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Ceramic CAD/CAM Materials: An Overview of Clinical Uses and Considerations

Technical Report · April 2017

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Ceramic CAD/CAM Materials: An Overview of Clinical Uses

and Considerations
Abstract: Minimum Strength Requirements for Common Indications
Ceramic CAD/CAM materials have become popular among Indication Minimum Strength
dentists whose patients are looking for a metal-free or Inlay, Onlay or Veneer 50 MPa
more natural-looking option for indirect restorations. The Adhesively Cemented Single Crown 100 MPa
significant advances in digital fabrication techniques and Single Crown 300 MPa
the development of newer, stronger ceramic materials give Three-unit Fixed Dental Prostheses (No Molars) 300 MPa
practitioners the ability to combine esthetics with durability. Three-unit Fixed Dental Prostheses (Molars) 500 MPa
Although an improved spectrum of materials provides clinicians Long-Span Fixed Dental Prostheses 800 MPa
with many options, it can be challenging to determine which s Table 1. Minimum strength requirements for key indications
one is the best fit for a given situation. All-ceramic CAD/CAM according to ISO 6872.
materials differ in composition, material properties, processing
methods and clinical indications, all of which work together
this review are quick reference guides on the different ceramic
when determining a material’s best use. For this reason, it is
CAD/CAM materials, which can assist dentists in selecting the
imperative that dentists understand the different classes of
best material for a particular treatment.
ceramic CAD/CAM materials available to them.

Broadly speaking, the flexural strength of a ceramic material Introduction:

has traditionally been used to determine its appropriate
usage. ISO 6872 establishes specific minimum strength
guidelines for a ceramic material’s particular clinical indication
(Table 1). These guidelines factor into manufacturers’ clinical
recommendations (Figure 1), but additional factors can
impact the success of ceramic materials in various clinical
scenarios. For instance, ceramic restorations have been shown
to fail clinically under fatigue, as the functional forces enable
internal flaws to form cracks, similar to those that form in
a car windshield. Exploring and understanding the relevant
properties and material-specific options can help dentists to
make the best decisions for their patients.
The following review explores three key classes of ceramic
materials for CAD/CAM restorations –zirconia, glass-ceramics
and resin-ceramic composites. This review is intended to
provide clinicians with an increased understanding of key
properties, processing considerations, delivery modes, shade
options and recommended surface treatments. Included in
Historically, metals were commonly used in posterior
restorations because of their strength and durability. The
demand for more esthetic restorations led to an exploration of
alternative materials, including ceramics. Feldspathic porcelain
crowns were the first foray into all-ceramic restorations,
but the brittle nature of porcelain limited its use to anterior
restorations. In the 1950s, dentists began using porcelain
bonded to metal. This process strengthened the restoration
and led to the common use of metal-ceramic restorations
in clinical scenarios where strength and durability were vital.
Despite their desirable mechanical properties, the opacity of
the metal coping used in metal-ceramic restorations limits
their ability to mimic the natural tooth.
The quest for stronger materials with a more natural appearance
led to further development of ceramic restorative materials. The
introduction of glass-ceramics and polycrystalline materials with
higher strength, such as aluminum oxide and zirconium oxide-
based ceramics, allowed for the use of all-ceramic restorations

