matt roberts-final
DESCRIPTION
Special Edition IPS M AT T R O B E R T STRANSCRIPT
Empress® EstheticIPS
Special Edition
M AT T R O B E R T S
INTRODUCTION
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The IPS Empress® pressableceramic material has been usedby ceramists to provide patients
with very esthetic indirect restorationsfor more than 17 years. With over 25million restorations placed worldwide,it's easy to see why IPS Empressmaterials have become the standardfor indirect inlay, onlay, full-contourcrown, and veneer restorations. IPSEmpress was originally designed withsurface color and stain, but it waslacking in the area of incisal detail. LeeCulp started doing cutbacks and mixingcorrection powders that were designedfor layering different colors on ingots.I started doing that shortly after Lee inthe early 90’s and we used thatsuccessfully until last year, when IvoclarVivadent came out with incisal layeringporcelains and ingots that worked welltogether. This is the history behind thedevelopment of IPS Empress Esthetic.The system's newest components - theIPS Empress Esthetic ingot, IPS EmpressEsthetic Veneering Materials, and IPSEmpress Esthetic Wash Pastes - allowyou to optimize the materialsperformance and esthetics by refiningthe optical, chameleon, and functionalaspects of the restorations.
The biggest advantage to using the IPSEmpress Esthetic system is that you canquickly and accurately transfer theentire envelope of function and shapeof the restoration to your final wax-upfrom successful provisionals via aninjection process. This not only lendsaccuracy to the final restoration interms of shape and position, it alsosaves substantial waxing time. You cando this in about 90 seconds with verypredictable results, versus the 3 hoursit used to take. Historically, the waxing
process for restorations like theseconsisted of a technician dipping a hotinstrument into cold wax and touchingit to a stone model to build up littlepiles of wax until the whole wax-upwas created. Now, using the injectionprocess to capture shape and otherdetails, the temporaries become the“mold” for the finals.
Another advantage realized with IPSEmpress Esthetic is having only tobuild up the incisal edge if you choseto use the cutback technique. You usedto have to layer all the way from thecervical margin to the incisal edge toachieve characterizations. This newingot material accurately replicatesenamel over dentin in the gingivalhalf, and you can achieve a little moretranslucency in the incisal half bydoing the type of layering described inthis Special Edition.
Combining the improved homogeneity,natural translucency, and fluorescenceof the ingots with the 14 new veneerlayering materials allows you to createinternal characterizations, recreatemamelons, and truly customizenatural-looking pressed ceramicveneers or anterior crowns. We nowuse it for approximately 80% of therestorations we do in the laboratory.Because these new opalescent incisalsand shading materials are easy tohandle and fire, incorporating thistechnique into your current regimen issimple and will yield the estheticresults you, the dentist, and patientswill really be wowed by.
Figure 1-Full face preoperative photo.
Figure 2-Preop close-up of occlusion.
Figure 4a, b, cLateral views demonstrate the wear anderosion.
Figure 3-Retracted. Preoperative condition displays wear and erosion.
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IPS EMPRESS® ESTHETIC
4b
4a
4c
Figure 5-A Diagnostic wax-up is accomplished,taking into acccount the patientsesthetic and occlusal requirements. Animpression of the completed wax-upwill be used intra-orally to fabricatethe temporary restorations.
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5a
5b 5c
5d
Wax-UpWax-Up
Figure 8-IPS Empress Esthetic ETC0 restorations mounted on Stumpf dies.
Figure 6-After the provisional restorations are approved, they arecemented with temporary cement and a photograph is taken.An impression is made to capture the shape and other details ofthe temporaries. The impression of the temporaries is placed onthe stone model of the prepared teeth. A small hole is made inthe incisal edge and liquid wax is injected into the spacesaround the preparations to reproduce the shape of the tempo-raries on the stone model. Then the wax-up is refined, and anyshaping details are designed as necessary for optimal functionand esthetics. The wax-ups are then invested and pressed usingstandard techniques.
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Figure 7a-Silicone matrix, using SilTech®
Putty, being taken of the whitetemporary model.
Figure 7c-Injection tool going into thematrix.
Figure 7b-White temporary model.
Figure 7d-Preliminary wax-up with the spruestill attached.
7a 7b
7c 7d
Contouring
Figures 9Fit the restorations from the Stumpfdies back on the stone model. Whenthe midline is not broken it is hard toseal margins in wax without compro-mising the contact. Die spacer has beenadded to the model to create space forluting materials when the restorationsare seated.
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Figure 10-Adjusting contacts.
Figure 13-It is important to use a straight-sided diamond to adjust theinterferences and reestablishcontacts without creating blacktriangles.
Figure 11-Accufilm is used to detect interferences.
Figure 12-Marks from Accufilm indicateinterferences to seating.
Figure 14-Contact is reestablished and restora-tions are fitted back onto the model.
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Contouring
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IPS EMPRESS® ESTHETIC
Figure 15a, b, c, dProvilink® temporary cement is usedto hold restorations on the model. Itis important to use a little of the sep-arator from the Stumpf die kit on theceramic so it doesn't bond too tena-ciously to the die. Apply a smallamount of cement to the die, pushthe veneer down onto the die, andwipe off any excess cement as itextrudes.
