CAD

INSTRUCTIONS

FOR

USE

CHAIRSIDE

TABLE

OF

CONTENTS

3

IPS e.max System – all you need

4

IPS e.max CAD – Product Information
Material
Usage
Composition
Block concept
Product overview for CEREC®
Preparation guidelines and minimum thicknesses

10

IPS e.max CAD – Overview of the treatment procedure
Treatment procedure
Shade determination
Intra-oral imaging
Milling
Preparing for Crystallization
Characterization / Glaze / Adjustments
Combination firing
Preparing for cementation
Cementation

16

IPS e.max CAD LT – Staining technique
Preparation
Finishing
Preparing the restoration for the combination firing
Characterization Guide
Combination firing (crystallization / glaze)
Preparing for cementation
Etching and silanating
Cementation

32

IPS e.max CAD LT – Cut-back technique

34

IPS e.max CAD – General Information
Preparing for cementation
Care instructions
Crystallization / firing parameters
Combination tables
Questions and answers

2

IPS

e.max System –
®

ALL YOU NEED
Your purchase of IPS e.max means you have chosen more than simply an all-ceramic system. You have taken the decision to benefit from the unlimited possibilities of allceramic. IPS e.max delivers high strength and highly aesthetic materials for the PRESS and the CAD/CAM technology.
The IPS e.max products are unique. They are recognized for their outstanding properties as well as exceptional versatility and flexibility – and they produce results with maximum aesthetics.
IPS e.max CAD is the first, high-strength, highly aesthetic glass-ceramic material that enables you to fully benefit from the full range of chairside CAD/CAM possibilities. The main area of indication is full crowns that are subsequently adhesively or self-adhesively placed. With the other components of the IPS e.max System you are now also in the position to combine restorations fabricated chairside with lab-fabricated reconstructions in an ideal manner and thus provide your patients with comprehensive IPS e.max restorations. This combination also enables you to fully use the entire spectrum of modern all-ceramics ranging from glass-ceramics to zirconium oxide and thus offer your patients restorations with a maximum of personalized characteristics and true-tonature individual appearance.

3

IPS

e.max CAD –
®

P R O D U C T I N F O R M AT I O N
M AT E R I A L
IPS e.max CAD is a lithium silicate glass-ceramic block for the
CAD/CAM Technology. It is manufactured in an innovative process, which results in the exceptional homogeneity of the material.
In its crystalline intermediate («blue») state, the block can be easily milled with CAD/CAM equipment. The striking colour that is characteristic for the pre-crystallized IPS e.max CAD blocks ranges between white, blue and bluish grey. This colour is created by the composition and microstructure of the glass-ceramic. The strength of the material at this machinable intermediary stage is 150 MPa. It is, therefore, comparable to other commercially available glassceramic blocks. After the IPS e.max CAD blocks have been milled, the material is crystallized in one of the Ivolcar Vivadent ceramic furnaces (eg Programat® CS or P300). The crystallization process is easy to conduct and takes approx. 25 minutes. In contrast to some other CAD/CAM ceramics, the blocks do not shrink significantly and they do not require complicated infiltration processes. The crystallization process at 840 ºC (1544 °F) causes the microstructure to change through controlled growth of lithium disilicate crystals.
The milling software takes the resulting densification of 0.2% into account in the milling process. The transformation of the microstructure produces the final physical properties including 360 MPa flexural strength and the suitable optical characteristics, such as shade, translucency and brightness.
The IPS e.max CAD LT blocks demonstrate a true-to-nature brightness. The translucency and shade variety permit the fabrication of fully anatomic restorations from this glass-ceramic without any problems.

