All ceramic restorations

1. B Y ,
P A A V A N A
I I I M D S
ALL CERAMIC
RESTORATIONS

2. CONTENTS
• INTRODUCTION
• HISTORY
• DENTAL CERAMICS
• ALL CERAMIC SYSTEMS
• FACTORS AFFECTING SELECTION OF ALL CERAMIC
RESTORATIONS
• DIFFERENT CERAMIC RESTORATIONS
• CLINICAL PROCEDURES
• RELATED ARTICLES
• CONCLUSION
• REFERENCES

3. INTRODUCTION
• All-ceramic restorations are some of the most esthetically pleasing
restorations currently available. Well-made all-ceramic restorations can
be virtually indistinguishable from unrestored natural teeth.
• In the last few decades, there have been tremendous advances in the
mechanical properties and methods of fabrication of ceramic materials.
• Advances in bonding techniques have increased the range and scope
for use of ceramics in dentistry.

4. HISTORY
 1774- Alexis Duchateau used ceramics for the first time.
 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)
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 674

5. DENTAL CERAMICS
• CERAMICS- compounds of one or more metals with a nonmetallic element, usually
oxygen; they are formed of chemical and biochemically stable substances that are
strong, hard, brittle, and inert nonconductors of thermal and electrical energy(GPT 9)
• DENTAL CERAMICS-An inorganic compound with nonmetallic propertics typically
consisting of oxygen and one or more metallic or semimetallic. elements (e.g.,
aluminum, calcium, lithium, magnesium, potassium, silicon, sodium,tin, titanium, and
zirconium )that is formulated to produce the whole or part of a ceramic based dental
prosthesis.
Phillips' science of dental materials- Anusavice KJ, Shen C, Rawls HR;11th edition:pg 656

6. Dental Materials Science-Ramakrishna alla;1st edition:pg 388

7. ALL CERAMIC RESTORATIONS
INDICATIONS CONTRAINDICATI
ONS
ADVANTAGES DISADVANTAGES
1.High esthetic
requirements
2.No longer be
effectively restored
with composite
resin
3.Relatively intact
with sufficient
coronal tooth
structure
1. Teeth with an
edge-to-edge
occlusion that will
produce stress in
the incisal area of
the restoration.
2. Teeth with short
cervical crowns
1.Superior
esthetics
2.Excellent
translucency
3.Tissue response
good
1.Reduced strength
of the restoration
2.Shoulder type
margin
circumferentially
3.Connector
strength
4.Wears opposing
natural teeth

8. ALL CERAMIC SYSTEMS

9. DIFFERENT FABRICATION TECHNIQUES
Rosenblum MA, Schulman A. A review of all-ceramic restorations. J Am Dent Assoc. 1997 Mar 1;128(3):300

10. COMPOSITION
Warreth A, Elkareimi Y. All-ceramic
restorations: a review of literature.
Saudi Dent. J. 2020.pg 4

11. ROSSENSTIAL
• Aluminous core ceramics
• Heat pressed ceramics
• Machinable ceramics
• Metal reinforced ceramics
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 676-687

12. ALUMINOUS CORE CERAMICS
• McLean and Hughes in 1965.
• COMPOSITION-Aluminum oxide (alumina) crystals
dispersed in a glassy matrix.
Porcelains used in this technique are
 Core porcelain-Highest strength opaque porcelain- 50% by wt fused
alumina crystals wt fused alumina crystals
 Body porcelain - 15% crystal alumina and
 Enamel porcelain -- 5% crystal alumina
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 676-687

13. ADVANTAGES
1.Simple fabrication
2.Improved strength
compared to conventional
feldspathic (95% success
rate on maxillary anterior
teeth)
DISADVANTAGES
1.Alumina is very bright, therefore
crown must be built to disguise the
core. Some times bright at neck.
2.Not indicated for posterior teeth
(15% fracture), FDPs and in cases
of bruxism.
3.Aluminous porcelain shrinks
during the baking procedure, the fit
of finished aluminous crown is
generally much poorer than that of
ceramo-metal crowns.

14. ALUMINOUS
CORE
CERAMICS
INCERUM
ALUMINA
INCERUM
ZIRCONIA
INCERUM
SPINELL
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 676-687

15. INDICATIONS
INCERUM
ALUMINA
• Onlays,
• anterior
and
posterior
crowns
• Anterior
FPDs
INCERUM
SPINELL
• Inlays
• Onlays
• Anterior
and
posterior
crowns
INCERUM
ZIRCONIA
• Onlays
• Posterior
crowns,
and
• Posterior
FPDs,
Peampring C, Sanohkan S. All-ceramic systems in esthetic dentistry: A review. M Dent J 2014; 34: 84.

