Ivoclar Vivadent IPS Empress CAD Chairside v.1 – page 4

Staining and veneering

There are three different techniques for staining, characterizing, and veneering

IPS Empress CAD:

1. Internal characterization

Tetric

®

Color are light-curing composite stains for individualized characterizations.

They are ideally suitable for internal characterizations (cementation side) of

IPS Empress CAD restorations (e.g. veneers). After etching (60 seconds with

IPS Ceramic Etching Gel) and silanating (Monobond-S), the stains are applied. After

that, the stains are polymerized with a curing light of the bluephase family. No further

ceramic firing cycles should be conducted after the "internal characterization" with

Tetric Color.

2. External characterization*

IPS Empress

®

Universal Shade / Stains are ceramic stains for individualized

characterizations. Among other things, they are ideal for external staining and

characterization of IPS Empress CAD restorations.

The dentin stains are available in 9 A-D and 15 Chromascop shades. For individualized

characterizations, 14 intensive stains are available. To reproduce the incisal

area, there are 2 Incisal Shades, which provide the incisal third with

optical translucency and an in-depth effect. For the final glaze firing

of the IPS Empress restorations, a smooth and fine-grained glazing paste is available.

3. Cut-back technique*

IPS Empress

®

Esthetic Veneer ceramic material are leucite-reinforced layering

materials for the cut-back technique. In this technique, fully anatomical IPS Empress

CAD restorations (veneers and anterior crowns) are reduced in the incisal third to a

dentin-mamelon structure and subsequently completed using materials in paste and

powder form in order to design a true-to-nature and aesthetic incisal third.

The IPS Empress Veneer Kit comprises a selection of the most popular wash pastes and

layering materials required for the cut-back technique of IPS Empress restorations

(Esthetic and CAD). With the wash pastes, an excellent and homogeneous bond with

the reduced restoration is achieved. The layering materials feature incisal-like

fluorescence and true-to-nature opalescence. Additional wash pastes and layering

materials available as Refills are indicated on the material shade guide supplied with

the Kit.

* please refer to the Combination Tables for the available shades and materials.

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Ceramic firing

IPS Empress CAD restorations are generally fired on a honey-comb firing tray. For that

purpose, the restorations are placed either on a firing pillow or metal pins. As an

alternative and to better secure the restorations on the metal pins,

IPS

®

Object Fix auxiliary firing paste can be used.

Ceramic firing is conducted in the Programat

®

P300. ceramic furnace. The furnace

convinces users with its economic efficiency and easy operating concept. The furnace

is supplied from the factory with preset programs for IPS Empress and IPS e.max.

Etching and silanating

Conditioning of the ceramic furnace to prepare for adhesive cementation is required

for a sound bond between the cementation material and the all-ceramic restoration.

Generally, glass-ceramics are etched using IPS

®

Ceramic Etching Gel.

Etching produces retentive bonding surfaces, which increases the bond

between the luting composite and the all-ceramic restoration.

IPS Ceramic Etching gel is exclusively intended for extra-oral use

and must not be applied in the oral cavity.

Subsequent silanating of the bonding surface using Monobond-S results in a sound

bond between the etched all-ceramic material and the luting composite. The

bonding silane is thus an important contributor to the bonding strength between

the IPS Empress CAD restorations and the tooth structure.

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Cementation

In preparation for adhesive cementation, reliable isolation of the treatment field must

be achieved, preferably with a rubber dam.

OptraDam

®

is a convenient, 3-dimensional rubber dam, which can be quickly and

easily inserted thanks to its anatomical shape and the integrated

frame. Given its high flexibility and new functional concept, the

OptraDam is very comfortable for patients even for longer

treatments. The gentle, circular retraction of lips and cheeks enables

substantially facilitated access to an enlarged treatment field with

simultaneous isolation.

Total Etch

For the preparation of adhesive cementation with Variolink, Total Etch is used. It is an

enamel etching and dentin conditioning gel used during the adhesive

cementation of all-ceramic restorations.

For the adhesive cementation of IPS Empress CAD restorations, you may choose

between tried-and-tested luting composites from Ivoclar Vivadent. Adhesive

cementation achieves an excellent bond between the preparation and the restoration.

