empressips esthetic - ivoclar vivadent · ips empress esthetic e tc0 restorations mounted on ips...

Empress® EstheticIPS

Special Edition

M AT T R O B E R T S

INTRODUCTION

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The IPS Empress® pressable ceramicmaterial has been used by ceramists toprovide patients with very esthetic

indirect restorations for more than 17 years.With over 25 million restorations placedworldwide, it's easy to see why IPS Empressmaterials have become the standard forindirect inlay, onlay, full-contour crown, andveneer restorations. IPS Empress wasoriginally designed with surface color andstain, but it was lacking in the area of incisaldetail. Lee Culp and Jürgen Seger starteddoing cutbacks and mixing correctionpowders that were designed for layeringdifferent colors on ingots. I started doing thatshortly after Lee in the early 90’s and weused that successfully until last year, whenIvoclar Vivadent came out with incisallayering porcelains and ingots that workedwell together. This is the history behind thedevelopment of IPS Empress Esthetic.The system's newest components – the IPS Empress Esthetic ingot, IPS EmpressEsthetic Veneering Materials, and IPS Empress Esthetic Wash Pastes – allowyou to optimize the materials performanceand esthetics by refining the optical,chameleon, and functional aspects of therestorations.

The biggest advantage to using the IPS Empress Esthetic system is that you canquickly and accurately transfer the entireenvelope of function and shape of therestoration to your final wax-up fromsuccessful provisionals via an injectionprocess. This not only lends accuracy to thefinal restoration in terms of shape andposition, it also saves substantial waxing

time. You can do this in about 90 secondswith very predictable results, versus the 3 hours it used to take. Historically, thewaxing process for restorations like theseconsisted of a technician dipping a hotinstrument into cold wax and touching it to astone model to build up little piles of waxuntil the whole wax-up was created. Now,using the injection process to capture shapeand other details, the temporaries becomethe “mold” for the finals.

Another advantage realized with IPS EmpressEsthetic is having only to build up the incisaledge if you chose to use the cutbacktechnique. You used to have to layer all theway from the cervical margin to the incisaledge to achieve characterizations. This newingot material accurately replicates enamelover dentin in the gingival half, and you canachieve a little more translucency in theincisal half by doing the type of layeringdescribed in this Special Edition.

Combining the improved homogeneity,natural translucency, and fluorescence of theingots with the 14 new veneer layeringmaterials allows you to create internalcharacterizations, recreate mamelons, andtruly customize natural-looking pressedceramic veneers or anterior crowns. We nowuse it for approximately 80% of therestorations we do in the laboratory. Becausethese new opalescent incisals and shadingmaterials are easy to handle and fire,incorporating this technique into your currentregimen is simple and will yield the estheticresults you, the dentist, and patients willreally be wowed by.

Full face preoperative photo.

Preop close-up of occlusion.

Lateral views demonstrate wear and erosion as well.

Retracted. Preoperative condition displays wear and erosion.

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IPS EMPRESS® ESTHETIC

A Diagnostic wax-up is accomplished, taking into acccount the patients esthetic andocclusal requirements. An impressionof the completed wax-up will beused intra-orally to fabricate thetemporary restorations.

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Wax-UpWax-Up

IPS Empress Esthetic E TC0 restorations mounted on IPS Natural Die Material.

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 detailsof the temporaries. The impression of the temporaries isplaced on the stone model of the prepared teeth. A small holeis made in the incisal edge and liquid wax is injected into thespaces around the preparations to reproduce the shape of thetemporaries on the stone model. Then the wax-up is refined,and any shaping details are designed as necessary for optimalfunction and esthetics. The wax-ups are then invested andpressed using standard techniques.

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Silicone matrix, using SilTech® Putty,being taken of the white temporarymodel.

Injection tool going into the matrix.

White temporary model.

Preliminary wax-up with the sprue stillattached.

Contouring

Fit the restorations from the Stumpf dies back onthe stone model. When the midline is not brokenit is hard to seal margins in wax without compromising the contact. Die spacer has beenadded to the model to create space for lutingmaterials when the restorations are seated.

It is important to use astraight-sided diamondto adjust the inter-ferences and reestablishcontacts without creating black triangles.

