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Strength, esthetics drive selection of restorative material in unusual case

Final outcome is deemed a success by the restoring dentist and patient. (Photo: Drake Laboratory)
Dental Tribune USA

Dental Tribune USA

Thu. 8 May 2014

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In the esthetic restorative material arena, Ivoclar Vivadent once again has found an ideal niche with its IPS e-max lithium disilcate product. The application as a full contour restorative material provides improved strength and cementability that compares to the original, extremely successful, pressed Empress formulation. Designed with simplicity and versatility in mind, e-max is available for both the PRESS and CAD/CAM techniques.

When utilizing the PRESS technique, two different types of ingots are available: IPS e.max Press, a high-strength glass-ceramic, and IPS e.max ZirPress, an esthetic glass-ceramic that is pressed onto zirconium oxide in a fast and efficient procedure. Pressed flexural strength is 400 mpa.

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For CAD/CAM applications, either the highly esthetic IPS e.max CAD ceramic glass blocks or the high-strength IPS e.max ZirCAD zirconium oxide can be selected, depending on the case requirements (Fig. 1).

The nano-fluorapatite layering ceramic IPS e.max Ceram completes the all-ceramic system. This material is used to veneer all IPS e.max components, no matter if they are glass-ceramic or zirconium oxide. Milled flexural strength is 360 mpa.

Case study

The patient presented with a desire to improve the appearance of her smile. She is an early-40s female in excellent general health.

The overall patient desire was a bright and white smile with as many improvements to gingival outline and occlusal relationship as possible. The patient was not interested in orthodontic treatment and wanted as much improvement as could be created with restorative treatment. The entire upper arch was in need of restorative treatment, so a full arch plan was developed (Fig. 2).

Following standard procedure with cases involving anterior guidance, the procedure began with facebow-mounted models in centric relation. It was determined that a slight increase in vertical dimension was indicated for restorative convenience. Also, the lower occlusal plane was erratic and inappropriate.

A complete diagnostic wax-up was developed to simulate the improved occlusal plane and proposed gingival outline of final restorations at the raised vertical. Incisal edge position, and final restoration contours were developed with this wax-up.

Upon approval, the wax-up was converted to a provisional restoration through the use of a putty matrix. The entire arch was prepared and the provisional was relined to accommodate the preparation discrepancy and gingivectomy performed at the time of preparation.

The patient was evaluated multiple times postoperatively to perfect the appearance of the provisional and to evaluate lip support, occlusion and phonetics. Once all patient expectations were achieved, the provisional was impressed to be used as the final blueprint for the case.

Final impressions were taken, and the case was mounted in such a way as to cross mount the approved provisional and the die model. A labial incisal matrix was developed, into which the permanent restorations could be built.

Based on its physical and esthetic properties, e-max was chosen as the restorative material. Wax patterns were developed for pressing, simulating a “cut back” upon which final porcelain layering could be accomplished.

The case was developed by Drake Laboratory (Charlotte, N.C.) and delivered. Post-op visits consisted of minor occlusal modifications and production of an occlusal splint to be worn at night.

The patient was very pleased with the final result. Although the case was compromised because of the lack of pretreatment orthodontics, the final outcome was deemed a success by both the restoring dentist and the patient (Figs. 3, 4).

Conclusion

The type of predictability exhibited in this case study is possible because of many factors. Chief among them are proper evaluation and planning combined with the skill of the clinician and technician.

The Ivoclar IPS e-max material selected for the case ensured functional and esthetic success.

(Source: Drake Laboratory)

Note: This article was published in Cosmetic Tribune U.S. Edition, Vol. 7, No. 1, April 2014 issue.

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