How to: Achieve ceramic esthetics with a nano-hybrid composite

Since its debut, more than 37 million crowns and veneers have been fabricated with the IPS Empress pressed ceramic system. As a result, the IPS Empress all-ceramic brand has become synonymous with the highest level of esthetics for mimicking natural teeth. Unfortunately, it has been difficult to restore the optical properties of natural teeth using one shade of composite and achieve similar results.

Therefore, the IPS Empress family of products recently added IPS Empress Direct. This light-curing, nano-hybrid direct composite demonstrates exceptional handling properties, meaning consistent anterior esthetics-similar to ceramics-can be realized with the on-demand simplicity of composite. With a broad range of true-to-nature dentin and enamel shades, as well as different translucencies and opacities, IPS Empress Direct represents a welcome addition to dentists’ armamentaria for esthetically restoring every indication-even in the posterior

IPS Empress Direct Dentin and Enamel shades have calibrated translucencies that work together to provide exceptional esthetics with consistently accurate color matches. Dentists can easily mimic the optical effects of natural tooth structures in a way similar to ceramic, but with the ease of direct composite.

IPS Empress Direct demonstrates a high radiopacity compared with a natural tooth, so restorations are clearly visible on radiographs for enhanced diagnosis. The composite is less sensitive to light than other materials, so dentists have ample working time for sculpting a restoration’s anatomy. Because IPS Empress Direct is a nano-hybrid composite, it retains its gloss similar to a microfill or nanofill. However, because it is a hybrid, it also demonstrates a higher strength and modulus of elasticity, which is why it can be used in the posterior.

The case

A patient in her mid-40s presented with a failing amalgam restoration (Fig. 1). We showed the patient photographs of the open margins in the surface of the tooth and warned her that decay may be present under the failing amalgam. If this were the case, she would require an onlay restoration.

After the decay was removed, some unsupported walls were exposed, indicating an onlay may be necessary. The patient could choose another amalgam, resin or porcelain for the restoration. She wanted an esthetic solution such as porcelain, but couldn’t afford it. I suggested an esthetic nano-hybrid composite restoration (IPS Empress Direct), a solution that would achieve high esthetic value (Fig. 2) and longevity similar to that of ceramics while still cost effective.

Clinical protocol

01. After administering anesthesia, rubber dam (Optradam) was placed to ensure tooth isolation. The amalgam restoration was removed (Fig. 3).

02. The underlying decay was assessed and removed. The tooth was inspected for further decay.

03. After preparing the cavity, it was scrubbed using hydrogen peroxide, followed by another scrub using 0.2% chlorhexidine solution. The preparation was rinsed with water to ensure the surface was clean.

04. The preparation was conditioned using a total-etch technique. An etchant gel was applied to the enamel for 10 seconds (Fig. 4). The etchant gel was then added to the dentin for 10 seconds (Fig. 5).

05. The surface was rinsed with copious amounts of water for 10 seconds and lightly air dried to leave a slight sheen on the dentin. If water pooling had occurred, it would have been blotted with a cotton pellet.

06. Three clicks from a VivaPen were placed onto the surface for 5 seconds. The bonding agent was agitated into the dentin, after which the surface was lightly air dried using an A-dec Tooth Warmer.

07. The bonding agent was cured for 20 seconds, then 10 seconds in a circular motion at different angles, to ensure a total cure.

08. A flowable composite (Tetric Flow) was applied to the dentin floor and lightly cured for 20 seconds (Fig. 6).

09. The IPS Empress Direct Dentin composite in shade A1 was placed in increments short of the enamel level to create morphology during the layering process. The composite was then cured for 20 seconds (Fig. 7).

10. The IPS Empress Direct Enamel composite in shade A1 was then placed over the dentin layer and sculpted to create proper but slightly steeper inclines to create pits and fissures. This process was followed by 20 seconds of light curing (Fig. 8).

11. Tetric Color brown (ochre) was applied into the grooves on the surface to lightly tint them and then cured for 10 seconds. After applying the Tetric Color, a Trans 30 layer was placed and shaped (Fig. 9), followed by a final cure of 20 seconds.

12. The surface was then polished with a regular fluted carbide and shaped into grooves with a pointed diamond bur, followed by a final polish with polishing points and brushes (Astropol) for even more shine.

13. The rubber dam was removed, the tooth was checked for occlusion, and little adjustment was necessary. After a final polish, the restoration was complete (Figs. 10 and 11). The total procedure time was 35 minutes.

Closing thought

Over the years, the IPS Empress system has evolved significantly in response to the various demands of dental professionals. The newest addition is IPS Empress Direct, a light-curing, nano-hybrid composite that demonstrates outstanding handling properties to enable dentists to achieve anterior esthetics similar to ceramics, but with the on-demand ease of composite.

As well as providing easy use chairside, the IPS Empress System has moved with the shifting tides of the economy, giving patients an option that looks and performs as well as ceramics, but costs less. Its variety of true-to-nature dentin and enamel shades, as well as different levels of translucencies and opacities, provides limitless opportunities for realizing esthetic results. Because IPS Empress Direct is a nano-hybrid composite, it provides the benefit of a higher strength and modulus of elasticity, making it suitable for posterior indications.

Dr. Wilson Kwong graduated from the Faculty of Dentistry at the University of British Columbia in 1989. He currently has a cosmetic practice in Vancouver, British Columbia, Canada.