All ceramics clinical/academy of orthodontics

All – ceramicsAll – ceramics
oror
metal free ceramicsmetal free ceramics
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

CONTENTSCONTENTS
 INTRODUCTIONINTRODUCTION
 HISTORY OF CERAMICSHISTORY OF CERAMICS
 CLASSIFICATIONS OF SYSTEMSCLASSIFICATIONS OF SYSTEMS
 Strengthening mechanismsStrengthening mechanisms
 Various systemsVarious systems
 Comparision of systemsComparision of systems
 SELECTION CRITERIASELECTION CRITERIA
 CONCLUSIONCONCLUSION

INTRODUCTIONINTRODUCTION
 The desire for a restorative material to be durable and esthetic is ancient.The desire for a restorative material to be durable and esthetic is ancient.
Routine use of ceramics as restorative material is a recent phenomenon.Routine use of ceramics as restorative material is a recent phenomenon.
 Since the advent of metal free ceramic materials, the esthetic value of theSince the advent of metal free ceramic materials, the esthetic value of the
restorations were overlooked and gained popularity in last three decades.restorations were overlooked and gained popularity in last three decades.
 Considerable research and development were carried out to improve theConsiderable research and development were carried out to improve the
strength of all ceramics comparable to metal ceramics.strength of all ceramics comparable to metal ceramics.
 Current thinking and trends about all ceramics will be emphasised in thisCurrent thinking and trends about all ceramics will be emphasised in this
presentation.presentation.

DefinitionsDefinitions
 CERAMICSCERAMICS : compounds of one or more: compounds of one or more
metals with a nonmetallic element, usuallymetals with a nonmetallic element, usually
oxygen. They are formed of chemical andoxygen. They are formed of chemical and
biochemical stable substances that are strong,biochemical stable substances that are strong,
hard, brittle, and inert nonconductors of thermalhard, brittle, and inert nonconductors of thermal
and electrical energyand electrical energy
 PORCELAINPORCELAIN: a ceramic material formed of: a ceramic material formed of
infusible elements joined by lower fusinginfusible elements joined by lower fusing
materials.materials.

History of ceramicsHistory of ceramics
 Alexis duchateau in 1774 – denture teethAlexis duchateau in 1774 – denture teeth
 C.H. Land – ceramic crowns and inlaysC.H. Land – ceramic crowns and inlays
 The first comercial porcelain was developed by VitaThe first comercial porcelain was developed by Vita
Zahnfabrik in about 1963.Zahnfabrik in about 1963.
 1965 , Mc lean and Hughes developed dental aluminous1965 , Mc lean and Hughes developed dental aluminous
core ceramiccore ceramic
 In 1968 , MacCulloch first proposed the use of glassIn 1968 , MacCulloch first proposed the use of glass
ceramicceramic
 In 1970s and 1980s , the porcelain fused to metalIn 1970s and 1980s , the porcelain fused to metal
restorations became the primary restorationrestorations became the primary restoration

HistoryHistory
 In 1984 , Adair and Grossman developed aIn 1984 , Adair and Grossman developed a
ceramic system by controlled crystallization of aceramic system by controlled crystallization of a
glass ( Dicor ) .glass ( Dicor ) .
 Glass infiltrated ceramics (INCERAM ) wereGlass infiltrated ceramics (INCERAM ) were
introduced in 1988. The strength of theseintroduced in 1988. The strength of these
ceramics is about 3 to 4 times greater than earlierceramics is about 3 to 4 times greater than earlier
alumina core material.alumina core material.
 In 1990s , pressable glass-ceramics ( IPSIn 1990s , pressable glass-ceramics ( IPS
Empress )Empress )

HistoryHistory
 First chair side-produced ceramic inlay based onFirst chair side-produced ceramic inlay based on
CAD-CAM unit (Cerec, Siemens) wasCAD-CAM unit (Cerec, Siemens) was
introduced in 1985.introduced in 1985.
 Second generation Cerec system i.e. Cerec-2,Second generation Cerec system i.e. Cerec-2,
was introduced in 1994.was introduced in 1994.
 Third generation Cerec system i.e. Cerec-3, wasThird generation Cerec system i.e. Cerec-3, was
 PROCERA system was introduced in 1993.PROCERA system was introduced in 1993.

All ceramicsAll ceramics
 Ceramic coresCeramic cores
 High strength ceramicsHigh strength ceramics
 Poor estheticsPoor esthetics
 Veneering materialVeneering material
 Low strength ceramicsLow strength ceramics
 Good estheticsGood esthetics
Strongest – non esthetic core materialsStrongest – non esthetic core materials

CLASSIFICATIONCLASSIFICATION
 Ceramics can be classified in four categoriesCeramics can be classified in four categories
 Silicate ceramicsSilicate ceramics
 An amorphous glass phase with a porous structure
Main component is SiO2 Dental porcelain fall in this
category
 Oxide ceramicsOxide ceramics
 Presence of mainly oxides (Al2O3, MgO with either
no glass phase or Small content of glass phase .

 Non-oxide ceramicsNon-oxide ceramics
 Impractical for dentistry - high processing temp,
unaesthetic color & opacity
 Glass ceramicsGlass ceramics
 Partially crystallized glasses that are produced by
nucleation and growth of Crystals in the glass matrix
phase.