CTE (100–400°C) [10-6 /K]

10.2

CTE (100–500°C) [10-6 /K]

10.5

Flexural strength (biaxial) [MPa]*

360

Fracture toughness [MPa m0.5]

2.25

Modulus of elasticity [GPa]
Vickers Hardness [MPa]

95
5800

Chemical solubility [µg/cm2]*

40

Crystallization temperature [°C]

840

*according to ISO 6872

4

USAGE

COMPOSITION

Indications
– Veneers
– Partial crowns
– Anterior and posterior crowns

–

IPS e.max CAD Blocks
Components: SiO2
Additional contents : Li2O, K2O, MgO, Al2O3, P2O5 and other oxides Contraindications
– Full veneers on molar crowns
– Very deep subgingival preparations
– Patients with severely reduced residual dentitions
– Bruxism

–

IPS e.max CAD Crystall./Glaze, Shades and Stains
Components: Oxides, glycols

–

IPS e.max CAD Crystall./Glaze Spray
Components: Oxides, propyl alcohol; Propellant: Isobutane

Important processing restrictions
Failure to observe the following restrictions may compromise the results achieved with IPS e.max CAD:
– The frameworks must not fall below the required minimum thickness – The blocks must not be milled in a non-compatible CAD/CAM system – Crystallization must not be conducted in a ceramic furnace that has not been calibrated
– Crystallization must not be conducted in a ceramic furnace that has not been approved and/or recommended.
– Crystallization must not be conducted in a high-temperature furnace (eg Sintramat)
– IPS e.max CAD Crystall./Glaze, Shades, Stains, and Add-On must not be used on other dental ceramics.
– Do not mix IPS e.max CAD Crystall./Glaze, Shades, Stains, and
Add-On with other dental ceramics (e.g. IPS e.max Ceram Glaze,
Stains, and Essence).
– Veneering ceramics other than IPS e.max Ceram must not be used

–

IPS e.max CAD Crystall./Glaze Liquid
Components: Butandiole

–

IPS e.max CAD Crystall./Add-On
Components: Oxides

–

IPS e.max CAD Crystall./Add-On Liquid
Components: Water, propylene glycol, butandiol, and chloride

–

IPS Object Fix Putty / Flow
Components: Oxides, water, thickening agent

–

IPS Contrast Spray Chairside
Components: Pigment suspension in ethanol; the propellant is a fluoridated hydrocarbon

–

IPS Natural Die Material
Components: Polyester urethane dimethacrylate, paraffin oil,
SiO2 and copolymer

–

IPS Natural Die Material Separator
Components: Wax dissolved in hexane

–

IPS Ceramic Etching Gel
Components: Hydrofluoric acid

Side effects
If the patient is known to be allergic to any of the components of
IPS e.max CAD, the product should not be used to fabricate restorations. Warnings
– Hexane is highly flammable and detrimental to health. Avoid contact with skin and eyes. Do not inhale the vapours and keep away from sources of ignition.
– Do not inhale ceramic grinding dust during processing – use suction equipment and a face mask.
– Etching gel contains hydrofluoric acid. Avoid contact with skin, eyes, and clothing at any time, since the material is highly toxic and corrosive. The etching gel is intended for professional use only and must not be applied intra-orally (in the oral cavity).

5

BLOCK CONCEPT
The shading and opacity control of the IPS e.max CAD blocks is based on a unique translucency/ opacity concept. The system offers flexibility and can be used with A-D, Chromascop and Bleach BL shades.
IPS e.max CAD blocks are available in 2 degrees of translucency. The individual levels of the concept are determined by processing techniques and indications. Consequently, maximum flexibility and application variety can be achieved. For chairside applications (staining and cut-back technique) the IPS e.max CAD
LT block is used.

Processing technique
Translucency level

Staining technique Cut-back technique Indications
Layering
technique

Veneers

Anterior crowns

Posterior crowns



Low
Translucency

Partial crowns







IPS e.max CAD LT (Low Translucency)
The blocks are available in 9 A-D, 4 Bleach BL shades and in 2 different sizes (I12, C14). Due to their translucency, they are ideal for fabricating restorations in the staining and cut-back technique. Shading is based on the tried-and-tested shades of IPS Empress CAD LT. The blocks are shaded according to the tooth shade. Thus, staining and veneering is reduced to a minimum.