Continued on next page

1 ADA Professional Product Review  I  April 2017  I  V12 (1)  I  ADA.org/ppr
 Continued from page 1
in posterior crowns and fixed dental prostheses (FDPs), which
are subjected to higher load levels than anterior crowns. Despite
having a more natural appearance than their metal-based
predecessors, there is always a trade-off between strength
and translucency in dental ceramics. Higher strength ceramics
are predominantly crystalline, which gives a more opaque
appearance. As a result, crystalline ceramics are often used as
a framework in a bilayer restoration with a feldspathic porcelain
veneer. On the other end of the spectrum, highly aesthetic
dental ceramics are predominantly glassy, which allows them
to be more translucent (Figure 2), but can make them relatively
weaker when compared to crystalline ceramics. The continued
search for strong, natural-looking ceramic materials has led to
the development of glass-ceramics and polycrystalline ceramics,
which can be used in a single layer.
Along with newer materials, there has been a simultaneous
advancement in fabrication techniques for ceramic
restorations. There has been a shift from the traditional hand
Common Uses of Ceramic Materials
Framework zirconia
Full-contour zirconia
1000
800
Flexural strength (MPa)
600 Cubic zirconia
400
LDS
200
RCC
P
0
I/O/V Single 3-Unit FDP 3-Unit FDP
crowns (No molars)
KEY:
I/O/V (Inlay, Onlay, Veneer)
LDS (Lithium disilicate-based ceramics)
P (Feldspathic porcelains)
s Figure 1. Manufacturers base their clinical indications in large
part on minimum strength requirements established by ISO 6872.
However, strength is only one of the many factors to consider
when choosing restorative materials.
2 ADA Professional Product Review  I  April 2017  I  V12 (1)  I  ADA.org/ppr
layering or powder-condensation technique to CAD/CAM
technology. With CAD/CAM systems, the oral environment is
captured using intraoral or laboratory scanners, and the data
is used to design and mill the restoration digitally. This process
reduces human error and labor, and can allow for faster, more
consistent restoration processing. Unlike traditional methods,
CAD/CAM materials are available as “green stage,” or partially
sintered blanks, which are porous and enable fast cutting
without fracture. Once milled, additional sintering is necessary
to obtain the material’s desired mechanical properties.
There are a wide variety of materials available for CAD/CAM
restorations, each differing in terms of their microstructure,
strength, translucency, and clinical indications. In light of
these differences, the material selection plays an important
role in the esthetics and long-term success of restorations.
The following sections explore three major classes of ceramic
materials for CAD/CAM restorations – zirconia, crystalline
glass-ceramics and resin-ceramic composites. n
Strength and Translucency of Ceramic Materials
Feldspathic porcelain
A
Glass-ceramics
Translucency
B
Polycrystalline ceramics (zirconia)
C
Multi-unit
(with molars) FDP
Flexural strength
RCC (Resin-ceramic composites)
FDP (Fixed dental prostheses)
s Figure 2. From (A) to (C), the crystal content increases, while the
glass phase content decreases. The strength of a ceramic increases
with an increase in crystal content, while the translucency decreases
with a decrease in glass content. Feldspathic porcelain with the
highest glass (silica) content shows the most translucency, while
zirconia with the highest crystal content shows the most strength.
Continued on next page
 ZIRCONIA
Zirconia ceramics were introduced in dentistry more than
a decade ago and quickly gained popularity due to their
outstanding mechanical properties and the availability of
CAD/CAM machining. Pure zirconia exists in three crystal
structures – monoclinic, tetragonal and cubic. A common
form in dentistry is yttria- stabilized zirconia, in which
the tetragonal phase is stabilized at room temperature by
adding yttria. While traditionally used in bilayer restorations,
improvement in translucency means some forms of zirconia
can also be used for monolithic, single layer restorations.
Figure 3 highlights major characteristics of three types
of dental zirconia. The main differences lie in the alumina
and yttria contents, which can impact the strength and
translucency.
Types
Framework Zirconia:
Indications: Framework zirconia is indicated for multi-unit
bridge frameworks for the anterior and posterior regions.
It provides an alternative to porcelain-fused-to-metal
(“PFM”) and full metal restorations.
Emerging Product: Cubic Zirconia
Indications: Cubic zirconia is most suited for single
crowns or anterior three-unit bridges. It provides a
stronger alternative to glass-ceramics and a more
translucent alternative to full-contour zirconia.
Key properties: The desire to use zirconia in more esthetic
restorations required a more natural appearance, which
resulted in the recent development of cubic zirconia.
Increased levels of yttria (>5 mol% yttria) and a high
proportion of cubic phase give it more translucency. While
the translucency of cubic zirconia is better than that of
full-contour zirconia, it is still inferior to that of glass-
ceramics and feldspathic porcelains.
There are a few disadvantages to cubic zirconia when