 ACCORDING TO TYPE:ACCORDING TO TYPE:
 Feldspathic porcelainFeldspathic porcelain
 Aluminous porcelainAluminous porcelain
 Glass infiltrated aluminousGlass infiltrated aluminous
 Glass infiltrated spinelGlass infiltrated spinel
 Glass ceramicsGlass ceramics

 ACCORDING TO FIRINGACCORDING TO FIRING
TEMPERATURE:TEMPERATURE:
 High fusing > 1300 cHigh fusing > 1300 c
 Medium fusing 1101 –1300 CMedium fusing 1101 –1300 C
 Low fusing 850 – 1101 CLow fusing 850 – 1101 C
 Ultra low fusing <850 C.Ultra low fusing <850 C.

 According to Substructure materialAccording to Substructure material
 Glass ceramicGlass ceramic
 CAD- CAM porcelainCAD- CAM porcelain
 Sintered ceramic coreSintered ceramic core

According to the technique of FabricationAccording to the technique of Fabrication
1. Conventional powder slurry system1. Conventional powder slurry system
 Medium fusing Felspathic porcelainMedium fusing Felspathic porcelain
 Aluminous porcelainAluminous porcelain
 DUCERAM LFC (Degussa)DUCERAM LFC (Degussa)
 OPTEC HSP (Jeneric/Pentron)OPTEC HSP (Jeneric/Pentron)

 2. Castable ceramics2. Castable ceramics
 DicorDicor
 Cerapearl (Kyocera Inc.)Cerapearl (Kyocera Inc.)
 3. Pressable ceramics3. Pressable ceramics
 IPS Empress I, II , cosmo, (Ivoclar)IPS Empress I, II , cosmo, (Ivoclar)
 Optec pressable ceramics (Jeneric/Pentron)Optec pressable ceramics (Jeneric/Pentron)
 Cergo (Dentsply )Cergo (Dentsply )
 VitaPress ( Vitadent )VitaPress ( Vitadent )
 4. Glass infiltrated ceramics4. Glass infiltrated ceramics
 In-Ceram aluminia (Vident)In-Ceram aluminia (Vident)
 In-Ceram spinell (Vident)In-Ceram spinell (Vident)
 In-Ceram zirconia (Vident)In-Ceram zirconia (Vident)

 5. Injection molded ceramics5. Injection molded ceramics
 Alceram (Cerestore)Alceram (Cerestore)
 6. Machinable ceramics6. Machinable ceramics
 CAD CAMCAD CAM
 Cerec: Vita Mark I, Vita Mark II,Cerec: Vita Mark I, Vita Mark II,
 Dicor MGC( Machinable Glass Ceramic)Dicor MGC( Machinable Glass Ceramic)
 ProceraProcera
 Cercon baseCercon base
 VitaBloc alumina , spinell & zirconiaVitaBloc alumina , spinell & zirconia
 Lava frameLava frame
 Celay( coping milling )Celay( coping milling )

Flaws in brittle ceramicsFlaws in brittle ceramics
 Fabrication defectsFabrication defects
 Condensation with ceramic slurry by hand induce porosityCondensation with ceramic slurry by hand induce porosity
 Porosity will be fracture initiation sitePorosity will be fracture initiation site
 Due to Thermal contraction mismatchDue to Thermal contraction mismatch
 Surface cracksSurface cracks
 Induced by machining or grindingInduced by machining or grinding
 Fracture takes place from the most severe flawFracture takes place from the most severe flaw
 Depends on size and spatial distribution of crackDepends on size and spatial distribution of crack

METHOD TO OVERCOMEMETHOD TO OVERCOME
Methods of
strengthening
brittle materials
Designing
components to
decrease stress
concentration
Development of
residual compressive
stresses
Interruption of crack
propagation
1. Dispersion of crystalline
phase
2. Transformation
toughening
1. Ion exchange
2. Thermal tempering
3. Thermal compatibility

STRENGTHENING MECHANISMSSTRENGTHENING MECHANISMS
 Strengthened byStrengthened by
 Crystalline reinforcementCrystalline reinforcement
 Chemical strengtheningChemical strengthening
 Stress induced transformationStress induced transformation
 GlazingGlazing
 Prevention of stress corrosionPrevention of stress corrosion

Crystalline reinforcementCrystalline reinforcement
 high proportions of crystalline phase like leucitehigh proportions of crystalline phase like leucite
to improve the resistance to crack propagationto improve the resistance to crack propagation
 Crack deflection brought about byCrack deflection brought about by
 Weakened interface between grains in single-phaseWeakened interface between grains in single-phase
materials caused by incomplete sinteringmaterials caused by incomplete sintering
 Residual strains between two phase materialsResidual strains between two phase materials

Crystalline reinforcementCrystalline reinforcement
 Greater thermal coefficient ofGreater thermal coefficient of
expansion of crystalline phaseexpansion of crystalline phase
than the matrix producesthan the matrix produces
tangential compressive stresstangential compressive stress
near crystal-matrix interfacenear crystal-matrix interface
 This tangential stress divert theThis tangential stress divert the
crack around the particlecrack around the particle
 Leucite has the greater theramalLeucite has the greater theramal
expansion than than glassyexpansion than than glassy
matrixmatrix www.indiandentalacademy.com

