•ii

Gdrafd Ubassy

Shape and Color

The Key to Successful Ceramic Restorations

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 Shape and Color
The Key to Successful Ceramic Restorations

Gerald Ubassy
Dental technician , Avignon, France

Q
Quintessence Publishing Co, Inc
Chicago, Berlin, London, Sao Paulo, and Tokyo
Title of the Original French Edition:
Formes et couleurs - Les cl6s du succ6s en c ramique dentaire
^
© 1992 by Qumtessenz Verlags- GmbH. Berlin
© Editions CdP. Paris 1992.

For Landry

diiiVERSITY HF «11
? 993
JUL
'
DEIITAL Li'diiiiiiY

Library of Congress Cataloging-in-Publication Data

Q•O
i «
f}
.
Ubassy Gerald.
[Formen und Farben. English]
Shape and color : the key to successful ceramic restorations /
Gerald Ubassy.
p. cm.
Includes bibliographical references and index.
ISBN 0-86715 - 207-9
1. Dental ceramics. 2. Fillings (Dentistry) 3. Inlays
(Dentistry) 4. Dentistry - Aesthetics. I. Title.
.
[DNLM: 1. Dental Restoration Permanent. 2. Dental Porcelain.
.
3. Ceramics. 4. Estetics Dental. WU 190 U12f 1993a]
RK655, U2313 1993
617.6’95-dc20
DNLM/DLC
for Library of Congress 93-1039
CIP

quintc // cncc
book /

Copyright © 1993 by Quintessence Publishing Co. Inc.

Lithography: Toppan Printing Co., (H. K .) Ltd., Hong Kong

Typesetting, Printing, and Binding: Bosch- Druck, Landshut/Ergoldmg

ISBN 0 - 86715- 207- 9

 Contents

Preface 7
Acknowledgements 11
Foreword 13
:r-
r6 1 Basic Terms of the Phenomenon of Color 17
- Absorption and Reflection 18
v0
OQ - Light , Color, and Pigments in Dental Porcelain 18
- Additive and Subtractive Syntheses 20
r0 - The Language of Colors 20
0- - Simple and Complex Grays 23
ri
i 2 Relation of Personality, Facial Esthetics, and Dentolabial Esthetics 25
r
3 Colored Wax 31
c - Educational Advantages 32
S 7 - Psychological Advantages for Better Communication 33

4 Color Selection 41
- Breaking Down into Coats 42

5 The Three-Dimensional Shade Guide and Changing Luminosity of Colors 49

6 Instruments 51

7 Basic (Opaque) Porcelains 57

8 The Ceramic Shoulder 61

- Prerequisites for a Ceramic Shoulder 61
- Preparing the Die 61
- First Shoulder Porcelain Bake 61
- Second Shoulder Porcelain Bake 63

9 Artificial Gingiva 67
- Fabrication of Removable Artificial Gingiva 69

10 Processing and Natural Layering of Metal Ceramic 73

- Table of Firing Temperatures 88

5
Contents

11 Tricks to Make Porcelain Layering Easier 91

- Fabrication of a Multi-Span Fixed Partial Denture 91
- Fabrication of Anterior Fixed Partial Dentures 91
- Layering and Firing of the "Dentin" Core 91
- Density of Porcelain During Layering Procedure 94
- Another Trick: Grinding the Incisal Guidance 94

12 Lateral Segmentation and Enamel Cracks 97

- Restoration and Segmentation for Teeth of Older Patients 98
- Segments of Different Opacity 98
- Restoration and Segmentation for Teeth of Younger Patients 98
- Segmentation of Posterior Teeth 98
- Modeling Criteria for Porcelain of Superior Optic Quality 99
- Enamel Cracks 99

13 Transparency and Translucency 109

14 Original Colors in Dental Ceramics 115

15 Porcelain Inlays and Onlays 119

- General Criteria for Preparation of Ceramic Inlays and Onlays 119
- Preparing the Working Cast 121
- Thermal Processing of the Investment 122
- Modeling of a Medium-Sized Inlay 123
- Modeling of Smaller Inlays 128
- Modeling of Large Onlays 128
- Removal of the Investment 131
- Natural-Appearing Fissures 135

16 Leucite-Reinforced Ceramic 141

- IPS Empress: A New Technology in Dental Ceramics
(contributed by Gerhard Beham) 141
- The Material 143
- Working Procedures 150
- Pressing Technique 152
- The IPS Die Material in Dentin Colors 153

17 Post and Core in Ceramics 179

- Fabrication of a Porcelain Post and Core 180

18 Facial Veneers 185

- The Empress Method for Porcelain Facial Veneers 188

19 Analysis of the Surface Structure - Polishing 197

- Observation and Application of Information 197

References 213
Index 215

6
Preface

The development of new techniques and character of the patient . Artificial teeth should
materials enables the contemporary dental definitely reflect all these parameters and
technician to satisfy even those patients who include the finest detail regarding shape and
are particularly concerned about the esthetics microshape as a contribution to perfect
of their teeth. Because of this legitimate integration of dental restorations.
expectation, our profession must keep con- It is obvious that periodontal conditions as
sistently informed and must exchange infor - well as functional aspects must be con-
mation. Thus the basic thought that kept me sidered while striving for form, color, and
motivated while completing this textbook was esthetics because they stand for long-lasting
the strong desire for "communication” - a success.
keyword and characteristic of a progressive Consequently, I envisage an ideal where a
profession. dental restoration is not only represented by
This book is dedicated especially to those its name and function but even more so by
technicians who apply our methods in prac- its appearance.
tice. Clinical aspects are part of every chapter None of this can be accomplished, how-
in order to imbue the described methods ever, without close collaboration on the con-
with necessary pertinence and reliability. cept and the goal, or without excellent inter -
Another keyword of our book is observa- personal contact between dentist and dental
tion, which is the basis of my work , and technician.
nature as a most important “ keyhole." This book is highly illustrated because dia-
The study of shapes and microshapes and grams and photographs represent the best
how they interact with color is the guideline of explanation for many techniques.
this book. These studies are of utmost impor - Finally, I admonish the reader to remember
tance to me. that all results should be questioned over and
On the other hand, I abolished concepts over if we are to progress beyond our current
that are all- too- rigid and that merely stereo- possibilities and knowledge.
type artificial teeth. This influenced me to take
into consideration characteristics such as
gender, personality, morphology, and the Gerald Ubassy

7
Preliminaries

8
Preliminaries

9
Preliminaries

10
Acknowledgments

Completion of this book demanded many to my friend Herbert Frick for the technical
hours of work as well as moral and technical help and attention they contributed.
support . My gratitude to all my customers with
I am most pleased to have the opportunity whom I have developed strong professional
to thank all those who contributed to the as well as extraordinary personal relations.
publication of this book. Skillful work of superb quality cannot be
First of all I thank my wife, Helen, who has performed with an adequate laboratory
always been a constructive critic owing to her team; here I must mention my friends and
patience and sensitivity as well as her natural colleagues: Jean- Marie Milesi and Jean-
sense for esthetics; her technical assistance Frangois Zalejski, both devoted and out-
during preparation of the manuscript was standing dental technicians.
always appreciated. The acknowledgments would be incomplete
I thank Andre Moreau , who teaches at the without thanks to the publishers Quintessence
School of Dental Technology, Montpellier, and H .W. Haase for the confidence they
who was able to impart his knowledge and showed by encouraging me to write this
his devotion to us, his students. book.
Special thanks to Ivoclar and in particular

