The Era of Dental ceramics/ dentist practices


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  • We’ve talked about the differences in material --- but the next question is how do these differences manifest themselves clinically?
    The difference we see comes in:
    Marginal Fit:
    In a market research study, we found that marginal fit is the most important criteria to doctors.
    3M and others have performed numerous studies on fit. The studies have found that Lava consistently performs high on marginal fit.
    2. Strength and Long Term Stability:
    We have found flexural strengths of Lava zirconia to be very high – as high in some cases as 1400 MPa and consistently higher than 1000 MPa. However, many of the competitive zirconias are able to produce high initial flex strengths as well, so the gap is narrowing.
    What is even more important than the initial flex strength, is the LONG-TERM STABILITY of the material.
    3M has 5-yr. Clinical studies that show 100% survival rate.
    And finally- the translucency of the material. Lava zirconia shows natural translucency and unmatched esthetics.Additionally, Lava is unique with a patented substructure shading system producing 8 shades, which further increase the final esthetics.
    [1] 0828 In-Vitro Vertical Marginal Gap Comparison of CAD/CAM Zirconium Copings
    A.J.T. SHANNON, F. QIAN, P. TAN, and D. GRATTON, University of Iowa, Iowa City, USA
    [2] 3M ESPE Lava showed the lowest marginal and absolute marginal gap in comparison to Cercon and DCS
    A. Piwowarczyk, H.-C. Lauer (2006), Determining the marginal fit of CAD/CAM bridge frameworks, Pan European Federation Conference (PEF; CED) #0254
    [3] Lava 3-unit bridges showed smallest Marginal gap v. Etkon, Cercon brain, CerecInlab
    F. Beuer, T. Fischer, K.-J. ERdelt, H.-U. Aggstaller, K. Spiegl, W. Gernet; (2005) IADR #1336 and In vitro Study Marginal fit of Lava restorations; F. Beuer, T. Fischer, K.-J. ERdelt, H.-U. Aggstaller, K. Spiegl, W. Gernet, industrial report (2006)
    [4] Key Group Study, October 2006, “Accuracy of fit” listed as #1 out of 16 possible attributes. 134 total doctor responses
    [5] 3M ESPE Internal 3 pt- Bending Test – ISO 6872, July/September 2005
    [6] 3-unit posterior bridges, Start 2000, P. Pospeich, University of Homburg, Homburg
  • Crowns (anterior and posterior)
    Splinted crowns (up to 4 abutments)
    All possibilities of 3- and 4-unit bridges
    5- and 6-unit bridges (max. 2 pontics in posterior region, max. 4 pontics in anterior region)
    Inlay bridges
    Maryland bridges
    Cantilever bridges (with the pontic maximally on the second premolar (OOX, OXOX, OOOX)
    Primary copings
  • The Era of Dental ceramics/ dentist practices

    1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
    3. 3.
    4. 4.
    5. 5. 5 a ceramic restoration fabricated by use of a computer aided design - computer aided milling a process of milling a structure using a device that traces the surface of a metal, ceramic or a polymer pattern and transfers the traced spatial positions to a cutting station. C A D -C A M C e r a m ic s C o p y -M il l e d C e r a m ic s M ac h in able C er am ic s
    6. 6. CAD-CAM DCS–PRESIDENT -1991 AUTO MILL – 1994 CEREC 2 – 1994 CEREC 3 – 2000 CEREC InLab PROCERA all Ceram System. LAVA CERCON COPY MILLING CELAY – 1991 PRO CAM - 1996
    7. 7. 7 Types of CAD – CAM Devices:  DIRECT: Fully integrated CAD – CAM devices for chair side restorative approach. CAD & CAM stations are located at the dental office.  INDIRECT: System that consists of several modules with at least, distinctive CAD & CAM stations.
    8. 8. MATERIALS Silicate Ceramics Aluminium oxide ceramics with glass infiltration. Aluminium oxide ceramics with dense sintering. Titanium. Precious alloys Non precious alloys
    9. 9. Zirconium dioxide ceramics(ZrO2 Y-TZP zirconia)[yttria –tetragonal zirconia poly crystal] with dense sintering Acrylics of improved strength Castable acrylics Green stage Presintered stage Completely sintered stage.
    10. 10. ZIRCONIA: ZrO2 Zirconia is an oxidized form of the zirconium metal,just as alumina(Al2O3) is an oxidized form aluminium metal. It may exist in several crystal types (phases) ,depending on the addition of minor components such as calcia(Cao),magnesia(MgO),yttria(y2o3).