Accufilm is used to detect inter-ferences.

Marks from Accufilm indicate inter-ferences to seating.

Contact is reestablished and restorations are fitted back ontothe model.

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Contouring

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Systemp.®link temporary cement isused to hold restorations on themodel. It is important to use a little of the separator from the IPS Natural Die Material Kit on theceramic so it doesn't bond too tenaciously to the die.

Apply a small amount of cement to the die, ...

... push the veneer down onto the die, ...

... and wipe off any excess cement as it extrudes.

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After Systemp.link application, theveneers are light cured to holdrestorations on the dies while theyare being contoured.

An incisal matrix is used to recordthe incisal edge position against thelower arch model.

It is important to trimthe matrix so that thefacial incisal edges ofthe anterior restora-tions are right at theedge of the matrix.Doing this will make iteasy to see any changein the incisal length.


After trimming the matrix, place the restorations back into the matrix to verify they fit accurately.They should be fully seated into the matrix.

The result of detailed waxing is reduced finishingtime; it also will reduce the necessity of grindingthe porcelain. Here, you can see the surface lobeformation detail that was picked up from thewaxing, before any grinding was done.

Embrasure areas are opened slightly to allow illumination of the papilla and prevent a bulky,overcontoured look.

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A smaller diamond is used to soften any transitionlines left by the disk.

Incisal embrasures can also be refined using asmall tapered diamond.

Initial adjustments to the silhouette and reflectiveshape are refined before starting on the surfacemorphology.

Incisal embrasures are refined.

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The mesial half of the middle lobe is formed.

The horizontal structure at the gingival half isestablished.

Creating reflective facets.

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Surface TextureSurface Texture

The matrix is re-checked after contouring, and before cutback.

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Final contours complete.

Canine disclusion is evaluated. Note that the canine disclusion isclearing any balancing interferences.

Evaluating canine guidance on theother side.

Balancing side.


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The functional evaluation detected the need for further restorative treatment to thelower anterior teeth to distribute occlusal forces. The dentist was informed that the end-to-end protrusive position demonstrated that the forces of occlusion would not be evenlyspread across the lower teeth. This was corrected with direct composite restorations onthe lower central and lateral teeth in this case. This diagnosis could also have been treated with additional porcelain veneers.

FunctionEvaluating Envelope of Function

Because this is a pressed ceramic material, the whole tooth isthe same color and value. Natural teeth are different colorsand translucencies at the margins and around the incisal edge.Choose an ingot that is an appropriate base color for the gingival half of the tooth that won't need to be layered overto look natural. The base ingot willalso filter the underlying tooth colorand provide the right shade, texture,luster, and translucency to the surface.

In the incisal area, the base materialis too dense to replicate the internalstructure we see in natural teeth, sowe cut away the area we want to bemore translucent in a very systematicmanner. First, shorten the teeth bythe amount of translucency youwant, and then feather it from thefacial and the lingual to create a very sharp-edged cutback. Note thevertical cutback on tooth No. 11 and the whole facial cutbackprior to dental lobing on tooth No. 21. You can see how muchit has been shortened in the process of cutting back.

A diamond-impregnated wheel isused to cut back the incisal edge atan angle.

The cutback should form a rounded edge toensure blending into the more translucent incisalarea. The base material should fade out to createa zone of transition between the two opacities.

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EffectsCutback for Incisal Effects


Note the dentin lobing created during the cutback phase.Typically, the central incisors have three dentin lobes that arelike opaque fingers running through the translucent incisaledge. The lobes you cut into the incisal edge should look like a serrated knife blade; however, be careful not to create sharplines of demarcation.

Dentin lobe formations are reflected in incisaltranslucency patterns; the cutback should represent dentin lobe shapes.

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 dentin whenstaining these restorations. After the cutbacks arefinished put the restorations on the Stumpf diesto verify the color of the underlying material,what the dentist/patient’s desired color is, andstart applying stains to characterize the teeth andmake them look more natural. On the cutback, Iuse the wash pastes. Paint the pastes on the teethand the interface that has been cut back in theincisal area to create some internal effects (whichwill later be layered over) in the incisal third.