11
Foreword

In recent years there has been no shortage

of publications dealing with dental ceramics.
The indisputable superiority of this biomaterial
over any other cosmetic material, and the
most recent developments in this field of
metal ceramic restorations without metal sub-
structures, have influenced clinical researchers
as well as dental technicians to strive for
a realistic, even artistic use of dental
ceramics.
In their books, however, ceramists often
tend to describe modeling methods or their
build-up technique without communicating a
clear or comprehensive view to the reader
about this subject.
If we try to mimic nature from now on -
without the claim to do it even better but
ambitious nevertheless to achieve equal
results - there is only one rule to follow:
observation. And if there were only one term
to keep in mind after reading Gerald Ubassy’s
book , this would be the one.
In the sun- and light -dominated region of
Provence where Ubassy was born, he devel- Oil painting by Bernard Touati.
oped powers of observation that deserve
more than just attention: modesty and pa-
tience.
Natural teeth vary greatly in color and
shape. They reveal ample information about tion of adjacent soft tissues. Eventually, in his
the background and personality of our pa- honest ways, he merely hands over the keys
tients. for success.
Modern dental ceramics also demand in- Rarely has there been a book about dental
terest in the individual as technical know-how, ceramics so complete without being super -
and Ubassy makes it obvious in his book . He ficial: it covers how to polish ceramic, create
clearly explains in a sensitive way how to treat fissures, fabricate working casts in the
each patient individually in order to observe laboratory. All that is apparently of sub-
and understand precisely the means of color, ordinate significance is marvelous. Without
its value, texture of surfaces, and the condi- exaggerating, no compromise in creating a

13
Foreword

restoration will be necessary if thorough convincingly the necessary laboratory pro-

observation is the guideline. cedures like Ubassy ' s.
A dental ceramist will only mature, if he or There is no doubt about it : Ubassy shines
she respects details and strives for perfec - in every chapter of this book . His inborn
tion. Every illustration in this book gives sense for adaptation and his enthusiasm
evidence of the methodical quest for natural- for the new provide his work with some of
ness and beauty. Ubassy depicts vividly new the highest esthetic qualities I have ever
fields such as ceramic inlays and onlays and feasted my eyes on. And sometimes it seems
leucite-reinforced all-ceramic crowns. These to me as if I were contemplating a beautiful
resin- retained restorations introduce new and picture . . .
seemingly successful solutions in prosthodon-
tics. Few books can describe so vividly and Bernard Touati

14
 Foreword

Several illustrations are included in this book the same time. Pietro, in his own brilliant
that have nothing to do with our profession. ways, is capable of playing with shape and
These pictures have been created with the color. But most of all I believe that with these
assistence of computers. computer drawings he indicates a strong and
Let me now introduce Pietro Migliaccio, the miraculous connection between art and tech-
artist who created such artistic work that is nology if it is performed with like perfection.
surrealistic, baroque, and abstract - all at

15
1 Basic Terms of the Phenomenon of Color

In 1676, the physicist Isaac Newton performed Color Wavelength No. of

an experiment that showed that a single ray oscillations
of white light can be broken up into the colors
of the spectrum when made to pass through Red 800 - 650 mu 400 - 470 trillion
a crystal prism. This spectrum includes all Orange 640 - 590 mu 470 - 520 trillion
basic colors except purple. Newton performed Yellow 580 - 550 mu 520 - 590 trillion
the experiment as follows (Fig 1-1): a ray of Green 530 - 490 mu 590 - 650 trillion
light passing through an aperture strikes Blue 480 - 460 mu 650 - 700 trillion
the prism. The “ white” light, now passing Indigo 450 - 440 mu 700 - 760 trillion
through the prism, is separated into the colors Violet 430 - 390 mu 760 - 800 trillion
of the spectrum. These bands of colors can
be projected on a screen, thereby creating a
spectrum too. The spectrum spreads uninter-
ruptedly from red through orange, yellow,
green, and blue to violet. If the separated The ratio of oscillation from red to violet
bands of color are further collected through is approximately 1 : 2, similar to that of an
a lens, this addition process will result in octave. Every spectral color is specified by
" white” light on a second screen. Thus, the wavelength and the number of oscillations.
spectrum is a result of refraction of light. Lightwaves are colorless; color is created in
Colors originate from lightwaves, which our eyes and brains.
represent a specific type of electromagnetic The physicist Young later performed New-
energy. The human eye can only perceive ton’s experiment conversely. Whereas New-
light ranging from 400 to 700 mu. Wave- ton broke up light into its spectral colors
lengths are measured in microns: using a crystal prism, Young put them
- 1 micron = 1 p = 1/1,000 mm together again. He made the separated rays
- 1 millimicron = 1 mji = 1/1,000,000 mm of light converge and so regained the “ white”
Wavelengths of the spectral colors and the light.
number of oscillations per second are: In order to understand this physical
phenomenon (ie, the fact that several bright
colors, which sometimes become darker by
mixing, result in a lighter color) we must
remember that all these colors are fractions
of “ white” light; colors that are generated by
rays of light that merely reproduce the effects
of light. That means if we combine one so-
called light-mixture or light-color with another,
the result will be a more intense and lighter
color. The sum of the combination green, and

17
 Basic Terms of the Phenomenon of Color

red must consequently yield a lighter color - colors: blue, red, and green. Some of these
yellow in this case. objects reflect all of the light they receive,
In addition, Young proved something whereas others absorb it totally or almost
significant regarding our studies: while ex- totally. But most of them absorb partially and
perimenting with his color lanterns, he found reflect the rest. Thus the natural law is:
out by elimination that the spectral colors for - Opaque objects that are exposed to light
the same spectrum can be reduced to three reflect all or a certain part of the light they
basic colors. We can "reconstruct ” “ white” receive.
light by combining the colors red, green, and As yet it is not fully understood why we
blue (Fig 1-2). He mixed two out of the three perceive color and relate to a particular one
and the result was the other three: blue, pur- as, eg, red. Why are tomatoes red? What we
ple or magenta, and yellow. All in all he know is that if light strikes this tomato it
specified primary and secondary colors of receives all three primary colors: blue, green,
the spectrum: and red (Fig 1-3, C).
Even the page you are reading right now
• Primary
Red
O
spectral colors: absorbs these three invisible colors of light
(blue, green, and red), and the way the paper
o Green receives the light colors are returned. The
o Blue object reflects the colors and the sum of
all three is white, the color of the paper
• (Secondary spectral colors:
mixing of two primary colors)
(Fig 1-3, A ).
If the object struck by light is a pot of India
o blue light + green light = cyan (1) ink, the exact opposite will happen: the three
o red light + blue light = purple (2) primary colors strike the pot but will be fully
O green light + red light = yellow absorbed, thus leaving the object unchang-
ed; it appears black to us (Fig 1-3, B).
(1) Cyan: technical term for that secondary If light strikes a banana, again the three
color. The hue of cyan is identical with a primary colors are received. The banana ab-
neutral blue of medium intensity. sorbs the blue and reflects the green and red
(2) Purple: or magenta is identical with a components. Red and green combined
carmine of medium hue. yields yellow (Fig 1-3, D). Take a plum: it
The previous classification of spectral colors absorbs green and reflects red and blue,
enables us to specify those colors that are giving the plum its purple appearance
complementary to certain other spectral col- (Fig 1-3, E).
ors. The secondary colors lack only one
primary color to appear as complementary
color and to recompose the " white" light Light, Color, and Pigments
(and vice versa). in Dental Porcelain
l

• Complementary colors:
o Yellow is complementary to indigo
We are just about to delve into dental
ceramics. This material consists of colored
\ o Cyan is complementary to red powder and pigments with which we try to
o Purple is complementary to green imitate the phenomena of light and color
previously explained. We will learn to under-
stand the way color acts to enable this imita-
Absorption and Reflection tion.
We have seen that light, while “coloring"
Imagine: all that surrounds you, every object objects exposed to its influence, uses three
you can see, is receiving the three primary colors - bright and dark ones. Mixing of two

18
 Light, Color, and Pigments in Dental Porcelain

Fig 1-1 Light is broken up into the

colors of the spectrum when it is
passed through a prism. (A) sun-
light, (B) lenses, (C) prism, (D) with-
out prism, ( E) with prism, (F) spec-
trum.

