INDEX

SR . CONTENTS PAGE

NO. NO.
1. INTRODUCTION 4-8
2. HISTORICAL PERSPECTIVE OF DENTAL CERAMICS 9-22
3. CERAMICS

 CLASSIFICATION OF DENTAL CERAMICS 23-

 COMPOSITION

 PROPERTIES AND LIMITATIONS

 MECHANISMS OF INCREASING FRACTURE

RESISTANCE OF CERAMICS
4. ALL CERAMIC SYSTEMS

 CLASSIFICATION SYSTEMS

 INDICATIONS AND CONTRAINDICATIONS

 ADVANTAGES AND DISADVANTAGES

5. GLASS CERAMICS

 FELDSPATHIC PORCELAIN

 LEUCITE REINFORCED FELDSPATHIC PORCELAIN

 LITHIUM DISILICATE GLASS INFILTRATED ALUMINA

6. GLASS INFILTRATED CERAMICS

 GLASS INFILTRATED ALUMINA

 GLASS INFILTRATED MAGNESIA ALUMINA

 GLASS INFILTRATED ALUMINA WITH 35% ZIRCONIA

7. ZIRCONIA

 ORIGIN AND APPLICATIONS

 PROPERTIES ZIRCONIA PRODUCTS

 ZIRCONIA PRODUCTS

1
  PREPARING ZIRCONIA FOR USE

 AGING OF ZIRCONIA CERAMICS

8. POLYCRYSTALLINE CERAMICS

 DENSLY SINTERED HIGH PURITY ALUMINA

 Y-TZP
9. CAD-CAM SYSTEMS

 HISTORICAL BACKGROUND

 CAD/CAM COMPONENTS

 TYPES OF CAD/CAM SYSTEMS

 ADVANTAGES OF CAD/CAM SYSTEMS

 CAM TECHNOLOGIES

 DIFFERENT CAD/CAM SYSTEMS

10. CLINICAL ASPECTS OF ALL-CERAMIC RESTORATIONS

 SELECTION OF THE CERAMIC FOR A CLINICAL CASE

 PREPARATION DESIGN

 MARGINAL FIT

 SURFACE TREATMENT

 CEMENTATION
11. CAUSES OF FAILURE OF ALL-CERAMIC RESTORATIONS
12. SURVIVAL RATES OF ALL-CERAMIC RESTORATIONS
13. DISCUSSION AND SUMMARY
14. REFERENCES

2
 INTRODUCTION

Today the concept of dental aesthetics is in initiation of tooth

substitute so realistic as to almost defy ditection. Dental ceramics

are the most naturally appearing replacement material available for

missing tooth substance available in a range of shades and

translucencies to achieve life like results. Ceramics were the last to

move into the high-technology phase of development. During the

past decade, the demand for non-metallic highly biocompatible

dental restorative material has, however, markedly increased. The

esthetic demands made on dental restorations have resulted in an

increased use of dental ceramics. Esthetically, these materials are a

preferred alternative to traditional materials and ceramics are also

regarded as bio-compatible and inert materials. Furthermore, the

introduction of bonding procedures and new luting techniques has

increased the general acceptance of these all- ceramic systems. In

an attempt to meet the requirements of dental materials and to

improve their strength and toughness, several new all-ceramic

materials and techniques have been developed during the past

decade. These recent developments have attempted to overcome

3
the principal disadvantages of inherent brittleness and strength by

either the use of increasingly complex technology or by

simplification of existing techniques and/or materials. Recent

material, technical and clinical innovations in restorative dentistry

have increased the complexity of treatment planning and decision-

making. Many of these advances have not replaced, but have rather

augmented a wide variety of already existing materials or treatment

protocols, as well as clinical technique and skills. Dentists today

can choose from a variety of all-ceramic material systems and

hence should be familiar with the range of all-ceramic material

available for fabrication of ceramic restorations.

The word “ceramic” is derived from the Greek word “Keramos”

which means “pottery.”1 Keramos in turn is related to an older

Sanskrit root meaning “to burn”.

According to Gilman(1967), a ceramic is an earthy material,

usually of a silicate nature and may be defined as a combination of

one or more metals with a non-metallic element, usually oxygen.

It is relating to the manufacture of any product made essentially

from a nonmetallic mineral (as clay) by firing at a high

temperature.2 Ceramics were the most sophisticated materials of

4
stone age more than 10,000 years ago and they have retained their

importance in human societies ever since.

Dental porcelains actually are non-crystalline glasses [McLean,

1979] and whether by convention or convenience are referred to as

ceramics.3 The name porcelain is said to have been coined by

Marco Polo in the 13th century from the term porcelino, which is

the Italian name for the cowrie shell (also called the Venus

shell).

The cowrie got its name because of its resemblance to a "little pig",

which is the real meaning of the term "porcelino". Polo referred to

the cowrie shell to describe Chinese porcelain to fellow Europeans

because of the shell's thinness, translucency, hardness and

strength.

Feldspathic porcelains with reliable chemical bonding have

been used in metal ceramic restorations for more than 35 years.

Recent developments such as opalescence, specialized internal

staining techniques, greening resistant porcelains and porcelain

shoulder margins have significantly enhanced the overall

appearance and “vitality” of metal ceramic crowns and bridges and

the clinical serviceability of their restorations. Unfortunately

feldspathic porcelains have been too weak to use reliably for the

5
construction of all ceramic crowns without a cast-metal core or

metal foil coping.

Since the introduction of Aluminous porcelain jacket crowns

in early 1900’s, development in both the composition of the

ceramics and the methods of forming the core of all- ceramic

crowns have greatly enhanced our ability to produce more accurate

and fracture resistant jacket crowns made entirely of ceramic

material.

Dental Ceramic technology is one of the fastest growing

areas of dental material research and development. The future of

Dental Ceramics is bright because of increased demand for tooth-

coloured restorations, especially ceramic-based and polymer based

restorations and the reduced use of amalgam and traditional cast

metal.

6
HISTORICAL PERSPECTIVE 1,4

The desire for an esthetic restorative material is an ancient

one. To understand the true significance of introduction of ceramics

to dentistry, knowledge of its historical development is essential.

Ceramics were probably the first materials to be artificially

made by humans and porcelain was among the first materials to be

the subject of early laboratory research by scientists.

Historically, 3 basic types of ceramic materials were

developed,1

1. Earthenware is fired at low temperatures and is relatively

porous.

2. Stoneware which appeared in China in about 100 B.C., is fired

at a higher temperature than earthenware, resulting in higher

strength.

3. Porcelain the third material obtained by fluxing white China

clay with “Chine Stone” to produce a white translucent

stoneware, this was developed in King-Tetching in China in

about 1000 A.D.

Dental Ceramics were first used in dentistry in the late 1700s.

The originator of the first porcelain paste used for denture work

was a French apothecary, Alexis Duchateau. In 1774, he teamed up

7
with the Parisian dentist Nicholas Dubois de Chemant and the two

were able to construct the first successful porcelain dentures at

Guehard porcelain factory, from a material “Mineral paste.”

In 1788, De Chemant eventually patented the formulation and

published his books on artificial tooth. Jhon Woodforde in his book

“The strange story of False teeth” described how De Chemant set

up in London in 1792, and continued to manufacture dentures of

porcelain paste supplied by the famous Wedgeword porcelain

factory. In 1792 in his more definitive text, “A Dissertation on

Artificial teeth,” de Chemant illustrated a porcelain bridge of 10

teeth, supported by four pivots.

In 1808, the foundation for the modern mass production of

artificial teeth was laid by Italian dentist Giuseppangelo Fonzi,

when he produced first individual porcelain “Terrometallic teeth”,

in which platinum brackets baked into porcelain were soldered

with gold to platinum denture base. This was the first landmark in

porcelain fused to metal system.

Commercial manufacture of porcelain teeth began in 1800s in

France and 1817 in America from ‘Parian China’ type of porcelain

with principal constituent as feldspar. Stockton in 1825 produced

first porcelain teeth in America, while White in 1845 using

Stockton’s formula produced porcelain teeth on commercial basis.

8
 Amber Tess in 1880 improved the design of dental coke

burning porcelain ovens. Dentistry went through various designs of

ovens using gas, oil and electric furnace to computerized electronic

circuits at the end of the century.

Porcelain teeth were initially manufactured with metal pins

which had to be soldered to metal denture bases. With the

introduction of Vulcanite, the metal pin had to be bent by the

dentist to give mechanical retention.

HISTORICAL ASPECT AS RELATED TO CROWNS

1

Single tooth porcelain restorations were first introduced in

1844. They become popular in 1860 with English tube teeth, in

which a hole was present to adapt them as individual post crown

for attachment to root of natural teeth by means of wood post.

Richmond crown improved by Logan in 1885, was an

improvement in this direction. In this system, porcelain was fused

to platinum post which solved the retention problem between post

and crown.

9
 The porcelain Jacket crown is said to have originated from

gold shell crown, the idea for which is credited by Beers of

California in 1873.

In 1886, the first successful porcelain inlays and crowns

were said to be made by land of Detroit. Swedged platinum foil

was used as a matrix for fusing porcelain within a gas furnace.

In 1890, Porcelain inlays were also produced by

Philadelphia Dental College. Although these early porcelain inlays

were lacking in esthetic merit.

In 1900, Brewster of Chicago brought out medium fusing

porcelain. At about the same time Jenkins of Dresden, Germany,

demonstrated his low fusing (9980C) porcelain.

Fickes in 1910 and 1918 published perhaps the earliest

mechanical properties of dental porcelain. Crushing strength of

porcelain was found to be double than that of amalgam and silicate

cement.

The all porcelain crown system despite its esthetic

advantages failed to gain popularity because of brittle nature.

However introduction of Alumina changed the picture. This

material was much less prone to static fatigue than earlier material.

10
 In the late 1960s, Veneer materials developed from

aluminous porcelain, in which thermal coefficient of expansion

was reduced to be compatible with the aluminous core.

Another noteworthy development of 1950s is the addition of

Leucite to thermal expansion to allow their fusion to certain gold

alloys.

By 1962, M Weinstein, S. Katz and A. A. Weinstein,

patented a method to fabricate the first metal ceramic crown.

HISTORICAL ASPECT AS RELATED TO CASTING

OF DENTAL PORCELAIN 1

Fabrication of inlays and crown by means of casting molten

porcelain was described by Wain in 1923.

Mac Culloch in 1968 experimented with the castable glass

that could be heat-treated to produce a crystallization or ceramming

effect.

In 1984, the Corning Glass Company and Dentsply

Company introduced a Commercial glass-ceramic system for

scasting dental crowns. After casting, the glass crown is heat

treated, which produces crystallization and a subsequent increase in

strength.

11
 Vacuum firing of dental porcelain was introduced in the late

1940s by Semmelman, Lee and Fonvielle in U.S.A.

Helberger in Germany has been given credit for developing

and using the first vacuum furnace as early as 1913 for fusing silica

in order to eliminate the amount of trapped air.

The development of dental ceramics was continuing into the

1980s with the introduction of new low fusing porcelains, castable

glass ceramics and moldable aluminous core systems.

CHRONOLOGIC RECORD OF DEVELOPMENT OF

DENTAL CERAMICS 1

PERIOD DEVELOPMENT
24,000 B.C. Human made ceramics uncovered in

Czechoslovakia in the form of animal and human

figurines,slabs and balls.

9,000 B.C. First pottery produced.
100 B.C. First Stoneware.
1,000 A.D. First Chinese Porcelain produced in King-te-

Tching in China.
1671 Jhon Dwight granted English patent No. 164 for

transparent porcelain.
1717 D’ Entrecolles learns secret Chines porcelain.
1723 Pierre Fauchard first suggested the use of

12
 porcelain in dentistry.
1774 Alexis Duchateau and Nicholas Dubois De

Chemant first made a porcelain denture.

1791 De Chemant obtained French and English patents

for dental porcelain.

1800 Wedgewood supplied porcelain material for denture

work.
1801 Guiseppangelo Fonzi fused porcelain to metal to

produce ‘terrometallic’ teeth.

13
1816 De chemant suggested use of porcelain for bridge

work.
1830 Stockton produces first porcelain teeth in United

States.
1837 Ash Wildman produced porcelain with much

improved translucency and colour.

1845 White produced first commercial porcelain

denture teeth.
1880 Tess improved the design of porcelain furnace.
1886 Porcelain inlays and Jacket crowns were

established by Land of Detrait.

1900 Introduction of medium fusing porcelain.
1902 First electric porcelain furnace used.
1905 Dr Chares Land patented first ceramic crowns.
1918 First Chemical analysis of dental porcelain.
1923 First casting of dental Porcelain by Wain.
1940 Vaccum firing of dental porcelain by Helberger.
1942 Patent taken out for uranium compounds to

produce fluorescent porcelains (Dietz, C.U.S. Pat.

No. 2301)
1956 Development of porcelain fused to gold systems.
1957 Strength of low fusing and high fusing porcelains

were found to be about the same.

1962 Development of a much improved gold alloy which

was used for porcelain fused to metal system.

1965 Development of dental aluminous core and

veneer porcelains by Mclean And Hughes.

1968 MacCulloch first used a glass-ceramic in dentisty.
1969 Concern expressed in publication about uranium

content of some porcelain.

1970 Development of porcelain fused to base metal

14
 systems.
1971 CAD - CAM technique was introduced first time.
1974 Introduction of palladium-silver alloys which was

used for porcelain fused to metal system.

1979 Heitlinger and Rodder started the application of

CAD-CAM system in dental profession.

1981 Development of “nonshrink” aluminous direct

moulding core system for crowns.

1983 Development of high expansion core material by

O’Brien.
1984 First international standard published for dental

ceramic powders - ISO 6872-1984 (E) “Dental

Ceramic”.

Introduction of first commercial glass-ceramic

system for dentistry by Corning Glass Company.

1985 Dr. Michal Sedaoum developed Slip Cast

technique.

Dr. Duret introduced Duret CAD-CAM system.

1987 Cerec1 system was introduced by Dr. Mormamm

and Brandestini in Zurich.

1988 Cerec introduces CEREC VITABLOCS.
1989 Vita Zahnfabrik presented In Ceram.

Innotek, Lakewood Co. introduced AllCeram.

Cerec Vitablock Mark II was introduced by Vita.

1991 Woldewend and Scharer described IPS Empress

system.
1992 Mikrona Technologie, Spreitenback, Switzerland

15
 designed Celay machinable Ceramic System as a

result of doctoral thesis by Dr. Stefan Eeidenbaez.

Duceram LFC was marketed as as ultralow-

fusing ceramic.

Anusavice et al reported the significant

strengthing of Leucite containing feldspathic

porcelain by using Ion Exchange technique.

1993 Anderson and Ogen introduced Procera AllCeram
1994 Cerec 2 unit CAD CAM system was introduced.

Denticad system was designed by Foster Miller

that can be used intraorally.

IPS Empress TC ingots introduced.

1995 Nissan CAD CAM system first presented at the

Tokyo Dental.

1995 Segi R. and Rosenstiel SF compared 11 dental

ceramics system and found Aluminous reinforced

porcelain resulted highest fracture toughness.

1997 Vita introduces In Ceram alumina and In Ceram

spinell blanks.
1998 IPS Empress 2 introduced.

ProCAD introduced.
1999 LAVA Zirconium oxide ceramic system was

introduced by 3M ESPE in the market.

Vita In Ceram Zirconia blanks for crowns.

16
2000 CEREC3 introduced.

2001 Vita In Ceram Alumina and Zirconia blanks for

bridges.
2003 Vitablocs Triluxe milling blocks.

CEREC 3D introduced.
2004 IPS Empress Esthetic launched.

2005 IPS e-max system.

2006 IPS Empress CAD introduced.

2008 Sirona release the MCXL milling unit, this milling unit can

produce a crown in 4 mins

CLASSIFICATION OF DENTAL CERAMICS

There are several categories of dental ceramics-

17
(1) Conventional Leucite- containing porcelain.

