Lava Ultimate

CAD/CAM Restorative

Technical Product Profile

 Table of Contents
Introduction................................................................................................................................................ 3

Background..........................................................................................................................................4 – 5

Indications.................................................................................................................................................. 6

Preparation Guidelines................................................................................................................................ 6

Step-by-Step Guide.................................................................................................................................... 7

Clinical Case............................................................................................................................................... 8

Mechanical Performance....................................................................................................................9 – 13
Flexural Strength and Flexural Modulus......................................................................................9 – 10
Fracture Toughness...................................................................................................................10 – 11
Flexural Fatigue Limit ...............................................................................................................11 – 12
Resiliency.......................................................................................................................................... 12
Compressive Strength....................................................................................................................... 13

Wear Performance............................................................................................................................13 – 14
Two-Body Wear................................................................................................................................. 13
Three-Body Wear.............................................................................................................................. 14

Restoration Fabrication and Placement.............................................................................................15 – 16

Millability.......................................................................................................................................... 15
Characterization, Adjustment, Intraoral Repair................................................................................... 15
Cementation...................................................................................................................................... 16

Esthetics...........................................................................................................................................17 – 19
Polish and Polish Retention............................................................................................................... 17
Plaque Resistance............................................................................................................................. 18
Fluorescence..................................................................................................................................... 18
Stain Resistance............................................................................................................................... 19

Customer Feedback..........................................................................................................................19 – 21

Technical Data Summary.......................................................................................................................... 22

References............................................................................................................................................... 23

Bibliography............................................................................................................................................. 23

2
 introduction

Introduction
Technical advances in hardware, software and materials provide dentists with new and improved options
for indirect prosthetic treatments. CAD/CAM technologies are becoming more versatile, robust and offer
more options to dentists and technicians for fabricating dental prosthetics. Fueling this trend are the
development of intraoral scanning, faster and more accurate milling machines and stronger, tougher
CAD/CAM materials. [1,2]

In recent years, perhaps the biggest driver in new material development is the desire to improve crown
and bridge esthetics compared to the traditional porcelain-fused-to-metal or all-metal restorations. As
such, zirconia, leucite-containing glass ceramics and lithium disilicate glass ceramics have become
prominent in the dental practice. Each material type performs differently regarding strength, toughness,
ease of machining and the final preparation of the material prior to placement. Location of production
(e.g. chairside or at a dental laboratory) also determines material selection. For example, glass ceramics
are typically weaker materials which limits its use to single-unit restorations; however mill times are
relatively short, enabling chairside production. On the other hand, zirconia has a high fracture toughness
which enables multi-unit restorations; however this material requires a long sintering procedure which
excludes its use for fast chairside production.

3M™ ESPE™ Lava™ Ultimate CAD/CAM Restorative is a “new to the world” CAD/CAM product utilizing
3M’s revolutionary nanoceramic technology. This new material, called a Resin Nano Ceramic (RNC), is
unique in durability and function. The material is not a resin or composite. It is also not a pure ceramic.
The material is a mixture of both and primarily consists of ceramic. Like a composite, the material is not
brittle and is fracture resistant. Like a glass ceramic, the material has excellent polish retention for lasting
esthetics. These unique qualities enable the material to be named with the Lava™ brand, 3M ESPE’s
premier brand for digital materials. This new material is highly heat cured through a controlled, proprietary
manufacturing process, which eliminates the need for a firing step after milling. The material is easily
machined chairside or in a dental lab, polishes quickly to an esthetic finish and if necessary, can be
further adapted using light-cure restoratives.

Lava Ultimate CAD/CAM blocks perform similarly to or better than glass ceramic and composite materials.
Lava Ultimate CAD/CAM restorative’s high fracture toughness, flexural strength and resiliency, assure that
milled restorations will exhibit excellent durability. This enables 3M ESPE to offer an industry-leading
10-year warranty.

