ALL CERAMIC MATERIALS

INTRODUCTION
 Dental ceramic is one of the most biological and
esthetically acceptable material in dentistry.

 Ceramics are used for manufacturing artificial teeth,

pontics, facing, crowns and fixed bridges.

 Dental porcelain in this domain is superior over

polymers and reinforced polymers regarding toothshade
reproduction, translucency, biological compatibility,
chemical stability and abrasion resistance.
• 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 . (G.P.T 9)

• Porcelain : a ceramic material formed of infusible elements joined

by lower fusing materials. Most dental porcelains are glasses and
are used in fabrication of teeth for dentures, pontics & facings,
crowns, inlays, onlays and other restorations. (G.P.T 9))
HISTORY & EVOLUTION OF CERAMICS

 The first porcelain tooth material was patented

in 1789

 By a French dentist DeChemant in collaboration

with a French pharmacist Duchateau.

 The first commercial porcelain was developed by

Vita Zahnfabrik in about 1963
 1887 PJC – CH. Land (platinum foil technique)

1957 Vines and Sommelman – Vaccum firing

1962 PFM – Weinstein

1965 McLean and Hughes aluminium core porcelain

Kelly JR, Nishimura I, Campbell SD. Ceramics in dentistry: historical roots and current
perspectives. The Journal of prosthetic dentistry. 1996 Jan 1;75(1):18-32.
1957 Vines and Sommelman – Vaccum firing

1968 – castable ceramics

1970 – hydrothermal ceramics

1980 – Duceram LFC

1980 – Cerec system (Brain.A.g, Switzerland)

1984 – Magnesia reinforced porcelain

1988 – Inceram

1994 - Cerec 2 system (Morman &

Brandestini)

2006 – Cerec 3 (Akbar, Walker, Williams)

 COMPOSITION OF CERAMICS

• Silica (Quartz or Flint) – Filler.

• Feldspar – Basic glass former

• Kaolin (China clay) – Binder.

• Water – Important glass modifier.

• Fluxes – Glass modifiers.

• Colour pigments.

Craig RG. Craig's restorative dental materials/edited by Ronald L.

Sakaguchi, John M. Powers. Philadelphia, PA :Elsevier/Mosby,; 2012.
FEATURES :

Excellent esthetic result.

 Moderate strength for single - unit
anterior tooth restorations when bonded
with resin cement.
 Lack of gray/ brown metal show
through since a metal substructure is
absent.
Inability to cover the color of a darkened
tooth preparation or post core, since the
crowns are translucent.
 Laboratory costs higher than those for typical PFM
crowns

 Difficulty in removing the crown and cementing medium

when replacement is necessary

 Bonded pressed ceramic crowns are much more difficult

to remove than standard PFM crowns.
OPTICAL PROPERTIES OF DENTAL CERAMICS

Color matching
 The shades of commercial premixed dental porcelain powders are in the
yellow to yellow-red range.

 These modifiers are strongly pigmented porcelains usually supplied in

blue, yellow, pink, orange, brown, and gray.

 Extrinsic surface staining is another way of changing the appearance of a

ceramic crown. It involves the application of highly pigmented glazes.

Translucency
 The translucency of opaque, dentin (body), and enamel (incisal)
porcelains differs considerably.
 By design, opaque porcelains have very low translucency, allowing them
to efficiently mask metal substructure surfaces.

 Tin oxide (SnO2) and titanium oxide (TiO2) are important opacifying
oxides for opaque porcelains.
 CLASSIFICATION OF DENTAL
CERAMICS
1) USE/INDICATION: Anterior, Posterior, crowns,
veneers, post and cores, stain and glaze ceramic.

2)COMPOSITION: pure alumina, pure zirconia,

silica glass, leucite based glass, Lithia based
glass.

