Step by Step: IPS e.max Press Abutment Solutions for Implant Restorations [VIDEO]

Traditional dental implant restorations can be challenging for dentists and laboratories. Several factors must be considered to ensure predictable, successful placement and subsequent restoration.

When dental implants are cement-retained, inadequate clean-up of excess cement adjacent to implant margins could lead to peri-implantitis. When dental implants are screw-retained, screw access channels require careful management to create proper anatomy, esthetics and function.

To address these challenges, a simplified option has been developed. This has been accomplished with the creation of hybrid abutment solutions. IPS e.max Press Abutment Solutions from Ivoclar Vivadent allow for simple, accurate placement of dental implant restorations that demonstrate a natural emergence profile, shape and esthetic properties based on the individual clinical situation. Custom characterizations can be added to further enhance the life-like esthetics and seamless blending with natural dentition.

The use of lithium disilicate over a titanium base produces a restoration with a strength of 400 MPa and life-like optical properties. The IPS e.max Press Abutment Solutions allows laboratories to create either one-piece hybrid abutment crowns attached to titanium bases, or hybrid abutments bonded to a titanium base onto which a crown can be cemented. Benefits of this fabrication technique include providing a laboratory a new product offering for dentists, cost savings compared to other customized abutments, faster turnaround and improved esthetics compared to traditional titanium or zirconia abutments.

[Editor's note: All case images in video above]

The case

01  An appropriate titanium base that corresponds to the implant being used is selected. The titanium base (Ti base) is placed on a model of the patient’s mouth, and a pin is inserted into the screw channel (Fig. 1).

02 Modeling resin is then used to design a coping around the Ti base and pin because the resin is more rigid than wax and will better withstand being slid on and off the Ti base (Fig. 2).

03 The emergence profile is created with resin (Fig. 3), and the remainder of the coping is built up in wax (Fig. 4).

04 The dimensions are verified against a putty matrix (Fig. 5). After removing the pin from the screw channel, attach a 2.5 mm sprue to a circular area, keeping the sprue parallel with the screw channel. Do not tilt the sprue (Fig. 6).

05 The wax-up is placed in an investment ring, and the investment is poured slowly, being sure to fill the screw channel (Fig. 7).

06 The investment is placed in the pressing furnace and preheated for 60 minutes. The appropriate press program is selected according to the ingot and ring size used.

07 The restorations are removed from the ring, divested (Fig. 8), and immersed in Invex Liquid to remove the reaction layer.

08 The fit of the abutment is verified on the Ti base, and minor adjustments can be made with diamond-coated instruments (Fig. 9).

09 The sprues are cut with a separating disc, and the attachment points of the abutment and crown are smoothed. The emergence profile and fit of the abutment are verified on the model.

10 Characterizations can be applied to the emergence profile of the abutment using IPS e.max Ceram shades and Essence stains (Fig. 10), after which the abutment should be fired. Glaze is then applied and the abutment fired again.

11 The Ti base is prepared for bonding by placing wax on the screw channel and emergence to protect them, while the boding area is carefully sandblasted with AI₂O₃ at low pressure (Fig. 11). Monobond Plus is applied to the bonding surface of the Ti base and allowed to react for 60 seconds (Fig. 12).

12 IPS Ceramic Etching Gel is then applied to the bonding surface of the IPS e.max Press abutment and left for 20 seconds, after which Monobond Plus is applied to the bonding surface of the abutment and left to react for 60 seconds (Fig. 13).

13 An opaque shade of cement is then applied directly to the bonding surfaces of the Ti base and the IPS e.max Press abutment, and the two components are seated together (Fig. 14). Excess cement is easily cleaned away from the emergence and screw channel with a brush (Fig. 15).

14 Liquid Strip Glycerin Gel is then applied to the cement joint of the completed hybrid abutment complex to prevent the formation of an inhibition layer. The cement is allowed to set for about seven minutes (Fig. 16). Rubber polishers can be used to smooth the cement joint (Fig. 17), completing the hybrid abutment.

15 The abutment is placed in the patient’s mouth and torqued to equigingival margins (Fig. 18). The screw access channel is then sealed with composite material (i.e., Tetric EvoCeram, Ivoclar Vivadent) and light cured. The IPS e.max Press crown is then cleaned and etched, and both the abutment and crown are treated with Monobond Plus for 60 seconds.

16 An opaque shade of implant cement is used to bond the crown to the abutment. The finished restoration will blend seamlessly with adjacent teeth (Fig. 19).

Closing thought

Using the technique outlined above will enable laboratory ceramists and technicians to produce implant supported restorations that demonstrate the proper emergence profiles, esthetics and function. The restorations also will be more predictable. IPS e.max Abutment Solutions simplify and increase predictability of a once challenging laboratory function. In addition to the ability to easily create custom hybrid abutment solutions, the technique also allows the creation of quickly fabricated hybrid implant crowns (Fig. 20). Both of these options help to maintain a patient’s oral health, with minimal trauma to the gingival tissue (Fig. 21).

In addition to an optimum design of the emergence profile, the individually fabricated, tooth-colored abutment features a long-lasting esthetic appearance, even in cases of gingiva recession. Given the fluorescence of the LS₂ glass-ceramic in conjunction with individual characterizations, a lifelike appearance is achieved. The seating of hybrid abutments is facilitated as a result of their geometry, and excess cementation material can be easily removed.

About IPS e.max Press Abutment Solutions: In addition to an optimum design of the emergence profile, the individually fabricated, tooth-colored abutment features a long-lasting esthetic appearance, even in cases of gingiva recession. Given the fluorescence of the LS₂ glass-ceramic in conjunction with individual characterizations, a lifelike appearance is achieved. The seating of hybrid abutments is facilitated as a result of their geometry, and excess cementation material can be easily removed. For more information, contact Ivoclar Vivadent at 800-533-6825 or visit www.ivoclarvivadent.us.