BL1

BL2

BL3

BL4

A1

A2

A3

A3.5

B1

B2

B3

C2

D3

A1

A2

A3

A3.5

B1

B2

B3

C2

D3

Comparison: IPS e.max CAD LT before and after crystallization

BL1

BL2

BL3

BL4

IPS e.max CAD LT (above) compared to IPS Empress CAD LT (below)

6

PRODUCT OVERVIEW FOR CEREC®
IPS e.max CAD for CEREC® Basic Kit LT
(Low Translucency) A–D

The IPS e.max CAD for CEREC Basic Kit LT comprises blocks as well as the necessary working accessories for chairside applications using the CEREC System (Sirona). The Basic Kit is supplied in a materials cabinet and can be expanded as desired with other IPS e.max Kits.
Delivery form:
IPS e.max CAD for CEREC Basic Kit LT (Low Translucency) A–D
– 6x 5 IPS e.max CAD LT for CEREC and inLab Blocks C14;
Shades: LT BL2, LT A1, LT A2, LT A3, LT A3.5, LT B1
– 5x 3 g IPS e.max CAD Crystall./ Shades
Shades: SH 0, SH 1, SH 2, SH3 , SH 4
– 2x 3 g IPS e.max CAD Crystall./ Shades Incisal
Shades: SH I1,SH I2
– 7x 1 g IPS e.max CAD Crystall./ Stains
Shades: white, crème, sunset, copper, olive, khaki, mahogany
– 1x 3 g IPS e.max CAD Crystall./Glaze Paste
– 1x 270 ml IPS e.max CAD Crystall./Glaze Spray
– 1x 15 ml IPS e.max CAD Crystall./Liquid
– 1x 5 g IPS e.max CAD Crystall./Add-On
– 1x 15 ml IPS e.max CAD Crystall./Add-On Liquid
– 1x IPS e.max CAD Crystallization Tray
– 1x 10 ml IPS Object Fix Flow
– 1x 10 g IPS Object Fix Putty
– 1x 50 ml IPS Contrast Spray Chairside
– 1x IPS Ceramic Etching Gel Kit
– 1x IPS e.max Press/CAD LT Materials Shade Guide
– var. accessories

IPS e.max CAD for CEREC® and inLab® LT Blocks
(Low Translucency)

The Blocks for the staining and cut-back technique are available in
2 sizes (I12 and C14) and in 9 A–D shades as well as in 4 Bleach BL shades. Delivery form:
IPS e.max CAD for CEREC and inLab LT Blocks Refill
– 13 x 5 IPS e.max CAD for CEREC and inLab LT I12
Shades: LT BL1, LT BL2, LT BL3, LT BL4, LT A1, LT A2, LT A3,
LT A3.5, LT B1, LT B2, LT B3, LT C2, LT D3
– 13 x 5 IPS e.max CAD for CEREC and inLab LT C14
Shades: LT BL1, LT BL2, LT BL3, LT BL4, LT A1, LT A2, LT A3,
LT A3.5, LT B1, LT B2, LT B3, LT C2, LT D3

For information about the CEREC® System , please contact:
Sirona Dental Systems GmbH
Fabrikstrasse 31
64625 Bensheim
Germany
E-mail: contact@sirona.de www.sirona.com 7
CEREC® is a registered trademark of Sirona Dental Systems GmbH

P R E P A R AT I O N G U I D E L I N E S A N D M I N I M U M T H I C K N E S S E S
Successful results can only be achieved with IPS e.max CAD if the guidelines and framework thicknesses are strictly observed. Veneer
If possible, the preparation should be entirely located in the enamel. The incisal preparation margins should not be located in the area of the abrasion surfaces or dynamic occlusal surfaces. By preparing orientation grooves using a depth marker, controlled enamel reduction can be achieved. Dissolution of the proximal contacts is not required.
For preparation without involving reduction of the incisal edge (only labial reduction), the preparation depth in the labial area should be at least 0.6 mm.
For preparation involving reduction of the incisal edge (labial/incisal reduction), the preparation depth in the cervical and labial area should be at least 0.6 mm. The incisal edge must be reduced by 0.7 mm. The extent of the incisal reduction depends on the desired translucency of the incisal area to be built up. The more transparent the incisal edge of the intended veneer, the more pronounced the reduction should be. Discoloured teeth may require more preparation.

