Ivoclar Vivadent IPS e.max CAD Chairside User Manual

CAD

all ceramic

all you need

Instructions for use

c h a i r s i d e

Table of Contents

3 IPS e.max System – one system for every indication

CAD

pr o d u c t

in f o r m a t ion

n o t e s o n p r o c e s s i ng

pr a c t i c a l

4 Product Information Material Usage Composition Scientific Data CAD/CAM Partners Block Concept Preparation Guidelines

11 Overview of the Treatment Procedure Overview of the treatment procedure Shade Determination — Tooth Shade, Shade of the Preparation Intraoral imaging Milling Preparation for Crystallization Characterization / Glaze / Adjustments Combination Firing Preparing for Cementation Cementation

18 Processing Possibilities IPS e.max CAD

19 Staining Technique

Veneers, Inlays, Onlays – Preparation – Finishing – Combination Firing (Crystallization/Glaze firing) – Completion of the Restoration

24 Partial Crowns, Crowns – Preparation – Finishing – Preparing the Restoration for Combination Firing – Combination Firing (Crystallization/Glaze firing) – Option A: Crystallization and Stain/Glaze Firing in One Step with Glaze Spray – Option B: Crystallization and Stain/Glaze Firing in One Step with Glaze Paste – Completion of the Restoration

38 Cut-back Technique

40 Seating and Follow-Up Care Possibilities for Cementation Cementation Recall

CAD

ti o n

45 General Information

Frequently Asked Questions

Table on Block Selection Crystallization and Firing Parameters

in f o r m a

IPS

e.max

System –

all you need

IPS e.max – one system for every indication

IPS e.max is an innovative all-ceramic system which covers the entire all-ceramic indication range – from thin veneers to 12-unit bridges.

IPS e.max delivers high-strength and highly esthetic materials for the Press and the CAD/CAM technologies. The system consists of innovative lithium disilicate glass-ceramics used mainly for single-tooth restorations and high-strength zirconium oxide for large-span bridges.

Every patient situation presents its own requirements and objectives. IPS e.max meets these requirements. Due to the system components you obtain exactly what you need. – The components of the Press technology include the highly esthetic IPS e.max Press lithium disilicate

glass-ceramic ingots and the IPS e.max ZirPress fluorapatite glass-ceramic ingots for the fast and efficient press-on-zirconia technique.

– Depending on the case requirements, two types of materials are available for CAD/CAM techniques:

the innovative IPS e.max CAD lithium disilicate blocks and the high-strength zirconium oxide IPS e.max ZirCAD.

– The nano-fluorapatite layering ceramic IPS e.max Ceram, which is used to characterize/veneer all

IPS e.max components – glass or oxide ceramics – completes the IPS e.max system.

IPS e.max CAD

The shades and translucency levels of the IPS e.max CAD blocks are based on the overarching IPS e.max shade system. The IPS e.max CAD blocks are available in three different levels of opacity; the opaque MO blocks are for labside use (layering technique). The more translucent LT and HT blocks are suitable for the chairside fabrication of fully anatomical restorations (staining technique). The selection of the translucency level is based on the clinical requirements (indication, shade of the prepared tooth, desired tooth shade) presented by the patient.

IPS

e.max

CAD –

Product Information

Material

IPS e.max CAD is a lithium disilicate glass-ceramic block for the CAD/CAM technique. It is fabricated using an innovative process which provides an impressive homogeneity of the material. The block can be processed very easily in a CAD/CAM unit in its pre-crystallized (“blue”) state. The typical and striking colour of the pre-crystallized IPS e.max CAD blocks ranges from whitish to blue and bluish-grey. The shade is a result of the composition and the microstructure of the glass-ceramic. The strength of the material is 130 to 150 MPa and thus comparable to other glass-ceramic blocks currently available on the market. After the IPS e.max CAD blocks are milled, the restoration is crystallized in an Ivoclar Vivadent ceramic furnace (e.g. Programat® CS). Contrary to some other CAD/ CAM ceramics, the crystallization process does not lead to significant shrinking and does not require time-consuming infiltration processes. Crystallization is completed after approx. 20 to 25 minutes. The crystallization at a temperature of 840°C (1544°F) causes a transformation of the microstructure, during which lithium disilicate crystals grow in a controlled manner. The densification of

0.2% is accounted for in the CAD software and taken into account upon milling. The key physical parameters, such as the strength of 360 MPa and the corresponding optical properties, are achieved through the transformation of the microstructure. IPS e.max CAD blocks show a natural brightness. Due to the translucency and shade variety, fully anatomical restorations can easily be fabricated with this glass-ceramic.