3) PROCESSING METHOD: sintering, partial sintering,

glass infiltration, CAD-CAM, copy milling,
condensation, heat pressing, casting, slip- casting.
10

Kenneth AJ, Shen C, Rawls HR. Philips' Science of Dental

Materials. 11th.
4) FIRING TEMPERATURE:

HIGH FUSING : 1300 C

MEDIUM FUSING : 1101-1300
C
LOW FUSING
ULTRA LOW FUSING:: < 850
850-1100
C C

5) MICROSTRUCTURE: glass, crystalline, crystal-

containing glass
11
 6) TRANSLUCENCY:
Opaque, Translucent, Transparent

7) FRACTURE RESISTANCE

8) ABRASIVENESS

12
 9.According to composition

GLASS-MATRIX CERAMICS
• feldspathic
• synthetic
• Glass infiltered
POLYCRYSTALLINE CERAMICS
• Alumina
• Stabilized zirconia
• Zirconia-toughened alumina
RESIN-MATRIX CERAMICS

• Resin nanoceramic
• Glass-ceramic in a resin interpenetrating matrix
• Zirconia-silica ceramic in a resin interpenetrating matrix
 Why are Ceramics
weak ?
1. Brittle – Covalent bonds
2. Inherent flaws;
fabrication defects and
surface cracks
3. > # in moist environment

Griffiths Flaw Crack Growth

Sintering Process

Richard Van Noort, Introduction to dental materials;4th edition

Methods of strengthening ceramics

INTRINSIC EXTRINSIC

CRYSTALLINE CHEMICAL
REINFORCEMENT STRENGTHENING

TRANSFORMATION
TOUGHENING
Dispersion of crystalline phase:

 Dispersion strengthening/ crystalline reinforcement

 Reinforcing ceramic with a dispersed phase of a

different material that is capable of hindering a crack
from propagating through the material.

 Dental ceramics can be strengthened by increasing the

crystal content of leucite, lithia disilicate,
alumina ,magnesia-alumina spinel,and zirconia
Transformation toughening:

 When small tough crystals are

homogenously distributed in the
glass, the ceramic structure is
strengthened because cracks cannot
penetrate the fine particles as easily
as they can penetrate the glass.

 Various dispersed crystalline phases

includes alumina,leucite,tetrasilicic
fluormica, lithia disilicate, and
magnesia alumina spinel.
Ion exchange/ chemical tempering:

 Increase in the flexural strength depending on

the ionic species involved and the composition
of the porcelain.

 Chemical strengthening applies by

replacement of small ions with larger ions
within the matrix and above the glass transition
temperature by diffusion from a molten salt
bath in which the ceramic or glass is immersed.
Glazing

 This standard technique, also called self-glazing, does

not significantly improve the flexural strength of
feldspathic dental porcelains.
 A low-expansion glass called glaze is applied to the
surface of the ceramic, then fired to high temperature.
 Upon cooling, this glaze layer is placed under
compression from the greater contraction of the
underlying ceramic.
 This layer is also known to reduce depth and width of the
surface flaws, thereby improving the overall resistance of
the ceramic to crack propagation.

Richard Van Noort, Introduction to dental materials;4th edition

 All Ceramic Systems

• Conventional Powder – Slurry Ceramics

• Castable Ceramics
• Pressable ceramics
• Slip cast Ceramics
• Digital systems (CAD / CAM)
• Analogous Systems (Pantograph systems – copying methods)
 CONVENTIONAL POWDER/ SLURRY
CERAMIC
TYPES :

• Alumina – Reinforced porcelain (Aluminous

Porcelain)

• Magnesia – Reinforced porcelain (magnesia core

ceramics)

• Leucite Reinforced

• Low fusing ceramics

• Zirconia whisker - fiber reinforced

Craig RG. Craig's restorative dental materials/edited by Ronald L. Sakaguchi,
John M. Powers. Philadelphia, PA :Elsevier/Mosby,; 2012.
 ALUMINA – REINFORCED PORCELAIN

• Devoloped by Mc Lean & Hughes (1965) consists

of Aluminous core porcelain : which contains 40-
50 % by weight fused alumina crystals fritted in a
low- fusing glass.