Chemical strengtheningChemical strengthening
 Ion exchange by replacement of small allkaliIon exchange by replacement of small allkali
ions with larger ions below the strain point ofions with larger ions below the strain point of
ceramicceramic
 Stress relaxation is not possible in theirStress relaxation is not possible in their
temperature range, exchange of ions lead totemperature range, exchange of ions lead to
compressive layer at the surfacecompressive layer at the surface
 Ions of salts with melting point lower than theIons of salts with melting point lower than the
glass transition temperature of ceramic materialglass transition temperature of ceramic material
were chosenwere chosen

Stress induced transformationStress induced transformation
 Polycrystalline zirconia in which stress-inducedPolycrystalline zirconia in which stress-induced
transformation can strengthen ceramicstransformation can strengthen ceramics
 Teteragonal zirconiaTeteragonal zirconia monoclinic zirconiamonoclinic zirconia
 Monoclinic zirconia at room temperatureMonoclinic zirconia at room temperature
 Tetragonal zirconia at 1170 and 2370 degreesTetragonal zirconia at 1170 and 2370 degrees
 To retain tetragonal form of zirconia at roomTo retain tetragonal form of zirconia at room
temperature oxides such as yttrium oxide are added.temperature oxides such as yttrium oxide are added.
 Increase in grain volume in the vicinity of crack tipIncrease in grain volume in the vicinity of crack tip

GlazingGlazing
 The addition of a surface glaze can also be used to
strengthen ceramics
 The principle is the formation of a low-expansion
surface layer formed at high temperature.
 Upon cooling, the low-expansion glaze places the
surface of the ceramic in compression and reduces the
depth and width of surface flaws.
 Selfglazing does not significantly improve the flexure
strength of feldspathic dental porcelain

Prevention of stress corrosionPrevention of stress corrosion
 The strength of ceramics is reduced in moist
environments.
 This weakening is due to a chemical reaction between
water and the ceramic at the tip of the strength-
controlling crack
 Resulting in an increase in the crack size-a phenomenon
called stress-corrosion or static fatigue.
 Prevention:
 Reducing the moisture exposure at the internal surface where
the fracture thought to initiate
 Baking ceramic on a metal foil as in the Captek system of
ceramic

ALUMINOUS PORCELAINALUMINOUS PORCELAIN
(Hi-Ceram-Vita Zahnfabrik)(Hi-Ceram-Vita Zahnfabrik)
 Developed byDeveloped by Mclean and Hughes in 1965Mclean and Hughes in 1965
 Feldspathic porcelain to which approx. 50%Feldspathic porcelain to which approx. 50%
aluminum oxide is added to increase strength.aluminum oxide is added to increase strength.

Aluminous core porcelainAluminous core porcelain
 Porcelains used in this technique arePorcelains used in this technique are
 Core porcelainCore porcelain--; highest strength opaque porcelain- 50% by; highest strength opaque porcelain- 50% by
wt fused alumina crystalswt fused alumina crystals
 body porcelainbody porcelain - 15% crystal alumina and- 15% crystal alumina and
 enamel porcelainenamel porcelain -- 5% crystal alumina5% crystal alumina
 Firing temp.Firing temp.
 Core-1050-1100 degree CCore-1050-1100 degree C
 Veneer- 900-995 degree CVeneer- 900-995 degree C

Diagramatic representationDiagramatic representation

AdvantageAdvantage
 Simple fabricationSimple fabrication
 Improved strength compared to conventionalImproved strength compared to conventional
feldspathic porcelain (95% success rate onfeldspathic porcelain (95% success rate on
maxillary anterior teeth)maxillary anterior teeth)

DisadvantageDisadvantage
 Alumina is veryAlumina is very brightbright, therefore crown must be built to, therefore crown must be built to
disguise the core. Some times bright at neck.disguise the core. Some times bright at neck.
 Not indicated for posterior teeth (15% fracture), FDPs andNot indicated for posterior teeth (15% fracture), FDPs and
in cases of bruxism.in cases of bruxism.
 Aluminous porcelainAluminous porcelain shrinksshrinks during the baking procedure,during the baking procedure,
the fit of finished aluminous crown is generally muchthe fit of finished aluminous crown is generally much
poorer than that of ceramo-metal crowns.poorer than that of ceramo-metal crowns.

PLATINUM FOIL TECHNIQUEPLATINUM FOIL TECHNIQUE
 ADVANTAGESADVANTAGES
 No need of refractory dieNo need of refractory die
 Easy to measure thickness during fabricationEasy to measure thickness during fabrication
 DISADVANTAGESDISADVANTAGES
 Foil distortion possibleFoil distortion possible
 Difficult to assess actual colourDifficult to assess actual colour

 Core porcelain is appliedCore porcelain is applied
and then firedand then fired

 Building body dentineBuilding body dentine  Completed dentineCompleted dentine
porcelain build upporcelain build up

 Cut back of the incisal dentineCut back of the incisal dentine
 Enamel blend smoothenedEnamel blend smoothened
with brushwith brush

Application of enamel porcelainApplication of enamel porcelain Completed enamel build upCompleted enamel build up
Small quantity of stains are addedSmall quantity of stains are added

Completed restorationCompleted restoration

SLIP CAST CERAMICSSLIP CAST CERAMICS
 In-ceram-developed by Dr. Sadoun in paris.In-ceram-developed by Dr. Sadoun in paris.
 In In-ceram system the glass infiltrated aluminaIn In-ceram system the glass infiltrated alumina
core is produced by “SLIP CASTING”core is produced by “SLIP CASTING”
procedure.procedure.

