.max Press MO
Medium-opacity ingots are ideal for restoring slightly discolored teeth, creating lifelike restorations that can be finished using the layering technique.
IPS e.max Press HO
These highly opaque ingots are best used when restoring discolored and darker teeth or where a titanium abutment has been used.
These ingots are ideal for replacing enamel as they have exceptional pearlescent properties, making them excellent for fabricating thin veneers.
IPS e.max ZirPress
These fluorapatite ingots are ideal for restoring IPS e.max ZIrCAD and other zirconium frameworks. With this material, several ingots can be pressed together. The ingots are available in high-translucency, low-translucency, and medium-opacity, as well as gingiva ingots. These ingots are designed for the fabrication of the gingival portion of a restoration and are especially suitable for a larger, implant-retained frameworks.
IPS e.max Ceram
IPS e.max Ceram is a nano-fluorapatite ceramic that may be layered onto lithium disilicate and onto zirconium oxide restorations. It includes a wide range of powders, allowing a skilled ceramist to create aesthetically-pleasing and natural-looking restorations.
IPS e.max provides dental laboratories and clinicians with durable restorations offering the highest visual appearance. Our experienced technical staff can offer advice about individual cases to achieve optimal results when using this product.
Please be reminded that should you wish to discuss case in more detail, our experienced technical team is here to assist you.
Click here to schedule a consultation with our technical team »
Step-by-step: IPS e.max Press
IPS e.max Press lithium disilicate glass ceramic is increasingly being selected as the material of choice for esthetic restorations based on its versatility and strength and its ability to satisfy multiple requirements for technicians.
Additionally, the IPS e.max Press lithium disilicate is available in four different ingot opacities that can be used to satisfy different esthetic demands: High Opacity (HO), Medium Opacity (MO), Lower Translucency (LT), and Higher Translucency (HT).
This is significant because dental ceramists today must accurately match tooth shades while being as productive as possible. The recent introduction of lithium disilicate enables dental laboratories to fabricate esthetic restorations with greater efficiency.
The cutback and layering technique described here is a step-by-step process for using the IPS e.max Press lithium disilicate material not only to precisely and predictably deliver the patient’s desired shade and internal effects, but also to support proper soft-tissue response. The technique results in the creation of natural-looking optical effects by enameling over the imparted characteristics to return the restoration to full contour and blend seamlessly with the natural dentition.
An 18-year-old female entering her freshman year of college presented with an angular fractured maxillary left central incisor (Fig. A). Seven years ago, tooth Nos. 8 and 9 were severely fractured and had since been restored three times with direct bonded composite.
The patient sought more esthetic, functional, and long-lasting restorations. Based upon examination findings, Dr. Wehrkamp and the patient agreed upon a treatment plan that included a take home, tray-based whitening system to establish the lightest baseline shade for her teeth; direct bonded occlusal restorations on tooth Nos. 2, 3, 12, 14, 15, 18, 19, 21, 30, and 31; and placement of IPS e.max Press veneers on tooth Nos. 8 and 9 to restore esthetics and function.
Refer to the slideshow for pictures
In the laboratory
01 A Kois transfer jig was used to mount and fabricate cross-mounted split cast master models.
02 A wax-up was created and contoured to the desired buccal/incisal position. A Siltek matrix was fabricated to capture this (Fig. B).
03 The wax patterns were then cut back to allow for effect and enamel layering and transferred to the sectioned master model (Fig. C).
04 The margins were then sealed and verified, and the wax patterns sprued and invested (Fig. D).
05 The ring was burned out, placed into a pressing furnace (Programat EP 5000), with an HTBL2 ingot and plunger loaded to complete the pressing.
06 After pressing, the pressed units were fitted to the master dies and de-sprued, and desired cutback verified
(Fig. E). With the cutback complete, the restorations were removed from the dies, lightly sandblasted, steam cleaned, and readied for internal stains and effects.
07 A thin layer of propylene glycol was applied to the entire surface of the restoration. Then, e.max stains were applied for internal character modifications and a slight amount of “blue” brushed onto the mesial and distal incisal corners (Fig. F).
08 The restorations were dusted with IPS e.max Ceram Bleach enamel and fired (Fig. G).
09 To extend the mamelon structure, the Siltek matrix was used while applying an equal mixture of 040 enamel and neutral. IPS e.max enamel powder EO2 was used to fill in the void areas of the matrix. Neutral/bleach and translucent OE1 were used to layer the incisal and incisal/facial surfaces in a symmetrical pattern to achieve the desired effect (Fig. H).