• Method of production was to form a tin oxide

coating on a platinum foil thereby providing
atomic bonding with with the aluminous porcelain

• There by reducing subsurface porosity on the

inner side of the porcelain and increasing the
fracture resistance.
• Incorporation of alumina produces dull/ opaque porcelain with lack of
translucency. Hence used as a core material (0.5 -1mm) over plantinum foil
veneered with feldspathic porcelain. Although improved in strength, it is
still insufficient to bear high stresses.
• Low coefficient of thermal expansion
• Eg:Vitadur – N(Vident) Hi – Ceram (Vident)
 MAGNESIA – REINFORCED PORCELAIN

• Magnesia Core Ceramics are high expansion ceramics described by

O’Brien in 1984 for use as core material .
• The magnesia crystals strengthen the glass matrix by both dispersion
strengthening and crystallization within the matrix .

• The flexural strength of the material is 131 Mpa but may be doubled
(upto 269 Mpa) by the application of a glaze internally. In addition, glass
infiltration also significantly increases the fracture strength of magnesia
core.
 Leucite Reinforced

• Leucite reinforced feldspathic porcelain that is condensed and sintered like

aluminous and traditional feldspathic porcelain on a refractory die instead of a
platinum foil.
• Despite the increase in crystallization ,the material retains its translucency
apparently because of the closeness of the refractive index of leucite with that of
the glass matrix .
• The flexure strength is approximately 140 Mpa.
• Eg: OPTIC HSP
 CASTABLE CERAMICS

• First proposed by MacCulloch.

• Glass-ceramics that are polycrystalline materials developed for application
by casting procedures using the lost wax technique, hence referred to as
“castable ceramic”.

Kenneth AJ, Shen C, Rawls HR. Philips' Science of Dental Materials. 11th.
 EXAMPLES

a. Fluoromicas e.g: Dicor

b. Hydroxyapatite based Glass-Ceramics e.g Cera pearl
c. Other Glass-Ceramics
e.g: leucite based,Lithium disilicate based, calcium phosphate based.
 Dicor

• Dicor, the first commercially available castable glass-ceramic material by Densply .

• Dicor is a castable polycrystalline fluorine material, initially cast as a glass by a lost-
wax technique and subsequently heat - treated resulting in a controlled
crystallization to produce a glass - ceramic material.
• Major Ingredients

• SiO2 45-70%
• K2O upto 20%
• MgO 13-30%
• MgF2 (nucleating agent & flux 4 to 9%)
 ADVANTAGES

• Relatively high strength (reported flexural strength of 152 MPa), surface hardness
(abrasion resistance) and occlusal wear similar to enamel.
• Excellent esthetics resulting from natural translucency, light absorption, light
refraction and natural colour for the restoration.
• Inherent resistance to bacterial plaque and biocompatible with surrounding tissues.
• Excellent marginal adaptation (fit).
• Low thermal conductivity.
 Disadvantages

• Requires special and expensive equipments such as Dicor casting machine,

ceramming oven.

• Failure rates as high as 8% (# of the restoration) were reported, especially

in the posterior region. In addition, failure rates as high as 35% have been
reported with full coverage Dicor crowns not bonded to tooth.
 HYDROXYAPATITE GLASS CERAMIC

• Commercially available as Cera Pearl (Kyocera Bioceram, Japan).

Composition:
Calcium oxide -45%
Phosphorus Pentoxide -15% glass formation
Magnesium oxide -5% Decreases viscosity
Silicon dioxide -35% glass matrix
Other -Trace elements Nucleating agents
• Advantages similar to that of dicor but with increased strength.

McCabe JF, Walls AW, editors. Applied dental materials. John Wiley & Sons; 2013 May 7.
 PRESSABLE CERAMICS

• Leucite based
Eg: IPS Empress (Ivoclar viva dent ) , Cerpress SL (Leach &Dillon) ,Finesse all
ceramic system(DENSPLY)

• Lithium disilicate based

Eg: IPS Empress II (Ivoclar viva dent ) ,Optec OPC 3G.