Lava Ultimate restorative is available as a block for chairside systems (eg. CEREC® and E4D) and
as finished restorations from lab systems (Straumann® CARES®). 3M ESPE also plans to make the
material available for Lava™ Milling Centers.

Benefits of Lava Ultimate restorative to the dentist and patient include:

• a faster procedure compared to other CAD/CAM materials: firing is not required and
milling, polishing and adjustment are easier
• durability and shock absorption characteristics from a unique combination of
mechanical properties
• intra-oral adjustability with light cured restoratives

3
 Background
3M ESPE utilizes nanotechnology, a science employed throughout multiple product lines at 3M, to develop
the proprietary process used to create the Resin Nano Ceramic. Lava™ Ultimate CAD/CAM Restorative is
the direct result of this TRUE nanotechnology, which distinguishes itself by precise manipulation of the
ceramic architecture at the nano scale (about 1-100 nm), yielding unique and controllable properties.[3]
The nanotechnology in Lava Ultimate restorative is coupled with resin technology to achieve a combination
of strength and esthetics beyond what current feldspathic ceramics or composite blocks offer.
Nanomer particles are monodisperse, nonaggregated, and nonagglomerated nanoparticles. Lava Ultimate
restorative contains two types: silica nanomers of 20 nm diameter, and zirconia nanomers of 4 to 11 nm
diameter. The engineered nanoparticles are treated with a silane coupling agent using a proprietary
method. This functionalized silane bonds chemically to the nanoceramic surface and also bonds
chemically to the resin matrix during manufacturing of the blocks.
Nanocluster particles consist of bound aggregates of engineered nanoparticles. Although structurally
different from dense particles, these nanoclusters have structural integrity that allows a high proportion
of ceramic filler to be incorporated into the blocks, which provides excellent strength, fracture and wear
resistance properties. The zirconia-silica nanocluster particles in Lava Ultimate restorative are synthesized
via a proprietary process from 20 nm silica particles and 4 to 11 nm zirconia particles; the nanoclusters
are treated with the same silane coupling agent used with the nanomer particles. The average nanocluster
particle size is 0.6 to 10 micrometers.
Lava Ultimate restorative was formulated using both nanomer and nanocluster fillers with a total
nanoceramic material content by weight of approximately 80%. The addition of nanomer particles to
formulations containing nanoclusters reduces the interstitial spacing of the filler particles, leading to
higher nanoceramic content. The reinforced matrix (resin plus nanoparticles) is significantly harder
and much more wear-resistant than resin alone. The resin has a unique chemical composition different
from any light-cure or self-cure composite. Lava Ultimate restorative is processed multiple hours in a
special heat treatment process. This unique formulation and processing results in a material that
combines the high strength and wear resistance provided by nanoclusters with significantly improved
polish retention and optical properties of the nanoparticles. (see Figure 1). The nanoceramic imparts
excellent wear and polish retention properties. The new mill block technology is referred to as Resin Nano
Ceramic (RNC).

Figure 1

4
 Background

3M ESPE’s manufacturing process provides a final product that is highly cured and does not require firing
in the dental lab or operatory. (Figure 2)

3
2
Figure 2

1
• High speed polish in less than 4 minutes

• No firing step required

Lava™ Ultimate CAD/CAM Restorative is available in eight shades and two translucencies and are based
on the VITAPAN® Classical Shade Guide. (figure 3, 4).

Figure 3
Low Translucency (LT)
A1-LT A2-LT A3-LT A3.5-LT B1-LT C2-LT D2-LT Bleach

High Translucency (HT)

A1-HT A2-HT A3-HT B1-HT

Figure 4

Photo shows shade range but is not meant for exact shade matching.

5
 Indications
Permanent, adhesive, single-tooth
restorations including
crowns, crowns over implants,
inlays, onlays and veneers.

Preparation Guidelines
Lava™ Ultimate CAD/CAM Restorations follow the same guidelines as all-ceramic restorations. Do not undercut. All internal edges and line
angles should be rounded. Non-beveled shoulder finish lines are recommended.

