Evolution of all ceramics&recent advances (2)/ dental courses

Evolution of All-Ceramics
&
Recent advances
INDIAN DENTAL ACADEMY
Leader in continuing Dental Educationwww.indiandentalacademy.comwww.indiandentalacademy.com

contentscontents 1.Introduction
2.Evolution & history
3.Methods to strengthen porcelain
4.Alluminous core porcelain
5.In-ceram
6.Castable ceramics
7.Machinable ceramics
8.Scope of all ceramics
9.Conclusion
10.References
www.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTION

DEFINITIONS
Ceramics : compounds of one or more metals with a non metallic element(usually
silicon,boron,oxygen) that may be used as a single structural component or as one of
the several layers that are used in the fabrication of a ceramic based prosthesis .
(G.P.T 7, Anusavice)
Porcelain : a ceramic material formed of infusible elements joined by lower fusing
materials.Most dental porcelains are glasses and are used in fabrication of teeth for
dentures, pontics & facings, crowns, inlays, onlays and other restorations. (G.P.T 7)
Ceramic is derived from Sanskrit word meaning Burnt earth

HISTORY
&
EVOLUTION OF
CERAMICS

Denture teeth
&
Dentures -Duchateau 1774
Ceramic paintings and Vaseswww.indiandentalacademy.comwww.indiandentalacademy.com

1887 PJC – CH. Land (platinum foil technique)
1962 PFM – Weinstein
1965 McLean and Hughes aluminium core porcelain
1957 Vines and Sommelman – Vaccum firing
1940 with advent of acrylics PJC lost popularity.

 1887 – CH. Land gave porcelain jacket crown
 1965 - McLean and hughes aluminous core porcelain
 1980 - In ceram-slip casting, castable ceramics
 Latest 1990’s - machinable ceramics(CADCAM)
Evolution of all ceramic restorations :

METHODS
TO
STRENGTHEN
PORCELAIN

Griffiths Flaw Crack GrowthSintering Process
Why are Ceramics weak ?
On moisture exposure 33 times > #
1. Brittle – Covalent bonds
2. Inherent flaws
3. > # in moist environment

Methods of strengthening brittle materials
1.Ion exchange
2.Thermal tempering
3.Thermal compatiability
Minimise stress concentration
1. Reducing stress raisers
2. Minimise tensile stresses
Residual compressive
stresses
Interruption of crack
propagation
Addition of
dispersion phase
Change in crystalline
structure
Particle stabilized
zirconia
Toughness of
particle
Al, dicor

All-Ceramic Systems

2 Options
1. Strong Core ( Unaesthetic )
Layered with Veneering Porcelain
2. Esthetic as well as
strong Core

1965 Mc lean and Hughes
40 t0 50 wt% of Al2O3
Flexural strength 131 Mpa
Platinum foil technique
ALUMINOUS CORE PORCELAINALUMINOUS CORE PORCELAIN
Finished CoresMaster model
with dies Platinum foil
adapted to die
(Hi-Ceram)

Unsintered CrownsDentin Ceramic
additions
Finished Crowns on dies
Post-Cementation
Mc lean 1979 Five year failure rate 2% for anteriors 15% for posteriors
Large sintering shrinkage
Seiber et al 1981 :light reflection better than porcelain fused to metalwww.indiandentalacademy.comwww.indiandentalacademy.com

IN-CERAMIN-CERAM
A process used to form green ceramic shape by applying a
slurry of ceramic particles and water or a special liquid to a porous
substrate Such as a die material, there by allowing capillary action
to remove water and densify the mass of deposited particles
Flexural
strength
350 MPa 500 MPa 700 MPa
In-ceram
Alumina
In-ceram
Spinell
In-ceram
Zirconia
Crack deflection is the main Phenomenon
( Slip casting technique )
Saadoun 1989

Al2O3 slip Glass infiltration
Vita Inceramat3
Giordono 1995 : Al2O3 Core glass infiltrated Ceramic > Strength than
Hi-Ceram, Di-Cor & Feldspathic Porcelain
Vaccumat 4000 Premiumwww.indiandentalacademy.comwww.indiandentalacademy.com

Duplication
In-Ceram
refractory dies
In-Ceram
application
Al2O3 slip
10 hrs 1120 0
C- 2hrs
vita inceramat
Working model
Glass infiltration
4hrs 11000
CShrinkage of dies

Application of body
and incisal porcelain
Postoperative veiw of
In-Ceram crowns
Finished In-Ceram
copings
(Air abraded)
Finished crowns
Preoperative veiw
Probster et al : Strength of In-Ceram > IPS Empress < PFMwww.indiandentalacademy.comwww.indiandentalacademy.com