Craig RG. Craig's restorative dental materials/edited by Ronald

L. Sakaguchi, John M. Powers. Philadelphia, PA
:Elsevier/Mosby,; 2012.
 Leucite based
• IPS EMPRESS (Ivoclar Williams) is a pre-cerammed, pre-coloured
leucite reinforced glass-ceramic formed from the leucite system
(SiO2-AI2O3-K20) by controlled surface crystallization and heat
treatment.
• The glass contains latent nucleating agents and controlled
crystallization is used to produce leucite crystals measuring a few
microns in the glass matrix.

• These glass ceramics have low flexural strength and fracture

toughness ,and not recommended for molar crowns or bridges.
 Advantages

•
Lack of metal or an opaque ceramic core.
• Moderate flexural strength (120-180MPa range).
• Excellent fit (low-shrinkage ceramic).
• Improved esthetics (translucent, fluorescence).
• Etchable.
• Less susceptible to fatigue and stress failure.
• Less abrasive to opposing tooth
• Biocompatible material
 Disadvantages :

• Potential to fracture in posterior areas therefore difficulty in removing the

crown and cementing medium during replacement
• Need for special laboratory equipment such as pressing oven and die
material (expensive).
 Lithium disilicate based

• IPS EMPRESS 2
• Second generation of pressable materials for all-ceramic bridges.
• It is made from a lithium disilicate framework with an apatite layered ceramic. The glass-ceramic
ingots are made from lithium silicate glass crystals with crystal content of more than 60 volume
%.
• The apatite crystals incorporated are responsible for the improved optical properties
(translucency, light scattering) which contribute to the unique chameleon effect of leucite glass-
ceramic materials.
• IPS Empress 2 is used with special investment material, an EP500 press furnace and a fully
automatic high-tech furnace.
 SLIP CAST ALL CERAMIC

1) Alumina based e.g: In-Ceram Alumina

2) Spinel based e.g: In-Ceram Spinel

3) Zirconia based e.g: In-Ceram Zirconia

Property Inceram-Alumina Inceram-Spinell Inceram-Zirconia

Composition Alumina and Lanthanam Glass MgO and Alumina Alumina and Zirconia

Flexural Strength (MPa) 500 350 700

Translucency Translucent Highly Translucent Opaque

Anterior and posterior crowns, Anterior 3- Posterior Crown and

Indications Anterior crowns, inlays and onlays.
unit bridges. Bridges.

Srinivasa Raju Datla et al. Dental Ceramics: Part II – Recent Advances in Dental Ceramics. American Journal of Materials
Engineering and Technology, 2015, Vol. 3, No. 2, 19-26. doi:10.12691/materials-3-2-1
 DISADVANTAGES

• Marginal adaptation not very good.

• Relatively high degree of opacity.
• Inability to be etched.
• Technique sensitive

McLaren EA. All-ceramic alternatives to conventional metal-ceramic

restorations. Compendium. 1998 Mar;19(3):307-25.
 ZIRCONIA BASED SYSTEMS
• It was introduced into dentistry in the early
1990s f in implant dentistry as implant
abutments and for crown and bridge since 2004.
• Pure zirconia exibit 3 different crystal structure
cubic (2367 C)
tetragonal (1167-2367 C)
monoclinic (1167 C)
• Tetragonal to monoclinic cause 3% to 5%
volume increase therefore stabilised with
Y,Sc,Ca,Nd,Mg .
• Y-TPZ core is relatively translucent and, at the same time may mask the
underlying discolored abutment.

•Moreover it can be colored in 1 to 7 shades corresponding to the Vita- Lumin

shade guide.

•This ability to control the shade of the core may eliminate the need for veneering.
 Fracture resistance of monolithic zirconia molar
crowns with reduced thickness
 It was revealed that the occlusal thickness significantly
affected the fracture load but the axial thickness did not .

 Although the reduction of the occlusal thickness decreased the

fracture resistance of the monolithic zirconia crowns, the
fracture load of the zirconia crowns with the occlusal thickness
of 0.5 mm was significantly higher than that of lithium
disilicate crowns with an occlusal thickness of 1.5 mm .