compared to other types of zirconia. Its higher cubic
phase content makes it more brittle, allowing easier crack
propagation, and it does not exhibit the transformation
toughening found in other types of zirconia. Because of its
susceptibility to fracture, caution should be exercised in its
handling and grinding. Cubic zirconia demonstrates a lower
flexural strength at 500-700 MPa, and due to its recent
introduction to the market, its fracture toughness has not
yet been reported. n
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Evolution of Zirconia Ceramics
2014
2009
Cubic Zirconia
Early • Yttria: >5 mol%
2000s
Full-Contour Zirconia
• Yttria: ~3 mol% • Alumina: ~0.05%
• Alumina: ~0.05%
Framework Zirconia
• Yttria: ~3 mol%
• Alumina: ~0.25%
s Figure 3. The development of the three main types of dental
zirconia was characterized by changing amounts of yttria and
alumina, which influence a restoration’s strength and translucency.
Key Properties: Framework zirconia is opaque due to its
higher alumina content (~0.25%). It is veneered with a more
translucent feldspathic porcelain or glass-ceramic to create a
more natural appearance. The material proved to be valuable
for dentists looking for an alternative to metal frameworks.
Currently, the most commonly-used composition for
framework zirconia is 3 mol% yttria-stabilized tetragonal
zirconia, which is still quite opaque.
Zirconia owes its excellent mechanical properties to a
unique process of transformation toughening. Upon
application of external stress, the material expands in
volume, which inhibits crack propagation and enhances the
toughness of the material. The flexural strength (900-
1400 MPa) and fracture toughness (5-9 MPa.m1/2) are the
highest among dental ceramics.
Full-contour zirconia
Indications: Full-contour zirconia is a preferred choice of
many practitioners for molar single crowns and posterior
multi-unit bridges. It can provide an alternative to gold
crowns and PFM restorations.
Key properties: Compared to framework zirconia, full-
contour zirconia’s lower alumina content (~0.05%) gives
it improved translucency, and makes it more appropriate
as a monolithic (single-layer) material. Unlike bi-layer
restorations, monolithic restorations are fabricated in a
single process and are quickly becoming popular for use in
the posterior region
Like framework zirconia, full-contour zirconia is commonly
3 mol% yttria-stabilized zirconia and demonstrates similar
transformation toughening. The two materials also have
See ZIRCONIA page 4
 ZIRCONIA (continued)
similar flexural strength and fracture toughness. While the
wear of antagonist enamel was first thought to be a concern
when using monolithic zirconia, this has been shown to be
alleviated by the maintenance of a polished surface finish.
Polished zirconia results in less of wear of antagonist enamel
(and the material itself) versus glazed zirconia, and causes
less antagonist wear than feldspathic porcelain or glass-
ceramics1.
Format and Processing:
Zirconia is available in partially sintered blocks or discs that
are available in a variety of sizes to accommodate different
restoration sizes and can be used for dry or wet milling.
Some blocks and discs require specific milling machines, so
it is important to verify a particular product’s compatibility.
The milled restorations are sintered at a high temperature
(1400-1600ºC) and that typically take several hours to
complete. The sintering protocol is specific to the product,
and a strict adherence to those guidelines is necessary to
achieve optimal strength, translucency and color.
Shade Options:
Traditionally, tooth color reproduction with zirconia has
been a challenge, and manufacturers have approached it
in several ways. Some manufacturers offer zirconia in 16
classic VITA shades, while other manufacturers offer a few
base shades that can be combined with coloring liquids to
provide the desired look. However, these liquids may result
in non-uniform surface coloring, caused by the porosity
variation (gradient) that occurs during processing. Another
concern with coloring liquids is the grinding for occlusal
adjustments, which may result in lighter colored areas.
Another way that some manufacturers approach coloring
is to mimic the decreasing intensity of color (chroma)
from the cervical to incisal area found in natural teeth.
This is done with multilayered discs, which provide a color
gradient from the cervical to incisal area of the restoration,
and is intended to give the restoration a more life-like
appearance. Figure 4 provides a schematic diagram of a
cross-section of such a disc.
Cementation and Bonding:
In preparations with adequate retention form, zirconia
restorations can be cemented using traditional cements
following the protocol used for metal crowns. The bonding
of zirconia to tooth structure is problematic due to a lack
of glassy phase for acid etching and lack of silica for resin
bonding. However, where there is less than optimum
4 ADA Professional Product Review  I  April 2017  I  V12 (1)  I  ADA.org/ppr
Monochromatic versus Chroma Gradient
A B
Incisal third
Middle third
Cervical third
s Figure 4. This figure illustrates two color options for zirconia
restorations. While some manufacturers utilize monochromatic blocks
(A), others offer blocks with a chroma gradient, which decreases in