CASTABLE CERAMICS

CASTABLE CERAMICSCASTABLE CERAMICS
A glass ceramic material that combines the properties of a
restorative material for function with the capability to be cast
using the lost wax process
 Di-Cor
 Cerestore
 IPS Empress
 New types
1968 Mc Culloch
Cera pearl
Canasite glass ceramic
Optimal pressable ceramic
Olympus castable ceramics
Castable phosphate glass ceramic

DI-CORDI-COR
Non porous, homogenous, microstructure with uniform
crystal size which is derived from the controlled growth of crystals
within an amorphous matrix of glass.
Ancestry Fredrick carter corning glass works
Composition : SiO2, K2O and MgO, MgF2, Al2O3, ZrO2 and
flourescing agent – TETRA SILICIC FLUOROMICA GLASS
CERAMIC.
Mica crystals Feldspathic porcelainwww.indiandentalacademy.comwww.indiandentalacademy.com

Wax pattern
Spruing
Investing
Burnout
Divesting
Cast glass coping
Ceramming
17500
C for 12hr
450 0
Cfor 12 hr
Centrifugal casting
26000
f

Ceramming Ceramming oven Crystallised glass coping
Conventional porcelain application & Firing Finished crown
Cerramming done from room temparature- 19000
f for 1½ hrs and
sustained for 6hrs inorder to form tetra silicic flouro mica crystals

Properties :
Flexural strength 81 ± 6.8 Mpa
Marginal adaptation :
Weaver et al 1988 – conducted a study on 10 dicor crowns
Marginal opening – 57 ± 9 µm
Due to less seating pressure, increase in density of ceramic
after ceramming.
Biocompatibility :
Less bacterial counts
Reason : smooth surface, low surface tension, flouride content,
Low thermal conductivity

Esthetics :
Gross man and adiar : Hue and chroma of metal ceramics
and castable ceramics matched natural teeth.
Value of only castable ceramics matched natural teeth.
Presence of mica crystals scatter light similar to enamel rods.
Cementation :
zinc phosphate, light activated urethane resin
Bailey&Bennet 1988 etching with ammonium biflouride for 2 min

Survival rate :
Kenneth et al 1999 - 14yr study
Crowns 82%
Cores 100%
Inlay and onlay 90%
Partial coverage 92%
Posterior 70% anterior 82.7% Expenstein et al 2000www.indiandentalacademy.comwww.indiandentalacademy.com

CERESTORECERESTORE
(SHRINK FREE CERAMICS)
Chemistry :
Binder → silicone SiO SiO2
Unfired cerestore core :
Al2O3
MgO
Glass frit
Silicone resin
Fillers
Al2O3 + MgO MgAl2O4 + Corrundum
Strength
160-1800
C
Fired cerestore core :
α- Al2O3 (Corrundum)
MgAl2O4 (Spinel)
Ba Mg2Al3 (Si9Al2O30) – Barium
osumilite

TECHNIQUE :
Tooth preparation :
1.25 – 1.5 mm (Labial-lingual,interproximal)
1.5 – 2.mm (occlusal)
900 (
full shoulder ) Conventional wax-up on
heat stable Epoxy dies
Investing Ceramic pellet in flask for pressing
1600
Cwww.indiandentalacademy.comwww.indiandentalacademy.com

Ceramic injected into mold
Plaster removal from
pressed coping
Refining green state
coping
Coping on master die fired
at 13000
C

Tooth preparation and impression
Cerestore epoxy die
Wax up and invest with master die
Boil out
Heat flask to 1800
C
Transfer mould ceramic into lost wax
cavity directly on master die
Retrieve master die
Refine coping, add veneer porcelainwww.indiandentalacademy.comwww.indiandentalacademy.com

Properties :
• Flexural strength : 225 Mpa
• Fit : exceptional fit because of direct moulding process.
• Low thermal conductivity
• Radio density similar to enamel
• Biocompatible

IPS-EMPRESSIPS-EMPRESS
(PRESSABLE CERAMIC)
Hot pressed ceramics
Leucite reinforced
K2O – Al2O3 – 4 SiO2
Lithium Disilicate reinforced
SiO2 – LiO2 – P2O5 – ZrO2
2 types
IPS Empress IPS Empress 2

LEUCITE REINFORCED IPS EMPRESS
Feldspar Leucite + glass phase
In congruent
Melting
Resistance to crack propagation
Pre cerammed Ingots
Processing :

Wax pattern
Ceramic ingot &
Al plunger
Investing
Pressing under vaccum
11500
C
Sprue removal
Edward B Goldin 2005 compared leucite IPS Empress with PFM
Mean marginal discrepancy 94 + 41 PFM
81 +25 IPS
Burn out 8500
C
26 min hold

Properties :
Flexural strength : 117.3 - 167 Mpa
Ion exchange method used to strengthen IPS empress (KnO3)
204 Mpa 11 hr immersion
Esthetics : high esthetic value
Clinical survival : Deniz G in 2002
95% survival → 2-4 years
Marginal adaptation : Shearer et al in 1996 : better marginal adaptation
with hot pressed ceramics than aluminous core material.