 It is suggested that monolithic zirconia crown with chamfer

width of 0.5 mm and occlusal thickness of 0.5 mm can be used
in the molar region in terms of fracture resistance.

Nakamura K, Harada A, Inagaki R, Kanno T, Niwano Y, Milleding P, Örtengren U. Fracture

resistance of monolithic zirconia molar crowns with reduced thickness. Acta Odontologica
Scandinavica. 2015 Nov 17;73(8):602-8.
 MACHINABLE CERAMICS

• Digital systems (CAD / CAM)

• Analogous Systems
 Digital systems (CAD / CAM)

• 1)Direct e.g: Cerec 1 & Cerec 2.

• 2) Indirect e.g : Cicero, Denti CAD, Automill, DCS-President.

Beuer F, Schweiger J, Edelhoff D. Digital dentistry: an overview of recent developments

for CAD/CAM generated restorations. British dental journal. 2008 May;204(9):505.
 Analogous Systems

1) Copy milling / grinding techniques

a) Mechanical
e.g: Celay
b) Automatic
e.g:Ceramatic II
2) Erosive techniques
a) Sono-erosion
e.g: Erosonic
b) Spark-erosion
e.g: Procera
 Digital systems (CAD / CAM)

• Steps in fabrication :
• 3-dimensional surface scanning
• CAD -Modelling of the prosthesis
• Milling of prosthesis
• Cutting of the framework
• Sintering
• Evaluation

McCabe JF, Walls AW, editors. Applied dental materials. John Wiley & Sons; 2013 May 7.
 Advantage of CAD/CAM (Cerec system)

• Eliminates impression model making and

fabrication of temporary prosthesis.
• Dentist controls the manufacturing of the
restoration entirely without laboratory
assistance.
• Single visit restoration and good patient acceptance.
• Alternative materials can be used, since milling is not limited to
castable materials.
• The use of CAD/ CAM system has helped provide void free
porcelain restorations, without firing shrinkage and with better
adaptation.
• Glazing is not required and Cerec inlay onlays can easily be polished.

• Minimal abrasion of opposing tooth structure because of homogeneity of the

material (abrasion does not exceed that of conventional and hybrid posterior
composite resins).

• The mobile character of the entire system enables easy transport from one dental
laboratory to another.
 Disadvantages:

• Limitations in the fabrication of multiple units.

• Inability to characterize shades and translucency.
• Inability to image in a wet environment (incapable of obtaining an accurate image in the presence of
excessive saliva, water or blood).
• Incompatibility with other imaging system.
• Extremely expensive and limited availability.
• Lack of computer-controlled processing support for occlusal adjustment.
• Technique sensitive nature of surface imaging that is required for the prepared teeth.
• Time and cost must be invested for mastering the technique and the fabrication of several restorations,
to develop proficiency in the operator
.
 Analogous Systems
• Based on a mechanical device that trace the surface of a prefabricated
pattern on a resin composite material or the pattern made directly on the
tooth.
• A milling machine copies the movement and mills the ceramic material.
• Eg: celay system
Name of Processing technique Type of ceramic Crystalline Phase Brand & Manufacturer

Leucite- reinforced Feldspathic

Sanidine Optec HSP, Jeneric/Penetron Inc.,
porcelain
Alumina based porcelain Alumina Hiceram, Vident, Baldwin Park, CA.
Sintered porcelains
Magnesia based core porcelain Forsterite Vident, Baldwin Park, CA.

Zirconia based porcelain Mirage II Myron International, Kansas City, KS

Mica based porcelains Tetrasilicic fluoromica DICOR, Dentsply International

Castable glass ceramics Hydroxyapatite based porcelains Oxyapatite Cerapearl, Kyocera, San Diego, CA.