(2) Leucite-enriched porcelain.

(3) Ultra-low fusing porcelain that may contain –

a. Leucite.

b. Glass-ceramic,

c. Specialized core ceramics like alumina, glass infiltrated

alumina, magnesia and spinel.

(4) CAD-CAM Ceramic.

Dental ceramics can also be classified by5 –

(I) CLASSIFICATION BASED ON COMPOSITION-

1) Pure alumina,

2) Pure zirconia,

3) Silica glass,

4) Leucite-based glass ceramics,

5) Lithia-based glass ceramics.

(II) CLASSIFICATION BASED ON USE -

1) Denture teeth,

2) Metal – Ceramics,

3) Veneers,

18
 4) Inlays,

5) Crowns and anterior bridges.

(III) CLASSIFICATION BASED ON BY PROCESSING

METHOD -

1) Sintering,

2) Partial sintering and glass infiltration,

3) CAD/CAM,

4) Copy milling.

(IV) CLASSIFICATION BASED ON TRANSLUCENCY-

1) Opaque,

2) Translucent,

3) Transparent.

(V) CLASSIFICATION ACCORDING TO THEIR FIRING

TEMPERATURES-

1) High fusing – 13000C (23720 F)

2) Medium fusing – 1101-13000C (2013-20720 F)

3) Low fusing – 850-11000C (1562-20120 F)

19
 4) Ultra- low fusing -- < 8500C (15620 F)

The medium-fusing and high-fusing types are used for the

production of denture teeth.

The low-fusing and ultra-low fusing porcelains are used for

crown and bridge construction.

(VI) CLASSIFICATION BASED ON SUBSTRUCTURE

MATERIAL

1) Cast metal,

2) Swaged metal,

3) Glass ceramic,

4) CAD/CAM porcelain

5) Sinterd ceramic core.

COMPOSITION6,7

The quality of any porcelain depends on the choice of ingredients,

the correct proportioning of each, and the control of the filling

procedure. Ceramics are composed of essentially the same material

20
as porcelain, the principle difference being in the proportioning of

the primary ingredients and the firing procedures.

The ingredients are:

1. Feldspar

2. Silica (Quartz or flint)

3. Kaolin (Clay)

Other compounds such as potash, soda or lime are often

added to give special properties.

Glass is a fusible combination of silica and potash, whereas

porcelain contains infusible elements held together by lower-fusing

materials and is less transparent.

FELDSPAR: -

21
Natural feldspar is a mixture of albite (Na2Al2Si6O16) and

orthoclase or microcline (K2Al2Si6O16) with free crystalline quart.

In its mineral state, feldspar is crystalline and opaque with an

indefinite colour between gray and pink. Chemically it is

designated as potassium-aluminium silicate, with a composition of

K2OAl2O36SiO2. On heating, it fuses at about 1290 0 C, becomes

glossy and unless overheated, retains its form without rounding.

This last is a desirable property, since it is necessary to retain the

form of porcelain restorations while they are fusing.

Iron and mica are commonly found as impurities in feldspar.

It is particularly important to remove the iron, since metallic oxides

act as strong coloring agents in porcelain. For removal of iron, each

piece of feldspar is broken with a hammer, and only uniformly

light colored pieces are selected. These pieces are ground in ball

mills until they become fine powder. The final particle size is

carefully controlled by screening to remove the coarser particles

and flotation processes are used to remove the excessively fine

22
particles. The dry powder is then slowly vibrated down the inclined

plane equipped with a series of narrow ledges formed by induction

magnets. In this way, the remaining iron contaminants are

separated and remove, and the feldspar is made ready for use.

Potassium and sodium feldspar are naturally occurring

materials composed of potash (K2O), soda (Na2O), alumina (Al2O3)

and silica (SiO2). It is used in the preparation of many dental

porcelains, designed for metal-ceramic crowns and many other

dental glasses and ceramics. When potassium feldspar is mixed

with various metal oxides and fired to high temperatures, it can

form leucite and a glass phase than will soften and flow slightly.

The softening of this glass phase during porcelain firing allows the

porcelain powder particles to coalesce together. For dental

porcelains, the process by which the particles coalesce is called

“liquid-phase sintering,” a process controlled by diffusion between

particles at a temperature sufficiently high to form a dense solid.

The driving force for sintering is the decrease in energy caused by

reduction in surface area.

Another important property of feldspar is its tendency to

form the crystalline mineral leucite when it is melted. Leucite is a

potassium-aluminium silicate mineral with a large coefficient of

thermal expansion (20 to 25 x 10-6/0C) compared with feldspar

23
glasses (has coefficient of thermal expansion less than 10x10-6/0C).

When feldspar is heated at temperatures between 11500C and

15300C, it undergoes incongruent melting to form crystals of

leucite in a liquid glass. “In-congruent melting” is the process by

which one material melts to form a liquid plus a different

crystalline material. This tendency of feldspar to form leucite

during in-congruent melting is used to advantage in the

manufacture of porcelain for metal bonding.

SILICA:-

It is not so difficult to obtain silica, as feldspar. Pure quartz

crystals (SiO2) are used in dental porcelain. Traces of iron may be

present, but are removed to prevent discoloration. The preparation

of silica, therefore, is much the same as that of feldspar, except that

silica is ground to the finest grain size possible. Silica remains

unchanged at temperature normally used in firing porcelain, and

24
this contributes stability to the mass during heating by providing a

framework for other ingredients.

Silica can exist in four different forms -- crystalline quartz,

crystalline cristobalite, crystalline tridymite, and non-crystalline

fused silica. Fused silica is a high melting material whose high-

melting temperatures is attributed to the three-dimensional network

of covalent bonds between silica tetrahedral, which are the basic

structural units of glass network. Fluxes are often included to

reduce the temperature that is required to sinter the porcelain

powder particles together at low enough temperature so that the

alloy to which it is fired does not melt or sustain sag (flexural

creep) deformation.

25
KAOLIN:-

It is produced in nature by weathering of feldspar, during which the

soluble potassium silicate is washed out by acid waters. In this

process the residue is deposited along the banks and at the bottom

of the streams in the form of clay. The Kaolin, represented by the

formula Al2O3. 2SiO2. 2H2O, is prepared by repeated washings with

water until all foreign materials are separated. The clay is then

allowed to settle, and after it has been dried and screened, the

nearly white powder is ready for use. Kaolin gives porcelain its

properties of opaqueness. When mixed with water, it becomes

sticky and aids in forming a workable mass of the porcelain during

molding. When subjected to high heat, it adheres to the frame-work

of quartz particles and shrinks considerably.

26
COLOR FRITS:-

The coloring pigments added to the porcelain mixture are

called “color frits”. These powders are added in small quantities to

obtain the delicate shades necessary to imitate the natural teeth.

They are prepared by grinding together metallic oxides with fine

glass and feldspar, fusing the mixture in a furnace, and regrinding

to a powder. These powders are blended with the unpigmented

powdered frit to provide the proper hue and chroma. The metallic

pigments include:

1. Titanium oxide for yellow- brown shade

2. Manganese oxide for lavender

3. Iron oxide for brown

4. Cobalt oxide for blue (the enamel shades).

5. Copper or chromium oxide for green

6. Nickel oxide for brown

7. In the past, uranium oxide was added to provide fluorescence,

however because of the small amount of radioactivity,

lanthanide earths are being substituted for this purpose.

8. Chromium tin or chrome-alumina for pink.

27
OPACIFYING AGENTS:-

The addition of concentrated color frits to dental porcelain is

insufficient to produce a life- like tooth effect since the

translucency of the porcelain is too high. In particular, dentin

colors require greater capacity if they are to simulate natural dentin

overlaid by enamel.

An opacifying agent generally consists of metal oxide

(between 8% and 15%) ground to a very fine particle size (<5 µm)

to prevent a speckled appearance in porcelain.

Commonest oxides are:

 Cerium oxide

 Zirconium oxide

 Titanium oxide

 Tin oxide

The Dentists Supply Company have used opacifying agents of a

size range close to the magnitude of the wavelength of light and it

28
is claimed that particles between the size of 0.4 to 0.8 µm produce

a blue tinge in reflected light but turn yellowish-red in transmitted

light, thus more closely resembling a natural tooth.

Zirconium oxide is the most popular opacifying agent and is

usually added with the concentrated color frit to the uncolored

porcelain during final preparation. Other oxides that might be

included in opaque porcelain are rubidium oxide, barium oxide,

and/or zinc oxide. The opaque layer serves three primary functions:

1. It wets the metal surface and establishes a metal-porcelain bond.

2. It masks the color of the metal substructure.

3. It initiates development of the selected shade.

A stain is more concentrated than the color modifier, the latter

are used to obtain gingival effects or to high light body colors,

where as former are more generally used as surface colorants or to

provide enamel check lines, decalcification spots etc. in the body

of porcelain jacket crown.

Stains can be supplied as pure metal oxides but are sometimes

made from lower fusion point glasses so that they can be applied at

temperatures below the maturing temperature of the enamel and

dentin porcelains. Stain powder contains less silica or alumina and

more sodium and potassium oxide, plus special colorant oxides.

29
GLAZES AND ADD-ON PORCELAIN:-

One purpose of an industrial glaze is to seal the open pores in the

surface of fired porcelain. Dental glazes consist of colorless low

fusing porcelains, which can be applied to the surface of a fired

crown to produce a glossy surface. A glaze should normally mature

at temperature below that of the restoration and the thermal

expansion of the glaze should be fractionally lower than the

ceramic body to which it is applied. In this way, the glaze surface is

placed under compression and crazing or peeling of the surface is

avoided.

Detailed surface characterization is almost impossible to

obtain when separate glazes are used since they tend either to

produce too high a gloss or a rough surface and do not reproduce

the satin-like finish of human enamel.

The so called Add - on Porcelains are of definite use and

are generally made from similar materials as the glaze porcelain

except for the addition of opacifiers and coloring pigments. An

Add-on porcelain can be made from the same frit as used for the

manufacture of regular porcelain and the glazing temperature can

then be reduced by finer grinding of the powder. Add-on porcelain

should be used sparingly for simple corrections to tooth contour or

contact points.

30
FRITTING:-

The term “frit” is used to describe the final glass product. The raw

mineral powder (oxides or carbonates) are mixed together in a

refractory crucible and heated to a temperature well above their

ultimate maturing temperature when used in dental laboratory. The

oxides melt together to form a molten glass, gasses are allowed to

escape and the melt is then quenched in water. The red hot glass

striking the cold water, immediately breaks up into fragments and

this is termed the “frit”. The process of blending, melting and

quenching the glass components is termed “fritting”. The natural

feldspar and glass fluxes are mixed together in powder form before

the fritting process is commenced.

GLASS MODIFIERS:-

The sintering temperature of crystalline silica is too high for use in

veneering aesthetic layers onto dental casting alloys. At such

temperatures, the alloys would melt. In addition, the thermal

contraction coefficient of crystalline silica is too low for these

alloys. Bonds between the silica tetrahedral can be broken by the

31
addition of alkali metal ions such as sodium, potassium and

calcium. These ions are associated with the oxygen atoms at the

corners of the tetrahedral and interrupt the oxygen-silicon bonds.

As a result, the three-dimensional silica network contains many

linear chains of silica tetrahedral that are able to move more easily

at lower temperatures than the atoms that are locked into the three-

dimensional structure of silica tetrahedral. This case or movement

is responsible for the increased fluidity (decreased viscosity), lower

softening temperatures and increased thermal expansion conferred

by glass modifiers. Too high a modifier concentration, however,

reduces the chemical durability (resistance to attack by H2O, acids

and alkalies) of the glass. In addition, if two many tetrahedral are

disrupted, the glass may crystallize (devitrify) during porcelain

firing operations. Hence, a balance between a suitable melting

range and good chemical durability must be maintained.

Manufacturers employ glass modifiers to produce dental porcelain

with different firing temperatures.

To ensure adequate chemical durability, a self glaze of

porcelain is preferred to an add-on glaze. A thin external layer of

glassy material is formed during a self-glaze firing procedure at a

temperature and time that causes localized softening of the glass

phase and setting of crystalline particles within the surface region.

32
The Add - on glaze slurry material that is applied to the porcelain

surface for an applied glaze procedure contains more glass

modifiers and thus has a lower firing temperature. However, a

higher proportion of glass modifiers tend to reduce the resistance

of the applied glazes to leaching by oral fluids.

Another important glass modifier is water, although it is not

an intentional addition to dental porcelain. The hydronium ion,

H3O+, can replace sodium or other metal ions in a ceramic that

contains glass modifiers. This fact accounts for the phenomenon of

“Slow Crack growth” of ceramics that are exposed to tensile

stresses and moist environments. It also may account for the

occasional long term failure of porcelain restorations after several

years of service.

BODY MODIFIERS:-

These porcelains are more color concentrated and were

designed to aid in achieving internal color modifications. Modifiers

can be used full strength for vivid characterization or diluted by

mixing with dentin and enamel powders for more subtle shade

alteration.

33
OTHER ADDITION TO DENTAL PROCELAINS:-

Boric oxide (B2O3) can behave as a glass modifier, that is, it

decreases viscosity, lowers the softening temperature and forms its

own glass network. Because boric oxide forms a separate lattice

interspersed with the silica lattice, it still interrupts the more rigid

silica network and lowers the softening temperature of the glass.

The role of alumina (AL2O3) in glass formation is

complicated. Alumina cannot be considered as a true glass former

by itself because of the dimensions of the ion and the oxygen:

aluminum ratio. Nevertheless, it can take part in the glass network

to alter the softening point and viscosity.

Lithium oxide may be added as an additional fluxing

agent. However, this oxide does tend to induce rather more

pyroplastic flow than is often desirable in a dental porcelain.

Magnesium oxide (MgO) may also be present but in

minute quantities. This oxide can replace CaO.

Phosphorous pentoxide (P2O5) is sometimes added to

induce opalescence and is also a glass-forming oxide.

34
 PROPERTIES AND LIMITATIONS

Most of the ceramics are characterized by their refractory nature,

hardness, and chemical inertness. Hardness of a ceramic similar to

that of enamel is desirable to minimize the wear of resulting

ceramic restorations, and reduce the wear damage that can be

produced on enamel by the ceramic restoration. Chemical

inertness ensures that the surface of dental restorations does not

release potentially harmful elements, and reduces the risk for

surface roughening and an increased susceptibility to bacterial

adhesion to insure excellent biocompatibility over time.

Furthermore, ceramics demonstrate excellent insulating

properties, such as low thermal conductivity, low thermal

diffusivity, and low electrical conductivity. Their most attractive

property is their potential for matching the appearance of natural

teeth, offering great esthetic results6.

On the other hand, the susceptibility of ceramics to brittle fracture

is a drawback, particularly when flaws and tensile stresses coexist

in the same region of the restoration. The flaw can be a microcrack

on the surface (e.g. created during occlusal adjustment with a

diamond stone), or it can be a subsurface porosity (e.g. from a

35
processing error during the build-up and baking of the porcelain)8.

When tension stress is applied, small flaws tend to open up and

propagate cracks (crack propagation theory9).

36
Irregularities in a bulk of the material, such as discontinuities

and/or abrupt changes in shape or thickness in the ceramic contour,

act as stress raisers, making the restoration more prone to failure.

Stress around a stress raiser is higher than the average stress in the

body of the material. The amount of this increased stress depends

on the shape of the stress raiser (e.g._ stress at the tip of a sharp

notch would be greater than that of a semicircular groove). Because

of the stress concentration at surface scratches and other defects

(brittleness), ceramics tend to fail at stress levels that are much

lower than the theoretical strength to be tolerated.

37
Compared to metals, which can yield to high stress by deforming

plastically, ceramics tend to have no mechanism for yielding to

stress without fracture8. Therefore, cracks may propagate through a

ceramic material at low average stress levels. As a result, ceramics

and glasses have lower tensile strengths than compressive

strengths9.

