6Fabrication of Hybrid Abutments and Hybrid Abutment Crowns Treatment/fabrication process
Shade – tooth shade, preparation shade/abutment shade
Model preparation
Selecting a Ti base
Layer thicknesses of the ceramic components
Modeling
Sprueing
Investing
Preheating
Pressing
Divesting
Removing the reaction layer
Finishing
Stain and Characterization firing
Glaze firing
Crown on hybrid abutment
32Optional: Clinical Try-in Temporarily securing the pressed object on the Ti base
Clinical try-in
applicationprocedure
37Permanent Cementation Pre-treatment of the Ti base
Preparing the pressed object
Cementation with Multilink Implant
43Seating and AftercareSterilization
Intraoral preparation
Seating the hybrid abutment and crown
Seating the hybrid abutment crown
Care notes – Implant Care
50General Information
Frequently Asked Questions
Material Selection Table
Press and Firing Parameters
Clinical Cases
2
®
IN ST RUC TI ONS FO R U SE
Press
all ceramic
all you need
emax Press-VA 2009-d_emax Press-VA-d.qxd 22.09.11 14:13 Seite 1
e.max
IPS
Press Abutment Solutions
Product Information
Press ceramics have been synonymous with esthetics, accuracy of fit, shape and function for decades. The IPS e.max Press lithium disilicate
(LS2) glass-ceramic additionally offers an outstanding strength of 400 MPa. The already extensive indication range from thin veneers (0.3 mm)
and monolithic molar crowns to anterior and premolar bridges is now expanded to include hybrid abutment restorations.
With IPS e.max Press, you can fabricate such restorations in combination with a titanium base (Ti base). Two different approaches are available:
– Hybrid abutment and separate crown
– Hybrid abutment crown
Both solutions show outstanding function, efficiency and esthetics. The durable bond to the Ti base is achieved by means of the self-curing
Multilink Implant luting composite.
Hybrid abutment
The hybrid abutment is an individually pressed LS2 abutment which is luted to the Ti base. The shape,
emergence profile and esthetic properties of this abutment can be ideally adjusted to the clinical
situation.
Individual esthetics
Given the lifelike appearance of LS2 glass-ceramics, the esthetic possibilities are virtually limitless,
particularly in the anterior region. Due to the individual characterization, a lifelike appearance is
achieved near the root and the transition area to the crown. With the preparation margin of the crown
located on the gingival level, the geometry of the hybrid abutments allows for an easy integration of
the restoration. Excess cementation material is therefore easily removed.
Hybrid abutment
IPS e.max Press LS
AbutmentBase
Ti base
2
Flexibility due to laboratory fabrication
The pressed LS2 abutment is extraorally luted to a Ti base with Multilink Implant, then screwed into
place in the oral cavity and finally provided with a permanent IPS e.max crown. As the hybrid abutment
is conveniently fabricated in the lab, the process is time-saving and flexible.
Hybrid abutment crown
Hybrid abutment crowns are characterized by combining abutment and monolithic crown in one piece.
This is an efficient two-in-one solution made of lithium disilicate (LS2), which is directly luted to a Ti base.
Efficient fabrication due to two-in-one approach
LS2 glass-ceramics provide for strength, durability and efficiency, particularly in the posterior area.
Moreover, the material offers well-known esthetic properties allowing restorations to be simply
characterized with IPS e.max Ceram stains.
Luted extraorally, screwed in intraorally – for improved flexibility
The monolithically pressed hybrid abutment crown is reliably luted to the Ti base by means of Multilink
Implant. Then, the restoration is screwed onto the implant – in one piece. Thus, the bothersome task of
excess cement removal is a thing of the past. Subsequently, the screw access channel is sealed with a
composite material (e.g. Tetric EvoCeram®). If required, the screw can be accessed at any time, which
affords the dental team clincial flexibility.
