Dental all ceramic restorations /orthodontic straight wire technique


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Dental all ceramic restorations /orthodontic straight wire technique

  1. 1.
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. ALL CERAMIC SYSTEMS 1) Conventional Powder – Slurry Ceramics (using condensing & sintering) (a) Alumina reinforced Porcelain e.g. : Hi-Ceram (b) Magnesia reinforced Porcelain e.g.: Magnesia cores (c) Leucite reinforced (High strength porcelain) e.g. : Optec HSP (d) Zirconia whisker – fiber reinforced e.g.:MirageII (Myron Int) (e) Low fusing ceramics (LFC): (i) Hydrothermal LFC e.g.: Duceram LFC : (ii) Finesse (Ceramco Inc)
  4. 4. 2) Castable Ceramics ( Using casting & ceramming)  Flouromicas e.g.: Dicor  Apatite based Glass-Ceramics e.g. Cera Pearl  Other Glass-Ceramics  Lithia based  Calcium phosphate based
  5. 5. 3) Machinable Ceramics A) Analogous Systems (Pantograph systems – copying methods) 1)Copy milling / grinding techniques a) Mechanical e.g. : Celay b)Automatic e.g:Ceramatic II. DCP 2) Erosive techniques a) Sono-erosion e.g: DFE, Erosonic b) Spark-erosion e.g: DFE, Procera B)Digital systems (CAD / CAM): 1) Direct e.g.: Cerec 1 & Cerec 2 2) Indirect e.g. : Cicero, Denti CAD, Automill,
  6. 6. 4) Pressable Ceramics (pressure molding & sintering)  Shrink-Free Alumina Reinforced Ceramic (Injection Molded) E.g. : Cerestore / Alceram  Leucite Reinforced Ceramic (Heat – Transfer Molded) E.g.: IPS Empress,, Optec OPC.  Lithia reinforced glass ceramic: Eg. IPS empress 2, OPC 3G
  7. 7. 5. Infiltrated Ceramics (slip-casting, sintering & glass infiltration)  Alumina based e.g: In-Ceram Alumina  Spinel based e.g: In-Ceram Spinell  Zirconia based e.g.: In-Ceram Zirconia
  8. 8. Porcelain Jacket Crown  Land ---- high Feldspathic Porcelain with platinum foilLand ---- high Feldspathic Porcelain with platinum foil matrixmatrix  Excellent estheticsExcellent esthetics  Difference in modulus of elasticity---supportive roleDifference in modulus of elasticity---supportive role played by the preparation is limited.played by the preparation is limited.  Poor flexure strengthPoor flexure strength  Poor marginal adaptabilityPoor marginal adaptability  Thus to increase their reliability in service they need toThus to increase their reliability in service they need to have surfaces that are flawless and they need tohave surfaces that are flawless and they need to stiffened.stiffened.
  9. 9. Requirements of a porcelain jacket crown TechniqueRequirements of a porcelain jacket crown Technique  Should not be opacifiedShould not be opacified  Should not contain quartz and light transmission of the body andShould not contain quartz and light transmission of the body and veneered porcelain should approach that of dentine and enamelveneered porcelain should approach that of dentine and enamel respectively.respectively.  Reduction of gross internal subsurface and surface defectsReduction of gross internal subsurface and surface defects  Accurately adapted crown marginsAccurately adapted crown margins  Relief of 50Relief of 50µm for cementµm for cement  Matched COTEMatched COTE  Method of stiffening without optically dense backgroundsMethod of stiffening without optically dense backgrounds  Good cement retentionGood cement retention  Future RCT scopeFuture RCT scope  Should not obscure pulp outline in radiographShould not obscure pulp outline in radiograph
  10. 10. IndicationsIndications  Conservation of tooth structureConservation of tooth structure  Maintenance of periodontal healthMaintenance of periodontal health  EstheticsEsthetics  Lower incisors with available spaceLower incisors with available space  Limited use in premolars with protectedLimited use in premolars with protected occlusion.occlusion.
  11. 11. ContraindicationsContraindications  Para-functional activityPara-functional activity  Deflective malocclusionDeflective malocclusion  Unfavorable occlusal clearanceUnfavorable occlusal clearance  Insufficient tooth supportInsufficient tooth support  Tooth preparation with sudden change in shapeTooth preparation with sudden change in shape  Molar teeth----?????Molar teeth----?????