38
Mechanisms of increasing the fracture resistance of

ceramics:

1. Development of residual compressive stresses:

The thermal expansion coefficient (TEC) of the core ceramic is

slightly greater than that of the veneering ceramic. This mismatch

allows the core material to contract slightly more upon cooling

from the firing temperature to room temperature, and leave the

veneering ceramic in residual compression while offering

additional strength10.

2. Minimize the number of firing cycles:

Firing procedures sinter the particles densely together and produce

a relatively smooth surface. In addition, they increase the

concentration of leucites in the porcelain, which in turn leads to an

increase of the TEC and a further mismatch between

core/veneering porcelain. This mismatch will cause immediate or

delayed crack formation in the porcelain11,12.

39
3. Minimize tensile stress through optimal design of ceramic

restorations

Dental restorations containing ceramics should be designed in a

way to overcome their weaknesses. The design should avoid

exposure of the ceramic to high tensile stresses 6. In the case of a

crown, tensile stresses can be reduced by using strong core

materials with appropriate thickness, since these stresses are

distributed on the inner surface (core material is in tension) 13,14. In

the case of a FPD, high tensile stresses develop at the gingival

surface of the connector_ and a larger radius of curvature at the

gingival embrasure reduces the concentration of tensile stresses,

thus affecting the fracture resistance of the FPD15. To promote

achieving the required connector dimensions without

compromising the health of the supporting tissues, it was suggested

to fabricate the gingival and lingual aspects of the connectors

exclusively out of the framework material16.

4. Ion Exchange (or chemical tempering):

This process involves the exchange of larger potassium ions for the

smaller sodium ions (a common constituent of a variety of

glasses)17. If a sodium-containing glass article is placed in a bath of

molten potassium nitrate, potassium ions in the bath exchange

40
places with some of the sodium ions on the surface of the glass

particles. The potassium ion is about 35% larger than the sodium

ion. Squeezing of the potassium ion into the place formerly

occupied by the sodium ion creates large residual compressive

stresses in the surfaces of the glasses subjected to this treatment.

However, the depth of the compression zone is less than 100 μm,

so that this effect would be easily worn out after long–term

exposure to certain inorganic acids17,18. Ion exchange using a paste

method (10gm of KNO3 and4mL of water) is found to improve

strength,reduce slow crack growth in artificial saliva and reduce

strength degradation over time.19

5. Thermal Tempering:

This is a process of creating residual surface compressive stresses

by rapidly cooling the surface of the object while it is hot and in

the softened (molten) state. This rapid cooling produces a skin of

rigid glass surrounding a soft (molten) core. As the molten core

solidifies_ it tends to shrink, but the outer skin remains rigid. The

pull of the solidifying molten core, as it shrinks, creates residual

tensile stresses in the core and residual compressive stresses within

the outer surface, inhibiting the initiation and the growth of

cracks20,21.

41
6. Dispersion strengthening:

This involves the reinforcement of ceramics with a dispersed phase

of a different material that is capable of hindering a crack from

propagating. Dental ceramics containing primarily a glass phase

can be strengthened by increasing the crystal content of leucite,

lithium disilicate, alumina, magnesia-alumina spinel, zirconia and

other types of crystals. When a tough, crystalline material such as

alumina (Al2O3) is added to a glass, the glass is toughened and

strengthened, because the crack cannot pass through the alumina

particles as easily as it can pass through the glass matrix1.

The amount of toughening depends on the crystal type, its size, its

volume fraction, the interparticle spacing, and its relative thermal

expansion coefficient to the glass matrix. In most instances, the use

of a dispersed crystalline phase to disrupt crack propagation

requires a close match between the thermal contraction coefficients

of the crystalline material and the surrounding glass matrix (Jones,

1983).Of late, the solgel process has been employed to introduce

zirconia uniformly into feldspathic porcelains. Feldspathic

porcelain reinforced with 30% zirconia shows maximum hardness

and flexural strength.However, increasing the strength of zirconia

42
to 50 % reduces the strength due to reduction in feldspar content

which acts as a binder.22

7. Transformation toughening:

The dispersion strengthening process relies on the toughness of the

particle to absorb energy from the crack and deplete its driving

force for propagation. The transformation toughening process relies

on a crystal structural change of a material under stress to absorb

energy from the crack.

Zirconia (ZrO2) ceramic is a good example for this mechanism.

The material is polymorph occurring in three forms: monoclinic

(M), tetragonal (T) and cubic(C). Pure zirconia is monoclinic in

room temperature. This phase is stable up to 1170°C. Above this

temperature it transforms into tetragonal and then into a cubic

phase at 2370°C. When ZrO2 is heated above 1170°C, the

transformation from the monoclinic to the tetragonal phase is

associated with a 5% volume decrease. Reversely, during cooling,

the transformation from the tetragonal to the monoclinic phase is

associated with a 3% volume expansion. These phase

transformations, however, induce stresses which result in crack

formations. The inhibition of these transformations can be achieved

by adding stabilizing oxides (CaO, MgO, Y 2O3), which allow the

43
existence of tetragonal-phase particles at room temperature. When

sufficient stress develops in the tetragonal structure and a crack in

the area begins to propagate, the tetragonal grains transform to

monoclinic grains. The associated volume expansion results in

compressive stresses at the edge of the crack front and extra energy

is required for the crack to propagate further.

CLASSIFICATION OF ALL-CERAMIC SYSTEM –

44
  Based on composition and fabrication8:-

(1) Conventional powder slurry ceramic:-

e.g. - 1) Optec HSP, 4) Cerinate,

2) Duceram LFC, 5) Mirage,

3) Finesse, 6) Ceramco.

(2) Castable Ceramics:-

e.g. - 1) Dicor, 3) CD-200

2) Cerapearl,

(3) Pressable ceramics:-

e.g. - 1) IPS Empress,

2) Optec pressable ceramic,

(4) Infiltrated ceramics:-

e.g.– 1) In- ceram

2) In- ceram spinell

3) Hi- Ceram

4) Cerestore (Alceram)

(5) Machinable Ceramics:-

e.g.- 1) Celay,

2) Cerec

 Based on manufacturer recommended clinical

indications23-

45
CORE SYSTEM MANUFACTURING CLINICAL

MATERIAL TECHNIQUES INDICATIONS

GLASS

CERAMIC
Lithium disilicate IPS Empress 2 Heat pressed Crowns,anterior FPD
IPS e.max Press Heat pressed Onlays,3/4th

crowns,crowns,FPD
Leucite IPS Empress Heat pressed Onlays,3/4th crowns,

crowns
Optimal Heat pressed Onlays,3/4th crowns,

Pressable crowns

Ceramic
IPS ProCAD Milled Onlays,3/4th crowns,

crowns
Feldspathic VITABLOCS Milled Onlays,3/4th crowns,

MarkII crowns,veneers
VITA Triluxe Milled Onlays,3/4th crowns,

Bloc crowns,veneers
VITABLOCS Milled Anterior crowns,

Esthetic Line veneers

ALUMINA
Aluminium oxide In-Ceram Slip cast,milled Crowns,FPD

Alumina
In-Ceram Milled Crowns

Spinell
Synthoceram Milled Onlays, 3/4th crowns,

FPD
In-Ceram Slip cast,milled Crowns,posterior

46
 Zirconia FPD
Procera Densly sintered Crowns,veneers,

anterior FPD
ZIRCONIA
Y-TZP Lava Green milled,sintered Crowns,FPD
Cercon Green milled,sintered Crowns,FPD
Dc-Zirkon Milled Crowns,FPD
Denzir Milled Onlays,3/4th

crowns,crowns
Procera Densly sintered,milled Crowns,FPD,implant

abutments

 Based on the core material 24:-

GLASS CERAMICS

 FELDSPATHIC PORCELAIN

 LEUCITE REINFORCED FELDSPATHIC PORCELAIN

 LITHIUM DISILICATE GLASS INFILTRATED ALUMINA

GLASS INFILTRATED CERAMICS

 GLASS INFILTRATED ALUMINA

 GLASS INFILTRATED MAGNESIA ALUMINA

 GLASS INFILTRATED ALUMINA WITH 35% ZIRCONIA

POLYCRYSTALLINE CERAMICS

 DENSLY SINTERED HIGH PURITY ALUMINA

 Y-TZP

47
ALL CERAMIC SYSTEM 3,5,6,7,8,26,27

INDICATIONS

 All anterior teeth where aesthetics is of prime importance.

 Posterior teeth which are not subjected to heavy forces.

48
  Patients giving more importance to esthetics than

conservation of tooth structure.

CONTRAINDICATIONS

 Parafunctional activity

 Insufficient support from the tooth preparation.

 Opposing teeth that occlude with the cervical fifth of the

crown

 Short clinical crowns

ADVANTAGES

 Better aesthetic results: The inherent translucency of all

porcelain restorations and the absence of the underlying

metal substructure which would have to be masked produce

excellent aesthetic results.

49
  Biocompatibility: Glazed porcelain produces a non porous

surface which is the most biocompatible of all restorative

materials. Potential metal allergies or toxicity reactions are

avoided.

 Periodontal health: butt joint margin design places less

material subgingivally when compared to the beveled

margin design of the ceramometal restoration.

 Transillumination of the gingiva: These translucent

materials allow light to be transmitted into the tooth and do

not cause tissue darkening adjacent to the restoration.

DISADVANTAGES

 Low compressive strength – All porcelain restorations are

inherently weak and have high fracture rates.

 Limited placement – All porcelain restorations are limited

primarily to the restoration of the anterior teeth, although

50
 some manufacturers (Cerestore and Dicor) claim the

materials can be used posteriorly.

 Limited ability to create multiple units: Except in special

cases, porcelain systems are limited to single units.

 Adequate remaining tooth structure is required for ideal

preparation form. All porcelain restorations require uniform

reduction for equal distribution of internal stresses.

Therefore these restorations cannot compensate for

extensive loss of tooth structure. The metal component of

ceramometal restorations, on the other hand, can be

fabricated to provide optimum porcelain support.

 Marginal integrity is laboratory technique sensitive:

Good marginal integrity is technically more difficult to

achieve with the porcelain butt joint as compared to a metal

margin.

 Wear of opposing tooth structure: Porcelain, especially

unglazed porcelain, causes wearing of opposing enamel,

dentin and metal. When the opposing tooth structure

exhibits areas of wear, metal occlusal surfaces should be

used to minimize destruction. Cast glass restorations show

great promise because studies indicate that they wear at the

same rate as tooth structure.

51
  Inability to attach a removable partial prosthesis:

currently no precision or semi precision attachment is

available to adhere to the all porcelain restoration. Splinting

is not possible.

ALUMINA- REINFORCED PORCELAIN28,29

The alumina-reinforced crown was introduced by Mclean

and Huges in 1965. They were driven by the clinical failures of

existing porcelain jacket crowns to address the problem of

weakness. It was the first attempt to replace quartz bearing,

vacuum sintered porcelains with relatively esthetic reinforced

porcelains.The objective of the technique was to improve esthetics

52
by the replacement of the thicker metal coping with a thin platinum

foil, thus allowing more room for porcelain. They did this by

adding large quantities (up to 50%) of finely ground aluminum

oxide particles to the raw materials used to make their feldspathic

porcelain glasses. Most of it remained in crystalline form. This

creates an aluminous porcelain. While the added alumina

recreated the refractory internal skeleton that had strengthened

Land's original porcelain, it also reintroduced the problem of

opacity. The solution was to cut back the facing of the aluminous

crown and overlay it with a veneer of the more esthetic feldspathic

porcelains that were formulated without the alumina particles.

Thus, the aluminous porcelain was used as a substructure, or

core, over which a veneer could be applied. This substructure

became known as an aluminous core.

INDICATIONS -

1. Individual anterior teeth when excellent aesthetic is required.

CONTRAINDICATIONS -

1. Patients with heavy occlusion or bruxism

2. Patients with short clinical crowns

3. Patients requiring splinting of teeth.

53
ADVANTAGES -

1. Strength: alumina – reinforced crowns have a higher modulus

of elasticity and double the compressive strength of regular

feldspathic porcelain.

2. Aesthetics: alumina – reinforced crowns exhibit excellent

aesthetics because they transmit light better than ceramometal

restorations.

3. Biocompatibility is good.

4. Periodontal health is also good.

5. Transillumination of gingiva.

DISADVANTAGES -

1. Microcracks – internal surface microcracks invariably occur in

aluminareinforced crowns. They are caused by the inability to

adequately wet the foil.

2. Limited to anterior tooth placement

3. Limited ability to create multiple units

4. Marginal integrity is laboratory technique sensitive.

54
ALUMINOUS PORCELAIN CORE POWDERS:

The core powder provides the main reinforcement in the

porcelain jacket crown and the free alumina content varies between

40 to 50% by weight. The strength and opacity of aluminous

porcelain is related to the grain size of alumina crystals. The finer

the grain size, the greater the strength, but this is accompanied by

increased opacity of the fired body due to differences in refractive

indices between the crystals and the glass matrix. Very high opacity

in opaque or core porcelain is not desirable since it increases the

amount of light reflection from the surface when translucent

enamel veneers are applied. Thereby, it increases the incidence of

metameric colour effects. Aluminous core porcelain is therefore

formulated so that it will transmit some light and not produce a

“mirror” effect when the enamel porcelains are applied.

The strength of aluminous porcelain, unlike dental porcelain,

is very much affected by the density of the fired ceramic. Porosity,

when present at the grain boundaries of alumina crystals, can cause

considerable weakening of aluminous porcelain. Aluminous

porcelain is preferably fired in low pressure atmosphere and a

vacuum furnace is essential. The firing schedule should be slow in

order to allow porosity to escape at the grain boundaries. Prolonged

55
firing under vacuum at the maximum maturing temperature is

strongly deprecated, since at these elevated temperatures, the glass

may “bloat” or swell. Vacuum must therefore, be broken

immediately after porcelain reaches the maturing temperature.

Then the porcelain can be safely fired on normal atmosphere for

prolonged periods.

TYPES OF ALUMINA

A) CALOINED ALUMINA:

It may be obtained with purities in excess of 99 %. The fine

powdered alumina consists of agglomerates of tiny crystals and

when incorporated in dental porcelain tends to cause excessive

opacity due to differences in refractive indices between the glassy

porcelain and the alumina crystals. Single crystals of alumina are

therefore preferred for dental purposes.

B) FUSED ALUMINA:

In order to obtain single crystals of alumina, it is necessary

to fire alumina at much higher temperatures than employed. During

calcinations, single crystals of alumina may be prepared by fusing

high purity alumina (99.6%) in an electric furnace at 2150 0 C, the

56
crystals formed on cooling are generally very large and may be

subsequently ground and sized.

The porcelains used in the aluminous porcelain crown are:

1) Core porcelain: contains 50 % by weight fused alumina

crystals. These crystals are fused or fritted with a glass powder.

The transverse strength of these alumina glass composites is 130 to

150 N/mm2.

2) Dentin or body porcelain: made from a boro-silicate glass,

containing highly dissolved alumina content or, alternatively, a

completely dissolved feldspar glass flux containing additional

quantities of alumina both in free and dissolved state in the glass.

3) Enamel porcelain: made from the same frit as the dentin

porcelain except that their free alumina crystal content is reduced

to improve translucency.

57
 When the thickness of the current high fusing gold alloy

copings is reduced much below 0.5 mm. there is a risk of metal

creep occurring during the sintering of the porcelain veneer which

results in unacceptable clinical fit. Alternatively, when a base metal

alloy of higher melting point is used to overcome the problem of

metal creep, the effectiveness of the bond between porcelain and

metal remains in doubt. In addition, base metals are difficult to cast

in thin section and obtain a good fit and they tend to induce grey

color effect in the porcelain.