LITHIUM DISILICATE REINFORCED
Base glass Melted with raw materials
1400 to 16000
C
Poured into water
Glass grains 20-30 µ Cylindrical ingots obtained
Pressed into mold at 9000
Cin
Vaccum for 10 minutes
Automatic molding cycle
200 to 300 N
Manufacturing :
Mainly for post and core purposes Flexural strength :164+26 Mpa
Cosmo glass Ceramic

Full contouring Cut back
Sprued pattern
Investing Ingot pressingwww.indiandentalacademy.comwww.indiandentalacademy.com

CERAPEARLCERAPEARL
CaO – P2O5 – MgO – SiO2 – Hobo and Kyocera bioceram group 1985
Crystalline microstructure similar to natural enamel
Mechanical properties superior to enamel
Laboratory steps :
Tooth preparation, die preparation
Wax patterns
2 stage burn out (8000
C final temperature)
Melted ceramic at 14600
C casted under vaccum
(special ring liners required {1.2mm} )
Reheating -870 0
C– Crystalline oxy apatite - moisture exposure – hydroxy apatitewww.indiandentalacademy.comwww.indiandentalacademy.com

Clinical success : Nahara Y et al (1991)
2 year success rate – 100%
Burn out chamber Centrifugal casting machine
Ceramming unit and shading
A) Pretreatment
B) 3 months after
cementation
C) 2 yrs post-
cementation
Mainly indicated for inlays and full crowns

FLUORCANASITEFLUORCANASITE
Multiple chain silicate glass ceramic that exhibits high strength
and fracture toughness.
Al2O3 – CaO – F – K2O – SiO2
CaF2 → Nucleating agent
Procedure :
Wax pattern invested in Crystoballite investment
Burn out at 7000
C Heat soak for 0.5 hours
Temperature drop to 5900
C
Centrifugal casting machine used at 12000
C
Direct ceramming Heat soaking
5200
C
Heating at
8600
C CANASITEwww.indiandentalacademy.comwww.indiandentalacademy.com

Properties :
Flexural strength : 116 ± 12 MPa
Johnson et al in 2000 : Biaxial flexural strength 280.4 Mpa
Fracture toughness : 660 Mpa

OLYMPUS CASTABLE CERAMICOLYMPUS CASTABLE CERAMIC
It consists of
Glass phase of LiO2 – Na2O – ZnO – Al2O3 – TiO2 – SiO2 and
Crystalline phase of Na Mg3 (SiO3AlO10) F2 and Li2OAl2O3 – 4SiO2
Procedure :
Burn out 3000
C 30 min → 8000
C for 30 min
Casting at 5500
C → Ceramming at 7500
C for 2 hrs.
Shimida et al 2000 : prior to cementation : Silane coupling agent +Primer
increases bond strength

OPTIMAL PRESSABLE CERAMICOPTIMAL PRESSABLE CERAMIC
1996 Janeric Pentron Company
Optimally pressable
ceramic system
Glass ceramic with leucite phase
Crystalline compacted ceramic
on heating
Die fabrication Wax pattern

Sprued wax patterns ready for
investing
Paper casting ring is closed from top
as the material sets
Paper casting ring is peeled Investment placed in burnout furnace
850 c -90min

Colored pellets
used for casting
Hot mold placed in optimal
auto press machine
Pressed molds cooled
to room temperature
mold is scored and broken apart Recovering of casting
Removal of remaining investment
1150 0
C -20min hold

CASTABLE PHOSPHATE GLASS CERAMICCASTABLE PHOSPHATE GLASS CERAMIC
Contains :
Natural phosphate as natural teeth
Marketed as ‘Crys-Cera’

MACHINABLE
CERAMICS

Luthy et al 1991
Kelly et al 1991
Strength > Laboratory fabricated Ceramic
CEREC SYSTEMS PROCERA SYSTEM
CELAY SYSTEM

CEREC SYSTEMSCEREC SYSTEMS
Materials involved :
Vita mart II, Dicor MGC and Pro Cad
Sanidine
KAlSi3O8
Mica
crystals
70%
Leucite containing
ceramic
CERamic REConstruction,
Optical scanningwww.indiandentalacademy.comwww.indiandentalacademy.com

The compact, mobile unit consists of three components: a
small camera, a computer screen and a three – axis – of – rotation
milling machine.