    11. 11.
    12. 12. High strength through very small grains High-Performance Structural Ceramics (Zirconium Oxide, ZrO2)
    13. 13. Principle of strengthening by the incorporation of a crystalline material that is capable of undergoing a change in crystal structure when placed under stresses. This crystalline material is usually termed as Partially Stabilized Zirconia(PSZ). The energy required for the transformation of PSZ is taken from the energy that allows the crack to propagate. One drawback of PSZ is that its refractive index is much higher than that of the surrounding glass
    15. 15. Principle of transition strengthening(l eft) and a scanning electron micrograph photo of a crack (next to the red line) that is running through the infiltration glass of the substructure material and stopped (head of the arrow) by a zirconium oxide grain (whit color).
    16. 16. Bonding porcelain Glass- ceramics Infiltration technique High tech ceramic The strength values of dental ceramics
    18. 18. YTTRIUM TETRAGONAL ZIRCONIA POLYCRYSTALS (Y-TZP) BASED MOST RECENT Excellent Mechanical Properties and Biocompatibility Early 1990s - Endodontic’ Dowels and Implant Abutments.
    19. 19. 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
    20. 20. Y-TZP cores are Glass Free Do not exhibit SUB CRITICAL CRACK PROPAGATIONSUB CRITICAL CRACK PROPAGATION. Flexural strength ofFlexural strength of 900 to 1200 MPa900 to 1200 MPa DoubleDouble of Alumina-based Materialsof Alumina-based Materials 3 Times3 Times Lithium DiSilicate–based MaterialsLithium DiSilicate–based
    21. 21. 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
    22. 22.
    23. 23. Standard Prep • preparation: 120–140° • 6° taper
    24. 24. Marginal Prep •Shoulder or Chamfer Preparation •1 mm circumferential
    25. 25. Prep Standard Procedure, line angles must be softened
    26. 26. Sharp, clear impressions are a must !! A reliable bite is needed !! Stable dies are required !
    30. 30. CERCON SYSTEM Conventional Waxing Techniques DCS-PRESIDENT & LAVA systemsDCS-PRESIDENT & LAVA systems CAD Technology.CAD Technology.
    31. 31. CEREC SYSTEMS (Seimens, Germany ) Utilizes CAD-CAM technology CEREC 2 System - 1994. CEREC 3 SYSTEM -2001
    32. 32.
    33. 33. CEREC CAD/CAM Systems CAD/CAM for dental practices • CEREC 3D • CEREC Scan CAD/CAM for dental laboratories • inLab MCXL • inEos 33
    34. 34. CEREC 2 SYSTEM CAD - CAM COMPUTER INTEGRATED MILLING The Marginal Fit and Accuracy of restorations is Superior to CEREC OCCLUSAL MORPHOLOGY MACHINED
    36. 36. CEREC 3 Network and Multimedia ready combination with an Intraoral Color Video Camera OR Digital Radiographic Unit
    37. 37. 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.
    38. 38.
    39. 39. CEREC 3D Indications NO IMPRESSION - NO TEMPORARY  Inlays  Onlays  Veneers  Crowns  Partial crowns  Endocrowns (rec. on molars)  Anterior crowns  Posterior crowns
    40. 40. Cerec video presentation
    41. 41. 08/07/14 41
    42. 42.
    43. 43. 08/07/14 43
    44. 44. 08/07/14 44
    45. 45. 08/07/14 45
    46. 46. 08/07/14 46
    47. 47. 08/07/14 47
    48. 48. 08/07/14 48
    49. 49. 08/07/14 49
    50. 50. 08/07/14 50
    51. 51.
    52. 52.
    53. 53.
    54. 54. PROCERA SYSTEM (Nobel Biocare,Sweden) Procera Scanner scans the surface of the prepared tooth
    55. 55. Transmits theTransmits the information to ainformation to a computer controlledcomputer controlled design station, wheredesign station, where the copings arethe copings are fabricated.fabricated.
    56. 56. Procera The dental laboratories which decide toThe dental laboratories which decide to use the technique of Procera invest inuse the technique of Procera invest in Procera Scanner. Using Procera®Procera Scanner. Using Procera® scanner and a standard PC, the shapescanner and a standard PC, the shape of the tooth can be registered withof the tooth can be registered with extremely high precision.extremely high precision.
