All-Ceramic Restorations

part 1: posterior teeth

Dr. Mohammed Yehya BDS, MSc
Lecturer in Department of Fixed Prosthodontics,
Collage of Dentistry
Qassim university
1. Definition of all-ceramic restorations.
2. Types of all ceramic system.
3. Indications of all ceramic restorations.
4. Contraindications of all ceramic restorations
5. Advantages of all ceramic restorations.
6. Disadvantages of all ceramic restorations.
7. Tooth preparations of all ceramic crown for posterior teeth.
8. Most Common All-Ceramic Preparation Errors.
 Definition of all-ceramic restorations

• Ceramic :
Compounds of one or more metals with a non metalic elements, usually
oxygen. They are formed of chemical and biochemical stable substances
that are strong, hard, brittle and inert nonconductors of thermal and
electrical energy.

The Glossary of Prosthodontic Terms

• Ceramic crown :
A ceramic fixed dental prosthesis that restores a clinical crown without a
supporting metal framework.
 Types of all-ceramic system
IPS Empress
• Crystalline phase: Leucite

• Recommended usage: Inlay, Onlay, Crowns & Veneers

• Translucency: Medium

• Strength: Medium/ Low

• Enamel abrasiveness: Medium

 Types of all-ceramic system
IPS Empress 2
• Crystalline phase: Lithium disilicate

• Recommended usage: Anterior 3-unit FPDs* , crowns

• Translucency: Medium

• Strength: High

• Enamel abrasiveness: Low

*FPDs : Fixed partial dentures

 Types of all-ceramic system
In-Ceram Alumina
• Crystalline phase: Alumina

• Recommended usage: Crowns, veneers

• Translucency: opaque

• Strength: High

• Enamel abrasiveness: High

 Types of all-ceramic system
In-Ceram spinell
• Crystalline phase: Alumina, spinell

• Recommended usage: Crowns, veneers

• Translucency: Medium

• Strength: High

• Enamel abrasiveness: High

 Types of all-ceramic system
In-Ceram Zirconia
• Crystalline phase: Zirconia, alumina

• Recommended usage: 3-unts FPD

• Translucency: Opaque

• Strength: Very high

• Enamel abrasiveness: High

 Types of all-ceramic system
Cercon Zirconia, Lava, Procera Zirconia

• Crystalline phase: Zirconia

• Recommended usage: crowns, FPDs .

• Fabrication method: CAD/CAM* and sintered

• Translucency: Opaque

• Strength: Very high

• Enamel abrasiveness: High

*CAD/CAM : Computer-Aided Design& Computer-Aided Manufacturing

Indications of all ceramic crowns

• High esthetic requirement.

• Considerable proximal caries.
• Incisal edge reasonable intact.
• Endodontically treated teeth with post and cores.
• Favorable distribution of occlusal load.
Contraindications of all-ceramic crown
• When superior strength is warranted and metal-ceramic crown is more
appropriate.
• High caries index.
• Insufficient coronal tooth structure for support (short clinical crown).
• Insufficient porcelain thickness in the lingual aspect (< 0.8 mm).
• Thin teeth faciolingually.
• Unfavorable distribution of occlusal load(edge to edge).
• Parafunctional habits : Bruxism
• when the opposing teeth occlude on the cervical fifth of the lingual surface
("half-moon" fracture).
Note :
• Rarely it is recommended for molar teeth. Because of the
increased occlusal load and the reduced esthetic demand,
metal-ceramic restorations are the treatment of choice.
Advantages of all-ceramic crown
• Esthetically supreme.

• Good tissue response even for subgingival margins.

• Slightly more conservative of facial wall than metal ceramic.

Disadvantages of all-ceramic crown

• Reduced strength in comparison with metal-ceramic crown.

• Proper preparation extremely crucial.

• Among least conservative preparation.

• Brittle nature of material (fracture).

• Wear on the functional surface of natural teeth that oppose

ceramic restoration.
Mammatus Clouds
 Preparation for all-ceramic crowns
Shoulder

• A well-defined 90 o shoulder of adequate width improves the fracture resistance of the crown
because it provides for additional bulk.

• The shoulder is also required for strength at the margin because the marginal area bears much
support of the crown in the function
 Preparation for all-ceramic crowns
Shoulder versus chamfer

• The internal shoulder angle should be rounded to reduce the stress concentration factor up to
50% and because sharp internal line angles cannot be easily reproduced with porcelain.

