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All Ceramics – Dr. Nithin Mathew


ALL CERAMICS
(Material Aspect)

Dr. Nithin Mathew


CONTENTS

• Introduction • Methods of strengthening ceramics

• History • All Ceramic Systems

• Classification • Selection of ceramics

• Composition • Conclusion

• Advantages & disadvantages • References

• Manufacture

• Fabrication

All Ceramics – Dr. Nithin Mathew 3


INTRODUCTION

• Ceramic - First material to be artificially made by humans.

• Ceramic is derived from the Greek word ‘keramos’, which means ‘potter's clay’.

• Earliest techniques consisted of shaping the item in clay/soil and then baking it to fuse the
particles together, which resulted in coarse and porous products.

All Ceramics – Dr. Nithin Mathew 4


• The term CERAMIC refers to any product made essentially from a non metallic inorganic
material processed by firing at a high temperature to achieve desirable properties.

• DENTAL CERAMIC (Anusavice)

• A specially formulated ceramic material that exhibits adequate strength, durability and
color that is used intraorally to restore anatomic form and function, and/or esthetics.

All Ceramics – Dr. Nithin Mathew 5


• CERAMICS

Compounds of one or more metals with a non metallic element (usually silicon,
boron, oxygen) that may be used as a single structural component or as one of the
several layers that are used in the fabrication of a ceramic based prosthesis.

(Glossary of Prosthodontic Terms)

• PORCELAIN

A ceramic material formed of infusible elements joined by lower fusing materials.


(Glossary of Prosthodontic Terms)

All Ceramics – Dr. Nithin Mathew 6


Terminologies

• COPY-MILLING
• A process of machining a structure using a device that traces the surface of master
metal, ceramic, or polymer pattern and transfers the traced spatial positions to a
cutting station where blank is cut or ground in a manner similar to key-cutting
procedure.

• SINTERING

• The process of heating closely packed particles to achieve interparticle bonding and
sufficient diffusion to decrease the surface area or increase the density of the
structure.
All Ceramics – Dr. Nithin Mathew 7
• VITRIFICATION :

• The development of a liquid phase by reaction or melting, which on cooling provides


the glassy phase, resulting in a vitreous structure.

• When the glass begins to crystallize , the process is called DE-VITRIFICATION.

• GREEN STATE :
• A term referred to as pressed condition before sintering.

• SPINEL :

• A crystalline mineral composed of mineral oxides such as magnesium oxide or


aluminium oxide.

All Ceramics – Dr. Nithin Mathew 8


• SLIP CASTING :

• A process used to form “green” ceramic shapes by applying a slurry of ceramic


particles and water or special liquid to a porous substrate, thereby allowing capillary
action to remove water and densify the mass of deposited particles.

All Ceramics – Dr. Nithin Mathew 9


ADA SPECIFICATION ISO SPECIFICATION

 Dental ceramic : 69  Dental ceramic : 6872


 Dental porcelain teeth : 45  Dental porcelain teeth : 22112
 Metal ceramic system : 38  Metal ceramic system : 9693

All Ceramics – Dr. Nithin Mathew 10


HISTORY

 1728 : Proposed the use of porcelain in dentistry – Pierre Fauchard


 1774 : Made first porcelain denture– Alexis Duchateau
 1789 : First porcelain tooth material patented - de Chemant & Duchateau
 1808 : Terrometallic porcelain tooth – Fonzi
 1817 : Porcelain teeth introduced in the US – Planteau
 1825 : Commercial production of porcelain teeth (SS White Company) – Samuel Stockton
 1837 : Introduced improved version of porcelain- Ash
 1887 : Introduced porcelain jacket crown using platinum foil matrix technique - CH. Land
 1903 : First ceramic crowns introduced to dentistry – Charles Land
 1957 : Introduced Vacuum firing - Vines & Sommelman
 1962 : Formulation of feldspathic porcelain – Weinstein & Weinstein
All Ceramics – Dr. Nithin Mathew 11
 1963 : First commercial feldspathic porcelain developed – Vita Zahnfabrik
 1965 : Aluminous core ceramic – Mclean and Hughes
 1968 : Use of glass ceramics – MacCulloh
 1983 : Bonding composite resin to acid etched porcelain – Simonsen & Calamia
 1983-84 : First castable ceramic – Dicor – Grossman & Adair
 1985 : First CAD/CAM was publicly milled and installed in the mouth – Morman & Brandestini
 1987 : CEREC 1 was introduced
 1989 : First slip cast alumina ceramic- Inceram alumina- Sadoun
 1991 : Pressable glass ceramics- Wohlwent
 1994 : CEREC 2 was introduced

All Ceramics – Dr. Nithin Mathew 12


 1997 : Sirona CROWN 1.0 program for producing full-ceramic posterior crowns was introduced
 2000 : CEREC 3 was introduced
 2008 : Sirona released the MCXL milling unit which can produce a crown in 4 mins

All Ceramics – Dr. Nithin Mathew 13


CLASSIFICATION

 Firing temperature

 Use / Indications

 Fabrication techniques

 Crystalline phases

 Microstructure

 Translucency

 According to system

All Ceramics – Dr. Nithin Mathew 14


FIRING TEMPERATURE USE / INDICATIONS
 Veneers
 High fusing : > 1300°C  All ceramic crowns
 Inlays and onlays
 Medium fusing : 1101 - 1300°C
 Ceramic dentures
 Low fusing : 850 - 1100°C  Post & Cores
 Orthodontic brackets
 Ultralow fusing : < 850°C  FPD

All Ceramics – Dr. Nithin Mathew 15


FABRICATION TECHNIQUE CRYSTALLINE PHASE
 Sintered (Metal Ceramics)  Alumina based (Optec HSP)
 Cast (Dicor)  Feldspar based (Conventional Ceramics)
 Heat pressed (IPS Empress)  Leucite based (IPS Empress)
 Slip cast (Inceram)  Spinel based (Inceram Spinel)
 Machined (Cerec Vitablocs)
 Partial sintering and glass infiltration
 CAD CAM & copy milling

All Ceramics – Dr. Nithin Mathew 16


TRANSLUCENCY MICROSTRUCTURE

 Opaque  Glass

 Translucent  Crystalline

 Transparent  Crystal containing glass

All Ceramics – Dr. Nithin Mathew 17


COMPOSITION APPLICATION

 Pure alumina
 Core porcelain
 Pure Zirconia
 Silica glass  Body porcelain
 Spinelle
 Leucite based glass ceramic  Enamel porcelain

 Lithia based glass ceramic

All Ceramics – Dr. Nithin Mathew 18


According To Systems

• Metal ceramic systems


• Cast metal systems and non cast systems

• All –ceramic systems


• Conventional powder slurry ceramic
i. Alumina reinforced porcelain
ii. Magnesia reinforced porcelain
iii. Leucite reinforced
iv. Zirconia-whisker fiber reinforced
v. Low fusing ceramics

All Ceramics – Dr. Nithin Mathew 19


• Castable Ceramics • Pressable Ceramics
i. Flouormicas i. Shrink free ceramics
ii. Other Glass Ceramics ii. Leucite reinforced ceramics
• Machinable Ceramics
i. Analogus Systems • Infiltrated Ceramics
a. Copymilling i. Alumina based
a. Mechanical ii. Spinel based
b. Automated iii. Zirconia based
b. Erosive Techniques
a. Sono - erosion
b. Spark - erosion
ii. Digital Systems (CAD/CAM)
i. Direct
ii. Indirect
All Ceramics – Dr. Nithin Mathew 20
Composition of Dental Ceramics

• Primary constituent
Feldspar • Minerals composed of potash (K₂O), soda(Na₂O) and silica (SiO₂)
• 75-85%

• 4-5%
• Increases the moldability of the plastic porcelain
Kaolin • Serves as a binder
• Consists of Al₂O₃ 2SiO₂ 2H₂O (Hydrated Aluminium Silicate)
• Kaolin is opaque and can lower the translucency of porcelain

• Present in concentrations of 13-14%


Quartz • Provide strength, firmness and improve translucency of porcelain
• Serves as a framework for other ingredients
All Ceramics – Dr. Nithin Mathew 21
GLASS MODIFIERS OPACIFYING AGENTS

• Potassium, sodium and calcium oxides • Zirconium oxide


• Serve as fluxes
• Titanium oxide
• Lower the viscosity of glass
• Increase thermal expansion • Tin oxide

All Ceramics – Dr. Nithin Mathew 22


PIGMENTS

• To obtain various shades to mimic natural tooth colour.