saturation from cervical area to incisal edge and mimics the more
natural color gradations of teeth (B).
retention form, the use of resin cement may improve the
bonding and integrity of the tooth-crown complex. While
there is no consensus regarding the bonding protocol
for zirconia, one common approach is a combination of
mechanical roughening (sandblasting with alumina or
silica-coated alumina) followed by the use of a primer or
resin cement containing 10-methacryloxydecyl dihydrogen
phosphate (MDP)2. The roughening increases the surface
area for bonding, while MDP improves the resin cement’s
chemical bonding. It is important to note that the use
of large alumina particles and high air pressure while
sandblasting may have a negative impact on the strength.
Therefore, using an abrasive particle size of less than
50µm and an air pressure of 0.1-0.25 MPa (15 -36 psi) is
recommended. n
Clinical Note: Some zirconia materials are susceptible
to surface degradation at body temperature in the
presence of water. This spontaneous transformation of
tetragonal to monoclinic phase can potentially degrade
the strength of the material, leading to premature
failure. This phenomenon is called low temperature
degradation (LTD). The decrease in strength has been
observed after small amounts of monoclinic content
present in the initial stages increases to approximately
fifty percent. Grain size can be another factor in LTD.
Reducing the grain size of zirconia increases stability
of tetragonal phase, increasing the resistance to LTD3.
Since cubic zirconia has a higher yttria content and only
a small amount of tetragonal phase, it is less susceptible
to LTD than the other types of zirconia.
1. In vitro wear behavior of zirconia opposing enamel: a systematic review.
2. Bonding to oxide ceramics—laboratory testing versus clinical outcome.
3. Low temperature degradation -aging- of zirconia: A critical review of the
relevant aspects in dentistry.
 GLASS-CERAMICS
The first CAD/CAM ceramic used in dentistry was
composed of feldspathic porcelain, which has a similar
composition as that of the traditional hand-layered
porcelain. Feldspathic CAD/CAM materials are still
available on the market, and because of their excellent
esthetic properties, are mainly indicated for veneers
and inlays. The feldspathic porcelains were followed by
leucite-reinforced porcelains with improved flexural
strength (~160 MPa). However, feldspathic porcelains
and leucite-based porcelains are being replaced with
even stronger glass-ceramics. Glass-ceramics have
a glassy matrix similar to feldspathic porcelains and
a crystal phase embedded in the matrix. The glassy
component creates a translucency similar to that of a
natural tooth, while the crystal phase imparts better
mechanical properties. This section focuses on three
of the most commonly used glass-ceramics, which
have a crystalline lithium disilicate embedded in the
glassy matrix (i.e. “lithium disilicate-based ceramics”).
Types:
Lithium disilicate ceramics (LDS):
Indications: LDS is a versatile material that
provides an excellent combination of strength and
translucency. LDS is available in both high and low
translucency blocks. The high translucency blocks are
recommended for anterior veneers, inlays or onlays,
while the low translucency blocks are preferred for
anterior single crowns and three-unit anterior bridges.
Additionally, LDS could be considered for posterior
single crowns with limited retention or patients with
higher esthetic demands.
Key properties: LDS was first introduced as a
substructure material to be veneered with feldspathic
porcelain. Later improvements in optical and
mechanical properties allowed it to be used in a single,
monolithic layer, avoiding the problems of veneer
chipping. The material was later introduced as a CAD/
CAM material, which could be also used for chairside
milling. LDS is more translucent than all three types of
zirconia and stronger than other glass-based ceramics.
Its flexural strength ranges between 250-400 MPa,
while its fracture toughness is approximately 2-2.5
MPa.m1/2. Glazed ceramics wear opposing dentition
more than polished ceramics. Additionally, milled
LDS is more abrasive than its pressed counterpart.
Therefore, it is recommended that dentists or
5 ADA Professional Product Review  I  April 2017  I  V12 (1)  I  ADA.org/ppr
technicians polish the restoration to remove the
milling marks before sintering.
Zirconia-reinforced lithium silicate (ZRS) and
lithium silicate (LS):
Indications and Key Properties: Zirconia-reinforced
lithium silicate (ZRS) and lithium silicate (LS) were
both developed as alternatives to LDS. Unlike LDS,
the glassy matrix of ZRS has 10% dissolved zirconia in
addition to lithium disilicate and lithium metasilicate
crystals. Because these materials have similar
translucency, flexural strength and fracture toughness
to LDS, they have similar clinical indications.
Format and Processing:
Glass-ceramics are available in partially crystallized
blocks and can be easily milled in this stage. The heat
treatment they receive in this phase is how they
attain their final strength and translucency. LDS is
available in blue-colored blocks (“blue state”), which
have lithium meta-silicate and lithium disilicate nuclei.
