Dental Ceramics and Porcelain fused to metal isabel
Dental porcelain (also known as dental ceramic) is a dental material used to create biocompatible lifelike dental restorations, such as crowns, bridges, and veneers.
Dental Ceramics and Porcelain fused to metal isabel
Dental porcelain (also known as dental ceramic) is a dental material used to create biocompatible lifelike dental restorations, such as crowns, bridges, and veneers.
In the last decades the development of the porcelain materials, the reliable bonding strength to enamel and dentin, and the bonding of resin cement to the porcelain through the silane, Porcelain laminates become trusted type of treatment in the daily practice.
It is an aesthetic treatment that concerns mainly the labial face of the anterior teeth, its thickness is about 0.3 mm in the cervical area to 0.4 -7 at the incisal third, in certain cases it can be done without any prep or just little touch of the enamel (lumineer), but in most prep is indicated to improve the adaptation in the cervical area also to remove the aprismatic enamel layer which which has low bonding strength with the resin cement, however prep should be in the enamel limits, 3 different type of prep are practiced, however, they are the same on the labial surface but the but the difference concerns the incisal edge.
In this lecture, indications and contraindications are exposed. All the materials in use and their indications as well as the clinical procedures are detailed.
brief description about pressable ceramicsCONTENTS: • Introduction • Definition For Dental Ceramics • Definition For Pressable Ceramics • History • Various All Ceramic Systems • Classification • Pressable Ceramics • History • Generation Of Pressable Ceramics • Cerestore – Development Fabrication Advantage Disadvantage 2
3. IPS Empress - Materials And Composition Special Furnace Fabrication Advantage Disadvantage IPS Empress 2- INDICATION Properties Fabrication Method Advantage Disadvantage IPS Emax Press - Microstructure Composition Properties OPC 3G- Development Indication Properties 3
4. INTRODUCTION There have been significant TECHNOLOGICAL advances in the field of dental ceramics over the last 10 years which have made a corresponding increase in the number of materials available. Improvements in strength, clinical performance, and longevity have made all ceramic restorations more popular and more predictable 4
5. DEFINITION FOR DENTAL CERAMICS⁶ An inorganic compound with non metallic properties typically consisting of oxygen and one or more metallic or semi metallic elements (e.g ;Aluminium, Calcium, Lithium, Mangnesium, Potassium, Sodium, Silicon, Tin , Titanium And Zirconium)that is formulated to produce the whole or part of a ceramic based dental prosthesis 5
6. DEFINITION FOR PRESSABLE CERAMICS ⁶ • A ceramic that can be heated to a specified temperature and forced under pressure to fill a cavity in a refractory mold 6
7. HISTORY OF DENTAL CERAMICS ⁶ • 1789-first porcelain tooth material by a French dentist De Chemant • 1774- mineral paste teeth by Duchateau in England • 1808-terrometallic porcelain teeth by Italian dentist Fonzi • 1817- Planteu introduced porcelain teeth in US • 1837- Ash developed improved version of porcelain teeth 7
8. • 1903 – Dr.Charless introduced ceramic crowns in dentistry he fabricate ceramic crown using platinum foil matrix and high fusing feldspathic porcelain excellent esthetics but low flexural strength resulted in failure • 1965- dental aluminous core Porcelain by Mclean and Huges • 1984- Dicor by Adair and Grossman 8
9. 9
10. VARIOUS ALL CERAMIC SYSTEMS Aluminous core ceramics Slip cast ceramics Heat pressed ceramics Machined ceramics Machined and sintered ceramics Metal reinforced system 10
11. MICROSTRUCTURAL CLASSIFICATION⁵ Category 1: Glass-based systems (mainly silica) Category 2: Glass-based systems (mainly silica) with fillers usually crystalline (typically leucite or a different high-fusing glass) a) Low-to-moderate leucite-
Techniques of direct composite restorationMrinaliniDr
Techniques of the direct composite restoration. Includes different instruments, matrix system, wedges, bevel, etching, bonding, and placement of composite along with finishing and polishing and clinical management
There have been several changes since inception in the field of dental ceramics. Need for newer materials with improved aesthetics, flexural strength and optical properties made it necessary for introduction of advanced technology in fabrication of dental ceramics.
