Lithium Disilicate. Zirconia

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3 e.max CAD e.max Press e.max ZirCAD CadCAM Milled Crystalized Lithium Disilicate Pressed Lithium Disilicate CadCAM Milled Sintered Yttrium Zirconia 360 Lithium Disilicate Zirconia 400 1,000 Esthetic anterior & premolar crowns Esthetic crowns premolar & anterior bridges Strong esthetic crown & bridge frames throughout the mouth e.max ZirPress Pressed Fluorapatite Glass 110 Esthetic press to zirconia esthetic anterior laminates e.max Ceram Layered Fluorapatite Glass 90 Layering all e.max materials

4 IPS e.max Lithium Disilicate

5 IPS e.max Press Lithium disilicate glass ceramic High flexural strength 400 MPa 16 A-D, 4 Bleach BL shades LT and HT Adhesive or conventional cementation Fabricated through traditional press technique for superb fit and ease of production

6 IPS e.max Press Indications Anterior and posterior full-contour crowns Implant superstructures Veneers 3-unit anterior bridges Inlays/Onlays Thin Veneers

7 IPS e.max Press Thin Veneer IPS e.max Press can be used for the fabrication of very thin veneers (minimal Prep). If sufficient space is available, e.g. retrusion of a tooth, no preparation is required. labial incisal IPS e.max Veneers are not just for no-prep but the right prep. 0.3 mm 0.4 mm The following minimum thicknesses for fabricating thin veneers have to be observed:

8 Advantages Higher edge strength vs. traditional glass ceramic materials (can be finished thinner without chipping) Low viscosity of heated ingot enables pressing to very thin dimension (minimal prep or no-prep veneers) Chameleon effect due to higher translucency

9 IPS e.max Press Thin Veneer Please observe the following procedures for the fabrication of thin veneers: Apply the spacer to the preparation or tooth to be treated according to the veneer preparation guidelines For thin veneers without preparation, locate the restoration margins in the proximal area as well as along the gingival margin. Observe the minimum thickness of the veneer. Sprue, invest, press, divest and remove the reaction layer according to the stipulations It is possible to apply IPS e.max Ceram Incisal or Transpa. Conduct the Stain and Glaze firing with IPS e.max Ceram. Thin veneers have to be adhesively cemented.

10 Material Properties

11 Flexural Strength Felds Pressed Leucite Lithium Aluminum Zirconia PFM

12 Flexural Strength Felds Pressed Leucite Lithium Aluminum Zirconia PFM

13 Flexural Strength Felds Pressed Leucite Lithium Alu minum Zirconia PFM

14 Flexural Strength Felds Pressed Leucite Lithium Aluminum Zirconia PFM

15 Flexural Strength Felds Pressed Leucite Lithium Aluminum Zirconia

16 Monolithic Lithium Disilicate Crown Monolithic vs. Zirconia Zirconia Crown 90 MPa MPa 1000 MPa

17 Lithium Disilicate Glass Ceramic for Press Flexural strength: 400 MPa CTE ( C): K -1 Press temperature: 920 C

18 Thin Veneer

19 Wax-up

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21 Pressing Quality

22 Fitting Quality

23 Fitting Quality high mechanical stability

24 Material Thickness

25 temperature stability Stain / Glaze process stone die natural color die

26 Translucency Effect

27 Opalescence Effect

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29 Standard Prep Cross Section 10x magnification Cross Section 30x magnification

30 Minimal Prep Cross Section 10x magnification Cross Section 30x magnification

31 No Prep (using feldspathic materials) Cross Section 10x magnification Cross Section 30x magnification

32 No Prep (using lithium disilicate) Cross Section 10x magnification Cross Section 30x magnification

33 Feldspathic Veneer (Foil Technique)

34 Feldspathic Veneer (Refractory Technique)

35 IPS e.max Press Veneer

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37 Minimal and No-prep Veneers Good arch form and axial contours for using a no-prep approach. Dark triangles at cervical embrasures can be easily closed without creating unsanitary contours

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39 IPS e.max Press HT Veneer

40 IPS e.max Press HT Veneer

41 IPS e.max Press HT Veneer

42 IPS e.max Press HT Veneer

43 IPS e.max Press HT Veneer

44 IPS e.max Press HT Veneer

45 ` Bonding and Thickness Effect on Fracture Load of CAD/CAM Crowns

46 Question asked How does thickness and cementation affect the load that a e.max CAD restoration can take? Objective To measure the fracture load of CAD/CAM lithium disilicate glass-ceramic crowns (e.maxcad, Ivoclar Vivadent, Inc.) milled with two thicknesses and cemented either conventionally (Vivaglass CEM, Ivoclar Vivadent, Inc.) or adhesively (Multilink Automix, Ivoclar Vivadent, Inc.).