For these reasons, preformed copings or foil in various

thicknesses were used with aluminous porcelain for bonding. The

problem of creep during firing of the porcelain at about 1000 0C

should be less with platinum alloys since the firing temperature is

much further reduced from the melting point of the metal in the

case of platinum. In addition to improvement in aesthetics achieved

by using thinner copings, an oxidisable platinum alloy, when pre-

58
oxidized for the application of porcelain, should appear light grey

in colour in contrast to the gold alloys. The expansion coefficient

of platinum (9.7x10-6/0C) would not permit successful bonding to

the feldspar based porcelains used for gold-alloy/porcelain

restorations. It is however sufficiently close to that of aluminous

porcelain (Al2O3 – 6.8 to 8.7x 10-6/0C) to permit bonding.

BONDED FOIL CROWNS -

Ceramics suffer from static fatigue, which is generally

believed to be due to a stress-dependent chemical reaction between

water vapor and the surface faults in the porcelain crown. This

causes flaws to grow to critical dimensions, allowing spontaneous

crack propagation.

One method of eliminating this problem was found to be the

bonding of porcelain to foil. A method was devised whereby the

surface of the platinum foil was coated with up to 2 µm of tin;

oxidation of the tin coating provided the mechanism for bonding of

the porcelain. Either tin coating or thermal cleaning of the platinum

matrix could increase the shell strength of the core porcelain to

over 300 MPa, provided that the platinum is left intact with the

porcelain.

59
PLANTINUM BONDED ALUMINA PORCELAIN CROWN -

Fabrication of the platinum bonded alumina crowns involves the

use of a thin (0.05mm) platinum foil matrix, which is burnished

directly to a die and is bonded with alumina reinforced porcelains.

The micro cracks that occur on the internal surface of porcelain

crowns and alumina reinforced crowns are virtually eliminated by

the increased ability of the porcelain to wet and bond to the

platinum foil. Upon completion of the porcelain laboratory stages,

but prior to cementation procedures, the platinum foil matrix is

removed. Problems arose from this technique because the incisal

edge lengths and occlusion often are altered when the foil is

removed. Refiring after the foil is removed is difficult because

overall distortion of the crown is no longer controllable.

A two foil technique has been developed to overcome these

shortcomings and to ensure an accurate porcelain but joint fit.

Initially, two layer of platinum foil are burnished to the die and the

crown is fabricated. Upon completion, only one foil is removed

and, if an additional over firing is needed, it can now be

accomplished. Repeated firings of the porcelain restoration may

result in dimensional change.

60
INDICATION:

1. In individual anterior teeth when excellent aesthetics.

CONTRAINDICATIONS:

1. Patients with heavy occlusion or bruxism.

2. Patients with short clinical crowns.

ADVANTAGES :

Platinum bonded alumina restorations offer all the

advantages of alumina reinforced crowns plus,

1. Elimination of internal surface micro cracks produced at the

internal surface.

2. Improved marginal integrity.

3. ‘Twin foil’ technique improves the predictability of the final fit

and allows firing of porcelain after the first foil is removed.

DISADVANTAGES:

Platinum bonded alumina restorations have all the disadvantages of

alumina reinforced crowns and,

1. Require additional laboratory time

61
2. Single layer technique precludes the ability to refine the

restoration following the removal of the single layer of foil.

PRINCIPLES OF THE TECHNIQUE --

The bonded alumina crown consists of an aluminous

porcelain crown bonded to a 0.025mm thick platinum coping. In

order to provide a porcelain butt fit and eliminate the dark shadow

produced by a metal collar, the crown is baked onto an inner

platinum foil matrix which is removed after baking and provides

space for the cement.

TWIN-FOIL TECHNIQUE: [By Mclean et al. (1976)]

This technique involves the laying down of two platinum

foils in close apposition to each other. The inner foil of 0.025 mm

platinum provides a matrix for the baking of the porcelain and the

outer foil which forms the inner skin to crown is tin-plated and

oxidized to achieve strong chemical bonding with the aluminous

core porcelain. The outer or “bonded foil” remains in position on

62
the internal fit surface of the crown and will eliminate surface

micro-cracks in the porcelain.

The bonded alumina crown has enabled in:

1. Reduction of metal and labor costs in construction.

2. Provision of a porcelain butt fit on the labial or buccal surface of

the crown, eliminating the dark shadow of a metal collar.

3. Reduction of stresses at the porcelain metal interface during

cementation procedures.

4. Improvement in strength of the aluminous porcelain crown by

reducing internal micro-cracks and sub-surface porosity which

are the sites for crack propagation. The shrinkage of porcelain

makes it difficult to achieve an accurate fit of the core porcelain

in one bake. It is therefore very important to allow for shrinkage

and prevent the fired porcelain from lifting the platinum skirt

and spoiling the fit.

Two ways have been advocated:

a) The cervical contact technique

b) The cervical ditching technique

The cervical contact technique relies on the application of a

layer of porcelain around the shoulder area to shrink first. The

second bake will then shrink towards the cervical porcelain and

maintain the fit. The cervical contact technique does not always

63
work since the bulk of the core porcelain still has to shrink during

the second bake. It is for this reason that the cervical ditching

technique is strongly recommended. Here the porcelain is removed

from the shoulder area after the initial build-up is complete.

REMOVAL OF PLATINUM FOIL -

It is facilitated by soaking the crown in water. When

removing the foil, a fine pointed tweezer is used to lift the skirt

away from the edge. Peal the platinum away from the entire

circumference without damaging the fine porcelain edge.

LABORATORY TECHNIQUE

A 0.025 mm platinum foil is adapted to the die and

burnished. The buildup is best done with the brush technique. A

fine sable brush is used. The brush is dipped in distilled water and

excess moisture is absorbed on a sponge.

The low fusing aluminous core porcelain is mixed with

distilled water on a glass slab to a thick and creamy consistency.

The point of the brush is gently pushed into the edge of the

64
porcelain mix so that it picks up a small bead of porcelain. The

bead is then transferred to the platinum matrix and placed in

position on the palatal surface. By repeating these movements the

core layer is built up to an even thickness of approximately 0.6 mm

over the entire crown. Once the initial buildup of the core is

complete the die is vibrated with a porcelain carver handle and the

porcelain core is held on the labial side in a folded paper tissue.

The tissue may then be folded over the incisal edge to absorb

excess water on the palatal surface. The die is reseated in the

model, the surface of the core-porcelain slightly moistened and

further porcelain added on by the brush technique. This additional

porcelain should cover the entire lingual surface of the preparation

and increase the thickness at the labial cervical collar. The lingual

porcelain must be built-up to the maximum extent of the occlusion

and finally brush shaped.

CERVICAL RELIEF --

Aluminous porcelain has 40 % volume porosity in the

powder bed and must shrink on firing like any ceramic material.

One of the satisfactory ways of overcoming this shrinkage is to

‘ditch’ the cervical shoulder with a sharp Instrument. The clearance

of porcelain from this area will allow the main bulk of aluminous

65
porcelain to shrink centrally onto to platinum foil without over

distorting the apron.

ALUMINOUS CORE PORCELAIN –FIRST FIRING:

The core porcelain must be slowly dried in front of the open

furnace door for at least 4 minutes it may then be placed on the

firing platform for a further 3 minutes. Modern vacuum furnaces,

which employ a pushrod on a vertical slide, are ideal for this

procedure. The recommended firing schedule for the 1922 0 F core

porcelain is,

Drying (Furnace 17500 F)

Muffle entrance 4 minutes

Firing platform 3 minutes

Apply vacuum 28 minutes

Firing

Enter hot zone of furnace at 17500 F

Raise temperature to 19220 F at 500 F per minute

Switch off vacuum at 19220 F

Hold at 19220 F in air for 5 minutes

66
Cooling

Slow cool to 15000 F

Remove work and allow cooling at room temperature.

67
ALUMINOUS CORE PORCELAIN - SECOND FIRING:

The Platinum apron is reburnished at the gingival shoulder

and more core porcelain is applied to fill in the ditched area.

The second firing should now follow the exact procedure

adopted for the first firing, except for the final period of maturation

in air, which should be extended to 8 minutes.

GRINDING AND STAINING --

The biscuit stage aluminous porcelain crown should be

ground with diamond stones used exclusively for this work. After

any occlusal or contact area adjustments have been made the crown

may be tried in the mouth. Duplication of the surface forms; of the

adjoining natural teeth may be achieved by grinding of the

aluminous porcelain surface with very fine diamond wheel stones.

Surface effect stains may now be applied and a thin streak of

orange stain on a darker dentin color may be applied behind the tip

of the incisal edge to produce the slight milkiness present in many

68
natural teeth. Orange or brown stain is also effective when applied

on the mesial and distal surface, since these colors are highlighted

through the enamel surface.

GLAZING --

All glazing must be accomplished in air and where possible

a powerful electric lamp will enable the ceramist to view this

glazed surface directly. The recommended glazing period for the

aluminous porcelain is 4 to 4.5 minutes.

69
I.FELDSPATHIC PORCELAINS 5,6,8,27

Domestic porcelain contains about equal amounts of kaolin

and quartz, and also a great deal of feldspar when compared with

other forms of clay. Feldspar is a naturally occurring glass that

contains silica, fluxes and alumina, all neatly bound together.

Feldspar in fact binds all three forms of clay bodies together once it

has been fused at high temperature.

Porcelain can be defined as a highly vitrified ceramic body. The

term "ceramic body" includes both the glass, and a refractory

skeletal structure which retains it shape first through the sintering

process, and then through the final fusing process. The key here is

that porcelain is not simply a form of glass. It is glass with a

refractory internal structure. In domestic porcelain, the refractory

structure forms a sort of skeleton around which the feldspathic

glass can flow so that the final ceramic body keeps its shape

without slumping, distorting or simply melting into a puddle on the

floor of the kiln. This was why Dr Land's porcelain crowns were

reasonably strong. Since it was made from domestic porcelain,

each crown contained both glass, and a refractory skeletal structure

to strengthen it.

70
This refractory skeleton was composed of about equal parts of

kaolin which is an alumino silicate, and fine grains of pure silica in

the form of quartz. These materials are present in in the form of

crystals which remain unmelted except at their points of contact

where they fuse together during the sintering process. Kaolin

however, is opaque due to the fact that much of it it remains in

crystalline form throughout the ceramic body. The opacity is the

result of the internal scattering of light by refractory alumina in the

form of kaolinite crystals.This was the reason that Land's

porcelain jackets were not very esthetic, and this opacity remained

a recurring problem in early dental porcelains.

In light of this problem, ceramic technologists began to formulate

feldspathic porcelains with less and less kaolin until by 1938 kaolin

was omitted entirely. The glass itself was strengthened by the

addition of various stabilizers such as boron and dissolved alumina,

but these did not entirely make up for the loss of the crystalline

alumina substructure. Very fine particles of refractory quartz were

left in the formulation in order to give the glass enough structure to

resist sagging and to stop cracks from propagating through the

structure, but unfortunately, as the proportion of aluminous

kaolin decreased, the strength of the glass declined. (Note--

71
Quartz crystals have a refractive index close to that of the

surrounding glass, and therefore do not have as much of an effect

on the optical qualities of the glass as do alumina crystals.) Thus

feldspathic dental porcelains slowly began to to be formulated with

only a weak refractory skeleton composed of quartz particles and

became more prone to failure as a result. On the other hand, they

were (and still are), highly esthetic materials for building tooth-like

structures.

These products are supplied as powders to which the technician

adds water to produce slurry, which is build up in layers on a die

material to form the contours of the restoration. The powders are

available in various shades and translucencies and are supplied

with characterizing stains and glazes.A study to investigate the

effect of surface finish on flexural strength of feldspathic

porcelains revealed that while grinding and polishing produced the

most optimal flexural performance, polishing and self glazing

caused a decrease in the mean flexural strength.31

e.g. – Finesse, Duceram LFC, Cerinate, Mirage,

Ceramco, VITA VMK 95.

72
 (1) FINESSE-

A low-fusing porcelain developed to offset the major disadvantages

of traditional dental porcelains. One of the basic differences

between this formulation and those that have been used for long

periods of time is a significant reduction in the firing temperature.

The firing temperature of Finesse is 760 0C versus around 9400C for

conventional porcelain. This 2000C differential has imparted a

number of positive characteristics to the final restoration. The

reduction of the fusion temperature allows for increased

opalescence in the enamel porcelain. It also permits the clinician to

generate a highly polished surface at chairside, thereby eliminating

the need for reglazing after possible adjustments. The low-fusing

porcelain offers considerably less potential for abrading any

materials against which it occludes.

Many of the greatly improved properties of low-fusing

porcelains can be related to the changes made to leucite

73
components. Leucite’s primary function in dental porcelain is to

raise the coefficient of thermal expansion, consequently increasing

the hardness and fusion temperature. FINESSE contains 8 to 10%

leucite. The formulation has been designed to employ optimum

levels of finer and less leucite crystal for the purpose of

maximising the desirable characteristics of dental porcelain.

(2) DUCERAM LFC8 -

74
 This is relatively new category of restorative material,

referred to as “hydrothermal low-fusing ceramic.” It is composed

of an amorphous glass containing hydroxyl ions. The manufacturer

claims that this noncrystalline structure has greater density, higher

flexural strength, greater fracture resistance and lower hardness

than feldspathic porcelain, causing less abrasion against tooth

structure than leucite containing systems.

The higher flexural strength results from an ion exchange

mechanism of hydroxyl ions.This ion exchange mechanism is said

to promote a healing of surface microcracks. The lower hardness

results from the absence of leucite crystals in this material.

75
 Duceram LFC is used for the fabrication of ceramic inlays,

veneers and full contour crowns. The restoration is made in two

layers. The base layer is a leucite- containing porcelain; it is placed

on a refractory die using powder slurry techniques and then baked

at 9300 C. Over the base layer Duceram LFC is applied using the

powder-slurry technique and backed at relatively low temperature

(6600 C). The material is supplied in a variety of shades and can be

surface characterized with compatible stains and modifiers. The

fabrication process requires no special laboratory techniques or

equipment. The results of a one year clinical study recently

conducted (Shotwell J et.al in 1990) indicate that the material

wears at a rate equivalent to that of natural tooth enamel.

Flexural strength of Duceram LFC is 110 Mpa.

76
(3) CERINATE25 -

It is feldspathic ceramic that contains aluminous oxide.

PROPERTIES: -

1. Flexural strength is 95 to 195 Mpa.

2. Fracture toughness is less than 1.15 Mpa.

3. Hardness is high - >7 Gpa.

4. Enamel wear is high - >2.0 mm/rev.

5. Good esthetics.

INDICATIONS :-

Inlays,crowns and veneers.

(5) MIRAGE25 -

It is a feldspathic ceramic that contains zirconium oxide fibers.

PROPERTIES :-

1. Flexural strength is between 50-90 Mpa.

2. Fracture toughness is 1.15 to 1.45 Mpa.

3. Hardness is 5 - 7 Gpa.

4. Good esthetics.

5. Opaque.

77
(6) CERAMCO6 –

It is a feldspathic ceramic.

PROPERTIES:-

1) Flexural strength - 50 to 90 Mpa.

2) Fracture toughness - <1.15 Mpa.

3) Hardness - 5 to 7 Gpa.

4) Enamel wear - 1.0 to 2.0 mm/rev.

5) Good esthetics.

INDICATIONS :-

1) Inlays,

2) Veneers.

(7) VITA VMK 95

78
 VMK 95 is the latest generation ceramic from Vita.

Features:

1) Made with yellow-orange glass for warmer tones

2) New with opaque has gold coat effect

3) Available in paste or powder opaque

4) Coefficient of Thermal Expansion:14.0 - 14.6

5) Density g/cm3: 2.4

6) Flexural strength dentine MPa (Nmm-2): 85

7) Average particle size μm (d50) dentine: 17.3

8) Adhesive bond MPa (Nmm-2) :43

9) Modulus of elasticity GPa: 91

1o)Hardness (Vickers) enamel: 470

79
Applications:

Crowns,bridges and laminates.

GLASS CERAMICS32,

MacCulloch first described methods for making artificial

teeth, veneers, and crowns in a glass ceramic in 1968. His

pioneering effort, in cooperation with the Pilkington Glass

Company in St Helen’s England, received very little recognition.