This presentation provide brief information about different types of cements in Dentistry. also you will find information about cementation tips and techniques. Recent resin cements are also included in this presentation
This is a journal club presentation featuring a recent article in which the authors have attempted a new classification of all ceramic materials.
The presentation and all the related material is available on request. Mail me at apurvathampi@gmail.com
In the last decades the development of the porcelain materials, the reliable bonding strength to enamel and dentin, and the bonding of resin cement to the porcelain through the silane, Porcelain laminates become trusted type of treatment in the daily practice.
It is an aesthetic treatment that concerns mainly the labial face of the anterior teeth, its thickness is about 0.3 mm in the cervical area to 0.4 -7 at the incisal third, in certain cases it can be done without any prep or just little touch of the enamel (lumineer), but in most prep is indicated to improve the adaptation in the cervical area also to remove the aprismatic enamel layer which which has low bonding strength with the resin cement, however prep should be in the enamel limits, 3 different type of prep are practiced, however, they are the same on the labial surface but the but the difference concerns the incisal edge.
In this lecture, indications and contraindications are exposed. All the materials in use and their indications as well as the clinical procedures are detailed.
brief description about pressable ceramicsCONTENTS: • Introduction • Definition For Dental Ceramics • Definition For Pressable Ceramics • History • Various All Ceramic Systems • Classification • Pressable Ceramics • History • Generation Of Pressable Ceramics • Cerestore – Development Fabrication Advantage Disadvantage 2
3. IPS Empress - Materials And Composition Special Furnace Fabrication Advantage Disadvantage IPS Empress 2- INDICATION Properties Fabrication Method Advantage Disadvantage IPS Emax Press - Microstructure Composition Properties OPC 3G- Development Indication Properties 3
4. INTRODUCTION There have been significant TECHNOLOGICAL advances in the field of dental ceramics over the last 10 years which have made a corresponding increase in the number of materials available. Improvements in strength, clinical performance, and longevity have made all ceramic restorations more popular and more predictable 4
5. DEFINITION FOR DENTAL CERAMICS⁶ An inorganic compound with non metallic properties typically consisting of oxygen and one or more metallic or semi metallic elements (e.g ;Aluminium, Calcium, Lithium, Mangnesium, Potassium, Sodium, Silicon, Tin , Titanium And Zirconium)that is formulated to produce the whole or part of a ceramic based dental prosthesis 5
6. DEFINITION FOR PRESSABLE CERAMICS ⁶ • A ceramic that can be heated to a specified temperature and forced under pressure to fill a cavity in a refractory mold 6
7. HISTORY OF DENTAL CERAMICS ⁶ • 1789-first porcelain tooth material by a French dentist De Chemant • 1774- mineral paste teeth by Duchateau in England • 1808-terrometallic porcelain teeth by Italian dentist Fonzi • 1817- Planteu introduced porcelain teeth in US • 1837- Ash developed improved version of porcelain teeth 7
8. • 1903 – Dr.Charless introduced ceramic crowns in dentistry he fabricate ceramic crown using platinum foil matrix and high fusing feldspathic porcelain excellent esthetics but low flexural strength resulted in failure • 1965- dental aluminous core Porcelain by Mclean and Huges • 1984- Dicor by Adair and Grossman 8
9. 9
10. VARIOUS ALL CERAMIC SYSTEMS Aluminous core ceramics Slip cast ceramics Heat pressed ceramics Machined ceramics Machined and sintered ceramics Metal reinforced system 10
11. MICROSTRUCTURAL CLASSIFICATION⁵ Category 1: Glass-based systems (mainly silica) Category 2: Glass-based systems (mainly silica) with fillers usually crystalline (typically leucite or a different high-fusing glass) a) Low-to-moderate leucite-
Techniques of direct composite restorationMrinaliniDr
Techniques of the direct composite restoration. Includes different instruments, matrix system, wedges, bevel, etching, bonding, and placement of composite along with finishing and polishing and clinical management
There have been several changes since inception in the field of dental ceramics. Need for newer materials with improved aesthetics, flexural strength and optical properties made it necessary for introduction of advanced technology in fabrication of dental ceramics.