CTE (100–500°C) [10-6/K] 10.5 ± 0.5

Flexural strength (biaxial) [MPa] ≥ 360 according to ISO 6872

Fracture toughness [MPa m

Chem. solubility [µg/cm2] ≤ 50 according to ISO 6872

Classification: Ceramic Materials Type 2 / Class 3

0.5

] ≥ 2.0 according to ISO 6872

Usage

Composition

Indications

– Veneers – Inlays – Onlays – Partial crowns – Crowns for anterior and posterior restorations – Implant superstructures for single-tooth restorations (anterior and

posterior region)

Contraindications

– Full veneers on molar crowns – Very deep subgingival preparations – Patients with severely reduced residual dentition – Parafunctions – Any other use not listed in the indications

Important processing restrictions

Failure to observe the following restrictions may compromise the results achieved with IPS e.max CAD: – The frameworks must not fall below the required minimum

thickness. – Do not mill the blocks with non-compatible CAD/CAM systems. – Crystallization must not be conducted in a ceramic furnace that

has no vacuum function. – Crystallization must not be conducted in a ceramic furnace that

has not been calibrated. – Crystallization must not be conducted in a ceramic furnace that

has not been approved and/or recommended. – Crystallization must not be conducted in a high-temperature

furnace (e.g. Programat S1). – Do not mix IPS e.max CAD Crystall./Glaze, Shades and Stains with

other dental ceramics (e.g. IPS e.max Ceram Glaze, Stains and

Essence).

Side effects

If the patient is known to be allergic to any of the components of IPS e.max CAD, the material must not be used to fabricate restorations.

– IPS e.max CAD Blocks

Components: SiO

Additional contents: Li2O, K2O, MgO, Al2O3, P2O5 and other oxides

– IPS e.max CAD Crystall./Glaze, Shades and Stains

Components: oxides, glycols

– IPS e.max CAD Crystall./Glaze Spray

Components: oxides, propanol, propellant: isobutane

– IPS e.max CAD Crystall./Glaze Liquid

Components: butandiol

– IPS e.max CAD Crystall./Add-On

Components: oxides

– IPS e.max CAD Crystall./Add-On Liquid

Components: water, propylene glycol, butandiol and chloride

– IPS Object Fix Putty/Flow

Components: oxides, water, thickening agent

– IPS Contrast Spray Chairside (blue-lemon, cream-lemon)

Components: pigment suspension in ethanol, propellant:

fluorinate hydrocarbon

– IPS Ceramic Etching Gel

Components: hydrofluoric acid (approx. 5%)

Warning

– Do not inhale ceramic dust during finishing — use exhaust air

discharge and mouth protection.

– IPS Ceramic Etching Gel contains hydrofluoric acid. Contact

with skin, eyes and clothing must be prevented at all costs, since the material is extremely toxic and corrosive. The etching gel is intended for extraoral use only and must not be applied intra-orally (inside the mouth).

Scientific Data

Further scientific data (i.e. strength, wear, biocompatibility) are contained in the “Scientific Documentation IPS e.max CAD”. The Documentation also provides a set of studies that describe the clinical performance of IPS e.max CAD. This Scientific Documentation can be obtained from Ivoclar Vivadent.

For further information about all-ceramics and IPS e.max in general, please refer to the Ivoclar Vivadent Reports No. 16 and No. 17.

Scientific Documentation

CAD/CAM partners

IPS e.max CAD has to be processed with an authorized CAD/CAM system. For questions regarding the different systems, please contact the respective cooperation partners.

More information is available on the Internet from www.ivoclarvivadent.com.

Block Concept

IPS e.max CAD is available in the A-D and Bleach BL shades as well as in three levels of translucency (HT, LT, MO) and two sizes (I 12, C 14). From a processing point of view, basically all restorations can

be fabricated from any block. Both the IPS e.max CAD HT and IPS e.max CAD LT blocks are used for chairside applications (staining technique). For reasons of esthetics, however, the following processing techniques and indications are recommended for the individual blocks (translucency levels):

Translucency level

High Translucency

Low Translucency

Medium Opacity

CR %

Processing Technique

Staining

Technique

Cut-Back

Layering

Technique

Inlays Onlays Veneers Partial

✓ ✓ ✓ ✓

✓

Indications

Crowns

✓ ✓

Crowns

✓

IPS e.max CAD HT (High Translucency)

The HT Blocks are available in 16 A-D and 4 Bleach BL shades and 2 sizes (I 12, C 14). Given their high translucency, HT blocks are ideally suitable for the fabrication of smaller restorations (e.g. inlays and onlays). Restorations made of HT blocks convince users with their true-to-nature chameleon effect and the exceptional adaption to the remaining tooth structure.