New possibilities for economically efficient restorations
IPS e.max Press hybrid abutment crowns are a new, economically attractive alternative to conventional
implant-supported restorations, particularly for the posterior area, where strength, durability and convenient clinical handling matter.
Hybrid abutment crown
IPS e.max Press LS
Abutment
Ti base
Base
2
Note regarding the Instructions for Use:
The present Instructions for Use deal only with IPS e.max Press Abutment Solutions and represent a
supplement to the existing IPS e.max Press Instructions for Use. The IPS e.max Press Instructions for Use
contain more detailed descriptions of the material (e.g. ingot concept) and the entire indication range.
In case you do not have the IPS e.max Press Instructions for Use, you can order them from your sales
representative or simply download it from www.ivoclarvivadent.com.
3
Material
Uses
Press ceramic
IPS e.max Press are lithium disilicate glass-ceramic (LS2) ingots for
the press technology. The industrial
production process creates absolutely homogeneous ingots in different translucency levels. For IPS e.max Press Abutment Solutions,
ingots from the exisitng range of products are used.
The ingots feature a strength of 400 MPa and are thus the pressed
ceramic ingots with the highest strength. They are pressed in Ivoclar
Vivadent press furnaces to produce objects with outstanding accuracy
of fit. The pressed, tooth-coloured, highly esthetic restorations are
completed with IPS e.max Ceram.
CTE (100–400°C) [10-6/K] 10.2
CTE (100-500°C) [10-6/K] 10.5
Flexural strength (biaxial) [MPa]* 400
Fracture toughness [MPa m
Modulus of elasticity [GPa] 95
Vickers hardness [MPa] 5800
Chem. solubility [µg/cm2]* 40
Pressing temperature [°C] 915–920
*according to ISO 6872
0.5
] 2.75
Indications
– Hybrid abutments for anterior and posterior single-tooth
restorations
– Hybrid abutment crowns for anterior and posterior restorations
Contraindications
– Use of Ti bases which do not fulfil the geometry requirements.
– Failure to observe the requirements stipulated by the implant
manufacturer for using the selected implant type (diameter and
length of the implant must be approved for the respective position
in the jaw by the implant manufacturer).
– Bruxism
– Failure to observe the permissible maximum and minimum ceramic
wall thicknesses.
– All uses not stated as indications are contraindicated.
Important processing restrictions
Failure to observe the following restrictions may compromise the
results achieved with IPS e.max Press:
– If hybrid abutment crowns are fabricated, the opening of the
screw channel must not be located in the area of contact points
and areas with masticatory function. If this is not possible, a
hybrid abutment with a separate crown would be preferred.
– No extension units; only single-tooth restorations
– Layering with a veneering ceramic other than IPS e.max Ceram
– Pressing of two or more IPS e.max Press ingots in one investment
ring
– Pressing of IPS e.max Press in the IPS Investment System 300 g
– Use of a luting composite other than Multilink® Implant to lute
IPS e.max Press to the Ti base
– Temporary cementation of the crown on the hybrid abutment.
– Failure to observe the manufacturer's instructions regarding the
processing of the Ti base.
Side effects
If the patient is known to be allergic to any of the components,
IPS e.max Press Abutment Solutions should not be used.
Ti base
For IPS e.max Press Abutment Solutions, customary Ti bases made of
titanium or titanium alloys are used.
Please observe the instructions for use and processing of the manufacturer of the Ti bases used.
4
Composition
IPS e.max Press ingots and accessories required in conjunction with
IPS e.max Press Abutment Solutions consist of the following main
components:
Optimum integration in the oral cavity of the patient is the prerequisite for a true-to-nature all-ceramic
restoration. To achieve this, the following guidelines and notes must be observed by both the dentist and
the laboratory.
With IPS e.max Press Abutment Solutions, you can imitate not only the clinical crown of a natural tooth,
but also a part of the "root". By defining/determining the "root shade" you can adjust the shade of the
IPS e.max Press Abutment Solution restoration accordingly. This allows you to achieve a highly esthetic
implant-supported restoration which retains its lifelike appearance also in the case of gingiva recession.