The matrix is used to evaluate the amount ofincisal translucency created. Evaluate the overallshape of the translucency pattern and establishhow much of a translucency band you're going tohave on the various teeth. At this point, you canadjust the amount of reduction. Using the matrixkeeps you oriented to where the shape should be.The matrix can be made from the temporarymodel, and then checked again repeatedly on thepressed-ceramic model until the restorations arefinished.

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Wash pastes are used to create characterizationeffects in the incisal third and to establish a bondwith layering materials. After the colored pastesare fired, clear neutral wash paste is applied tothe remaining incisal third.

Reverse illumination shows the translucencyachieved just by thinning the incisal cutback. Thishelps prevent a harsh translucency demarcationline in the incisal third.

This series demonstrates how the incisallayering is accomplished. Here, incisalwhite powder is used on the mesial, distaland as an accent in several places inbetween.

Small amounts of yellow also are used,primarily in the middle of the incisal.

For this case I used IPS Empress Esthetic Incisalpowders white, yellow, blue and Opal Incisal HT(High Translucent).

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Layering Layering for Incisal Effect

Some of the blue is placed just outside of thewhite to create a little band of translucencyaround the mesial and distal corners.

Fill in with Opal Incisal HT (HighTranslucent) to silhouette the structure shapes we just created.This achieves a thin band of translucency.

The silhouette of the tooth is filledout, but note that the buildup isvery thin facial-lingually and is stillundercontoured. This will serve as apalette for stains and mamelonpastes. This also provides a two-dimensional silhouette of how thetooth will look from the facialincisal-edge position.

The completed silhouette on the central incisor.


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Cuspids also display their own unique translucency patterns.

Note: the dentin lobe patterns in laterals differsfrom those in centrals.

The effect buildup is kept very, very thin, just like the cutback.

Backlighting helps you see where the procelain is from a facial view.

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Next, the mamelon wash pastes areadded. High Value paste is used onthe mesial and distal, and a fewstreaks are placed in the middle ofthe tooth. This is starting to give theincisal edge a little more pizzazz.

Here, we're adding Mamelon Light-Salmon throughout the incisal, andYellow-Orange or Reddish-Orangeto create accents in the middle.

A splayed porcelain brush is used tofeather the effects and to blendthem in lightly at the incisal edge.

If necessary, incisal effects can bemodified by adding more porcelainor grinding away excess before filling out to final contour.

Fired result of the incisal palate andthe mamelon effects.

The fired result of all these effects is a very dynamic, polychromatic color gradation in theincisal third of the teeth.

A low-value blue is used on themesial and distal to provide inter-proximal translucency.

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Opal Incisal HT (High Translucent) is then used to complete the desired contour and encapsulate all the previous effects.

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.

The gingival half of the restorationsare complete, but the incisal thirdmust be contoured to blend withgingival lobe patterns.

Second incisal correction buildup to fill any deficient areas.

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Incisal after firing, but before grinding. Incisal shape is reestablished by grinding withoutadversely affecting the finished gingival areas.

The midline and incisal plane are evaluated witha horizontal plane tool and stick-bite. The stickwas set up to be level with the patient's eyes. Ourmidline must be perpendicular to that and theincisal edge should follow that line.

Final contour before glazing. IPS Empress Universal Glaze is applied.


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The solid model is trimmed with a sharpened carbide bur in a high-speed handpiece to open upthe sulcus without damaging the tissue detail.

Small corrections are made to control the shapeof the incisal embrasures, improve contours, fill inany black triangles gingivally, etc, and fired.

The restorations are set on the stone model andproximal contacts are adjusted with Accufilm.

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 place toensure that the final restorations tuck right in tothe patient's soft tissue, look natural, and will notcause any clinical problems.

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Contacts should extend from the incisal embrasure to the tip of the papilla, thus preventing any black triangles above tissue level.

Reverse illumination captures the opalescense ofthe incisal materials.

An explosion of color demonstratedwith special photography.

Clinical photos taken the day of placement. The patient had undergone 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!


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Descriptions and data constitute no warranty of attributes.Printed in Liechtenstein © Ivoclar Vivadent AG, Schaan/Liechtenstein600047/0106/e/BVD

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