10 The restorations were removed from the dies and filled internally with Object Fix and then fired.
11 Another layer of neutral/EO2 bleach, neutral/bleach, and neutral/OE2, as well as IPS e.max powder OE3 were applied to achieve the desired incisal halo.
12 The restorations were fired and fit to the master dies. Contacts, occlusion, and function were established using Accufilm articulating tape and all contours shaped using diamond burs (Brasseler). Surface anatomy and morphology were established to blend the restorations with the surrounding dentition. Goldfinger silver surface paste was applied to verify that surface texture and contours blended well with the adjacent dentition. The restorations were then cleaned, the fit verified on the solid model, and then lightly sandblasted and steamed (Fig. I).
13 Here, e.max stains were applied wherever necessary, the restorations glazed using IPS e.max Fluorescence Glaze, then fired to seal and protect the stain layer (Fig. J).
14 Full embrasures, contacts, and fit of the final restorations were verified.
15 To achieve the desired satin luster and reflectivity, #2 pumice was used to polish the external surface. Ivoclar Ceramic Etching Gel was applied for 15 seconds, rinsed, and dried (Fig. K).
16 Post-operative view of the patient’s final IPS e.max Press veneer restoration in place on tooth Nos. 8 and 9 (Fig. L).
- Step-by-step: Single central solution
- Investing in quality
- Step-by-step: Veneer esthetics
Proven luting materials
IPS e.max Press restorations can be placed with a variety of proven luting materials, which are available for a wide spectrum of indications. Crowns and bridges made of IPS e.max Press accommodate self-adhesive and conventional luting protocols (e.g. SpeedCEM Plus). Inlays, (thin) veneers, occlusal veneers and minimally invasive 1-mm crowns are placed with the adhesive technique (e.g. using Variolink Esthetic).
IPS e.max Press Multi
The innovative Multi ingots are available in selected Bleach BL and A–D shades. The material demonstrates a natural-looking colour transition from the dentin to the incisal areas and therefore imparts monolithic restorations with a highly esthetic appearance. With these ingots, veneers and anterior, posterior and hybrid abutment crowns are fabricated quickly and efficiently. Ideally, these restorations only need to be glazed. If desired, however, they can be modified using the staining or cut-back technique.
IPS e.max Press HT
HT ingots are supplied in 16 A–D and 4 Bleach BL shades. Due to their high translucency – similar to that of natural enamel – these ingots are suitable for producing small restorations (e.g. inlays). Their lifelike "chameleon effect" allows these restorations to adapt seamlessly to the natural tooth structure. The restorations are efficiently customized with the staining technique.
IPS e.max Press MT
The MT ingots are provided in the following shades: A1, A2, A3, A3.5, B1, B2, C1, C2, D2, BL2, BL3 and BL4. These medium-translucency ingots are used in cases where a brighter material than HT and a more translucent material than LT is needed. Restorations made of the MT ingots are ideal for the staining and cut-back techniques.
IPS e.max Press LT
The LT ingots are available in 16 A–D and 4 Bleach BL shades. Their low translucency – similar to that of natural dentin – renders these ingots suitable for creating large restorations (e.g. posterior crowns). The material exhibits true-to-nature brightness and chroma. The esthetic appearance of the restorations is maximized by the cut-back technique.
IPS e.max Press MO
The MO ingots are available in five group shades (MO 0, MO 1, MO 2, MO 3, MO 4). Given their opacity, these ingots are intended for the fabrication of substructures that are placed on vital or slightly discoloured prepared teeth. They form an excellent base for natural-looking restorations completed with the layering technique.
IPS e.max Press HO
The HO ingots are supplied in three group shades (HO 0, HO 1, HO 2). Due to their opacity, these ingots are used to create frameworks on severely discoloured teeth and on titanium abutments. They successfully mask dark backgrounds to achieve highly esthetic results. The anatomical shape of the restorations is customized with IPS e.max Ceram.
IPS e.max Press Impulse
The Impulse ingots are available in two different levels of brightness (Opal 1, Opal 2). The restorations produced with these ingots have exceptionally opalescent properties. Therefore, this material is ideal for producing (thin) veneers for light teeth, which require an opalescent effect.
