How to Restore the Maxillary Arch Using IPS e.max ZirCAD Prime Esthetic Dental Team: Yuki Momma, RDT, Ceramic Artisan Dental Lab, Weston, MA, and Yousef Sidki, DMD, Chelmsford Dental Specialists Group, Chelmsford, MA. Restorative Challenge: A male patient presented for his annual exam. Although some clinicians may have prescribed only a nightguard, the patient’s bruxism, heavily acidic diet and parafunctional habits called for a more comprehensive treatment.
long-term integrity and natural-looking final restorations. Historically, achieving lifelike esthetics in milled zirconia monolithic restorations has meant either a sacrifice in mechanical strength or a sacrifice in labor efficiency. Since this new generation of zirconia offers a seamless gradient from dentin to incisal that offers the desired esthetics and translucency without the loss of mechanical strength, it can be milled to full contour and characterized using simple timesaving techniques.
Yuki Momma created a diagnostic waxup of the proposed treatment plan which allowed Dr. Sidki to prepare the teeth with the most conservative approach.
Stage 1
The weakened enamel of teeth #5-#12 and teeth #21-28 had begun to break away during normal function, causing hypersensitivity, decreased function and an unesthetic appearance. The patient had generalized recession, extensive wear and compensatory eruption. Treatment Plan: The clinician explained that to restore the balance of function and esthetics to the patient’s smile, the dental team would create very strong, highly esthetic and natural-looking crowns for teeth #5-#12 and #21-#28. The discussion led to a sequential treatment plan with the maxillary arch being restored to improve his smile, as this was his chief complaint, and the mandibular arch treated at a later date for a fully functional reconstruction. The positioning, shape and location of the maxillary anterior teeth dictated the entire direction for the reconstruction, from design to completion. Upon examination it was determined his posterior teeth were sound with no decay and his vertical dimension of occlusion and chewing surfaces had not been damaged by his bruxing habit to the point of needing to be restored. The dental team chose Ivoclar’s IPS e.max ZirCAD Prime Esthetic to restore this case due to the high strength required and the optimal esthetics of the material that would ensure the
Momma’s diagnostic mockup of the maxillary restorative design lengthened teeth #8 and #9 to the esthetic standard of 10-11mm in order to set the parameters of the case and balance the esthetics and functionality of the patient’s smile. Once the clinician and ceramist agreed on the final design, Momma created a putty matrix and delivered it to the practice prior to the prep appointment.
Stage 2 Dr. Sidki took pre-operative photographs of the patient’s existing arches and videos of the patient speaking. He took alginate impressions using Jeltrate Plus from Dentsply Sirona.
Dr. Sidki prepped teeth #5-#12 to receive full contour zirconia crowns; a few teeth in the lower jaw were adjusted to prevent interference with the maxillary restorations until the mandibular teeth were restored. LMT • October 2022 • LMTmag.com 34
Dr. Sidki took the final impressions and fabricated the chairside temporaries. He and Momma evaluated the temporaries for shade, function and esthetics as well as phonetics and, again, took videos of the patient speaking, laughing and smiling to ensure the final restorations would meet his expectations. Once the patient approved the esthetics and function of the temporaries, an impression was taken and sent to the laboratory.
Stage 3
To add the final lifelike touch, the ceramist added a white spot on the incisal edge of crowns #8 and #9 using Ivocolor Essence E01White and then executed the final firing. The full contour crowns #5-#12 were milled from IPS e.max ZirCAD Prime Esthetic A1 with the Zenotec Select Hybrid mill from Wieland.
Final Result
The final restorations after sintering. At the laboratory, models of the patient’s prepped teeth and approved temporaries were created from the impressions.
The crowns after the initial staining
The models were scanned using 3Shape for the final CAD design which included surface characterizations that would be replicated during the milling process.
To create the natural esthetics the patient desired, the ceramist stained each restoration using IPS Ivocolor E16 Ocean, E04 Sunset, E02 Cream, Shade 2 and glazed with IPS Ivocolor Glaze Paste.
LMT • October 2022 • LMTmag.com 35
The clinician seated the restorations and fabricated a custom nightguard to ensure the restorations wouldn’t be damaged pending finalization of the mandibular restorative process. The patient was highly satisfied with the esthetic result of his new smile; in fact, he was so pleased he scheduled an appointment for restoring his mandibular teeth just two weeks later!
IPS e.max ZirCAD Prime Esthetic is a highstrength, preshaded zirconium oxide disc with a gradual shade and translucency gradient. Made from 4Y-TZP and 5Y-TZP zirconium oxide raw materials, IPS e.max ZirCAD Prime Esthetics powders are coordinated with the A-D tooth shade guide. For more details, visit ivoclar.com.