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Allceramic restorations /certified fixed orthodontic courses by Indian dental academy
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Allceramic restorations /certified fixed orthodontic courses by Indian dental academy


Welcome to Indian Dental Academy …

Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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  • 1. EVALUATION OF CERAMICS FOR ALL CERAMIC RESTORATIONS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. One of the most serious drawbacks with the earlier described porcelains was their lack of strength and toughness which seriously limited their use To overcome this the developments are 1. Provide dental porcelain with support from a stronger substructure 2. Ceramics which are stronger and tougher www.indiandentalacademy.com
  • 4. REINFORCED CERAMIC CORE SYSTEMS CORE CERAMIC “Opaque dental ceramic material that provides sufficient strength , toughness and stiffness to support overlying layers of veneering ceramics” - Philips’ www.indiandentalacademy.com
  • 5. RESIN BONDED CERAMICS Support Of Ceramic Is Provided By Tooth Structure Itself By The Bonding The Esthetic Ceramics Directly To The Enamel And Dentine. www.indiandentalacademy.com
  • 6. WOL – CERAM Based on high density core material from VITA InCeram Alumina. WOL-CERAM EPC-CAM (Electro-Phoretic Ceramic Deposition Technology & Computer Aided Manufacturing) www.indiandentalacademy.com
  • 7. Electronically Deposited Alumina Oxide coping gives the highest marginal integrity. www.indiandentalacademy.com
  • 8. Ensures a Perfect Fit for ANY Preparation Designs Featheredge Chamfer www.indiandentalacademy.com Shoulder
  • 9. Electrically Conductive Wax Prior to Dipping www.indiandentalacademy.com
  • 10. www.indiandentalacademy.com
  • 11. Advantages Clinical ease of preparation Precise fit system Natural looking esthetics Good strength Indications Full coverage crowns Bridges www.indiandentalacademy.com
  • 12. INCERAM SPINEL (Vident) Most Translucent Glass infiltrated Magnesium Aluminum Oxide core for Improved Translucency avoiding the typical yellow opacity of the In-Ceram www.indiandentalacademy.com
  • 13. Reduced flexural strength - 350 mpa (compared to Inceram Alumina 400500mpa) Inlays Onlays Anterior Crowns Veneers www.indiandentalacademy.com
  • 14. INCERAM ZIRCONIA Glass-infiltrated Alumina with 35% partially stabilized Zirconia core Good Marginal Fit High strength of 700 Mpa Fracture toughness- 6-8 Mpa.m1/2 High level of opacity - not recommended for Anterior Prosthesis Posterior Crowns and FPDs, Post & Core, Implants Strongest And Toughest Of Available Ceramics www.indiandentalacademy.com
  • 15. Procera Allceram – Alumina based ( Nobel Biocare) 99.9 % Aluminum Oxide Densely sintered, high purity alumina core on which low fusing porcelain is built Local dental lab scan the dies and the information is sent to centres via internet enabled oversized www.indiandentalacademy.com dies to be made.
  • 16. Small defects caused by machining are eliminated during sintering. 0.4 mm cores are used for esthetically critical crowns on anterior teeth and first premolars. Flexural strength is 487-699 MPa Fracture toughness- 4.48 – 6 MPa.m1/2 www.indiandentalacademy.com
  • 17. Strength is twice that of In-Ceram and five times that of Empress Anterior & Posterior Crowns Veneers Onlays Inlays. www.indiandentalacademy.com
  • 18. PROCERA-ZIRCONIA BASED Flexural strength TWICE that of Alumina based CAD-CAM Ideal in areas of maximum strength SINGLE UNITS ONLY www.indiandentalacademy.com
  • 19. YTTRIUM TETRAGONAL ZIRCONIA POLYCRYSTALS (Y-TZP) BASED MOST RECENT Excellent Mechanical Properties and Biocompatibility Early 1990s - Endodontic’ Dowels and Implant Abutments. www.indiandentalacademy.com
  • 20. Yttrium oxide is a stabilizing oxide added to pure zirconia to stabilize it at room temperature and to generate a multiphase material known as Partially Stabilized Zirconia which gives it its High Initial Strength and Fracture Toughness www.indiandentalacademy.com
  • 21. Y-TZP cores are Glass Free Do not exhibit SUB CRITICAL CRACK PROPAGATION. PROPAGATION Flexural strength of 900 to 1200 MPa Double of Alumina-based Materials 3 Times Lithium DiSilicate–based Materials www.indiandentalacademy.com
