When placing direct composite restorations, ensuring both the long-term functional and esthetic success of treatment is usually a challenge for clinicians. Although there have been advancements in direct restorative materials, dentists continue to seek a universal material that demonstrates the same superior strength and esthetics as indirect ceramics, making it suitable for placement in anterior and posterior regions.

For many years, the IPS Empress all-ceramic brand has been associated with a high level of esthetics in indirect restorations. IPS Empress Direct was developed to keep pace with the latest trends in cosmetic dentistry—including the need for durable, highly esthetic and convenient materials for placing direct restorations.

Based on the latest technology and featuring a wide variety of true-to-nature dentin and enamel shades, IPS Empress Direct is a light-curing, nano-hybrid composite resin that provides various levels of translucencies and opacities, thereby providing many opportunities to realize esthetic results for any indication—both anterior and posterior. As a result, IPS Empress Direct enables dentists to mimic the optical effects of natural tooth structure in a way that is similar to ceramic, but with the direct simplicity of composite.

• Refer to the slideshow for figures

The case

This article demonstrates the technique for placing IPS Empress Direct composite for a posterior restoration. This esthetically optimized nano-hybrid composite was selected for a 17-year-old male who presented with clinical occlusal decay on tooth Nos. 30 and 31 (Fig. 1). Given his age and his concern about  restorations looking like “fillings,” the IPS Empress Direct material was the optimal choice.

Clinical protocol

01. A rubber dam (Optradam) was placed to ensure complete isolation.

02. Caries were removed from tooth Nos. 30 and 31, and the occlusal surface was prepared (Fig. 2).

03. The teeth were treated with a 37% phosphoric acid etchant (Fig. 3).

04. Two coats of a bonding agent (ExciTE) were applied to the preparations and agitated for 10 seconds per tooth and air dried for 5 seconds (Fig. 4).

05. The bonding agent was then light cured for 10 seconds per tooth using an LED curing light (bluephase 20i) in “soft” mode. A thin layer of flowable composite resin (Tetric EvoFlow) in shade A2 was applied into each preparation and light cured for 10 seconds per tooth using the LED curing light (Figs. 5 and 6).

06. The dentin layer was simulated with the placement of IPS Empress Direct composite in shade A2 Dentin. Some general anatomy was placed in this dentin layer, after which the restorations were cured for 10 seconds per tooth using the LED curing light (Fig. 7). The enamel layer was replaced using IPS Empress Direct A2 Enamel.

07. The anatomy placed in the dentinal layer was replicated with the enamel layer of resin, and this layer was cured for 10 seconds per tooth (Fig. 8). It’s important to note that many clinicians use single “dentin” shade resin systems that don’t blend invisibly into the tooth. With this system, a simple layering technique can be used to replace the dentin and enamel to achieve life-like esthetics.

08. To simulate depth in the restorations, Tetric Color in Medium-Brown shading was added to the occlusal grooves, after which both teeth were cured for 10 seconds using the LED curing light (Fig. 9).

09. A final layer of IPS Empress Direct Opal Shade composite was added for a layer of translucency over the enamel shade and Tetric Color shading (Fig. 10). The rubber dam was removed, and the final restorations were finished using fine carbide burs and polished with polishing points (Astropol) (Fig. 11).

Closing thought
With the latest addition to the IPS Empress System, ceramic esthetics now can be achieved with chairside, direct placement convenience. This universal nano-hybrid composite is suitable for placing both anterior and posterior restorations, and demonstrates easy handling capabilities that result in nature-replicating esthetics.

The resin’s ability to duplicate the natural tooth structure’s translucency and opacity through a layering system simplified the process of replacing the dentin with a dentin shade and the enamel with an enamel shade to realize life-like esthetics. Its physical properties are specially designed for simplified application; low sensitivity to light ensures ample, pressure-free working time for designing restorations. 

Dr. Skramstad is a 2000 graduate of the University of Minnesota School of Dentistry. He is a trainer for Patterson Dental and has lectured nationally on the CEREC restorative process. Dr. Skramstad is a CEREC Beta tester for Sirona Dental Systems and a faculty member in the CAD/CAM Department at the Scottsdale Center for Dentistry. He maintains a private practice in Orono, Minn. that focuses on esthetic and CAD/CAM dentistry.