Anterior Values in Emax

[Wyolab]

Hello Everyone,
I was talking to a dentist who has not been happy with all of his emax cases. I just did my first one for him, and he liked it more then some of the others. Here is the problem, he feels his cases have been to opaque in the past. The six unit anterior case I did came with some photos and a slanted stick bite. He did not do a diagnostic, and the clearances were tight on the labial. The incisal edge of the teeth were very labial, so it made it a challenge to keep everything where I wanted it. I feel that if this has been a problem in the past it may be the ingot choice and the room for layering. Any thoughts out there from the experts? I have read through a lot of the emax threads, and they have all been extremely helpful. It seems that HT ingots cause issues with values, as do LT, are people using MO ingots more? Everything looks good on the bench of course, but then what. Here is a preop photo, I tried to take some photos in the lab but I don't have a macro setup so they didn't come out very good. I am going to try and get some pictures of the seated crowns today.

 

[paulg100]

if you are matching another tooth ie a single central then MO or LT fully layered.

For smile makeover cases i have been doing LT with cutback however this is the CAD varient.

I have just started doing press also and have noticed that the transluciencies are lower with press VS CAD.

From my initial observations i would say that cutback LT in press might very well look to opaque.

CAD works fine for this though.

Obviously the goal here is full contour with stain or cut back for productivity and control of morphology.

Check Matt Roberts videos at Welcome to Team Aesthetics for a nice cut back case in HT.

for smilemakeover cases in press i can see myself going down the HT route with cut back when doing anteriors and using LT for stain technique for posteriors.

Of course it does depend on the stump colour, the final desired shade and the amount of labial space you have to work with.

 

[sixonice]

are you getting stump/preparation shades from this dentist? this information is paramount in ingot selection, controlling value & translucency. is the dentist using a transparent cement? shaded cements can and will certainly affect value & shade on all ceramics. these are good spots to start with. LT ingots are higher in value for sure, and I always like to work off of something higher value versus lower value - for example, if the prescribed shade is A2 (with a reasonably light prep shade) i like to press one shade lighter if possible and either shade or layer down some. making e.max transparent, especially when layering or "enamelizing" restorations should be very reasonable, especially if you utilize some of the opal effect powders. HT ingots work nice, but I really only like them for bleach shades, A1 and B1 and ALWAYS on a light prep. a member on here (named Al) had posted loads of e.max makeover cases with pictures and tips on how to create the effects you are looking for.

 

[Wyolab]

I got a stump shade of ND2. I looked at the restorations, and part of the problem is they picked A1 for a patient who is A3.5 everywhere else. He is coming in for bleaching, and that should help. I will try and get some photos of the final product.

 

[paulg100]

how about they actually finish the course of bleeching first then wait a couple of weeks for relapse, THEN give you a shade..

That way you have some hope in hell of matching.

Hate it when Dr's do this, so dumb.

 

[dmonwaxa]

WOW!', a35 to a1 bleaching regiment, and the restorations are already made? SWEET. Just luv when that happens.

 

[Wyolab]

Here is a look at the seated crowns. Sorry, I don't have a great camera.

 

[Old Navy Tech]

I'm probably alone in my thoughts on Emax in this forum, but I did want to raise awareness and maybe get some discussion.

Emax is Lithium Disilicate

Ivoclar put on the market Empress 2, also Lithium Disilicate.(DDS Lab | Products | All-Ceramics | IPS Empress II)

Jeneric/Pentron put on the market 3G, also Lithium Disilicate.

Everyone hated 3G and Empress 2. both Lithium Disilicates

Ivoclar ends up buying the facilities that were owned by Jeneric/Pentron that
manufactured the 3G system.

Ivoclar then starts marketing Emax.

There are some guys on here that make some pretty awesome looking emax restorations, my hat is off to them.
If we have to use it, it's mostly for inlays, that HT ingot is nice at the margins and blends to existing tooth color, we have made monolithic full contour stain and glaze units for posteriors.

We gave it a shot for veneers, since we use Heraceram press and powder ceramic, needed to find a new material that is as easy to use and as beautiful... Not a product for us... we didn't like the porcelain for it, using GC initial Zr made it look better, but what a PIA...

So it looks like the regular GC pressing ingots and porcelain will be our go to when all our Heraceram is gone.
We use zirconia and GC initial and have not had a fracture in the layering porcelain, EVER... we wax copings like we would for PFG, and have them scanned, so we layer 1.5 to 1.7 and stay within the manufactures 2mm rule of unsupported porcelain.

As far as the Heraceram press and layer, we have many premolar to premolar upper and lower restorative cases that have been in the mouth since 2002, and they are also in tact... no remakes. We follow the Occlusion teaching of The John Kois Center and are recognized specialists of his curriculum.
So in my opinion, if you want anterior veneers to look great, do refractory models or platinum foil and layer feldspathic porcelain, or press and layer GC which by the way is basically Creation 2, a much improved version, designed by Willi Geller as well.