  • 23. CER ADAPT (Wohlwend innovative). ALUMINIUM OXIDE & YTRRIUM STABILIZED ZIRCONIUM OXIDE High Flexural Strength Biocompatible Low Corrosion Potential. Low Thermal Conductivity Enhanced Tissue Compatibility Low Colonization Potential than www.indiandentalacademy.com Titanium
  • 24. Cercon(Dentsply) and Lava (3M ESPE) Zirconia Core Ceramics CERCON, DCS-PRESIDENT White Colored Core limit their indications from an esthetic standpoint. LAVA Core Relatively Translucent and at the same time may Mask Underlying Discolored Abutments. www.indiandentalacademy.com
  • 25. CERCON SYSTEM Conventional Waxing Techniques DCS-PRESIDENT & LAVA systems CAD Technology & Different Features and Design Options. www.indiandentalacademy.com
  • 26. Disadvantage with all High Strength Core systems is that None Of Them Are Amenable To Acid Etching Fit surface are made of alumina rather than silica, no coupling agents are available that can effectively bond to the core resins CANNOT BE RESIN BONDED TO THE TOOTH SURFACE www.indiandentalacademy.com
  • 27. RESIN BONDED CERAMICS Etched with 9.6% Hydrofluoric Acid Increase Strength of Porcelains Natural dentine acts as Core Extension of use from Veneers to Anterior and Posterior Crowns and Inlays www.indiandentalacademy.com
  • 29. GLASS CERAMICS Multiphased solids containing a Residual Glass Phase with a Finely Dispersed Crystalline Phase To ensure a high strength of glass ceramic the crystals should be numerous and uniformly distributed throughout the glassy phase. www.indiandentalacademy.com
  • 30. LEUCITE REINFORCED GLASS CERAMICS Leucite – KAlSi2O6 Reinforcing phase due to tangential stresses it creates within the porcelain Varies from 35%-50% by volume Flexural strength – 120 Mpa www.indiandentalacademy.com
  • 31. Mechanical Strength is Insufficient for construction of All Ceramic Bridges Crowns Inlays Veneers Leucite containing materials are IPS Empress (Ivoclar) IPS Finnesse . Authentic Pressable Ceramics www.indiandentalacademy.com
  • 32. IPS FINNESSE (Micro Dental Laboratories) “PERFECTION IN PORCELAIN” 8-10% leucite crystals Less wear on opposing dentition www.indiandentalacademy.com
  • 33. HIGHLY POLISHABLE Flexural strength – 125mpa Fracture toughness – 1.25 Mpa.m1/2 INLAYS ONLAYS VENEERS FULL COVERAGE CROWNS. www.indiandentalacademy.com
  • 34. Authentic Pressable Ceramic (Microstar) Low Fusing Most Delicate Forms can be Accurately Reproduced Staining and Layering Technique Anterior Crowns Inlays/ Onlays Veneers www.indiandentalacademy.com
  • 35. Lithium Disilicate and Apatite Glass Ceramics IPS EMPRESS II (Micro Dental Laboratories) Lithium Disilicate crystals in glass matrix Li2Si2O5 Veneering ceramic – Apatite Crystals 70% of volume of glass ceramic www.indiandentalacademy.com
  • 36. www.indiandentalacademy.com
  • 37. Consists of small interlocking plate like crystals randomly oriented which Block Propagation of Cracks Increased flexural strength – 350-450 MPa 3 times GREATER than IPS Empress Accurate fit Less Translucent than IPS Empress 3 unit FPDs Anterior to 2nd premolar CROWNS /VENEERS/INLAYS www.indiandentalacademy.com
  • 38. IPS ERIS (Ivoclar) LITHIUM DISILICATE crystals adds strength to bridge spans Layering material contains FLUOROAPATITE crystals Flexural strength – 350-400MPa Fracture toughness - 3.2Mpa.m1/2 Excellent Marginal Adaptation Full Coverage Crowns and Anterior FPDs www.indiandentalacademy.com
  • 39. www.indiandentalacademy.com
  • 40. HOT PRESSED CERAMIC Ceramic is heated to a specified temperature and forced under pressure to fill a cavity in a refractory mould www.indiandentalacademy.com
  • 41. 1180 degrees over a period of 45min High Degree of Marginal Fit can be Achieved www.indiandentalacademy.com
  • 42. Although newer core ceramics have excellent fracture resistance, improper design of the connector area of a FPD can significantly reduce the fracture resistance and clinical survivability of the prosthesis www.indiandentalacademy.com
  • 43. TECHNIQUES COPY MILLING and CAD-CAM • • • • CAD-CAM DCS–PRESIDENT -1991 AUTO MILL – 1994 CEREC 2 – 1994 CEREC 3 – 2000 COPY MILLING • CELAY – 1991 • PROCERA 1994 • PRO CAM - 1996 www.indiandentalacademy.com
  • 44. CEREC SYSTEMS (Seimens, Germany ) Utilizes CAD-CAM technology • CEREC 2 System - 1994. • CEREC 3 SYSTEM -2001 www.indiandentalacademy.com