• A chamfer is conservative and simpler but the fracture resistance is greater for crowns produced on
a shoulder preparation.
 Preparation for all-ceramic crowns
step by step procedure
A combination facial and lingual A midsagittal index
index

• Condensation-reaction
silicone putty.
 Preparation for all-ceramic crowns
step by step procedure

• Occlusal reduction: large round-end tapered diamond.

Preparation for all-ceramic crowns
step by step procedure

• Use the large round-end tapered diamond place depth-orientation grooves on

the occlusal surface. The final occlusal reduction should be 1,5 to 2,0 mm deep.
 Preparation for all-ceramic crowns
step by step procedure

• Remove the tooth structure remaining between the depth-orientation grooves with the
large round-end tapered diamond.

• The reduction will follow the geometric inclined planes of the occusal surfece to insure
sufficient bulk of material, support for porcelain, and preparation length.
 Preparation for all-ceramic crowns
step by step procedure

• Functional cusp bevel: large round-end tapered diamond.

 Preparation for all-ceramic crowns
step by step procedure

• Use the same round-end tapered diamond to produce depth-orientation

grooves for the functional cusp bevel, which in this case ( mandible tooth ) is
the facial incline of the facial cusp.
 Preparation for all-ceramic crowns
step by step procedure

• Create the functional cusp bevel to insure that the facial incline of the facial
cusp will have the same porcelain thickness as the lingual incline.

• On the maxillary tooth, the reduction would be on the lingual incline of the
lingual cusp. The functional cusp bevel roughly parallels the inclines of the
cusps of the opposing teeth.
 Preparation for all-ceramic crowns
step by step procedure

Checking the occlusal clearance:

by having the patient close completely on a strip of red utility wax.
Evaluate occlusal clearance with the wax bite and measure with the wax gauge.
Preparation for all-ceramic crowns
step by step procedure

• Facial and lingual axial reduction : large round-end tapared

diamond.
Preparation for all-ceramic crowns
step by step procedure

• Make depth orientation grooves on the facail and lingual surfaces. Axial
reduction amounts of 1.0, 1.2, and 1.5 mm .
 Preparation for all-ceramic crowns
step by step procedure

• Remove the tooth structure remaining between depth-orientation grooves,

carrying the axial reduction as far into the facial embrasures as possible.

• Shoulder with a rounded internal angle can be formed at the same time as the
axial reduction .
 Preparation for all-ceramic crowns
step by step procedure

• Complete axial reduction: short needle and round-end tapered diamonds

 Preparation for all-ceramic crowns
step by step procedure

• Use the short needle diamond to begin the proximal axial reduction.
• Avoid touching the adjacent tooth with the instrument, but do not overtaper the wall
in the process.
• After proper alignment of the bur : A lip of tooth enamel is maintained between the
needle diamond and the adjacent tooth that protects it from any damage.
 Preparation for all-ceramic crowns
step by step procedure

• It may be necessary to lay the diamond over in a horizontal attitude along the
marginal ridge to begin the cut into the interproxial area.
 Preparation for all-ceramic crowns
step by step procedure

• The needle diamond can be brushed across the entire proximal surface.
The finish line may still be a bit irregular at this point, but that will be
remedied shortly.
 Preparation for all-ceramic crowns
step by step procedure

• Complete the axial reduction interproximally by running the round-end

tapered diamond.
 Preparation for all-ceramic crowns
step by step procedure

• Preparation finishing: round-end tapered carbide bur for all surfaces. Removing all sharp angles .
 Preparation for all-ceramic crowns
step by step procedure
• A combination facial and • A midsagittal index
lingual index
 Preparation for all-ceramic crowns
step by step procedure
• Lingual view Facial view
 Preparation for all-ceramic crowns
step by step procedure
The features of a preparation for a porcelain jacket crown on a posterior
tooth and the function served by each
Most Common All-Ceramic Preparation
Errors

Sharp line angles

Incomplete shoulder

Rough shoulder
• Rosenstiel , S. Land, M. Fujimoto J.(2006). Contemporary
fixed prosthodontics. Mosby selver.

• Shillinburg et al.(1996).Fundamentals of Tooth Preparations.

Quintessence book.

• Cheche, G. & Pinault, A. (1994).Esthetics of Anterior Fixed

Prosthodontics. Quintessence book.
Thank you