More recently, a different glass ceramic material based on

the work of Grossman and Adair in 1984 has been marketed under

the trade name Dicor (Dentsply International Inc, York, pa.).

However, as MacCulloch reported, shade modification

could be achieved only with surface colorants, which tend to erode

over time. Dicor, because of its high translucency, has a

chameleon-like effect and merges with the surrounding teeth. To

overcome the problems associated with surface colorants, Dicor

was used as a cast coping that could be veneered with specially

80
prepared aluminous porcelain. Although it is highly esthetic, Dicor

lacks fracture toughness.

(1)DICOR75

Though no longer sold, the first commercially available castable

dental ceramic was Dicor. The mica crystals formed in Dicor are

based on the composition SiO2 · K2O · MgO · Al2O3 · ZrO2. and

fluorides are added to the mixture to help produce a degree of

fluorescence in the finished prosthesis. For this reason, this

formulation is called a fluoromica glass ceramic.

It was invented by S.D. Stookey for the corning glass works in

1957. In 1972, Dr. S.G. Grossman of the corning glass works

pursued the use of this glass ceramic that could be machinable and

translucent. In 1977, Mr. P. Adai felt that this material might prove

to be a superior dental restoration because of its easy adjustability

and similarities to natural tooth enamel.

D entsply International joined with Cor ning Glass works to

develop and market this translucent glass ceramic under the name

of Dicor.

81
The crystals are stacked on top of each other like pages in a book,

and it is easy to pry paper thin sheets of mica off the top using the

point of a pin. These thin sheets are composed of even thinner

sheets which could be separated from each other if one has a fine

enough pointed instrument to do it with. In the detail on the right

above, the flat plane structure of mica crystals is visible from the

top.

The passage of light through the material is affected by the

crystal size and the difference in the refractive indices of the glass

phase and the crystalline phase. If the crystals are smaller than the

wavelength of visible light (0.4-0.7um) the glass will appear

transparent. The refractive index of the small mica crystals is

closely matched to that of the surrounding glass phase, such that

the tendency for light to scatter is lower than for the aluminous

porcelains.

82
 Dicor ceramics, introduced in the early 1980”s is

micaceous glass ceramic (45%volume glass and 55% crystalline

tetrasillicic mica) processed by a combination of conventional wax

investment techniques and glass casting. Early application of glass

ceramic technology to dentistry was made by Macculloh who had

obtained his materials from Pilkington Brothers Ltd. 3

This polycrystalline glass ceramic material is initially formed as a

glass and subsequently heat treated under controlled crystallization

conditions to produce a glass ceramic material. The fabrication

method uses lost-wax and centrifugal-casting techniques similar to

those used to fabricate alloy casting.

A full contour transparent glass crown is casted at 13500C,

and then it is heat treated at 10750C for 10 hours. This heat

treatment, which is known as “Ceramming”, causes partial

crystallization (55%) of tetrasillicic mica like crystals. The crystals

function is two ways, they create a relatively opaque material out

of the initially transparent crown and they significantly increase the

fracture resistance and strength of the ceramic. These crystals are

also less abrasive to opposing tooth structure than the leucite

crystals found in traditional feldspathic porcelains. To achieve the

83
appropriate shade, the colorant stains are baked on the surface of

the glass ceramic material.

Casting unit utilizes a thermostatically controlled platinum would muffle,

which is spun centrifugally by electric motor.

Electrically controlled ceramming oven takes the casting through a

specific time temperature schedule.

There has been some evidence that the stain layer might be lost

during occlusal adjustment, during routine dental prophylaxis or

through the use of acidulated fluoride gels. Dentsply has

introduced Dicor Plus, which is a shaded feldspathic porcelain

veneer applied to the Dicor substrate. However, as Dicor Plus is a

84
fieldspathic porcelain that contains leucite, it is expected that these

restorations will be as abrasive to teeth as other fieldspathic

porcelain.

ADVANTAGES:-

1. Superior fit of cast-glass restoration reportedly superseded that

of conventional porcelain.

2. Less wear of opposition dentition.

3. Greater flexural strength than conventional porcelain.

DISADVANTAGES :-

1. Colorant is a surface stain hence any grinding of the restoration

leaves an unesthetic opaque white area.

2. Failure rates as high as 35% for full coverage Dicor crowns.

3. Whole process is technique-sensitive.

4. Special investment and casting equipment is required.

INDICATIONS :-

1. Veneers,

2. Inlays and onlays,

3. Anterior and posterior crowns,

4. Three-quarter crowns.

CONTRAINDICATIONS :-

85
1. Where strong lateral forces on the restoration are present as a

result of posterior group function and reduced vertical

dimension.

2. Where heavy bruxism and wear are apparent as evidence by

broadly faceted occlusal relationships.

3. Where short teeth preclude developing adequate resistance and

retention form.

4. When large pulp chambers limit the amount of tooth structure,

which may be safely removed.

PHYSICAL PROPERTIES:-

Density 2.7 gm/cm.3

Refractory Index 1.52

Translucency 0.56

Thermal conductivity .0040 cal/sec/cm.2/0c/cm.

Thermal diffusivity 800mm2/sec.

Modulus of Rupture 22000 psi

Compressive strength 120,000 psi

Modulus of elasticity 10.2 psix106

Microhardness 362 KHN

86
CLINICAL CHARACTERISTICS –

1) AESTHETIC QUALITIES :

The translucency of the cast ceramic material is close to that

of enamel. Light entering a crown is relectively filtered by the

colorants incorporated into exterior shading porcelain. The colored

light is then dispersed by the scattering events within the material.

In addition, because a Dicor Crown is one-piece restoration made

entirely of the same material, there is no opaque substructure to

impede light scattering, thus further enhancing translucency. The

high translucency of the Dicor material provides an exceptional

“Chameleon’ effect as the crown acquires tones from adjacent teeth

and feelings.

2) PRECISION FIT:

A careful build up to the wax pattern to avoid inducing

stresses is important. The pattern should have a smooth and

completely formed internal surface. Waxed margins should have

adequate thickness, be well blended, and have no

87
overextensions.Carving the occlusal anatomy in wax allows for the

production of a precise occlusal relationship.

Because both the investment and the castable glass are

silicated, the glass wets the walls of the investment to a greater

extent than metals. Thus, the minute details placed in the wax are

faithfully transferred to the casting. Final dimensional accuracy is

controlled after casting by the embedding and ceramming process.

Before heat treating, the glass pattern is embedded in an

investment-like material. This helps to control the final size of the

casting.

3) TISSUE ACCEPTENCE:

The chemical inertness of the castable ceramic material is

inherent in its base composition – Sio2, K2o, Mgo, Al2o3 and Zro2 as

well as fluoride component and a fluorescing agent.

In clinical testing, the reaction of the periodontal tissues to

the DICOR materials has been classified as very favourable. There

are mainly 2 reasons for these clinical judgements. First, the

DICOR system eliminates the coarser opaque porcelains used to

cover the metal substructure. These coarse-grained porcelains tend

88
to act as hosts for plaque, which can irritate the tissues. Secondly,

the absence of an opaque layer allows the technician to obtain

natural translucence in the gingival area, avoiding the over

contouring often found in metal ceramic crowns.

Because the thermal conductivity of the castable ceramic is

very low compared with metals and amalgams, the discomfort

from contact with hot or cold foods is minimized. The thermal

expansion coefficient of the cast ceramic material is close to that

natural enamel. This near match of thermal coefficients means less

expansion and contraction during normal temperature fluctuations,

thus helping to preserve the marginal seal provided by the luting

agent.

4) OCCLUSAL WEAR AND ATTRITION:

There is little or no attrition to the opposing natural dentition.

There are two reasons why the DICOR system is thought to be

beneficial in this respect,

a. First is the close match in hardness between the cast

ceramic material and natural enamel.

b. Secondly, the DICOR porcelain shading material contain

minimal abrasive opacifying agents

89
(2)CERAPEARL68

Among inorganic materials, hydroxy-apatite has long been

considered the most favourable material to restore missing tooth

structure because it is the constituent of natural enamel and is bio-

compatible. However, it was not castable. Even though it could be

fused to provide the crown shape; its colour and translucency are

different from those of natural enamel, and the surface texture is

too porous. Thus it is not suitable for the fabrication of restorations.

Habo and Kyocera Bioceram group developed a new apatite

ceramic in 1985, which is castable and forms apatite crystals after

the reheating process. This material cerapearl has a translucency

comparable to natural enamel. It is strong enough to resist occlusal

forces. Wear of natural enamel and cerapearl is minimal if the

occlusion is well balanced. The technique for producing cerapearl

restoration is very similar in concept to the Dicor-glass-ceramic

system. The calcium phosphate based glass is transformed to

partially crystalline structure by a controlled heat treatment and

then tinted by the application of colored glazes. Formation of the

crystalline phase was said to produce a three - fold increase in

tensile strength from 50 Mpa to 150 Mpa. Refractive index,

90
density, hardness, thermal expansion and thermal conductivity

were all found to be similar to natural enamel.

INDICATIONS :-

1. Anterior and posterior crowns.

2. Inlays and onlays.

CONTRAINDICATIONS :-

1. A tooth with a large pulp which prevents adequate tooth

preparations.

2. Tooth with a short clinical crown, which may not have

sufficient retention and stability after reduction.

COMPOSITION :-

Cerapearl is composed of CaO, P205, MgO and SiO5 plus

traces of other metals. Cerapearl contains approximately 45% CaO

and 15% P205 respectively. Cao and P205 are the important

compositions in glass formation. They are essential to form

hydroxyapatite crystals. MgO constitutes 5% in weight of the total

composition, and is used in an attempt to help formation of

hydroxyapatite. MgO and CaO decrease the viscosity of this

compound, when melted. Improvement of the flow makes it

possible to cast this material.

91
 SiO2 constitutes 34% in weight. With the combination of

P2O5, it forms the matrix. They provide network structure which

serve to stablize the physical and chemical properties. Further

more, SiO2 is the important constituent to regulate the thermal

properties being comparable to natural enamel.More importantly

these compositions contribute to biocompatibility.

CRYSTALLIZATION:-

The process by which the casting is reheated under

appropriate conditions to develop the microcrystals of the apatite is

called crystallization. Immediately after casting, Cera Pearl is in a

state of superliquidity and has an amorphous structure. When the

casting is reheated the nucleus begins to form the crystals of

oxyapatite which will eventually become the hydroxyapatite

crystals. Crystallization makes the casting a highly dense structure

that is stronger, harder and chemically stable. The crystallization

process is started at 7500 C and this temperature is maintained for

15 minutes so that the mold and casting are evenly heated. Oven

temperature is then raised gradually until it reaches 870 0 C. After

one hour the crystallization process is completed.

Cera Pearl is stronger than enamel. In crystallized Cera

Pearl, apatite crystals are bound with the strong non crystalline

inorganic matrix, which is similar in composition to the apatite.

92
They bond cohesively and the resultant homogenous composition

and microstructure provides mechanical strength.

Crystallized Cera Pearl shows very similar density, hardness,

coefficient of thermal expansion and thermal conductivity to that of

enamel.

After CeraPearl is crystallized the investment mould is

removed from the oven and cooled to room temperature and the

casting is then removed from the investment. Because the

investment is fragile after the crystallization process, the casting

can be easily separated from the mould. The sprue is cut with the

carborundum disk and surface is smoothed.

STAINING & GLAZING -

The crystallized Cera Pearl casting, which is very white in

comparison with natural tooth color, requires the application of an

external stain. Cerastain, formulated especially for this purpose,

consists of B2O3-SiO3-K2O glass and traces of various metal

oxides. Its fourteen cervical shades and three incisal shades match

the vita lumin vacuum shade guide. In addition, a glaze similar to

overglaze porcelain is required.

93
MICROSTRUCTURE -

X-ray diffraction analysis is used to identify crystal

structures. It was found that Cera Pearl showed the same

diffraction features as enamel.

Under the scanning Electron Microscope, the crystalline

microstructure of Cera Pearl and natural enamel were observed in

fractured sections. Enamel and Cera Pearl crystals show similar

surface characteristics. However, the crystals of Cera Pearl have a

some what irregular arrangement. Cera Pearl has the same crystals

as enamel, but its different arrangement provides superior

mechanical strength.

MECHANICAL PROPERTIES -

1. Young’s Modulus of Cera Pearl is 103 Gpa, which is greater

than that of,

Gold alloy = 95 Gpa

Enamel = 58 Gpa

Composite resin = 18 Gpa

It indicates that Cera Pearl is a rugged material and hard to

bend, and that the distortion would barely occur under a

reasonably strong occlusal force.

94
2. The tensile strength of Cera Pearl is approximately 150 Mpa,

which is much greater than that of,

Enamel = 14 Mpa

Composite resin = 18 Mpa

Amalgam = 70 Mpa

Porcelain = 80 Mpa

Gold alloy = 140 Mpa

Hence, Cera Pearl and Gold Alloy are strong enough to with

stand normal occlusal forces.

3. Compressive strength of Cera pearl is 590 Mpa, one and half

time greater than -

Enamel = 390 Mpa , or

Amalgam = 360 Mpa

Three times greater than,

Composite resin = 185 Mpa

Thus Cera Pearl has compressive strength sufficient to

withstand severe occlusal forces.

4. Hardness of Cera Pearl (wet) is 350 KHN, compares favorably

to that of,

Enamel = 340 KHN

95
 Ni - Cr alloys = 300 KHN

Type IV gold alloy = 220-240 KHN

Hence, wet specimen of Cera Pearl shown comparable

hardness to that of natural enamel. This similarity in hardness

prevents wear of opposing enamel, and at the same time Cera Pearl

is hard enough to resist wear on occlusal surfaces.

5. Flexural strength of Cera Pearl is similar to Dicor (150Mpa)

FABRICATION TECHNIQUE -

Wax pattern fabrication is carried out. Disclusion is essential

for posterior Cera Pearl restoration. Disclusion prevents not only

protrussive and lateral cuspal interferences but the tipping or

fracture of the occlusal surfaces as well. Cera Pearl can also be

used for anterior teeth that provide the ecentric closure stops.

96
(3)CD - 20074

It is a new glass ceramic, which has been presented as a

castable glass ceramic material that is bio inert and has excellent

flexural strength and chemical durability.

COMPOSITION:-

The formulation of CD - 200 is 50% SiO2, 10% Al2O3, 10% P2O5,

20% CaO, and 10 % MgO.

FABRICATION:-

To fabricate this material, a vacuum pressure casting

machine and ceramic furnace was developed. The technique uses

conventional lost wax process. A special investment material that

does not react with the cast glass allows the glasses to be

crystalized (cerammed) within the ring investment immediately

after casting, simplifying the laboratory procedures.

Wax patterns are made and then invested using a special

ring, ring liner and investment material. The wax is eliminated at

8500 C for 30 min. The ingot of glass was placed into the casting

machine, maintained at 15000 C and cast according to the

manufacturer’s instructions. The cast glass is left in the casting

machine for 15 minutes and then placed in the ceramming furnace.

The ceramming process is performed at 8900C for 2 hours after

which the glass is allowed to cool. The casting is then removed

97
from the furnace and air abraded with 40 um particles of aluminum

oxide under 4 Kg/Cm2 of air pressure.

In a study carried out by Nagakazu Koh et al in 1994 to

evaluate the marginal and internal adaptations and fracture

strengths, it was seen that the material expanded 0.57% after

casting, ceramming and application of surface colorant. Marginal

openings ranged between 2.8 and 11.25 um. Single crowns

exhibited fracture strengths lower than or comparable to DICOR

single crowns. Fixed Partial denture made from CD-200 were

weaker than those fabricated with Dicor.