Slip cast ceramicsSlip cast ceramics
 SLIP- dispersion of alumina particles in water.SLIP- dispersion of alumina particles in water.
 Slip casting is the science of preparing stableSlip casting is the science of preparing stable
suspensions and fabricating structures bysuspensions and fabricating structures by
building a solid layer on the surface of a porousbuilding a solid layer on the surface of a porous
mold that absorbs the liquid phase by means ofmold that absorbs the liquid phase by means of
capillary forces.capillary forces.

 The starting media is a “slip” i.e. an aqueous suspensionThe starting media is a “slip” i.e. an aqueous suspension
of fine alumina particles in water (or 1% polyvinylof fine alumina particles in water (or 1% polyvinyl
alcohol).alcohol).
 Slip is applied on to a porous special refractory dieSlip is applied on to a porous special refractory die
which absorbs water from the slip and leads towhich absorbs water from the slip and leads to
condensation of the slip on die.condensation of the slip on die.
 This is then fired at temp. of about 1150This is then fired at temp. of about 1150OO
CC

 The refractory die shrinks more than slip and thusThe refractory die shrinks more than slip and thus
allows easy separation after firing.allows easy separation after firing.
 This initial shrinking process of alumina core producesThis initial shrinking process of alumina core produces
minimum volume shrinkage, since temperature andminimum volume shrinkage, since temperature and
time are sufficient only to cause bonding betweentime are sufficient only to cause bonding between
particles at small area.particles at small area.
 Therefore marginal adaptation of this core is excellentTherefore marginal adaptation of this core is excellent
because of minimal shrinkage.because of minimal shrinkage.

GLASS INFILTRATIONGLASS INFILTRATION
 Fired porous core is glass infiltrated (low fusing SodiumFired porous core is glass infiltrated (low fusing Sodium
lanthanum glass).lanthanum glass).
 Molten glass is drawn into the pores by capillary actionMolten glass is drawn into the pores by capillary action
at higher temperature (1120 degree C) over 4-5 hourat higher temperature (1120 degree C) over 4-5 hour
period.period.
 The diffusion of glass through porous alumina fills theThe diffusion of glass through porous alumina fills the
spaces between alumina particles, which enhancesspaces between alumina particles, which enhances
strength and color (increases its index of refraction andstrength and color (increases its index of refraction and
thus increases translucency).thus increases translucency).

PROCEDURE (Inceram)PROCEDURE (Inceram)

InceramInceram
 The strength of In-ceram is 3-4 times more thanThe strength of In-ceram is 3-4 times more than
earlier alumina core materials.earlier alumina core materials.
 Concentration of alumina in In-ceram is 72%,Concentration of alumina in In-ceram is 72%,
compared to 50% in aluminous porcelain.compared to 50% in aluminous porcelain.

CASTABLE GLASS CERAMICSCASTABLE GLASS CERAMICS
 A glass -ceramic is material that is formed into theA glass -ceramic is material that is formed into the
desired shape as a glass, then subjected to a heatdesired shape as a glass, then subjected to a heat
treatment to induce partial devitrification (ie loss oftreatment to induce partial devitrification (ie loss of
glassy structure by crystallization of the glass).glassy structure by crystallization of the glass).
 The crystalline particles, needles, or plates formedThe crystalline particles, needles, or plates formed
during this process serve to interrupt the propagationduring this process serve to interrupt the propagation
of cracks in the material when an intraoral force isof cracks in the material when an intraoral force is
applied, thereby causing increased strength andapplied, thereby causing increased strength and
toughnesstoughness

CASTABLE GLASS CERAMICSCASTABLE GLASS CERAMICS
 The use of glass-ceramics in dentistry was firstThe use of glass-ceramics in dentistry was first
proposed by MacCulloch in 1968.proposed by MacCulloch in 1968.
 The first commercially available castable ceramicThe first commercially available castable ceramic
material for dental use, Dicor, was developed bymaterial for dental use, Dicor, was developed by
Corning Glass Works and marketed by DentsplyCorning Glass Works and marketed by Dentsply
International.International.