Hybrid abutment and separate crown
Restoration shade
(pressed ceramic LS
characterization)
,
2
(crown on hybrid abutment)
Shade luting material
Shade hybrid abutment
(Ti base, luting material, pressed
ceramic LS2)
Hybrid abutment crown
Shade hybrid abumtent crown
(Ti base, luting material, pressed ceramic LS
, characterizations)
2
Please refer to the table on page 52 for the selection of the suitable IPS e.max Press ingot.
Application procedure – Fabrication Hybrid Abutment and Hybrid Abutment Crown
7
Model preparation
For the fabrication of an IPS e.max Press Abutment Solutions restoration, a model with gingiva mask is fabricated.
– Select the suitable model analog according to the implant system used.
– Fabricate a model with gingiva mask.
Prepared model with gingiva mask
Selecting a Ti base
The following paragraphs outline the selection criteria for a suitable Ti base. As a general rule, the instructions of the
respective manufacturer regarding the use of the Ti base have to be observed.
– Only bases consisting of Ti or Ti alloys must be used.
– Select a Ti base with a size that matches the clinical situation and the chosen implant system. The geometry
requirements must be observed.
– The rotation lock must be designed in such a way that stress concentrations on the pressed object are avoided.
– Ti bases with undercuts, e.g. retention grooves, are suitable to some extent.
– Check the available space for the pressed object taking the geometry of the Ti base into account on the model (e.g.
silicone key).
– Observe the instructions of the manufacturer when modifying the Ti base.
Height H
Minimum dimensions
Height H
(bonding surface)
Ti
Shoulder width S
Ti baseHTi min. 4.0 mm STi min. 0.6 mm
Ti
Ti
(luted area)
Marginal shoulder
width S
Ti
8
Layer thicknesses of the ceramic components
Observing the geometry requirements of the pressed objects made of IPS e.max Press material is the key to success for a
durable restoration. The more attention given to the design, the better the final results and the clinical success will turn out
to be. The following basic guidelines have to be observed:
Hybrid abutment
Width abutment crown B
A
Height H
Wall thickness W
Marginal
shoulder width S
AK
AK
Height H
A
A
Hybrid abutment crown
Height
Ti base
Width abutment crown B
Wall thickness W
Marginal
shoulder width S
AK
AK
Application procedure – Fabrication Hybrid Abutment and Hybrid Abutment Crown
A
– The marginal shoulder width SA must be at least
0.6 mm.
– Create an emergence profile with a right angle at
the transition to the crown (see picture).
– The wall thickness WA must be at least 0.5 mm.
– The height HA must not exceed twice the height of
the Ti base HTi.
– The hybrid abutment should be designed in a simi-
lar way as a prepared natural tooth:
– Circular epi-/supragingival shoulder with rounded
inner edges or a chamfer.
– In order for the crown to be cemented to the
hybrid abutment using a conventional/self-
adhesive cementation protocol, retentive surfaces
and a sufficient "preparation height" must be
observed.
– The width BAK of the crown is limited to 6.0 mm
from the axial height of contour to the screw
channel of the hybrid abutment.
– The marginal shoulder width S
must be at least
A
0.6 mm.
– The wall thickness WAK must be larger than 1.5 mm
for the entire circumference.
– The opening of the screw channel must not be
located in the contact point areas or areas with a
masticatory function. If this is not possible, a hybrid
abutment with a separate crown should be
preferred.
– The width of the hybrid abutment crown BAK is
limited to 6.0 mm from the axial height of contour
to the screw channel.
– The height HAK must not exceed twice the height of
the Ti base by more than 2 mm.