15a 15b
15c
15d
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Figure 16-After Provilink application, the veneers are lightcured to hold restorations on the dies while theyare being contoured.
Figure 17-An incisal matrix is used to record the incisal edgeposition against the lower arch model.
Figure 18It is important to trim thematrix so that the facialincisal edges of the anteri-or restorations are right atthe edge of the matrix.Doing this will make it easyto see any change in theincisal length
IPS EMPRESS® ESTHETIC
Figure 19-After trimming the matrix, place the restorations back into the matrix to verify they fit accurately. They should be fully seated into the matrix.
Figure 20-The result of detailed waxing is reduced finishing time; it also will reduce the necessity of grinding the porcelain. Here,you can see the surface lobe formationdetail that was picked up from the waxing,before any grinding was done.
Figure 21-Embrasure areas are opened slightly toallow illumination of the papilla and prevent a bulky, overcontoured look.
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Figure 23-A smaller diamond is used to soften anytransition lines left by the disk.
Figure 24-Incisal embrasures can also be refined usinga small tapered diamond.
Figure 25-Initial adjustments to the silhouette andreflective shape are refined before startingon the surface morphology.
Figure 22-Incisal embrasures are refined.
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Figure 26-The mesial half of the middle lobe isformed.
Figure 27-The horizontal structure at the gingivalhalf is established.
Figure 28-Creating reflective facets.
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Surface TextureSurface Texture
Figure 29-The matrix is re-checked after contouring, and before cutback.
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Figure 30-Final contours complete.
Figure 33-Canine disclusion is evaluated.
Figure 34-Note that the canine disclusion isclearing any balancing interferences.
Figure 35-Evaluating canine guidance on theother side.
Figure 36-Balancing side.
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Figure 31-32The functional evaluation detected the need for further restorative treatment to thelower anterior teeth to distribute occlusal forces. The dentist was informed that theend-to-end protrusive position demonstrated that the forces of occlusion would not beevenly spread across the lower teeth. This was corrected with direct composite restora-tions on the lower central and lateral teeth in this case. This diagnosis could also havebeen treated with additional porcelain veneers.
FunctionEvaluating Envelope of Function
Figure 37-Because this is a pressed ceramic material, thewhole tooth is the same color and value.Natural teeth are different colors and translu-cencies at the margins and around the incisaledge. Choose an ingot that is an appropriatebase color for the gingival half of the tooththat won't need to be layered over to looknatural. The base ingot will also filter theunderlying tooth color and provide the rightshade, texture, luster, and translucency to thesurface.
In the incisal area, the base material is toodense to replicate the internal structure wesee in natural teeth, so we cut away the areawe want to be more translucent in a very sys-tematic manner. First, shorten the teeth by theamount of translucency you want, and thenfeather it from the facial and the lingual tocreate a very sharp-edged cutback. Note thevertical cutback on tooth No. 8 and the wholefacial cutback prior to dental lobing on toothNo 9. You can see how much it has been short-ened in the process of cutting back.
Figure 38-A diamond-impregnated wheel is used tocut back the incisal edge at an angle.
Figure 39-The cutback should form a rounded edgeto ensure blending into the more translu-cent incisal area. The base material shouldfade out to create a zone of transitionbetween the two opacities.
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EffectsCutback for Incisal Effects
IPS EMPRESS® ESTHETIC
Figure 40-Note the dentin lobing created during thecutback phase. Typically, the central incisorshave three dentin lobes that are likeopaque fingers running through the translu-cent incisal edge. The lobes you cut into theincisal edge should look like a serrated knifeblade; however, be careful not to createsharp lines of demarcation.
Figure 41-Dentin lobe formations are reflected in incisaltranslucency patterns; the cutback should represent dentin lobe shapes.
Figure 43-Much of the color seen in IPS Empress Estheticrestorations comes from the underlying dentinlayer, so it is important to use composite Stumpfdies, which replicate the color of the dentinwhen staining these restorations. After the cut-backs are finished put the restorations on theStumpf dies to verify the color of the underlyingmaterial, what the dentist/patient’s desired coloris, and start applying stains to characterize theteeth and make them look more natural. On thecutback, I use the wash pastes. Paint the pasteson the teeth and the interface that has been cutback in the incisal area to create some internaleffects (which will later be layered over) in theincisal third.
Figure 42-The matrix is used to evaluate the amount ofincisal translucency created. Evaluate theoverall shape of the translucency pattern andestablish how much of a translucency bandyou're going to have on the various teeth. Atthis point, you can adjust the amount ofreduction. Using the matrix keeps you orient-ed to where the shape should be. The matrixcan be made from the temporary model, andthen checked again repeatedly on thepressed-ceramic model until the restorationsare finished.
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Figure 45-Wash pastes are used to create characteri-zation effects in the incisal third and toestablish a bond with layering materials.After the colored pastes are fired, clearneutral wash paste is applied to theremaining incisal third.
