The Era of Dental ceramics/ dentist practices

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

METAL CERAMICS
METAL FREE CERAMICS

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

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

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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. www.indiandentalacademy.com

MATERIALS
Silicate Ceramics
Aluminium oxide ceramics with glass
infiltration.
Aluminium oxide ceramics with dense
sintering.
Titanium.
Precious alloys
Non precious alloys

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.

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).

High strength through very small grains
High-Performance Structural Ceramics
(Zirconium Oxide, ZrO2)

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 matrix.www.indiandentalacademy.com

TRANS FORMATION TOUGHENING

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).

Bonding
porcelain
Glass-
ceramics
Infiltration
technique
High tech
ceramic
The strength values of dental ceramics

TYPES:
GREEN STAGE
PRE SINTERED
SINTERED

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 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 Materialswww.indiandentalacademy.com

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

Standard Prep
• preparation:
120–140°
• 6° taper

Marginal Prep
•Shoulder or Chamfer Preparation
•1 mm circumferential shoulderwww.indiandentalacademy.com

Prep
Standard Procedure,
line angles must be
softened

Sharp, clear impressions
are a must !!
A reliable bite is needed !!
Stable dies are required !www.indiandentalacademy.com

MECHANICAL SCANNER
INTRAORAL OPTICAL SCANNER
EXTRAORAL OPTICAL SCANNER

CLOSED CAD/CAM SYSTEMS OPEN CAD /CAM SYSTEMS

HARD WARE (CAM)
SUBTRACTIVE
TECHNIQUE FROM A
SOLID BLOCK:
SOLID FREE FORM
FABRICATION.

CERCON SYSTEM
Conventional Waxing
Techniques
DCS-PRESIDENT & LAVA systemsDCS-PRESIDENT & LAVA systems
CAD Technology.CAD Technology.

CEREC SYSTEMS
(Seimens, Germany )
Utilizes CAD-CAM technology
CEREC 2 System - 1994.
CEREC 3 SYSTEM -2001

CEREC CAD/CAM Systems
CAD/CAM for dental practices
• CEREC 3D
• CEREC Scan
CAD/CAM for dental laboratories
• inLab MCXL
• inEos
33

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

CEREC 2 OCCLUSAL MORPHOLOGY MACHINEDOCCLUSAL 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.

CEREC 3D Indications
NO IMPRESSION - NO TEMPORARY
 Inlays
 Onlays
 Veneers
 Crowns
 Partial crowns
 Endocrowns (rec. on molars)
 Anterior crowns
 Posterior crowns

Cerec video presentation

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PROCERA SYSTEM
(Nobel Biocare,Sweden)
Procera Scanner
scans the surface
of the prepared
tooth

Transmits theTransmits the
information to ainformation to a
computer controlledcomputer controlled
design station, wheredesign station, where
the copings arethe copings are
fabricated.fabricated.

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.

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.

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.

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.

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.

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.

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

Controlled shaping of spacer. Overall design.
Constant monitoring of connector cross section. Pontic shaping

Parallel milling with two tools:

High speed milling of copings and bridge frame work.

Completed bridge framework

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

cercon CAM or CAD-CAM System
cercon eye cercon art
cercon heatcercon cleancercon brain
cercon hardware

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

cercon smart ceramics – CAM

Models must be aligned and
surveyed for proper path of
Insertion
Surveyor
Analyzing
Rod
Represents
What the
Laser can
See at Any
Given point

Confirm that preps have a parallel path of
insertion

Always use the surveyer....never
“eyeball it“

Standard waxing procedure
Wax the copings 0.5mm
thick
Add
the pontic,
connectors at
least
3x3mm

To control the right fitting of the modellation in the
scanning frame use the scanning pattern

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

Cover the wax up with scan powder

Cercon Art, CAD

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)

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

Cercon heat

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.

as milled as sintered
Sintering Behavior

Influence of Sintering on the Microstructure
as milled as sintered

Always use water-cooled turbines for
grinding the sintered frameworks

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

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.

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.

Lava Crowns & Bridges

• The processing of Zirconia effects the
clinical requirements for a dental
restorations
• Excellent marginal fit.
• Good compatibility with oral tissues.

Marginal Fit
Greenbody state
Exact and reproducible sintering parameters
Homogeneity of the material
No deformation during sintering process
2 µm
Sintered Material

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
D4D4www.indiandentalacademy.com

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

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

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*

OPTICAL IMPRESSION-VIDEO

CERCON
CELAY* System

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.

Procedure:

OTHER
CROWNS BRIDGES IMPLANTS
Cercon Link
Cercon exress
..many applications...

Cercon Link
Cercon link
Attachment for
bridge
framework on
divergent posts

Fixing the Cercon Link

Fitting and veneering the primary part

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 patientwww.indiandentalacademy.com

Thank you
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The Era of Dental ceramics/ dentist practices

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