9
Modeling
Fabrication of a resin coping
To prepare the wax-up, a resin coping is prepared if both hybrid abutments and hybrid abutment crowns
are fabricated. Please observe the following procedure:
– Check the implant position and inclination with regard to the position of the screw channel.
– Screw the Ti base onto the model analog with the corresponding screw.
– Tip: Make sure that an additional model analog is available as this will facilitate some steps.
– Clean the Ti base with a steam cleaner.
– Insert a pin with the same diameter as the screw channel to "seal" and "extend" the screw channel.
– Do not apply die spacer.
– Isolate the Ti base and the pin with a thin application of separator. If too much separator is used, this
might result in uneven areas on the inner aspect of the pressed object.
– In order to achieve a sound fit and to facilitate the subsequent wax-up, a coping is first fabricated on
the Ti base with modelling resin. Design the coping in such a way that it can subsequently be completely covered with modelling wax. Please observe the instructions of the manufacturer regarding the
processing of modelling resin.
– Remove the Ti base from the model.
– Eliminate possible over-contoured areas of the resin coping at the transition area to the Ti base by
means of rubber polishers. Do not damage the Ti base.
– Remove the resin coping together with the pin from the T i base.
– Loosen and remove the pin by rotating the resin coping.
– Screw the Ti base onto the model analog again.
– Place the resin coping back on the Ti base and check the fit and dimension (e.g. silicone key). If
necessary, adjust the coping by means of rotary instruments.
Screw the Ti base onto the model analog with the corresponding screw.– Insert a pin with the same diameter as the screw channel to "seal" and "extend"
10
the screw channel.
Isolate the Ti base and the pin with a thin application of separator.
Apply the modelling resin to the Ti base in increments.
Application procedure – Fabrication Hybrid Abutment and Hybrid Abutment Crown
Design the resin coping on the entire Ti base.
Loosen and remove the pin by rotating the resin coping.
Remove the resin coping together with the pin from the Ti base.
Eliminate possible over-contoured areas of the resin coping at the transition area to
the Ti base by means of rubber polishers.
Place the resin coping back on the Ti base and check the fit and dimension (e.g. silicone key). If necessary, adjust the coping by means of rotary instruments.
Design the coping in such a way that it can subsequently be covered with modelling wax.
11
Wax-up
Please observe the following notes with regard to modelling:
– Observe the stipulated layer thicknesses.
– Create an accurate model of the restoration, particularly at the transition area to the Ti base.
– Do not over-contour the margins, since this would require time-consuming and risky fitting procedures after pressing.
– Use an organic wax for modelling to ensure that it burns out without leaving residue in the investment ring.
Procedure for hybrid abutments
– Before creating the wax object, re-insert the isolated pin into the screw channel.
– Design the emergence profile by flooding the area between the gingiva mask and the resin coping with wax.
– Contour the hybrid abutment to a reduced tooth shape. The hybrid abutment should be designed in such a way that the
required layer thicknesses are met in the crown that is fabricated. Check by means of the silicone key and in relation to
the opposing dentition.
– Determine the crown margins in relation to the gingiva level.
– Design a chamfer on which the crown is subsequently seated.
– Remove the object together with the Ti base from the model and check the emergence profile. If necessary, make
adjustments.
– Check the transition to the Ti base and remove excess wax.
– Check the required minimum thicknesses (page 9) prior to attaching the sprue.
Design the emergence profile by flooding the area between the gingiva mask and the
resin coping with wax.
Check the dimensions by means of the silicone key and in relation to the opposing
dentition.
Design the hybrid abutment with a reduced tooth shape and determine the crown
Remove the object together with the Ti base from the model and check the emergence
profile. If necessary, make adjustments. Check the transition to the Ti base and
12
margin in relation to the gingiva level.
thoroughly remove excess wax.
Procedure for hybrid abutment crowns:
– If required, re-insert the isolated pin into the screw channel before creating the wax object.
– Design the emergence profile by flooding the area between the gingiva mask and the resin coping with wax.