Variolink

®

Multilink

®

(Variolink II, Variolink Veneer)

(Multilink, Multilink Automix)

Veneers



––

Inlays





Onlays





Partial crowns





Anterior and posterior crowns







indicated

––

contraindicated

Variolink

®

II

The dual-curing luting composite Variolink II has been used for more than ten

years and in over 20 million restorations. It is the world's leading highly

aesthetic material concept.

Numerous awards as the best product in the category of adhesive luting

composites and excellent results from clinical long-term studies are testimony

to this success.

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Variolink

®

Veneer

Purely light-curing luting composite in 7 "Value" shades for the adhesive cementation

of translucent all-ceramic restorations with a layer thickness of < 2.0 mm (veneers,

inlays, onlays).

Multilink

®

Automix

The universal, self-curing (with light-curing option) resin based luting cement Multilink

offers a broad range of indications and produces very high adhesive strength on all

material surfaces. Together with the self-etching Primer, which is applied as a simple

preliminary layer on enamel and dentin, Multilink is processed quickly and efficiently.

LED lights of the bluephase

®

family are used for the polymerization of light-curing

and dual-curing adhesive composites. The high light intensity achieved with bluephase

permits comparatively short polymerization times with simultaneous good polymeriza-

tion depth.

Especially for the demanding polymerization of adhesively cemented all-ceramic

restorations, bluephase 16i is used. In the process, the entire strength of the high

performance LED is utilized. All-ceramic restorations are incorporated as quickly as

possible.

Polishing

OptraFine, the specially developed, high performance chairside diamond polishing

system for ceramic materials combines the highest efficiency with outstanding

polishing results. With regard to both low surface roughness and

outstanding aesthetic gloss, OptraFine leaves nothing left to be desired.

In contrast to other ceramic polishers, OptraFine is autoclavable and

therefore reusable. OptraFine is available in the shapes

"flame", "cup", and "disc".

Polishing is carried out in three steps:

– Finishing/smoothing out of the surfaces using the Finisher F

– Polishing using the Polisher P

– Polishing to a high gloss using the high-gloss brush and diamond polishing paste HP

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Fabrication of an IPS Empress CAD Restoration

IPS Empress CAD Inlays / Onlays – polished

IPS Empress CAD restorations are ideally suitable to restore small defects with an all-ceramic material, as well as to replace

less aesthetic restorations. Given the true-to-nature chameleon effect, IPS Empress CAD restorations beautifully blend in

with the residual tooth structure. In this processing technique, the restoration is polished and incorporated after milling in

the CAD/CAM system. The surface lustre is achieved by manual polishing. Therefore, this processing method is very effi-

cient and leads to aesthetic results in a quick and easy fashion.

Preparation

After the determination of the tooth shade, preparation is carried out according to the preparation guidelines. As a

preparation for intra-oral imaging, the cleaned and dried preparation is covered with IPS Contrast Spray Chairside with one

short spray discharge.

Starting situation. the amalgam restoration in the second molar is to be replaced

After preparation

Spraying the preparation with IPS Contrast Spray Chairside Preparation ready for intra-oral imaging

Please refer to the corresponding Operating Instructions and/or Manuals of the respective CAD/CAM system

for further information on the CAD/CAM processing procedure. The instructions by the manufacturer must be

observed.

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Finishing

For finishing glass-ceramics, appropriate grinding instruments are indispensable. If the wrong grinding instruments are

used, marginal chipping and local overheating my occur.

The following procedure is recommended for finishing IPS Empress CAD restorations:

– Use only suitable, fine-grained (grain size < 60 µm), ceramic-bonded grinding instruments or diamonds at a speed of up

to 20,000 rpm and little pressure.

– Overheating the glass-ceramic must be prevented.

– Smooth out attachment point of the holder and take the proximal contact points into account.

– Carry out individual shape adjustments, if required.

– Try in and adjust occlusion/articulation, if necessary.

– Extra-oral polishing of proximal areas and large surfaces prior to cementation.

