Allceramic restorations /certified fixed orthodontic courses by Indian dental academy

EVALUATION OF CERAMICS FOR
ALL CERAMIC RESTORATIONS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


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

REINFORCED CERAMIC CORE
SYSTEMS

RESIN BONDED CERAMICS


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’

RESIN BONDED
CERAMICS
Support Of Ceramic Is Provided By
Tooth Structure Itself By The
Bonding The Esthetic Ceramics
Directly To The Enamel And
Dentine.

WOL – CERAM
Based on high density core material from VITA InCeram Alumina.
WOL-CERAM EPC-CAM
(Electro-Phoretic Ceramic Deposition Technology
&
Computer Aided Manufacturing)

Electronically Deposited Alumina Oxide coping
gives the highest marginal integrity.

Ensures a Perfect Fit for ANY Preparation Designs

Featheredge

Chamfer


Shoulder

Electrically Conductive Wax Prior to
Dipping

Advantages
Clinical ease of
preparation
Precise fit system
Natural looking
esthetics
Good strength
Indications

Full coverage crowns
Bridges

INCERAM SPINEL
(Vident)
Most Translucent
Glass infiltrated
Magnesium Aluminum Oxide core for
Improved Translucency
avoiding the typical yellow opacity of the
In-Ceram


Reduced flexural strength - 350 mpa
(compared to Inceram Alumina 400500mpa)

Inlays
Onlays
Anterior Crowns
Veneers

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

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
dies to be made.

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

Strength is twice that of In-Ceram and
five times that of Empress
Anterior & Posterior Crowns
Veneers
Onlays
Inlays.

PROCERA-ZIRCONIA BASED
Flexural strength TWICE that of Alumina
based

CAD-CAM
Ideal in areas of maximum strength
SINGLE UNITS ONLY

YTTRIUM TETRAGONAL ZIRCONIA
POLYCRYSTALS (Y-TZP) BASED
MOST RECENT

Excellent Mechanical Properties and
Biocompatibility

Early 1990s - Endodontic’ Dowels and
Implant Abutments.

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

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

ZIRCONIUM-OXIDE CERAMICS
indicated for
ENDODONTIC POSTS (Cera Post)
IMPLANT ABUTMENTS (Ceradapt)
FULL-COVERAGE CROWNS
FIXED PARTIAL DENTURES

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
Titanium

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.

CERCON SYSTEM
Conventional Waxing
Techniques

DCS-PRESIDENT & LAVA systems
CAD Technology
&
Different Features and Design Options.

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

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



GLASS CERAMICS

LEUCITE BASED

FLUOROMICA BASED

LITHIUM DISILICATE BASED

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.


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

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

IPS FINNESSE
(Micro Dental Laboratories)
“PERFECTION IN

PORCELAIN”
8-10% leucite crystals

Less wear on
opposing dentition

HIGHLY POLISHABLE
Flexural strength – 125mpa
Fracture toughness – 1.25 Mpa.m1/2
INLAYS
ONLAYS
VENEERS
FULL COVERAGE CROWNS.

Authentic Pressable Ceramic
(Microstar)
Low Fusing

Most Delicate Forms can be Accurately
Reproduced
Staining and Layering Technique

Anterior Crowns
Inlays/ Onlays
Veneers


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

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

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

HOT PRESSED CERAMIC
Ceramic is heated to a
specified
temperature and
forced under
pressure to fill a
cavity in a refractory
mould


1180 degrees over a period
of 45min

High Degree of Marginal Fit can be Achieved

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

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


CEREC SYSTEMS
(Seimens, Germany )

Utilizes CAD-CAM technology

• CEREC 2 System - 1994.

• CEREC 3 SYSTEM -2001

CEREC 2 SYSTEM
CAD - CIM
COMPUTER INTEGRATED MILLING
The Marginal Fit and Accuracy of restorations
is Superior to CEREC
OCCLUSAL MORPHOLOGY MACHINED

CEREC 2

OCCLUSAL MORPHOLOGY


MACHINED

CEREC 3
Network and
Multimedia ready
combination with an

Intraoral Color Video
Camera
OR
Digital Radiographic
Unit


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.

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

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.

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.

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’

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.

• The remaining intact cusps and part
of occlusal surfaces are recorded by
an “occlusal impression”

• After preparation they are matched
with the “preparation impressions”

Computer Aided Machining
Cerec 3 system has a
Separate Recording and Design Unit
and
Form-Grinding Unit

The change from disks to Cylindrical and
Tapered burs were used to Replicate Better

Occlusal Morphology.

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

PROCERA SYSTEM
(Nobel Biocare,Sweden)

Procera Scanner
scans the surface
of the prepared
tooth

Transmits the
information to a
computer controlled
design station, where
the Aluminum Oxide
copings are
fabricated.


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
increase the toughness of ceramic materials.

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.

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.

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.

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

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

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.

•


•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

•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

•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.

Thank you
Leader in continuing dental education


Allceramic restorations /certified fixed orthodontic courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

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

Similar to Allceramic restorations /certified fixed orthodontic courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Allceramic restorations /certified fixed orthodontic courses by Indian dental academy

Editor's Notes