ALL-CERAMIC

RESTORATIONS
Dr. Tamer Shokry
Professor of Fixed Prosthodontics
 Denture teeth
1774 Alexis Duchateau

first ceramic crowns and inlays with a platinum

1887 foil matrix technique (gas powdered furnace)
C. H. Land

The popularity of porcelain declined with

introduction of acrylic .
1940 increased wear, high permeability leading to
discoloration and leakage
 1962

Metal ceramic restorations Weinstein and Weinstein

Improvement done through using of vacuum firing which produced denser,

stronger, more translucent ceramic

Development of high strength ceramics

 Strength

esthetics
Composition of Dental Porcelain

1-The feldspars 70-90%

Mixtures of potassium aluminosilicate and sodium DENTAL
aluminosilicate.
The feldspar fuses when it melts, forming a glass matrix
PORCELAIN
(give translucency)
2-The quartz (silica) 11-18%.
Remains unchanged during the firing process and acts as
a strengthening agent
3-Kaolin 1- 10%.
Is a hydrated aluminum silicate (Al2O.2SiO2.2H2O) and
acts as a binder,
 Highly
esthetic

Bad Hard but

conductor brittle

Wear
resistant

ADVANTAGES OF DENTAL PORCELAIN

 mix the components, adds
additional metal oxides,
fuses them and then
quenches the molten mass
in water. The resultant
product is known as a frit,
and the process is known
as fritting.
•porcelain usually have flaws within it called Griffith
flaws
•The surface flaws act as sharp notches whose tips
may be as narrow as the spacing between several
atoms in the material.
• When the induced mechanical stress (tensile,
impact or shear) exceeds the actual strength the
material, the bonds at the notch tip break, forming a
Crack
  Microstructural classification

Glass based systems Glass based systems with

(mainly Silica) fillers, crystalline (Leucite
or high fusing glass )

Crystalline based
systems with glass fillers Polycrystalline solids
(mainly alumina) (alumina and zirconia)
Classification based on processing technique

Powder
/liquid

pressable 3D
Printing

CAD/CAM
Strengthening mechanisms of ceramics

1. Fabrication defects
2. Surface cracks
3. Crystalline reinforcement
4. Chemical strengthening
5. Stress induced transformation
6. Glazing
7. Prevention of stress corrosion
 Fabrication defects

1. Created during processing

2. Condensation by hand create voids in the ceramic which may be

considered as the initial crack site

3. Sintering under vacuum reduces the porosity in dental ceramics from 5.6 to

0.56 volume percent .

4. micro cracks develop within the ceramic upon cooling in leucite-

containing ceramics and are caused by thermal contraction mismatch

between the crystals and the glassy matrix

 Surface cracks

Surface cracks are induced by machining or grinding.

The average natural flaw size varies from 20 to 50 μm

 Crystalline reinforcement
introduction of a high proportion of crystalline phase into
the ceramic material to improve the resistance to crack
propagation
 The process of cooling to room temperature offers the

opportunity to take advantage of mismatches in coefficients of

thermal contraction of adjacent materials in the ceramic

structure.

 if the porcelain veneer contracts more than the metal coping or

framework, axial and hoop tensile stresses develop that can

cause cracking of the ceramic

 One method of introducing residual compressive stresses

within the ceramic is to choose veneering ceramics whose

thermal expansion or contraction coefficient is slightly less

than that of the core ceramic.

 Another procedure is to rapidly cool the prosthesis by removing the

prosthesis and cooling it on the benchtop rather than slowly cooling

the prosthesis in the furnace. It is especially useful for metal-ceramic

prostheses, since the thermal conductivity and diffusivity of metal

leads to increased compression in the veneer.

mismatch leaves the porcelain

adjacent to the metal in a state of

residual compression, which

effectively protects the metal-

ceramic restoration against fracture

of the veneering ceramic

 Chemical strengthening
(Ion exchange)

If a sodium-containing glass article is placed in a bath of

molten potassium nitrate, potassium ions in the bath
exchange places with some of the sodium ions in the surface
of the glass article and remain in place after cooling. Since
the potassium ion is about 35% larger than the sodium ion,
the diffusion of the potassium ion into the place formerly
occupied by the sodium ion creates residual compressive
stresses in the surface.
 Stress-Induced Transformation

Zirconia is monoclinic at room temperature and tetragonal between about

1170°C (≈2140°F) and 2370°C (≈4300°F). The transformation between
tetragonal and monoclinic zirconia is accompanied by an increase in
volume. The tetragonal form can be retained at room temperature by
addition of various oxides such as yttrium oxide. Stress can trigger the trans-
formation from tetragonal to monoclinic zirconia, thereby leading to
strengthening as a result of an increase in grain volume in the vicinity of the
crack tip
 Glazing