98
Glass ceramics contain a substantial refractory crystalline core.

However, they are not like aluminous glass since they start out as

a pure glass in which finely dispersed crystalline structures are

stimulated to "grow" within the solidified glass matrix by a

process of controlled devitrification. Devitrification means the

formation of crystals on or within an amorphous glass, generally

due to a prolonged cooling cycle. The presence of native

crystalline inclusions strengthens the glass and makes it more

flexible, reducing the presence and severity of microcracks and

acting as crack stoppers,

There are four main advantage to these "home grown" crystals.

The size and distribution of the crystalline substructure

within the glass can be precisely controlled, making it

possible to fabricate cores and veneers out of the same

glass. The cores are strong and sometimes opaque while

the veneer is translucent and esthetic, yet they are made out

of the same glass ceramic. This insures the best integration

of the two components with the best combination of

strength and esthetics for the finished crown.

These native crystals are much more compatible with the

existing glass chemistry and their complete integration with

99
 the glass gel allows for much better translucency than the

older aluminous core crowns. In some cases, it is possible

to create a porcelain that is strong enough to act as a core,

while at the same time remaining esthetic enough to require

no additional esthetic veneer.

The crystals formed within the glass lend the finished body

various characteristics such as greater thermal expansion

and elasticity which can be precisely controlled to suit the

purpose of the specific porcelain.

Glass ceramics are still a form of glass, and thus they can

be etched. This means that they can be bonded directly to

tooth structure which improves the strength of the

restoration tremendously.

The process of forming crystalline structures in (or on) a glass

body is called devitrification. In general, devitrification within a

glass body creates opacity which makes the glass unusable for

esthetic purposes unless a veneer of non crystalline feldspathic

porcelain is fused on visible surfaces, and indeed, most glass

ceramics are cloudy or opaque. On the other hand, this is less of a

problem with some of the glass ceramics, and these can be used

without the addition of a feldspathic veneer. The reasons for this

100
will become apparent later. The heat treatment that encourages

the growth of these native crystals throughout the glass is called

ceramming and it is a two step process.

Ceramming

Ceramming is a controlled crystallization (devitrification) of the

glass that results in the formation of tiny crystals that are evenly

distributed throughout the body of the glass structure. The size of

the crystals, as well at the number and rate of growth is

determined by the time and temperature of the ceramming heat

treatment

There are two parts to the ceramming process; crystal nucleation

and crystal growth. Each phase happens because the glass body

is held at a specific temperature for a specific length of time.

101
FELDSPAR GLASS CERAMICS

The ceramic used in the original experiments of Horn was a

leucite (KALSi2O6) containing feldspathic glass, which he used

in the construction of metal-ceramic restorations. This ceramic

was optimized with regard to being able to bond to the metal

surface. The ceramics used now for resin-bonded ceramic

restorations are a modified version of the ceramic used by Horn.

They differ from the ceramic used in metal-ceramics primarily in

the composition and microstructure.

Whereas the leucite-containing ceramics used in metal-

ceramic restorations have a flexural strength in the range of 30-40

MPa, the leucite-reinforced glass ceramics have flexural strengths

of up to 120 MPa.

102
 Leucite (KAlSi2O6)

The original feldspathic glass

used in the production of porcelain fused to metal restorations

contained additional leucite crystals as crack stoppers. In this

case, the leucite was added because of its optical properties, and

because its thermal expansion properties made it possible to more

easily fit the veneer to the metal substructure. These leucite

containing porcelains had about the same flexural strength as the

original feldspathic porcelains, about 30-60 MPa. The crystals in

cerammed leucite, however can be controlled more precisely, and

their size and density within the glass matrix produces a much

more translucent glass at a flexural strength of up to about 120

MPa.

Lucite was the first, and is still probably the most popular of the

crystalline inclusions that form in cerammed feldspathic glass. It

forms when nearly any feldspathic glass is heated and held at

temperatures between 1150°C and 1530°C. (Note that the

103
chemical formula for leucite contains the same elements as are

found in ordinary feldspars.) One of the main functions of these

crystalline inclusions within the porcelain body is to act as crack

stoppers, however the usefulness of leucite crystals goes beyond

that. It is a potassium-aluminum-silicate mineral with a large

coefficient of thermal expansion when compared with non-

cerammed feldspar glasses. This property makes it especially

useful because it becomes possible to adjust the thermal

expansion of the glass body to suit the specific structures over

which it is to be placed. It is especially useful when formulating

veneers that will be placed over a metal substructure as in

porcelain fused to metal crowns and bridges. In a porcelain jacket

crown, the porcelain can be matched to the thermal expansion

properties of the tooth structure over which it will be placed.

Leucite ceramic glasses produce cores with about the same

flexural strength as the older aluminous porcelain cores

(~120MPa). Since both types of cores can be etched and bonded

directly to tooth structure, the major advantage of the glass

ceramic core is the translucency that these cores display when

compared with that of their aluminous competitors. The internal

surface microcrack problem still remains, but is greatly

104
diminished due to the increased elasticity leant by the leucite

crystals. The techniques that allow for strong bonding of the

internal surface of the PJC with the surface of the prepared tooth

compensate for any remaining weaknesses due to internal

microcracking The construction of ceramic restorations using

leucite-reinforced feldspars can be done either by sintering, using

a modified version of the sintering process described earlier to

construct the porcelain jacket crown, or by a process known as

hot-pressing.

 Sintering Process (e.g. Fortress and Optec-HSP)

In the sintering process, slurry of the ceramic powder is

applied to a refractory die (as opposed to a platinum foil coated

die in the case of the porcelain jacket crown), dried and

subsequently fired in a porcelain furnace. Multiple layers can be

built up to develop characterization. Great skill is required by the

dental laboratory technician to get the best aesthetics appropriate

contour.

 Hot-pressing (e.g. Empress IvoclarVivadent, Optec

OPC)

In order to surmount the problems of the inherent

inaccuracies of fit of the sintered ceramics, due to the high firing

105
shrinkage, attention has recently been paid to the possibility of

using glass ceramics, which employ a casting process for the

manufacture of crowns, veneers and inlays. Hot-pressing is one

such approach.

This method utilizes parts of the lost-wax casting technique.

As in lost-wax casting, a wax pattern is produced, which is then

invested in a refractory die material. The wax is burnt out to create

the space to be filled by the leucite-reinforced glass ceramic. A

specially designed pressing furnace is then used to fill the mould

space from a pellet of the glass ceramic using a viscous flow

process at a temperature of 11800C.

For posterior restorations, the final shading may be done by

applying surface stains. For anterior restorations, the crown or

veneer is cut back and a powdered form of the leucite-reinforced

glass ceramic is bonded using the conventional sintering

technique. The aesthetic results are excellent due to the high

translucency, fluorescence and opalescence of the leucite-

reinforced glass ceramic; however, the mechanical strength is

insufficient to be used in the construction of all-ceramic bridges.

106
IPS EMPRESS I (IVOCLAR PORCELAIN SYSTEM)

A patented heat-press technique was first described in 1936 for the

construction of ceramic complete dentures. However, a

commercially available furnance was never developed. In 1969.

Droge described a ceramics press technique based on the hot-press

resin technique. In his work he was using two-part flasks. Instead

of stone, the wax crown was invested in a refractory die material.

After opening the two halves of the flask and removing the wax

with boiling water, the cavity was filled with ceramic powder and

pressed together in the hot stage. Improving Droge’s technique,

McPhee was able to produce complete-coverage metal-ceramic

restorations that accurately duplicated oclusal surfaces.

Incase of castable ceramic, there is an additional ceramic

shrinkage during the ceramming procedure. To overcome this

disadvantage, a heatpress technique (IPS Empress) was developed

in 1983 by the Department of Fixed and Removable Prosthodontics

107
and Dental Materials at the University of Zurich. Since 1986 the

development has proceeded in conjunction with a dental company

lvoclar, Schaan, Liechtenstein.

IPS Empress technique is designed for the fabrication of

crown, inlays and veneers. The glass ceramic ingots used in this

technique is precerammed and precolored.

COMPOSITION -

The glass-ceramic material developed for this technique is

basically a feldspathic porcelain having the following composition

in weight %,

63 % SiO 2

17.7 % AL2 O 3

4.6 % Na2O 3

0.6 % B2o3

0.4 % CeO2

1.6 % CaO

0.7 % BaO

108
 0.2 % TiO2

The crystalline part of the ceramic consists of leucite crystals.

PROPERTIES

1. Flexural Strength - 120 Mpa initially and 160-182

Mpa after heat treatment.

2. Fracture toughness - 1.3 Mpa.

3. Abrasion behaviour - similar to that of natural teeth

4. Translucency - similar to that of natural teeth

5. Coefficient of linear - 14.90+0.5.10-6 K-1 m/m

thermal expansion - 18.25+ 0.5.10-6 K-1 m/m

6. Solubility - < 200mg/cm2

7. Pressing temperature - 1075 or 11800 C

Heat pressing not only shapes and forms, but it also

strengthens the material by improving dispersion of the leucite

crystals in the matrix. Because of the compressive stresses created

by the matrix configuration, the ceramic has an increased

resistance to surface damage by preventing surface cracks. The

combination of heat pressing, initial firing, stain and glaze of the

veneer created an additional 50 % increase in strength.

109
 In addition, pressed ceramics have a coefficient of wear

similar to that of enamel , so that there is less wear of antagonistic

teeth and restorative materials. Good marginal adaption is also

possible because the heatpressing technique can minimize

additional shrinkage. The transluency of pressed ceramics is

similar to that of enamel, which allows the material to blend with

natural tooth structure. Unfortunately, heat-pressed leucite

reinforced veneers exhibit a loss of strength and pressing

diffficulties when the veneer is thinner than 0.5 mm. Therefore

preparations must be 0.6 to 0.8 mm in depth, decreasing the

conservative nature of the restoration.

ADVANTAGES

1. Moderate flexural strength

2. Excellent fit

3. Excellent aesthetics

DISADVANTAGES

1. Potential to fracture in posterior areas.

2. Need for special laboratory equipment

3.preparation for the veneer requires preparation depth upto

0.6 to 0.8 mm, which is against the conservation of the

tooth structure.

110
INDICATIONS

1. Anterior crowns

2. Inlays

3. Laminate veneers

4. Post and cores

CONTRAINDICATIONS

1. The clinical crown lengh of the tooth is exceptionally short.

2. Parafunctional habit.

FABRICATION PROCEDURES

111
 A special furnance (Empress EP500) is designed for this

system. The pressing furnance contains an enlarged heat home, a

pneumatic pressure system, a displacement transducer is mounted

on top of the furnance and is connected to the pneumatic plunger.

The restorations are waxed and placed on a specially designed

cylindrical crucible former and invested using a phosphate-bonded

investment. The mold is heated in a burnout furnance to 850 0C.

The cylindrical opening into the mold is filled with a ceramic ingot

and an Al203 pushing rod. The assembly is then placed into the

preheated furnance. The automatic press furnance makes it possible

to change the following parameter :

1. The rate of temperature increase can be varied from 5 0C to

800C/min.

2. The furnance can be heated to 12000 C

112
 3. The holding time at the final temperature can be varied from

0 to 60 minutes.

4. If the pneumatic plunger does not continue to move more

than 0.3 mm/min, the pressure maintenance of 1 to 4

minutes is necessary depending on the thickness of the

cavity that has to be filled.

5. The press procedure is performed in a vacuum, and the

beginning and ending points for the vacuum application can

be programmed.

When the start button is pushed, the furnance heats up

automatically to the programmed press temperature (11500C). After

a 20-minutes holding time at this temperature the press procedure

is activated and then plastic glass-ceramic material is pressed (0.3

to 0.4 Mpa) into the mold. The mold is filled with the glass ceramic

material and the furnance stops automatically. The ceramic

restorations are divested and prepared for further treatments.

Surface coloration :

113
A strongly pigmented surface colour is applied until the desired

colour is established. The colour pigments are covered with a

surface glaze that consists of the same components as the base

material. The surface glaze is applied in a thickness of

approximately 50 to 60 um.

Veneer Technique :

A complete-counter wax pattern is made and then a portion is

removed where enamel translucency is desired. The remaining

dentin structure is then invested and heat pressed. After divesting

and sprue removal, the dentine structure can be characterised using

surface colour, finally enamel porcelain is applied to complete the

desired form.

PRESSABLE CERAMICS PROCESSING MACHINE

114
Empress Esthetic and Empress CAD

115
The IPS Empress glass-ceramic material is made of a glass phase

and a type leucite crystal phase. The growth of the leucite crystals

starts at the grain boundaries of the glass frit. The leucite crystals

are grown in a multi-step fabrication process up to a size of few

microns. The semi-finished product in powder form is then pressed

to ingots and fired. These ingots are components of the IPS

Empress Esthetic System and are used to fabricate individual

restorations. The compressive stress resulting from the leucite

crystal structure in a silicate glass matrix provides increased

strength. The material is based on a system of SiO2 – Al2O3 –

K2O.

The broader ingot shade range gives more selection to meet patient

demands.The greater dispersion of leucite crystals in the ingots

provides greater homogeneity and improved flexural strength.

116
Indications

– Inlays (glazed)

– Onlays (glazed)

– Veneers (glazed or partially layered)

– Anterior crowns (glazed or partially layered)

– Posterior crowns (glazed)

Contraindications

– Fully veneered crowns

– Bridge constructions

– Very deep sub-gingival preparations

– Patients with severely reduced residual dentition

– Bruxism

– Limited space

PROCESSING TECHNIQUE

117
 Sprue the wax pattern . Mix IPS Empress Esthetic Speed Investment material under
vacuum

Pour the investment material slowly. Avoid the formation of air bubbles. Remove
the stabilizing ring and slowly place the ring gauge on the investment ring

Close the furnace head Remove the investment ring from the preheating furnace.
Place the preheated IPS Empress Esthetic ingot in the investment ring. Place the
rings in the preheating furnace as quickly as possible. Next, position the AlOx
plunger. Place the investment ring with the ingot and the AlOx plunger at the center
of the EP500/EP600 press furnace. Close the furnace head.

The press cycle runs automatically. An acoustic signal indicates the end of 118
the
press cycle. Mark the length of the AlOx plunger on the cooled investment ring.
Break the investment ring at the predetermined breaking point using a plaster
knife. Use a fine diamond disk to cut the sprues

Evenly apply the glaze paste with the glaze and stain liquid on the restoration.

Lithium Disilicate glass ceramics

119
The crystalline phase that forms is a lithium disilicate (Li 2Si2O5)

and makes up some 70% of the volume of the glass ceramic.

Lithium disilicate has an unusual microstructure in that it consists

of many small inter-locking plate-like crystals that are randomly

oriented. This is ideal from the point of view of strength because

the needle-like crystals cause cracks to deflect, branch or blunt;

thus, the propagation of cracks through this material is arrested by

the lithium disilicate crystals, providing a substantial increase in

the flexural strength.

A second crystalline phase, consisting of a lithium

orthophosphate (Li3PO4) of a much lower volume, is also present.

120
 The mechanical properties of this glass ceramic are far

superior to that of the leucite glass ceramic, with a flexural strength

is in the range of 350-450 MPa and a fracture toughness

approximately three times that of the leucite glass ceramic.

The glass ceramic is claimed to be highly translucent due to

the optical compatibility between the glassy matrix and the

crystalline phase, which minimizes internal scattering of the light

as it passes through the material. The processing method is the

same as the hot-pressing method described above, except that the

processing temperature, at 9200C, is lower than for the leucite glass

ceramic.

For the alumina-based core systems described earlier it is

possible to use feldspathic glasses to provide the aesthetic surface

layer, as their coefficients of expansion are closely matched at~7-

8ppm/0C. For the leucite glass ceramics the layering ceramic is

identical to the core ceramic and so a mismatch in coefficient of

expansion does not arise. However, for the lithium disilicate glass

ceramic the coefficient of expansion is greater that 10 ppm/ 0C and

consequently a new compatible layering ceramic had to be

developed. This new layering ceramic is an apatite glass ceramic.

The crystalline phase formed on ceramming is a hydroxy-apatite

121
(Ca10(PO4)6.2OH), which is the same basic constituent from which

enamel is made. Thus, it represents a material that, at least in

composition, is the closest match to enamel that has been achieved

so far.