This presentation provide brief information about different types of cements in Dentistry. also you will find information about cementation tips and techniques. Recent resin cements are also included in this presentation
This is a journal club presentation featuring a recent article in which the authors have attempted a new classification of all ceramic materials.
The presentation and all the related material is available on request. Mail me at apurvathampi@gmail.com
Metal free ceramics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Dental Courses by Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Indian Dental Academy: will be one of the most relevant and exciting training
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professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
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Introduction
CERAMICS : An inorganic compound with non-metallic prosthesis typically consisting of oxygen and one or more metallic or semi-metallic elements that is formulated to produce the whole part of a ceramic based dental prosthesis. – GPT 7.
The word Ceramic is derived from the Greek word “keramos”, which literally means ‘burnt stuff’, but which has come to mean more specifically a material produced by burning or firing.
Metal free ceramics /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dental all ceramic restorations /orthodontic straight wire techniqueIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Dental ceramics /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
7. Light Dynamics in Natural Teeth
Tooth colours are
produced by the colour of
the dentine and pulp
reflecting through the
enamel layer which is
influenced by the amount
of demineralisation
8. Raptis et al. 2006
The Effect of Light Transmission
Four crowns placed on tooth 11
Which two are PFM and which two are All-ceramic crowns?
9. In-Ceram Spinell
IPS Empress
PFM
PFM (with porcelain shoulder)
Note how light is blocked by the metal copings
Raptis et al. 2006
11. Charles Land
• Invented dental porcelain in 1886
• Granted Patent 1887
• Platinum foil matrix
Land CH (1903) Porcelain dental art: No II. Dental Cosmos 45:615-620
John McLean & TJ Hughes
• Replaced metal reinforcement with Alumina (Al2O3) to develop first all-
ceramic core
The reinforcement of dental porcelain with ceramic oxides. (1965) BDJ
119(6):251-267
Evolution of Ceramic Crowns
13. Three main types of ceramics in dentistry 1
1. Predominantly glass
• Veneering porcelains for PFM and
all-ceramics
• Most translucent – high aesthetics
2. Particle-filled glass (Glass-ceramics)
i. High glass content
• Lost wax system (Dicor) [no longer
available]
• Machinable feldspar-based ceramic
(Vita Mark II blocks)
• Heat-pressed Leucite reinforced
(Empress I)
(Kelly 2008)
14. Three main types of ceramics in dentistry 2
2. Particle-filled glass (Glass-ceramics)
ii. Low glass content
•
Heat-pressed or CAD/CAM Lithium
Disilicate (IPS emax)
•
Slip-cast or CAD/CAM Glass-infiltrated
alumina (In-Ceram)
3. Polycrystalline (Ceramic oxides)
i. Alumina Oxide (Procera Alumina)
ii. Zirconia (3mol%Y-TZP) (Procera
Zirconia)
18. VITABLOCS® Materials
VITABLOCS
Block
Restoration
Indication
Mark II
Inlays, onlays,
anterior/posterior
crown and
veneer
TriLuxe
Anterior/posterior
crown and
veneer
TriLuxe forte
Anterior/posterior
crown and
veneer
RealLife
Anterior/posterior
crown/ veneer
for natural
aesthetics
21. Structural Ceramics
• In-Ceram Alumina
• Good combination of strength and
aesthetics
• Substructure for anterior crowns and
3-unit bridges
• In-Ceram Zirconia
• Very good strength
• Substructure for anterior and posterior
crowns and 3-unit bridges
22.