• Made by fusing metallic oxide with fine glass and feldspar & regrinding to a powder.

. Metallic oxide Colour


• Iron or nickel oxide ⎼ Brown
• Copper oxide ⎼ Green
• Titanium oxide ⎼ Yellowish brown
• Manganese oxide ⎼ Lavender
• Cobalt oxide ⎼ Blue

All Ceramics – Dr. Nithin Mathew 23


ADVANTAGES of Dental Ceramics

 Highly esthetic

 Biocompatibility

 Electrical Resistance

 Thermal Insulation

 Wear resistance

 Can be formed to precise shapes

 Ability to be bonded to tooth structure

All Ceramics – Dr. Nithin Mathew 24


DISADVANTAGES

 Brittleness

 Fabrication : Technique sensitive

 Wear of opposing natural teeth

 Difficult to repair intraorally

 High cost of fabrication

All Ceramics – Dr. Nithin Mathew 25


MANUFACTURING OF CERAMICS

• Pyro-chemical reactions during manufacture of porcelain:

• Ceramic raw materials are mixed together in a refractory crucible and heated to a
temperature well above their fusion temp
MgO MgF2 CaF2
• Series of reactions occur. CaCO3
Al2O3 BaCO3

SiO2
P2O5

All Ceramics – Dr. Nithin Mathew 26


MANUFACTURING OF CERAMICS

• After the water of crystallization is lost,

• Flux reacts with the outer layers of silica, kaolin and feldspar

• Feldspar fuses and intermingles with kaolin and quartz

• Feldspar undergoes decomposition to form glass and leucite MgF2 CaF2


MgO CaCO3
• The molten glass begins to dissolve the quartz and kaolin Al2O3 BaCO3

• Continuous heating results in total dissolution SiO2


P2O5

• Then the fused mass is quenched in water

All Ceramics – Dr. Nithin Mathew 27


• Internal stresses within the glass are produced and breaks into fragments frit

• The process of blending, melting and quenching the glass is called FRITTING

MgF2 CaF2
MgO CaCO3
Al2O3 BaCO3

SiO2
P2O5

Crucible
All Ceramics – Dr. Nithin Mathew 28
MgO MgF2 CaF2
CaCO3
Al2O3 BaCO3

SiO2
P2O5

Melting Quenching

MANUFACTURING OF CERAMICS

Sieving
Frit

All Ceramics – Dr. Nithin Mathew Tank with cool water 29


• Ceramics : 2 phases

• Glassy Phase (Vitreous)


• Provides translucency
• Makes ceramic brittle

• Crystalline Phase
• Added to improve the mechanical properties
• Newer ceramics (35-90%)

All Ceramics – Dr. Nithin Mathew 30


DISPENSING

• Conventional dental porcelain kit supplied as a kit containing :

• Fine ceramic powder in different shades of enamel, dentin, core/opaque

• Special liquid or distilled water

• Stains and colour modifiers

• Glazes and add-on porcelain

• Shade guide

All Ceramics – Dr. Nithin Mathew 31


FABRICATION OF CERAMIC RESTORATIONS

• The fabrication of conventional porcelain restoration is by :


• Condensation
• Sintering
• Glazing
• Cooling

CONDENSATION :
• Padding or packing of wet porcelain into position
• The movement of particles is generated by vibration, spatulation or whipping, brush
technique and spray opaquing.

All Ceramics – Dr. Nithin Mathew 32


CONDENSATION :

• Build-up of Cervical Porcelain

• Build-up of Body Porcelain

• Cut-back

• Build-up of Enamel Porcelain

• Condensation methods:
• MANUAL CONDENSATION
• ULTRASONICCONDENSATION

All Ceramics – Dr. Nithin Mathew 33


Advantages of ultrasonic condensation:

• Reduces the fluid content of layered ceramics; resulting in denser and more vibrant porcelain
mass.

• Enhances translucency and the shade qualities of the fired ceramic.

• Shrinkage can be reduced to below 5%

• Time-saving as it reduces the number of compensatory firing cycles

All Ceramics – Dr. Nithin Mathew 34


SINTERING / FIRING :

• Process of heating closely packs particles to achieve interparticle bonding and sufficient
diffusion to decrease the surface area or increase density of the structure.

• Process of partial fusion of compact glass

• Steps:

• Pre-heating the furnace

• Condensed mass placed

• Green porcelain is fired

All Ceramics – Dr. Nithin Mathew 35


Pre-heating (Drying):

• Placing the porcelain object on a tray in front of a preheated furnace at 650C for 5min for low
fusing porcelain and at 480C for 8min for high fusing porcelains till reaching the green or
leathery state.

• Significance:

• Removal of excess water allowing the porcelain object to gain its


green strength.

• Preventing sudden production of steam that could result in voids


or fractures.
Ceramic particles held together in the “green
All Ceramics – Dr. Nithin Mathew state” after all liquid has been dried off 36
SINTERING / FIRING : FIRING
TECHNIQUES

According to
temperature According to the media
presetting: employed for firing:

Temperature – AIR VACUUM DIFFUSABLE


Temperature FIRING
controlled time control FIRING GASES
method method
Reduce
porosity Helium,
hydrogen or
Porosity due steam are
to air inclusion substituted for
the ordinary
furnace

All Ceramics – Dr. Nithin Mathew 37


Stages of Maturity of Porcelain during Firing

Bisque bake

A series of stages of maturation in the firing of ceramic materials depending on the degree of
pyrochemical reaction and sintering shrinkage occurring before vitrification (glazing).

• Low bisque

• Medium bisque

• High bisque

All Ceramics – Dr. Nithin Mathew 38


• Low bisque

• Surface of porcelain is very porous and will easily absorb water.

• Medium bisque

• Surface is still porous but the flow of the glass grains is increased and entrapped air
will become sphere shaped.

• High bisque

• Surface is completely sealed and presents a smooth texture.

• Overfired porcelain become milky or cloudy in appearance – Devitrification.

All Ceramics – Dr. Nithin Mathew 39


STAGES OF MATURITY

Low bisque stage Medium bisque stage High bisque stage


Characteristics Grains of porcelain start to Flow of glass grains Firing shrinkage is complete,
soften and coalesce at the increase and the residual and has adequate strength, for
contact points entrapped furnace air any corrections by grinding
becomes sphere shaped prior to glazing
Particle cohesion Incomplete Considerable Complete
Porosity Highly porous and absorbs Reduced although still Slight/absent depending upon
water porous the material used

Shrinkage Minimal Majority / definite Complete


Strength Weak & friable Moderate High
Surface texture Porous Matte surface Egg shell appearance

Color & Opaque Less opaque Color and translucency


translucency developed
All Ceramics – Dr. Nithin Mathew 40
GLAZING :

• Produces smooth, shiny and impervious outer layer, also effective in reducing
crack propagation.
• 2 ways :
• Add-on glazing
• Self glazing – most preferred technique

COOLING :
• Carried out slowly
• Rapid cooling results in cracking or fracture of glass and loss of strength.
• After firing, placed under a glass cover to protect it from air current and
contamination by dirt.
All Ceramics – Dr. Nithin Mathew 41
Porcelain Surface Treatment

 Natural or Autoglaze

• Porcelain has the ability to glaze itself when held at its fusing temperature in air for 1-4
mins.