    57. 57. Procera system The coping is then designed on theThe coping is then designed on the computer using the CADD (Computercomputer using the CADD (Computer Aided Dental Design) program. ThisAided Dental Design) program. This information is sent via theinformation is sent via the telecommunications network to atelecommunications network to a Procera production unit where theProcera production unit where the coping is produced.coping is produced.
    58. 58. Procera Using a unique software program fromUsing a unique software program from Procera, the dental technician can useProcera, the dental technician can use a 3D (three-dimensional) technique toa 3D (three-dimensional) technique to create crown designs for both teethcreate crown designs for both teeth and implants.and implants. The target for the development workThe target for the development work that is being done within Procera is tothat is being done within Procera is to produce a comprehensive CAD/CAMproduce a comprehensive CAD/CAM system for allsystem for all permanent prosthetics.permanent prosthetics.
    59. 59. The Procera coping has the ability toThe Procera coping has the ability to transmit light without becomingtransmit light without becoming transparent. When combined withtransparent. When combined with Procera AllCeram porcelain, theseProcera AllCeram porcelain, these remarkable esthetic characteristicsremarkable esthetic characteristics provide a vital natural beauty andprovide a vital natural beauty and perfect shade blending.perfect shade blending.
    60. 60. Following the success of ProceraFollowing the success of Procera AllCeram Crown and Bridge, theAllCeram Crown and Bridge, the opportunity to make veneers (link) isopportunity to make veneers (link) is now offered, Procera AllCeramnow offered, Procera AllCeram Laminate. The laminate is producedLaminate. The laminate is produced from the same well-proven material asfrom the same well-proven material as AllCeram Crown and Bridge.AllCeram Crown and Bridge.
    61. 61. 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.
    62. 62. 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
    63. 63. Strength is twice that of In-Ceram and five times that of Empress Anterior & Posterior Crowns Veneers Onlays Inlays.
    64. 64. PROCERA-ZIRCONIA BASED Flexural strength TWICE that of Alumina based CAD-CAM Ideal in areas of maximum strength SINGLE UNITS ONLY
    65. 65. Controlled shaping of spacer. Overall design. Constant monitoring of connector cross section. Pontic shaping
    66. 66. Parallel milling with two tools:
    67. 67. High speed milling of copings and bridge frame work.
    68. 68. Completed bridge framework
    69. 69. CERCON Cercon can be used in cases of multipleCercon can be used in cases of multiple pontics in a row including posteriorpontics in a row including posterior teeth. Cercon is conventionallyteeth. Cercon is conventionally cemented with glass ionomer cementcemented with glass ionomer cement or Enamel-dentin adhesive bondingor Enamel-dentin adhesive bonding system.system. Fabricated with yttria-stabilizedFabricated with yttria-stabilized zirconia, Cerconzirconia, Cercon
    70. 70. cercon CAM or CAD-CAM System cercon eye cercon art cercon heatcercon cleancercon brain cercon hardware
    71. 71. Cercon Base ZrO2 (Zirconium Oxide) 94% Y2 O3 (Yttrium Oxide) 5% HfO2 (Hafnium Oxide) <0.8% Aluminium Oxide <0.2% Bases come in white or shaded color Cercon Base
    72. 72. cercon smart ceramics – CAM
    73. 73. Models must be aligned and surveyed for proper path of Insertion Surveyor Analyzing Rod Represents What the Laser can See at Any Given point
    74. 74. Confirm that preps have a parallel path of insertion
    75. 75. Always use the surveyer....never “eyeball it“
    76. 76. Standard waxing procedure Wax the copings 0.5mm thick Add the pontic, connectors at least 3x3mm
    77. 77. To control the right fitting of the modellation in the scanning frame use the scanning pattern
    78. 78. Inserting the scanning frame into the parallelometerRemove all unnecessary parts off the modelLower scanning frame over the wax modellationSetting wax sticksFix the wax modellation to the scanning frameRemove modellation from the model
    79. 79. Cover the wax up with scan powder
    80. 80.
    81. 81. Cercon Art, CAD
    82. 82. Product presentation This and more is possible with CAD More rapid digitization More rapid modeling Adjustable cement gap Faster and better milling (new strategy) More economical use of blanks (Nesting)
    83. 83. separating the frame work • the not sintered material shows a chalky consistence • first the frame- work has to be separated from the frame • therefore sandblasting with 50 µm Al2O3 with 1 bar pressure has to be applied onto the gates
    84. 84. Cercon heat
    85. 85. Units are place in the Cercon Heat. The temperature goes up to 13500 C and holds for 2 hours. • Put the crown or the framework with the occlusal side on the furnace tile. • Push the start button and the sintering process begins. • After 6.5 hours the shrinking process is done.