0.6

0.6

0.6

0.6

0.7

0.7

Partial crown
Provide at least 1.5 mm of space in the cusp areas. Partial crowns are indicated if the preparation margin is less than approx. 0.5 mm away from the cusp tip, or if the enamel is severely undermined. The shoulder should be prepared without a chamfer, i.e. in a 90° angle to the residual tooth structure.

1.5

1.5
1.5
1.5
1.0

8

Anterior and posterior crowns
The anatomic shape is evenly reduced while observing the given minimum framework thickness. A circular shoulder is prepared with rounded inner edges or a chamfer at an angle of 10-30º: The width of the circular shoulder/chamfer is approx. 1.0 mm. Reduction incisal or occlusal by approx. 1.5 mm. The vestibular or lingual reduction is approximately
1.2 mm for anterior teeth and approximately 1.5 mm for posterior teeth. The incisal edge of the preparation should be at least 1.0 mm (milling tool geometry) in order to permit optimum milling of the incisal edge during CAD/CAM processing.

1.5

1.5
1.5

1.0
1.0

1.5

1.5
1.0

1.0

1.2

1.2

1.0

6°

1.5

1.0

1.5

9

IPS

e.max CAD –
®

O V E R V I E W O F T H E T R E AT M E N T P R O C E D U R E
Treatment procedure
Working Steps

Ivoclar Vivadent products
Tooth Shade
Determination

IPS e.max Press/CAD LT
Materials Shade Guide
For optimum selection of the block shade

Die Shade
Determination

IPS® Natural Die Material
To determine the die shade of the prepared tooth

Shade Determination

OptraGate®
Provides easy access to the extended treatment area by circular retraction of lips and cheeks.

Intra-Oral Imaging

IPS® Contrast Spray Chairside
Enables optimum imaging through detailed definition of the margins.

IPS e.max CAD Blocks
Lithium silicate glass-ceramic blocks for the CAD/CAM technology Milling

IPS e.max CAD Crystallization Tray / Pins
Special firing tray and pins for the crystallization of
IPS e.max CAD.

Preparing for crystallization IPS® Object Fix Putty / Flow
Auxiliary firing paste in different viscosities for the crystallization of IPS e.max CAD.

IPS e.max CAD Crystall./Shades, Stains, Glaze and
Glaze Liquid
Special Shades, Stains and Glaze in paste form for
IPS e.max CAD

Characterization /
Glaze / Adjustments

IPS e.max CAD Crystall./Glaze Spray
Special glaze in spray form for IPS e.max CAD.
IPS e.max CAD Crystall./ Add-On und Add-On Liquid
Special add-on material for IPS e.max CAD LT

Programat® CS
Compact, easy-to-operate ceramic furnace with vacuum function for the dental office.

Combination firing
(Crystallization/Glaze)

IPS® Ceramic Etching Gel
For the fabrication of retentive bonding surfaces on ceramic restorations.

Preparing for cementation Monobond-S®
Produces silanated bonding surfaces on etched allceramic restorations.

Variolink®, Multilink® Automix
Tried-and-tested adhesive cementation systems.
Multilink® Sprint
Dual-curing, self-adhesive luting composite.

Cementation

bluephase®
The cordless high-performance LED for all indications.
10

Shade determination
The correct tooth shade is the basis for a restoration with a life-like appearance. After tooth cleaning, the tooth shade of the non-prepared tooth and/or the adjacent teeth is determined. Individual characteristics have to be taken into consideration when determining the tooth shade. If a crown preparation is planned, for example, the cervical shade should also be determined. In order to achieve true-to-nature results, shade determination should be carried out at daylight. Furthermore, the patient should not wear clothes of intensive colours and/or lipstick. Basically, it has to be kept in mind that the final shade of the restoration is the result of the following individual shades:
– Die shade
– Shade of the ceramic block
– Shade of the layering ceramic
– Shade of the cementation material
IPS e.max Press/CAD LT Materials Shade Guide
Since the IPS e.max CAD blocks demonstrate a bluish shade prior to crystallization, they cannot be used for the selection of the block shades. For that purpose, the materials shade guide is used, which shows the shade of all the available IPS e.max CAD blocks after crystallization, as well as all the IPS e.max Press ingots.