47 Thickness and Cementation Groups Four groups were used for this study: (1) Standard thickness and conventional cementation (2) Reduced thickness and conventional cementation (3) Standard thickness and adhesive cementation (4) Reduced thickness and adhesive cementation.

48 Load to Failure was measured Standard Thickness Reduced Thickness Fifteen specimens were produced for each group. A standardized molar crown was scanned using the Cerec InLab (Sirona). Thirty crowns were designed with thicknesses exceeding the minimal dimensions for e.maxcad material (Standard thickness). Thirty more crowns were milled with the thickness reduced internally by 0.6 mm. The occlusal morphology was the same for all the crowns. The specimens were then fired and glazed in one firing according to the manufacturer s instructions in a P500 Programat oven (Ivoclar Vivadent, Inc.).

49 Load to Failure was measured The crowns were cemented to composite (Heliomolar, Ivoclar Vivadent) preparations which were formed from the internal surface of each crown using either a conventional cement (VivaglassCEM) or an adhesive cement (Multilink Automix) and stored in water for 24 h at 37 C. The crowns were loaded using a 15 mm diameter steel ball at a crosshead speed of 0.5 mm/min with an Instron Universal Testing machine until a crack was produced.

50 Failure Load (N) e.maxcad standard conventional e.maxcad reduced conventional e.maxcad standard adhesive e.maxcad reduced adhesive Thickness and Cementation Type EmpressCAD standard adhesive Effect of Thickness and Cement Type

51 Conclusion Within this study, increased thickness and adhesive cementation greatly increased the failure load of CAD/CAM lithium disilicate crowns.

52 ` Cementation Effect on the Fracture Load of Two CAD/CAM Materials

53 Question asked How does cementation affect the failure load for e.max CAD and zirconia core restorations? Objective To measure the fracture load of CAD/CAM lithium disilicate glass-ceramic crowns (e.maxcad, Ivoclar Vivadent, Inc.) and zirconia core (Lava core, Lave Ceram 3M/ESPE) cemented either conventionally (Zinc Phosphate, Fleck s) or adhesively (Multilink Automix, Ivoclar Vivadent, Inc.).

54 Thickness and Cementation Groups Four groups were used for this study: (1) e.max CAD LT full contour and conventional cementation (2) zirconia core/veneered and conventional cementation (3) e.max CAD LT full contour and adhesive cementation (4) zirconia core/veneered and adhesive cementation.

55 Load to Failure was measured Ten specimens were produced for each group. A standardized molar crown was scanned using the Cerec InLab (Sirona). Twenty crowns were designed with recommended dimensions for lithium-disilicate material. The specimens were fired and glazed according to the manufacturer s instructions in a P500 Programat oven (Ivoclar Vivadent, Inc.). Twenty copings with proper support were milled in zirconia using the Lava system. These copings were layered in a matrix to full anatomy. The occlusal morphology was the same for all the crowns in the study. All crowns were cemented to composite (Heliomolar, Ivoclar Vivadent) preparations which were formed from the internal surface of each crown using either conventional cementation (Fleck s Zinc Phosphate) or adhesive cementation (Multilink Automix) and stored in water for 24 h at 37 C. The crowns were loaded using a 15 mm diameter steel ball at a crosshead speed of 0.5 mm/min with an Instron Universal Testing machine.

56 crown crunch test Mean breaking load [N] Multilink Automix Fleck's Cement Multilink Automix Fleck's Cement lava zirconia lava zirconia e.max CAD e.max CAD

57 Conclusion Within this study, adhesive cementation increased the failure load of CAD/CAM crowns, though no statistical difference was found between the crown materials.

58 IPS e.max Lithium Disilicate Wear

59 Testing Equipment Oral Wear Simulator 2000

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61 Strength vs. Wear