Smooth out attachment point and take proximal contacts into account Extra-oral polishing of proximal areas and larger surfaces

Adhesive cementation

Conditioning the IPS Empress CAD restoration

To condition it for placement, etch the IPS Empress CAD restoration for 60 seconds using IPS Ceramic Etching Gel and

subsequently clean it under running water. Then, silanate the restoration using Monobond-S. Observe the corresponding

safety instructions.

Etching of the IPS Empress CAD restoration using IPS Ceramic Etching Gel Silanating the IPS Empress CAD restoration using Monobond-S

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Conditioning the preparation

You may choose between tried-and-tested luting composites from Ivoclar Vivadent for the adhesive cementation. In the

documented case, Variolink II / Syntac were used.

– To condition the preparation for adhesive cementation with Variolink II/Variolink Veneer, Total Etch is used. Total Etch is

an enamel etching (30 seconds of etching) and dentin conditioning material (10–15 seconds of etching).

– To condition the preparation for adhesive cementation with Multilink Automix, Multilink Primer A/B is used.

Position the restoration and remove excess. For polymerization,cover the restoration margin with glycerine gel and

polymerize the restoration from all sides.

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Polishing

After adhesive cementation, the occlusion/articulation of the restoration is adjusted using diamonds. Subsequently, the

restoration is manually polished in 3 easy steps. In order to achieve a life-like surface gloss, follow the instructions below:

– For polishing, we recommend OptraFine, the high-performance, chairside diamond polishing system.

– Observe contact points and margins during the entire polishing procedure!

– Use the corresponding speed and little pressure to avoid heat development.

– Polish proximal areas and large surfaces extra-orally prior to cementation.

Step 1:

Finish/smooth out the surfaces (e.g. proximal areas) using the Finisher F (speed: max. 15,000 rpm, water cooling). This

polisher smoothes out the milling grooves of the approx. 60 µm diamond of the CAD/CAM milling unit.

Step 2:

Polish restoration using the Polisher P (speed: max 15,000 rpm, water cooling)

Step 3:

Polish the restoration to a high gloss using the high-gloss brush and diamond polishing paste HP

(speed: max. 15,000 rpm).

Adjusting the occlusion/articulation using a fine diamond

Finishing/smoothing out the surfaces using Finisher F (light-blue)

Polishing using Polisher P (dark-blue)

High-gloss polishing using the high-gloss brush and diamond paste HP

Completed, polished IPS Empress CAD restoration

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IPS Empress CAD Inlays / Onlays – stained / glazed

The 2-in-1 technique is suitable for efficient glazing and staining of inlays, onlays, and partial crowns. In this technique,

the glaze and stain firing is conducted in one single step. Even though this technique does not permit as many shade

adjustments as a separate stain firing, the possible adjustments are entirely sufficient for the size of the restoration. If more

intensive and extensive shade adjustments are desired, we recommend conducting a separate stain and characterization

firing (as described in the following chapter).

Please refer to the corresponding Operating Instructions and/or Manuals of the respective CAD/CAM system

for further information on the CAD/CAM processing procedure. The instructions by the manufacturer must be

observed.

Finishing and preparing for stain and glaze firing

For finishing glass-ceramics, appropriate grinding instruments are indispensable. If the

wrong grinding instruments are used, marginal chipping and local overheating my occur.

The following procedure is recommended for finishing IPS Empress CAD restorations:

– Use only suitable, fine-grained (grain size < 60 µm), ceramic-bonded grinding instruments

or diamonds at a speed of up to 20,000 rpm and little pressure.

– Overheating the glass-ceramic must be prevented.

– Smooth out attachment point of the holder and take the proximal contact points into

account.

– Carry out individual shape adjustments, if required.

Smooth out attachment point and take proximal contacts into account

Before the stain and glaze firing, the restorations must be free of dirt and grease. Avoid any

contamination after cleaning. Observe the following procedure.

– Clean the restoration with ultrasound in a water bath or blast with Al

2

O

3

at 0.5 bar

pressure (Caution: abrasive) and clean under running water or using the steam jet.

– Certain blasting devices require different settings for the intended blasting procedure.