Once milled, the restorations are then heated to
850ºC (in vacuum) for 20-25 minutes. The material
has ~70% lithium disilicate crystals by volume at this
stage, which changes the material from blue to tooth-
colored. The processing of ZRS differs from LDS in
that it can be used with or without sintering. However,
the strength of pre-sintered ZRS is lower (~200 MPa)
than its sintered counterpart (300-400 MPa).
Shade Options:
LDS blocks are available in VITA A-D shades and a
variety of translucencies, including low translucency
(LT), high translucency (HT), and medium opacity
(MO). MO blocks are recommended for masking a
discolored tooth stump or as a substructure, but
require a feldspathic porcelain veneer.
Cementation and Bonding:
Because of the presence of glassy phase, LDS
restorations can be used with adhesive cementation
but require a prior surface treatment. The
recommended surface treatment is etching with 5%
hydrofluoric acid (HF) followed by the application of
a silane primer. While manufacturers recommend the
same surface treatment for ZRS and LS materials,
there is no long-term history of clinical use available
for either material. n
 RESIN-CERAMIC COMPOSITES
The availability of CAD/CAM technology led to the
development of composite materials with new curing modes,
compositions and microstructures. As a result, indirect
composites have evolved in the last few years. While there
are two distinct approaches for manufacturing resin-ceramic
composite (RCC) blocks – dispersed fillers in polymer matrix
(similar to direct composites) and infiltration of sintered
ceramic with polymer matrix (interpenetrating phase network
or IPN), — they both have very similar characteristics and uses.
Types:
Dispersed fillers composites and IPN Composites
Indications: Both types of indirect CAD/CAM composites
provide an alternative to glass-ceramics for inlays, onlays and
veneers.
Key properties: RCCs have a translucency similar to that of
glass-ceramics, but have superior mechanical properties than
those of light-cured direct composites. The flexural strength
is approximately 100-200 MPa, and the fracture toughness
ranges from 0.8 to 1.2 MPa.m1/2.
Both dispersed filler composites and IPN composites are
more flexible in response to masticatory forces than glass-
ceramics due to their lower elastic modulus (10-15 GPa and
25-30 GPa, respectively, compared to the 60-100 GPa of
glass ceramics). They are also less abrasive to the opposing
dentition than glass-ceramics.
CLINICAL PERSPECTIVE ON CERAMIC CAD/CAM ALTERNATIVES
While the information above can be used to make decisions
on the best material for a specific clinical situation, Figure 5
provides an easy-to-use reference guide for the materials
discussed, while Figure 6 looks at the conventional materials
and ceramic CAD/CAM alternatives for five key clinical
indications.
Inlays, Onlays, and Veneers:
Most materials meet the minimum strength requirement of
50 MPa for inlays, onlays and veneers. However, adhesive
cementation and esthetics are crucial factors, and among
those to consider when selecting a material. LDS and RCC
are often chosen for several reasons: LDS provides better
mechanical properties and esthetics, while RCC is easy to
fabricate and requires less chair time.
6 ADA Professional Product Review  I  April 2017  I  V12 (1)  I  ADA.org/ppr
Format and Processing:
RCCs are available as polymerized blocks of different sizes
and do not need further sintering after milling. Because
these materials are easy to mill, there is less milling time and
bur wear, and they show less marginal chipping than glass-
ceramics. This makes them an attractive option for chairside
milling. Another benefit to RCCs is that they are chemically
similar to direct composite materials, making them easy to
repair.
Shade Options:
The blocks or discs are available in VITA A-D shades and in
two levels of translucencies.
Cementation and Bonding:
Adhesive cementation is recommended for RCCs, and similar
techniques can be used for both types. For dispersed fillers
composites, the recommended process involves sandblasting
with alumina (50 µm) at an air pressure of 0.1-0.25 MPa
(15 – 36 psi), followed by an application of silane primer. The
sandblasting roughens the surface, while the silane primer
improves chemical bonding with the resin cement. While the
same procedure can be used for IPN, etching with 5% HF can
substitute for sandblasting, which results in the dissolution of
the ceramic and creates a rough surface for bonding. n
Anterior Single Crowns:
For anterior single crowns, LDS restorations provide an
excellent combination of esthetics and strength. They
provide better mechanical properties than feldspathic
or leucite-reinforced porcelains and improved esthetics
compared to the traditional PFM.
Posterior Single Crowns:
With its high strength and low cost, full-contour zirconia
provides an alternative to conventional full-metal crowns
and PFMs. As a single layer restoration, it requires
less manufacturing time than PFM, but provides less
translucency. LDS is preferred for low retention preparations
over zirconia because of its improved bonding, and should
also be considered for patients whose wide smiles call for a
more natural appearance in the molar region.
See CLINICAL PERSPECTIVE page 7
 CLINICAL PERSPECTIVE (continued)