23. Structural Ceramics
• In-Ceram AL
• Very good strength
• Substructure for anterior and 3-unit
bridges and posterior crowns
• In-Ceram YZ
• Excellent strength
• Substructure for anterior and
posterior crowns and multi-unit
bridges
24. Alumina and Zirconia
• The increase in crystalline content in
alumina and zirconia has:
• Improved the mechanical properties allowing
all-ceramic crowns and bridges
• Is hard to machine and resistant to etching
so resin bonding is a challenge
31. Vita Enamic
CAD/CAM Hybrid Ceramic
product description from Vita
• For the first time, this innovative hybrid materials
combines enormous strength with exceptional elasticity
• As a result, the material is perfectly suited for crown
restorations and moreover allows to achieve reduced
wall thicknesses for minimally invasive restorations
• Additionally, VITA ENAMIC excels by utmost reliability
and precise and accurate milled restorations featuring
high edge stability
• This tooth-colored hybrid material also exhibits tooth-
like material properties and produces highly esthetic
results thanks to its excellent translucency
33. Common Ceramic Core Materials
Amorphous glass - Veneering porcelains
Glass ceramics (reinforced by crystalline phases)
• Leucite reinforced - Empress I
• Lithium disilicate - Empress II
• Magnesium aluminium oxide - In-Ceram Spinnell
• Feldspathic Glass - Vita Mark II Blocks
Glass infiltrated mixtures
• In-Ceram alumina
• In-Ceram zirconia
Polycrystalline
• Alumina - Procera
• Zirconia - Lava, Everest, Cercon, Procera, Zeno, Ivoclar etc
34. 1. Amorphous glass – Vita Mark II
2. Crystalline glass ceramics
(reinforced by crystalline
phases)
1. Leucite reinforced - Empress I
2. Lithium disilicate - Empress II
3. Glass infiltrated mixture
1. Magnesium Aluminium Oxide -
Spinell
2. InCeram alumina
3. InCeram zirconia
4. Polycrystalline
1. Alumina - Procera
2. Zirconia – Lava
35. All-Ceramic Material
Type!
Aesthetic Properties! Applications!
Feldspathic Glass
(predominantly glass)
Intrinsically tooth
coloured
Anterior veneers &
crowns
Can be stained & glazed
Crystalline Ceramics
(particle-filled glass - high
glass content)
Intrinsically tooth
coloured
Anterior veneers &
crowns
Can be stained & glazed
Glass Infiltrated Mixtures
(particle-filled glass – low
glass content)
Core material
Core can be pigmented
Anterior and posterior
crowns
Are veneered with
porcelain
Polycrystalline Ceramics
(no glass content)
Core material
Core can be pigmented
Anterior and posterior
crowns & bridges
Are veneered with
porcelain
52. Systematic Review
Goodacre et al 2003!
Mean fracture rate for all-ceramic crowns
increases as you move posteriorly
Anteriors
3%
Premolars
7%
Molars
21%
This review did not distinguish between:
• fracture modes (core or veneer chipping)
• or types of ceramic systems
53. Systematic Review
Pjetursson et al 2007 - All-ceramic vs PFM crowns
5yr survival rates:
PFM
95.6%
All-ceramic
93.3%
85% of all-ceramic crowns failures due to core fracture
Chipping usually repairable
Anteriors:
All-ceramics = PFM
Posteriors:
Material dependent
ü Alumina oxide
95%
ü Reinforced glass ceramics (Empress)
94%
² In-Ceram
90%
² Glass-ceramics (Dicor)
85%
54. Systematic Review
Wang et al 2012 - All-ceramic single crowns
5 yr Fracture rate: (veneer + core)
all systems
Overall
7.7%
Posteriors
10%
Anterior teeth
4.4%
Core fracture:
Overall
7.2%
Posteriors
9.5%
Anteriors
3.9%
Veneer chipping: Overall
3%
Molars
3%
Premolars
1.5%
Canines
2.5%
Incisors
2%
No clear difference found
Statistically significant
Statistically significant
55. Systematic Review
Sailer et al 2007 - fixed partial dentures
5yr survival rates:
Metal-ceramic FPDs
94.4%
All-ceramic FPDs
88.6%
Frequency of:
core #
veneer #
Metal-ceramic FPDs
1.6%
2.9%
All-ceramic FPDs
6.5%
13.6%
Mainly Lithium disilicate and In-Ceram
Rare in zirconia FPD
Annual rate:
Zirconia
1.98 – 12.2
Empress/emaxP
0.83 – 1.55
In-Ceram
no chipping reported
56. Recommended Indications
Class 1 Ceramics
• Aesthetic ceramic for coverage of a metal
or ceramic subsurface
and/or
• Aesthetic ceramic for single-unit anterior,
veneers, inlays, or onlays
Example IPS Empress, IPS e.max Ceram (Ivoclar)
Della Bona, 2009
57. Recommended Indications
Class 2 Ceramics
• Aesthetic ceramic for adhesively cemented,
single unit, anterior or posterior prostheses