IPS Natural Die Material
In order to facilitate the reproduction of the tooth shade, the shade of the prepared tooth can be determined with the help of the
IPS Natural Die Material shade guide. With the help of the die shade and the desired tooth shade, the corresponding block can be selected.
Further information regarding the influence of the die shade on the final shade of the restoration can be found on the combination tables.

11

Intra-oral imaging
To prepare for optical imaging, OptraGate® is placed to facilitate access to the treatment field. OptraGate is a clinical auxiliary device that retracts lips and cheeks during dental treatment. It enables a full view of the treatment field, facilitates the accessibility, and improves the moisture control in the oral cavity.

IPS® Contrast Spray Chairside is used to achieve optimum recordings for CAD/CAM restorations. The
IPS Contrast Spray Chairside balances out the different optical properties of the natural tooth (dentin and enamel) and thus permits excellent impressions using a camera. With the atomizing nozzle, an optimum covering layer with a detailed representation of the preparation surfaces and margins is achieved easily and efficiently with only a short spray discharge. Angled atomizing heads are available for the spray. Please observe the corresponding Instructions for Use.

Milling
The IPS e.max CAD LT block is selected in accordance with the clinical situation. It not only determines the selection of the block in the required shade, but also the block size to be used. Once the desired block has been selected, it is mounted in the
CAM unit and the restoration is milled.

12

Preparing for crystallization
IPS Object Fix Putty and IPS Object Fix Flow are auxiliary firing pastes to support all-ceramic restorations during the firing and/or crystallization procedure. The pastes are used to stabilize and secure the corresponding restoration on the
IPS e.max CAD Crystallization Pins.
IPS Object Fix Putty / Flow are easy to apply, as well as easy to remove after the firing procedure.

Characterization / Glaze / Adjustments
IPS e.max CAD restorations are characterized with IPS e.max CAD Crystall./Shades and Stains.
There are 7 IPS e.max CAD Crystall./Stains and 5 IPS e.max CAD Crystall./Shades available. To imitate the incisal area, 2 IPS e.max Crystall./Shade Incisal can be used, which enhance the optical in-depth effect and translucency in the incisal third.

To glaze the IPS e.max CAD restoration, you may choose between the
IPS e.max CAD Crystall./Glaze Paste and the IPS e.max CAD Crystall./
Glaze Spray.

For shape adjustments (e.g. proximal or occlusal contact points), IPS e.max CAD
Crystall./Add-On is available. It is mixed with IPS e.max CAD Crystall./Add-On
Liquid and can be directly applied with the Crystallization firing or any subsequent corrective firing.

13

Combination firing
(Crystallization / Glaze)
For crystallization, IPS e.max CAD is fired on the IPS e.max CAD Crystallization Tray and the corresponding IPS e.max CAD Crystallization Pins.
This firing tray stores heat and ensures slow and most of all tension-free cooling of the glass-ceramic.

The firing cycles are conducted in the Programat CS or any other Ivoclar Vivadent ceramic furnace.
The Programat CS is easy to operate and is especially suitable for glaze and crystallization firings. Including its integrated vacuum function, the furnace has been ideally coordinated with the IPS e.max CAD blocks.

Preparing for cementation
Conditioning of the ceramic furnace to prepare for adhesive cementation is required for a sound bond between the cementation material and the all-ceramic restoration.
Generally, glass-ceramics are etched using IPS® Ceramic Etching Gel.
Etching produces retentive bonding surfaces, which increases the bond between the luting composite and the all-ceramic restoration.
IPS Ceramic Etching gel is exclusively intended for extra-oral use and must not be applied in the oral cavity.