• Porcelain loses its ability to form a natural glaze after multiple firings

 Applied Overglaze

• Applied overglaze is a low fusing clear porcelain painted on to the restoration and fired at
a fusing temperature much lower than that of the dentin and enamel porcelain.

• An applied overglaze is indicated in large restoration that have numerous corrections.


All Ceramics – Dr. Nithin Mathew 46
Instrumentation for Finishing and Polishing Ceramic Restorations

Sequence Instruments

1 Medium to fine grit diamond instrument

2 30 fluted carbide burs

3 Rubber, abrasive impregnated porcelain polishing points

4 Diamond polishing paste

All Ceramics – Dr. Nithin Mathew 47


Methods of Strengthening Ceramics

• Minimize the effect of stress raisers

• Develop residual compressive stresses

• Minimize the number of firing cycles

• Ion exchange

• Thermal tempering

• Dispersion strengthening

• Transformation toughening

All Ceramics – Dr. Nithin Mathew 48


1. Minimize the effect of stress raisers

• Stress raisers are discontinuities in ceramic and metal ceramic structure that causes stress
concentration.

• Restoration should be designed in such a way that it avoids exposure of ceramic to high tensile
stresses.

• Use of maximum thickness of ceramic on the occlusal surface.

• Abrupt changes in the shape or thickness in ceramic contour should be avoided.

• Sharp line angles in the preparation can cause stress concentration.

All Ceramics – Dr. Nithin Mathew 49


2. Develop residual compressive stresses

• The coefficient of thermal contraction of metal should be slightly higher than that of porcelain.

• Metal contracts slightly more than the porcelain on cooling from firing temperature to room
temperature

• Leave porcelain in residual compression and provides additional strength for the prostheses.

All Ceramics – Dr. Nithin Mathew 50


3. Minimize the number of firing cycles

• Leucite is a high expansion crystal phase which affects the thermal contraction coefficient of
porcelain.

• Multiple firings increases concentration of crystalline leucite.

• Increasing the no. of firing cycles can increase the LCTE of veneering porcelain. This leads to
stresses on cooling.

All Ceramics – Dr. Nithin Mathew 51


4. Ion exchange/ Chemical tempering

• Effective method of inducing residual compressive stresses.


• Sodium containing glass article is placed in a bath of molten potassium nitrate

• Exchange of ions take place

• Since potassium ion is 35% larger than sodium ion, squeezing of the potassium ion creates
very large residual compressive stresses.

• Potassium rich slurry, applied to ceramic surface and heated


to 450°C for 30 mins.

All Ceramics – Dr. Nithin Mathew 52


5. Thermal Tempering

• Creates residual compressive stresses by rapidly cooling the surface of the object while it is in
the molten state.

• Rapid cooling produces a skin of rigid glass surrounding a molten core.

• The solidifying molten core as it shrinks, creates residual compressive stress within the outer
surface.

All Ceramics – Dr. Nithin Mathew 53


6. Dispersion Strengthening

• Process of strengthening ceramics by reinforcing them with a dispersed phase of a different


material.

• Most dental ceramics are reinforced by dispersion of crystalline substances.

• Ex. Alumina in aluminous porcelain, spinel in In Ceram.

• When crystalline material such as alumina (Al₂O₃) is added to a glass, the glass is
strengthened and crack propagation does not take place easily.

• Resulted in development of aluminous porcelain for porcelain jacket crowns.

All Ceramics – Dr. Nithin Mathew 54


7. Transformation Toughening

• This method also relies on dispersion of a crystalline material within the ceramic.

• Strengthening occurs due to a change in the crystal structure under stress which prevents
crack propagation.

• Dental ceramics based primarily on zirconia crystals when heated to a temperature between
1470°C and 2010°C undergo change in the crystal structure from tetragonal to a monoclinic
phase at approx. 1150°C

• The toughening mechanism results from the controlled transformation of metastable


tetragonal phase to the stable monoclinic phase.
All Ceramics – Dr. Nithin Mathew 55
ALL CERAMIC SYSTEMS

• Classified according to the method of fabrication:

• Conventional (powder – slurry) ceramics

• Infiltrated / Slip Cast Ceramics

• Castable Ceramics

• Pressable Ceramics

• Machinable Ceramics

All Ceramics – Dr. Nithin Mathew 56


CONVENTIONAL CERAMICS
(POWDER – SLURRY)

All Ceramics – Dr. Nithin Mathew


• Supplied as powders in different shades & translucencies.

• Mixed with water to form slurry

• Slurry build up in layers on a refractory die

All Ceramics – Dr. Nithin Mathew 58


ALUMINOUS CORE PORCELAIN

• Mc Lean and Hughes developed a PJC with an alumina reinforced

• Significant improvement in fracture resistance

• Consisted of a glass matrix containing between 40-50 wt% of Al2O3.

• Large sintering shrinkage (15-20%)

• Inadequate translucency

• Principle indication: maxillary anterior crown restoration

All Ceramics – Dr. Nithin Mathew 59


Advantages Disadvantages

• Improved Fracture Resistance • Low CTE : 8 x 10-6/0C.

• Large sintering shrinkage (15-20%)

• Improvement in strength is insufficient to


bear high stresses

All Ceramics – Dr. Nithin Mathew 60


MAGNESIA – REINFORCED PORCELAIN

• O’Brien in 1984
• High expansion ceramics
• Core material
• Crystalline magnesia (40-60%) ‘Forsterite’.

• Magnesia crystals strengthen glass matrix by both dispersion strengthening and crystallization
within the matrix .

• Flexural strength is 131 MPa


• Doubled upto 269 MPa by the addition of glaze.

All Ceramics – Dr. Nithin Mathew 61


Advantages

• Increased co-efficient of thermal expansion

• Improved strength (glass infiltration of magnesia core)

• High expansion property

All Ceramics – Dr. Nithin Mathew 62


LEUCITE-REINFORCED PORCELAIN

• They are feldspathic porcelains, dispersion strengthened by crystallization of leucite crystals


in the glass-matrix.

• The leucite and glassy components are fused during the baking process at 10200C.

• Leucite crystals in the glass - matrix (50%).

• Strength : Nucleation and growth of leucite crystals.

• Translucency : Closeness of the refractive index of leucite with that of the glass matrix.

• Flexure strength : approximately 140 MPa.


All Ceramics – Dr. Nithin Mathew 63
Advantages Disadvantages

• High strength (leucite reinforcement) • Marginal inaccuracy due to sintering


shrinkage.

• Good translucency
• Fracture in posterior teeth.

• Moderate flexural strength


• High abrasive effect on opposing teeth.