  12. 12. Technique employed to reinforce porcelainTechnique employed to reinforce porcelain jacket crownsjacket crowns  Platinum- bonded alumina crownsPlatinum- bonded alumina crowns  Electroformed gold matrixElectroformed gold matrix  Gold coated platinum foilGold coated platinum foil  Metal-ceramicMetal-ceramic  Alumina-reinforced porcelain crownsAlumina-reinforced porcelain crowns  Aluminous crowns reinforced with sintered highAluminous crowns reinforced with sintered high alumina profilesalumina profiles  Previous refractory die techniquePrevious refractory die technique
  13. 13. Aluminous Core CeramicsAluminous Core Ceramics  High strength ceramic core (High strength ceramic core (Mc Lean and Hughes -1965Mc Lean and Hughes -1965))  Aluminum oxide crystals dispersed in a glassy matrix (40-Aluminum oxide crystals dispersed in a glassy matrix (40- 50%)50%)  High fracture toughness and hardnessHigh fracture toughness and hardness  Technique involves use of an opaque inner core containingTechnique involves use of an opaque inner core containing 50% alumina for strength and the core was veneered with50% alumina for strength and the core was veneered with 15% and 5% crystalline alumina for esthetic body and15% and 5% crystalline alumina for esthetic body and enamel porcelain respectively.enamel porcelain respectively.  Large sintering shrinkage and decreased translucencyLarge sintering shrinkage and decreased
  14. 14. Fabrication procedureFabrication procedure  Diamond shape foil is adapted to the facialDiamond shape foil is adapted to the facial surfacesurface  Two cuts are made, one on each incisal cornerTwo cuts are made, one on each incisal corner and a triangle of foil is removed by cutting atand a triangle of foil is removed by cutting at 45° toward the corners.45° toward the corners.  Foil is folded on to the lingual surface andFoil is folded on to the lingual surface and burnished.burnished.
  15. 15.  Foil is gathered on lingual surface with tweezersFoil is gathered on lingual surface with tweezers and adapted with finger pressure.and adapted with finger pressure.  Foil is trimmed to follow the lingual contour andFoil is trimmed to follow the lingual contour and two ends are separated.two ends are separated.  One end is trimmed half the width of otherOne end is trimmed half the width of other  Long end is folded over the shorter and relievingLong end is folded over the shorter and relieving cuts are made.cuts are made.  Three thickness joint is folded toward the shortThree thickness joint is folded toward the short end.end.
  16. 16.  Foil is adapted with a wooden point, startingFoil is adapted with a wooden point, starting from incisal edge and working towards margin.from incisal edge and working towards margin.  Beaver-tail burnisher, working toward theBeaver-tail burnisher, working toward the internal angle to prevent perforation.internal angle to prevent perforation.  Matrix is removed with sticky wax and annealedMatrix is removed with sticky wax and annealed in a Bunsen a Bunsen flame.
  17. 17.
  18. 18.  Platinum matrix is heated to drive off dissolvedPlatinum matrix is heated to drive off dissolved gases, and the core material is built up.gases, and the core material is built up.  A thin blade is used to form a cervical ditchA thin blade is used to form a cervical ditch which will matrix distortion during firing andwhich will matrix distortion during firing and finally the foil is readapted and ditch is filled withfinally the foil is readapted and ditch is filled with additional porcelainadditional porcelain..
  19. 19. Captek systemCaptek system  Coping is produced from twoCoping is produced from two metal impregnated waxmetal impregnated wax sheets that are adapted to asheets that are adapted to a die and fired.die and fired.  The first sheet forms aThe first sheet forms a porous gold-platinum-porous gold-platinum- palladium layer that ispalladium layer that is impregnated with 97% goldimpregnated with 97% gold when the second sheet iswhen the second sheet is fired.fired.
  20. 20. AdvantagesAdvantages  Excellent estheticsExcellent esthetics  Marginal adaptationMarginal adaptation
  21. 21. HICERAM  19851985 – Vita Zahnfabrik, Germany.– Vita Zahnfabrik, Germany.  Similar to traditional alumina but higher aluminaSimilar to traditional alumina but higher alumina content.content.  Specific size distribution of crystalline phase ---Specific size distribution of crystalline phase --- without worsening opacitywithout worsening opacity  Flexure strength of 155 MpaFlexure strength of 155 Mpa  Epoxy die ---- swaged resin copingEpoxy die ---- swaged resin coping
  22. 22. Indications for HiceramIndications for Hiceram  Anterior crownsAnterior crowns  Posteriors with favorable occlusalPosteriors with favorable occlusal  Patient allergic to metal corePatient allergic to metal core  Some amount of light reflection is requiredSome amount of light reflection is required from tooth.from tooth.