Fig 1-2 Primary colors of the spec-

trum. Synthesis through addition.
Overlapping of all three recomposes
the “ white” light.

)
i *

Fig 1-3 Absorption and reflection.

Opaque objects that are exposed to
light reflect all or a certain part of the
light they receive.

19
Basic Terms of the Phenomenon of Color

produces another three, lighter colors, and describe the entire polyehromy of colors in a
finally mixing all colors together recomposes diagram (Fig 1-5).
the “ white” light. As far as we are concerned, Below is the classification of primary,
however, we cannot “ paint ” with light. secondary, and tertiary pigments:
In the field of dental ceramics it is not
possible to obtain lighter colors by means of • Primary
OCyan
pigments:
mixing darker colors as is done in painting. o Purple (magenta)
o Yellow
Primary colors are those that cannot be
produced by mixing others; they are the
Additive and Subtractive original colors that can be combined to make
Syntheses all the other colors of nature.

When painting pictures we learn that com- • Secondary

O
pigments:
Orange red
-
binations of colors change depending on
O Green
what has been omitted from light , ie, we
always work from lighter colors to darker
o Indigo
colors. For instance, if you mix red and green These secondary colors can be obtained
you obtain the darker color brown. And if you by mixing the above-mentioned primary
mix cyan with purple and yellow (three very colors according to Fig 1-4.
bright colors) you will get black. This is If we mix secondary and primary colors, a
precisely the reverse to the combination of different, darker tone will be obtained,
spectral colors. representing a tertiary color, and so forth. In
Thus, when light “paints" an object it is this way we can produce innumerable
adding light rays of different colors: the colors nuances, all deriving from the primary pig-
are produced by addition or additive syn- ments (cyan, purple or magenta, and yellow).
thesis.
When we work with colors in dental
ceramics, we subtract light; we obtain these
colors by means of subtraction or subtractive The Language of Colors
synthesis.
How does light “ paint ” (Fig 1-2)?: Conveying information about what we see is
- Additive synthesis: to produce the an intricate process because the human
secondary color yellow, red and green visual system depends on interpretation.
are mixed: such mixture yields a lighter If we describe an object by means of two
color, a brighter light. Yellow represents of its characteristics, in this case shape and
the sum or additive synthesis of red and color, the object may appear to be relatively
green. simple when we talk about tangible dimen-
How do pigments “ paint " (Fig 1-4)?: sions such as height, length, and width.
- Subtractive synthesis: to produce the However, for most of us it will prove a very
secondary color green, we have to mix difficult task to describe an object ’s exact
cyan and yellow. Regarding spectral color, because it has never occurred to many
colors, blue absorbs red and yellow of us that color, too, is a three-dimensional
absorbs blue. The only color that reflects phenomenon. Therefore, remarks like “darken
both of them is green, which is therefore with yellow ” or “gently lighten” apparently
subtracted out from blue and red. give evidence of how little is known about this
After having investigated provenance and phenomenon.
origin of colors we are in possession of a Anyone wanting to work intelligently with
fundamental knowledge that enables us to dental ceramics must know about the dimen-

20
 The Language of Colors

Fig 1-4 When working with colors

we subtract from light and we obtain
these colors by means of subtraction
or subtractive synthesis. Mixing of
the three primary colors in a certain
ratio produces black.

Fig 1-5 Polychromy of colors that

are classified in primary (or basic),
secondary, and tertiary.

sions of colors. Otherwise he or she will be ball (Fig 1-6). The three dimensions of color
entangled in an awkward system of trial- are hue, brilliance (value), and saturation
and-error while attempting to find the ap- (chroma).
propriate color match. - Hue is the quality that distinguishes one
Albert Henri Munsell’s contribution to the family of colors from another, eg, red from
understanding of colors is relatively recent. It yellow or green from blue. If we say, for
was in 1915 when his Atlas of the Munsell instance, that a tooth looks yellow or
Color System was published. He describes orange, we are describing its hue.
color as a three-dimensional phenomenon - Value or brilliance is the quality by which
and compares it to the body of an ashlar. we distinguish a light color from a dark
Whereas all colors in this atlas are arranged one. It is represented by the achromatic
in subsequent order, the three-dimensional axis in the center of Munsell’s cylinder,
model is similar to the shape of an irregular where white is at the top and black at the

21
Basic Terms of the Phenomenon of Color

Fig 1-6 Three-dimensional classifi-

cation of colors by Henri Munsell.

bottom (Fig 1-6). There is a scale of grays too dominant, the result will inevitably appear
ranging gradually from black to white and artificial. There is a simple method to alter (ie,
thus connecting the two extremes. Black decrease) the brilliance of ceramic without
has zero brilliance whereas white shows coloring the surface. This method will be
maximum brilliance. discussed later (chapter 5: “The three-dimen-
- Chroma or saturation is the quality by sional shade guide and changing brilliance
which we distinguish a strong color from of colors”). Conversely, if the hue is correct
a weak one. For example: one tooth may while brilliance is low, the restoration will
look more yellow or orange than another. appear gray.
It is so difficult to describe color strictly Artificial teeth should be produced more
visually that dictionaries are filled with hun- realistically after the model, including all
dreds of names of colors all meant to depict distinctions concerning hue and saturation of
objects. Some of these names are more, colors. If, for instance, canines are compared
others less, familiar. The expression a “green to the rest of the dentition they may show a
apple” may act as a graphic example, but different hue and more chroma. Because of
everyone has a different idea what this is reasons mentioned above, colors of differing
supposed to mean. brilliance should not be selected.
To specify color it would be more precise Few objects show as much visual differen-
to refer to a tone that we use as standard. tiation as human teeth. It would be a serious
The discrepancies can then be described by error to focus solely on the hue even though
means of hue, brilliance, and saturation in “hue" and “color ” are virtually on equal
accordance to the Munsell system (Fig 1-6). terms. What we should try to imitate is the
Brilliance is the most important of the three appearance of a tooth that is the sum of all
dimensions of color. If the hue of a restoration its visual dimensions. For example: a piece
matches the adjacent teeth but its brilliance is of wood and a piece of glass may be of

22
 Simple and Complex Grays

Fig 1-7 The composed gray in the

center has been created by mixing
the three primary colors.

identical color and still look completely dif- posed grays are a combination of primary
ferent. The degree of translucency of a dental colors of which every component absorbs a
material is doubtless equally significant. particular part of the spectrum (Fig 1-7). The
Human teeth are characterized by degrees of difference, for instance, is the fact that the
translucency. The characteristic of a human composed grays can show a considerable
tooth is mainly designated by its translucen- degree of translucency while the color pig-
cy; light penetrates the tooth and vanishes in ments are largely scattered in a transparent
the oral cavity. This is precisely the reason core. Simple grays, on the other hand, are
that makes the subject of “color " so com- inevitably opaque; there is no such thing as
plicated in dentistry. Therefore, provided a transparent white color pigment. Staining
color is used in relation to translucent objects, colors in (dental) ceramics are mostly similar
we may use four dimensions as definition: to coloring matter. All objects can be colored
hue, saturation, brilliance, and the degree of with any color except for white. Therefore, a
translucency (see chapter 13: “ Transparency simple gray will never be used for the adapta-
/
and Translucency ”). tion of brilliance, particularly not on the
surface of a translucent object , unless a
“ painted” object is the desired result .
Simple and Complex Grays It seems imperative that every dental
ceramist have some basic knowledge about
If we relate to gray as pigmentation and not color before working with colors in dental
the degree of translucency, we will notice ceramics. Furthermore, this basic knowledge
there are two kinds of grays: simple ones and will ensure improved ways of communication
composed ones. Simple grays contain black between the dentist and the dental techni-
and white color pigments, whereas the com- cian.