All Ceramics – Dr. Nithin Mathew 64


INFILTRATED / SLIP CAST CERAMICS

All Ceramics – Dr. Nithin Mathew


GLASS INFILTRATED CORE CERAMICS
• Inceram Alumina
• Inceram Spinel
• Inceram Zirconia

• 2 components : Powder & Glass

• Fabrication:
• Powder mixed with water to form suspension called “SLIP”
• SLIP is painted onto refractory die : absorbs water – leaving solid alumina
• Baked at 11200C for 10 hours : opaque, porous core
• Glass powder applied to core and fired at 11000C for 3-4hrs
• Molten glass infiltrates the porous alumina or spinel by capillary action
• Veneering
All Ceramics – Dr. Nithin Mathew 66
Mixing aluminous powder with water to The slip is painted onto the die
Die preparation
produce slip with a brush

The water is removed by


the capillary action of the
porous gypsum, which
packs the particles into a
rigid porous network
Porous
network
Sintering : 10 Hrs 11200C
All Ceramics – Dr. Nithin Mathew
Glass Infiltration (4hrs 11000C)
Glass powder is used to fill the
Glass becomes molten and flows into the
pores in the alumina core.
pores by capillary diffusion

Removal of excess glass Veneering with esthetic porcelain

All Ceramics – Dr. Nithin Mathew


• The internal surface is sandblasted (with 50µ A12O3)

• Since the density of In-ceram core makes conventional methods of etching with HF acid
ineffective for bonding with a resin-cement.

All Ceramics – Dr. Nithin Mathew 69


INCERAM ALUMINA

• Developed by a French scientist and dentist Dr. Michael Sadoun (1980) and first introduced in
France in 1988.

Composition:

Two three-dimensional interpenetrating phases :

• Alumina/ Al2O3 crystalline : 99.56 wt%

• An Infiltration of glass lanthanum aluminosilicate

All Ceramics – Dr. Nithin Mathew 70


• Lanthanum

• Decreases the viscosity of the glass to assist infiltration

• Increases its refractive index to improve translucency.

Fabrication stages :
• Slip casting
• Veneering of core

All Ceramics – Dr. Nithin Mathew 71


PROPERTIES

STRENGTH :

• Densely packed crystalline particles (70% alumina) limit crack propagation and prevent
fracture.

• Flexure strength : 450 MPa range

All Ceramics – Dr. Nithin Mathew 72


PROPERTIES

COLOR :

• Final color : influenced by the color of the alumina core (opaque).

• Colorants used : transitional metal ions incorporated into the glass structure itself

• Spinel ceramic : the core is more transparent and its corresponding infiltration glass is slightly
tinted.

All Ceramics – Dr. Nithin Mathew 73


Advantages Disadvantages

• Minimal firing shrinkage, hence an • Requires specialized equipment.


accurate fit. • Poor optical properties or esthetics
• High flexure strengths (3 times) (opaque alumina core)

• Aluminous core (opaque) : used to cover • Incapability of being etched


darkened teeth or post/ core. • Slip casting is a complex technique
• Wear of opposing teeth is lesser • Considerable reduction of tooth surface
• Biocompatible : less plaque accumulation.

All Ceramics – Dr. Nithin Mathew 74


IN-CERAM SPINELL

• Introduced due to the comparatively high opacity of the alumina core.

• Incorporating magnesium aluminate (Mg A12O4) results in improved optical properties


characterized by

• Increased translucency

• About 25% reduction in flexural strength

• Spinel or Magnesium aluminate (Mg A12O4) is a composition containing A12O3 and Mg2O.

All Ceramics – Dr. Nithin Mathew 75


Advantages Disadvantages

• Spinel renders greater strength • Incapable to be etched by HF

characteristics.
• 25% reduction in flexural strength.

• Spinell has extended uses (Inlay / Onlay,


ceramic core material and Veneers.)

All Ceramics – Dr. Nithin Mathew 76


IN-CERAM ZIRCONIA

• A mixture of zirconium oxide / aluminium oxide is used as a framework material,.

• Physical properties were improved without altering the proven working procedure.

• The final core of ICZ consists of

• 30 wt% zirconia

• 70 wt% alumina.

All Ceramics – Dr. Nithin Mathew 77


Advantages Disadvantages

• High flexural strength • Poor esthetics due to increased opacity

• 1.4 times the stability


• Inability to etch
• 2-3 times impact capacity compared to
ln-Ceram Alumina

• Excellent Marginal Accuracy

• Biocompatibility

All Ceramics – Dr. Nithin Mathew 78


CASTABLE CERAMICS

79

All Ceramics – Dr. Nithin Mathew


• Introduced by Mc Culloch in 1968

• Di-Cor
• New types
• Cera pearl
• Canasite glass ceramic
• Optimal pressable ceramic
• Olympus castable ceramics
• Castable phosphate glass ceramic

All Ceramics – Dr. Nithin Mathew 80


• Supplied as ceramic ingots

• Fabricated using Lost Wax technique and Centrifugal casting technique

• Steps:
• Wax pattern – invested
• Dewaxing
• Molten glass cast into mould using centrifugal casting machine
• Glass core : ceramming (heat treatment process)
• Microscopic plate-like crystals grow within the glass matrix
• Veneered using feldspathic ceramics : Dicor Plus

All Ceramics – Dr. Nithin Mathew 81


DI-COR (Dentsply + Corning Glass Co)

• First commercially available castable ceramic material.

• Non porous, non homogenous, microstructure with uniform crystal size which is derived from
the controlled growth of crystals within an amorphous matrix of glass.

• Dicor composed of:


• Tetrasilicic fluormica crystals : 55 %
• Glass ceramic : 45 %

All Ceramics – Dr. Nithin Mathew 82


Major Ingredients Minor Ingredients
• SiO2 : 45-70% • A12O3 : upto 2% (durability & hardness)
• K2O : upto 20% • ZrO2 : upto 7%
• MgO : 13-30% • Fluorescing agents (esthetics)
• MgF2 (nucleating agent) • BaO : 1 to 4% (radiopacity)

Supplied as :
• Special Dicor casting crucibles, 4.1 gm Dicor glass ingot
• Dicor shading porcelain kit.

All Ceramics – Dr. Nithin Mathew 83


PROPERTIES

• Flexural strength : 81 ± 6.8 Mpa

• Strength : 440-505 KHN

• Biocompatible

• Less bacterial counts : smooth surface, low surface tension, fluoride content.

All Ceramics – Dr. Nithin Mathew 84


PROPERTIES

Esthetics :

• Gross man and Adiar


• Hue and chroma of metal ceramics and Castable ceramics matched natural teeth.
• Value of only Castable ceramics matched natural teeth.

• Presence of mica crystals scatter light similar to enamel rods.

• Chameleon effect i.e. the restoration acquires a part of the color from adjacent teeth and
fillings as well as the underlying cement lute.

All Ceramics – Dr. Nithin Mathew 85


PROPERTIES

Cementation :
• Zinc phosphate, light activated urethane resin
• Etching with ammonium difluoride for 2 min (Bailey & Bennet 1988)

Survival rate :
• Kenneth et al 1999 - 14yr study
• Crowns : 82%
• Cores : 100%
• Inlay and onlay : 90%
• Partial coverage : 92%

• Expenstein et al 2000 : Posterior 70%, anterior 82.7%


All Ceramics – Dr. Nithin Mathew 86
Advantages Disadvantages

• Chemical and physical uniformity. • Requires special equipments

• Excellent marginal adaptation


• Veneers failure rate as high as 8%

• Compatibility with lost-wax casting


process. • Must be stained with low fusing feldspathic
porcelain
• Ease of adjustment

• Low thermal conductivity

• Radiographic density is similar to that of


enamel

All Ceramics – Dr. Nithin Mathew 87


CASTABLE APATITE GLASS CERAMIC (CERAPEARL)

• 1985 -Sumiya Hobo & Iwata

• Available as Cera Pearl

• Crystalline microstructure similar to natural enamel

• Mechanical properties superior to enamel

All Ceramics – Dr. Nithin Mathew 88


Composition

• CaO : 45% - reacts with P2O5

• P2O5 : 15% - Aids in glass formation

• SiO2 : 35% - Forms the glass matrix.