  23. 23. New foil systemNew foil system  Modifications of original foil crownModifications of original foil crown  Layered noble metal foilsLayered noble metal foils  Strength – 30-80% of metal ceramic systemStrength – 30-80% of metal ceramic system  ExamplesExamples  RenaissanceRenaissance  SunriseSunrise  FlexobondFlexobond  PlatideckPlatideck
  24. 24. MAGNESIA BASED CORE PORCELAIN  High expansion magnesia core material compatibleHigh expansion magnesia core material compatible with porcelain.with porcelain.  Flexure strength ( 131 MPa)  Allows to veneer it with more widely available porcelain ( match of COTE)  Glazing strengthen the magnesia core  Highly opaque
  25. 25.  Feldspathic porcelain higher leucite tetragonal crystalFeldspathic porcelain higher leucite tetragonal crystal content.content.  The leucite and glassy components are fused during the bakingThe leucite and glassy components are fused during the baking process…at 1020ºC.process…at 1020ºC. Leucite reinforced porcelain (OPTEC HSP) 45% vol
  26. 26. ADVANTAGESADVANTAGES ☺ More esthetic due to a more translucent core.More esthetic due to a more translucent core. ☺ Greater strength. (104 MPa)Greater strength. (104 MPa) ☺ No special processing equipment required.No special processing equipment required. DISADVANTAGESDISADVANTAGES  Increased leucite content contributes to theIncreased leucite content contributes to the relatively high wear of opposing teethrelatively high wear of opposing teeth  Potential marginal inaccuracyPotential marginal inaccuracy USESUSES Inlays,onlays,low stress crowns.Inlays,onlays,low stress crowns.
  27. 27. Low fusing Ceramics  In 1992 Duceram LFC was marketed as an ultra-low fusing ceramic with amorphous glass containing hydroxyl ions.  Hydrothermal low fusing ceramics  Greater density  Higher flexural strength ---- ion exchange  Greater fracture resistance  Low hardness --- lack of leucite crystals  Use of refractory dies. USES: Inlays,Veneers,Full contour crowns. ( DUCERAM LFC)
  28. 28. Slip casting ceramics ( INCERAM)  Slip casting is defined as a process used to form greenSlip casting is defined as a process used to form green ceramic shapes by applying a slurry of ceramic particlesceramic shapes by applying a slurry of ceramic particles and water or a special liquid to a porous substrate thereand water or a special liquid to a porous substrate there by allowing capillary action to remove water, densify theby allowing capillary action to remove water, densify the mass of deposited particles.mass of deposited particles.  IN CERAM (IN CERAM ( Sadoun- 1985Sadoun- 1985) is based on the slip casting) is based on the slip casting of an alumina core with its subsequent glass infusion.of an alumina core with its subsequent glass infusion. INCERAM
  29. 29. Fabrication procedure  Duplication of master die and preparation ofDuplication of master die and preparation of refractory dierefractory die  Application of alumina slip 38gm:5 mlApplication of alumina slip 38gm:5 ml ( ultrasonic agitation- 3 minutes)( ultrasonic agitation- 3 minutes)  Initial firing cycle of long duration to 120Initial firing cycle of long duration to 120°C, then°C, then alumina is fired at 1120°C .alumina is fired at 1120°C .
  30. 30.  Paint a thick coat of appropriate shade ofPaint a thick coat of appropriate shade of glass (lanthum aluminosilicate) mixtureglass (lanthum aluminosilicate) mixture and fire it at 1100°C.and fire it at 1100°C.  Apply body and incisal porcelain in usualApply body and incisal porcelain in usual manner to achieve appropriate estheticmanner to achieve appropriate esthetic results.results.
  31. 31. Master die Duplication with refractory material Ultrasonic dispersion Slip application Ceramet furnace Trimming Lanthum aluminosilicate Veneering
  32. 32. ADVANTAGES  Flexure strength ( 450- 600 MPa) --- strongest  Accurate marginal fit  Highly dense and fewer processing defect  Highly strong .. Used for fixed dental prosthesis DISADVANTAGES  Opaque alumina  Special technique  Technique sensitive
  33. 33. INCERAM SPINELLINCERAM SPINELL  Porous core is fabricated from the magnesiumPorous core is fabricated from the magnesium alumina with specific crystalline structure.alumina with specific crystalline structure.  Light reflection and glass like shineLight reflection and glass like shine  Not as strong as conventional Inceram aluminaNot as strong as conventional Inceram alumina (350MPa)(350MPa)  Increased translucency and biocompatibleIncreased translucency and biocompatible  Used in crowns, inlays, onlays, veneers inUsed in crowns, inlays, onlays, veneers in esthetic areas.esthetic areas.
  34. 34. INCERAM ZIRCONIA  33% Zirconia --- transformation toughening  Phase transformation from tetragonal to monoclinic is stabilized at room temperature by addition of 16% cerium oxide.  Highly strong (700 MPa)  Excellent marginal accuracy and biocompatibility  Least translucent in series  Inability to etch  Used in posterior three unit FDP’s.
  35. 35. CASTABLE CERAMICS FLUORO-MICASFLUORO-MICAS APATITE GLASSAPATITE GLASS OTHER GLASSOTHER GLASS DICOR CERAPEARL (BIOCERAM) Lithia based Calcium phosphate based These are polycrystalline materials developed for application by casting procedures using the lost wax technique, hence referred to as “Castable ceramics”. They are fabricated in the vitreous (Glass or non- crystalline/amorphous) state and converted to a ceramic (crystalline state) by controlled crystallization using nucleating agents during heat treatment.
