IPS. Special Edition. Press-on-Metal Ceramic. Harald Gritsch Max Wörishofer Christoph Zobler

Transcription

1 InLine PoM Press-on-Metal Ceramic IPS Special Edition Harald Gritsch Max Wörishofer Christoph Zobler

2 Press-on technique on metal frameworks Combining the widely known casting technique and press technique results in high-quality dental reproductions. The advantages of the high-precision casting technique and the aesthetic possibilities of pressed ceramics provide results that can hardly be outperformed. All wax patterns ranging from single crowns to long-span bridges can be processed with the presson-metal technique to provide exceptional dental reconstructions. Subtle details of the wax pattern, such as occlusal contacts and high-precision ceramic shoulders, are reliably preserved until the final glaze is applied because the press-on ceramic does not shrink, unlike conventional metal-ceramics. 2

3 Insight The IPS InLine PoM ceramic system enables dental technicians to produce high-quality dental reconstructions from alloys and ceramic materials using an efficient, predictable technique. Those who know the pitfalls involved in reproducing e.g. two opposing PFM crowns with extensive ceramic shoulders, a fully functional relationship between cusps and pits, aesthetic ridges, marginal ridges and fissures will soon discover the advantages of the IPS InLine PoM Press-on-Metal ceramic system. Technicians can allow all their experience and creativity to flow into designing the wax pattern without having to make allowances for material shrinkage during the shoulder, dentin and add-on firing cycles. For the first time ever, accurate 1:1 copies can be reproduced in ceramic from fully anatomical wax-ups without having to sacrifice the positive advantages of the conventional metal-ceramic method. A fully anatomical wax-up is designed on the opaqued metal framework, invested and pressed, similar to the conventional ceramic press technique used e.g. in IPS e.max Press. Obvious success: Straightforward construction of circular ceramic shoulder (metal margin is not visible). Homogeneous ceramic material without inclusion of air bubbles or possible lifting of the ceramic material, unlike conventional metal ceramics. Final shape achieved in a single press cycle. No shrinkage during characterization and add-on firing cycles (shoulders and centric stops are preserved). Optimally adjusted translucency providing reliable masking of metal substructures and enamel-like appearance of cusp areas. All key colours can be accurately reproduced with only seven ingot shades; a layering diagram is not needed. Ceramic surfaces can be easily polished. Touch-up materials (add-on materials) are available in seven ingot shades for possible later adjustments. The logical conclusion: An easy work flow helps dental technicians to save time and energy and concentrate on such essential factors as functional movement paths and aesthetic shaping of the restoration. 3

4 Preparation Preparation for an implant-supported IPS InLine PoM bridge Machined implant attachments with a slightly conical shape and additional retention grooves 4

5 Wax-up and opaquer The cusp-supporting wax framework is checked with a silicone key. Pear-shaped sprues and cooling grits are connected to the wax pattern. Clear-cut homogeneous gold cast made of Callisto Implant 78 (same criteria as for PFM technique). The framework is honed with a cross-cut tungsten carbide bur in one direction. Left: The first layer of opaquer (wash) is applied. Right: The second layer of opaquer is applied, covering the entire framework. After the second opaquer firing: A small amount of intensive opaquer material is applied to enhance the colour depth in the occlusal and marginal areas. 5

6 Wax-up In contrast to the conventional PFM technique, the functional occlusal concept of sequential guidance with front-canine dominance can be incorporated into the reconstruction already at the wax-up stage. The final shape of the restoration can be achieved in a hassle-free manner. A mandibular model with detachable segments is utilized to accurately adjust the inclination angles, which are decreasing towards the back on the upper buccal cusps. During laterotrusion of the left side, the function of the remaining posterior teeth at one removed to the rear is checked on the mediotrusion side. Each tooth discludes each distally following tooth during laterotrusion. Laterotrusion is also checked on the right hand side. At the same time, the functional contacts on the left mediotrusion side are checked. 6

7 Sprueing, pressing, finishing Each unit of the bridge is provided with a sprue. In comparison: fully pressed IPS InLine PoM bridge immediately after divesting The IPS Sprue Guide indicates the correct angle at which the sprues should be attached to the units of the restoration. 7

8 Finishing Possible ceramic bubbles along the margin are removed and the contacts are adjusted. The bridge fits snugly on the master model. The shape of the restoration is now completed; nothing can adversely affect it, except if a mistake is made during smoothing the attachment points. It is essential to design the interdental spaces accurately. This technique provides an exact copy of the wax pattern in ceramic. 8

