IPS Empress

This pressed glass, all-ceramic restoration continues to be our premium metal-free alternative as it demonstrates the necessary strength, durability and natural appearance to provide maximum aesthetics and long term function.

Pressed Ceramic Veneers, Crown and Bridgework Utilizing Empress® & Eris

Occasionally an all-ceramic restoration that is stronger than stacked porcelain is needed to achieve the ideal aesthetic goals. Pressed ceramic restorations are ideal in these situations. They can be used for veneers, full crowns and anterior bridges (when a 4.0 mm x 4.0 mm connector is achieved).

Pressed ceramics do well in situations when greater than 2.0 mm of unsupported ceramics exist. it is also possible to place veneers next to crowns of the some material and achieve a beautiful aesthetic result. it is important to note that when planning an aesthetic rehabilitation, it is never a good idea to place differing porcelains next to one another since the optical properties of the ceramic materials differ. When an all-ceramic crown is placed next to a veneer, pressed ceramic materials work extremely well.

Sun Dental Labs provide you with three highly successful pressed glass alternatives.

IPS Empress aesthetic:

For years we have provided our customers with the many benefits and aesthetic advantages of IPS Empress pressed glass. Now, dramatic aesthetic results are even further improved with a new addition to the IPS Empress family – IPS Empress aesthetic. IPS Empress aesthetic offers a new leucite reinforced glass ceramic with a broader ingot shade range and enhanced ingot density for improved flexural strength. When coupled with the new line of IPS Empress aesthetic Layering Porcelains, Empress aesthetic offers the ultimate benchmark for highly aesthetic, pressed porcelain veneers and anterior single tooth replacement (bicuspid forward).

IPS Eris:

When posterior single unit or 3 unit anterior pressed glass bridgework is indicated, Sun Dental Labs recommend the use of IPS Eris. Both of these pressed glass alternatives combine the beauty of pressed gloss with the added strength of a lithium disilicate core framework. Eris features a pressed core of interlocked needle-shaped lithium disilicate crystals. The lithium disilicate provides a base that has twice the strength (300 MPa's) of the original leucite reinforced ingots and twice the fracture toughness. The unique Eris apatite glass-ceramic is then layered and finished with glaze and internal staining. The result is a strong and beautiful restoration that will allow you to expand the aesthetic options you can provide your patients.

Contraindications

• Not to be used when a more conservative option is possible
  
  
• Not to be used when underlying colour is to shine through (cannot achieve contact lens effect)
  
  
• Not to be used for anterior bridgework when a 4.0 mm x 4.0 mm connector is not possible

Bonding

IPS Empress aesthetic crown should be bonded with an enamel-dentin adhesive bonding system - a dual cure resin cement i.e. Nexus 2 (Kerr) Variolink 11 (Ivoclar/Vivadent). Veneers should be bonded using a light cure resin cement - RelyX Veneer Cement System (3M).

Insurance Codes

Single Unit - D2740 Crown - Porcelain/Ceramic Substrate

Bridgework

D6740 Crown - Porcelain/Ceramic
D6245 Pontic - Porcelain/Ceramic

Veneer

D2962 Labial Veneer, (Porcelain Laminate) - Laboratory

3/4 Veneer

D2783 Crown - 3/4 Porcelain/Ceramic

Prep Design

1.5 -2.0 mm circumferential, with rounded heavy
chamfer; 1.5 mm incisal reduction

Choosing the right material for anterior restorations

Dentistry continues to roll through an "aesthetic revolution," with more restorative choices than ever to take better care of your patients. This multitude of information provides you with a tremendous opportunity to provide optimum care from an aesthetic, functional and disease prevention standpoint, however, it can also lead to confusion when deciding upon which option is best for your patients.

"Factors Affecting Restoration Selection"

By Dr. John C Cranham

Choose the material that's right for your patient

Perhaps nothing is more confusing than sifting through the myriad of aesthetic materials to choose the right product for any given situation. As practitioners, we have a tendency to get comfortable with one or two materials, and then make our patients fit the material. But that is not the best way to practice dentistry.

Know your options

A much wiser method is to spend time studying the advantages of as many materials as possible so you can consistently choose the right material to meet the demands of each individual patient. The purpose of this selection guide is to provide you with pertinent information necessary to assist you when considering the optimum treatment plan for your patients.

