Improve efficiency with IPS e.max Press Multi

Improve Efficiency: An Alternative to Cut-Back
and Layering with IPS e.max Press Multi
By: Rafael Choi, CDT
Source from LMT’s May 2015 issue, www.LMTmag.com

As an alternative to conventional materials and
pressing methods that use cut-back and layering,
Ivoclar Vivadent’s IPS e.max Press Multi is a new
material that provides a simple solution for
fabricating esthetic and polychromatic restorations
in a monolithic form.

The IPS e.max Press Multi ingot is the same high-strength
(400 MPa) lithium disilicate material as IPS e.max Press but,
due to its gradient layers, provides higher chroma and
opacity in the cervical and dentin regions and increased
translucency in the incisal areas. It eliminates the need for
layering methods and produces strong, esthetic and lifelike
anterior crowns in a predictable and efficient manner.

RESTORATIVE CHALLENGE&
TREATMENT PLAN:
A 17-year-old patient presented with
recurrent caries and failed composite
restorations; her chief complaint was
dark spots on her teeth.
After Dr. Fiona Vismans of Damascus
Dental Group discussed the treatment
options with the patient and her
parents, we decided to restore the
posterior teeth with direct composite
restorations. Due to the size of the
failing anterior restorations and their
recent placement, we selected IPS
e.max Press all-ceramic crowns for
teeth 13 - 23 to provide the patient
with excellent esthetics and
predictable, long-lasting results.

Step 1
I created a diagnostic waxup to guide
the clinical process and Dr. Vismans
prepared the teeth. Because the
stump shade was ideal and without
any discoloration, we decided the IPS
e.max Press Multi ingot was
appropriate for this case.

Step 2
After wearing acrylic temporaries
made by Dr. Vismans, the patient
decided she wanted to make
changes to the shape of the
restorations, so I created a mock-
up (shown here) from the matrix
of the diagnostic waxup to
visualize the outcome and
adjusted the occlusion.

Step 3
I scanned and designed the
case using 3Shape’s D800
scanner and design software.

Step 4
Using virtual articulation, I verified the occlusion and anterior guidance.

Step 5.1
I milled the wax crowns using Roland’s DWX-
50 and 3D BioCAD’s Press Wax block and re-
burnished the margins. In order to control the
flow of the molten ingot and maintain the
gradient effect in the restoration, I followed
Ivoclar Vivadent’s special spruing technique
for the IPS e.max Press Multi.
I invested the restorations using BEGO’s
Bellavest® SH investment and the IPS e.max
Investment Ring System. Investment liquid
was mixed in the vacuum for a full two
minutes and applied to the occlusal surface
and inside the crown, and I filled the
investment ring.

Step 5.2
After letting the investment ring set on
the bench for 30 minutes, I placed it in
my Naberthem burnout furnace and
burned it out at 1,562°F for one hour. I
placed the cold IPS e.max Press Multi
ingot into the investment ring with the
printed side up and positioned the IPS
Multi One-Way Plunger and the IPS
Alox Plunger in the investment ring. I
placed the completed investment ring
in the center of the preheated
Programat EP3000 furnace for
pressing.

Step 6
The finished press was allowed to
cool.

Step 7
I carefully removed the sprues
using a diamond disk, then
divested the restorations by
blasting the investment from the
crowns with glass beads and then
placing them in IPS e.max Press
Invex liquid to soften the surface
reaction layer. After about 25
minutes, I easily removed the
reaction layer by low-pressure
blasting with 100-micron
aluminum oxide. I checked the fit
and adjusted the proximal
contacts on the master cast.

Step 8
I adjusted the occlusion to ensure
the ideal anterior guidance during
both lateral and protrusive
movements.

Step 9
I stained the crowns using four
staining modifiers: IPS e.max
Ceram Essence sunset (E04) for
the cervical area; sunset and
crème (E04 and E02) at a ratio of
1:1 for the mamelon effect; IPS
e.max Ceram Shades Incisal 1 for
the mesial and distal line angles;
and Incisal 2 on one-third of the
incisal. After achieving the desired
shade and characterization, I fired
the restorations.

The Final Result
The crowns were seated, and the occlusion and esthetics verified. After two
weeks, the patient returned and Dr. Vismans reevaluated the occlusion,
appearance and function. The gums healed well and were adapting ideally to
the restorations and the patient was very happy with her new smile.

Rafael Choi, CDT
Is the CEO of Confidental Studio,
Gaithersburg, MD, which he opened in
2002. He holds a degree in Dental
Technology, has been a technician for
more than 25 years, and has trained
with Dr. Peter Dawson.
For more information on Ivoclar
Vivadent’s IPS e.max Press Multi, call
Tel: +423 235 35 35
E-mail: info@ivoclarvivadent.com
Website: www.ivoclarvivadent.com.

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