Subsequent silanating of the bonding surface using Monobond-S results in a sound bond between the etched all-ceramic material and the luting composite. The bonding silane is thus an important contributor to the bonding strength between the IPS e.max CAD restorations and the tooth structure.

14

Cementation
For the cementation of the IPS e.max restorations, you may select between adhesive and self-adhesive luting composites from the coordinated assortment of Ivoclar Vivadent.

Variolink®

Multilink®

Esthetic Resin Cements

Universal Resin Cements

Variolink II

Variolink Veneer Multilink Automix

Multilink Sprint

IPS e.max Press
IPS e.max ZirPress Veneers

–

–

IPS e.max ZirCAD

–

–

–

–

IPS e.max CAD
IPS e.max Ceram Veneers
–

recommended product combination not recommended product combination

Self-adhesive cementation
Multilink Sprint is a self-adhesive, universal resin cement for quick and easy cementation of IPS e.max CAD restorations. Multilink Sprint is dual-curing and available in 3 shades (translucent, yellow, opaque). Multilink Sprint is easier to use than a conventional cement. The self-adhesive luting composite is extruded from the double-push syringe, automatically mixed in the mixing cannula, and directly applied in the restoration to be placed. Since Multilink Sprint is self-adhesive, no bonding agent needs to be applied on the preparation.

Adhesive cementation
As an alternative to self-adhesive cementation, adhesive luting composites may be used to incorporate IPS e.max CAD restorations. To prepare for adhesive cementation, absolute isolation of the operating field, preferably with a rubber dam, e.g.
OptraDam®, should be carried out. Enamel etching and dentin conditioning is performed using Total Etch. As far as the adhesive cementation materials are concerned, you may choose between the tried-and-tested Multilink Automix or Variolink II systems from Ivoclar Vivadent.

LED lights of the bluephase® family are used for the polymerization of light-curing and dual-curing adhesive composites. The high light intensity achieved with bluephase permits comparatively short polymerization times with simultaneous good polymerization depth.
Especially for the demanding polymerization of adhesively cemented all-ceramic restorations, bluephase 16i is used. In the process, the entire strength of the high performance LED is utilized. All-ceramic restorations are incorporated as quickly as possible. 15

IPS

e.max CAD LT –
®

S TA I N I N G T E C H N I Q U E
The IPS e.max CAD blocks have been developed for processing in CAD/CAM systems. After the CAD/CAM process, the restorations are tried-in in the blue state. Any necessary adjustments should be done in this stage. Individualized characterizations and glaze are applied before the combined Crystallization and Glaze firing is conducted. In this way, processing is very efficient and leads to an aesthetic result quickly and easily.

Preparation
After the determination of the tooth shade, preparation is carried out according to the preparation guidelines. As a preparation for intra-oral imaging, the cleaned and dried preparation is covered with IPS Contrast Spray Chairside with one short spray discharge.

Starting situation: The crown on tooth 37 has to be replaced.

Preparation: Buccal view

Preparation: Occlusal view

Preparation sprayed with IPS Contrast Spray Chairside ready for intra-oral recording.

Please refer to the corresponding Operating Instructions and/or Manuals of the respective CAD/CAM system for further information on the CAD/CAM processing procedure. The instructions by the manufacturer must be observed. 16

Finishing
It is of critical importance to use the correct grinding instruments for finishing and adjusting IPS e.max CAD. If unsuitable grinding instruments are used chipping of the edges and local overheating may occur (please see the corresponding recommendations from Ivoclar Vivadent).
The following procedure is recommended to finish IPS e.max CAD restorations:
– Grinding adjustments of milled IPS e.max CAD frameworks must be made in the precrystallized (blue) state if possible.
– Only use suitable grinding instruments, low rpms and light pressure to prevent delamination and chipping at the edges in particular.
– Adjustments by grinding are carried out with fine-grained diamonds (