Full Crown Onlay

≥ 1.0 5–6°
≥ 1.0 ≥ 1.5 ≥ 1.5
≥ 1.5 ≥ 1.5
≥ 1.5 ≥ 1.5
≥ 1.5 ≥ 1.5

≥ 1.5 ≥ 1.5 ≥ 1.0 ≥ 1.0

≥ 1.5 5–6°

Inlay Veneer

5–6° ≥ 0.4 ≥ 0.4

≥ 1.5
≥ 1.5

≥ 0.6 ≥ 0.6

≥ 0.5 ≥ 1.5

6

Step-by-Step Guide
Preparation
1. Prepare the tooth according to
the preparation guidelines.
2. After design, choose your block
size, shade and translucency,
and mill your restoration.
Finishing and Polishing
3. Remove the sprue and finish
the restoration.
4. Try in the restoration. Check
the occlusion and adjust the
contacts, if needed.
5. S mooth the restoration with a
disc, e.g. Sof-Lex™ Discs. For
final shine apply polishing
compound with bristle brush.
Do not fire. With a Resin Nano
Ceramic, esthetics are created with
the polishing step.
Step-by-step
Bonding/Cementation
6. Sandblasting with aluminum
oxide ≤50 μm is recommended.
Clean with alcohol and dry
with air.
7. If required by the selected
adhesive or self-adhesive resin
cement, apply silane primer
(e.g. 3M™ ESPE™ RelyX™
Ceramic Primer) to the bonding
surface of the restoration. Dry for
5 seconds.
8. Use an adhesive or self-adhesive
resin cement in accordance with
the Instructions for Use.
Final Lava™ Ultimate CAD/CAM
Restoration.
7
 Clinical Case

Initial situation: Fractured glass ceramic partial crown needs to be replaced.

Preparation according to the guidelines for CAD/CAM restorations.

Final restoration made with Lava™ Ultimate CAD/CAM Restorative.

8
 Mechanical Performance

Mechanical Performance
Details specific to the test methods will be given in the subsequent individual testing sections. Statistical
analysis was performed with Minitab 15 using Analysis of Variance (ANOVA) and two-sample t-tests with a
95% confidence level (p<0.05 confidence). Error bars on plots represent +/- one standard deviation.

Flexural Strength and Flexural Modulus

Flexural strength is measured by applying a load to a material specimen that is supported at each end, which
combines the forces found in compression and tension. Flexural modulus is a measure of a material’s stiffness;
low modulus indicates a flexible material.
Flexural strength and modulus were measured according to ISO 6872,
modified to accommodate bar sizes that could be sectioned from
commercially available mill blocks. Bar-shaped specimens with dimensions
1mm x 4mm x ~12mm were cut from blocks, then polished. Testing was
conducted using a test fixture with a 10mm span and a crosshead speed
of 1mm/min.

Figure 5
200 Source: 3M ESPE internal data
Flexural Strength (MPa)

150

100

50

0
IPS Empress® VITABLOCS® Tetric Paradigm™ Lava™ Ultimate
CAD Mark II EvoCeram® MZ100 CAD/CAM Restorative

The flexural strength of Lava™ Ultimate CAD/CAM Restorative was statistically higher than that of
Paradigm™ MZ100, Empress® CAD, VitaBLOCS® Mark II and Tetric EvoCeram®.

9
 Figure 6 60,000
Source: 3M ESPE internal data
50,000

Flexural Modulus (MPa)

40,000

30,000

20,000

10,000

0
IPS Empress® VITABLOCS® Sinfony™ Paradigm™ Lava™ Ultimate
CAD Mark II MZ100 CAD/CAM Restorative

The flexural modulus of Lava™ Ultimate CAD/CAM Restorative was statistically lower than that of Empress® CAD
and VITABLOCS® Mark II, statistically not different from Paradigm™ MZ100, and statistically higher than Sinfony™.
The flexural modulus of Lava Ultimate restorative is similar to the values reported for human dentine.
As postulated by Magne, et al,[4] a lower flexural modulus correlates to increased deformation under
load, suggesting that Lava Ultimate restorative is more likely to absorb the stress than glass-ceramics. In
addition, the combination of high strength with low modulus translates to greater resilience.