23
2 Relation of Personality, Facial Esthetics, and
Dentolabial Esthetics

It is incomprehensible that an extensive one must briefly study different personalities

esthetic reconstruction of anterior teeth could and temperaments.
be fabricated without the ceramist ever know- We are constantly striving to have access
ing the gender or age of the patient or with- to maximum information; this may mean work-
out even having seen the patient before. ing from esthetic “schemes” of sets of teeth ,
Hence it is also improper to shape and ar- as it used to be a few years ago. It can also
range teeth identically for each and every mean using photographs, eg, an older pic-
patient. Frequently people can be seen in ture of the patient ’s smile, a current photo-
everyday life or on television with artificial graph of the patient ’s face, even extracted
teeth that do not match their personality. One teeth or old provisional restorations that
of the major misconceptions in our profes- simulate exactly the final shape of the plan-
sion is that a certain technological quality ned restoration.
standard of a restoration suffices. There is a The most desirable information, of course,
strong interaction between all aspects of comes from seeing the patient and having a
esthetics, particularly concerning personal talk about his or her expectations
and the professional ’s possibilities.
- Personality
- Esthetics of facial structures
The following pictures illustrate successful
restorative solutions that embody a harmonic
- Dentolabial esthetics balance between personality, facial esthetics,
Hence, before one reconstructs a smile, and dentolabial esthetics.

25
Relation of Personality, Facial Esthetics, and Dentolabial Esthetics

Figs 2-1 and 2-2 A 13 - year-old boy who still has a mixed dentition. But the relation between his personality, his
facial esthetics, and his teeth is already showing. Note the irregular surface texture of his teeth.

26
 Relation of Personality, Facial Esthetics, and Dentolabial Esthetics

Figs 2-3 and 2- 4 This patient ' s smile and her personality are in harmonic balance. Note that the smile is esthetic
although the teeth are not aligned as regularly as piano keys; they show slight differences in position and variations
in color.

27
Relation of Personality, Facial Esthetics, and Dentolabial Esthetics

Figs 2-5 and 2-6 A smile that is conspicuous by its distinct tooth shape makes a strong personality recognizable.
This pretty smile is in harmony with the face.

28
 Relation of Personality, Facial Esthetics, and Dentolabial Esthetics

IW * + t

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Fig 2-7 The visible line of incisal i "

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edges contributes significantly to a i !
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harmonic balance of a face. Nothing ! •!
'
i

appears stern or rigid. Teeth 11 and >! *

12 have been restored with all-
ceramic crowns (Empress system).

Fig 2-8 We must learn to observe

teeth in each and every position.
Side views are important for study-
ing tooth shape and tooth axis.

Fig 2-9 Lips are one of the major

criteria of personality. Complete
rehabilitation of anterior regions
involves consideration about the ba-
lance between projection of the
teeth and lip support.

29
 TOOTH SHAPE

SURFACE STRUCTURE
ESTHETIC SUCCESS
(microshape and glaze)

COLOR OF TEETH

30
3 Colored Wax

A smile - an esthetic smile - can only be our sight at the cost of detail and dimension
reconstructed successfully if thorough studies (Fig 3-1).
on wax models are used as a first step. Ivory-colored wax contrasts with dark wax
The use of dark red, green, or blue wax is to more suitably show contour, but too much
common practice in many dental laboratories. reflection of the light-colored wax is detrimen-
If the wax differs in color from the working tal for detail perception. Studies about the
model and contrasts seemingly better with esthetics of a person’s smile show less depth
the lighter cast, however, perception of shape and seem to present only a two- dimensional
and its dimensions appears to be inaccurate. image - not three- dimensional - as in a model
Absorption of light by dark objects reduces of a three- dimensional space (Fig 3- 2).

Fig 3-1 The visual perception of

colors and its dimension is quite
inaccurate if dark-colored wax is
used. The absorption of light by dark
objects reduces our visual abilities at
the cost of details and real dimen-
sion of these objects.

31
Colored Wax

Fig 3-2 Ivory-colored wax con-

trasts with dark wax more suitably to
show contour, but too much reflec-
tion of the light-colored wax is
detrimental for detail perception: the
objects appear “ flat.” The ivory-col -
ored wax models have been fabri-
cated by Jean- Marie Milesi.

Using colored wax enables us to reproduce seems to me crucial. The similarities of the
the shades of natural teeth and eliminate the colors of wax and those of natural teeth im-
lack of perception by adding the three- prove the dental technician’s knowledge
dimensional aspect. So the uniformity of the about color and make vividly clear how color
shades of a monochromatic, ivory-colored and shape interact. For the build-up of
wax is split (Figs 3-3 and 3- 4). posterior teeth , colored wax is equally useful;
Two advantages - educational and psycho- three- dimensional occlusal concepts are
logical - seem to favor the use of colored wax easier to grasp (Fig 3 -5). The first attempts
models. will presumably take longer compared to
working with wax of one color, but this dif -
ference will be quickly erased. With due con-
Educational Advantages centration it is relatively easy to apply the wax
layers step by step and not in just one ap-
The making of colored wax models can be plication.
coupled with step- by-step build-up of the Just as we can study interaction of reflected
ceramic, thus generating interest in studying rays of light , we can also study different sur -
and valuing color properly. Using wax face structures. This knowledge is particularly
models, it is possible to imitate desired effects important because a carefully structured sur-
and correct them without difficulty, making face and its microgeography play an impor -
the fabrication of the final restoration easier tant role with regard to integration of the
for the future ceramist. restoration in the patient 's mouth.
The build-up of artificial teeth can be
studied methodically without being hindered
by constant humidity as a precondition or the
experience of undesirable shifts of the
ceramic layers. To include the use of colored
wax into the training of dental technicians

32
r Psychological Advantages for Better Communication

Figs 3-3 and 3- 4 Using colored wax enables us to reproduce the shades of natural teeth and overcome the lack
of perception by adding a three- dimensional aspect , ie, volume.

Psychological Advantages
for Better Communication

Use of colored wax models ensures improved

communication between dental laboratory,
dentist, and patient. There is nothing worse
than having to refabricate a restoration
because of errors in shape, color, and other
characteristics. In the case of repeated fir-
ings, liveliness and individuality are lost , as is
motivation.
Under such difficulties it is more important Fig 3-5 For the build-up of posterior teeth, colored
to thoroughly study shape and characteristics wax is equally useful; three- dimensional occlusal con-
cepts are easier to grasp.
using colored wax before ceramic work takes
place (Figs 3-6 to 3-9).
Try-ins with provisional restorations - all
made of colored wax - are of great psycho-
logical significance. They give the patient an
idea of what the final restoration will look like
(Figs 3-10 and 3-11). In this try-in phase, lems of characterization and form, can fully
modifications are still possible and can be concentrate on the process of fabrication and
easily done. This saves a lot of back and forth avoid time-consuming tries during the ceramic
between the dentist and the laboratory. build-up process (Fig 3-12).
Studies of the wax model beforehand can Colored wax provides a three-dimensional
provide a solid basis for the final restoration. approach to dental anatomy and, at the
The ceramist , having already solved prob- same time, clearly shows the relation between

33
Colored Wax

Figs 3-6 to 3-9 The use of colored wax supplies psychological advantages in communication between dental
laboratory, dentist , and patient. Colored wax is essential to the study of tooth shape and characteristics.

34
 Psychological Advantages for Better Communication

Figs 3-10 and 3-11 Try-ins of provisional restorations - all made of colored wax - with evaluation made while the
restorations are placed inside the patient ’s mouth are of great psychological value. The patient then gets an idea
of what the final restoration will look like.

Fig 3-12 Studies made before-

hand with colored wax enable the
ceramist to concentrate entirely on
the ceramic during the build-up
stage. Being free from thoughts
about shape and characteristics, he
can avoid awkward first attempts.
Teeth 11, 12 , 13, 21, 22, and 23 have
been restored with metal ceramic
crowns. (Clinical dentistry by Dr
Daniel Gleyzolle, Avignon, France).