The cad/cam cerec system has evolved from the: cerec-
1,which fabricated only marginally fitting single and dual surface
ceramic inlays.
Cerec-2,which showed advances in computing, upgraded
software and expanded form of grinding technique.www.indiandentalacademy.comwww.indiandentalacademy.com

Cerec-3 that can design well-fitting inlays, onlays, crowns,
veneers etc., in a single visit.

3D cerec
Scanning and designing
3 dimensional viewing Milling

CELAY SYSTEMCELAY SYSTEM
Uses copy milling technique
Resin pattern fabricated directly on master die and pattern is used
for milling porcelain restorations
Jacot et al 1998 : in ceram blanks in celay system.
Inlay pattern mounted
(copy side)
Copy milling pattern out
of ceramic material
(milling side)
Sorenson 1994 : marginal fit of CELAY > CEREC

PROCERA SYSTEMPROCERA SYSTEM
Dies are enlarged to compensate for sintering shrinkage.
Scanning
Milling machine
Shape on computer screen
Contact scanner

Processing method
Procera restorationswww.indiandentalacademy.comwww.indiandentalacademy.com

Tooth color gradation reproducibility : CCM ( computer color matching )
Shigemi Ishikawa et al 2005

Metal reinforced systems

CAPTEK SYSTEM :CAPTEK SYSTEM :
Duplicated refractory die
Metal
impregnated
wax sheet
Final coping
Porcelain veneering
CAPTEK is the answer for the most challenging situation because of
its strength and excellent esthetics
Captek G-97.5
gold, 2.5 silver
Au-Pt-pd

(HELIO FORM HF 600 SYSTEM)
Equipment Polyurethane dies
Completed restorations
ELECTRO FORMEDELECTRO FORMED

Scope of All-Ceramics

Anterior Crowns
Posterior Crowns

Ceramic inserts
Inlays & Onlays

Porcelain laminate veneers
Laminate : Is an extremely thin shell of porcelain applied directly to tooth structure
1930-1940 Charles Pincus used thin porcelain shells,denture adhesives were used
1970-1980 Composite resin laminate veneers
Monochromatic appearance
Staining
Loss of luster

1980s Bonding porcelain to etched surfaces
Hsu et al 1985 - Mechanical retention increased by etching porcelain
Shear bond strength of etched 4 > Unetched
Calamia et al 1984 - Application of silane coupling agent-
Improved bond strength
*min thickness of laminate: 0.3 – 0.5 mm

All ceramic F P D
Two part build up
Pre (PFM)
Post (All Ceramic)3 unit FPD

DC – ZIRKON technique : Vult von steyern et al in 2004
< 5% flaws, flexural strength : 900 Mpa
Used for posterior FPD’s
DC-Zirkon Blocks Milled Block
FPD framework tried on Working Castwww.indiandentalacademy.comwww.indiandentalacademy.com

All ceramic Resin bonded fixed partial dentures
Introduced 1986-1988 Ibsen et al and Garber et al
Matthias kern 2005 :Cantilever all-ceramic resin bonded FPDwww.indiandentalacademy.comwww.indiandentalacademy.com

Ceramic veneer F P D
Ceramic inlay metal reinforced F P D
Ceramic veneer / Composite substructure F P D

All ceramic Posts
1993 Luthy et al – Post made of TZP-ZrO2
High flexural strength 1400 Mpa
1994 Sandhaus – Zirconia post with composite core
1995 Akagawa et al - Castable ceramic attached to zirconia post
1997 Ivoclar – introduced Ceramic core directly pressed onto Zirconia post
IPS Empress Cosmo ingot

CONCLUSION

One who works with his hands is a labourer

One who works with his hands & mind is a craftsman

One who works with his hands , mind & heart is an artist

1.CONTEMPORARY FIXED PROSTHODONTICS
-ROSENSTIEL
2.PHILLIPS SCIENCE OF DENTAL MATERIALS
-ANUSAVICE
3.FUNDAMENTALS OF FIXED PROSTHODONTICS
-SCHILLINGBURG
4.CONTEMPORARY ESTHETIC DENTISTRY:
-BRUCE J.CRISPIN
5.ESTHETIC DENTISTRY: AN ARTISTS SCIENCE
-RATNADEEP PATIL
6.JPD 1996;75:18-32
7.JPD 2004;91:136-43
8.OPERATIVE DENTISTRY 1990;15:61-70
9.QUINT INT 1991;22:257-262
REFERENCES

21.QUINT INT 1998;29:285
22.INT J PROSTHOD 1997;10:478
23.J PROSTHET DENT 1999;81:277
24.QUINT INT 1991;22:257-262
25.INT J PROSTHOD 1992;5:9-16
REFERENCES

Thought for the Day
There are two kinds of failures
One who thought and never did
One who did but never thought

Thank You

Evolution of all ceramics&recent advances (2)/ dental courses

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