All ceramic crown restorations:

Introduction
The word “Ceramics” refers to an old Greek word that describes materials used for
fabrication of earth-ware pots for domestic use.

Ceramics can be defined as solid compounds composed in large part of inorganic

nonmetallic materials and are made by mixing the solid components together with the
application of heat to form crystalline solid structures.

The properties of ceramics are basically determined by crystal contents and chemical
compositions.

Generally, ceramics have high resistance to compressive stress, good chemical

resistance, and high temperature stability.

Because of their advantages, they have been used in wide range of industries
including biomedical engineering and biomaterial science.

In dentistry, ceramics have been used as restorative material for many years.

Land, in 1886, introduced the first all-porcelain crown to restore extensively damaged
teeth.

Due to low fracture resistance and high failure rate of ceramic jacket crowns, the idea
of fabricating a metal substructure to support brittle feldspathic porcelain was
originated.

A porcelain-fused to metal crown consists of a metal substructure covered with

esthetic veneering porcelain to mask the grayish color of metal and improve the
eshetics.

Although porcelain-fused to metal crowns have been successfully used in patients, the
mismatch of thermal expansion coefficient between feldspathic porcelain and a metal
substructure can cause chipping of the veneering part.

Later, McLean introduced leucite-containing feldspathic porcelain to overcome

chipping problem.

The leucite crystals help in crack deflection, as a consequence, the energy required for
crack propagation in ceramic body increases.
1) Leucite Reinforced Pressable Porcelain Crowns:
These crowns were originally introduced 15 years ago.

The IPS Empress pressable crowns have a flexural strength of 160MPa and have
proven to be a durable option while providing excellent aesthetics, allowing clinicians
to create restorations that closely replicate natural teeth.

IPS Empress crowns have a high translucency, it contains 63% SiO2.

This helps them to transmit the shade from adjacent teeth, making it possible to get an
exact shade match even for difficult cases.

Examples of leucite reinforced porcelain are IPS Empress (heat pressed) and IPS
ProCAD (milled).

Its flexural strength ranges between 120 and 150 MPa and its fracture toughness is
about 1.2 MPa.m-2.

It is mainly used for making inlays, onlays, and single anterior crowns.

Pressed glass-ceramics are materials containing high amounts of leucite crystals (35%
by volume).

The basic component of this ceramic is feldspathic porcelain consisting of 63% SiO 2,
19% Al2O3, 11% K2O, 4% Na2O, and traces of other oxides.

Leucite crystals are added to the aluminum oxide.

This material is manufactured using a process known as heat-pressing, which is

performed in an investment mold.

This mold is filled with the plasticized ceramic, thus avoiding the sintering process
and the subsequent pore formation.

This ceramic undergoes dispersion strengthening through the guided crystallization of

leucite.

Dispersion strengthening is a process by which the dispersed phase of a different

material (such as alumina, leucite, zirconia, etc.) is used to stop crack propagation,
since these crystalline phases are more difficult to penetrate by cracks.

Leucite crystals are incorporated during ceramming, hence performing this process
again is unnecessary when inducing crystal growth.
2) Lithium Disilicate Porcelain Crowns:
This type of crown is made from biocompatible lithium disilicate ceramic glass
ingots.

IPS e.max crowns have the quality of being resilient to fracturing, with a flexural
strength of 400MPa – three times stronger than Empress.

These crowns can either be pressed or milled to offer good fit as well as function.

They make it possible to create full-contour restorations or to layer enamel porcelain

using IPS e.max Ceram, which is a comprehensive layering ceramic that provides
highly aesthetic results.

This material is also a heat-pressed glass-ceramic with a 60% content of lithium

disilicate crystals, which form an intertwined structure after being pressed, hence
fracture strength is increased.

Li2O and SiO2 aid in the crystallization of the required phase of lithium disilicate,
BaO and Cs2O stabilize residual glass and Al2O3 and B2O3 render this ceramic
chemically durable.

The crystallization process is comprised of two steps: nucleation (one hour at 645°C)
and crystal growth (four hours at 850°C).

3) Zirconia
In 1969, Zirconium oxide was first used for medical purposes.

There are many uses of Zirconium oxide, but today there are only three types of
Zirconia, containing ceramic, used in dental applications:

1. Yttrium cation-doped tetragonal zirconia polycrystals

2. Magnesium cation-doped partially stabilized zirconia
3. Zirconia toughened alumina

In most studies the Zirconia fracture force was higher than 900N (usually> 1000N).