  • 45. CEREC 2 SYSTEM CAD - CIM COMPUTER INTEGRATED MILLING The Marginal Fit and Accuracy of restorations is Superior to CEREC OCCLUSAL MORPHOLOGY MACHINED www.indiandentalacademy.com
  • 46. CEREC 2 OCCLUSAL MORPHOLOGY www.indiandentalacademy.com MACHINED
  • 47. CEREC 3 Network and Multimedia ready combination with an Intraoral Color Video Camera OR Digital Radiographic Unit www.indiandentalacademy.com
  • 48. Fabrication of restorations Accelerated (24 min.-27% time saving) Rapid occlusal and functional registration is possible and ACCURATE OCCLUSION established Eliminates waiting periods for image adjustment, data storage , matching of two optical impressions in construction of occlusal surfaces with correlation and functional modes. www.indiandentalacademy.com
  • 49. www.indiandentalacademy.com
  • 50. FORM GRINDING UNIT Greater Detail than Cerec 2 and fitted with one Cylindrical and one Tapered diamond rotatory tool and controlled with radio communication from the control unit independent of its location. The next restoration can be designed while the first is being milled www.indiandentalacademy.com
  • 51. Intra Oral 3 Dimensional Scanning Camera Optical impression recorded with Single Exposure from Single Viewing Line, representing the Preparation and Insertion Axes respectively in a Fraction of a second without Reference Markings on the Teeth and is Reproducible. www.indiandentalacademy.com
  • 52. www.indiandentalacademy.com
  • 53. www.indiandentalacademy.com
  • 54. SCANNING PRINCIPLE Principle Of Active Triangulation The camera projects a linear pattern under triangulation angle on the preparation, and the projected image is recorded. Amount of shift depending on the Depth of preparation. www.indiandentalacademy.com
  • 55. CEREC 2 camera Depth scale is limited to 6.4mm.with time consuming software adjustments the depth scale can be stretched to 14mm. CEREC 3 with active double triangulation principle preparation recorded from two different triangulation angles providing immediate depth scale of >20mm. The double set of data is processed immediately through a specialized ‘twin grab board’ www.indiandentalacademy.com
  • 56. COMPUTER AIDED DESIGN The two -impression Correlation and Function modes for designing crowns can proceed using occlusion and preparation optical impressions without loss of time Large carious lesion with loss of cusp or insufficient occlusal surface the situation can be recorded in function design mode. www.indiandentalacademy.com
  • 57. www.indiandentalacademy.com
  • 58. • The remaining intact cusps and part of occlusal surfaces are recorded by an “occlusal impression” • After preparation they are matched with the “preparation impressions” www.indiandentalacademy.com
  • 59. Computer Aided Machining Cerec 3 system has a Separate Recording and Design Unit and Form-Grinding Unit www.indiandentalacademy.com
  • 60. The change from disks to Cylindrical and Tapered burs were used to Replicate Better Occlusal Morphology. www.indiandentalacademy.com
  • 61. www.indiandentalacademy.com
  • 62. CELAY SYSTEM (Mikrona, Switzerland,1991 • Proinlay made from light curing resin composite directly in cavity/on the die. • The inner and occlusal morphology of proinlay are copied • Final restoration is performed by the CELAY Milling Machine. www.indiandentalacademy.com
  • 63. PROCERA SYSTEM (Nobel Biocare,Sweden) Procera Scanner scans the surface of the prepared tooth www.indiandentalacademy.com
  • 64. Transmits the information to a computer controlled design station, where the Aluminum Oxide copings are fabricated. www.indiandentalacademy.com
  • 65. Review of Literature 1. Yoichiro Ichikawa et al (1992). Conducted a study to evaluate the tissue reaction and stability of partially stabilized Zirconia ,in vivo, with the use of subcutaneous implantation test. They concluded that zirconia ceramic is biocompatible and no degradation of the ceramic occurred 2. Seghi RR et al (1995). Evaluated the resistance to crack propagation of 11 ceramic materials which included Fluormica-, Leucite-, alumina-, and Zirconia-reinforced glasses. Their study showed that Alumina reinforced material had the highest toughness values and Leucite and Fluormica www.indiandentalacademy.com increase the toughness of ceramic materials.
