Printer Friendly

Email Article

Seamless Integration

Using IPS e.max Press HT to create highly esthetic anterior ultra thin veneers and crowns.

By Steve Hoofard, CDT, Aesthetic Designs Laboratory, Hermiston, Ore.
Dentistry by Dr. Mike Cole, private practice, Ellensburg, Wash. Information provided by Ivoclar Vivadent Inc.

A healthy, 49-year-old female presented with bulky, dark PFMs on her two maxillary centrals (Fig. A). She wanted the best possible esthetic result with the least amount of invasive dentistry.

A good compromise could be achieved by restoring her four maxillary anteriors after improving her periodontal health; establishing a stable, restorative point; and limiting her parafunctional tendencies.

Once her bite was stable, PVS impressions, bite registrations, and a Kois Dento-facial transfer were taken. This information along with appropriate photos of the patient were sent to Aesthetic Designs Laboratory. A four-tooth wax-up was requested to include a Siltek temporary matrix and a split Siltek for buccal and lingual prep depth guides. The patient approved the wax-up and was excited for the preparation date.

On the day of the preparation, the patient was anesthetized, and the gingival of teeth #7 and #8 re-probed to ensure the ability to diode lase the gingival contours to be more symmetrical to teeth #9 and #10. The patient’s bone was sounded to evaluate gingival response and possible black triangle development. This was a concern since the patient had a thick gingival biotype.

The PFMs were then removed and the laterals minimally prepped facially with interproximal slice preps to include existing Class III incipient lesions. As much lingual tooth structure as possible was retained on the laterals, and 1 mm to 1.5 mm of lingual tooth structure was removed from teeth #8 and #9 to reduce the over-contouring present on the old PFMs. Final impressions, a stick-bite, and photos were taken (Figs. B, C, and D).

Temporaries were made using A2 Luxatemp by DMG America with the Siltek guide supplied by Aesthetic Designs Laboratory. DMG America’s LuxaGlaze was placed after an occlusion check and a final finish of the provisionals.

THE TECHNIQUE IN PICTURES: SLIDESHOW
(refer to slideshow for figures) 

Laboratory procedures

01 Pour the impressions and fabricate master models to continue the restorative process (Fig. E).

02 Wax the restorations to full contour and check for esthetics and function (Fig. F).

03 Form an incisal edge using a Siltek matrix to aid in cutting back the incisal one-third of the waxed patterns before pressing (Fig. G).

04 Sprue and invest the wax patterns and then press with IPS e.max Press HT BL3 ingots (Fig. H).

05 Fit the pressed restorations back to the master model and check against the Siltek incisal matrix to verify proper reduction for layering of enamels (Fig. I).

06 Apply glaze liquid to wet the surface of the restorations (Fig. J) for the application of internal stains and to hold a “dusting” of E02 enamel for a wash firing (Fig. K).

07 After firing, place the restorations back on the master model for the application of enamel and effect powders (Figs. L and M). Use the Siltek incisal edge matrix to re-establish the contours to the ideal position.

08 Fire a second time and fit the restorations to the master model using a variety of diamond burs and wheels, verifying contacts, incisal edge position, function, and facial contours (Figs. N and O).

09 Glaze the restorations using a fluorescing glaze paste (Figs. P and Q) and check the definitive restorations on the solid model for fit and finish (Fig. R). Etch the restorations prior to delivery.

Note: Ivoclar Vivadent does not recommend veneers pressed thinner than 0.3 mm.

The translucent qualities of the HT ingot allowed for ultra-thin (0.2 mm) veneers on the laterals (Fig. S) alongside conventional full crown preps on the centrals with seamless integration (Fig. T).

Post-op photos of the definitive restorations show a harmonious and pleasing result (Figs. U and V). 

IPS e.max press HT
Ivoclar Vivadent Inc. www.ivoclarvivadent.com Ivoclar Vivadent Inc. 175 Pineview Drive Amherst, NY 14228 800-533-6825 Canada 2785 Skymark Ave. Mississauga, ON L4W 4Y3 800-263-8182	Features Biocompatible lithium disilicate glass ceramic Offers exceptional fit, form, function, and flexural strength (400 MPa) Kind to opposing dentition Offered in low, medium, and high opacities to meet clinical needs Lifelike esthetics independent of prepared tooth shade Allows conventional or adhesive cementation