• MgO : 5% - Decreases the viscosity (anti flux)

• Other : Trace elements (Nucleating agents during ceramming)

All Ceramics – Dr. Nithin Mathew 89


CHEMISTRY

1460°C Amorphous 750°C Crystalline


CaPO4 – 1510°C Mass – 870°C Oxyapatite
Ceramming

Hydroxy Exposed to
Apatite moisture

Ceramming :

The ceramming oven is preheated at 750°C for 15 minutes. After the cast glass ceramic is
placed in the oven the temperature is raised at the rate 500C / min until it reaches 870°C and held
for 1 hr.

External staining : Cerastain ( Bioceram )


All Ceramics – Dr. Nithin Mathew 90
PROPERTIES

• Cerapearl is similar to natural enamel in Composition

• Density : 2.97 gm/cm2


• Refractive index : 1.66
• Thermal conductivity : 0.002
• Hardness : 343

• Clinical success : (crowns) 2 year success rate –100%

All Ceramics – Dr. Nithin Mathew 91


PRESSABLE CERAMICS

92

All Ceramics – Dr. Nithin Mathew


• Supplied as ceramic ingots

• Fabricated using Lost Wax technique and heat pressed into the mould

• Steps:
• Wax pattern – invested in phosphate bonded investment
• Placed in specialized mould with alumina plunger
• After burnout, ceramic ingot is placed under plunger and heated to 11500C
• Veneered using feldspathic ceramics

All Ceramics – Dr. Nithin Mathew 93


CLASSIFICATION

• Shrink free ceramics


• Cerestore
• Al-ceram

• Leucite reinforced glass ceramics


• IPS empress
• Optec/OPC

• Lithia reinforced glass ceramic


• IPS empress 2
• OPC 3G

All Ceramics – Dr. Nithin Mathew 94


CERESTORE (Shrink Free Ceramics)

• Consists of Al2O3 and MgO mixed with Barium glass frits.

• On firing crystalline transformation produces Magnesium aluminate spinel, which occupies a


greater volume than the original mixed oxides compensates for the conventional firing
shrinkage.

All Ceramics – Dr. Nithin Mathew 95


• Unfired Cerestore core : • Fired Cerestore core :
• Al2O3 • α- Al2O3 (Corrundum)
• MgO • MgAl2O4 (Spinel)
• Glass frit • Ba Mg2Al3 (Si9Al2O3) – Barium osumilite
• Silicone resin
• Fillers

All Ceramics – Dr. Nithin Mathew 96


Chemical And Crystalline Transformation

• Silicone Resin SiO SiO2 Alumina Aluminosilicate


(160-8000C)

(900-13000C)
• Al2O3 + MgO MgAl2O4 (decreased shrinkage )

All Ceramics – Dr. Nithin Mathew 97


PROPERTIES

• Flexural strength : 225 Mpa

• Fit : exceptional fit because of direct moulding process.

• Low thermal conductivity

• Radiodensity similar to enamel

• Biocompatible

All Ceramics – Dr. Nithin Mathew 98


Advantages

• Dimensional stability of the core material in the molded (unfired) and fired states
• Better accuracy of fit and marginal integrity
• Esthetics
• Biocompatible (inert) and resistant to plaque formation (glazed surface)
• Radio density similar to that of enamel
• Low thermal conductivity; thus reduced thermal sensitivity
• Low coefficient of thermal expansion and high modulus of elasticity results in protection of
cement seal

All Ceramics – Dr. Nithin Mathew 99


Disadvantages
• Complex

• Specialized laboratory equipment and cost

• Inadequate flexural strength compared to the metal-ceramic restorations

• Poor abrasion resistance, hence not recommended in patients with heavy bruxism or
inadequate clearance

• LIMITATIONS and high clinical failure rates of the Cerestore led to the withdrawal of this
product from the market.

• Improved version : 70 to 90% higher flexural strength - marketed as Al Ceram.

All Ceramics – Dr. Nithin Mathew 100


IPS-EMPRESS

• Hot pressed ceramics

• 2 types:

• Leucite reinforced (K2O – Al2O3 – 4 SiO2)

• Lithium Disilicate reinforced (SiO2 – LiO2 – P2O5 – ZrO2)

All Ceramics – Dr. Nithin Mathew 101


COMPOSITION

• Pre cerammed, pre colored : INGOTS


• SiO2 : 63%
• Al2O3 : 17.7%
• K2O : 11.2%
• Na2O : 4.6%
Conventional IPS Empress
• B2O3 : 0.6% Dicor
Leucite Porcelain Pressable ceramic
• CaO : 1.6% content
30-35% 50-60% 80-85%
• BaO : 1.6%
• TiO2 : 0.2%

• Contains higher concentration of leucite crystals, which increases the resistance to crack
propagation
All Ceramics – Dr. Nithin Mathew 102
FABRICATION

Lost-wax technique:

• Wax pattern is invested

• Burnout (at 850°C)

• The ceramic ingot plunger and the entire assembly is


preheated to 11000C

• After 20 minute holding time the plunger presses the ceramic


under vacuum (0.3-0.4 MPa) into the mould

• Held under pneumatic pressure (45-mins) to allow complete


and accurate fill of the mould.
All Ceramics – Dr. Nithin Mathew 103
PROPERTIES

• Flexural strength : 160-180 Mpa

• The increase in strength has been attributed to :


• Pressing step which increases the density of leucite crystals
• Subsequent heat treatments which initiate growth of additional leucite crystals

• Esthetics : High esthetic value (translucent, fluorescent)


• Clinical survival :
95% survival rate of 2-4 years (Deniz G et al 2002)

• Marginal adaptation : Better marginal adaptation compared to aluminous core material.

All Ceramics – Dr. Nithin Mathew 104


Advantages

• Lack of metal or an opaque ceramic core

• Moderate flexural strength (160-180 MPa)

• Excellent fit (low-shrinkage ceramic)

• Improved esthetics (translucent, fluorescent)

• Etch-able

• Less susceptible to fatigue and stress failure

• Less abrasive to opposing tooth

• Biocompatible material

All Ceramics – Dr. Nithin Mathew 105


Disadvantages

• Potential to fracture in posterior areas.

• Special laboratory equipment such as pressing oven and die material (expensive)

• Inability to cover the color of a darkened tooth preparation or post and core, since the crowns
are relatively translucent.

• Compressive strength and flexural strength lesser than metal-ceramic or glass-infiltrated (In-
Ceram) crowns.

All Ceramics – Dr. Nithin Mathew 106


IPS EMPRESS 2 (IVOCLAR)

• Second generation of pressable materials for all- ceramic bridges.

• Lithium disilicate crystal >60vol%.

• The apatite crystals are layered which improved optical properties (translucency, light
scattering) which contribute to the unique chameleon effect.

IPS Empress IPS Empress 2

Flexural
Upto 150 MPa > 400 Mpa
strength

All Ceramics – Dr. Nithin Mathew 107


• Other applications :
• Core build-up system with the pre-fabricated zircon oxide root canal posts

Advantages
• High biocompatibility
• Excellent fracture resistance
• High radiopacity
• Outstanding translucency

All Ceramics – Dr. Nithin Mathew 108


IPS E.MAX PRESS

• Introduced in 2005.

• Considered as an enhanced lithium disilicate press-ceramic material when compared to


Empress II.

• Better physical properties and improved esthetics

All Ceramics – Dr. Nithin Mathew 109


Strength

All Ceramics – Dr. Nithin Mathew 110


MACHINABLE CERAMICS

All Ceramics – Dr. Nithin Mathew


Traditional Technique Higher Technology

Impression
Data Contact
Camera Laser
Acquisition Digitizer
Casts & Die

Restoration Computerised
Design Wax Pattern
Design

Investing Electrical
Restoration Machine Discharge
Sinter
Fabrication Machine
Casting

Lost Wax Technique CAD / CAM System


All Ceramics – Dr. Nithin Mathew
• Application of CAD/ CAM techniques was actively pursued by three groups of researches

• Group supported by Henson International of France.

