IPS e.max ZirCAD Prime brings back the artistry in full-contour zirconia
Written by Jason Ripple, CDT. CRN Dental Lab
For the past 23 years Jason Ripple, CDT has worked tirelessly to build a reputation for his Austin, Texas-based full-service laboratory as a high-end cosmetic business focused on delivering quality, life-like esthetic restorations to his clients from single crowns to complex implant-supported full-arch restorations. The foundation of his success has been built on years of education and hands-on workshops at top institutions, learning the latest techniques from the masters, and on research into ceramic materials that would deliver the most predictable and esthetic outcomes.
From labor-intensive PFM layering to all-ceramic pressing production techniques and then CAM milling, Ripple’s journey along the analog/digital highway has been uncompromising when it comes to selecting restorative materials and production processes and techniques that render the results he demands of himself and his 17 employees at CRN Dental Laboratory.
However, when it came to milling zirconia in-house, he struggled to find a material that yielded the predictability and esthetics he needed. That is, until now.
Selecting restorative materials that deliver the highest quality functional esthetics is critical for my business and that of my clients. From layering ceramics for PFMs to materials for pressing, I choose restorative materials and processes that will determine the best outcome of the final prosthetic in terms of predictability, durability, functionality and esthetics. The goal is to create a restoration that is so natural-looking it disappears in the mouth whether it’s a single central, lower molar or bicuspid. I also look for a material that is flexible enough to use for multiple indications.
|IPS e.max ZirCAD Prime restoration made by Jason Ripple, CDT. CRN Dental Lab|
My introduction to zirconia was in the early 2000s, when it was introduced to the dental industry as a substructure for layered ceramics. Like so many other laboratory owners back then, I outsourced my zirconia copings. But when the market made the dramatic shift to monolithic full-contour restorations, I knew we had to adapt. I made the investment in the equipment and began milling zirconia in-house. However, I found myself competing in a price- and volume-driven market with a material that presented extreme esthetic challenges. Even with layering, our attempts to achieve life-like results from these opacious monolithic materials fell short of expectations, limiting the number of indications for which it could be used.
Then came the introduction of translucent and multi-layered iterations of zirconia. Although both were steps in the right direction, what was lacking in these materials was the transition gradient from dentin to enamel. In addition, many of these multi-layered materials came in different shades and multiple translucency levels per shade, which was an inventory nightmare. I tried them all and began beta testing for manufacturers to stay at the forefront of material science as they worked to improve the material. However, none provided a natural-looking dentin to incisal transition right out of the mill that, once sintered, provided a canvas on which to efficiently add small characterizations to achieve the high quality esthetics my clients and their patients demanded.
Then 3 years ago I was introduced to Ivoclar’s IPS e.max ZirCAD Prime. Immediately, our first test runs with this monolithic material resulted in milled and sintered full contour restorations that looked like a hand-crafted two-powder build up PFM with a nice seamless dentin to enamel transition. The unique gradient technology built into the ZirCAD Prime disc offers a seamless progression and transition of shade and translucency unlike multi-layered zirconia pucks that have visible layers of color. Once milled and sintered in Ivoclar’s S1 1600 sintering oven, the restoration is a canvas we can easily use to efficiently and artistically shade-in anatomical features to characterize the restoration. And it’s a higher end restoration that I can charge a premium for without the labor involved in trying to make it look pretty as we had to do with other zirconia materials. From a timesaving aspect we can scan, design, and mill a single unit in about 45 minutes to an hour and speed sinter that crown in as few as 75 minutes. If necessary, can produce a 10-unit case in a single day and deliver it the next morning to the practice.
We did have a learning curve in the CAD nesting process in order to get the best results from a ZirCAD puck. In my opinion, the technician using the CAD nesting software is the new ceramist. The way the restoration is arranged within the puck determines the amount of incisal translucency. The technician can tilt the CAD design at an angle to provide a seamless transition from dentin to enamel or position it straight up and down to create a line of demarcation between dentin and enamel much like an enamel halo. As a ceramist, this is the first material I’ve experienced that gives us control again over the final product and brings back the artistry in full-contour zirconia.
Our lab currently averages 80 units a day, a majority of which are cosmetic cases from anterior and posterior single unit crowns to now, with the 25mm puck, All-on-4 full-arch restorations milled of ZirCAD Prime. We get the same predictable highly esthetic results every time, which has made it our go-to material for all our high-end cosmetic cases.
My clients love the esthetics of these restorations, often thinking they are built-up porcelain, not zirconia. One of our clients is the Advanced Education in General Dentistry program offered by the San Antonio School of Dentistry. Primarily involved in large comprehensive cases, they were so impressed by the esthetic results they are getting from the ZirCAD Prime cases we deliver that they transitioned all their restorative work to this material.
I have always sought out the best materials to offer to my clients. In my opinion, Ivoclar currently has the best materials and systems from pressing to milling to the final glazing process for creating the highest quality functionally esthetic restorations on the market.
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