  36. 36.  First commercially available castable glass-ceramic  Developed by Corning Glass Works  Dicor is a micaceous glass ceramic consist of 45% vol. glass and 55% crystalline tetrasilicic mica. DICOR Glass Melt Super cooled glass ( Room temperature) Crystalline Glass ( dense mass with interlocking crystals) Nucleating agents
  37. 37. Glass ingots castable ceramic material is placed in a special zirconia crucible (melted at 1360°C / 2600°F) and centrifugally cast in the electronically-controlled DICOR Casting Machine. Fabrication procedure The transparent glass casting obtained is amorphous and fragile. After cooling, it is divested, sandblasted and carefully separated from the sprue. The wax pattern of the proposed restoration made on the die is invested in Castable Ceramic Investment and burned out in a conventional burnout at 900°C for 30 mins.
  38. 38. The transparent fragile casting is embedded in castable ceramic embedment material in the DICOR Ceramming Furnace ( produce controlled crystallization by internal nucleation and crystal growth of microscopic plate like mica crystals within the glass matrix) Ceramming (1075 °C for 10 hours)
  39. 39.  Excellent esthetics resulting from natural translucency, light absorption, light refraction and natural colour for the restoration. (Chameleon effect)  Relatively high strength ( flexural strength of 152 MPa), surface hardness (abrasion resistance) and occlusal wear similar to enamel.  Inherent resistance to bacterial plaque  Chemical resistant  Low thermal conductivity.  Excellent marginal adaptation ( 30-60 µm) ADVANTAGES
  40. 40.  Special and expensive equipments  Failure rates as high as 8% in the posterior region  Highly translucent --- require external veneering or staining  More prone for stress cracking DISADVANTAGES
  41. 41. CASTABLE HRDROXYAPATITE GLASS CERAMICS (CeraPearl) ( Kyocera Bioceram Group of Kyota city, Japan)  Sumiya Hobo & Iwata (1985)  Composed of CaO, P2O5, MgO, and SiO2 and traces of other elements  Has similar crystalline microstructure to enamel but different arrangement. It is very white , so require external stains supplied by Bioceram with complex glass formulation and various metal oxides.
  42. 42. Properties  Similar to natural enamel in composition, density, refractive index, coefficient of thermal expansion and hardness.  Bonding to tooth structure.  Biocompatible  Superior mechanical strength
  43. 43.   Lithia Based Glass-Ceramic (Olympus Castable Ceramic- OCC)  Developed by Uryu  It contains crystals of LiO.AI2O3.4SiO2 after heat treatment.
  44. 44.  Kihara et al  It is a combination of calcium phosphate and phosphorus pentoxide plus trace elements.  The glass ceramic is cast at 1050°C which is converted to a crystalline ceramic by heat treating at 645°C for 12 hours.  Reported Flexural strength (166 MPa)  Hardness close to tooth structure.  Weaker than other castable ceramics  Opacity reduces the indication for use in anterior teeth. Calcium Phosphate Glass-Ceramics
  45. 45. PRESSABLE CERAMICS(Heat transfer molded or Injection molded) Shrink free ceramics Leucite reinforced glass ceramics Lithia reinforced glass ceramic Cerestore Al-Ceram IPS Empress Optec OPCIPS Empress 2 OPC 3G
  46. 46. CERESTORE  This shrink-free ceramic material essentially consists of Al2O3 and MgO mixed with a Barium glass frits.  On firing crystalline transformation produces Magnesium aluminate spinel, which occupies a greater volume than the original mixed oxides compensates for the conventional firing shrinkage.   Good dimensional stability  Better accuracy of fit and marginal integrity  Esthetics enhanced due to the lack of metal coping  Biocompatible.  Low coefficient of thermal expansion Advantages
  47. 47.  Complexity of the fabrication process.  Need for specialized laboratory equipment  Inadequate flexural strength (89MPa)  Poor abrasion resistance, hence not recommended in patients with heavy bruxism or inadequate clearance.  Limitations and high clinical failure rates led to its withdrawal from the market. It underwent further improvement with a 70 to 90% higher flexural strength and was marketed under the commercial name Al Ceram Disadvantages
  48. 48.  Recrystallization of residual glass – Fracture toughness 22.5 N/m2 (32,000psi)  High polycrystalline content  Same relative thermal conductivity of core and veneer porcelain  Low coefficient of thermal expansion - Thermal shock resistance.  High modulus of elasticity - Low stress on cement. AL CERAM
  49. 49. Leucite Based Heat-Pressed Ceramics IPS EMPRESS Wohlwend & Scharer Leucite used as a reinforcing phase in amount varying from 35-55% dispersed in a glassy matrix. Particle size ( 3-10 µm) Ceramic ingots are pressed at a high temperature (1165°C) into a refractory mold made by lost wax technique Two finishing techniques Characterization / stain Layering / veneering
  50. 50. Fabrication procedureFabrication procedure  Wax the restoration to final contour, sprue and invest.  Heat the investment to 800°C to burn out the wax pattern  The ceramic ingot, plunger and the entire assembly is preheated to 1,100ºC  Insert ceramic ingot and alumina plunger in the sprue and place the refractory in special pressing furnace.