Figure 44-Reverse illumination shows thetranslucency achieved just by thinningthe incisal cutback. This helps preventa harsh translucency demarcation linein the incisal third.
Figure 47-This series demonstrates how theincisal layering is accomplished. Here,incisal white powder is used on themesial, distal and as an accent in sev-eral places in between.
Figure 48-Small amounts of yellow also are used,primarily in the middle of the incisal.
Figure 46-For this case I used IPS EmpressEsthetic incisal powders white, yel-low, blue and opal incisal hightranslucency.
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Layering Layering for Incisal Effect
Figure 49-Some of the Blue is placed just outside of the whiteto create a little band of translucency around themesial and distal corners.
Figure 50-Fill in with Opal Incisal HighTranslucency to silhouette the struc-ture shapes we just created. Thisachieves a thin band of translucency.
Figure 51-The silhouette of the tooth is filled out, but note thatthe buildup is very thin facial-lingually and is stillundercontoured. This will serve as a palette for stainsand mamelon pastes. This also provides a two-dimen-sional silhouette of how the tooth will look from thefacial incisal-edge position.
Figure 52-The completed silhouetteon the central incisor.
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Figure 54-Cuspids also display their own uniquetranslucency patterns.
Figure 53-Note: the dentin lobe patterns in laterals differs from those in centrals.
Figure 55-The effect buildup is kept very, verythin, just like the cutback.
Figure 56-Backlighting helps you see where the procelain isfrom a facial view.
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Figure 57-Next, the mamelon wash pastes are added. HighValue paste is used on the mesial and distal, anda few streaks are placed in the middle of thetooth. This is starting to give the incisal edge a little more pizzazz.
Figure 58-Here, we're adding Mamelon Light-Salmonthroughout the incisal, and Yellow-Orange or Reddish-Orange to create accents in themiddle.
Figure 59-A splayed porcelain brush is used to featherthe effects and to blend them in lightly atthe incisal edge.
Figure 62-If necessary, incisal effects can be modifiedby adding more porcelain or grinding awayexcess before filling out to final contour.
Figure 63-Fired result of the incisal palate and the mameloneffects.
Figure 61-The fired result of all these effects is a very dynamic, polychromatic color gradiation in the incisalthird of the teeth.
Figure 60-A low-value blue is used on the mesial anddistal to provide interproximal translucency.
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Figure 64-65-Opal Incisal High Translucency is then used to complete the desired contour and encapsulate all the previous effects.
Figure 66-67-After a layer of High Translucency is fired over the effects palette, halos will form naturally in this material or can be enhanced with an opacified incisal edge material.
Figure 68-The gingival half of the restorations arecomplete, but incisal third must be contoured to blend with gingival lobepatterns.
Figure 69-Second incisal correction buildup to fillany deficient areas.
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Figure 70-Incisal after firing, but before grinding.
Figure 71-Incisal shape is reestablished by grindingwithout adversely affecting the finishedgingival areas.
Figure 72-The midline and incisal plane areevaluated with a horizontal planetool and stick-bite. The stick was setup to be level with the patient'seyes. Our midline must be perpendi-cular to that and the incisal edgeshould follow that line.
Figure 73-Final contour before glazing.
Figure 74-Universal glaze is applied.
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Figure 76-The solid model is trimmed with a sharpenedcarbide bur in a high-speed handpiece toopen up the sulcus without damaging thetissue detail.
Figure 78-Small corrections are made to control the shapeof the incisal embrasures, improve contours, fillin any black triangles gingivally, etc, and fired.
Figure 77-The restorations are set on the stone modeland proximal contacts are adjusted withAccufilm.
Figure 75-Incisal translucency patterns are soft, feathery,and natural in appearance. After everything isglazed, the next step in creating high qualityrestorations is to fit the veneers to a solid modelwith the tissue/gingival architecture still intact. Ispend a lot of time fitting and adjusting therestorations to a solid stone model that has notbeen sawed and still has the soft tissue in placeto ensure that the final restorations tuck rightin to the patient's soft tissue, look natural, andwill not cause any clinical problems.
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Figure 79-Contacts should extend from the incisal embrasureto the tip of the papilla, thus preventing any blacktriangles above tissue level.
Figure 80-Reverse illumination captures theopalescense of the incisal materials.
Figure 81-An explosion of color demonstrated with special photography.
Figure 82-85-Clinical photos taken the day ofplacement. The patient had under-gone tooth whitening and therestorations are a perfect match.
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Two Months Restorations Two Months
After Placement
Press for Fit...Layer for Beauty!
IPS EMPRESS® ESTHETIC
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USA CANADA175 Pineview Drive 2785 Skymark Ave. Unit 1Amherst, NY 14228 Mississauga, Ontario L4W 4Y3716.691.0010 905.238.57001.800.533.6825 1.800.263.8182 (Inside Canada)716.691.2285 Fax 905.238.5711 Faxwww.ivoclarvivadent.us.com [email protected] [email protected]
© 2005 Ivoclar Vivadent, Inc. IPS Empress and Provilink are registered trademarks of Ivoclar Vivadent, Inc.Restorations and photography courtesy of Matt Roberts and Dr. Tom Trinkner.