Fracture Toughness Instron Fixture

Figure 7
Source: 3M ESPE internal data
Fracture Toughness K1c (MPa m0.5)
The values reported for fracture toughness (K1c) are
related to the energy required to propagate a crack. In Anvil
this test, a defined notch is cut into the bar of material.
Sample Notch
The bar is placed on a fixture that supports either end and
the stylus is positioned above the notch in a 3-point bend Fixture
configuration similar to that used for flexural strength. A
high fracture toughness reflects a high ability of a material to hinder crack propagation.
Fracture toughness was measured according to ISO 6872, modified to accommodate bar sizes that
could be sectioned from commercially available mill blocks. A notch was cut using the V-notch option
in bar-shaped specimens with dimensions 3mm x 4mm x 14mm. Testing was conducted on a test fixture
with a 10mm span and a crosshead speed of 0.5mm/min. K1c was calculated from the failure load, notch
depth, and specimen dimensions.
The fracture toughness of Lava Ultimate restorative was statistically higher than that of Paradigm™ MZ100,
Empress CAD, and VitaBLOCS Mark II.
2.5

2.0

1.5

1.0

0.5

0.0
VITABLOCS® IPS Empress® Paradigm™ Lava™ Ultimate
10 Mark II CAD MZ100 CAD/CAM Restorative
 mechanical performance

3.5 Figure 8
Fracture Toughness vs.
3.0 Fluexural Strength
Fracture Toughnes K1C (MPa m^1/2)

Lava™ Ultimate Source: 3M ESPE internal data

CAD/CAM Restorative
2.5

2.0 Paradigm™ MZ100

1.5 Typical Glass Ceramics

1.0

0.5

0.0
100 150 200 250
Flexural Strength (MPa)

Figure 8, shows a schematic of material fracture toughness (K1c) vs. flexural strength for various material
classes. Fracture toughness range for glass ceramic materials was determined from literature values (see
orange area in Figure 8). Paradigm™ MZ100 provides greatly enhanced mechanical properties compared
to glass ceramics. The Lava™ Ultimate CAD/CAM Restorative provides further improvement over Paradigm
MZ100 and provides substantially greater resilience compared to brittle glass ceramic materials.

Flexural Fatigue Limit

The initial flexural strength of dry samples is the parameter most used to compare materials regarding
strength. However, clinical use introduces a moist and functional environment. This investigation looks at
the difference between the initial strength under dry and wet conditions and at the flexural fatigue limit
of Lava Ultimate restorative as compared to a acrylic CAD composite, a feldspathic glass ceramic and a
lithium disilicate glass ceramic material.
Initial strength of Lava Ultimate restorative, VITA CAD-Temp®, IPS Empress® CAD and IPS e.max® CAD
was determined according to ISO 6872 in a 3-point-bending geometry. Both dry and wet conditions were
investigated. Flexural fatigue limit was determined according to the staircase method for 10,000 cycles
at 10 Hz. A sinusoidal load was applied under water using the same 3-point-bending geometry as for the
initial strength tests.
600
Figure 9
Initial Strength
(Dry Conditions) Lithium Disilicate Source: 3M ESPE internal data
500
Resin Nano Ceramic

400
-222 MPa
Stress Load (MPa)

300

200 -59 MPa

100
Fatigue Strength (Wet Conditions)
0
0.1 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000
Number of cycles
11
 Figure 10 600
Source: 3M ESPE internal data Initial Strength dry (MPa)
500 Initial Strength in water (MPa)
Flexural Fatigue Limit at 10Hz, 10k cycles in water (MPa)
400