  51. 51. • When the temperature reaches 1150ºC after a 20 minute holding time the plunger presses the ceramic under vacuum (0.3-0.4 MPa) into the mold, in which it is held under pneumatic pressure (for a 45-minute period) to allow complete and accurate fill of the mold. • After pressing, recover the restoration from the investment by airborne particle abrasion, remove the sprue, and refit on the die. • Esthetics can be enhanced by applying an enamel layer of matching porcelain or by adding surface characterization.
  52. 52.
  53. 53. Properties :  Reported flexural strengths are in the range of 160 to I80MPa.  The increase in strength has been attributed to the pressing step which increases the density of leucite crystals.  Subsequent heat treatments which initiate growth of additional leucite crystals. Uses :  Laminate veneers and full crowns for anterior teeth  Inlays, Onlays and partial coverage crowns  Complete crowns on posterior teeth.
  54. 54.   Lack of metal or an opaque ceramic core  Moderate flexural strength (120-180MPa range)  Excellent fit (low-shrinkage ceramic)  Improved esthetics (translucent, fluorescence)  Etchable  Less susceptible to fatigue and stress failure  Less abrasive to opposing tooth  Biocompatible material  Does not require ceramming to initiate the crystalline phase of leucite crystals ADVANTAGES
  55. 55.  Potential to fracture in posterior areas  Need for special laboratory equipment  Inability to cover the colour of a darkened tooth preparation or post and core, since the crowns are relatively translucent.  Difficulty in removing the crown and cementing medium during replacement.  Compressive strength and flexural strength lesser than metal-ceramic or glass-infiltrated (In-Ceram) crowns. DISADVANTAGES
  56. 56.  Feldspathic porcelain with increased leucite content  Processed by molding under pressure and heat. Reduced particle size and Increased Crystalline Leucite content Increase in Flexural strength (over 23,000 psi ) Increase in Compressive strength (187,320 psi). Higher abrasion resistance OPTEC OPC
  57. 57. Lithium Disilicate Based Heat-Pressed Ceramics IPS Empress 2  Consist of core of 70% Lithium disilicate crystals of 0.5- 4µm length Lithium orthophosphate crystals ( 0.1- 0.3µm diameter  Veneering ceramic fluorapatite crystals  The apatite crystals incorporated are responsible for the improved optical properties (translucency, light scattering) unique chameleon effect.
  58. 58.  High biocompatibility  Excellent fracture resistance  High radiopacity  Outstanding translucency. Uses  Anterior and posterior crown  Premolar FPD. ADVANTAGES • IPS Empress 2 is used with special investment material, an EP500 fully automatic high-tech press furnace.
  59. 59. Other applications • Cosmopost • IPS Empress cosmoingot - core build-up system with the pre-fabricated zircon oxide root canal posts.
  60. 60.
  61. 61. IPS EMPRESS ESTHETIC  The most recent innovation  Developed by Lee Culp CDT, and further refined with Lee, Matt Roberts and Jürgen Seger, CDT .  It is a high-strength, optimized Leucite reinforced glass ceramic.  Broader ingot shade range (11 with extended shades in the bleach range) gives more selection to Used with a traditional staining technique or a cutback technique.
  62. 62.  When coupled with the new line of IPS Empress Esthetic Veneering Materials and IPS Empress Esthetic Wash Pastes, Empress Esthetic offers ceramists the added flexibility of using a cutback technique to fabricate life-like restorations.  Used for single units, all-ceramic restorations, including partially layered or stained veneers, crowns, inlays and onlays.
  63. 63. wax-up to optimal function and Esthetics, Spruing, investing, burn out and heat pressing with IPS Empress Esthetic ingot into the mold. Varify on the cast and then intraorally for contours , occlusion and accuracy of fit. The incisal edge of the tooth is reduced to maintain a minimal thickness of 0.5 mm. Facial surfaces are reduced while maintaing contour
  64. 64. Add surface characterization using the IPS Empress Esthetic Veneer Wash Pastes to build up internal effects. To obtain a three dimensional effect, layer over this using different values and translucencies of clear and opal enamel IPS Empress Esthetic Veneer Materials. Final contouring and glazing
  65. 65. IPS e.max  IPS e.max comprises highly aesthetic and high-IPS e.max comprises highly aesthetic and high- strength materials for both the PRESS andstrength materials for both the PRESS and CAD/CAM technique.CAD/CAM technique.  IPS e.max Press are new highly aesthetic lithiumIPS e.max Press are new highly aesthetic lithium disilicate glass-ceramic ingots with optimizeddisilicate glass-ceramic ingots with optimized homogeneity and high strength.homogeneity and high strength.  They allow the fabrication of restorations with a highThey allow the fabrication of restorations with a high accuracy of fit.accuracy of fit.