– Design the abutment crown to full contour according to functional and esthetic criteria. Check in relation to the
opposing dentition.
– Make sure to take a slightly reduced occlusal relief into consideration during the wax-up, since the application of the
Stains and Glaze results in a slight increase in vertical dimensions.
– Remove the object together with the Ti base from the model and check the emergence profile. If necessary, make
adjustments.
– Check the transition to the Ti base and remove possible excess wax.
– Check the required thicknesses (page 9) prior to attaching the sprues.
Application procedure – Fabrication Hybrid Abutment and Hybrid Abutment Crown
Design the emergence profile by flooding the area between the gingiva mask and the
resin coping with wax. If necessary, re-insert the pin prior to modelling.
Design the abutment crown to full contour according to functional and esthetic
criteria. Check the object in relation to the opposing dentition.
13
Sprueing
Please observe the following notes when attaching the sprues to the abutment or the abutment crown:
– Depending on the number and size of the objects to be invested, either the 100 g or 200 g IPS Investment Ring System
is selected. Before sprueing, weigh the ring base and record the weight (seal the opening of the ring base with wax).
Please note that the mixing ratio of the investment material is different for the various restoration types (e.g. inlays,
crowns, abutments).
– Use a 2.5 mm wax wire for sprueing.
– For abutments, the sprue is attached to an axial surface.
– For abutment crowns, the sprue is attached to a cusp.
– Align the wax wire as parallel as possible to the screw channel in order to prevent the investment material
from fracturing in the screw channel.
– The maximum length (object + sprue) of 16 mm must not be exceeded.
– Place the object on the investment ring base in such a way that the screw channel is parallel to the outer wall of the
investment ring. As a result, the investment material can subsequently be filled evenly and in a controlled manner. The
objects could be placed in a tilted position on the investment ring base, but this may lead to difficulties during investing
(e.g. bubbles in the screw channel).
– Observe a distance of at least 10 mm between the object and the silicone ring.
– If only one object is invested and pressed in an EP500 furnace, a second short (blind) sprue must be placed. This ensures
that the switch-off function of the furnace works properly at the end of the pressing procedure.
ø 2.5 mmø 2.5 mm
Attach the sprue to a circular area of the abutment model and as parallel as possible
to the screw channel. Use a 2.5 mm wax wire.
Attach the sprue to an oral cusp of the abutment crown and as parallel as possible to
the screw channel. Use a 2.5 mm wax wire.
Place the object on the investment ring base in such a way that the screw channel is parallel to the outer wall of the investment ring.
Furthermore, this reduces the risk of the investment material breaking in the screw channel while the ceramic material is pressed.
As a result, the investment material can subsequently be filled evenly and in a controlled manner.
14
Investing
Investing is carried out with either IPS PressVEST or IPS PressVEST Speed. The corresponding IPS Silicone Ring with the
matching ring gauge is used for investment.
Determine the weight of the object before investing.
– Position the wax objects on the ring base and attach them with wax and weigh.
– The difference between the empty and the loaded ring base is the definitive wax weight.
Small IngotLarge Ingot (L)
Wax weightup to max. 0.75 gup to max. 2 g
Investment Ring System100 g and 200 gonly 200 g
Please refer to the Instructions for Use of the corresponding investment material regarding the detailed processing
parameters. The following basic procedure is recommended:
– Do not use a debubblizer on the wax objects.
– Carefully place the IPS Silicone Ring on the ring base without damaging the objects. The silicone ring must sit flush on
the ring base.
– The processing temperature of the investment material is 18– max. 23 °C / 64 °F – max. 73 °F. Higher or lower
processing temperatures substantially affect the setting behaviour.
– Mix the investment material. Note: The investment material contains quartz powder. Therefore, avoid the inhalation of
dust.
– Important: Pour the investment material slowly into the investment ring, so that the material continuously
fills the screw channel. If the material does not sufficiently fill the screw channel, use an instrument to
carefully apply additional investment material to the screw channel from the top.
