Emax over implants

[finnster68]

Hi all

Just wondering if anyone has been pressing any LT/MO over implants.

I never really thought about it until late last year when a Dr i dont do any work for rang me and asked if i could press something for him.

He had waxed up a 3 unit bridge (2 xPreMolar + Molar) over Straumann abutments and simply wanted me to press it for him.

At that stage none of the literature i had recommended something like this so i raised my concerns. He said he had been doing it himself for some time so just press it.

It turned out quite nice and Dr was happy and inserted the bridge.

Got me thinking, since then i have pressed several single unit cases over Straumann abutments and they simply look so much better than what i could produce using PFM. I guess what concerns me however is the longevity of the crowns.

There now seems to be a lot of discussion that a 400 odd mpa solid core material such is Emax is actually stronger than using zirconia/PFM so maybe it really could be a better option.

Anyone else pressing over implants?

P.S it also says in literature you can use Emax for 3 unit bridges. I recently did a 5 unit anterior bridge case, 3 abutments, 2 pontics and Dr and patient were extremely pleased with the result.

Stretching the boundaries of the material ??? probably, i guess only time will tell

 

[sixonice]

Good post! Yes, the e.max Press material can be used over implants and for 3unit anterior bridges - the most distal abutment being the 2nd premolar. The manufacturer has guidelines on connector dimension for the bridgework. I like to maximize the connector dimensions by pressing full linguals in the e.max material. I simply glaze and polish this area and do my layering in the obvious areas. Pushing the boundaries, such as pressed posterior bridges, can work & last a very long time, but just as easily could fracture if things aren't quite right. Those posterior frames are great for zirconia. As far as more than 3 units, again, "grey area". I have done 3 & 4 unit splints successfully (just be sure to sprue to each unit!) and 2 pontics can be risky. I try to stay as close to manufacturers recommendations as possible.
Pressing over implants is a snap. The MO ingot does a good job at blocking undercolor (as long as it is thicker than .6mm) and needs a full porcelain layered buildup. Zirconia abutments work great with the MO ingot. They also have the HO (High opacity) ingot that can mask anything, especially the thinner substrates or metal abutments. These also need a full layered build with the e.ceram. 400 Mpa is enough for these single implant cases.

 

[zena]

At our lab we also have done emax over metal or zirconia abuts, we also have done IPS empress esthetic on implants to, when the metal abut is used we will put a layer of opaque on the abut so that the metal doesn't shine through the empress. For emax bridges we've only done them in 3 units any thing greater than that we do zirconia.

 

[Al.]

Six, emax is indicated to the 1st molar if the molar is pressed full contour and not layered. They told me not to sprue the pontics because when the material flows through the sprues and it fuses together inside the bridge frame they do not want the point where the material flows together to be in the connection but in the center of the pontic. You can often see the line where the material meets in the center of the pontic.

Ill do them to 2nd molar as long as I have plenty of clearence and a 4 unit it I have tons/excessive room but I did one 4 unit and it fratcured.
Its not worth it to push the limits and have failures becaues the Drs will loose confidence in the product and quit requesting it.

 

[sixonice]

Al, great connector dimensions on that bridge! You taught me something on the distal abutment being full contour and bridges. Nice high resolution pics also - as all yours are.

 

[sixonice]

At our lab we also have done emax over metal or zirconia abuts, we also have done IPS empress esthetic on implants to, when the metal abut is used we will put a layer of opaque on the abut so that the metal doesn't shine through the empress. For emax bridges we've only done them in 3 units any thing greater than that we do zirconia.

Really!?! The Esthetic over implants? I know that is defintely contraindicated, but if your having success I can't argue that. Esthetic is only 160 Mpa (bonded) and relying on a proper bond to just opaque I think would be risky? Just my opinion. You need the dentin-tubular bond to give the material it's longevity & strength. With e.max being indicated to go over implants, if you offer that material, I would switch over.

 

[zena]

Really!?! The Esthetic over implants? I know that is defintely contraindicated, but if your having success I can't argue that. Esthetic is only 160 Mpa (bonded) and relying on a proper bond to just opaque I think would be risky? Just my opinion. You need the dentin-tubular bond to give the material it's longevity & strength. With e.max being indicated to go over implants, if you offer that material, I would switch over.

We do empress when Dr asks for it, thats what they want, normally it's usually emax.

 

[finnster68]

I like to maximize the connector dimensions by pressing full linguals in the e.max material. I simply glaze and polish this area and do my layering in the obvious areas.

Yeah Six i think that is the trick, again something that Jurgen pointed out to us.

Keep the linguals full contour which increases your connector width substantially.

Al nice tip on not spruing pontics, Have not heard of that before but certainly makes sense

 

[dbinder4u]

Sound like you are on to something...

Hi all

Just wondering if anyone has been pressing any LT/MO over implants.

I never really thought about it until late last year when a Dr i dont do any work for rang me and asked if i could press something for him.

He had waxed up a 3 unit bridge (2 xPreMolar + Molar) over Straumann abutments and simply wanted me to press it for him.

At that stage none of the literature i had recommended something like this so i raised my concerns. He said he had been doing it himself for some time so just press it.

It turned out quite nice and Dr was happy and inserted the bridge.

Got me thinking, since then i have pressed several single unit cases over Straumann abutments and they simply look so much better than what i could produce using PFM. I guess what concerns me however is the longevity of the crowns.

There now seems to be a lot of discussion that a 400 odd mpa solid core material such is Emax is actually stronger than using zirconia/PFM so maybe it really could be a better option.

Anyone else pressing over implants?

P.S it also says in literature you can use Emax for 3 unit bridges. I recently did a 5 unit anterior bridge case, 3 abutments, 2 pontics and Dr and patient were extremely pleased with the result.

Stretching the boundaries of the material ??? probably, i guess only time will tell

I pressed two HO on my son #8 #9. He had a root canal in #9 and a gold post. His shade was 1M1 and the restorations were very vital with no show through on #9. I have often thought about pressing over ITI sold abutments. I do not see why it wouldn't work. It sure would be a less expensive option then having a custom abutment milled out of Zirconia. I don't know about the 5 unit bridge using E.max. I still use zirconia for bridges over 3 units. Plus Ivoclar does not suggest E.max on anything more than a 3 unit bridge only to a 1st bicuspid. Happy Pressing!