Clean the restoration before staining

2-in-1 Technique – Stain and glaze firing using IPS Empress Universal

Once the restoration has been cleaned, apply the stains and glazing material in 2 steps. First, the glazing paste is applied,

followed by the stains, which are applied on the unfired glaze layer. The following working procedure should be observed.

Step 1 – Application of the glazing material

– Extrude IPS Empress Universal Glazing Paste from the syringe and mix thoroughly.

– Thin the material to the desired consistency using IPS Empress Universal Glaze and Stain Liquid. Do not excessively dilute

the material, since this may render the glazing procedure difficult to control.

– Apply the glazing material on the entire outer surfaces of the restoration.

– The glazing material must not come into contact with the inner aspects of the restoration.

– Avoid pooling and excessively thick glazing material layers.

– Too thin glazing material layers result in an unsatisfactory gloss.

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Evenly apply the glazing material on the entire outer surfaces of the restoration.

Step 2 – Application of Shades / Stains

– Extrude IPS Empress Universal Shade or Stains from the syringe and mix thoroughly.

– Thin the material to the desired consistency using IPS Empress Universal Glaze and Stain Liquid.

– Apply the mixed Shade material directly into the unfired glazing material layer.

– Intensify the corresponding dentin shade in the cervical and occlusal areas using IPS Empress Universal Shades.

– To imitate the incisal area and translucency in the incisal third, use IPS Empress Universal Shade Incisal.

– Apply individualized effects and characterizations on cusps and in fissures using the Stains materials. Only apply the

Stains once staining with the Shade materials has been completed.

– Apply the Stains thinly and in a controlled manner on the unfired glazing material layer using a brush.

Apply the mixed Shade material directly into the unfired glazing material layer. Intensify the

Apply individualized effects and characterizations on cusps and in fissures using

corresponding dentin shade in the cervical and occlusal areas and use IPS Empress Universal

the Stains materials.

Shade Incisal to imitate the incisal areas.

After glazing and staining, the glaze and stain firing is conducted in a compatible ceramic furnace (e.g. P300).

The following points should be observed when placing the restoration in the furnace and setting the firing parameters:

– Support inlays, onlays, and partial crowns with a firing pillow and place them on a honey-comb firing tray.

– Place veneers as well as anterior and posterior crowns on metal pins and position them on the honey-comb firing tray.

– As an alternative to the firing pillow and to better secure the restoration

on the metal pins (particularly with veneers), a small amount of

IPS Object Fix may also be used.

– Restorations supported with a firing pillow on the honey-comb tray are

exposed to less heat due to their lower position in the firing chamber.

Therefore, in order to achieve a true-to-nature gloss, it is recommended

to extend the holding time from 1 minute to 2 minutes.

– Make sure that the firing pillow is regularly replaced in order to prevent

contamination. Keep firing pillows used for all-ceramic materials

separated from those used for metal-ceramics to avoid cross-contamination.

Place the objects on the honey-comb firing tray and start

the firing program

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IPS Empress CAD Veneers / Anterior Crowns – Cut-back and layered

In order to individualize restorations in the incisal area so that they correspond with their natural model, the IPS Empress

CAD restoration is additionally veneered using opalescent IPS Empress Esthetic Veneer ceramic materials. The cut-back

technique is very efficient if the fully anatomical anterior crown or the veneer are first designed according to the definite

final shape. After that, the incisal third is reduced and subsequently provided with an individualized aesthetic veneer.

Veneer

Anterior crown

Layer thickness =

approx.

Layer thickness =

approx.

0.5–1.0 mm

0.5–1.0 mm

0.5 mm

0.5 mm

Minimum thickness

Limited layering area:

Minimum thickness

Limited layering area:

of the milled objects

of the milled objects

labial, incisal third

labial, incisal third

after the

after the

corresponding

corresponding

reduction

reduction

= 0.5 mm

0.5 mm

= 0.5 mm

0.5 mm

Fully anatomical, milled veneer and anterior crown,which are reduced in the incisal area.

Please refer to the corresponding Operating Instructions and/or Manuals of the respective CAD/CAM system

for further information on the CAD/CAM processing procedure. The instructions by the manufacturer must be

observed.

32