The lithium disilicate core is somewhat opaque, but is the strongest

of all the glass ceramics (~350-450MPa). This makes the core

strong enough to fabricate crowns for molars, and adequate for the

fabrication of anterior three unit bridges.

122
IPS EMPRESS II - Eris

The IPS Empress II glass-ceramic represented the second

generation of material of the Empress system which does not bear

any resmblance to the leucite glass-cermaic IPS Empress I as far as

materials science was concerned. IPS ExpressII is a lithium

disilicate glass ceramic and the chemical basis for the material is to

SiO2- Li2O system.

From a historical perspective, the first lithium disilicate

glass-ceramics were developed as early as in the fifties. This

development was the work of Stookey. Following his fundamental

discovery, lithium disilicate glass-ceramics became the subject of a

considerable amount of research. The nucleation mechanism and

the kinetics of crystallization of the main lithium disilicate phase

received the most attention. A disadvantage of these lithium

disilicate glass-ceramics, however, was their poor chemical

durability.

Considerable progress in the development of a chemically

durable lithium disilicate-base glass-ceramics was achieved by

Becell and Echeversia.

COMPOSITION -

123
Components Wt %

SiO2 57-80

Al2O3 0-5

La2 O3 0.1-6

MgO 0-5

Zno 0-8

K2O 0-13

Li2O 11-19

P2O5 0-11

Additional components 0-8

PROPERTIES -

1. Mechanical

a. Flexural Strength 350+50 Mpa.

b. Fracture Toughness 3.2+0.3 Mpa.

c. Abrasion behaviour Similar to that of natural teeth

124
2. Optical Translucency Similar to that of natural teeth

3. Chemical solubility 100 mg/cm2

4. Pressing temperature 9200

INDICATIONS :

1. Three unit bridges for the anterior and posterior regions upto the

first premolar as a pontic.

2. Crowns in anterior and posterior regions.

3. Partial crown.

4.Conventional bridges with full crown retainers as well as

adhesively luted inlay retained bridges in the posterior region

are undergoing clinical testing. To date, the result are very

promising.

CONTRAINDICATIONS:

1. Short crown length

2. Parafunctional habits

3. Cantilever bridges

125
Recently,a new range of lithium disilicate based products has been

launched keeping in mind the drawbacks of the previous systems.

IPS e.max Press

The innovative IPS e.max Press lithium disilicate glass-ceramic

(LS2) offers excellent fit, form and function combined with high

strength of 400 MPa. The material is supplied in four levels of

126
translucency and two sizes for maximum flexibility. The resulting

restorations exhibit lifelike esthetics, independent of the shade of

the preparations.

A wide selection of ingots is offered from which any preferred

processing technique (staining, cut-back or layering technique) and

the case at hand (e.g. discoloured preparation) may be used. The

restorations are characterized or veneered with matching staining

materials or layering ceramic from the IPS e.max Ceram

assortment. The press material for the fabrication of full-contour

restorations is available in 16 A-D and four Bleach BL shades. The

materials for the layering technique are supplied in group shades.

Compared to IPS Empress® ingots, IPS e.max Press are larger in

127
diameter, i.e. more volume, which allows more restorations to be

produced per press cycle.

HT ingots

These highly translucent (HT) ingots are suitable for the fabrication

of minimally invasive full-contour restorations, such as inlays,

onlays and veneers. The restorations are efficiently customized

with staining materials.

LT ingots

These ingots showing low translucency (LT) are used to fabricate

full-contour partial and full crowns. In the anterior region in

particular, the esthetic appearance of the restorations is maximized

by employing the cut-back technique

MO ingots

These ingots of medium opacity (MO) are used to fabricate

substructures for vital or lightly discoloured teeth. They create an

ideal basis for lifelike restorations completed with the layering

technique.

128
HO ingots

In cases where the prepared tooth structure is discoloured or

titanium abutments are used, the HO ingots mask the dark

background to achieve highly esthetic results .

Indications

– Thin Veneers

– Veneers

– Partial crowns

– Anterior and posterior crowns

– 3-unit anterior bridges

– 3-unit bridges up to the second premolar as the abutment tooth

– Press-over electroplated single crowns

– Implant superstructures for single restorations (anterior and

posterior region)

– Implant superstructures for 3-unit bridge restorations up to the

second premolar as the abutment tooth

– Primary telescope crowns

Contraindications

– Molar bridges with the first molar as a pontic

– 4- and multi-unit bridges

129
– Inlay-retained bridges

– Very deep, subgingival preparations

– Patients with severely reduced residual dentitions

– Bruxism

– Cantilever bridges

– Maryland bridges

IPS e.max ZirPress

IPS e.max ZirPress is a fluorapatite glass-ceramic ingot for the

press-on technique on zirconium oxide. The fluorapatite crystals

contained in the material are of different sizes and therefore

selectively control the interplay of translucency, opalescence and

brightness of the restorations. Consequently, complete masking of

the less translucent zirconium oxide frameworks is achieved. The

press-on technique allows you to take advantage of the benefits of

the press technique (accuracy of fit) and CAD/CAM processing

130
(milling of zirconium oxide). IPS e.max ZirPress can be pressed

onto both IPS e.max ZirCAD single tooth copings and multi-unit

bridge frameworks. Very little time and effort is required to press

the IPS e.max ZirPress ingots onto the frameworks or copings

using the proven PRESS technique. Frameworks onto which IPS

e.max ZirPress has been pressed demonstrate precise heat resistant

ceramic shoulders. The restorations can be either characterized or

veneered with the efficient IPS e.max Ceram material. The superior

aesthetic and functional restorations achieved with these materials

are cost effective and fully satisfy individual patient

IPS e.max ZirPress Ingots

are supplied in three levels of opacity in A-D shades and in four

Bleach BL shades. In addition, two gingiva shades are available.

As several ingots can be pressed at the same time in the IPS

investment system, they are supplied in only one size. The

restorations are characterized with the staining materials or

veneered with the layering materials from the IPS e.max Ceram

assortment.

131
HT Ingots

These highly translucent ingots are used for the fully anatomical

technique. The restorations are characterized with the IPS e.max

Ceram staining materials. Even inlay-retained bridges can be

fabricated with all-ceramics without additional effort.

LT Ingots

These ingots showing low translucency are ideal for the cut-back

technique. After partially anatomical restorations have been

pressed on the frameworks, you can complete the incisal area

individually as you wish using the IPS e.max Ceram materials

MO Ingots

The MO ingots are used for pressing accurately fitting ceramic

shoulders, bridge pontics and the cervical third before the

restoration is completed with the IPS e.max Ceram materials.

132
Gingiva Ingots

These two ingots facilitate the fabrication of gingival parts,

particularly of large (implant) restorations, since the material does

not shrink and helps to reduce the number of firing cycles

Indications

– For pressing onto IPS e.max ZirCAD single tooth copings

– For pressing onto multi-unit IPS e.max ZirCAD bridge

frameworks

– For pressing onto IPS e.max ZirCAD inlay-retained bridge

frameworks

– For pressing onto implant superstructures made of IPS e.max

ZirCAD (single tooth copings and bridge frameworks)

– Veneers

Contraindications

133
– The material should not be pressed onto zirconium oxide

frameworks that have a CTE in a range other than that specified

– The material should not be pressed onto non-sintered zirconium

oxide frameworks

– Very deep subgingival preparations

– Patients with severely reduced residual dentition

– Bruxism

IPS e.max CAD

IPS e.max CAD is a lithium silicate glass-ceramic block for the

134
CAD/CAM Technology. It is manufactured in an innovative

process, which results in the exceptional homogeneity of the

material. In its crystalline intermediate state, the block can be

easily milled with CAD/CAM equipment. The unusual colouring

of IPS e.max CAD ranges between white, blue and bluish grey.

This colour is created by the composition and microstructure of the

glass-ceramic. The strength of the material at this machinable

intermediary stage is 130–150 MPa. It is, therefore, comparable to

other commercially available glass-ceramic blocks. After the IPS

e.max CAD blocks have been milled, the material is crystallized in

one of the Ivolcar Vivadent ceramic furnaces (eg P300, P500,

P700). The crystallization process is easy to conduct and takes

approx. 25–35 minutes. In contrast to some other CAD/CAM

ceramics, the blocks do not shrink significantly and they do not

require complicated infiltration processes. The crystallization

process at 840–850 ºC (1544–1562 °F) causes the microstructure to

change through controlled growth of lithium disilicate crystals. The

milling software takes the resulting densification of 0.2% into

account in the milling process. The transformation of the

microstructure produces the final physical properties including 360

MPa flexural strength and the suitable optical characteristics, such

as shade, translucency and brightness

135
IPS e.max CAD

blocks are available in three levels of translucency and in two

sizes. On the basis of the individual case, one can choose the

appropriate block and the preferred processing technique (staining,

cut-back or layering technique).

The blocks for fabricating full-contour restorations are supplied in

16 A-D and four Bleach BL shades. The MO blocks for the

layering technique are available in group shades.

HT blocks

These new highly translucent (HT) blocks are used to machine

minimally invasive full-contour restorations, for example, inlays,

onlays and veneers. These restorations are subsequently

characterized with staining materials.

136
LT blocks

These blocks showing low translucency (LT) are suitable for

fabricating full-contour partial and full crowns. The cut-back

technique and subsequent layering with IPS e.max Ceram produces

enhanced esthetic results in anterior restorations in particular.

MO blocks

Because of their high opacity, IPS e.max CAD MO blocks are used

to produce frameworks that are placed on vital and slightly

discoloured prepared teeth. The frameworks are veneered with IPS

e.max Ceram

Indications

– Veneers

– Partial crowns

– Anterior and posterior crowns

– Primary telescope crowns

Contraindications

– Full veneers on molar crowns

– Very deep subgingival preparations

– Patients with severely reduced residual dentitions

– Bruxism

137
IPS e.max ZirCAD

IPS e.max ZirCAD are presintered, yttrium-stabilized zirconium

oxide blocks for the CAD/CAM technology. After thorough

sintering, the material forms a polycrystalline oxide ceramic

material made up of a tetragonal zirconium oxide phase (TZP).

138
With a flexural strength of more than 900 MPa, the material

demonstrates a high fracture resistance and its fracture toughness is

more than twice that of glass-infiltrated ceramic. In its partially

sintered, "chalk-like" state, IPS e.max ZirCAD is easily milled

using a CAD/CAM machine. Milling is always carried out with an

enlargement of the framework of approximately 20% per spatial

axis. Given the controlled manufacturing process of the blocks,

combined with an optimized sintering process in the Sintramat high

temperature furnace from Ivoclar Vivadent, the shrinkage of the

slightly enlarged, milled frameworks can be controlled so that

accuracy of fit is achieved. During the sintering procedure, the

final, material-specific properties of the TZP are achieved. In the

process, a structure that is densified to more than 99% is created,

which features a high fracture resistance combined with high

fracture toughness as a result of the transformation reinforcement

of the ZrO2 crystals. As a result, the material meets the clinical

requirements to withstand the masticatory forces, particularly in the

posterior region. Therefore, IPS e.max ZirCAD supplements the

range of indications of the IPS e.max material in an ideal fashion.

Either IPS e.max ZirPress is pressed onto the high-strength IPS

e.max ZirCAD frameworks and/or the framework is veneered

using IPS e.max Ceram.

139
IPS e.max ZirCAD is indicated for long-span bridge frameworks,

both in the anterior and posterior region. In addition, it can be used

to fabricate primary parts for the telescope technique as well as

implant superstructures and crown copings.

IPS e.max ZirCAD is available in seven block sizes and three

shades (MO 0, MO 1, MO 2). The smaller blocks are used to

fabricate crown copings, while the larger blocks are used to

produce long-span bridge frameworks or for batch processing.

White lines at the transition between zirconium oxide supported

restorations and the gingiva as well as excessive brightness should

be prevented, as they could impair the esthetics of the result. The

new coloured blocks (MO 1 and MO 2) and the colouring liquids

(4 colours) for imparting colour to white frameworks (MO 0) are

helpful in this respect.

140
Combination dentures are particularly difficult to produce.

Therefore, the shade system of the IPS e.max ZirCAD blocks is

coordinated with that of IPS e.max Press and CAD MO.

As a result, a sound colour basis is created for producing excellent

esthetic veneering results irrespective of the IPS e.max framework

material used (lithium disilicate or zirconium oxide).

Indications

– Crown frameworks for the anterior and posterior regions

– 3- to 6-unit bridge frameworks for the anterior and posterior

regions

– Inlay-retained bridges

– Primary telescope crowns

141
– Implant superstructures (single tooth and bridge frameworks)

Contraindications

– More than two connected bridge units in the posterior region

– Very deep subgingival preparations

– Patients with severely reduced residual dentitions

– Bruxism

GLASS INFILTRATED MAGNESIA ALUMINA

 IN-CERAM SPINELL

142
 The In-Ceram spinell (MgAl 2O4) represents a more recent

development, introduced as an alternative to In-Ceram. It was

originally marketed for the fabrication of inlays and onlays, but can

be used for the fabrication of veneers.Spinell (MgAl204) is a

natural mineral that is mainly found together with limestone and

dolomite, sometimes also with granite or as loose sediment in sand.

Spinell crystals are colourless or coloured, glassy, transparent or

even opaque crystals with a cubic symmetry which often reveals

the tendency of twin formation. If the metal ions (Mg2+, Al3+) in a

highly pure, colourless spinell are replaced by other metal ions,

striking colour changes in the spinell can be observed: chromium

ions create a red spinell colour, iron ions of different valences

produce blue, brown or even green colour effects. Yet even yellow

and pink spinell can be found quite often. Due to the different types

of spinell that are found, the composition of natural spinells varies

strongly. Therefore, for industrial purposes, spinell is produced

synthetically. Originally, magnesium oxide and aluminium oxide

were mixed in a ratio of 1:1 and transformed to spinell at

temperatures above 1600°C. Since this was a tricky process due to

the high temperatures, nowadays other methods are used to

synthetize spinell, e.g. by thermal decomposition of salt mixtures

or by evaporation or decomposition of nitrides. Spinell ceramics

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feature some excellent material properties which are utilized in

industrial applications.

Accordingly, due to its high melting point (2135 °C), its excellent

stability - even at extreme temperatures and the low thermal

conductivity - spinell is used as a refractory material, e.g. in the

form of furnace lining or protective pipes for thermocouples. These

properties as well as the fact that spinell is highly resistant to acids

contributed to the suitability of spinell as a material for corrosion

resistant melting crucibles. The jewellery industry takes advantage

of the good transparency - the glass lustre as well as the possibility

of obtaining different colours by adding certain metal ions and

produces synthetic stones from spinell. High stability, good

chemical resistance, high translucency and low electric

conductivity are properties which have turned spinell into an

interesting material for dental. This SPINELL POWDER has been

matched to the proven In-Ceram Classic technique and the

subsequent veneering process with VITA VM 7 fine-structure

veneering ceramic. The colour of the originally white SPINELL

POWDER is obtained – as in the case of ALUMINA and

ZIRCONIA POWDER – by infiltrating with appropriate special

coloured glasses .

Porously sintered structure Glass-infiltrated structure

of In-Ceram Classic SPINELL of In-Ceram Classic SPINELL

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The spinell cores are more translucent than the aluminum oxide

cores, but some strength has been sacrificed for the translucency.

When compared to alumina the spinell shows a reduction of

flexural strength by 46% (283 Mpa). This can be logically

explained by both the increased size of the spinell particles and the

decreased intrinsic mechanical properties of the spinell itself.

Consequently the clinician should be careful when placing

complete coverage crowns with In-Ceram spinell, especially in

posterior areas. Use of adhesive cementation has proven to be an

essential step when placing such restoration; considering that

increased resistance to fracture may be obtained.

