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Inside Dental Technology

March 2012, Volume 3, Issue 3
Published by AEGIS Communications


Material Considerations

IPS e.max ZirCAD (Ivoclar Vivadent)

Specifically designed for use with CAD/CAM technology, yttrium-stabilized zirconia is a zirconia-oxide based ceramic. Yttria oxide stabilizes the zirconia oxide at room temperature. In a “chalk-like,” partly sintered state, its approximately 50% porosity enables easy processing.1 Color versatility is provided with the availability of natural and shaded pre-sintered zirconium oxide blocks. After the restoration has been milled into shape, the material is sintered to densify the microstructure.1 The final restoration is sintered to approximately 99.5% theoretical density (TD).1 Once sintered to full density, its hardness and inertness make it an ideal material for dental restorations. Sintered zirconium-oxide blocks boast a fracture toughness of more than twice that of glass-ceramic and a flexural strength of more than 900 MPa.1 IPS e.max ZirCad blocks achieve exceptional accuracy of fit, high fracture resistance, and a fracture toughness that meets the clinical requirements presented by posterior masticatory forces.

IPS e.max Ceram (Ivoclar Vivadent)

High-strength zirconia substructures layered with highly esthetic ceramic materials can produce the highly durable, functional, and esthetic fixed prosthetic results that patients demand.2 Specifically indicated for layering over high-strength lithium disilicate (IPS e.max) or zirconia implant and prosthetic substructures that have been pressed or CAD/CAM-fabricated, IPS e.max Ceram demonstrates high bond strength, exact shade matching, and exceptional masking abililities.2-5 Due to its ability to be characterized, and in consideration of the gingival porcelain shades available, IPS e.max Ceram can be used to fabricate gingival areas in implant-supported prostheses.

IPS e.max (Ivoclar Vivadent)

Characterized by high mechanical strength and superb esthetic properties, IPS e.max lithium disilicate is ideal for anterior and posterior tooth restorations. Developed with controlled size, shape, and density, and containing approximately 70% by volume needle-like crystals in a glassy matrix, IPS e.max possesses unique structural characteristics that ensure greater strength and durability than conventional ceramics.6,7 Lithium disilicate also demonstrates life-like translucency and superior optical properties due to a relatively lower refractive index.6-9 Pressable lithium disilicate demonstrates a flexural strength of 400 MPa7-9 and is the material of choice when using the wax hot-press technique. While press technology ensures exceptional fit, several translucencies and opacities and different brightness effects provide natural-looking shades with optimal light transmission, resulting in highly esthetic, life-like restorations.10-13 Providing fit and function with outstanding strength, IPS e.max Press offers superior performing and esthetically pleasing all-ceramic pressed restorations.14

IPS e.max ZirPress (Ivoclar Vivadent)

While zirconium-oxide ceramic IPS e.max ZirCAD is the material of choice for large restorations exposed to high masticatory forces, IPS e.max ZirPress is specifically designed to press onto IPS e.max ZirCAD and other ZrO2 frameworks with a CTE of 10.5 to 11.15 The fluorapatite glass-ceramic IPS e.max ZirPress ingots are indicated for zirconium-oxide–supported gingiva portions, single-tooth restorations, anterior and posterior bridges, inlay-retained bridges, and implant superstructures.15 Used with press technology, IPS e.max ZirPress ingots press over zirconium-oxide frameworks with less time and effort and produce an esthetic, highly functional, and extremely accurate-fitting restoration. Available in three levels of translucency (HT, LT, and MO) and four bleach shades, two gingiva shades are also available for fabricating the gingival portion of the restoration.15

All-on-4 (Nobel Biocare)

The All-on-4 treatment concept can be used in combination with a full-arch zirconia substructure and a variety of implants, such as NobelActive™, to provide edentulous patients with stable, functional, esthetic, and comfortable prosthesis.16-18 Additionally, a provisional prosthetic set-up can be screwed onto the implants after surgery to facilitate approval and completion of customized and single-unit restorations.17-21 Because the technique and implants can accommodate a broad range of prosthetics and abutments, high-strength zirconia substructures fabricated with CAD/CAM processes are possible.21

References

1. IPS e.max ZirCad: Instructions for Use [brochure]. Schaan, Liechtenstein: Ivoclar Vivadent; 2010.

2. IPS e.max Ceram: Instructions for Use [brochure]. Amherst, NY: Ivoclar Vivadent; 2009.

3. Ishibe M, Raidgrodski AJ, Flinn BD, et al. Shear bond strengths of pressed and layered veneering ceramics to high-noble alloy and zirconia cores. J Prosthet Dent. 2011;106(1):29-37.