16. HEAT PRESSED CERAMICS
HEAT
PRESSED
CERAMICS
• LEUCITEBASED
• LITHIUM
DISILICATE
BASED
LEUCITE BASED
• Leucite -major reinforcing
crystalline
phase,dispersed in a
glassy matrix.
COMMONLY AVAILABLE
SYSTEMS
 IPS Empress (Ivoclar
Vivadent);
 Optimal Pressable
Ceramic(OPC, Pentron
Clinical)
 Cerpress (ADS, Inc)
 Finesse(DentsplyProsthe
tics).
LITHIUM DISILICATE
BASED
COMMONLY AVAILABLE
SYSTEMS
 IPS e.max Press
 IPS e.max CAD
(IvoclarVivadent)
 3G (Jeneric
Pentron).
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 676-687

17. INDICATIONS
INLAYS
VENEERS
ONLAYS
ANTERIOR
FPD
CROWNS
Peampring C, Sanohkan S. All-
ceramic systems in esthetic
dentistry: A review. M Dent J
2014; 34: 84

18. MACHINABLE CERAMICS
• CEREC SYSTEM (Sirona Dental Systems, LLC)

19. CERAMICS USED IN CEREC SYSTEMS
• VITA Mark II (VITA North America)
• IPS Empress CAD (Ivoclar Vivadent)
• IPS e.max CAD (Ivoclar Vivadent)
• CEREC Blocs C (Cerec 3D, Sirona Dental Systems,
Inc.),
• In-Ceram Alumina and Spinell (Dentsply Prosthetics).
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 676-687

20. METAL REINFORCED SYSTEMS
• CAPTEK SYSTEM
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 676-687

21. ZIRCONIA CERAMICS
• Tetragonal zirconia stabilized with 3 mol% yttrium oxide.
DENTAL
ZIRCONIA
SOLID
HIGHLY
TRANSLUCENT
-Requires minimal
clearance or a crown to
stand up to a
severe bruxers..
-Lacks in esthetics,it
makes up in sheer
strength.
-Fabricated out of
100% monolithic
medical-grade zirconia
-Superior looks that
exactly resemble
your natural teeth.
-Used for single
anterior and
posterior
restorations, for
bridges up to three
units.

22. • Zirconium crowns are definitely more robust than porcelain crowns.
• They last longer too, compared to porcelain that chip and break.
• Porcelain crowns also need to be fused to a metal base and the metal is
that black unsightly line above the gums of people with porcelain crowns.
• Since Zirconium crowns are milled from a chunk of crystal, they are
guaranteed to be at least 5 times stronger than porcelain and it metal fuse.
Zirconium crowns also provide strength without that bulky appearance that
porcelain is so known for.

25. SELECTION OF ALL CERAMIC
RESTORATIONS
PATIENT
RELATED
FACTOR
ESTHETICS PULPAL STATUS ABRASIVENESS
FRACTURE
TOUGHNESS
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn:pg 688

26. ALL CERAMIC RESTORATIONS
ALL CERAMIC
RESTORATIONS
CROWNS
FIXED PARTIAL
DENTURES
INLAYS ONLAYS VENEERS
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn

27. CLINICAL PROCEDURES

28. SHADE SELECTION
Fundamentals of fixed
prosthodontics- Shillingburg; 4th
edn.pg 761-762

29. TOOTH PREPARATION

30. CROWNS AND FPDS
Armamentarium
• Handpiece
• Coarse-grit flat-end tapered diamond (6847-016)
• Coarse-grit football-shaped diamond (6379-023)
• Fine-grit flat-end tapered diamond (8847KR-016)
• CP-11/12 binangle chisel
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 279-282

31. PROCEDURE
• DEPTH ORIENATION GROOVES
• BUR USED-Coarse-grit flat-end tapered
diamond
• GROOVES PLACEMENT-1.2 to 1.4 mm
deep on the labial and 2.0 mm deep on the
incisal
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 279-282

32. • INCISAL REDUCTION
• BUR USED-coarse-grit flat-end tapered
diamond.
• Approximately 1.5 to 2.0 mm of tooth
structure is removed
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 279-282

33. • LABIAL REDUCTION
• The tooth structure still remaining between the
depth orientation grooves on the incisal portion
of the labial surface is planed away.
• The gingival portion of the labial surface is
reduced with the coarse-grit flat-end tapered
diamond to a depth of 1.2 to 1.4 mm. This
reduction extends around the labioproximal line
angles and fades out on the lingual aspects of
the proximal surfaces
• The end of the coarse-grit flat-end tapered
diamond bur will form the shoulder finish line,
while the axial reduction is done with the sides
of the diamond.
Fundamentals of fixed
prosthodontics- Shillingburg; 4th
edn.pg 279-282

34. • LINGUAL REDUCTION
• Lingual reduction incisal to the cingulum is
done with the coarse-grit football-shaped
diamond, with care taken not to over reduce
the junction between the cingulum and the
lingual wall (apical to the cingulum)
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 279-282