and/or
• Adhesively cemented, substructure ceramic
for single-unit anterior or posterior
prostheses
Example IPS Empress (Ivoclar), Cerec MkII (Vita)
Della Bona, 2009
58. Recommended Indications
Class 3 Ceramics
• Aesthetic ceramic for non-adhesively
cemented, single-unit, anterior or posterior
prostheses
Example IPS e.max Press or CAD (Ivoclar)
Della Bona, 2009
59. Recommended Indications
Class 4 Ceramics
• Substructure ceramic for non-adhesively
cemented, single-unit, anterior or posterior
prostheses
and/or
• Substructure ceramic for three-unit
prostheses not including molar restoration
• Example IPS Empress 2, (Ivoclar), Cerec MkII (Vita)
Della Bona, 2009
60. Factors that Influence Ceramics
• Ceramics are susceptible to chemical corrosion
and fatigue mechanisms
• This reduces their lifetime
• Unfavourable oral conditions include:
• Chewing forces from 100-700 N
• Moist environment at 37ºC
• Small contact area; stresses generated 3.5-890
MPa
Della Bona, 2009
61. Survival of Ceramics
To improve mechanical behaviour of ceramics
• Select the ceramic considering location
• Consider substructure similar to metal for PFM
• Minimise surface roughness
• Rougher surfaces have more cracks so need fewer
cycles of stress to fail
• Chemical interaction between ceramic (crack tips) and
environment (water) results in accelerated crack growth
due to stress corrosion
Della Bona, 2009
63. Considerations in Fixed
Prosthodontics 3
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64. Crown Margin
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65. Length of Edentulous Span 1
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66. Length of Edentulous Span 2
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67. Minimum occlusogingival and buccolingual connector
dimensions as a function of position of the bridge
connector and occlusal forces!
70. The image cannot be displayed. Your
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Ceramic Crown
Form
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73. Bonding Ceramic Crowns
• The crystalline content in alumina and zirconia
is resistant to etching so bonding is a challenge
• Silica coating systems (eg Rocatec and Cojet,
3M ESPE) creates a silica layer
• High-speed surface impact of silica-modified
alumina particles promotes resin bonding by:
• Rough surface allowing micromechanical bonding
to resin
• Promotes a chemical bond between the silanated
silica coated ceramic and the resin bond material
82. Custom Fabrication
• All-ceramic restorations are custom-fabricated
increasing susceptibility to fabrication defects
• Variety of techniques
• Sintering
• Heat-pressing
• Slip-casting
• CAD/CAM
• Combined with staining or veneering step
Each technique produces fabrication defects
[from Janine Tiu]
83. Diamond grinding is a major source of failure-inducing
flaws in dense ceramics. (Rice 2002)
Zirconia CAD/CAM machining creates damage that is
not fully healed by sintering process. (Kim et al 2010)
Effects of Abrasive Grinding
Thermal shock
85. Veneer Chipping in Zirconia-based Restorations
Systematic reviews confirm chipping of veneering
ceramic is the most frequent complication
More common than with metal-ceramic or other all-
ceramic restorations
(Al-Amleh et al 2010, Hientz et al 2010, Schley et al 2010,
Raigrodski et al 2012)
86. Al-Amleh et al 2010 “Clinical trials in zirconia: A systematic review
Summary:
• 17 clinical trials based on 3Y-TZP
• Posterior FPD
13 studies
• Single crowns
2 studies
• Implant abutments
2 studies
• 8 brands of zirconia
• Longest trial 5yrs (only 2 studies)
Chipping of veneering porcelain
• Two of 15 studies did not report chipping
• Was common for all brands
• Incidence ranged from 0 – 54%
• Not always noticed by patients – incidental finding
• Also found at non-load bearing areas
89. Reasons for Zirconia Veneer Chipping
High tensile residual stresses locked within
the veneering porcelain (Swain 2009)
Zirconia is a very poor thermal conductor:
• Gold:
315 W/m-K
• Alumina:
40 W/m-K
• Zirconia:
2 W/m-K
Substructure core design
• Cap-like core do not support veneering
porcelain
• Suggested “PFM-style” cut back method
[Tholey, Swain & Thiel 2011]
90. PFMs cool from the inside to the outside producing systematic
compression bonding from the inside to the outside.