35
 Colored Wax

p Fig 3-13 ( left ) Wax -up of a central

maxillary incisor with colored wax.
The first layer, being orange, pro-
duces a “ warm" impression from
underneath.

Fig 3-14 ( right ) For the wax-up the

material is of the color of dentin.

Figs 3-15 and 3-16 Orange-brown

effects are added beneath the
enamel layer in order to emphasize
the infiltration of dentin. The proximal
portions are built up using a transpa -
rent blue wax.

36
 Psychological Advantages for Better Communication

Fig 3 -17 (left ) Opalescent effects

are applied.

Fig 3-18 ( right ) The tooth is wholly

covered with a thin layer of trans-
parent wax onto which an incisal
wax is then applied.

Fig 3 -19 (left ) Minor effects can be

created with metal oxides.

Fig 3-20 (right) The crown wax- up

is finished. The making of colored
wax models can be coupled with
incremental build-up of the porcelain.
This is definitely an educational
advantage, making the ceramic stu -
dent ’ s work somewhat easier.

37
 1
Colored Wax

Figs 3- 21 to 3-27 Wax-up procedure for a molar. The same method was used as described for the central incisor.
The wax must be sufficiently hard to preserve the occlusal contacts.

color and shape (Figs 3 -13 to 3-30). Aside the ceramist . A few reusable types of wax
from offering numerous psychological and can form a comprehensive palette. If you
educational advantages, this particular ma- cannot afford the time to do this by yourself ,
terial and technique can also represent a quality products are commercially available
source of satisfaction as well as motivation for and can be purchased from dental suppliers.

38
 Psychological Advantages for Better Communication

Figs 3- 28 to 3 - 30 A study of the

esthetics of veneers, produced with
colored wax. The veneer has been
slightly overcontoured in order to
correct malalignment .

39
40
 I
;

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:

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S.;:
i: :
4 Color Selection
5
t ;
; ••

i i
S 1
t i \

Determining the shading of teeth is an intricate daybreak the sky is reddish, in the evening
process. Any shade selection made by the and during the day it has a more blue hue. :

dentist is usually unreliable from our point of On top of that , you will find it impossible to .!
view, hence we do this step largely by our- have an identically colored sky every day.
selves. We think this is an adequate approach Inside the laboratory, conditions for shade
and should be pursued. It is equally as im- selection must always be identical . The walls
portant for the ceramist to determine the and working station should be just one
color match as to check the placement of the neutral color (gray) (Fig 4-1) .
restoration in the patient’s mouth. Moreover, the patient should not wear
In the laboratory, shade selection is always brightly colored clothes in close proximity to
made under the same source of light (eg, by his or her teeth. Women should remove any !;
Gamain, Paris) * Daylight is kept out using lipstick because this, too, can negatively
blinds. Always using the same source of light affect the result (Fig 4-2) .
is most important. Daylight is too irregular; at To select the suitable color, the entire range

* “ Daylight” emanating from a

ceiling lamp. Models 1865 and
1765, by Gamain (Paris) . Color
temperature: 6,500 K .
°

Fig 4-1 The color of a tooth should

always be selected in an identical
surrounding. Daylight should be
kept out and a lamp like those made
by Gamain (Paris) should be used.
WT i :-

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Fig 4-2 All colors deemed too
bright can falsify the final result and
I
;ii must be removed: in this case, lip- 5

stick.
:
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:ft il
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I : Fig 4-3 For color selection, all

:
I available shades of a ceramic shade
guide system must be used. :
•

•:

I i
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=:
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ill
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i-i :'
of ceramic hues will be used (Fig 4-3). First Breaking Down into Coats i::
* we must choose the color group this tooth
l!a : belongs to (yellow, yellowish-brown, etc)
(Fig 4-4) . Because prefabricated colors rarely First , the basic porcelain (opaque) must be
f ! match exactly those of a natural tooth you chosen using a shade guide. The opaque
II *
! I should settle for the closest one (Fig 4-5) . It is porcelain is supposed to determine the color v
d ;

;
s therefore generally necessary to “create” a of the future restoration; metaphorically speak- i
:
:
:
;
; color (or “shade”). For that purpose the color ing, it is the “ basis” of our canvas. The color j*

must be broken down. of the opaque material should be more I

ii
;
saturated than the color of the final restora- a
ii.

!
tion. You can hold a color sample next to the %
ii

tooth in question if necessary. Even at this I

early stage you can control the final shade of •
ii
i:! I
i-i !
!
= •; i
: 42
iji
 Breaking Down into Coats

i .
i

Fig 4-4 The first step is to determine

i •
the color group the tooth belongs
with. ;

;
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:

Fig 4-5 The color that is the closest i

match to the natural teeth will
be selected. However, this rarely
represents the right color.

i
i
:

a restoration by choosing a different opaque to create a small custom shade guide for
(Fig 4-6). instant checks.
For instance, if the chosen color lacks brown
J The selected dentin color should always be
you can simply use an opaque porcelain that slightly more saturated because the build-up
has more brown. After the opaque has been procedure progresses from saturated hues to
selected, the dentin porcelain is specified in less-saturated ones, and a nonsaturated den-
the same way. Numerous kinds of dentin tin always overlies the dentin porcelain. !f you
porcelains are available - quite original den- do not use a saturated color as the first coat ,
tin colors as well as those of different color the final color of the restored tooth will in-
saturation (eg, dentin colors by Maverick). If evitably be too light (Fig 4-7) .
there is no suitable dentin color, you can pro- For teeth with transparent incisal edges
duce mixtures to obtain more subtle results. the transparent porcelain must be selected
! : ••
.
Dentin porcelain gained that way is then fired accurately (Fig 4-8). A comprehensive palette

43
 Color Selection

Fig 4-6 If the color the shade

guide offers does not accurately
match that of the natural tooth, we
have to proceed by dividing the
tooth's surface into different regions
regarding color. The opaque basic
color should be selected next. In
this case the opaque matches only
the cervical region. The color of
the opaque must always be more
saturated than that of the completed !
restoration .
;
::
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=:

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iv
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Fig 4-7 Selection of the dentin
color. Frequently it will be necessary
I to use more than one color
*
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a
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Ti
. Vi

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1 i; and translucent porcelain. The trans-
*Is iik :
parent porcelain is barely visible.
I&
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44
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 Breaking Down into Coats

RSI
ea&

Fig 4-9 A “ blinder ” of neutral gray is used to separate

the tooth from its surrounding, hence no nearby color
can interfere with our judgment.

of transparent and translucent materia! quantify. Color selection is done not only for
should be used. Currently there is not only a the labial surface but also for the lingual
range of gray hues available; instead, we are surface (Fig 4-13).
looking at a number of nine transparent and At times we must take color brilliance of
translucent materials, all of them moderately teeth into consideration. In order to reduce
colored. Registration of all minor effects of a the luminosity, a more gray opaque can be
tooth’s incisal edge must be perfect. The chosen and a transparent gray used as a
incisal third of anterior teeth is the most last coat. This diminishes color brilliance
complex and difficult part to reconstruct. All (see chapter 5 : " The Three- Dimensional
colors are subtly nuanced and distributed. Shade Guide and Changing Luminosity of
Here again Maverick ’s unsaturated dentin Colors”) .
porcelains are of great help. Having determined all parameters of color;
When selecting the color for anterior teeth, we must never forget to record the surface
we use a small “ blinder.” This is a piece of structure of teeth that are to be restored. For
neutral gray cardboard that has a cut- out in this purpose the surface is cleaned with a
the centers about the size of a maxillary or paper tissue to remove saliva (Fig 4-14). Then
mandibular central incisor. This blinder is characteristics in structure and the degree of
held in front of the tooth to be restored, allow- surface luster are registered (see chapter 19:
ing us to observe only that tooth without “Analysis of the Surface Structure - Polish-
being distracted by adjacent soft tissues or ing ”).
teeth (Fig 4-9) . The search for and final selection of a
Lastly we select the matching incisal specific color can prove most difficult ,
porcelain, of which often several are used especially if that color must be custom mixed.
(Fig 4-10). After the basic, dentin, and incisal With regard to efficiency we regard the
porcelains have been selected, all effects technique described here as one of the best ,
and nuances are evaluated. Note that all in- or at least as being practical and reasonable,
dicators should be marked (Figs 4-11 and However; as with any method, there is a sub-
4-12). We prefer to work with intense colors of jective component to the selection of color,
a soft dentin rather than metal oxides and it strongly demands profound knowl-
because the latter are hard to handle and edge about the build-up of ceramic.