300

200

100

0
IPS e.max® CAD IPS Empress® CAD VITA CAD - Temp® Lava™ Ultimate
CAD/CAM Restorative

Lava™ Ultimate CAD/CAM Restorative was the only material investigated that maintained its initial strength
when changing from dry to wet conditions. Initial strength of Lava Ultimate restorative was higher than the
feldspathic glass ceramic and the CAD acrylic composite and lower than lithium disilicate. All materials
show a decrease in strength upon cycling fatigue in water. The flexural fatigue limit (FFL) of Lava Ultimate
restorative is at 74% of its initial dry strength whereas the lithium disilicate material can only maintain
50%. FFL of feldspathic glass ceramic and CAD acrylic composite was at 64% of the initial dry strength.
Based on its high flexural strength and high fatigue resistance, the material is ideal for challenging cases
like implant crowns. 3M ESPE provides an industry-leading 10-year warranty for the material.

Resiliency
Resiliency is the capability of the material to absorb energy when it is deformed elastically and then to
recover its size and shape upon unloading. In other words, it is the maximum energy per unit volume that
can be elastically stored. It is represented by the area (integral) under the curve in the elastic region (the
initial, linear portion) of the stress-strain curve; the units are of pressure (MPa).

Figure 11 2.5
Source: 3M ESPE internal data
Modulus of Resiliency (MPa)

2.0

1.5

1.0

0.5

0.0
VITABLOCS® IPS Empress® IPS e.max® Paradigm™ Lava™ Ultimate
Mark II CAD CAD MZ100 CAD/CAM Restorative

The modulus of resilience of Lava Ultimate restorative is statistically significantly higher than VitaBLOCS®
Mark II, Empress® CAD, IPS e.max® CAD and Paradigm™ MZ100. This means that Lava Ultimate restorative
can absorb significantly more stress than these materials without suffering permanent deformation or failure.

12
 wear performance

Compressive Strength
Compressive strength is of particular importance because of chewing forces. Rods are made of the
material and simultaneous forces are applied to the opposite ends of the sample length. The sample
failure is a result of shear and tensile forces.

400 Figure 12
Source: 3M ESPE internal data
350
Compressive Strength, MPa

300

250

200

150

100

50

0
IPS e.max CAD VITABLOCS® Mark II IPS Empress® CAD Paradigm™ Lava™ Ultimate
MZ100 Block CAD/CAM Restorative

Lava™ Ultimate CAD/CAM Restorative has similar or higher compressive strength than leading chairside materials.

Wear Performance
Two-Body Wear
Two-body wear of human enamel on the test materials was measured at the Minnesota Dental Research
Center for Biomechanics and Biomaterials (MDRCBB) at the University of Minnesota. In this test developed
by DeLong[5] and coworkers, a human third molar palatal cusp abrades the test material in a computer-
controlled motion that mimics natural chewing. The surface topography of the enamel and test material
is profiled before and after abrasion with a contact digitizer, allowing volume loss of both the test material
and the antagonist cusp.

0.18 Figure 13
0.16 Source: University of Minnesota
Material Volume Loss (mm3)

0.14
0.12
0.10
0.08
0.06
0.04
0.02
0.00
IPS e.max® CAD IPS Empress® CAD Lava™ Ultimate
CAD/CAM Restorative

The wear of Lava Ultimate restorative material is statistically not different from that of
IPS Empress® CAD and IPS e.max® CAD.
13
 Figure 14 0.18

Enamel Antagonist Volume Loss (mm3)

Source: University of Minnesota 0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0.00
IPS e.max® CAD IPS Empress® CAD Lava™ Ultimate
CAD/CAM Restorative

Lava™ Ultimate CAD/CAM Restorative wear on enamel is statistically significantly lower than that of IPS
Empress CAD, and IPS e.max CAD. Lava Ultimate restorative is gentle to opposing enamel.