  66. 66.  The strength of 400 MPa which has been unmatchedThe strength of 400 MPa which has been unmatched to date by glass-ceramics enables conventionalto date by glass-ceramics enables conventional cementation.cementation.  Lifelike aesthetics independent of the shade ofLifelike aesthetics independent of the shade of the prepared tooththe prepared tooth  Adhesive, self-adhesive and conventionalAdhesive, self-adhesive and conventional cementation due to the unrivalled strength.cementation due to the unrivalled strength.
  67. 67.  IPS e.max CAD is based on the same materialsIPS e.max CAD is based on the same materials technology as IPS e.max Press and ideallytechnology as IPS e.max Press and ideally unites the CAD/CAM processing technique withunites the CAD/CAM processing technique with a high-performance Lithium disilicate ceramic.a high-performance Lithium disilicate ceramic.  The IPS e.max CAD blocks are used forThe IPS e.max CAD blocks are used for fabricating tooth-coloured restorations with highfabricating tooth-coloured restorations with high strength in an innovative manufacturing process.strength in an innovative manufacturing process.
  68. 68. IndicationsIndications  Anterior and posterior crownsAnterior and posterior crowns  Anterior and premolar bridges (only IPSAnterior and premolar bridges (only IPS e.max Press)e.max Press)  Implant superstructuresImplant superstructures
  69. 69.  IPS e.max ZirCADIPS e.max ZirCAD thus also fulfils clinicalthus also fulfils clinical requirements related to masticatory forces,requirements related to masticatory forces, particularly in the posterior region.particularly in the posterior region.  IPS e.max ZirCAD frameworks are eitherIPS e.max ZirCAD frameworks are either veneered with IPS e.max ceram or IPS e.maxveneered with IPS e.max ceram or IPS e.max ZirPress is pressed onto them. Consequently,ZirPress is pressed onto them. Consequently, highly aesthetic zirconium-reinforcedhighly aesthetic zirconium-reinforced restorations can be fabricated.restorations can be fabricated.
  70. 70. IPS e.max Ceram  One layering ceramic for different frameworkOne layering ceramic for different framework materials.materials.  Apart from the Chromascope an A-D shades,Apart from the Chromascope an A-D shades, IPS e.max Ceram is also available in 4 newIPS e.max Ceram is also available in 4 new modern Bleach shades (BL1, BL2, BL3, BL4) asmodern Bleach shades (BL1, BL2, BL3, BL4) as well as Gingiva shades.well as Gingiva shades.
  72. 72.  Regardless of the advanced state of the 300- year old technique of casting, each of its steps could induce error in the final casting.  Until 1988, indirect ceramic dental restorations were fabricated by conventional methods (sintering, casting and pressing) and neither were pore-free.  Pore-free restorations can be alternately produced by machining blocks of pore-free industrial quality ceramic.
  73. 73.  The industrially prefabricated ceramic ingots/ blanks do not require high temperature processing and glazing, hence have a consistently high quality.  The blanks measure approximately 9 x 9 x 13 mm and are industrially fabricated using conventional dental porcelain techniques.  Frit powder is mixed with distilled water, condensed into a 10 x 10 x l5 mm steel die and fired under vacuum Classes of machinable ceramics available are:  Fine-scale feldspathic porcelain  Alumina based  Glass-ceramics  Zirconia based
  74. 74.  The tremendous advances in computers and robotics could also be applied to revolutionize dentistry and provide both precision and reduce time consumption.  With the combination of optoelectronics, computer techniques and sinter-technology, the morphologic shape of crowns can be sculpted in an automated way.
  76. 76. CAD/CAM  Uses digital information about the cavity preparation or a pattern of the restoration to provide a computer- aided design on the video monitor for inspection and modification.  One of the three-dimensional image for the restoration design is accepted, the computer translates the image into a set of instructions to guide a milling tool (CAM) in cutting the restoration from a block of material.
  77. 77. Brains AG (Switzerland) --- 1985 Material Used : Vita Mark II, ProCad, Inceram Alumina and spinell Cerec System consists of :  A 3-D video camera (scan head)  An electronic image processor (video processor) with memory unit (contour memory)  A digital processor (computer) connected to,  A miniature milling machine (3-axis machine) CEREC SYSTEM
  78. 78. CERAC Computer,3D camera and milling unit 3D Impression 3D Porcelain restoration Milling
  79. 79. Clinical shortcoming of Cerec 1 system  Occlusal anatomy had to be developed by the clinician using a flame-shaped, fine-particle diamond instrument and conventional porcelain polishing procedures were required to finalize the restoration.  Inaccuracy of fit or large interfacial gaps.  Clinical fracture related to insufficient depth of preparation.  Relatively poor esthetics due to the uniform colour and lack of characterization in the materials used.