• Combined group effort between the University of Zurich and Brains, Brandestini
Instruments of Switzerland.

• University of Minnesota, supported by the U.S. National Institute of Dental Research.

All Ceramics – Dr. Nithin Mathew 113


FRENCH SYSTEM

• Optical impression – Laser scanner


• Data processing – By Shape recognition software
• It has a library (memory) describing theoretical teeth.

• The system uses:


• 3-D probe system based on electro-optical method
• Surface modelling and screen display
• Automatic milling by a numerically controlled 4-axis machine

All Ceramics – Dr. Nithin Mathew 114


SWISS SYSTEM

• Optical impression - Optical topographic scanning using a 3-D oral camera


• Data processing - By an interactive CAD unit

• The system uses:


• A desk top model computer
• Display monitor permitting visual verification of quality of data being acquired
• Electronically controlled 3-axis milling machine

All Ceramics – Dr. Nithin Mathew 115


MINNESOTA SYSTEM

• Optical impression - Photograph based system using a 35-mm camera with magnifying lens.

• Data processing - Data obtained in the dental office is sent to another location for processing
and machining.

• 3-D Reconstruction uses :


• Direct line transformation and an alternative technique proposed by Grimson

• Milling with a 5-axis milling machine

All Ceramics – Dr. Nithin Mathew 116


CLASSIFICATION - Machinable Ceramics

ANALOGOUS SYSTEM DIGITAL SYSTEMS

I. Copy milling
I. Direct
i. Fabrication of prototype for scanning
II. Indirect
ii. Copying and reproduction by milling
i. 3-D scanning
II. Erosive techniques
ii. CAD modelling
i. Sono Erosion
iii. Fabrication
ii. Spark Erosion

All Ceramics – Dr. Nithin Mathew 117


• 2 Classes of Machinable Ceramics

FINE SCALE FELDSPATHIC PORCELAIN GLASS PORCELAIN


I. DICOR
I. CEREC VITABLOC MARK I:
Flurosilica Mica Crystals Plates (2 microns)
• Feldspathic porcelain
• Larger particle size (10-50 micron)
II. MGC F
II. CEREC VITABLOC MARK II: Tetrasilica mica
(enhance fluorescence, machinability)
• Feldspathic porcelain reinforced
with aluminium oxide (20-30%)
• Fine grain size (4 micron) III. PRO CAD
Leucite - Reinforced Glass Ceramic
(high strength)
All Ceramics – Dr. Nithin Mathew 118
DIGITAL SYSTEMS

CAD-CAM:

• Uses digital information about the tooth preparation or a pattern of the restoration to provide
a computer-aided design (CAD) on the video monitor for inspection and modification.

• The image is the reference for designing a restoration on the video monitor.

• Once the 3-D image for the restoration design is accepted, the computer translates the image
into a set of instructions to guide a milling tool [CAM] in cutting the restoration from a block of
material.

All Ceramics – Dr. Nithin Mathew 119


STAGES OF FABRICATION

All systems ideally involve 5 basic stages:

1. Computerized surface digitization


2. Computer - aided design
3. Computer - assisted manufacturing
4. Computer - aided esthetics
5. Computer - aided finishing

• The last two stages are more complex and are still being developed for including in
commercial systems.

All Ceramics – Dr. Nithin Mathew 120


CAD-CAM Procedure (10-15mins)

Scanning 3D Miniature Camera

• Microprocessor unit stores the pattern

• Video display serves as a format for manual construction

• Final 3-D restoration is developed from above again by


microprocessor

All Ceramics – Dr. Nithin Mathew


• Electronic information is transferred to miniature multiple axis milling device

• Milling device generates a precision fitting restoration from a standard ceramic block

All Ceramics – Dr. Nithin Mathew


CEREC SYSTEM

• Brains. A. G, Switzerland in 1980


• Manufactured in West Germany, Siemens group

• Consists of:
• 3-D video camera (scan head)
• Electronic image processor with memory unit
• Digital processor
• Miniature Milling machine

All Ceramics – Dr. Nithin Mathew 123


Advantages Disadvantages

• Translucency and color of porcelain very • Occlusal anatomy to be developed


closely to natural dental tissues

• Inaccuracies in fit
• Quality of ceramic is not changed during
processing
• Poor esthetics systems

• Can be placed in one visit

• Prefabricated ceramic is wear resistant

All Ceramics – Dr. Nithin Mathew 124


CEREC 2 SYSTEM

• Morman & Brandestini in 1994


• Constant further development

• Major changes include:


• Enlargement of grinding unit from 3 to 6 axes
• Sophisticated software technology : occlusal surfaces

• Minor technical innovations:


• Magnification factor increased from 8x to 12x
• Improved grinding precision by 24 times
• Improved accuracy of fit

All Ceramics – Dr. Nithin Mathew 125


CEREC 3 SYSTEM

• Operator can record multiple images in seconds

• Creates a virtual cast for entire quadrant

All Ceramics – Dr. Nithin Mathew 126


OTHER DIGITAL SYSTEMS

• DURET SYSTEM
• Francois Duret : produced by Sopha (France)

• CICERO SYSTEM

• COMET SYSTEM

All Ceramics – Dr. Nithin Mathew 127


ADVANTAGES : Machinable Ceramics

• Single visit
• Good patient acceptance
• Eliminates procedures like impression model making and fabrication of temporary prosthesis
• Void free porcelains without firing shrinkage
• Better adaptation
• Inlay, onlay can be fabricated chair side
• Eliminates asepsis
• Since its computer assisted crowns of correct dimensions can be obtained
• Glazing is not required : can be polished
• Less abrasion of tooth structure : homogenous material
All Ceramics – Dr. Nithin Mathew 128
DISADVANTAGES : Machinable Ceramics

• Limitations in fabrication of multiple units


• Inability to characterize shades and translucency
• Inability to image in wet environment
• Technique sensitive
• Expensive
• Limited availability

All Ceramics – Dr. Nithin Mathew 129


ANALOGUS SYSTEMS : COPY MILLING

CELAY SYSTEM
COPYING SIDE
• Various size probes represent
size of diff milling burs is run
• Switzerland in 1992
over surface of pattern
• High precision manually operated

• Key duplication

MILLING SIDE
• Advantage : Recreation of all surfaces. • At same time matched rotary
instru-mills same shape out of
restorative block

All Ceramics – Dr. Nithin Mathew 130


ANALOGUS SYSTEMS : EROSIVE TECHNIQUES

SONO EROSION:

• Based on ultrasonic methods.

• The ceramic blank is surrounded by an abrasive suspension of hard particles, such as boron
carbide, which are accelerated by ultrasonics, and thus erode the restoration out of the
ceramic blank.

All Ceramics – Dr. Nithin Mathew 131


ANALOGUS SYSTEMS : EROSIVE TECHNIQUES

SPARK EROSION:

• 'Electrical Discharge Machining' (EDM)

• Metal removal process using a series of sparks to erode material from a workpiece in a liquid
medium under carefully controlled conditions.

• Liquid medium : light oil called the dielectric fluid.

All Ceramics – Dr. Nithin Mathew 132


CERCON & LAVA ZIRCONIA CORE CERAMICS

• Fabrication

Wax pattern Anchored on


Tooth Impression
made on to the Cercon
preparation made
model Brain

Milled prosthesis then removed Unit activated Presintered


zirconia blank
from unit and placed in the Pattern attached on other
cercon furnace (13500C for 6 hrs) scanned side of brain unit

Finished
Trimming ceramic core Veneering
framework
All Ceramics – Dr. Nithin Mathew 133
BONDING OF PORCELAINS

RESIN–CERAMIC BONDING

• Function of the silane primer between porcelain and the composite resin plays an important
role.