Posterior

Crowns

✓

labside application

* up to the second premolar

IPS e.max CAD LT (Low Translucency)

The LT Blocks are available in 16 A-D and 4 Bleach BL shades and 2 sizes (I 12, C 14). Due to their high brightness values compared to the HT blocks, LT blocks are ideally suitable for the fabrication of larger restorations (e.g. anterior and posterior crowns). Restorations made of LT blocks convince users with their lifelike brightness value and chroma. This prevents the incorporated restorations from graying. The cut-back technique can also be ideally used for restorations made from LT blocks.

The entire IPS e.max delivery program can be found at www.ivoclarvivadent.com!

Preparation Guidelines

0.6

0.7

1.0

1.5

1.0

1.5

1.2 1.2

1.0

0.6

0.7

1.0

1.5

1.2 1.2

1.0

Successful results can only be achieved with IPS e.max CAD if the guidelines and framework thicknesses are strictly observed.

Basic preparation guidelines for all-ceramic restorations

– no angles or sharp edges – shoulder preparation with rounded inner edges and/or chamfer preparation – the indicated dimensions reflect the minimum thickness for IPS e.max CAD restorations – the incisal edge of the preparation, particularly for anterior teeth, should be at least 1.0 mm (milling tool geometry) in

order to permit optimum milling during CAD/CAM processing.

Veneers Anterior crown

– If possible, the preparation should be located in the

enamel.

– The incisal preparation margins should not be located

in the area of static or dynamic enamel contact.

– Reduction in the cervical and/or labial area by 0.6 mm,

and the incisal edge by 0.7 mm.

– Reduce the anatomical shape and observe the

stipulated minimum thickness. Prepare a shoulder with rounded inner edges or a deep chamfer. Width of the

shoulder/chamfer at least 1.0 mm. – Reduce the incisal edge by approx. 1.5 mm. – Reduce the labial or lingual area by approx. 1.2 mm. – For conventional and/or self-adhesive cementation,

the preparation must demonstrate retentive surfaces.

1.0

1.5

1.2 1.2

1.0

1.5

1.0

1.5

6°

0.6

0.7

1.0

6°

1.0

100-120°

1.0

1.5

1.2 1.2

1.0

6°

1.0

100-120°

1.0

1.5

1.2 1.2

1.0

0.6

0.7

1.0

6°

1.0

100-120°

1.0

1.5

1.2 1.2

1.0

6°

1.0

100-120°

6°

1.0

Inlay Onlay

– Static and dynamic antagonist contacts must be taken

into consideration.

– The preparation margins must not be located on

centric antagonist contacts.

– A preparation depth of at least 1.0 mm and an

isthmus width of at least 1.0 mm must be observed in the fissure area.

– Prepare the proximal box with slightly diverging walls

and observe an angle of 100°-120° between the proximal cavity walls and the prospective proximal inlay surfaces.

For inlays with pronounced convex cavity walls with-

out adequate support by the proximal shoulder, marginal ridge contacts should be avoided.

– Round out internal edges in order to prevent stress

concentration within the ceramic material.

– Do not prepare slice-cuts/bevels or feather edges.

Partial crown Posterior crown

– Static and dynamic antagonist contacts must be taken

into consideration. – The preparation margins must not be located on

centric antagonist contacts. – A preparation depth of at least 1.0 mm and an isthmus

width of at least 1.0 mm must be observed in the

fissure area. – Prepare the proximal box with slightly diverging walls

and observe an angle of 100°-120° between the

proximal cavity walls and the prospective proximal

onlay surfaces.

For onlays with pronounced convex cavity walls with-

out adequate support by the proximal shoulder,

marginal ridge contacts should be avoided. – Round out internal edges in order to prevent stress

concentration within the ceramic material. – Do not prepare slice-cuts/bevels or feather edges. – Provide at least 1.0 mm of reduction in the cusp areas.

1.5

1.0

– Static and dynamic antagonist contacts must be taken

into consideration.

– The preparation margins must not be located on

1.5

centric antagonist contacts.

– Provide at least 1.5 mm of reduction in the cusp

areas.

– Prepare a circular shoulder with rounded inner edges

or a deep chamfer. Width of the shoulder/chamfer should be at least 1.0 mm.