In the latter studies the lower strength values seem to be related exclusively to the
design and construction of laboratory models.

However, in all studies the fracture thresholds were considered clinically accept-able
for people who do not show bruxism.

Increased durability of Zirconia models is also mentioned in the review of Ozcan,

ranging from 437 ± 35N to 2333 ± 183N.

However, the difference in breaking force in models with or without ceramic coating
varies in different studies.
Fracture in experimental models of Zirconia bridges is observed almost exclusively to
the nearest connector to the force application area between abutment tooth- pontic or
between two pontics demonstrating that the dimensions of the connector play an
important role in resistance to fracture

In single crowns fracture often starts at the cervical margin, indicating that the
cervical margin is the most delicate point of the crown.

In contrast, where chipping of the veneered ceramic ( partial or full) was observed, the
fragments came from the area where force was applied.

A) High Translucent Zirconia:

High translucent zirconia is a versatile material and can be utilized for single anterior
and posterior restorations, for bridges up to three units, and for implant crowns.

This material is highly biocompatible, promoting a healthy response with the

surrounding tissue.

High translucent zirconia can be used for posterior crowns and is particularly suitable
for anterior crowns.

It has a flexural strength between 590 and 720 MPa and offers lifelike translucency.

It also offers good aesthetics as it transmits the color of adjacent teeth once placed in
the mouth, thus blending in well with natural teeth.

High-translucent zirconia can be used in monolithic restorations or can be layered.

The way in which the material is processed creates its effect in translucency,
minimizing the effects of impurities and structural defects.

It seems like it should be the perfect material for dental veneers, but, unfortunately,
this isn’t the case because of the margin’s high visibility and the prep thinness.

Margin visibility also contraindicates its use for inlays and onlays.

High translucent zirconia restorations are easy to fit and can be cemented using
standard cementation materials and techniques.

It has a flexural strength between 590 and 720 MPa and offers lifelike translucency.

This material is highly biocompatible, promoting a healthy response with the

surrounding tissue.

It also offers good aesthetics as it transmits the color of adjacent teeth once placed in
the mouth, thus blending in well with natural teeth.

High-translucent zirconia can be used in monolithic restorations or can be layered.

The way in which the material is processed creates its effect in translucency,
minimizing the effects of impurities and structural defects.

B) Zirconia Solid:
Solid or monolithic full-contour zirconia crowns are highly effective for use with
posterior restorations as they are extremely strong, with a flexural strength of
1200MPa, it is made from 100% pure zirconia.

CAD/CAM-fabricated crowns provide a very precise fit and are virtually unbreakable.

The shades of this type of crown have improved considerably over time, and they can
now closely match neighboring teeth when placed.

Because of the smoothness of their surface and high durability, this type of crown can
be a good choice for patients who have bruxism.

If any occlusal corrections are needed during the fitting, monolithic zirconia can
easily be polished using conventional low-speed polishing materials.

Conventional PFMs can have issues with opaque showing through when adjusted, but
this is not a problem with monolithic zirconia as the shade is the same throughout the
crown.

At 1200 MPa, the Zirconia has a comparable flexural strength of traditional PFM
restorations while maintaining a natural and vibrant translucency.

The product is 100% metal-free, a feature that prevents gingival darkening and
removes the possibility of exposing metallic margins if gum recession begins.

They are naturally esthetic, transmit the color of adjacent teeth, and can be matched to
any shade.

Zirconia Solid is one of the strongest restorations available for any patient who may
have bruxing or grinding issues.

Utilizing CAD/CAM technology, it also has a precise marginal fit that can
significantly reduce chair time.

Since traditional cementation is recommended, there is no need to bond the

restoration.

Indicated for bruxers because of its durability and it is also indicated for its ability to
conceal dark colored preparations, endodontically treated teeth, post and cores, and
implant abutments

Ideal for posterior crowns and bridges of any span and also suitable for Maryland
bridges and inlays/onlays
Table (1) "differentiation between the tooth structure and all ceramic restorations"

REFERENCES

1. https://www.ivoclarvivadent.com/en/p/all/products/all-ceramics/ips-empress-
system-technicians/ips-empress-esthetic
2. https://actascientific.com/ASDS/pdf/ASDS-03-
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solid/?fbclid=IwAR0KeCX9eZ0mwiV_J8lNtZPi_A0E9TVJpjVrDz1cqiERA
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9. https://dt.mahidol.ac.th/th/wp-content/uploads/2017/08/All-ceramic-systems-
in-Esthetic-Dentistry-A-review.pdf