35. • AXIAL REDUCTION
• Reduction of the lingual axial surface is done with
the coarse-grit flat-end tapered diamond .
• The wall should form a minimum taper with the
gingival portion of the labial wall.
• The radial shoulder is at least 1.0 mm wide and
should be a smooth continuation of the labial and
proximal radial shoulders.
• All of the axial walls should be smoothed with a
fine-grit flat-end tapered diamond, accentuating
the shoulder at the same time
Fundamentals of fixed prosthodontics-
Shillingburg; 4th edn.pg 279-282

36. Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 279-282

37. POSTERIOR TEETH
Fundamentals of Tooth Preparation- Shillingburg; 2th edn.pg 291-299

38. • OCCLUSAL REDUCTION
Fundamentals of Tooth Prepatation- Shillingburg; 2th edn.pg 291-299

39. • FUNCTIONAL CUSP BEVEL
Fundamentals of Tooth Preparation- Shillingburg; 2th edn.pg 291-299

40. • FACIAL AND LINGUAL REDUCTION
Fundamentals of Tooth Preparation- Shillingburg; 2th edn.pg 291-299

41. • AXIAL REDUCTION
Fundamentals of Tooth Preparation- Shillingburg; 2th edn.pg 291-299

42. Fundamentals of Tooth Preparation- Shillingburg; 2th edn.pg 291-299

43. Fundamentals of Tooth Preparation- Shillingburg; 2th edn.pg 291-299

44. Fundamentals of Tooth Preparation-
Shillingburg; 2th edn.pg 291-299

45. INLAYS AND ONLAYS

46. INLAYS AND ONLAYS
• Armamentarium
Art and Science of Operative Dentistry-Sturdevant;4t edition:pg 580-581

47. • As a first clinical step, the patient is anesthetized and the area isolated,
preferably using rubber dam.
• The compromised restoration (if present is completely removed, and all
caries is excavated.
• If necessary the walls are restored to a more nearly ideal form with a
light-cured glass-ionomer liner/base or a composite restorative material
Art and Science of Operative Dentistry-Sturdevant;4t edition:pg 580-581

48. Art and
Science of
Operative
Dentistry-
Sturdevant;4t
edition:pg
580-581

49. VENEERS

50. VENEERS
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 785-789

51. Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 785-789

52. IMPRESSION PROCEDURE
IMPRESSIONS
CONVENTIONAL
ELASTOMERS
DIGITAL

53. TEMPORIZATION
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 232

54. TRY IN
• Patient is asked to moisten the ceramic and adjacent teeth with
saliva.
• The shade is evaluated under incandescent, fluorescent, and
natural light.
• The patient should be allowed to look at the completed restoration
in a wall mirror and approve it before cementation
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 800

55. • A thin coating of a pressure indicator such as Occlude (Pascal) can be applied to these materials
before seating to reveal the exact location of the contact.
• Broad, relatively flat surfaces -a large, smooth-cutting Busch Silent Stone (Pfingst)
• Reshaping of grooves and ridges -smaller pointed diamond stones and green stones
• Roughened ceramic surfaces are smoothed with clean white stones and polished with rubber
wheels of progressively finer grit such as those found in the Ceramisté porcelain adjustment kit
(Shofu) or diamond-impregnated wheels and points (Dialite, Brasseler

56. CEMENTATION PROCEDURE
CEMENTS
ADHESIVE
NON
ADHESIVE
Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations: recommendations for success. J Am Dent Assoc. 2011 Apr
1;142:20S-21S

57. Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations: recommendations for success. J Am Dent Assoc. 2011 Apr
1;142:20S-4S

58. • The crown is rinsed and then dried with compressed air.
• The tooth preparation is cleaned with a rubber cup and flour of pumice,
washed, and dried.
• A thin layer of cement is applied to the internal surfaces of the crown. The crown
is seated, and excess cement is removed from the marginal areas with an
explorer and a clean brush.
• A slight excess is left to avoid ditching the cement at the margin. The curing light
is aimed at marginal areas from facial, lingual, and occlusal directions for 40
seconds.
• When light activation is not used, 6 minutes be allowed for autopolymerization.
• Bulky margins or premature occlusal contacts are adjusted with a fine diamond
stone.
Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.pg 789-801

59. RELATED ARTICLES
• Complete rehabilitation of compromised full dentitions with
adhesively bonded all-ceramic single-tooth restorations: Long-
term outcome in patients with and without amelogenesis
imperfecta
Klink A, Groten M, Huettig F. J. Dent.. 2018 Mar 1;70:51-8.
Objectives: This clinical follow-up evaluated the long-term outcome of full-
mouth rehabilitations with adhesively bonded all-ceramic restorations in
patients suffering from amelogenesis imperfecta (AI) or affected by
extensive tooth wear including a loss of the vertical dimension of
occlusion.