• Etching of ceramic surface with 7.5 to 10% hydrofluoric acid for 2-10mins and then followed
by silanization increased the bond strength to porcelain (Peremuter and Montagonon, 1981)

All Ceramics – Dr. Nithin Mathew 134


METAL-CERAMIC BONDING

1. Chemical bonding across the metal-porcelain interface:


• Diffusion between surface oxide on the alloy and ceramic

2. Mechanical interlocking:
• Due to surface irregularity of the alloy
• Air abrasion with aluminium oxide particles

3. Residual compressive stresses:


• Core has slightly higher CTE than porcelain
• Porcelain draws towards the coping on cooling : residual compressive forces

All Ceramics – Dr. Nithin Mathew 135


REPAIR OF CERAMIC RESTORATIONS

1. PORCELAIN REPAIR :
• Fracture is totally in porcelain

• Simplest repair

• Preparation of porcelain surface by bonding :

• Surface roughening by using diamond burs, air abrasion and acid etching
with 9.5% HF acid

• Application of silane coupling agent & allowed to dry for 1 min.

• Application of bonding agent

• Shade matched composite


All Ceramics – Dr. Nithin Mathew 136
2. MIXED (PORCELAIN/METAL ) REPAIR :
• Involves exposed metal

• More complicated

• If remaining porcelain:

• Adequate : exposed metal and remaining porcelain is veneered with composite


opaquer & subsequently with layers of shade matched composite.

• Inadequate : exposed metal surface is used as an adhesive substrate after


preparation for bonding with composite opaquer layer followed by shade matched
composite.

All Ceramics – Dr. Nithin Mathew 137


3. METAL REPAIR:

• Involves the exposed metal with or no remaining porcelain

• Most difficult

• 2 methods :

• Veneering exposed metal surface with direct bonding of shade matched composite
after preparation of exposed metal surface for bonding.

• Fabrication of an over casting: small areas of remaining porcelain are removed if


present. Crown / pontic is reduced circumferentially to provide room for both
porcelain and metal, & provide margin for the laboratory technician and a thin metal
overcasting with fused porcelain veneer is fabricated.
All Ceramics – Dr. Nithin Mathew 138
OTHER APPLICATIONS OF CERAMICS

• ALL CERAMIC POST & CORES

DRAWBACKS of conventional Metal Post & Core

• Decrease depth of translucency of restoration

• Shine through in cervical root, altering appearance of thin gingival tissue

• Corrosion products

All Ceramics – Dr. Nithin Mathew 139


ADVANTAGES of All-ceramic Post & Core

• All ceramic restoration transmits certain percentage of incident light to ceramic core & post .
• Color of final restoration will be derived from an internal shade
• Depth of translucency in cervical root area
• Biocompatible

MATERIALS USED
• In–ceram
• Dense – sintered alumina ceramic
• Zirconium oxide ceramics

All Ceramics – Dr. Nithin Mathew 140


CERAMIC-DENTAL IMPLANTS

• Ceramic oxides : resistant to corrosion


• Tissue grow into surface porosity
• Ceramic Coating for Implant

• Bioactive Ceramics : High density Alumina, TriCalcium Phosphate, High Alumina polymer
composite
• Inert Ceramics : Alumina, Zirconium Oxide

All Ceramics – Dr. Nithin Mathew 141


CERAMIC INSERTS

• Megafillers for direct posterior composite restorations


• Reduce bulk of composite resin
• Decrease shrinkage
• Minimize wear

Composition
• Glass inserts
• Lithium – alumino-silicate glass (heat treated & silanated)
eg: Beta –Quartz Glass –ceramic inserts

All Ceramics – Dr. Nithin Mathew 142


CEROMERS

• Ceramics + Polymers = Ceromers

• Ceramics:
• Abrasion resistance
• High stability
• Esthetics

• Composites
• Ease of final adjustments
• Excellent polishability
• Bonding with luting cement
• Possibility of repair
All Ceramics – Dr. Nithin Mathew 143
ZIRCONIA IMPLANTS

• A radical new solution to immediate dental implant placement.

• Patient’s extracted tooth is laser scanned and modified in CAD


software

• Machined out of zirconium

• Implanted in the still healing socket

• Provides incredibly natural looking results.

All Ceramics – Dr. Nithin Mathew 144


All Ceramics – Dr. Nithin Mathew 145
Strength, Fracture Toughness and Microstructure of a Selection of All-Ceramic
Materials. Part I. Pressable and Alumina Glass-Infiltrated Ceramics
Part II. Zirconia-based dental ceramics
Guazzatoa, Mohammad Albakrya, Simon P. Ringerb, Michael V. Swain
Dental Materials (2004) 20, 441–448

• An increase of the crystalline content as seen in the pressable materials and the fully sintered
zirconia generally corresponds to an improvement of the mechanical properties.

• An increase of crystalline content of a glass–ceramic is accompanied with an increase of the


strength and fracture toughness.

All Ceramics – Dr. Nithin Mathew 146


An Evaluation of Two Modern All-Ceramic Crowns and their comparison with
Metal Ceramic Crowns in terms of the Translucency and Fracture Strength
Girish Nazirkar, Suresh Meshram
International Journal Of Dental Clinics 2011:3(1):5-7

• Vita Inceram crowns exhibited significantly higher fracture strength than conventional all-
ceramic crowns.

All Ceramics – Dr. Nithin Mathew 147


Fracture strength of monolithic all-ceramic crowns made of high translucent yttrium
oxide-stabilized zirconium dioxide compared to porcelain-veneered crowns and
lithium disilicate crowns
Camilla Johansson, Gratiela Kmet, Johnny Rivera, Christel Larsson & Per Vult Von Steyern
Acta Odontologica Scandinavica 2014; 72: 145-153

• The fracture strength of monolithic high translucent zirconia crown is considerably higher
than that of porcelain-veneered zirconia crown cores, porcelain-veneered high translucent
zirconia crown cores and monolithic lithium disilicate crowns.

All Ceramics – Dr. Nithin Mathew 148


Dynamic fatigue and fracture resistance of non-retentive all-ceramic full-coverage
molar restorations. Influence of ceramic material and preparation design
Jan-Ole Clausen, Milia Abou Tara∗, Matthias Kern
Dental Materials 26 (2010) 533–538

• Lithium Disilicate glass-ceramic restorations had higher fracture resistances than leucite
reinforced glass-ceramic restorations.

All Ceramics – Dr. Nithin Mathew 149


Choosing an all-ceramic restorative material
Porcelain-fused-to-metal or zirconia-based?
Gordon J. Christensen
JADA, Vol. 138; May 2007

• Observations regarding zirconia-based all ceramic restorations compared with PFM restorations:

• Better esthetically than typical PFM restorations

• Long-term color stability probably will be the same as that with PFM restorations

• Margins of the restorations have a more acceptable appearance than those of PFM.

• Strength and service record of PFM restorations and zirconia based restorations in three-unit
prostheses is similar.

• Gingival sensitivity to metal will be reduced or eliminated with use of zirconia-based.