  • 66. 3. Russell et al (1995) Assessed the performance of the Procera system and stated that it is cost effective, precise and biocompatible computerized method of crown fabrication though not superior to manual laboratory fabrication procedures by the technician. 4. Wagner WC et al(1996) Conducted study on three ceramic crown core materials, namely Empress, Inceram and Procera Allceram for their biaxial flexural strength and fracture toughness. They concluded that both Procera and Inceram were superior to Empress in fractural toughness. www.indiandentalacademy.com
  • 67. 5. Agneta Oden et al(1998) Evaluated the clinical performance of 100 Procera Allceram crowns after 5 years in service and concluded that the crowns maybe the restoration of choice for anterior and posterior single crown restorations. 6. Per Vult Von Steyen et al (2001) Investigated the properties of Inceram for use in Posterior FPD and evaluated the clinical methods regarding preparation technique, design and choice of cement. They concluded that when properly employed the Inceram technique is acceptable for 3 unit FPD in posterior region. www.indiandentalacademy.com
  • 68. 7. Antonio Scarano et al (2004) Conducted a study to characterize the percentage of surface covered bacteria on commercially pure Titanium and Zirconium Oxide disks and showed that zirconium oxide maybe a suitable material for manufacturing Implant abutments with low colonization potential. 8. Josephine F Esquivel et al (2004) Conducted a research to determine the clinical success rate of lithium disilicate base core ceramic for use in Posterior FPD’s as a function of bite force, cement type, connector height and width. They concluded that the performance was promising with only 7 % fracture rate in 2 years. www.indiandentalacademy.com
  • 69. Revolution in dental ceramics in the last decade led to its use as Anterior and Posterior restorative material. • IPS FINESSE is “Perfection in Porcelain” with improved esthetics and less wear on opposite tooth but with decreased strength • IPS Empress 2, Wol–ceram and IPS Finesse used for Anterior FPDs • Inceram Zirconia used for Posterior FPDS • Zirconia can also be used for Implants and Posts www.indiandentalacademy.com
  • 70. New materials and techniques in dental ceramics will continue to play a role in the provision of esthetic restorations. The dentist needs to update himself about the recent advances in dental ceramics to ensure that correct choice is made for each patient www.indiandentalacademy.com
  • 71. References • Anusavice Kenneth J.: Phillips Science of Dental Materials. 12th edition, W.B. Saunders, 2001 • Combe E.C.: Notes on dental materials: 6th ed. Churchill Livingstone, 1992. • Craig Robert G. and Powers J.M.: Restorative dental materials. 11th ed. Mosby Inc. 2002. • Gladwin Marcia, Bagby Michael: Clinical aspects of dental materials, Lippincott, 2000. • McCabe J.F. and Walls A.W.G.: Applied dental materials, 8th ed. Blackwell Science Limited, 1998. • www.indiandentalacademy.com
  • 72. •O’Brien W.J.: Dental material and their selection, 2nd ed. Quintessence, 1997. •Van Noort Richard: Introduction to dental materials, Mosby 1994. •Ariel J Raigrodski. Contemporary materials and technologies for all-ceramic fixed partial dentures: areview of literature.J Prosthet Dent2004;92:557-62 •Yoichiro Ichikawa,Yasumasa Akagawa, Hirosama Nikai.Tissue Compatibility and Stability of New zirconia ceramic in vivo.J Prosthet Dent 1992;68:322-6 •Antonio Scarano,Maurizio P,Sergio C.bacterial adhesion on Commercially Pure titanium and zirconium oxide disks:An In Vivo Human study.J Periodontol Vol 75:No2 www.indiandentalacademy.com
  • 73. •Josephine F Esquivel-_Upshaw, Kenneth J Anusavice.Int J Prosthodont 2004;17:469-475 •Agneta Oden,Matts Anderson, Ivana Krystek.Five year clinical evaluation of procera AllCeram Crowns. J Prosthet Dent 1998;80:450-6 •W C Wagner, T M Chu. Biaxial flexural strength and indentation fracture toughness of three new dental core ceramics. J Prosthet dent.1996;76:140-4 •Werner H Mormann,Andreas Bindl.Allceramic ,Chair side computer-aided design/computer-aided machining restorations.Dent Clin N Am 46(2002)405-426 www.indiandentalacademy.com
  • 74. •Sseghi R R, Denry I L, Rosensteil S F .Relative Fracture toughness and hardness of new dental ceramics. J Prosthet Dent.1995;74:145-50 •Russell A GiordanoII,Lionel Pelletier, Stephen Campbell. Flexural strength of an infised ceramic, glass ceramic and fldspathic porcelain. J Prosthet Dent.1995;73:411-8 •Stephen D Campbell, Ralph B Sozio. Evaluation of the fit and strenght of an all-ceramic fixed partial denture. J Prosthet Dent.1988;59:301-306 •Sueng –Mi-Jeong, Klaus Ludwig. Investigation of the fracture resistance of three types of Zirconia post and core restorations. Int J Prosthodont 2002;15:154-158. www.indiandentalacademy.com
  • 75. Thank you www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com