60. MATERIALS AND METHODS
• Seventeen patients were observed up to 16.5 years.
• All patients treated with adhesively bonded monolithic single-tooth
restorations made of silicate or lithium disilicate ceramics; allowing
a maximum four missing teeth and a facial feldspathic veneering of
LDS anterior crowns.
• After treatment, patients have been enrolled in a recall program for
dental check-ups including quality assessment of the restorations.
• Patients answered the oral health impact profile (OHIP-14) at their
last visit.

61. RESULTS

62. CONCLUSION
• Adhesively bonded single-tooth restorations provided a high
clinical quality in the long-run.
• However, while the survival and success were excellent in AI
patients, restorations in non-AI patients were affected by a
higher complication rate, likely related to a higher risk profile
due to a history of bruxism and tooth wear.

63. • Fracture Resistance of Molar Crowns Fabricated with Monolithic All-
Ceramic CAD/CAM Materials Cemented on Titanium Abutments: An
In Vitro Study
Dogan DO, Gorler O, Mutaf B, Ozcan M, Eyuboglu GB, Ulgey M. J. Prosthodont.. 2017 Jun;26(4):309-
14.
• Purpose: To assess the fracture resistance of single-tooth implant-
supported crown restorations made with different CAD/CAM blocks

64. MATERIALS AND METHODS
• Thirty-six titanium abutments were put on dental implant analogs
(Mis Implant).
• For each of three test groups (n = 12/group), implantsupported,
cement-retained mandibular molar single crowns were produced

65. CONCLUSION
Within the limitations of the present study, the following
conclusions were reached:
1. LD had the highest cracking and fracture resistance values.
2. RNC had low crack resistance but considerably high fracture
resistance.
3. FEL had considerably low crack and fracture resistance.

66. • Effects of New Generation All-Ceramic and Provisional Materials
on Fibroblast Cells
Atay A, Gürdal I, Bozok Çetıntas V, Üşümez A, Cal E. . J. Prosthodont 2019 Jan;28(1):e383-94.
• Purpose- To evaluate the cytotoxic and apoptotic effects of seven
new-generation all-ceramic materials for CAD/CAM and six
provisional materials

67. MATERIALS AND METHODS
• 24 disc-shaped specimens ( = 5 mm, h = 2 mm) were prepared
from each test material. Medium extracts were collected at the
1st, 3rd, and 7th days for each group and tested using the L929
cell line.
• Cytotoxicity was evaluated using XTT assay, and apoptosis was
determined by Annexin-V/PI staining.
• Data were analyzed using one-way ANOVA, Tukey’s multiple
comparison tests at a significance level of p < 0.05.

68. CONCLUSION
• Although some new-generation CAD/CAM and provisional
restoration materials display slight cytotoxicity values, the
results are still within the reliable range, and they can safely
be used in clinical conditions.

69. • Effect of Resin Cement Color on the Final Color of Lithium Disilicate All-
Ceramic Restorations
Vafaee F, Heidari B, Khoshhal M, Hooshyarfard A, Izadi M, Shahbazi A, Moghimbeigi A. J Dent (Tehran)
.2018 May;15(3):143.
• Purpose-
To evaluate the effect of the color of Variolink II resin cement on the final
color of lithium disilicate glass ceramic restorations.

70. MATERIALS AND METHODS
•

71. CONCLUSION
• The final color of the restoration is influenced by the cement color.
• Therefore, when IPS e.max Press is used over a metal core, it is
recommended to use a cement with an HO ceramic

72. CONCLUSION
• The use of all-ceramic restorations is increasing, and this
trend will continue.
• Higher-strength ceramic materials have expanded the
indications for all-ceramic restorations; however, at this time,
their efficacy is not similar to that of metal ceramic
restorations.
• There fore, long term clinical studies and experience is still
need to use all-ceramic restoration as an viable alternative
treatment option for patients especially in esthetically
demanding cases.

73. REFERENCES
• Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn
• Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.
• Fundamentals of Tooth Preparation- Shillingburg; 2th edn.
• Phillips' science of dental materials- Anusavice KJ, Shen C, Rawls HR;11th edition
• Dental Materials Science-Ramakrishna alla;1st edition
• Art and Science of Operative Dentistry-Sturdevant;4th edition
• Warreth A, Elkareimi Y. All-ceramic restorations: a review of literature. Saudi Dent.
J.. 2020.
• Rosenblum MA, Schulman A. A review of all-ceramic restorations. J Am Dent
Assoc”.. 1997 Mar 1;128(3):297-307.
• Peampring C, Sanohkan S. All-ceramic systems in esthetic dentistry: A review. M
Dent J 2014; 34: 82-90.
• Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations:
recommendations for success. J Am Dent Assoc. 2011 Apr 1;142:20S-4S.