Three-Body Wear
Three-body-wear of Lava Ultimate restorative, IPS e.max® CAD, IPS Empress® CAD, VITABLOCS® Mark II,
Esthet-X®, Paradigm™ MZ100, and Tetric EvoCeram® was determined with an ACTA Wear Machine (ACTA,
Amsterdam, NL). The material loss in µm was measured after 200,000 cycles with a profilometer.

Figure 15 35
Source: 3M ESPE internal data
Material Loss at 200k Cycles (µm)

30

25

20

15

10

0
IPS e.max® IPS Empress® VITABLOCKS® Esthet-X® Paradigm™ Tetric Lava™ Ultimate
CAD CAD Mark II MZ100 EvoCeram CAD/CAM Restorative
®

The three-body wear rate of Lava Ultimate restorative material is significantly lower than that of the
composites investigated. The glass ceramic materials showed nearly no wear in this test. For human
enamel three-body-wear values in the range of 10 µm to 60 µm were reported (ACTA method, 200k cycles,
Spiegl et al, #1288 IADR 03, #0175 CED 07). The resin nano ceramic material was found to be much more
wear resistant than composite and closer to the lower values reported for enamel than glass ceramic materials.
Lava Ultimate restorative offers a balanced wear resistance — it exhibits a significantly higher wear
resistance than composites and is better able to “give way” as compared to glass ceramic materials.

14
 restoration fabrication

Restoration Fabrication and Placement

Millability
The ability to mill materials was qualitatively assessed by examining the margins on MOD Inlays milled
on a chairside mill in “Fast Milling” mode. Milled samples were examined under scanning electron
microscopy (SEM).

Figure 16
Source: 3M ESPE internal data

Lava™ Ultimate Feldspathic glass ceramic Lithium disilicate

CAD/CAM Restorative

The images in Figure 16 show that the excellent millability of Lava™ Ultimate CAD/CAM Restorative
provides better marginal quality than glass ceramics. The low brittleness of Lava Ultimate restorative
results in excellent machinability, ease of adjustment and cutting, and suggesting less fragility at try-in.

Characterization, Adjustment, Intraoral Repair

Lava Ultimate restorative offers the dentist a high degree of versatility in characterization, adjustment,
and repair/service. Light-cured composites and stains can be bonded directly to Lava Ultimate restorations
with a simple procedure (Figure 17) that can be done intra- or extra-orally. This sets Resin Nano Ceramic
material apart from glass ceramics.
Figure 17

The material is especially suited for use as a crown over an implant;

in this case, it is possible to obtain access to the retention mechanism
through the crown, and reliably re-seal with light cured restorative materials
to maintain the original crown esthetics.
15
 Cementation
Shear bond strength of steel cylinders bonded to disks of the test materials was measured after 24 hours
water storage and 5000 thermocycles. RelyX™ Unicem 2 Automix Self-Adhesive Resin Cement was used
for all groups. For all glass ceramics, the manufacturers’ instructions were followed: hydrofluoric acid etch,
rinse, silane priming, bonding. Lava™ Ultimate CAD/CAM Restorative specimens were prepared
by sandblasting.

Figure 18 70
Source: 3M ESPE internal data 24 hours
60 5,000 Thermocycles
Shear Bond Strength (MPa)

50

40

30

20

10

0
IPS e.max® CAD IPS Empress® CAD VITABLOCS® Mark II Lava™ Ultimate
CAD/CAM
Restorative
HF Acid Etch, Silane, Monobond Plus Sandblast

All materials showed high bond strength to RelyX Unicem 2 Automix cement. However, the bonding
procedure with Lava Ultimate restorative is significantly easier — no HF etch, no silanation and no
bonding (when using RelyX Unicem cement).

16
 esthetics

Esthetics
Polish and Polish Retention
The polish retention property of Lava™ Ultimate CAD/CAM Restorative is similar to glass ceramics and
better than composite blocks.
Tiles of 2mm thickness were cut from blocks. The surfaces were polished wet using a variable-speed
grinder-polisher to ensure a uniform surface. They were stored in water at 37ºC for 24 hours. The samples
were brushed with toothpaste and a toothbrush that was mounted on an Automatic Toothbrush Machine.
Gloss measurements were taken after 6,000 toothbrush strokes.