Proven, high-strength material for long-lasting clinical results; flexible cementation options
Lifelike esthetics, regardless of the shade of the prepared tooth
Polychromatic Multi ingots for utmost efficiency
Five levels of translucency and additional Impulse ingots for maximum flexibility
Minimally invasive, accurately fitting restorations
Adhesive, self-adhesive, or conventional cementation options depending on the indication
Thin veneers (0.3 mm), veneers
Inlays, onlays, partial crowns
Minimally invasive crowns (≥ 1 mm)
Three-unit bridges (up to the second premolar as the terminal abutment)
Hybrid abutments and hybrid abutment crowns
IPS e.max Press Multi
A lifelike colour transition from the dentin region to the incisal areas imparts monolithic IPS e.max Press Multi restorations with a highly esthetic appearance.
The IPS e.max Press Multi ingots revolutionize the press technique. They are composed of the clinically proven lithium disilicate glass-ceramic (LS2) and show a graduated level of shade and translucency similar to that of natural teeth: The chroma and opacity of the material are higher in the cervical and dentin region, and the incisal areas are suitably translucent. Highly effective results are achieved in a single press sequence with subsequent glazing: Press in multi-colour and glaze and finish spectacularly!
Combination of press technique and CAD/CAM technology
With the software add-on IPS e.max Digital Press Design – Press Multi*, the sprues are automatically positioned at the virtual IPS e.max Press Multi restoration. The position of the wax pattern can be individually controlled. The milled wax objects optimized for the IPS e.max Press, e.g. ProArt CAD Wax yellow, are subsequently pressed. The IPS e.max Press Multi ingots are available in one size and in the following shades: A1, A2, A3, A3.5, B1, B2, C1, C2, D2 and BL2.
*The software add-on is part of the Add-on Solutions and builds on the standard software Dental Designer 2015 (from version 15.5.0) from 3Shape.
E.max press ips
IPS e.max Press (5 yr)
IPS e.max Press (Ivoclar Vivadent) is a high-strength, lithium disilicate ceramic used for anterior and posterior restorations as well as anterior three-unit bridges. IPS e.max Press can be overlaid with IPS e.max Ceram to optimize esthetics. This product received a 97% clinical rating.
Clinical Evaluation Protocol
• Four dentists placed 671 IPS e.max restorations in 282 patients over a five-year period.
• Three hundred eighty-one restorations were evaluated (Figure 1).
• Sixty-eight percent of these were in function for five years while the remaining 32% were in function for less than five years (Figure 1). The restorations represented a variety of anterior and posterior crowns as well as inlays and onlays (Figure 2).
• Before cementation the internal surfaces of all restorations were etched with 5% hydrofluoric acid gel for 20 seconds, then rinsed and coated with a silane (Monobond Plus). All were cemented with either self-adhesive resin or esthetic resin cements (Figure 3). Esthetics, resistance to fracture or chipping, resistance to marginal discoloration, lack of sensitivity, and retention were evaluated and rated on a 1 to 5 scale (1=poor, 2=fair, 3=good, 4= very good, 5= excellent).
Results at Five Years
Ninety-seven percent of the IPS e.max Press restorations received a five or an excellent rating (Figure 4). The restorations were not only clinically acceptable but also of superior esthetic quality. Many patients remarked positively on the esthetics of the restorations. Figure 5 shows an IPS e.max Press onlay at five years. Only 6% of the restorations were slightly opaque and lacked sufficient translucency, which could be a function of ingot selection.
Resistance to Fracture/Chipping
Of the 381 restorations evaluated, seven fractured and were replaced over the 5 year period (Figure 4). Only 1.5% of the restorations exhibited some chipping and these were smoothed and polished. Less than 2% fractured and were replaced. This fracture rate is less than half the average fracture rate of ceramics documented by THE DENTAL ADVISOR over the past 27 years.
Resistance to Marginal Discoloration
The lack of marginal discoloration of the restorations was excellent in 96% of the cases (Figure 4). Leakage at the margins is not just related to the fit but more to the bonding and the resin cement. In 2% of the recalled cases, some graying at the margins was noted but none necessitated their replacement at five years.
Lack of Sensitivity
Only seven cases (1.5%) of postoperative sensitivity were reported by patients (Figure 4). All except for one were mild in nature and subsided over time.
Twelve restorations (4%) debonded and needed to be recemented (Figure 4). This debonding rate is similar to debonding rates of other all-ceramic restorations monitored over 27 years by THE DENTAL ADVISOR and is related to the preparation and the cement rather than the ceramic.
IPS e.max Press has proven to be a very esthetic, high-strength, durable material with excellent clinical performance over the five years. Its performance has exceeded that of traditional PFM restorations as well as many all-ceramic restorations. IPS e.max Press is highly recommended by THE DENTAL ADVISOR.
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