DICORDICOR
 Dicor system composed of SiO2; K2O. MgO, andDicor system composed of SiO2; K2O. MgO, and
MgF2. Small amounts of Al2.O3 and ZrO2 are addedMgF2. Small amounts of Al2.O3 and ZrO2 are added
for durability and a fluorescing agent is added forfor durability and a fluorescing agent is added for
esthetics.esthetics.
 Dicor contain Tetra silicic fluor mica CrystalsDicor contain Tetra silicic fluor mica Crystals
 Lost wax casting technique is used , similar to thatLost wax casting technique is used , similar to that
employed for metals.employed for metals.
 Uses centrifugal casting machineUses centrifugal casting machine

DICORDICOR

 This heat treatment (which involves crystal nucleation andThis heat treatment (which involves crystal nucleation and
crystal growth process) is known as “Ceramming”.crystal growth process) is known as “Ceramming”.
The crystals function in 2 ways:The crystals function in 2 ways:
1) They create a relatively opaque material out of initially1) They create a relatively opaque material out of initially
transparent crown,transparent crown,
2) they significantly increase the fracture resistance and2) they significantly increase the fracture resistance and
strength of ceramic. These crystals are also less abrasivestrength of ceramic. These crystals are also less abrasive
to opposing tooth structure than the leucite crystals foundto opposing tooth structure than the leucite crystals found
in traditional feldspathic porcelainsin traditional feldspathic porcelains

Dicor – optical propertyDicor – optical property
 Dicor is a glass, it isDicor is a glass, it is
capable of producing acapable of producing a
“Chameleon Effect” ( i.e.“Chameleon Effect” ( i.e.
part of the colour of thepart of the colour of the
restoration is picked uprestoration is picked up
from the adjacent teeth asfrom the adjacent teeth as
well as from the cementwell as from the cement
used for luting theused for luting the
restoration).restoration).

DicorDicor
 Advantage :Advantage :
 Good marginal adaptationGood marginal adaptation
 Abrasiveness is same as that of the toothAbrasiveness is same as that of the tooth
 Chameleon effectChameleon effect
 Disadvantage:Disadvantage:
 Increased cost,Increased cost,
 Increased time of fabrication.Increased time of fabrication.
 When used for posterior crowns, ceramic crowns are mostWhen used for posterior crowns, ceramic crowns are most
susceptible to fracturesusceptible to fracture

DicorDicor
 Instead of using stains, alternative technique isInstead of using stains, alternative technique is
to cast the glass as a core and bake veneerto cast the glass as a core and bake veneer
shaded feldspathic porcelain over it. This isshaded feldspathic porcelain over it. This is
called ascalled as Willi’s glass.Willi’s glass.
 Color can then be built in layers.Color can then be built in layers.
 Dentsply has introducedDentsply has introduced Dicor PlusDicor Plus which is awhich is a
shaded feldspathic porcelain veneer applied toshaded feldspathic porcelain veneer applied to
the Dicor substratethe Dicor substrate

HEAT PRESSED CERAMICSHEAT PRESSED CERAMICS
 Leucite basedLeucite based
 Characterization (surface stain only)Characterization (surface stain only)
 Layering technique ( veneering)Layering technique ( veneering)
 IPS EMPRESS, optimal pressable , cerpress , FineeseIPS EMPRESS, optimal pressable , cerpress , Fineese
 Lithium silicate basedLithium silicate based
 Major crystalline phase is lithium silicateMajor crystalline phase is lithium silicate
 Layered with glass contained some dispersed apatite crystalsLayered with glass contained some dispersed apatite crystals
 IPS EMPRESS 2IPS EMPRESS 2

 These ceramics uses lost wax technique, butThese ceramics uses lost wax technique, but
unlike castable ceramics they are not cast. Theyunlike castable ceramics they are not cast. They
are pressed into the mold.are pressed into the mold.
 They are supplied as ingots which are melted atThey are supplied as ingots which are melted at
high temperature and pressed.high temperature and pressed.

IPS EmpressIPS Empress
 Leucite reinforced Ceramic Comes in Pre-Leucite reinforced Ceramic Comes in Pre-
cerammed cylinders ( ingots) of various shade.cerammed cylinders ( ingots) of various shade.
 Ingots are heated and molded under pressure toIngots are heated and molded under pressure to
produce restorations.produce restorations.
 Either full contour crown in wax and thenEither full contour crown in wax and then
stainedstained
 OR Wax pattern formed like a substructureOR Wax pattern formed like a substructure
(core material) which is later veneered by(core material) which is later veneered by
veneering porcelainveneering porcelain

 Insert a ceramic ingot of the appropriate shade and aluminaInsert a ceramic ingot of the appropriate shade and alumina
plunger in the sprue .plunger in the sprue .
 After heating to 1150After heating to 115000
c , the soften ceramic is slowly pressed intoc , the soften ceramic is slowly pressed into
the mold under vaccum .the mold under vaccum .

Pressable ceramic - FurnacePressable ceramic - Furnace

Recovering the restorationRecovering the restoration

PRESSABLE CERAMICPRESSABLE CERAMIC
 Veneering porcelainVeneering porcelain
 IPS Empress - EmpressIPS Empress - Empress
 IPS Empress 2 - Empress 2, ErisIPS Empress 2 - Empress 2, Eris
 Optec - optecOptec - optec
 Cergo - Ducera GoldCergo - Ducera Gold
 Vita Press - Vita OmegaVita Press - Vita Omega

MACHINABLE CERAMICSMACHINABLE CERAMICS
 ADVANTAGES:ADVANTAGES:
 No shrinkage after pressingNo shrinkage after pressing
 Stability of crown retained after several firingStability of crown retained after several firing
 High flexural strengthHigh flexural strength
 Increased marginal fitIncreased marginal fit
 DISADVANTAGE:DISADVANTAGE:
 Expensive.Expensive.
 Available only for single tooth restorationAvailable only for single tooth restoration

 These products are supplied as ceramic ingots inThese products are supplied as ceramic ingots in
various shades and are used in computer aidedvarious shades and are used in computer aided
designing-computer aided manufacturing (CAD-designing-computer aided manufacturing (CAD-
CAM) procedures.CAM) procedures.
 Ceramic ingots do not require further highCeramic ingots do not require further high
temperature processing.temperature processing.