1.5

1.0

6°

1.5

1.0

– Reduce the anatomical shape and observe the

stipulated minimum thickness. Prepare a circular

shoulder with rounded inner edges or a deep chamfer.

Width of the shoulder/chamfer at least 1.0 mm. – Reduce the incisal crown third by approx. 1.5 mm. – Reduce the buccal or lingual area by approx. 1.5 mm. – For conventional and/or self-adhesive cementation, the

preparation must demonstrate retentive surfaces.

IPS

e.max

CAD

Overview of the Treatment Procedure

Working Steps

Shade Determination

Intraoral imaging

Milling

Preparing for

Crystallization

Ivoclar Vivadent-Produkte

Tooth shade IPS e.max Press/CAD HT and LT determination materials shade guide

For optimum selection of the

Die shade IPS determination To determine the shade of the prepared tooth.

OptraGate

Provides easy access to an enlarged treatment area by circular retraction of lips and cheeks.

IPS

Enables optimum imaging through detailed definition of the margins

Virtual

Scannable bite registration material, e.g. to record data used for optical imaging.

IPS e.max CAD Blocks

Lithium disilicate glass-ceramic blocks for the CAD/CAM technology.

IPS e.max CAD Crystallization Tray / Pins

Special firing tray and pins for the crystallization of IPS e.max CAD

IPS

Auxiliary firing paste in different viscosities for the crystallization of IPS e.max CAD.

Contrast Spray Chairside (blue-lemon, creme-lemon)

CADbite Registration

Object Fix Putty / Flow

block shade.

Natural Die Material

Overview of the Treatment Procedure

Characterization /

Glaze / Adjustments

Combination firing

(Crystallization/Glaze)

Preparation for

Cementation

IPS e.max CAD Crystall./Shades, Stains, Glaze and Glaze Liquid

Special stains in paste form for the individual surface characterization of IPS e.max CAD in the “blue” state.

IPS e.max CAD Crystall./Glaze Spray

Special glaze in spray form for IPS e.max CAD

IPS e.max CAD Crystall./ Add-On und Add-On Liquid

Special add-on material for IPS e.max CAD

Programat® CS2

Compact, easy-to-operate ceramic furnace with vacuum function for the dental practice.

IPS® Ceramic Etching Gel

For the fabrication of retentive bonding surfaces on all-ceramic restorations.

Monobond

Produces silanated bonding surfaces on etched allceramic restorations.

Variolink® Veneer, Variolink® II, Multilink® Automix

Tried-and-tested adhesive cementation system.

SpeedCEM®

Self-adhesive, self-curing resin cement with light-curing option for quick and easy cementation.

Vivaglass® CEM

Esthetic glass-ionomer cement for the conventional cementation.

Bluephase

Cordless high-performance LED light for all indications.

Plus

Shade Determination — Tooth Shade, Shade of the Prepared Tooth

Optimum integration in the oral cavity of the patient is the prequisite for a true-to-nature all-ceramic restoration. To achieve this, the following guidelines and notes must be observed by the dentist. The overall esthetic result of an all-ceramic restoration is influenced by the following factors:

• Shade of the preparation (natural preparation, core build-up, abutment, implant)

• Shade of the restoration (framework shade, veneer, characterization)

• Shade of the cementation material

The optical effect of the preparation shade must not be underestimated during the fabrication of highly esthetic restorations. For that reason, the shade of the preparation should be determined together with the desired tooth shade in order to select the suitable block. Especially with severely discoloured preparations or non-tooth-shaded build-ups, this is of utmost importance. In order to achieve the desired esthetics, the shade of the prepared tooth must first be determined.

Preparation shade – Prepared natural tooth

– Core build-up – Implant, abutment

Restoration Shade

– Framework

– Veneer – Characterization

Desired Tooth Shade

Cementation Material

Shade determination of the natural tooth

After tooth cleaning, the tooth shade of the non-prepared tooth and/or the adjacent teeth is determined with the help of a shade guide. Individual characteristics have to be considered when determining the tooth shade. If a crown preparation is planned, for example, the cervical shade should also be determined. In order to achieve the best possible true-to-nature results, shade determination should be carried out in daylight. Furthermore, the patient should not wear clothes of intense colours and/or lipstick.

Die shade selection

In order to facilitate the reproduction of the desired tooth shade, the shade of the preparation is determined with the help of the IPS Natural Die Material shade guide. This allows the clinician to select the appropriate IPS e.max CAD blocks in terms of shade and translucency based on the indication. Please refer to the table on page 49 for block selection.