A particular situation may be encountered when a tooth with

a very high value (A1) must be reproduced on a low value

abutment. This specific situation will be better accomplished by

infiltrating the sintered alumina under vacuum with a glass of the

spinell system.

VITA In-Ceram® Classic SPINELL assortment

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METHOD OF FABRICATION :-

1. Producing working model and master model

2. Blocking out the working model

3. Applying VITA In-Ceram Classic Interspace Varnish

4. Duplicating

5. Deflasking duplicating mould

6. Manufacturing firing tray model

7. Mixing and applying VITA In-Ceram Classic SPINELL

POWDER

8. 1st sintering firing in the VITA INCERAMAT

9. 2nd sintering firing in the VITA INCERAMAT (crown only)

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10 Reworking sintered substructure

11. Applying VITA In-Ceram Classic SPINELL GLASS

POWDER

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12. Glass infiltration firing in the VITA INCERAMAT

13. Removing / sandblasting excess glass

14. 1st glass control firing in the VITA VACUMAT

15. 2nd glass control firing in the VITA VACUMAT

16. Veneering the substructure with VITA VM 7

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Advantages:

optimum aesthetics and excellent biocompatibility, i.e.

– no exposed metal margin

– good light transmission properties

– no retraction of the gingiva

– accurate marginal fit

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-withstands high functional stress due to excellent physical values

-no thermal irritations on account of low thermal conductivity

-offers the possibility of non-adhesive seating

-radiolucent

-high degree of acceptance among the patients

-positive cost / benefit ratio

-standardized working procedures for the dental technician

-expandable system

VITA In-Ceram SPINELL copings feature translucency

comparable to that of natural enamel.

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 v.MACHINABLE CERAMICS68,70,71,72,74,76,77,80,81
The introduction of machinable ceramics to restorative

dentistry represents a major technological breakthrough. It is now

possible to design and fabricate ceramic restoration at a single

appointment as opposed to the traditional method of making

impressions, fabricating a provisional prosthesis and using a

laboratory for development of the restoration. Machinable ceramic

system uses subtractive method i.e. grinding (milling) of the

material.

CLASSIFICATION OF MACHINING SYSTEM --

I) Copying process (Analogous) [Celay, Mikrona, Technologies

AG, Spreitenbach, Switzerland]:

(a) Copy grinding = Manual - Celay

Automatic - Ceramatic II

(b) Copy Erosion = Sonoerosion - DFE Erosonic

II) CAD-CAM Process (Digital) [Cerec, Sienmens, Bensheim,

Germany]:

(a) Direct = Cerec1, Cerec2, Cerec3

(b) Indirect = Automill, DCS- Precident

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Two Classes of ceramics are available for machining of individual

ceramic restorations and veneers-

1) Two fine- scale feldspathic porcelains -- Vita Mark II and

Celay by Vita.

2) Two glass ceramics – Dicor-MGC light and Dicor-MGC

by Dentsply.

The ceramic ingots used in CAD-CAM restorations do not require

further high- temperature processing. They are placed in a

machining apparatus to produce the desired contours. This is

followed by occlusal adjustment and then polishing, etching and

bonding the restoration to the prepared tooth.

The different types of ceramic ingots used in the process are as

follows:

1] CEREC VITABLOCKS MARK I

In September 1987, this machinable feldspathic ceramic block

was introduced in the market. The first generation of these blocks,

Cerec Vitablock Mark I was developed by Vita in close co-

operation with professor Mormann. It is a feldspathic porcelain,

which was the first composition used with the Cerec system

(Siemens). It is similar in composition, strength and wear

properties to feldspathic porcelain used for porcelain fused to metal

restorations.

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2] CEREC VITABLOCK MARK II

Introduced in 1991. This is feldspathic porcelain of increased

strength and has a finer grain size than the Mark I compositions; an

in vitro evaluation shows that this produces less abrasive wear of

the opposing tooth structure. There are no published clinical studies

as yet to support this claim.

COMPOSITION -

SiO2 - 60-64 %

Al2O3 - 22-23 %

Na2O - 7-9 %

K2O - 6-8 %

CaO - 0.3-0.6 %

TiO2 - 0-0.1 %

3] DICOR MGC (DENTSPLY L.D. CAULK DIVISION)

This is a machinable glass ceramic composed of fluorosilicic mica

crystals in a glass matrix. It has greater flexural strength than the

castable Dicor and the Cerec compositions. This material is softer

than conventional feldspathic porcelain. It produces less abrasive

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wear of the opposing tooth structure than Cerec Mark I and more

wear than Cerec Mark II in an in vitro study.

4] CELAY

This material can be used for CAD-CAM produced restorations or

used in the copy milling technique. It is fine grained feldspathic

porcelain that is said to reduce the wear of antagonist tooth

structure; however, there are no clinical studies to substantiate this

claim. The manufacturer claims that this material is identical in

composition to Cerec.

All the forementioned systems can be characterized with

stains after milling and occlusal adjustment.

These studies have shown that the gap between the

restoration and tooth structure is considerably wider than that in

other types of all-ceramic restorations. This gap can be filled in

with composite resin cement, but the cement itself is subject to

wear. This wear may be self-limiting after three to four years.

Clinical fracture seems to be related to insufficient depth of tooth

preparation and inadequate bonding to the tooth structure during

cementation.

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MACHINING SYSTEMS

I) ANALOGOUS SYSTEMS (COPYING METHODS)

Analogous copying methods includes two fundamental steps, at

first the fabrication of the so called pro-inlay which will be scanned

and copied in a second step. The best known commercially

available manually copy grinding system is Celay.

CELAY SYSTEM

Research leading to the Celay system (Mikrona Technologie,

Spreitenbach, Switzerland) was initiated at the university of

Zurich, Department of fixed and removable prosthodontics and

Dental Materials. As a result of doctoral thesis by Dr. Stefan

Eeidenbaez, a first prototype was designed and available in 1988.

The Celay system is available since 1992.

DESIGN OF MILLING MACHINE:

The resin pattern (Pre-inlay) is held for all surface tracing in a dry

chamber on the left side of the unit. The tip of the tracer is mounted

to touch the surface.

A Ceramic blank is machined using a high-speed turbine in

the wet carving chamber on the right side. The blank will become

the image of the pre-inlay mounted on the left. A pantographic arm

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is situated between the two stations and acts as a geometric transfer

mechanism to link the three-dimensional movements of the tracing

device with the milling device.

Clutches specially designed for rapid and secure retention

simplify tracing and milling tool changes while retaining accuracy.

The size and shape of the tracing tools are matched to the diamond

cutting tools. The rod-shaped ceramic blank is mounted on support

bracket produced by the manufacturer (Vita-Clay-Bank, Vita

Zahnfabrik Germany) and when mounted on the retaining device, it

can be repetitively fitted to the bearing in the same position. While

still connected to this device, the inlay can be checked for fit on the

die and returned to the machine, the restoration can be indentically

repositioned again.The turbine is driven by air pressurized at 4.2

bar and runs at 80,000 rpm. A special cooling liquid is sprayed on

the ceramic block as well as the carving diamond. The wet

chamber is protected by a clear cover that is automatically rotated

into place during milling to retain spray and debris.

PRE-INLAY FABRICATION

Because of different requirements for pre-inlay fabrication

intraorally or in the laboratory, two resin materials with different

setting characteristics were developed. Both materials provide rigid

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patterns with hard surface to resist deformation from handling as

well as tracing procedures.

DIRECT METHOD

When following techniques for direct composite inlay

fabrication, the removal of the “Pre-inlay” often proven critical,

several aspects other than undercuts must be considered. Light-

Activated resin composite materials require clear matrix band for

proximal wall formation. The wedging may be difficult and

adaptation to axial finish lines with proper proximal contacts often

proves impossible, control of marginal excess and carving occlusal

surface is difficult because of lack of color contrast with the natural

tooth. Also, light-activated pattern materials set rapidly and their

rigidity makes removal difficult.

A three-component composite material (Espe-Celay-Dent)

was developed to achieve a more “elastic” setting characteristic

that can be hardened later using a blue light. Therefore a

conventional steel matrix band can be used to facilitate proximal

contouring. The acrylic resin was loaded with a spherical

macrofiller to produce a putty-like material with high viscosity and

good shear characteristics that was ideal for molding. Dark blue

colorants provides better visualization of any excess. When used

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intraorally, the pattern is removed from the cavity while still

somewhat elastic and polymerization completed using a

conventional blue light source.

INDIRECT METHOD

A light-activated composite material was chosen for molding

on the die where undercuts can be more easily recognized and

eliminated. Longer working time allows the technician to form

natural occlusal form for more complex restoration. The material

also is colored with dark blue pigments but with less light activator

to delay setting and provide more manipulation time.

PRACTICAL PROCEDURE -

Tooth preparation follows the accepted rules for adhesive

inlay restorations. The cavity is cleaned and a steel matrix band is

secured using proximal wedging. A thin coat of a separating

medium is applied to the prepared tooth structure. The three-

component resin is adapted to the cavity walls using finger

pressure and a ball gauge. A special composite spatula is used for

final forming. Occulsal contacts are checked at maximum

intercuspation as well as during excursive movements. While the

material is still elastic after the initial setting, a manipulative device

is luted to the surface of the pattern to facilitate removal and

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pattern is left attached to the device until after final polymerization

is done using the blue light.

When the manipulative device is luted to the occlusal

surface using a short exposure (10sec.) of blue light, this surface

provides rigidity and acts as an impression tray for the material

beneath. It also serves to prevent deformation upon removal. After

the polymerization, small marginal overhang can be removed using

a blade or carbide bur. The pattern should then be replaced and

checked for fit. The different color of composite facilitates

evaluation of the pattern- tooth junction. Any undercut preventing

placement must be removed. When the pattern is acceptable, the

manipulative device can be removed, however to handle small

occulsal inlay it may remain attached, copied in the ceramic

material and eventually removed after final cementation.

When using the indirect procedure an elastomeric

impression of inlay preparations is needed to fabricate a working

cast. The stone die is fabricated, undercuts are eliminated with die

spacer or hard wax and the surface is isolated. After the Celay-Tech

material has been adapted, the die is replaced in to the mounted

working cast to adjust proximal and occulsal contacts. Heavy

contacts will result in easily detectable dents. After all contacts

have been adjusted the pattern is light activated.

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MILLING PROCEDURE

Mounting Pre-inlay --

The pattern is mounted on a jig in the left side of the unit. A

split pin with two sharp points allows for an effective contact with

the pattern. At the base two separate spikes attached to a rotating

table allow an ideal positioning and secure three-point fixation with

even pressure. This also provides ample access for tracing the

pattern.

Milling Instruments –

The following milling instruments and polishing instruments are

used,

1. A coarse diamond disk with a grit size of 126 µm (Diametal,

Bial, Switzerland) for efficient bulk reduction.

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 2. A finishing diamond disk with a grit size of 64 µm (Diametal)

for precision milling of the final contour.

3. Round tip diamonds with a grit size of 64 µm (Diametal) for

narrow concavities. i.e. secondary occulsal anatomy .

4. Sharp tip diamond with a grit size of 64 µm (Diametal) for

secondary occulsal anatomy.

5. Polishing instrument loaded with diamond powder (Shofu,

Tokyo, Japan).

Cooling --

Three nozzles are directed towards the ceramic block and the

milling tools for optimal cooling and lubrication of critical ceramic

surface and carving instruments. An efficient cooling circuit was

integrated into the equipment. The cooling liquid (Mikrona

Celecool, Mikrona) is a blend of water emulsified with very low-

viscosity wax.

PROCEDURE --

For economy, the smallest ceramic block possible should be

mounted. To reduce overall carving time, the bulk of excess

ceramic material is trimmed with the coarse diamond disk to a

rough estimate of the desired restoration. The pattern surface is

coated consecutively with adhesive (Celetouch, Mikrona) for better

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control of the tracing procedure. The surface of the ceramic

restoration is perfected using a finishing diamond tool. When all of

pattern has been traced the milling process stops. After the fit to the

master die has been evaluated, the ceramic restoration is separated

from the ceramic blank.

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 Celay system

Inlay pattern mounted (copy side)

Copy milling pattern out of ceramic material (milling

side)

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ADVANTAGES OF CELAY TECHNIQUE: 82

1. Precise fit based on a simple and reproducible technique.

2. Chairside restorations fabricated in one-session.

3. Experienced dentist, technician or staff can mill inlay in 10 to 15

minutes and more complex onlay in 20 minutes.

4. A ceramic restoration can be developed without the need for a

laboratory technician.

DISADVANTAGES:

1. The pre-inlay fabrication is considered difficult, especially when

CELAY technique has to be used clinically.

2. A substantial investment is needed and little research is available

to compare with other systems and techniques.

CERAMATIC II --

With Ceramatic II (Askim Corp. Sweden) Scanning of the pro-

inlay is performed automatically. Rest of the system is same as that

of Celay system.

DFE EROSONIC (KRUPP, GERMANY) --

In DFE erosonic system restorations are made by ultrasonic erosion

(An erosion procedure generated by ultrasonic waves). As a first

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step, metallic negative moulds (sonotrodes) are produced of the

desired restoration, both form the occulsal as well as from the basal

direction. Both sonotrodes fitting exactly together in the equatorial

plane of intended restoration are guided onto a ceramic blank after

connecting to an ultrasonic generator under slight pressure. The

ceramic blank is surrounded by abrasive carbide, which are

accelerated by ultrasonics and thus erodes the restoration out of the

ceramic blank. High performance ceramics (for example Al 2O3 and

ZrO2) are very hard with diamonds; hence for this purpose

sonoerosion is much more suitable.

II) DIGITAL SYSTEM (CAD-CAM SYSTEMS)68,74,76,77,80

[Computer Aided Design- Computer Aided Manufacturing]

A digital system which may be used directly or indirectly for

making restorations involves three steps for restoration fabrication,

1) Three dimensional surface scanning

2) CAD-modeling of the restoration

3) Fabrication of the restoration

CAD-CAM IN DENTISTRY

A series of closely linked steps are required to make a fixed

dental prosthesis. After any preparation the dentist must take an

165
impression of the prepared tooth together with adjacent and

opposing teeth using elastic impression material. This impression is

used to obtain a hard stone model and the pattern of the crown or

inlay is carved. The actual cast restoration is obtained by using the

“lost wax method”.

Regardless of the advanced state of this 300 year old

technique information must still be transferred by hand from the

impression to the finished crown via a series of material, each of

which may incline error in the final casting. This system of casting

does not allow us to take advantage of tremendous advances in

computers and robotics. For these reason CAD-CAM techniques

were introduced to the dental profession in 1971.

In 1979, Heitlinger and Rodder, followed by Moermann and

Brandestini in 1980, began the application of CAD-CAM rather

than using the fundamental aspects to fabricate the restoration.The

first dental CAD-CAM prototype was presented at the Garanciere

conference (Grance) in 1983 and the first crown was publicly

milled and installed in a mouth without any laboratory involvement

in 1985. Though 1985 was a decisive year for computer aided

dentistry, there was still a long way to go.

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 The advent of interactive computer graphics, computer

aided design and computer aided manufacturing laid the

groundwork for a revolution in engineering design and production,

improving productivity and quality.

Dental CAD-CAM systems are being developed to

produce dental restorations. Restoration design, whether with the

lost wax casting technique or CAD-CAM system has three

functional components --

1) Data acquisition,

2) Restoration design,

3) Restoration fabrication.

With the CAD-CAM system data acquisition (all the steps

currently involved in taking an impression and with some system

creating the model and dies) can be automated. Design, currently

the waxing process, is replaced with computer commands supplied

either interactively by the user or by special programs called an

expert system.

Investing and casting technique can be replaced by faster

fabrication techniques used in modern manufacturing. Varied

technologies can accomplish the automation in the dental CAD-

CAM systems.

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CAD-CAM SYSTEMS

Different CAD-CAM systems are –

1] Duret

2] Procera

3] Cerec System

4] Celay

5] Denticad system

6] Dux System

7] Cicero system

8] LAVA system

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