Lithia based porcelains Lithium Disilicate Vident, Baldwin Park, CA

Slip-Cast + Glass Infiltrated Alumina In-Ceram® Alumina, Vident, Baldwin Park, CA
Slip-Cast + Glass Infiltrated Spinel In-Ceram® Spinell, Vident, Baldwin Park, CA
Slip cast ceramics
12 Ce-TZP-alumina In-Ceram® Zirconia, Vident Baldwin Park, CA
Slip-Cast + Glass Infiltrated
3Y-TZP Cercon®, Dentsply
Leucite-based Leucite IPS Empress®, Ivoclar
Hot pressed, injection-molded Lithium based IPS Empress® Eris,
Lithium disilicate
ceramics Ivoclar
Cerestore Spinel Alceram, Innotek Dental Corp, Lakewood, CA.
Tetrasilicic fluoromica DICOR MGC, Dentsply International, Inc., York, PA
Cerec system Vitablocs®, Mark II
Sanidine
Vident, Baldwin Park, CA.
Sanidine Vita-Celay, Vident, Baldwin Park, CA
Celay system
Machinable ceramics Alumina In-Ceram® AL, Vident, Vident, Baldwin Park, CA.
Procera system Alumina Procera All Ceram, Nobel Biocare, USA
Leucite IPS Empress® CAD, Ivoclar
CAD Based
Lithium disilicate IPS e.max CAD, Ivoclar
Lava CAD/CAM System Y-TZP Lava CAD/CAM, 3M ESPE, St. Paul, Minnesouta

Srinivasa Raju Datla et al. Dental Ceramics: Part II – Recent Advances in Dental Ceramics. American Journal of Materials
Engineering and Technology, 2015, Vol. 3, No. 2, 19-26. doi:10.12691/materials-3-2-1
 CONCLUSION
 Current ceramic materials could “cover” every clinical situation
where single-tooth restoration and fixed partial dentures are
indicated for use, there are some limitations that should be taken
seriously.

 All-ceramic restorations are not recommended in patients with in

short clinical crowns, sub-gingival preparations , inadequate oral
hygiene, and patients diagnosed with excessive masticatory
functions.

 The future of all-ceramic materials is bright. Further

improvements in chemical composition, internal structure, grain-
size decreasing to nano dimensions and improved and laboratory
processing, all of them will for sure lead to a material with
extraordinary features fulfilling the esthetic, mechanical and
biocompatible demands.
 REFERENCES
 Craig RG. Craig's restorative dental materials/edited by Ronald L.
Sakaguchi, John M. Powers. Philadelphia, PA :Elsevier/Mosby,; 2012

 Richard Van Noort, Introduction to dental materials;4th edition

 McCabe JF, Walls AW, editors. Applied dental materials. John Wiley
& Sons; 2013 May 7.

 Kenneth AJ, Shen C, Rawls HR. Philips' Science of Dental Materials.

11th

 Kelly JR, Nishimura I, Campbell SD. Ceramics in dentistry:

historical roots and current perspectives. The Journal of prosthetic
dentistry. 1996 Jan 1;75(1):18-32.
 McLaren EA. All-ceramic alternatives to conventional metal-ceramic
restorations. Compendium. 1998 Mar;19(3):307-25.

 Srinivasa Raju Datla et al. Dental Ceramics: Part II – Recent Advances in

Dental Ceramics. American Journal of Materials
 Engineering and Technology, 2015, Vol. 3, No. 2, 19-26.
doi:10.12691/materials-3-2-1

 Nakamura K, Harada A, Inagaki R, Kanno T, Niwano Y, Milleding P,

Örtengren U. Fracture resistance of monolithic zirconia molar crowns with
reduced thickness. Acta Odontologica Scandinavica. 2015 Nov
17;73(8):602-8.

 Beuer F, Schweiger J, Edelhoff D. Digital dentistry: an overview of recent

developments for CAD/CAM generated restorations. British dental journal.
2008 May;204(9):505.

 Bajraktarova-Valjakova E, Korunoska-Stevkovska V, Kapusevska B,

Gigovski N, Bajraktarova-Misevska C, Grozdanov A. Contemporary Dental
Ceramic Materials, A Review: Chemical Composition, Physical and
Mechanical Properties, Indications for Use. Open access Macedonian
journal of medical sciences. 2018 Sep 25;6(9):1742.
THANK
YOU