 They are placed in a machining apparatus toThey are placed in a machining apparatus to
produce the desired contours .produce the desired contours .
 Can be made as core ceramic which can beCan be made as core ceramic which can be
veneered to obtain desired esthetics.veneered to obtain desired esthetics.
 The machined restoration can be stained or canThe machined restoration can be stained or can
be veneered by feldspathic porcelain to obtainbe veneered by feldspathic porcelain to obtain
desired characterization.desired characterization.

CEREC SYSTEMCEREC SYSTEM
Vita Block IVita Block I VidentVident
Vita Block IIVita Block II VidentVident
ProCadProCad IvoclarIvoclar
Dicor MGCDicor MGC DentsplyDentsply
Procera AllceramProcera Allceram Nobel biocareNobel biocare
DenzirDenzir DentronicDentronic
LavaLava 3M ESPE3M ESPE
CELAY (coping milling )CELAY (coping milling )
CelayCelay VidentVident
OPTICAL SCANNING MECHANICAL SCANNING

ADVANTAGESADVANTAGES
 Removes ceramic processing-Removes ceramic processing-
 Therefore micro structure control is in the hands ofTherefore micro structure control is in the hands of
manufacturer.manufacturer.
 Many properties (physical and optical ) are directlyMany properties (physical and optical ) are directly
dependent on how the ceramic is made.dependent on how the ceramic is made.
 Manufacturer merely provides a few sizes ofManufacturer merely provides a few sizes of
simple blocks and the complex shaping issimple blocks and the complex shaping is
controlled by the machining process.controlled by the machining process.
 Although the machining does lower the strengthAlthough the machining does lower the strength
of ceramics, strength is still equal or superior toof ceramics, strength is still equal or superior to
the strengths of lab fabricated ceramicsthe strengths of lab fabricated ceramics

 DISADVANTAGEDISADVANTAGE
 Gap between the restoration and tooth structure isGap between the restoration and tooth structure is
considerably wider than that in other type of ceramicconsiderably wider than that in other type of ceramic
systems .systems .

(Sirona Dental System, Germany)(Sirona Dental System, Germany)
 CERamic + REConstructionCERamic + REConstruction
 The basic philosophy of the CEREC unit was toThe basic philosophy of the CEREC unit was to
associate an optical impression method with aassociate an optical impression method with a
computer-driven fabrication module in a single mobilecomputer-driven fabrication module in a single mobile
workstation. The system development includedworkstation. The system development included
computer-aided 3-D imaging-designing and numericallycomputer-aided 3-D imaging-designing and numerically
controlled machining of the restoration.controlled machining of the restoration.

CerecCerec
 CEREC was first CAD/CAM system inCEREC was first CAD/CAM system in
restorative dentistry.restorative dentistry.
 Cerec I was introduced in 1985.Cerec I was introduced in 1985.
 Second generation Cerec system i.e. Cerec-2,Second generation Cerec system i.e. Cerec-2,
was introduced in 1994.was introduced in 1994.
 Third generation Cerec system i.e. Cerec-3, wasThird generation Cerec system i.e. Cerec-3, was

PROCEDUREPROCEDURE

CerecCerec
 There is difference in reflection and absorption of theThere is difference in reflection and absorption of the
incident light angles and dissimilar optical properties ofincident light angles and dissimilar optical properties of
dental tissues. Therefore entire field of view should bedental tissues. Therefore entire field of view should be
coated with a thin opaque layer.coated with a thin opaque layer.
 This Titanium oxide layer over prepared toothThis Titanium oxide layer over prepared tooth
produces a highly uniform scattering of light which isproduces a highly uniform scattering of light which is
appropriate for optical impression.appropriate for optical impression.

ADVANTAGESADVANTAGES
 Good strength and fracture resistance.Good strength and fracture resistance.
 No impression makingNo impression making
 Very low porosityVery low porosity
 Take very less time for fabrication( 20 mins,Take very less time for fabrication( 20 mins,
3-5 mins for cerec 3)3-5 mins for cerec 3)
 Meant for a chair side approach. No need ofMeant for a chair side approach. No need of
sending to lab. Need for only onesending to lab. Need for only one
appointmentappointment

DISADAVNTAGEDISADAVNTAGE
 Equipment is costly.Equipment is costly.
 Technique sensitive nature of surface imaging.Technique sensitive nature of surface imaging.
 Marginal fit not as good as other systems.Marginal fit not as good as other systems.