Material Selection Criteria

There are at least six factors to consider when choosing a restorative material. Let's take a look at each factor briefly.

1. aesthetic Risk

   Typically 1.0-3.0 mm of maxillary incisal tooth structure shows at rest in a youthful smile. From this position, if the patient has a high aesthetic demand and shows a great deal of tooth structure (more than 7 mm of lip hypermobility when smiling), choose a material that is as cosmetic as possible.1 If the patient is not as driven by aesthetics and the teeth are not too visible, it is more sensible to choose a more durable material - even though there may be a slight aesthetic compromise.
   
   Another consideration is whether the underlying colour of the anterior teeth needs to be blocked or if the colour is to be visible through the restoration. A material should be used with enough translucency to allow the natural colour to shine through or enough opacity to block out unaesthetic underlying chroma.
   
   

2. Occlusal Risk

   When working up the patient's case, make sure to note any evidence of intra-articulator TMJ signs or symptoms, occlusal-muscle disorders, masticatory muscle soreness or fatigue (tension headaches), tooth wear, tooth mobility without periodontal breakdown, or tooth migration. These issues should be considered indicative of a high occlusal risk patient.2 aesthetic restorations may still be an option, but extra attention to detail is essential to develop an occlusal scheme that ensures a harmonious stomatognathic system - minimizing stress on the restoration.
   
   

3. Quantity of Remaining Enamel

   One of the best reasons to preserve tooth structure during an adhesive procedure is to conserve a maximal amount of remaining enamel, since the crystalline structure of enamel is far less variable than dentin. Recent reviews of porcelain veneers during the past ten years suggest that, of the restorations that failed (4%), six of seven were only partially bonded to dentin.3 While the success rate shows the wonderful results of porcelain veneers, it also indicates a need to preserve as much enamel as possible.
   
   

4. Quantity and Quality of Remaining Dentin

   Recent studies also look at how bonding to sclerotic and carious dentin can affect bond strength.4,5 While predictable bonding success is hard enough to obtain inside the mouth, it seems that bond strengths may also vary depending on the kind of dentin that exists. A good rule of thumb is to consider a traditional cemented restoration if areas of discolored dentin are present that lack sensitivity to cold water, air blast or to preparation without anesthesia. This evidence may indicate that the wet collagen network within the dentin has been significantly altered, affecting the necessary optimum bond strengths.
   
   

5. Ability to Maintain 100% Isolation

   If 100% isolation cannot be obtained during an adhesive procedure, failure is imminent.6 Deep subgingival restorations, patients with limited openings (TMJ), or any area that is impossible to isolate are pure examples of clinical situations where traditionally cemented restorations may be indicated.
   
   

6. Desire for Maximum Tooth Conservation

   Generally, it is recommended to only remove the amount of tooth structure necessary to maximize aesthetics, obtain the necessary retention and resistance form, and preserve remaining tooth structure.
   

References

1. Spear F: The maxillary central incisor edge: a key to aesthetic and functional treatment planning. Compend Cant Educ Dent 20 (6): S 12-S 16, 1999.9. Garber DA: Porcelain laminate veneers: ten years later. Part I: Tooth preparation. J Esthet Dent 5(2):56-S9, 1993.
   
   

2. Dawson P: Evaluation, Diagnosis, and Treatment of Occlusal Problems. C.V. Mosby, 1989.
   
   

3. Dumfahrt H, Schaffer H: Porcelain laminate veneers, a retrospective evaluation after 1 to 10 years of service: Part II: Clinical results. Int J Prothodont 13(I):9-I 8, 2000.
   
   

4. Yoshiyama M, Urayama A, Kimoch T, et al: Comparison of conventional vs self-etching adhesive bonds to caries-affected dentin. Oper Dent 25 (3): 163-169, 2000.
   
   

5. Nakajima M, Ogata M, Okuda M, et al: Bonding to caries-affected dentin using self-etching primers. Am J Dent 12(6):309-3 14, 1999.
   
   

6. Nakabayashi N, Pashley D: Hybridization of Dental Hard Tissues. Quintessence Publishing Co., 1998.