YZr crowns cool from both the inside and the outside at a similar
rate resulting in a compression layer in the outer veneer and YZr
coping, and an inner zone of tension within the porcelain veneer.
W/(m.K), of a gold coping =
315
W/(m.K), of a zirconia coping
= 2
Thermal conductivity, W/(m.K),
of porcelain = 1.4
Zone of
tension
91. Loading Zirconia Crowns to Failure
fast cooled v slow cooled
Procera Zirconia
IPS e.max ZirPress
Al-Amleh 2011
92. Fast Cooled Samples
Common features:
• Midline fissure crack
• Cracking on mesial non-loaded side
• Average 902 N
93. Fracture after 2 days
Courtesy: Dr. L. Gruetter (University of Geneva)
94. Courtesy : Dr. L. Grütter (University of Geneva)
Occlusal
contact point
responsible for
shearing off
veneering
ceramic
95. 1. Clean (cotton pellet with
alcohol), rinse & dry
2. Inject siloxane impression material
(light body)
3. Cover the whole crown with
silicon material
Procera Alumina AllCeram (veneering
ceramic failure after 4 years)
96. Zirconia Abutment Fracture
Case description:
1. The zirconia
implant abutment
was screwed in
tightly
2. Contact points
M, D, were
adjusted in situ
3. On the first bite for
occlusal adjustment
the crown fractured
97. Zirconia
abutment CARES
(Straumann)
Zirconia Abutment Try-in Failure
The first bite to check
the occlusion created a
stress concentration at
the distal margin (white
arrow). The crack path
is marked by the red
arrows and result in the
crown splitting in half.
origin
Ø Fabrication defect
99. Poor framework design
• Not enough palatal clearance
• Thin tip zirconia framework
Both cause high stress concentrations
Take home message:
Always try-in zirconia frameworks before veneering
103. origi
n
Conclusion from the replica SEM analysis: The origin of the failure was
located on the occlusal-palatal cusp (wear facette). The crack continued along the arrows
downwards (interproximally) to the gingiva without reaching the margins.
The veneering porcelain was unsufficiently supported by the alumina core
104. Guidelines for Restoring Chipped !
All-ceramic Restorations
Grade 1: Fracture surface can be polished
Grade 2: Fracture surface can be repaired with composite resin
Grade 3: Severe fracture requires restoration replacement
1. Fracture extends into a functional area and repair is not
feasible
2. Re-contouring will result in a significant unacceptable
alteration of the anatomic form from the original anatomy
3. Re-contouring will significantly increase the risk of pulp
trauma by the generation of heat
4. Repair with resin composite will result in unacceptable
aesthetic result
(Heintze & Rousson 2010, Anusavice 2012)
105. Success or Failure?
• Is a chipped all-ceramic restoration a failed
restoration?