 

[Mark Jackson]

I'm probably alone in my thoughts on Emax in this forum, but I did want to raise awareness and maybe get some discussion.

Emax is Lithium Disilicate

Ivoclar put on the market Empress 2, also Lithium Disilicate.(DDS Lab | Products | All-Ceramics | IPS Empress II)

Jeneric/Pentron put on the market 3G, also Lithium Disilicate.

Everyone hated 3G and Empress 2. both Lithium Disilicates

Ivoclar ends up buying the facilities that were owned by Jeneric/Pentron that
manufactured the 3G system.

Ivoclar then starts marketing Emax.

I was one of the labs who got stung, and stung hard by Empress2. The units that didn't fail in the lab, failed in the mouth. I had hundreds of units that were screwed up, and we were getting almost weekly technicial bulletins with changed instructions and new materials to replace faulty materials.

I understand how you feel.

This was one of the reasons we implemented DAMAS and FDA GMP's here in our lab. I got tired of failures being blamed on me.

As for 3G, I know that Ivoclar and Jeneric Pentron were locked in a death match lawsuit, but I thought Kerr bought the facility, not Ivoclar? I heard Ivoclar only bought rights.

We have had great success with eMax, and the marketing has helped drive demand which for a lab like ours is the key to aggressive growth.

There is a new "fortified" LDS coming out from another manufacturer which I am anxiously awaiting!

 

[Old Navy Tech]

You may have better Intel on the facility ownership, so won't argue.

I was just a cog in a large lab here in Seattle when Ivoclar decided to have the labs do the testing and research on E2 rather than doing it themselves. I had to wax, press divest, cut off and seat after it soaked in the solution. Then do it all over again for the same cases because the expansion or something else was wrong. It was only part of my daily chores, since I was the only guy in the gold department, and waxing full contour was my thing. (part of Navy training)

Also Ivoclar reps gave away shade guides for their red/pink porcelain (?Chromascop?)... and forced labs to buy the guides AND the porcelain to be able to give accurate pinkish teeth matching the tabs back to the dentist. My point being Ivoclar is the best marketer in the world, they could sell ice cubes to Eskimos. I read through this forum and it's evident that a large percentage of labs have had to be supermen to make a product work. Like the CTE of GC initial matches the emax better than it's own emax porcelain.

I met a hygienist on Craigslist because I posted an ad for racquetball, she had horrible looking emax veneers, I'm told they looked ok the day they were bonded, but a couple days later, chipping and discoloration.... never ever has one of my veneers chipped with out the aid of beer bottle opening, or pistachio cracking. Or has HeraCeram "gone grey" like OPC and Empress 1 and Emax after bonding... even if the dentist uses the catalysis with the amine that has been touted to cause such problems. I was allowed to present information to her boss and we did a few crowns and I won an account out of the deal, and the Lab that did them was one of the better well know top $$$ in the State. We did a diagnostic wax up for the Hygienist and will be making her veneers in HeraCeram, when ever they can work out a time to cut the emax off.

Curious with the fortified DLS... how much stronger than 440Mpa does a material need to be? Will it be more or less abrasive than emax on opposing dentition?
I think natural enamel is 120? or less, right?
How about the full contour Zr? what's your thoughts...

 

[sixonice]

There is a new "fortified" LDS coming out from another manufacturer which I am anxiously awaiting!

Lithium Disilicate is patented by Ivoclar.

 

[Old Navy Tech]

correct Lithium disilicate glass ceramics dental product
Ivoclar AG (LI)

Lithium disilicate-containing glass-ceramics some of which are self-glazing
Corning Incorporated (Corning, NY)

and I'm sure a company that changes it up and adds something or "Fortifies" it the final product could be sold too... even if it contains LDS

 

[Mark Jackson]

correct Lithium disilicate glass ceramics dental product
Ivoclar AG (LI)

Lithium disilicate-containing glass-ceramics some of which are self-glazing
Corning Incorporated (Corning, NY)

and I'm sure a company that changes it up and adds something or "Fortifies" it the final product could be sold too... even if it contains LDS

It's different and it's patented, and it's coming this year.

 

[paulg100]

Empress 2, dont remind me! we lost some good accounts thanks to that

Targis and Vectris wasnt much better, thankfully Ivoclars dark past seems to be behind them for now.

 

[amadent]

as far as Emax what is everyone advising doc to insert them with.
what gives them the most esthetics
what will not suck up all the color that i have in the restorations (LT layered)
having an issue with a few of my anterior cases looking very life like on the model but losing alot of the "fire" when the DR seasts them