Example of the preparation shade effect

Crown made of IPS e.max CAD HT B1 on different preparation shades.

Overview of the Treatment Procedure

Which block should be used?

The suitable block is selected on the basis of the following criteria:

1. Desired tooth shade

2. Preparation shade or abutment shade

3. Type of restoration

4. Restoration thickness and/or preparation depth

5. Processing technique (staining and cut-back technique)

6. Cementation material

Please refer to the table on page 49 for block selection.

Intraoral Imaging

To prepare for the optical imaging, OptraGate® is placed to facilitate access to the treatment field. OptraGate is a clinical auxiliary device that retracts lips and cheeks during dental treatment. It enables a full view of the treatment field, facilitates the accessibility, and improves the moisture control in the oral cavity.

IPS® Contrast Spray Chairside is used to prepare the intraoral situation for optical imaging. The IPS Contrast Spray Chairside balances out the different optical properties of the natural tooth (dentin and enamel) and thus permits optimum recording using the camera. The optimized geometry of the rotatable single-use nozzle provides good accessibility to the preparation. The IPS Contrast Spray is available in the colours blue and cream; both versions feature a fresh lemon flavour.

Virtual® CADbite is a scannable bite registration material with a reflecting surface, which is ideally suitable for capturing images with intraoral scanning devices (antagonist data).

Milling

In order to mill the restoration, the appropriate IPS e.max CAD block is selected in accordance with the clinical situation. It not only determines the selection of the block in the required shade, but also the block size to be offered. Once the desired block has been selected, it is mounted in the CAM unit and the restoration is milled.

Preparing for Crystallization

IPS Object Fix Putty and IPS Object Fix Flow are auxiliary firing pastes with

different viscosities to support IPS e.max CAD restorations during the crystallization process. The pastes are used to stabilize and secure the corresponding restoration on the IPS e.max CAD Crystallization Pins. IPS Object Fix Putty and IPS Object Fix Flow are easy to apply and remove after the firing procedure.

Characterization / Glaze / Adjustments

IPS e.max CAD restorations are characterized with IPS e.max CAD Crystall./Shades and Stains. There are 7 IPS e.max CAD Crystall./Stains and 5 IPS e.max CAD Crystall./Shades available. To imitate the incisal area, 2 IPS e.max CAD Crystall./Shade Incisal materials, which enhance the optical in-depth effect and the translucency in the incisal third, can be used. IPS e.max CAD Crystall./Glaze Liquid is used to dilute the IPS e.max CAD Crystall./ Shades, Stains and Glaze pastes.

Overview of the Treatment Procedure

To glaze the IPS e.max CAD restoration, you may choose between the

IPS e.max CAD Crystall./Glaze Paste and the IPS e.max CAD Crystall./ Glaze Spray.

For shape adjustments (e.g. proximal or occlusal contact points), IPS e.max CAD Crystall./Add-On is available . It is mixed with the IPS e.max CAD Crystall./ Add-On Liquid and can be directly applied with the crystallization firing or any

subsequent corrective firing.

Combination Firing

(Crystallization/Glaze)

As a general rule, IPS e.max CAD is fired on the IPS e.max CAD Crystallization Tray and the corresponding IPS e.max CAD Crystallization Pins. This firing tray stores heat and ensures slow cooling of the glass-ceramic.

The firing cycles are conducted in a Programat® CS/CS2 or any other ceramic furnace from Ivoclar Vivadent. The Programat CS/CS2 is easy to operate and especially suitable for glaze and crystallization firings. Also because of the integrated vacuum function, this furnace is ideally suitable for processing IPS e.max CAD blocks.

Preparing for Cementation

Conditioning of the ceramic surface to prepare for cementation is decisive for generating a sound bond between the cementation material and the all-ceramic restoration. Generally, glass-ceramics are etched with IPS Ceramic Etching Gel (5% hydrofluoric acid). IPS e.max CAD is etched for 20 seconds. Etching produces retentive bonding surfaces, which increases the bond between luting composite and the all-ceramic restoration. IPS Ceramic Etching Gel is for extraoral use only and must not be applied in the oral cavity.

Subsequent silanization of the bonding surface with Monobond® Plus generates a sound bond between the etched all-ceramic material and the luting composite. The bonding silane thus plays an important role for the overall bonding strength between the IPS e.max CAD restoration and the tooth structure.

Total Etch Total Etch is used to prepare the tooth for the adhesive cementation using Variolink. Total Etch is a gel used to etch the enamel and condition the dentin in situations where all-ceramic restorations are to be cemented adhesively.

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