Advantage of cerec 3Advantage of cerec 3

ProCADProCAD
 It is a new Cerec ceramic material based on leucite-It is a new Cerec ceramic material based on leucite-
reinforced glass-ceramics with increased strength.reinforced glass-ceramics with increased strength.
 ProCAD BlocksProCAD Blocks
 –– VeneersVeneers
 –– Partial crownsPartial crowns
 –– Anterior andAnterior and
posterior crownsposterior crowns

PROCERA ALL CERAM SYSTEMPROCERA ALL CERAM SYSTEM
(Nobel Biocare)(Nobel Biocare)
 PROCERA system was introduced in 1986.PROCERA system was introduced in 1986.
 Initially it was used to fabricate crowns andInitially it was used to fabricate crowns and
FPDs by combining a Titanium substructureFPDs by combining a Titanium substructure
with a low fusing veneering porcelain.with a low fusing veneering porcelain.
 Later in 1993 it was used to produce AllLater in 1993 it was used to produce All
ceramic crowns.ceramic crowns.
 The crown is composed of a densely sintered,The crown is composed of a densely sintered,
high purity aluminium oxide coping that ishigh purity aluminium oxide coping that is
combined with a low fusing veneering porcelain.combined with a low fusing veneering porcelain.

PROCEDUREPROCEDURE
 Procera® PiccoloProcera® Piccolo
 enables single toothenables single tooth
scanning for crowns,scanning for crowns,
laminates and abutments.laminates and abutments.
 Procera® ForteProcera® Forte
 scan crowns, laminatesscan crowns, laminates
and abutments as well asand abutments as well as
bridges.bridges.

ProceraProcera
Within 3 mins , more than 50,000 data points areWithin 3 mins , more than 50,000 data points are
gathered , defining the three dimensional shape of the diegathered , defining the three dimensional shape of the die
Then the margins are marked in the two diemensionalThen the margins are marked in the two diemensional
plotsplots

ProceraProcera
 Next step in designing is to establish theNext step in designing is to establish the
thickness of the coping to be fabricated.thickness of the coping to be fabricated.
 Relief space for the luting agent is automaticallyRelief space for the luting agent is automatically
established by computer algorithm .established by computer algorithm .
 File saved in computer and transferred to theFile saved in computer and transferred to the
production station (Switzerland)production station (Switzerland)

ProceraProcera
 Sintering shrinkage of 20% is taken intoSintering shrinkage of 20% is taken into
account, so enlarge model of the preparation isaccount, so enlarge model of the preparation is
made with the help of the CAD-CAMmade with the help of the CAD-CAM
technique.technique.
 High purity aluminum oxide powder isHigh purity aluminum oxide powder is
compacted against the enlarged die .compacted against the enlarged die .
 The outer surface is milled and the coping isThe outer surface is milled and the coping is
sintered to full density .sintered to full density .
 Then veneering porcelain is addedThen veneering porcelain is added

LAVA CAD-CAM SYSTEMLAVA CAD-CAM SYSTEM
((3M ESPE)3M ESPE)
 The ceramic framework consists of zirconiaThe ceramic framework consists of zirconia
supplemented by a specially designed overlaysupplemented by a specially designed overlay
porcelain (Lava Ceram). The frameworks areporcelain (Lava Ceram). The frameworks are
fabricated using CAD/CAM manufacturingfabricated using CAD/CAM manufacturing
techniques and uses pre-sintered zirconia blankstechniques and uses pre-sintered zirconia blanks

LAVA SYSTEMLAVA SYSTEM

LAVALAVA
 ADVANTAGEADVANTAGE
 Superior strength of zirconia with high fractureSuperior strength of zirconia with high fracture
resistance Flexural strength >1100 MParesistance Flexural strength >1100 MPa
 Ideal for 3 and 4 unit bridge, crownsIdeal for 3 and 4 unit bridge, crowns
 Good marginal fit.Good marginal fit.
 Lava Frame zirconia is particularly suitable forLava Frame zirconia is particularly suitable for
posterior bridge frameworks and for long spans.posterior bridge frameworks and for long spans.

CELAY SYSTEMCELAY SYSTEM
(MIKRONA TECHNOLOGIES)(MIKRONA TECHNOLOGIES)
 Uses copy milling technique.Uses copy milling technique.
 This system is based on a mechanical device that is usedThis system is based on a mechanical device that is used
to trace the surface of a prefabricated pattern of ato trace the surface of a prefabricated pattern of a
designed restoration made from a blue resin baseddesigned restoration made from a blue resin based
composite( Celay-tech, ESPE).composite( Celay-tech, ESPE).
 The resin pattern can be produced directly on theThe resin pattern can be produced directly on the
prepared tooth or indirectly on dies made fromprepared tooth or indirectly on dies made from
impression. As the tracing tool passes over the pattern aimpression. As the tracing tool passes over the pattern a
milling machine duplicates these movements and grindsmilling machine duplicates these movements and grinds
a copy of this pattern from block of aluminaa copy of this pattern from block of alumina

CelayCelay

CelayCelay
 AdvantageAdvantage
 Improved strengthImproved strength
 Better marginal adaptation as compared to CerecBetter marginal adaptation as compared to Cerec
system.system.