The principle is the formation of a low-expansion surface

layer formed at a high temperature. Upon cooling, the
low-expansion glaze places the surface of the ceramic
in compression and reduces the depth and width of
surface flaws
 Prevention of Stress Corrosion

Strength of ceramic is reduced in the moist environment

It is a chemical reaction between water and ceramic at the

tip of the ceramic causing increasing the crack size. This is
called stress corrosion or static fatigue.
Lost wax technique (Hot pressing)
CAD/CAM Technology
 Lithium Disilicate Glass Ceramics (EMAX)
• Lithium disilicate (LS2) glass-ceramic is ideally suitable for the
fabrication of monolithic restorations or veneered restorations.
• anterior and posterior region.
• Due to its natural-looking tooth colouring and excellent light-optical
properties, this material produces impressive results.
• press or CAD/CAM technology.
• high strength of 500 MPa* for IPS e.max lithium disilicate
Indications

• Veneers (≥ 0.3 mm)

• Inlays and onlays
• Occlusal veneers, partial crowns
• Minimally invasive crowns (≥ 1 mm)
• Implant superstructures
• Hybrid abutment solutions
• Three-unit bridges up to the second premolar as the terminal
abutment
 Glass infiltrated alumina ceramic (In-Ceram)

VITA IN-CERAM VITA IN-CERAM VITA IN-CERAM

SPINELL ALUMINA ZIRCONIA
• Alumina and • High strength, • Very high strength
magnesia matrix moderate and lower
• Most translucent, translucency translucency
moderate strength • Used for anterior • Used for three-unit
• Used for inlays , and posterior posterior fixed
onlays, veneers, crowns dental prosthesis
anterior crowns
CAD/CAM Technology
MATERIALS PROPERTIES
Regarding opposing teeth wear
-E-max causes the greatset wear than zirconia (highly polished
zirconia causes less wear) than Hybrid ceramics.
CERA.Smart causes no wear
 CLINICAL RECOMMENDATIONS AND USES

Product name Flexural Modulus of Clinical indications

Ceramic Type Manufacturer strength elasticity
“MPa” “GPa”

Feldspar VITABLOCS® , VITA 154 45 veneers, inlays, onlays, partial crowns,

Zahnfabrik: Mark I anterior and posterior crowns, as a
(1985) Mark II (1991) veneering CAD/CAM material for multi-
VITA TriLuxe (2003) unit bridge substructure made of oxide
VITA TriLuxe forte ceramic
(2007) VITA RealLife
(2010)

Leucite IPS Empress CAD, 160 62 veneers, inlays, onlays, partial crowns,
Ivoclar Vivadent anterior and posterior crowns
(2006) IPS Empress
CAD Multi
GC initial LRF
CLINICAL RECOMMENDATIONS AND USES
veneers, inlays, onlays, partial
crowns, anterior and posterior
crowns, 3-unit bridges (anterior
and premolar), hybrid
IPS e.max CAD,
abutments, hybrid abutment
Lithium-disilicate Ivoclar Vivadent 360±40 95
crowns; 3-unit posterior bridges,
(2006)
as a veneering CAD/CAM
material of multi-unit bridge
substructure made of IPS e.max
ZirCAD

-Celtra Duo, 370

Dentsply (2013) veneers, inlays, onlays, partial
70 crowns, anterior and posterior
Lithium-silicate
-VITA Suprinity® , 420 crowns, implant-supported
VITA Zahnfabrik crown
(2013)
 Vita In-Ceram® YZ,
VITA Zahnfabrik primary telescope crowns,
>900
(2002) anterior and posterior crowns, anterior and
posterior bridge (up to 2 pontics),
cantilever bridges
Lava Frame
Zirconia, 3M ESPE anterior and posterior crowns, splinted crowns up
>1100
(2001) to 4 units, implant abutments, crowns on implant
abutments, 3-unit inlay and onlay bridges,
Zirconia 210
cantilever bridges, anterior adhesive bridges, 3–4
unit bridges , long-span and curved bridges
900±50
IPS e.max ZirCAD, anterior and posterior crowns, primary telescope
Ivoclar Vivadent crowns, implant superstructures, 3-unit bridges
(2006 (anterior, premolar and posterior), multiple-unit
bridges, inlay bridge frameworks
 Lava Plus High >1100 anterior and posterior crowns,
Translucency splinted crowns up to 4 units, implant
Zirconia, 3M ESPE abutments, crowns on implant abutments,
(2012) primary crowns, 3-unit inlay and onlay
bridges, cantilever bridges, anterior
adhesive bridges, 3–4 unit bridges , long-
Cercon® ht True span and curved bridges
Color, Dentsply, 1200
Degudent (2015
anterior and posterior crowns,
primary telescope crowns,
Zenostar® Full multi-unit bridges
All Zirconia Contour Zirconia, 210
Wieland 1200±200
Dental/Ivoclar
Vivadent (2013) anterior and posterior crowns,
primary telescope crowns,
multi-unit bridges (as frameworks or full-
contour)
 Lava Ultimate 204 13 veneers, inlays, onlays
CAD/CAM
Restorative, 3M ESPE
(2011)