45
mi
31
III
I if !!! Color Selection
*i U
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£
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t if £:
! if
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s-z S-3 S- 4 Fig 4-10 The incisal porcelain is

! i; determined . A single specimen rare-
$ a
ly suffices.
I ii t:
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Ill
Ii y I&
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111!
i i!
i II i
l i v
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!Mi Figs 4-11 and 4-12 Every effect the
tooth shows must be considered.
:• K: (above) Color selection for the incisal
5 si; edge ("halo effect”), ( left) Selection
i
of opalescent regions.

fli
hi
I
£

ii a
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'

Breaking Down into Coats

Fig 4-13 Determination for the

lingual surface. From this angle the
teeth show other interesting charac -
teristics.

Fig 4-14 Saliva must be removed

to allow unrestricted observation of
the tooth surface, its texture, and the
degree of luster.

47
 5 The Three-Dimensional Shade Guide and
Changing Luminosity of Colors

When selecting tooth colors, frequently it is luminosity. Afterwards it is possible to polish

the color brilliance that proves difficult to the ceramic.
evaluate and register. The most difficult part is This method is frequently used to correct
therefore not selecting the correct hue; regard- color brilliance. Therefore, we have added
ing the degree of saturation it is rather simple. three facets of brilliance to the shade guide
But with color brilliance, the amount of gray (ie, shade guide for study purposes) (Fig 5-1).
components a color contains makes it much These facets correspond to three ceramic
more complicated. None of the known systems powders of translucent gray:
of shade guides makes it any easier to 1. Light gray: 2 parts T4 + 1 part gray ID8,
choose between several degrees of luminosity 2. Grayer: 1 part T4 + 2 parts gray ID8,
of one specific color. 3. Grayest: pure ID8.
Communication between the dentist and These three facets are placed on the ce-
the dental technician concerning color selec- ramic facets of the shade guide and thus
tion is often imprecise. The reason is un- modify their luminosity (Fig 5-2) . If we do not
suitable shade guides and, in particular, a find a proper correspondent in brilliance for
complete lack of information on color bril- the tooth to be restored despite a suitable
liance, which is hard to judge. opaque and good color saturation, a facet is
It should be possible nowadays to improve paced against the ceramic teeth to obtain a
brilliance control on the existing shade distinct nuance. This will correct the color
guides. brilliance. Later we can check inside the
When the color brilliance of a tooth is too patient ’s mouth whether our correction cor-
bright although the saturation and basic responds with the color brilliance of the
color are correct, there are two ways to natural teeth. If this is not the case we repeat
remedy the situation; the procedure with the two other, grayer
The first method (which I regard as facets. Once the three dimensions of color
unsatisfactory) involves applying a coat of have been determined it is easy to record the
gray metal oxide to the surface during the appropriate color-reference (eg, color bril-
glaze bake; it is possible to reduce the liance 1, 2, or 3) .
brilliance when a combined gray is used. In the laboratory when fabricating a ceramic
This method has one major drawback, how- restoration we use the build-up technique;
ever. There is no way to mechanically polish except that when the last layer is to be
the ceramic surface without also removing applied we use a translucent gray. This does
the oxides. not alter the basic color or saturation, it merely
The second method involves applying a influences the brilliance (Fig 5-3).
very thin coat of gray transparent porcelain. For accurate determination of color bril-
This coat does not influence the color or its liance of a natural tooth, this method is simple
saturation but merely corrects the degree of and feasible. The process of selecting colors

49
 The Three-Dimensional Shade Guide and Changing Luminosity of Colors

Fig 5-1 A custom shade guide composed of several Fig 5-2 Each luminosity facet ( B ) can be clamped to
facets of different luminosity. This shade guide enables a commercial shade guide ( A). The facets influence and
the determination of the gray portion of a tooth. It is a change the brilliance of a tooth. For each of the four
completion of the commercially available shade guide degrees of luminosity a range of four different porcelains
systems and is the first guide to include the three- is provided. These porcelains are incrementally applied
dimensional aspect. The scale ranges from the lightest during build-up of a tooth to consequently obtain the
h to the grayest nuance (L1, L2, L3, L4). desired color brilliance.

ll
II Fig 5-3 These four porcelain teeth
are identical in terms of hue and
saturation. They are distinguished
only by their brilliance. On the far left
is the tooth with the highest luminosi-
ty and on the far right is the tooth
with the highest amount of gray.
Clearly the color of teeth can be
influenced by incremental applica-
tion of porcelain mass containing
more or less gray (L1, L2, or L3). It is
possible to quantify a tooth’s color
brilliance using facets of different
degrees of luminosity.

ll

and communicating the result from dentist to For the future it will be important that
dental technician is thereby improved; more- manufacturers provide systems of shade
over, the investment is minimal - three addi- guides with nuances that represent all three
tional powder jugs. It would be even more brilliance dimensions in order to make
convenient to have three gray plastic facets dentist - technician communication easier.
that can be adapted perfectly and contrast And we propose that our nuanced luminosity
distinctly with the nuances of the shade system is on the right path!
guide.

50
sr

6 Instruments

Technicians who work with dental ceramics as a reservoir for water in order to maintain a
must have profound knowledge of the constant degree of humidity while modeling.
ceramic material as well as of tooth mor- It is made of selected, pure hair of a marten’s
phology, occlusion, and color. Last but not fur, thus it has great density and a very sharp
least , they must also have the ability to point similar to that of a stinger. Using the
observe - plus have an artistic streak . All of same brush we can, for purposes of rapid
the above, though, will not suffice without ap- modeling , remove surplus ceramic material
propriate instruments and accurate methods and wipe it off on a paper napkin, as well as
chosen for every single step. Because of form even the most difficult incisal edges
organizational and simplifying reasons we incrementally, thanks to its flame shape. With
prefer to work with a minimum of instruments; its very sharp point we can recontour the
hence repeated manipulations are simplified occlusal fissures for the second firing . The
and will not distract the ceramist ’s concen- high-quality marten’s hair provides the brush
tration. with a variable geometry so we can ex-
Modeling brush . The modeling brush we clusively use only this one modeling brush
use is of medium size, big enough to function (by Prodentax , Lyon, France) . However, these

Fig 6-2 The very sharp yet dense point of this brush
can serve as an aid for shaping occlusal surfaces and
recontouring fissures.