  80. 80.  Siemens ( Germany) 1994  The major changes include –  Enlargement of the grinding unit from 3 axis to 6 axis.  Upgrading of the software with more sophisticated technology which allows machining of the occlusal surfaces for the occlusion and the complex machining of the floor parts. Cerec 2 system
  81. 81.  Data representation in the image memory and processing increased by 8 times  Magnification factor increased from 8X to 12X for improved accuracy during measurements.  Monitor can be swiveled and tilted, thus facilitating visual control of the video image.  The improved Cerec 2 camera : new design, easy to handle, a detachable cover (asepsis), reduction in the pixel   Improved in rigidity and grinding precision  Improved accuracy of fit
  82. 82. Cerec - 3  Werner H Mormann (2000)  Separate form grinding unit  Rapid occlusal and functional registration  Improved marginal adaptation  Tridimensional visualization of the projected restoration with virtual seating capability.  Network and multimedia-ready  Laser scanner for indirect restorations
  83. 83.  This is a machinable glass-ceramic composed of fluorosilica mica crystals in a glass matrix.  The mica-plates are smaller (2 µm) than conventional Dicor  Available as Dicor MGC - light and Dicor MGC – dark  Greater flexural strength than castable Dicor  Softer than conventional Feldspathic porcelain.  Less abrasive to opposing tooth than Cerec Mark I, and more than Cerec Mark II (invitro study results). Dicor MGC
  84. 84. PROCERA SYSTEM  Developed by Nobel Biocare AB, Sandvik Hard materials AB – 1993  It is composed of densely sintered, high purity aluminium oxide core combined with a compatible all ceram veneering porcelain  A unique feature of the procera system is the ability of the procera scanner to scan the surface of the prepared tooth and transmit the data to the milling unit to produce an enlarged die through a CAD-CAM processor.  Thus the 15-20% shrinkage during sintering will be compensated, which will shrink during sintering to the desired size to give an accurate fit.
  85. 85. Procedure Die preparation and ditching Scanning with contact scanner Data acquisition on computer screen Transfer of data through computer line Milling of enlarged die with high alumina block Copying is veneered with body and incisal porcelains 8 basic dentine and 12 modifiers
  86. 86. Procera scanner Procera software ver 2.0
  87. 87. Advantages and future  Natural colour effects  Fluorescence, opalescence, and translucency  Biocompatible  Excellent marginal fit  Excellent strength  5 year warranty for single units  Developing an optical camera  Procera Cera-one---customized implant superstructure
  88. 88.   USES   Anterior and posterior crowns  Veneers, onlays and inlays.  Ceramic abutment for implant supported single crowns
  89. 89. CERCON ( Dentsply) ZIRCONIA CORE CERAMICS FABRICATION Tooth preparation Impression made Wax pattern (0.8 mm) made on model Anchored on to the Cercon Brain A presintered zirconia blank is attached on to the other side of the brain unit Unit activated..pattern scanned Blank is rough and fine milled in an enlarged size
  90. 90. Milled prosthesis then removed from unit and placed in the Cercon furnace (1350 ºc for 6 hours) Trimming
  91. 91. Finished ceramic core framework After veneering Greatest potential fracture toughness and flexural strength(>900 MPa)
  92. 92. LAVA ( 3M ESPE) ZIRCONIA CORE CERAMICS  Zirconia frameworks all ceramic restoration  Tooth preparation – all ceramic guidelines  Preparations are scanned and frameworks are milled from presintered zirconia blanks.  The size of the framework is precisely increased to allow for the shrinkage that occur during sintering.
  94. 94. When used as a satellite scanner by Lava Design Centers, the CAD file is electronically transferred to the Authorized Lava™ Milling Center for milling and sintering via Lava Connect Application and a dedicated server for transfer.  Excellent marginal fit  Optimal strength  High translucency PFMLAVA
  95. 95. In vizion ( VIDENT)  YZ blocs  Zirconia based  Used as indirect scanning of die and CAD/CAM  High strength and fracture toughness  opaque
  96. 96. Scanning of Die CAD
  97. 97. OTHER DIGITAL SYSTEMS:  THE COMET SYSTEM  The Duret System (Hanson International):  The SOPHA System  The REKOW System  The Denti CAD system  The DUX system/The Titan System  CICERO System (Computer Integrated Crown Reconstruction)
  98. 98.
  99. 99. Ceramic CAD/ CAM restorations are bonded to tooth structure by -    Etching for a bond to enamel  Conditioning, priming and bonding (when appropriate)  Etching (by HF acid) and priming (silanating)  Cementing with luting resin. Properties:  Excellent fracture and wear resistance  Pore-free  Possess both crystalline and non-crystalline phase (a 2-phase composition permits differential etching of the internal surface for bonding).