VITA Enamic® , VITA

Zahnfabrik (2013) 150-160 30 veneers, inlays, onlays
Vita Enamic® anterior and posterior crowns,
multiColor (2017) implant-supported crowns

Hybrid
CERASMART , GC 231 veneers, inlays, onlays
(2014) anterior and posterior crowns,
implant-supported crowns
DESIGN AND PARAMETERS

 Veneers:
DESIGN AND PARAMETERS

Materials to be used for veneers:

 Feldspar porcelain
 Leucite
 Lithium disilicate
 Lithium silicate
 Hybrids
DESIGN AND PARAMETERS

 Crowns:
DESIGNS AND PARAMETERS

Materials of selection:

 All except Lava Ultimate .

 DESIGNS AND PARAMETERS

 Endocrown:

Materials can be used:

- Lithium disilicate is the gold
standard
-
DESIGNS AND PARAMETERS

 Onlay, Inlay, Overlay:

- Materials of selection:
Feldspar porcelain
Leucite
Lithium disilicate
Lithium silicate
Hybrids
DESIGNS AND PARAMETERS

 Crowns on implant abutment:

Materials to be used:
- Zirconia
- lithium silicate
- Lava Frame Zirconia, 3M ESPE (2001)
- Hybrid: VITA Zahnfabrik (2013) & Vita Enamic® multiColor
(2017)CERASMART , GC (2014)
DESIGNS AND PARAMETERS

 Bridges:
Materials to be used for short span bridges:
- Lithium disilicate (up to 2nd premolar)
- Glass infiltrated Zirconia
- Zirconia (polycrystalline)

 Materials to be used for long span and cantilever bridges:

- Glass infiltrated Zirconia
- Zirconia (polycrystalline)
DESIGNS AND PARAMETERS

 Post & Core:

- lithium disilicate (not recommended). all trials have been failed. due
to fracture of the tooth
- Vita Enamic (Hybrids in General) (needs more evidance)
- PEEK can be used
NOTES FOR CLINICAL CONSIDERATIONS:

 Bilayered zirconia is not recommended to use with posterior bridges due to the
delamination od the veneering material “in case of occlusal veneering. “Monolithic
zirconia is the alternative”
 Bilayered zirconia used only for aesthetics “labial veneering only”.
 Emax crowns is not recommended fot BOPT, Highly polished zirconia is recommended.
“Due to the very low egde sterngth of the glass ceramics including lihium-disilicate
causing thin edge fracture with time”
Even in Central incisor cases which is exposed to Huge laterals foces reflected
cervically.
Bonded to dentind (resilient) which is deflected when exposed to forces causing
failure.
 In Delta stage Bruxers, Zirconia is not recommended but Hybrids are the choice as
they are chock absorbant.
 FACTORS AFFECTING MATERIAL SELECTION

 Aesthetic needs:
-Feldspathic porcelain
- Glass Ceramics.
- Bilayered zirconia.
 Functions needs: (premolar and molars)
- Crowns: “ Lithium di-silicate, Lithium silicate, zirconia infilterated Glass ceramics, Monolithic
Zirconia)
- Crowns on Implant:
- Tooth supported FPD: (Lithium disilicate “up to 2nd premolar as distal abutment” & Monolithic
zirconia)
- Long span Tooth supported FPD: Monolithic Zirconia
- Implant supported FP: Monolithic zirconia, lithium silicate , Lava Frame Zirconia, 3M ESPE (2001),
Hybrid: VITA Zahnfabrik (2013) & Vita Enamic® multiColor (2017)CERASMART , GC (2014)
 Deep bite ana parafunction: Hybrids
 Delta Bruxers: Hybrids