– Carefully fill the investment ring with investment material up to the marking on the silicone ring and position the ring
gauge with a hinged movement.
– Allow the investment ring to set without manipulating it.
– To prevent crystallization of the IPS PressVEST investment material, the invested ring must be processed within 24 hours.
– If IPS PressVest Speed is used, make sure that the investment ring is placed in the preheating furnace after a setting time
of at least 30 and maximum 45 minutes.
Application procedure – Fabrication Hybrid Abutment and Hybrid Abutment Crown
Investment material: Liquid concentration and quantity
IPS PressVESTIPS PressVEST Speed
Indication
Investment Ring
Liquid : dist. water
200 g
Investment Ring
Liquid : dist. water
100 g
Investment Ring
Liquid : dist. water
200 g
Investment Ring
Liquid : dist. water
100 g
IPS e.maxPress
Hybrid abutment
Hybrid abutment crown
Mixing time
(under vacuum at approx. 350 rpm)
Liquid concentration: The data contained in the table are approximative values. Depending on the geometry of the Ti
base and the materials used for the wax-up, these values may be individually changed. However, the concentrated Liquid
content must not be lower than 50% in relation to distilled water.
Important: The total quantity of liquid (Liquid + dist. water) must not be altered.
16 ml : 6 ml32 ml : 12 ml20 ml : 7 ml40 ml : 14 ml
60 seconds
If a high-speed mixer is used, the mixing time under
2.5 minutes
vacuum has to be reduced.
15
Correctly sprued abutment (left) and abutment crown (right). The screw channel is in a
vertical position and parallel with the wall of the investment ring.
Continue to carefully fill the investment ring up to the marking and position the ring gauge with a hinged movement.
Pour the investment material slowly into the investment ring, so that the material can
continuously fill the screw channel.
16
Preheating
After the stipulated setting time of the respective investment material (IPS PressVEST or IPS PressVEST Speed), the investment ring is prepared for preheating as follows:
– Remove the ring gauge with a turning movement.
– Carefully push the investment ring out of the IPS Silicone Ring.
– Remove the ring base with a turning movement.
– Remove rough spots on the bottom surface of the investment ring with a plaster knife. Check the 90° angle. Investment
material residue must not enter the sprues. Blow into the sprues if necessary.
– If several investment rings are preheated together, mark them accordingly.
Temperature of the preheating furnace
when placing the investment ring
Position of the investment ring in the
preheating furnace
Final temperature for preheating the
investment ring
Holding time of the investment ring at
final temperature
IPS e.max Press ingotsno preheatingno preheating
IPS Alox Plungerno preheatingno preheating
ImportantIf several Speed investments are to be
Towards the rear wall, tipped with the
Room temperature
opening facing down
850 °C / 1562 °F850 °C / 1562 °F
min. 60 min
850 °C / 1562 °F; switch on the
preheating furnace in time.
Towards the rear wall, tipped with the
opening facing down
100 g investment ring – min. 45 min
200 g investment ring – min. 60 min
conducted, they should be invested
consecutively and placed into the pre-
heating furnace at an interval of
approx. 20 minutes. Make sure that
the furnace temperature does not
drop too much when placing the
investment rings into the preheating
furnace. The stipulated holding time
counts from the point when the pre-
heating temperature has been reached
again.
Application procedure – Fabrication Hybrid Abutment and Hybrid Abutment Crown
Towards the rear wall, tipped with the opening facing down Do not preheat the IPS e.max Press ingot and Alox Plunger.
In order to ensure smooth working procedures in the laboratory on a daily basis, impeccable functioning of the infrastructure, particularly the preheating furnaces, is essential. This includes their maintenance, cleaning with a vacuum cleaner in a
cool state as well as regular checks of the temperature controls and heating elements, etc., by the manufacturer.
17
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