100 Figure 19
90 Source: 3M ESPE internal data
80
70
60
Gloss (%)

50
40
30
20
10
0
IPS e.max® IPS Empress® VITABLOCS® Esthet-X® Paradigm™ Tetric Lava™ Ultimate
CAD CAD Mark II MZ100 EvoCeram® CAD/CAM
Restorative

Lava Ultimate restorative has statistically higher polish retention than Paradigm™ MZ100, Esthet-X®, and
Tetric EvoCeram®, and statistically not different polish retention from IPS e.max® CAD, IPS Empress® CAD,
and Vitablocs® Mark II after 6000 toothbrush cycles. Lava Ultimate restorative displays outstanding
polish retention, which far exceeds typical composites and is comparable to glass ceramics.

17
 Plaque Resistance
Two groups of disks were prepared for each material: polished, and polished followed by toothbrush
abrasion. Bovine enamel disks served as a control. Plaque was grown on the material disks and on bovine
enamel using original human saliva from a volunteer; all specimens were sterilized via ethanol prior to
incubation. Plaque was collected and freeze-dried to determine plaque biomass.

Figure 20 3.5
Dried biomass in mg/cm2 (grown Polished
in human saliva for 26 hours) 3.0 Toothbrushed
Dried Biomass (mg/cm2)

Source: 3M ESPE internal data

2.5

2.0

1.5

1.0

0.5

0.0
IPS Empress® IPS e.max® Enamel Lava™ Ultimate
CAD CAD Control CAD/CAM Restorative

These results show that Lava™ Ultimate CAD/CAM Restorative demonstrates plaque resistance equivalent
to glass ceramics, and demonstrates greater plaque resistance than enamel itself. Toothbrushing abrasion
did not affect the plaque resistance of Lava Ultimate restorative.

Fluorescence
The fluorescence of Lava Ultimate restorative was designed to match natural dentition. In a study by
Monteiro, fluorescence match was determined visually using UV lighting; photographic images were
collected with a digital camera (Figure 21).

Figure 21
Photo courtesy of Paulo Monteiro
DMD, MSC, Assistant Professor

18
 field evaluation

Stain Resistance
One millimeter thick tiles of each material were immersed in red wine for 7 days at 37°C. CIELAB color
was measured on a spectrophotometer before and after immersion.

45 Figure 22
40 Delta E color change after 7 days
storage in red wine at 37°C
35
Source: 3M ESPE internal data
30
25
20
15
10
5
0
IPS Empress® IPS e.max® VITABLOCS® Tetric Quixx® Lava™ Ultimate
CAD CAD Mark II EvoCeram® CAD/CAM Restorative

Lava™ Ultimate CAD/CAM Restorative shows stain resistance that is superior to composite materials, and
similar to some glass-ceramic materials. The excellent stain resistance of Lava Ultimate restorative helps
provide long-term color stability.

Customer Feedback
A total of 195 restorations (including inlays, onlays, crowns, crowns on implant abutments and veneers)
were completed by 44 evaluators selected by an independent agency. 98% of evaluators indicated the
overall esthetics of a restoration made with Lava Ultimate restorative were acceptable for use in the posterior.

Figure 23
Source: 3M ESPE internal data
Acceptable
98%

19
 Figure 24 On average, it took evaluators 3.7 minutes to polish a crown made of Lava™ Ultimate CAD/CAM Restorative.
Source: 3M ESPE internal data

3.7 Minutes

Evaluators were satisfied with the milling characteristics for all types of restorations.

Figure 25 Very Satisfied 5

Source: 3M ESPE internal data
Satisfied 4

Neutral 3

Dissatisfied 2

Very Dissatisfied 1
Time to Mill Ability to Achieve Ability to Achieve
Desired Anatomy Desired Marginal Edge

Over 80% of evaluators were satisfied with the features related to polish and esthetics.