9 Characterization Many dental technicians are familiar with the characterization technique using Shades, Shade Incisal and Stains materials. As the material offers high firing stability, the shape of the restoration remains unaffected by this working step. The characterizations can be applied in a relaxed manner. 9

10 Characterization After up to two stain firings and two glaze firings have been carried out, the completed bridge is replaced on the master model for a final check. The wax pattern is transferred in a 1:1 fashion to the ceramic, resulting in excellent accuracy of fit and precise morphology. Wax-up = ceramic 10

11 Designed to perfection: shade and shape Precision, function and aesthetics in one 11

12 Building an interference-free occlusion with front-canine dominance Working side Balancing side resting condyle moving condyle Lateral movement to the right side Mediotrusion to the right side This system enables dental technicians to design the occlusal surfaces of metalceramic restorations in a controlled, predictable fashion. 12

13 Building an interference-free occlusion with front-canine dominance Balancing side Working side moving condyle resting condyle Mediotrusion to the left side Lateral movement to the left side The teeth are brought as close together as possible whilst an appropriate safety distance is observed in posterior teeth during movement phases. This method results in functional dental reconstructions which offer optimum levels of masticatory efficiency and maximum protection of the periodontium and joints. 13

14 Patient case # 1 Upper arch: Single-tooth restorations on implant and natural teeth Lower arch: Single crown on natural tooth and splinted IPS InLine PoM crowns on implants (Patient case by Dr. Bertram Prinz, Innsbruck, Austria) 14

15 Step by step 1. A wax-up of the final tooth shape is produced. 2. An impression of the occlusal third is taken using a silicone material. 3. Completed metal framework with a cusp-supporting design 15

16 Step by step The occlusal surface is reconstructed with the help of the silicone key after the opaquer has been applied and fired. Investing, pressing and blasting are performed in the usual manner. Tip on divesting the restorations Doing it the other way round: Carefully remove investment material from the press button with the help of appropriate blasting equipment. (Restoration remains covered with investment material.) Remove the press button with diamond discs under water cooling. Blast the occlusal surfaces and, subsequently, the pressed object from direction of the crown margins. Single crowns after stains and characterization firing 16

17 Step by step Glazed IPS InLine PoM crowns Even if the margins are magnified several times, the restorations show an excellent marginal fit. 17 Aesthetic, functional, high quality!

18 Patient case # 2 This patient was treated in the practice of Dr. Bertram Prinz (Innsbruck, Austria) with splinted posterior IPS InLine PoM crowns and a cantilever pontic on each side. IPS e.max Press was used in the anterior region. 18

19 Step by step Although the restorations have been created with two different materials, their shades perfectly harmonize with each other without aesthetic compromise. 19

20 Patient case # 3 This patient was treated in the practice of Dr. Marlies Moser (Innsbruck, Austria). Each tooth of the upper arch was restored with a single crown. IPS e.max Press was used for the anterior region and IPS InLine PoM for the posterior region. Left: Wax-up of anterior region and precious metal frameworks Right: Second opaquer firing Left: Completed wax-up of posterior teeth Right: Pressed IPS InLine PoM crown 20

21 Step by step A harmonious overall impression 21

22 A passion for perfection IPS InLine PoM Press-on-Metal Ceramic INN-KERAMIK, Austria /0907/RDV This poster can be ordered from Ivoclar Vivadent. 22

23 In 2004, our team of three consisting of Max Wörishofer, Harald Gritsch and Christoph Zobler founded INN-KERAMIK in Innsbruck, Austria. Following several years of deepening our knowledge in allceramics, implant-technology and functional analysis at the dental clinic of the University of Innsbruck in Austria, it was and is important to us to make use of our experience within the setting of a commercial laboratory. Having a solid understanding of the relationships in the stomatognathic system is an essential requirement for us to treat complex patient cases with gnathological reconstructions. Careful assessment of a patient s oral situation, individualized treatment planning and appropriate selection of material are essential to offering durable solutions to patients. 23

24 Seeing the way «IPS InLine PoM offers a straightforward, uncomplicated method to create high-quality functional ceramic veneering without having to make allowances for sinter shrinkage. The reconstructions are modelled in wax and pressed onto proven precious metal frameworks in an efficient manner. The resulting restorations are completely satisfactory because of their homogeneous quality, shade stability and aesthetic appearance.» INN-KERAMIK, Innsbruck (Austria) /1008/e/RDV