How to: Create an esthetic anterior restoration

For many years, the IPS Empress all-ceramic brand was known for the highest level of esthetics when imitating the characteristics of natural teeth. Since it was introduced, more than 37 million indirect crown and veneer restorations fabricated from the IPS Empress pressed ceramic material have been placed.

It’s not surprising, then, that dentists have sought to recreate the same esthetic qualities they’ve achieved with indirect porcelain with direct composite. Unfortunately, ensuring long-term functional and esthetic durability of direct composite restorations is challenging, even with enhancements to direct restorative materials.

To keep pace with the latest trends in cosmetic dentistry, which include the need for durable, esthetic and convenient materials for placing direct restorations, the IPS Empress system has advanced significantly. The newest addition to the IPS Empress System is IPS Empress Direct resin composite material.

IPS Empress Direct is a light-curing, nano-hybrid composite that demonstrates excellent handling properties to achieve the consistent anterior and posterior esthetics of ceramic with the on-demand ease of composite. Additionally, IPS Empress Direct is based on the latest technology and features a variety of true-to-nature dentin and enamel shades, and different levels of translucencies and opacities to create limitless opportunities for realizing esthetic results for all indications.

IPS Empress Direct allows dentists to mimic the optical effects of natural tooth structures in a way that is similar to ceramic, but with the direct simplicity of composite. The basis for consistent and quality shade selection when using the IPS Empress Direct composite is two high-quality ceramic shade guides.

To demonstrate the convenience of placing IPS Empress Direct composite, the creation of an anterior restoration is illustrated. This esthetically optimized nano-hybrid composite was selected for treating a 50-year-old male who presented with a failing composite restoration on tooth No. 11 (Fig. 1).

Clinical protocol

01. Before removing the defective restoration and preparing the tooth, an accurate shade was taken (Fig. 2). It was determined that IPS Empress Direct A2 Dentin and IPS Empress Direct A1 Enamel composities would be used.

02. To ensure complete isolation, rubber dam (OptraDam) was placed.

03. The defective restoration was removed from tooth No. 11 and the tooth prepared (Fig. 3).

04. An etchant gel (Total Etch) was applied to the tooth for 15 seconds, after which the preparation was rinsed and dried.

05. A fifth-generation adhesive bonding agent (ExciTE) was applied to the preparation for 10 seconds using a convenient dispensing tool (ExciTE VivaPen) (Fig. 4).

06. The bonding agent was air-thinned with high pressure and light cured for 10 seconds using an LED curing light (bluephase 20i).

07. After light curing, the dentin replacement layer of IPS Empress Direct A2 Dentin was placed (Fig. 5). This increment was sculpted into place using an artist’s brush (Fig. 6). This composite layer was cured for 40 seconds.

08. IPS Empress Direct A1 Enamel was placed (Fig. 7). The mylar strip was used to help adapt the composite into the mesial and distal areas of the tooth (Fig. 8).

09. The rubber dam was removed, and the restoration was initially finished using Assorted ET Carbide (Brasseler) (Fig. 9).

10. The restoration was then polished using a series of integrated products, including the green OptraPol polisher (Fig. 10).

Closing thought

To further enhance the restorative process, IPS Empress Direct exhibits high stability, shade fidelity and enhanced polishing properties (Fig. 11). As a result, dentists can achieve the esthetics of ceramic with the chairside, direct placement convenience of a composite. Its physical properties are specifically designed for simplified application, while low sensitivity to light ensures ample, pressure-free working time for designing restorations. To meet the highest clinical demands, this nano-hybrid composite also demonstrates an optimum radiopacity.

Dr. Christopher Ramsey is accredited by the American Academy of Cosmetic Dentistry and lectures internationally on cosmetic dentistry. He also serves as a product consultant to dental product manufacturers.