Anterior Three-Unit Fixed Dental Prostheses (FDP):
The adequate strength and excellent esthetics of LDS make it
a good option for anterior three-unit FDPs, while a bi-layered
option - such as porcelain-fused-to-zirconia (PFZ) - can be
used in situations where strength is more important than
esthetics.
Posterior Three-Unit/Multi-Unit Fixed Dental
Prostheses (FDP):
Strength is a primary requirement in the posterior region. Full-
contour zirconia is a high-strength, single-layer restorative
material that can be used instead of more conventional metal
or PFM options. The bi-layered PFZ also provides adequate
strength and esthetics in such situations. n

Links of Interest
ISO 6872: 2015, Dentistry – Ceramic Materials
Current status of zirconia restoration
Making yttria-stabilized tetragonal zirconia translucent Join us at ADA 2017!
The Product Evaluation team hopes to see you in
Damage and reliability of Y-TZP after cementation surface
Atlanta for networking events and valuable clinical
treatment.
information on CAD/CAM solutions, including:
Fatigue behavior in water of Y-TZP zirconia ceramics after
abrasion with 30 µm silica-coated alumina particles. Continued Education
• State-of-the-Art Surface Treatments for Luting
Low-temperature degradation of Y-TZP ceramics: of All-Ceramic Restorations (Multiple Sessions)
A systematic review and meta-analysis.
• Material Selection for CAD/CAM Restorations
Ceramic dental biomaterials and CAD/CAM technology: (Course Code: 5809)
state of the art
ACE Panel Reception
From Artisanal to CAD-CAM Blocks: state of the art of Learn more about the ACE Panel and network with
indirect composites current members on Thursday, October 19 from
Resin-composite blocks for dental CAD/CAM applications 5:00 - 6:30 p.m. at the Omni Hotel International,
Ballroom E.
Effect of elasticity on stress distribution in CAD/CAM dental
crowns: Glass ceramic vs. polymer-matrix composite. Visit ADA.org/meeting for full course and speaker
information.

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 CAD/CAM Materials: Key Properties and Clinical Indications
Framework Zirconia Full-Contour Zirconia Cubic Zirconia Lithium Disilicate-Based Resin-Ceramic
Materials Composites
Preferred High Translucency
Indications