Figure 26 Satisfied (Rated 4) Very Satisfied (Rated 5)

Source: 3M ESPE internal data
Shade of the Restoration In Vivo 59% 27% 86%

Effort Required to Achieve Desired Polish 50% 34% 84%

Overall Polish, Gloss and Smoothness

of the Finished Restoration 59% 23% 82%

Blending of the Restoration

50% 32% 82%
with the Surrounding Dentition

Time Required to Achieve Desired Polish 48% 32% 80%

0% 20% 40% 60% 80% 100%

% of Respondents

20
 field evaluation

For a CROWN, evaluators rated 5 out of 8 attributes better compared to their current product Figure 27
(average rating > 3.0). Source: 3M ESPE internal data

Lava Ultimate is
Same Ease of Polish 33% 39% 19%
Better
Much Better Time to Polish 3 3 37% 43% 14%

Milling Time 6% 51% 31% 9%

Time after Milling Until Seating 66% 20% 11%

Blending with Neighboring Dentition 60% 20%

Esthetics of Final Posterior Restoration 54% 17%

Cementation 86% 11% 3

Shade Selection 72% 3

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
% of Respondents

We asked evaluators to tell one thing they liked best about Lava™ Ultimate CAD/CAM Restorative.

• The ability to shape and contour Intraorally

• The way that Lava Ultimate restorative shades blend with the natural teeth
• Easy to polish
• Great shine
• It’s great to be able to add-on or build up intraorally if necessary
• Fit and margins
• Fast, no firing
• Ease of milling
• Smooth finish right out of milling unit
• The ease of adjusting the occlusion
• It’s easy to add to. I didn’t realize that we had exposed dentin on part of the occlusal surface and it
was easy to do a mini cavity prep which solved the problem.
• Shade compatibility
• The potential of really making a crown from start to finish, prep to seating, within one morning or
one afternoon.
• Because it is so fast to finish, Lava Ultimate may accelerate the process by a critical 30 minutes.

21
 Lava™ Ultimate CAD/CAM Restorative
Technical Data Summary
Lava™ Ultimate
CAD/CAM
Restorative
K1c 2.02
Fracture Toughness
StDev 0.15
MPa 204.00
Flexural Strength
StDev 19.00
MPa 12.80
Flexural Modulus
StDev 1.00
MPa 12.77
Modulus of Elasticity (GPa)
StDev 0.99
um los 6.3
3-Body ACTA Wear Material Loss at 200k Cycles (µm)
StDev 0.4
Compressive Strength MPa 383
StDev 32

22
 References

References
[1] Christensen GJ. “In-office CAD/CAM milling of restorations. The future?” J Amer Dent Assoc 2008;
139: 83-85.
[2] Poticny DJ, Klim J. “CAD/CAM in-office technology.” J Amer Dent Assoc 2010; 141: 5S-9S.
[3] “US Nanotechnology Initiative.” <http://www.nano.gov/>.
[4] Magne P, Paranhos MP, Burnett LH Jr, Magne M, Belser UC. “Fatigue resistance and failure mode of
novel-design anterior single-tooth implant restorations: influence of material selection for type III
veneers bonded to zirconia abutments.” Clin Oral Impl Res. 2011 Feb; 22 (2): 195-200. 157 (University
of Southern California)
[5] DeLong R, Douglas WH. “Development of an artificial oral environment for the testing of dental
restoratives: bi-axial force and movement control.” J Dent Res. 1983 Jan; 62 (1): 32-6.

Bibliography
Fasbinder DJ, Dennison JB, Heys D, Lampe K. “Clinical Evaluation of CAD/CAM-Generated Polymer Ceramic
Inlays.” J. Dent. Res. 80 (AADR Abstracts #1882), 2001. (University of Michigan)

23
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