  100. 100. Mechanical shaping of an industrially prefabricated ceramic material, which is consistent in quality and its mechanical properties.  It includes fabrication of a prototype (pro-inlay or crown) usually via impression making and model preparation.  The pattern is placed in the machine, a tracing tool passes over the pattern and guides a milling tool which grinds a copy of the pattern from a block of ceramic.  The coping is then glass infiltrated…built up with veneering porcelain and fired. ANALOGOUS SYSTEMS (COPYING / PANTOGRAPHY METHODS )
  101. 101. The Celay System became first commercially available in 1992. It is a high precision, manually operated copy milling machine. Milling arms are able to move in 8 axes of freedom, which allows the milling of complex, three dimensional shapes.  Direct and indirect restorations  Replica of the restoration is mounted on one side (scanning side) and the ceramic block is mounted on the milling side. CELAY System (Vident)
  102. 102.  System uses a sequential milling procedure proceeding from coarse to fine milling burs, and can mill a typical restoration in about 15-20 minutes.  Materials used Vitabloc  inceram alumina Inceram spinell
  103. 103. Ceramic polymers Several unique materials are significant advancement in resin technology although their formulation is some what different, as a group they provide an existing breakthrough for esthetic ceramic alternatives.  Belle glass  Artglass  Sculpture / fibrekor  Targis / vectris
  104. 104. Artglass (Jelenko / Kulzer)  Artglass represents a new category of restorative materials. The polyglass, which combines benefits of both porcelain & composite.  Composed of multifunctional methacrylates, bifunctional monomers, 20% silica fillers, and microglass fillers.  Available in 16 Vita shades.  More wear resistant  Intra-oral corrections
  105. 105. Targis / Vectris (Ivoclar / Williams)  Targis is a new ceromer restorative material, vectris is a fiberglass reinforced composite. Advantages  Ease of final adjustment  Excellent polish  Translucency and fluorescence  Chair side repair of restorations  Low degree of brittleness  Less susceptible to fracture
  106. 106. Ceramic CAD/ CAM restorations are bonded to tooth structure by     Etching for a bond to enamel     Conditioning, priming and bonding (when appropriate)     Etching (by HF acid) and priming (silanating)     Cementing with luting resin.  Properties    Excellent fracture and wear resistance     Pore-free    Possess both crystalline and non-crystalline phase (a 2-phase composition permits differential etching of the internal surface for bonding)
  107. 107. EXTENDED & INNOVATIVE APPLICATIONS OF CERAMICS   Posterior esthetic restorations (Inlay & Onlays)   All-Ceramic Post & Core systems (Zirconia ceramics)   In Dental Implants:       Ceramic coating for dental implants        Implant supported ceramic restorations   Ceramic Orthodontic Brackets   Ceramics for Oral Mucosal Stimulation  Silanized ceramic fibers in Ceromers (Eg: Targis)
  108. 108. Criteria for selection and use of Dental Ceramics 1. Not to use in patients with extreme bruxism, clenching and malocclusions. 2. Degree of wear of tooth or restoration. 3. Bite force capability. 4. Any previous history of all ceramic inlay/crown fracture. 5. Experience of laboratory technician should be extensive. 6. Esthetic demands of specific patient. 7. Degree of translucency of adjacent teeth. 8. Skill of dentist is of paramount
  109. 109. Dental ceramic technology is one of the fastest growing areas of dental material research and development. The past decades have seen the development of several new groups of ceramics. The diversity of dental ceramics continues to stimulate laboratory and clinical research. Systems such as Dicor and Empress are now established. The potential of the In-Ceram system, remains to be exploited to the full. The diversity and sophistication of some of the CAD-CAM systems may prove to be influential in the future. CONCLUSION
  110. 110. Each system has its own merits, but may also have shortcomings. Combinations of materials and techniques are beginning to emerge which aim to exploit the best features of each. Glass-ceramic and glass-infiltrated alumina blocks for CAD-CAM restoration production are examples of these and it is anticipated that this trend is likely to continue ….
  111. 111. R e f e r e n c e s  Philips science of dental materials{10th and 11th edition}  Review of All ceramic restorations: JADA 1997;128:297  Recent advances in restorative dental ceramics: JADA 1993;124:72  A new method : CAD-CAM system: JADA 1989;118:703  Slip casting alumina ceramics for crown and bridge restorations: Quintessence international 1992;23:1 • Heat pressed ceramics:technology and strength: IJP 1999;5 • Procera All ceramic crowns: BDJ 1999;186:430 • Porcelain esthetics for 21 st century: JADA 2000;131:47
  112. 112.  Relative flexural strength of 6 new ceramic materials: IJP 1995;8:239  Cast glass ceramic: DCNA 1985;29:725  Recent advances in ceramic materials and systems: Dental update 1999;26:65  Dental CAD-CAM:A millstone or a milestone: Dental update 1995;22:200  Machinable glass ceramics and conventional lab restorations: Quint Int 1994;25:773  Ceramics in dentistry:Historical roots and current perspective: JPD 1996;75
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