Low Translucency

Flexural 900 - 1400 900 - 1400 500 - 700 250 - 400 100 - 200
Strength (MPa)
Relative H HH HHH HHHH HHHH
Translucency
Fracture 5-9 5-9 NR 2 - 2.5 0.8 - 1.2
Toughness
(MPa.m1/2)
Machinability HH HH HH HHH HHHHH
Processing Time H HH HH HHH HHHHH
Adhesion to H H H HHH HHH
Tooth Structure
Chairside Option No Possible No Yes Yes
Ease of Retrieval H H HH HHH HHHH
Commercial •  Cercon (Dentsply •  BruxZir NOW •  BruxZir Anterior •  Celtra Duo (Dentsply Sirona) •  CAMouflage NOW
Examples Sirona) (Glidewell Laboratories) (Glidewell •  IPS e.max CAD (Ivoclar (Glidewell
•  Clinical Zirconia •  BruxZir Shaded Laboratories) Vivadent) Laboratories)
(Glidewell Laboratories) (Glidewell Laboratories) •  Cercon xt (Dentsply •  Obsidian (Glidewell •  CERASMART
•  In-Ceram Classic •  BruxZir Shaded 16 Sirona) Laboratories) (GC America)
Zirconia (VITA North (Glidewell Laboratories) •  Katana ST (Kuraray •  VITA Suprinity (VITA North •  LAVA Ultimate (3M) 
America)  •  Cercon HT Noritake) America) •  Paradigm MZ100
•  In-Ceram YZ (VITA (Dentsply Sirona) •  LAVA Esthetic (3M) (3M)
North America) •  CEREC Zirconia •  Nexxzr+ (Sagemax) •  Shofu Block
•  inCoris ZI (Dentsply (Dentsply Sirona) •  ORIGIN Beyond (B&D (Shofu Dental)
Sirona)  •  GC Initial Zirconia Technologies)  •  VITA Enamic
•  IPS e.max ZirCAD (GC America)  •  Prettau Anterior (Vita Zahnfabrik)
(Ivoclar Vivadent)  •  inCoris TZI (Zirkonzahn)
•  LAVA Zirconia (3M) (Dentsply Sirona) •  Vericore ZR HTX
•  Nexxzr S (Sagemax)  •  inCoris TZI C (Whip-Mix
•  VITA YZ T (Dentsply Sirona) Corporation)
(VITA Zahnabrik)  •  Katana ML/HT (Kuaray •  Zenostar MT (Wieland 
•  Zenostar MO (Wieland Noritake) Dental)
Dental) •  LAVA Plus (3M) 
•  Nexxzr T (Sagemax)
•  ORIGIN Beyond Plus
(B&D Technologies)
•  ORIGIN LIVE
(B&D Technologies)
•  Prettau Zirconia
(Zirconzahn)
•  Vericore ZR HT
(Whip-Mix Corporation)
•  VITA YZ HT (VITA North
America)
•  Zenostar T (Wieland
Dental) 
•  Zirlux FC2 (Zahn Dental)
KEY:
H Least Favorable
H H H H H Most Favorable Single Crown Veneer Inlay/Onlay Posterior 3-unit FDP Anterior 3-unit FDP
NR: Not Reported
s Figure 5. Clinical indications and key properties of CAD/CAM ceramic materials.

8 ADA Professional Product Review  I  April 2017  I  V12 (1)  I  ADA.org/ppr

 Selecting Ceramic CAD/CAM Materials

IF YOU USE CONSIDER

Lithium Disilicate-Based Materials

Inlay, Onlay Feldspathic/Leucite-Reinforced
or
or Veneer Porcelain
Resin-Ceramic Composite

Feldspathic/Leucite-Reinforced Lithium Disilicate-Based Materials

Anterior Porcelain
or
Single Crown or
Porcelain-Fused-To-Metal (PFM) Cubic Zirconia

Metal Crown Full-Contour Zirconia

Posterior
or or
Single Crown
Porcelain-Fused-To-Metal (PFM) Lithium Disilicate-Based Materials

Lithium Disilicate-Based Materials

or
Anterior
Porcelain-Fused-To-Metal (PFM) Veneer-Fused-To-Zirconia
Three-Unit
or
Cubic Zirconia

Posterior Full Metal/Gold Full-Contour Zirconia

Three-Unit/ or or
Multi-Unit Porcelain-Fused-To-Metal (PFM) Veneer-Fused-To-Zirconia

KEY Esthetics Strength Ease of Process Emerging Product Low Cost Bonding

s Figure 6. CAD/CAM ceramics, with their strength and esthetics, can be great alternatives to more traditional materials in a variety of clinical
scenarios. Other considerations, such as cost or ease of processing, can help guide your selection process, and determine the best fit for your
patients’ needs.

9 ADA Professional Product Review  I  April 2017  I  V12 (1)  I  ADA.org/ppr

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