Comparison of different Metal freeComparison of different Metal free
ceramic systemsceramic systems
4 groups of ceramic systems used for porcelain4 groups of ceramic systems used for porcelain
laminate veneers were comparedlaminate veneers were compared
Systems compared wereSystems compared were
1.1. Feldspathic porcelain baked using traditionalFeldspathic porcelain baked using traditional
powder-water slurry methodpowder-water slurry method
2.2. Castable ceramicsCastable ceramics
3.3. Heat pressed ceramicsHeat pressed ceramics
4.4. Machinable ceramicsMachinable ceramicswww.indiandentalacademy.com

Feldspathic porcelainFeldspathic porcelain
 Advantage: Allow minimal veneer thickness ofAdvantage: Allow minimal veneer thickness of
0.3mm,therefore the amount of tooth structure0.3mm,therefore the amount of tooth structure
that has to be removed for preparation can bethat has to be removed for preparation can be
kept to minimumkept to minimum
 Disadvantage: Feldspathic porcelain are brittleDisadvantage: Feldspathic porcelain are brittle

Castable ceramics and Heat pressedCastable ceramics and Heat pressed
ceramicsceramics
 They offer greater flexural strength when veneerThey offer greater flexural strength when veneer
thickness is more than 0.5 mm therefore thethickness is more than 0.5 mm therefore the
preparation must be 0.6 to 0.8 mm in thickness –preparation must be 0.6 to 0.8 mm in thickness –
conflicts with conservative nature of theconflicts with conservative nature of the
restorationrestoration

Machinable CeramicsMachinable Ceramics
 Veneer restorations produced by CAD/CAM or CopyVeneer restorations produced by CAD/CAM or Copy
Milling techniques result in a mean interfacial gapMilling techniques result in a mean interfacial gap
between the restoration and the tooth structure , that isbetween the restoration and the tooth structure , that is
considerably wider than that of other all-ceramicconsiderably wider than that of other all-ceramic
systemssystems
 Although this gap is filled with composite resinAlthough this gap is filled with composite resin
cement ,the cement itself will be subjected to wear,cement ,the cement itself will be subjected to wear,
which may impair long term success.which may impair long term success.

Metal reinforced systemsMetal reinforced systems
 Eg. CaptekEg. Captek
 Involves adaptation of two metal imprignatedInvolves adaptation of two metal imprignated
wax sheets and firedwax sheets and fired
 First layer forms platinum palladium layer on theFirst layer forms platinum palladium layer on the
diedie
 Second layer forms gold platinum layerSecond layer forms gold platinum layer
 Build up body with opaque and incisal porcelainBuild up body with opaque and incisal porcelain
simillar to conventional metal ceramicssimillar to conventional metal ceramics

Selection of all ceramicsSelection of all ceramics
 Fracture resistanceFracture resistance
 EstheticsEsthetics
 AbrasivenessAbrasiveness

Choice of systemChoice of system
 Single crownSingle crown
 CaptekCaptek
 Inceram spinellInceram spinell
 inceraminceram
 Cercon zirconiaCercon zirconia
 Procera aluminaProcera alumina
 Procera zirconiaProcera zirconia

 Inlays onlays and veneersInlays onlays and veneers
 Ceramco 3Ceramco 3
 IPS EmpressIPS Empress
 FinesseFinesse
 In – ceramIn – ceram
 In-ceram spinellIn-ceram spinell
 Mark IIMark II
 ProCADProCAD

 Fixed Dental ProsthesisFixed Dental Prosthesis
AnteriorsAnteriors
 IPS Empress IIIPS Empress II
 In-Ceram ZirconiaIn-Ceram Zirconia
 All machinableAll machinable
PosteriorsPosteriors
 Inceram ZirconiaInceram Zirconia
 All machinableAll machinable

Marginal fit and enamel abrasivenessMarginal fit and enamel abrasiveness
 Excellent marginal fitExcellent marginal fit
 CaptekCaptek
 Fair marginal fitFair marginal fit
 ALL OTHER TESTED ALL CERAMICSALL OTHER TESTED ALL CERAMICS
 High abrasivenessHigh abrasiveness
 In-Ceram ( all types )In-Ceram ( all types )
 Very low enamel abrasivenessVery low enamel abrasiveness
 IPS Empress2IPS Empress2

ETCHING AND SILANATINGETCHING AND SILANATING
 Support the restoration in soft wax with theSupport the restoration in soft wax with the
fitting surface upper mostfitting surface upper most
 Apply 1 mm coat of etching gel to the fittingApply 1 mm coat of etching gel to the fitting
surface onlysurface only
 The etching time depends on the ceramicThe etching time depends on the ceramic
material (feldspathic porcelain etched for 5 min)material (feldspathic porcelain etched for 5 min)
 Very carefully rinse away under running waterVery carefully rinse away under running water
and dry it.and dry it.
 Apply silane according to manufactureApply silane according to manufacture
recommendationsrecommendations

CONCLUSIONCONCLUSION
 For many years all ceramic crowns were the material ofFor many years all ceramic crowns were the material of
choice to produce esthetic restorations.choice to produce esthetic restorations.
 Research and developments were carried out toResearch and developments were carried out to
improve strength comparable to metal ceramicimprove strength comparable to metal ceramic
restorationsrestorations
 Unfortunately the marginal fit of all all-ceramicUnfortunately the marginal fit of all all-ceramic
restorations were not comparable to metal ceramic.restorations were not comparable to metal ceramic.
 The long term clinical experience and research were stillThe long term clinical experience and research were still
lacking and hence the choice of all ceramic left to thelacking and hence the choice of all ceramic left to the
dental practitioner.dental practitioner.

Thank you
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All ceramics clinical/academy of orthodontics

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