4. Aboushelib MN, Dozic A, Liem JK. Influence of framework color and layering technique on the final color of zirconia veneered restorations. Quintessence Int. 2010;41(5):e84-89.

5. Luo XP, Zhang L. Effect of veneering techniques on color and translucency of Y-TZP. J Prosthodont. 2010;19(6):465-470.

6. McLaren EA, Phong TC. Ceramics in dentistry—part I: classes of materials. Inside Dentistry. 2009;5(9):94-103.

7. Tysowsky GW. The science behind lithium disilicate: a metal-free alternative. Dent Today. 2009;28(3):112-113.

8. Reynolds JA, Roberts M. Lithium-disilicate pressed veneers for diastema closure. Inside Dentistry. 2010;6(5):46-52.

9. Helvey GA. Chairside CAD/CAM. Lithium disilicate restoration for anterior teeth made simple. Inside Dentistry. 2009;5(10):58-66.

10. Sorensen JA, Cruz M, Mito WT, et al. A clinical investigation on three-unit fixed partial dentures fabricated with a dual-curing adhesive system and a self-curing resin cement. J Adhes Dent. 2006;8(6):427-431.

11. Höland W, Schweiger M, Frank M, Rheinberger V. A comparison of the microstructure and properties of the IPS Empress 2 and the IPS Empress glass-ceramics. J Biomed Mater Res. 2000;53(4):297-303.

12. Kheradmandan S, Koutayas SO, Bernhard M, Strub JR. Fracture strength of four different types of anterior 3-unit bridges after thermo-mechanical fatigue in the dual-axis chewing simulator. J Oral Rehabil. 2001;28(4):361-369.

13. Guess PC, Zavanelli RA, Silvia NR, et al. Monolithic CAD/CAM lithium disilicate versus veneered Y-TZP crowns: comparison of failure modes and reliability after fatigue. Int J Prosthodont. 2010;23(5):434-442.

14. Hoofard, S, Wehrkamp S. Pressed esthetics: Creating highly esthetic pressed veneers using Ivoclar Vivadent’s IPS e.max Press lithium disilicate. dlpmagazine.com. 2010: January;1-6.

15. IPS e.max Ceram: Instructions for Use [brochure]. Amherst, NY: Ivoclar Vivadent; 2009.

16. Onodera K, Sato T, Nomoto S, et al. Effect of connector design on fracture resistance of zirconia all-ceramic fixed partial dentures. Bull Tokyo Dent Coll. 2011;52(2):61-67.

17. Agliardi E, Panigatti S, Clerico M, et al. Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study. Clin Oral Implants Res. 2010;12(5):459-465.

18. Maló P, Nobre Mde A, Lopes I. A new approach to rehabilitate the severely atrophic maxilla using extramaxillary anchored implants in immediate function: a pilot study. J Prosthet Dent. 2008;100(5):354-366.

19. Maló P, de Araújo Nobre M, Lopes A, et al. A longitudinal study of the survival of all-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011;142(3):310-320.

20. Cehreli S, Ozçipici AA, Yilmaz A. Tilted orthodontic micro implants: a photoelastic stress analysis. Eur J Orthod. 2011; Jul 11 [Epub ahead of print].

21. Malo P, Rangert B, Nobre M. All-on-4 immediate-function concept with branemark system implants for completely edentulous maxillae: a 1-year retrospective clinical study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S88-94.


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Image Gallery

Figure 1  Radiograph demonstrating the impacted left maxillary canine.

Figure 1

Figure 2  Semi-lunar full-thickness flap reflected, showing the coronal aspect of the impacted canine.

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Figure 3  Resulting defect following extraction of the impacted canine.

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Figure 4  Atraumatic extraction of the lateral incisor.

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Figure 5  Communication between the lateral incisor extraction site and impacted canine site but the buccal crestal ridge has been preserved.

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Figure 6  NovaBone being utilized for the bone graft over the facial defect.

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Figure 7  NovaBone being utilized for the bone graft over the facial defect.

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Figure 8  The implant was placed into the osteotomy.

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Figure 9  The implant was seated in the osteotomy demonstrating the apical aspect of the fixture visible in the defect.

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Figure 10  Additional NovaBone was placed over the exposed implant and filling the defect.

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Figure 11  The surgical site was closed with sutures and a healing screw was placed in the implant.

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Figure 12  Radiograph at implant placement with graft filling the defect.

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Figure 13  Radiograph of the restored implant showing healing of the grafted defect.

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Figure 14  Facial view following insertion of the abutment head and zirconia crown.

Figure 14