• Restoration success is defined as the
demonstrated ability of a restoration to
perform as expected
• Acceptable surface quality
• Anatomic contour
• Function
• Aesthetics (where applicable)
• When should we repair or replace the
entire restoration?
• Restoration failure may be defined as
any condition that leads to replacement
of a prosthesis
• Why do all-ceramic fracture?
• How can we minimise this problem?
106. Origins of Fracture
• Fabrication flaws of various shapes
and sizes includes:
• Pores Micro-cracks
• Macro-cracks
• Machining grooves
• Air-abrasion surface defects
• Grinding adjustments surface
defects
• Location of the defect under tensile
stresses is important
• Thermal residual stresses
• Subcritical crack growth (SCCG)
• In humid environment, cracks grow
slowly but continuously
Weakest link
107. Early v Late Fractures
• Immediate failure or within a few hours or
days of cementation is likely to originate
from a major processing flaw
(Schmitter et al 2009, Lohbauer et al 2010)
• Failure after a few years is likely to involve
subcritical crack growth and/or cyclic
fatigue SCCG and/or cyclic fatigue
108. Most important factor affecting
fracture rates:
Position of restoration in the mouth
Ferrario et al 2004
Greatest forces
Molars > premolars > incisors (1/3-1/4 of
molars load)
111. Causes of Ceramic Substructure Failure
• Fracture initiating in the connector area
• Connector high stress area
• Chipping of the veneering material
• Residual stresses at the core-veneer
interface
• Differences in thermal conduction between
the core and veneer
• Thick veneer layer
• Poor bonding between the core and veneer
ceramic
• Sliding occlusal contacts more damaging
than axial contacts
112. Summary
• Stronger ceramics are more opaque than
aesthetic ceramics
• Aesthetic restorations without much structural
need – use single layer (monolithic) ceramics
• High strength needed, less aesthetic ceramics
veneers with tooth coloured porcelain
• Any ceramic system suitable for veneers and
anterior crowns
• Only a few ceramics successful for restoring
molars
• Need to consider other clinical factors such as
adequate preparation depth and cementation
113. Summary
• No equivalent long-term data as for PFMs
• ~75% at 15 years
• Many ceramics >90% after 5 years
• Reasonable evidence available for anterior 3-
unit FPDs in lithium disilicate, In-Ceram
Alumina and Zirconia
• Posterior 3-unit FPDs only zirconia indicated
• Chipping and fracture a problem
• Higher success when ceramics bonded to teeth
using resin cement rather than GIC
• Use a silica coating system or primers for acid resistant
ceramics such as zirconia
117. Ceramics
Slip Cast
• Build-up with core particles and fired
• High Strength
• Highly Abrasive
• Fair Marginal Fit
– In-Ceram: crowns
– In-Ceram Spinell: crowns (more translucent)
– In-Ceram Zirconia: 3 unit FPD’s
118. In Ceram
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143. All Ceramic Crowns
• Indications
– High cosmetic demand
– Incisal edge reasonably intact
– Favourable occlusion
• Advantages
– Cosmetics
– Good tissue response
– More conservative on labial
144. All Ceramic Crowns
• Contraindications
– High strength required
– Insufficient tooth structure for support
– Unfavourable occlusion
• Disadvantages
– Reduced strength
– Not conservative
– Brittle
– Single crowns only
145. Types of crowns
Full gold crown (FGC)
Porcelain fused to metal (PFM)
All ceramic
146. Affect of the Metal Coping
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147. Ceramic Crown Form 1
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148. Occlusal Considerations
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150. Tooth Preparation 1
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151. Tooth Preparation 2
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152. All-ceramics and Metal-ceramics
• The need to simulate in
dental porcelains the light
behaviour and
appearance of the natural
tooth
• Create the illusion of
nature within limited
space constraints and
light blocking effect of the
metal substructure or
ceramic substructure
Yamamoto 1985
Yamamoto 1985
158. Dimensions of the Preparation
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159. Light Transmission
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162. Preparation
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163. The image cannot be displayed. Your computer may not have enough memory to open the image, or
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