    86. 86. as milled as sintered Sintering Behavior
    87. 87. Influence of Sintering on the Microstructure as milled as sintered
    88. 88. Always use water-cooled turbines for grinding the sintered frameworks
    89. 89. Fit the frame work
    90. 90. The framework should be sandblasted with 110 µm Al2O3 and a pressure of 2,5 bar carefully except for the margins and cleaned with steam water
    91. 91. Cercon SMART CERAMICS PFM Bridge restoration with insufficent margins on the teeth 12 to 21. Preparation of the teeth for a zirconia all-ceramic restoration. After the insertion of the Cercon all-ceramic bridge.
    92. 92. Cercon SMART CERAMICS Teeth 13 and 12 with multiple and extensive insufficent composit restorations. Set-up of the teeth 13 and 12with quartz fiber posts, composit and preparation. One week after the insertion of the Cercon all-ceramic crowns.
    93. 93. Lava Crowns & Bridges
    94. 94. • The processing of Zirconia effects the clinical requirements for a dental restorations • Excellent marginal fit. • Good compatibility with oral tissues.
    95. 95. Marginal Fit Greenbody state Exact and reproducible sintering parameters Homogeneity of the material No deformation during sintering process 2 µm Sintered Material
    96. 96. Colored with liquid chemistry Developed together with Zirconia 8 different shades Characterized by different absorption spectra matched to the Vita Classic Real different colors instead of dilution of same coloring components Staining Lava FrameLava Frame Shade LiquidShade Liquid FS 1FS 1 FS 2FS 2 FS 3FS 3 FS 4FS 4 FS 5FS 5 FS 6FS 6 FS 7FS 7 Translation inTranslation in VITA ClassicVITA Classic ColorsColors A1A1 B1B1 B2B2 C1C1 A2A2 A3A3 A3,5A3,5 A4A4 B3B3 B4B4 C2C2 C3C3 C4C4 D2D2 D3D3
    97. 97. Mechanical/chemical bonding Coefficient of thermal expansion adjusted to the core material No pretreatment of surfaces necessary Interface ZrO2 - Veneering SEM Picture Lava Ceram™ on Lava™ Internal measurement polycrystalline Lava™-ZrO2 Lava Ceram ™ Veneering porcelain Good wetting behavior at interface
    98. 98.
    99. 99. Lava Zirconia  Precise fit  Most important to doctors1  Exceptional marginal fit2,3,4  Proven strength  Proven High Strength – 1440 MPa 3-pt bend test5  100% survival rate in 5-yr clinical study6  Natural Esthetics  Natural translucency  Patented substructure system available in 8 shades Mean Marginal Gap: Vertical Gap2 PFM PFM Lava Zirconia
    100. 100. Possible Indications withPossible Indications with the Lava Systemthe Lava System Crowns (anterior andCrowns (anterior and posterior)posterior) 3- and 4-unit bridges3- and 4-unit bridges 5- and 6-unit bridges5- and 6-unit bridges Inlay bridges*Inlay bridges* Maryland bridges*Maryland bridges* Cantilever bridges*Cantilever bridges*
    102. 102. CERCON CELAY* System
    103. 103. 104 The Celay* is a well hand operated system that represents an interesting alternative to CAD – CAM system for the dental laboratory.Marginal accuracy seems to be good ,a little better than the Cerec 2 system.
    104. 104. Procedure:
    105. 105. OTHER CROWNS BRIDGES IMPLANTS Cercon Link Cercon exress ..many applications...
    106. 106.
    107. 107. Cercon Link Cercon link Attachment for bridge framework on divergent posts
    108. 108. Fixing the Cercon Link
    109. 109. Fitting and veneering the primary part
    110. 110.
    111. 111.
    112. 112. New materials and techniques in dentalNew materials and techniques in dental ceramics will continue to play a role inceramics will continue to play a role in the provision of esthetic restorations.the provision of esthetic restorations. The dentist needs to update himselfThe dentist needs to update himself about the recent advances in dentalabout the recent advances in dental ceramics to ensure that correct choice isceramics to ensure that correct choice is made for each patientmade for each
    113. 113. Thank you For more details please visit