Fig 6-1 Modeling brush : this brush is foldable and

a removable cap ensures that moisture can be main-
tained for several hours. Its original flame-shape and
density will also be preserved.
Instruments

Fig 6-3 The brush for enamel cracks has a flat point Fig 6-4 This brush can be used to mimic cracks on
not unlike a chisel edge. stress- bearing areas of the tooth. Because of its chisel-
like point , a very defined area can be stained.

characteristics will be rapidly lost if the brush certain fragility because of its own softness.
is not protected. Therefore, a removable cap The tool is used to brush the occlusal sur-
must be used to preserve moisture for faces in the direction of the fissures (Fig 6-5) ,
several hours or even until the next day. The and it is of great help in producing ceramic
original flame shape and density of the shoulders, where the brush is worked in an
brush’s hair will also be preserved in this way incisocervical direction.
(Figs 6-1 and 6-2) . “ Painting” brush. This brush is rarely used
Brush for enamel cracks. This brush is and is not considered appropriate for the
quite small (no. 2) , flat, fine, and has a square amateur, who tends to overdo the application
soint . It, too, is made of choice marten’s hair, of staining colors. It is extremely fine (no. 00)
t is especially designed for lateral segmenta- and made of marten’s hair. The main function
tion and is used to create the illusion of of this brush is to apply staining colors, which
enamel cracks. The flat shape obviously are used to mimic all sorts of discolorations
predestined the brush for that purpose. It is natural teeth exhibit: partially or completely
also possible to apply staining colors in order stained fissures or interproximal spaces, and
to mimic cracks on stress-bearing segments. discolorations of concave areas of the tooth .
A brush with a pointed tip would only permit This brush also must be very dense, in order
the application of fine streaks of color. The to meet all these conditions.
square- pointed brush, on the contrary, Opaque “glass stick ”. This is surely the
permits small, colored patches, which give cheapest of all instruments and is available in
natural cracks the appearance of depth any pharmacy because one can use an or-
(Figs 6-3 and 6-4) . dinary medical ampule. The very end of the
Whipping brush . This brush is the thickest ampule should be smooth and rounded and,
of all. Its hair is not marten’s hair but is horse’s if possible, slightly bent . Using this device it
hair instead. It is very soft, not at all stiff . It can is possible to apply opaque porcelain without
be used after finalization of the ceramic build- any water. The method is quick and leads to
up to produce a well- rounded shape. More- very even and smooth surfaces (Fig 6-6).
over, it can impart to the entire restoration a Multifunctional separating spatula. This

52
 Instruments

Fig 6-5 The whipping brush is made of fine horse’s Fig 6-6 The opaque glass stick.
hair. It is useful for fabricating porcelain margins and
cleaning occlusal surfaces; the stroke must always be in
direction of the fissures.

Fig 6-7 The semicircular multifunctional separating Fig 6-8 The straight and cutting edge of this two-sided
spatula is used during the build-up process on fixed instrument helps to cut off fine tips of excess porcelain.
partial dentures and pontics.

53
Instruments

Fig 6-10 Because of its flexible blade, the multifunc-

tional spatula works well for mixing porcelain or metal
oxides.

Fig 6 -9 The same instrument is used here to erode

the porcelain mass; its fine, flat tip is particularly helpful
in pressure- packing the porcelain particles during cor -
rection and second firing.

instrument can be used in many ways. We

modified a flexible razor blade. Its original
shape has many functions: to separate the
pontics of a metal ceramic bridge (Fig 6-7) ,
cut off excess ceramic tips (Fig 6- 8) , erode
the ceramic or, for the second bake of a
ceramic fixed partial denture, to condense
the correction porcelain (Fig 6-9) . This spatula
can also be used for mixing the ceramic
(Fig 6-10).
Spatula to produce natural-looking fis-
sures. This instrument is indispensable for
creating natural- looking occlusal surfaces.
Because fissures never run in straight lines
we use this spatula and not a rotary instru-
ment to work with untreated dental porcelain.
Fig 6-11 The spatula is used to fabricate natural-look-
ing fissures. All fissures are produced with this instru- The spatula should be flat , smooth , and
ment; we do not advocate use of rotary instruments. slightly bent at the rounded tip, to adapt well
The spatula should be flat , smooth, and slightly bent at to the shape of cusps (Fig 6-11) .
the rounded tip, to adapt well to the shape of cusps.
Mixing spatula. This spatula should be
made of plastic, to avoid any contact of
the mixing slab - which is consistently kept
moist - and metal. When mixing, it is very
important not to trap any air in the porcelain .
The ceramist should observe carefully that
the porcelain exhibits a soft and workable
consistency.
Diamond-tip tweezers. These two tweezers

54
 Instruments

Figs 6-12 and 6-13 Diamond- tip tweezers.

Fig 6-14 The constant humidity box maintains a cer-

tain degree of moisture that is essential for dental
porcelain processing.

are essential for manipulating ceramic material plasticity that is extremely helpful for model-
that must not be touched with bare fingers, ing. It is not possible to obtain a moist powder
They make transport and placement on the of good quality on a glass slab. Therefore, we
heat-resistant plate easier during surface use a glass slab in a box of constant humidity
characterization (Figs 6-12 and 6-13). (Fig 6-14). There is a reservoir of distilled
)
Constant humidity box . In order to obtain water underneath the slab that will maintain
pleasing results, the ceramist must follow one the same degree of humidity even for a few
simple rule: dental porcelain always has to days. Economical aspects ought not to
be processed under a constant degree of be neglected when working with ceramic
l
humidity, which provides the material with powder.

55
7 Basic (Opaque) Porcelains

The application of basic porcelain may seem Covering gold coat. In order to rule out
of subordinate importance for the ceramist ’ s any gray reflections caused by the opaque, a
work. However, it is a difficult and serious covering gold coat is used . It is commercially
step. From the ceramist ’s viewpoint the available as a paste (Keradec by Wieland,
opaque should represent the final shade of a Dusseldorf , Germany). The kit contains a
tooth. This is the layer of highest saturation liquid with which the paste is thinned to
and will appear to be more or less intense creamy consistency. The material can then
depending on the thickness of the ensuing be easily applied to the entire surface of the
coats of ceramic material. The main function substructure with a small brush . It is not
of the basic porcelain is to mask the metal advisable to apply covering gold only on the
substructure. But light penetrating the cervical region. Even with sufficient thickness
ceramic and being reflected by the metal of the ceramic layer, the substructure’s gray
causes undesirable effects, in particular reflections will influence the color. According
because of the gray reflection of metal ox- to the manufacturers, this gold coat will only
ides. The thickness of application determines be a negligible 10 to 15 p,m thick. After the
the quality of the opaque porcelain layer. application, the coping is dried in the furnace
Hence, to avoid all gray reflections on cer - for 6 minutes. The initial temperature of
vical or buccal surfaces we use covering 600°C should be raised at a rate of 60°C per
gold; only a very thin layer of opaque minute to a final 820°C. After firing, the
material will then be necessary. covering gold should have a matte finish ; it
should not shine because this would provoke
too much reflection (Fig 7- 2) . By using cover-
ing gold the cervical edges show a yellowish-
Application of gold appearance instead of an unpleasant
Opaque Porcelains gray tinge from the metal substructure.
Application of dentin porcelain. This
Opaque “ wash”. Tlhe opaque wash is not opaque component represents the color that
supposed to fully mask the metal substruc- was specified. It should mask the covering
ture with just one single layer ; rather, it gold. If its layer shows some irregularities in
establishes a link between the metal sub- thickness, even the thinnest areas will cause
structure and the so-called covering gold no disadvantage because the coat is com-
(Fig 7-1) . Its hue is inconspicuous, possibly pletely underlayed by the covering gold’s
neutral to avoid any unwanted influence from yellow color. The opaque should be of
the layers underneath. We use the glass stick creamy consistency ; when applied with a
for distribution of the wash . It is necessary to glass stick , the opaque can be thinly
moisten the metal surface gently in order to distributed. Prior to the application , the metal
facilitate further wetting. The application must substructure must be slightly moistened in
be done rapidly to prevent the thin coat from order to facilitate further wetting.
drying too soon. The opaque wash is slightly The opaque is to be applied from top to
condensed at the same time. bottom , ie, from occlusal / incisal to cervical

57
Basic (Opaque) Porcelains

Fig 7-1 Opaque wash covering the

substructure after firing The opaque
wash should not mask the metal
substructure fully with just one single
layer ; rather it should establish a link
between the metal substructure and
the so-called covering gold .