All Ceramics – Dr. Nithin Mathew 150
SELECTION OF CERAMIC MATERIALS

• Four broad categories or types of ceramic systems:

 Category 1: Powder/liquid feldspathic porcelains

 Category 2: Pressed or machined glass-ceramics

 Category 3: High-strength crystalline ceramics

 Category 4: Metal ceramics

Ceramics: Rationale for material selection, Cosmetic Dentistry:2,2013


All Ceramics – Dr. Nithin Mathew 151
Clinical Parameters To Evaluate :

• Individual teeth evaluated for specific material selection


• Assessing four environmental conditions in which the restoration will function

1. Substrate
2. Flexure risk assessment
3. Excessive shear and tensile stress risk assessment
4. Bond/seal maintenance risk assessment

Ceramics: Rationale for material selection, Cosmetic Dentistry:2,2013


All Ceramics – Dr. Nithin Mathew 152
1. Substrate

• Is it enamel?
• How much of the bonded surface will be enamel?
• How much enamel is on the tooth?
• How much of the bonded surface will be dentine?
• What type of dentine will the restoration be bonded to? Is it a restorative material (e.g.
composite, alloy)?

• High bond strength : Enamel

• Dentine surfaces/composite : Less predictable


• More stress - between dentine and composite - more damage to the restoration and
underlying tooth structure
All Ceramics – Dr. Nithin Mathew 153
2. Flexure risk assessment

• Each tooth and existing restorations are evaluated for signs of past overt tooth flexure.

• Signs

• Excessive enamel crazing

• Tooth and restoration wear

• Tooth and restoration fracture

• Micro-leakage at restoration margins

• Recession

• Abfraction lesions

All Ceramics – Dr. Nithin Mathew 154


2. Flexure risk assessment

• Low risk
• Low wear; minimal to no fractures or lesions
• Patient’s oral condition is reasonably healthy

• Medium risk
• Signs of occlusal trauma
• Mild to moderate gingival recession along with inflammation
• Bonding mostly to enamel is still possible
• There are no excessive fractures

All Ceramics – Dr. Nithin Mathew 155


2. Flexure risk assessment

• High risk
• Evidence of occlusal trauma from parafunction;
• More than 50 % of dentine exposure exists
• Significant loss of enamel due to wear of 50 % or more
• Porcelain must be built up by more than 2 mm.

All Ceramics – Dr. Nithin Mathew 156


3. Excessive shear and tensile stress risk assessment

• All types of ceramics (especially porcelains) are weak in tensile and shear stresses.

• Ceramic materials perform best under compressive stress

• If a high-stress field is anticipated : Stronger and tougher ceramics are needed

• The substructure should reinforce the veneering porcelain by utilising the reinforced-
porcelain system technique

All Ceramics – Dr. Nithin Mathew 157


4. Bond/seal maintenance risk assessment

• Glass-matrix materials : powder/liquid porcelains and pressed or machined glass-ceramics,


require maintenance of the bond and seal for clinical durability.

• If the bond and seal cannot be maintained, then high-strength ceramics or metal ceramics are
the most suitable, since these materials can be placed using conventional cementation
techniques.

All Ceramics – Dr. Nithin Mathew 158


4. Bond/seal maintenance risk assessment

• Clinical situations in which the risk of bond failure is higher are

• Moisture control problems

• Higher shear and tensile stresses on bonded interfaces

• Variable bonding interfaces (different types of dentine)

• Material and technique selection of bonding

• The experience of the operator

All Ceramics – Dr. Nithin Mathew 159


Category 1: Powder/Liquid Feldspathic Porcelains

Aesthetic Factors • 0.2–0.3 mm is required for each shade change

Substrate Condition • 50 % or more remaining enamel on the tooth


• 50 % or more of the bonded substrate is enamel
• 70 % or more of the margin is in enamel
Flexure risk assessment • Higher risk and more guarded prognosis when bonding to dentine
• Increased enamel, prognosis improved
• Depending on the dentine/enamel ratio, the risk : low to moderate
Tensile and shear stress risk • Low to low/moderate risk.
assessment • Large areas of unsupported porcelain, deep overbite or overlap of
teeth, bonding to more-flexible substrates : Increase the risk of
exposure to shear and tensile stresses
Bond/seal maintenance risk • Absolute low risk of bond/seal failure
assessment
Indications • Indicated for anterior teeth

All Ceramics – Dr. Nithin Mathew 160


Category 2: Pressed or Machined Glass-ceramics

Aesthetic Factors • Minimum working thickness of 0.8 mm


• 0.2–0.3 mm for each shade change is required
Substrate Condition • Less than 50 % of the enamel on the tooth
• Less than 50 % of the bonded substrate is enamel
• 30 % or more of the margin is in dentine
Flexure risk assessment • Risk is medium for Empress, VITABLOCS Mark II and Authentic-type
glass-ceramics and layered IPS e.max
Tensile and shear stress risk • Flexure risk is medium to high (and full crown preparation is not
assessment desirable)
• Monolithic IPS e.max has been 100 % successful for as long as 30
months in service.
Bond/seal maintenance risk • Risk is medium for Empress, VITABLOCS Mark II and Authentic-type
assessment glass-ceramics, and layered IPS e.max.
• Medium to medium/high for bonded monolithic IPS e.max
Indications • Thicker veneers, anterior crowns, and posterior inlay and onlays
• Only indicated in clinical situations in which long-term bond and seal
can be maintained.
All Ceramics – Dr. Nithin Mathew 161
Category 3: High-strength Crystalline Ceramics
Aesthetic Factors • Minimum working thickness of 1.2 mm is required.
Substrate Condition • Substrate is not critical, since a high-strength core supports veneering
material.
Flexure risk assessment • Risk is high or low
• For high-risk situations, core design and structural support for
porcelain become more critical
Tensile and shear stress risk • Risk is high or low
assessment • High-risk situations : Preparations should allow for a 0.5 mm core
plus 1 mm of porcelain
• Anteriors: There should not be more than 2 mm of unsupported incisal
porcelain.
• Molars : Better to use zirconia cores rather than alumina cores
• High risk molar : Full-contour zirconia restorations recommended.
Bond/seal maintenance risk • If the risk of obtaining or losing the bond or seal is high, then zirconia
assessment is the ideal all-ceramic to use.
Indications • When significant tooth structure is missing
• Unfavourable risk for flexure and stress distribution is present
All Ceramics – Dr. Nithin Mathew • It is impossible to obtain and maintain bond and seal 162
Category 4: Metal ceramics
Aesthetic Factors • 1.5–1.7 mm is required for maximum aesthetics
Substrate Condition • Substrate is not as critical, since the metal core supports the
veneering material.
Flexure risk assessment • Risk is high or low
• For high-risk situations, core design and structural support for
porcelain become more critical
Tensile and shear stress risk • Risk is high or low
assessment • For high-risk situations, core design and structural support for
porcelain become more critical
Bond/seal maintenance risk • If the risk of obtaining or losing the bond or seal is high, then metal
assessment ceramics are an ideal choice for a full-crown restoration.
Indications • Indicated in all full-crown situations, esp when all risk factors are
high.

All Ceramics – Dr. Nithin Mathew 163


CONCLUSION

• Dental ceramic technology is one of the fastest growing areas of dental material research and
development. The past decades have seen the development of several new groups of ceramics.

• Each system has its own merits, but may also have shortcomings.

• Combinations of materials and techniques are beginning to emerge which aim to exploit the
best features of each.

• Glass-ceramic and glass-infiltrated alumina blocks for CAD-CAM restoration production are
examples of these.

• The diversity and sophistication of the CAD-CAM systems may prove to be influential in the
future.
All Ceramics – Dr. Nithin Mathew 164
REFERENCES

• Philips science of dental materials - Anusavice

• Craig’s restorative materials

• Dental materials & their selection - William ’O’ Brien

• Clinical operative dentistry - principles and practice - Ramya Raghu

• Textbook of Dental materials – Mahalekshmi

• Theory and practice of fixed prosthodontics - Tylmann

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All Ceramics – Dr. Nithin Mathew 167

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