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Scientific Abstract

The IPS e.max® system is an innovative all-ceramic system that comprises lithium disilicate (LS2) glass-ceramic and zirconium oxide (ZrO2) materials for the press and CAD/CAM technologies. Additionally, there is a universally applicable nano-fluor-apatite glass-ceramic available for veneering all IPS e.max components.

Since the beginning of its development until to today, the IPS e.max system has been monitored by the scientific community, and many renowned experts have contributed to an excellent data base with their studies. The worldwide success story, the ever-growing demand, as well as approx. 40 million fabricated  restorations are testament to the success and the reliability of the system.  More than 20 clinical in vivo studies to date and even more in vitro studies, as well as the continuously rising number of clinical studies involving the e.max system throughout the world show the long-term success in the oral cavities of the patients.

Summary of the IPS e.max® system

There are data on the IPS e.max system that cover a period of up to 5 years of clinical use for ZrO2 and of up to 10 years of clinical use for LS2.The survival rates* of IPS e.max Press (6 studies), IPS e.max CAD (6 studies) and  IPS e.max ZirCAD (8 studies) were combined and the overall survival rate for the entire system was calculated. A total of 1071 restorations from 20 clinical studies were included. The resulting overall survival rate for the IPS e.max system was 96.8%.

Fig. 1: Summary of the results of 20 clinical studies involving restorations (crowns and bridges) fabricated with IPS e.max materials; the distribution of success cases and failures is presented in percent.

Summary of IPS e.max® Press
(Lithium disilicate glass-ceramic LS2)

By now, there are results of clinical studies lasting up to 10 years for IPS e.max Press.

Six clinical studies (Boning et al. 2006; Etman and Woolford  2010; Guess et al. 2009; Gehrt et al. 2010; Dental Advisor 2010) and an internal Ivoclar Vivadent study with a combined total of 499 restorations (crowns) have shown a survival rate of 98.4% after a mean observation period of 4 years. The failure causes include fracture (0.4%), endodontic failure (0.2%), and secondary caries (0.2%). Moreover, 4 crowns (0.8%) were removed in one study because of crack develop-ment. Chipping occurred in 1.4% of the restorations. How-ever, all cases could be repaired in situ. Conventional and adhesive cementation work equally well.

Fig. 2: Summary of the results of 6 clinical studies involving IPS e.max Press restorations (crowns); the distribution of success cases and failures is presented in percent.

Summary of IPS e.max® CAD
(Lithium disilicate glass-ceramic LS2)

There are results of clinical studies lasting up to 4 years for  IPS e.max CAD.

Six clinical studies (Richter et al. 2009; Nathanson 2008; Reich et al. 2010; Fasbinder et al. 2010; Bind 2011; Sorensen et al. 2009b) with a total of 237 restorations (crowns) showed that 97.9% of the restorations survived after a mean observation period of 2.5 years. The failure rate of 2.1% includes 0.4% irreparable chipping, 0.4% secondary caries and 1.3%  fractures. In addition to the above case of irreparable chipping, no further chipping occurred.

Fig. 3: Summary of the results of 6 clinical studies involving IPS e.max CAD restorations (crowns); the distribution of success cases and failures is presented in percent.

Summary of IPS e.max® ZirCAD
(Zirconium oxide ZrO2)

There are data on IPS e.max ZirCAD that cover a period of up to 5 years of clinical use.

Eight clinical studies (Stanford 2009; Sorensen et al. 2009a;  Fasbinder and Dennison 2009; Beuer et al. 2010; Beuer 2011; Tinschert 2008; Christenensen 2008; Munoz 2009; Hicklin et al. 2008) involving a total of 335 restorations (203 crowns,  132 bridges) have shown a survival rate of 93.7%. The failure causes include 2.7% irreparable chipping, 2.4% fractures and 0.9% endodontic failure. Moreover, repeated decementation was rated as failure in one study. Chipping occurred in 12% of the restorations, but required replacement of the restora-tion in only 2.7% of the cases.

Fig. 4: Summary of the results of 8 clinical studies involving IPS e.max ZirCAD restorations (crowns, bridges); veneered with IPS e.max  ZirPress and/or IPS e.max Ceram. The  distribution of success cases and failures are presented in percent.

Summary of IPS e.max® ZirPress
(Fluorapatite glass-ceramic)

There are data on IPS e.max ZirPress that cover a period of up to 3 years of clinical use.

Four clinical studies (Tinschert 2008; Christensen 2008; Hick-lin et al. 2008; Fasbinder and Dennison 2009), involving a total of 124 restorations (61 crowns, 63 bridges) made of IPS e.max  ZirPress as a veneer on IPS e.max ZirCAD have shown a sur-vival rate of 95.2%. Overall, 4.8% of the restorations were replaced for the following reasons: irreparable chipping 2.4%, fracture 1.6%, endodontic failure 0.8%. Chipping occurred in 19% of the restorations, but was irreparable in only 2.4% of the cases. All other chipping incidents could be repaired in situ by means of polishing or composite.

Fig. 5: Summary of the results of 4 clinical studies involving IPS e.max ZirPress on  IPS e.max ZirCAD restorations (crowns and bridges); the distribution of success cases and failures is presented in percent.

Summary of IPS e.max® Ceram
(Nano-fluorapatite glass-ceramic)

There are data on IPS e.max Ceram that cover a period of up to 4 years of clinical use.

Eight clinical studies (Dental Advisor 2010; Nathanson 2008; Richter et al. 2009; Stanford 2009; Sorensen et al. 2009a;  Fasbinder and Dennison 2009; Beuer et al. 2010; Beuer 2011; Hicklin et al. 2008), involving a total of 377 restorations  veneered with IPS e.max Ceram have shown a survival rate of 95%. The failures include 2.4% irreparable chipping, 1.9% fracture of the framework (different materials), 0.5% endo-dontic failure and a decementation rated as failure. Chipping occurred in 5% of the restorations. However, more than half of them could be repaired in situ.

Fig. 6: Summary of the results of 8 clinical studies involving IPS e.max Ceram on IPS e.max ZirCAD or IPS e.max CAD and Crystal Zirconia restorations (crowns and bridges); the distribu-tion of success cases and failures is presented in percent.

* The most important study results as well as detailed information about the study design, successes, failures and survival rates can be found in the IPS e.max Scientific Report, vol. 01 / 2001 – 2011, and at:  www.ivoclarvivadent.com.