Fig 7-2 The covering gold should

not shine after firing, because this
would produce too much reflection;
it should have a matte finish

Fig 7-3 Opaque application using

a glass rod The tip of a medical
ampule is handy for this purpose.
The material is applied from top to
bottom; distinct transitions should be
covered last .

58
 Basic (Opaque) Porcelains

Fig 7-4 After firing the opaque

should have an eggshell appearance.

Fig 7-5 The colored opaque mate-

rial The coloration may be diffuse or
show distinct boundaries, according
to the shade guide.

surfaces; the occlusal surfaces and distinct ramie restoration is 1 or 2 mm thick. If the
transitions should be covered last (Fig 7-3). restoration is thinner, color and its character -
The material is condensed with a few light istic features must be considered during the
and gentle taps. After firing, the opaque opaque application. Selecting the right hue
should have an eggshell appearance. Above for the basic porcelain is of major impor-
all it should not shine, because that would tance; this may be achieved either by use of
create too strong a reflection and would thus intense opaque or with the application of
impair the final result (Fig 7-4). metal oxides, thus staining the opaque layer.
Modifying the opaque. Generally, the The opaque must be colored during applica-
opaque is not colored too conspicuously. In tion, which may look as blurred as a
most cases we prefer to use intense dentin photograph of the earth taken from space or
porcelain to reproduce all internal shades. show distinct junctions according to the
However, this is only possible when the ce- shade guide (Fig 7-5). The opaque should

59
Basic (Opaque) Porcelains

Fig 7-6 The completed fixed par -

tial denture.

be condensed with a few gentle taps with the Coloring the opaque makes it possible to
spatula. This gentle condensation will draw master even difficult situations, such as
the particles together; however, vibration underreduction and consequently lack of
should be avoided because it could shift the thickness. This technique can trick the eye
layers and force them into concavities. The because it creates the appearance of volume
basic porcelains are allowed to dry well and depth. However, it must not be used ex-
before they are fired. A drying time of 5 cessively for it may lead to results where
minutes is scheduled; the temperature is reduction of luminosity is important and cor-
raised at a rate of 80°C per minute, a little rection with adequate thickness of porcelain
quicker than firing of the dentin porcelain is no longer possible.
(60°C per minute) (Fig 7-6) .

60
8 The Ceramic Shoulder

The ceramic shoulder represents considerable of the root portion will later be a guideline for
progress in our endeavor for better esthetics, the crown margin. It is useful to apply some
Generally, we are tempted to use ceramic for hardening varnish to the die in order to
restoration of the margin as often as possible, secure the wax crayon marks and harden the
particularly with anterior teeth. Provided the well-defined cervical margin (ie, the shoulder
technique is mastered well, no precision will edge). These marks as well as the shoulder
be lost. In general, the labial portion of a edge are thus protected. This varnish works
restoration is produced with a ceramic like a protective shield, preventing the die
shoulder, but the entire margin of the restora- from absorbing the moisture of the sub-
tion can be fabricated in ceramic if the sequently applied porcelain. A cyano-varnish
preparation permits. This requires a wide, full- is used as hardener, but not before a first coat
shoulder formation. To obtain excellent preci- of gray and a second coat of gold die spacer
sion, two firings will be necessary. have been applied.

Prerequisites for a Ceramic First Shoulder Porcelain Bake

Shoulder
Before the porcelain is applied, the die
In order to fabricate a ceramic shoulder, the must be treated with a separating wax pencil
preparation must be adequate. A wide, cir- (Fig 8- 2). The shoulder porcelain is mixed
cumferential shoulder and an angle of 90° is with liquid to a creamy consistency. Substruc -
propitious. For optimal esthetic results, it is tures for ceramic restorations should exhibit
desirable to have a restoration margin 1 mm very gentle friction, and above all, no under-
thick (Fig 8-1). cut should create an impediment. The por-
celain is applied directly to the lower portion
of the metal coping without touching the
Preparing the Die prepared portion of the die (Fig 8-3). We do
not pack by condensing but use a paper
Prior to the porcelain application, the cervical napkin to press the porcelain onto the
edges of the preparation must be marked shoulder. The napkin absorbs excess
with a wax crayon. Great care must be exer- moisture and prevents the porcelain from
cised not to soften the right-angled finish line adhering to the die (Fig 8-4). When the cop-
of the prepared shoulder. This is essential ing is removed there will be no excess
for accurate marginal fit of the restoration, ceramic at the edges. The die is separated
Denudation of the cervical margin means again and the coping reseated. A very soft
careful preservation of the area where the brush is used to shift the porcelain in the
root portion of the die begins. The beginning direction of the cervical finish line while it is

61
The Ceramic Shoulder

Fig 8-1 The required width of an

esthetic porcelain shoulder is 1 mm
at least. The preparation margin
should be accurate and show a 90°
angle all around.

Fig 8-2 The shoulder is shown prior

to the application of the porcelain
and is separated with a wax pencil.

Fig 8- 3 The porcelain is applied

directly to the lower edge of the
metal coping without touching the
prepared portion of the die.

62
 Second Shoulder Porcelain Bake

Fig 8-4 A paper napkin is used

to press the porcelain onto the
shoulder. The napkin absorbs ex-
cess moisture and prevents the
porcelain from adhering to the die.

Fig 8-5 Using a soft brush of

horse’s hair, the porcelain is shifted
in the direction of the cervical finish
line while it is still moist.

still moist (Fig 8-5). All excess material is porcelain nodules that may cause problems
carefully removed using the blade of a when reseating. This initial check can
scalpel. The coping is lifted off the die, and disclose a small opening caused by firing
the marginal fit of the porcelain will exhibit a shrinkage, but the main reason for that
clean edge and be accurate. Now the first marginal deficiency is that we omitted to con-
bake can be performed. dense the porcelain slurry. In order to fill in
that opening, a mix of moist shoulder powder
and special glazing liquid is prepared. This
Second Shoulder Porcelain Bake considerably thicker liquid prevents the thin
corrective material from drying prematurely.
After the firing and before the coping is The same liquid is used to lightly cover the
reseated on the die, a fine-grit diamond is edge of the baked ceramic to facilitate further
used to free the internal surface of small wetting (Fig 8-6). A small bulge of shoulder

63
The Ceramic Shoulder

Fig 8-6 After the first bake a cor-

rection porcelain is applied with a
spatula. In order to facilitate further
wetting, glazing liquid is lightly
applied to the edge of the ceramic.

Fig 8-7 A small bulge of shoulder

porcelain mixed with some glazing
liquid is applied to this edge.

porcelain is later applied to this area (Fig 8-7). ing is removed in order to proceed to the
The coping is reseated on the die by exerting second bake. The firing is done according to
gentle pressure after the separating pencil the usual program. The more viscous liquid
has been carefully used once more (Fig 8-8). prevents the thin corrective porcelain from
This time, the material is lightly condensed drying out or crumbling away.
and excess moisture is absorbed with a After the second porcelain bake, the for-
paper tissue to ensure proper adaptation of mation of the ceramic shoulder is virtually
the coping. finished (Fig 8-9). Now the full crown contour
Again, we lift the coping off the die, treat can be established. Only when the restora-
the die with the separating wax pencil, reseat tion has been completed (ie, after the glaze
the coping, and ensure a perfect marginal fit bake) will the correction firing be done. For
while stroking gently with a flexible brush in this purpose a mix of shoulder porcelain and
an occlusocervical direction. Finally, the cop- 20% to 30% glazing powder (low-fusing por-

64
 Second Shoulder Porcelain Bake

Fig 8-8 The unfinished restoration

is reseated on the die while exerting
slight pressure.

Fig 8-9 After the second porcelain

bake, the ceramic shoulder is virtually
finished. Now the full crown contour
can be established. Only when the
restoration has been completed (ie,
after the glaze bake) will the correc-
tion firing be done.

Fig 8-10 Finally, the ceramic margin

is polished with a carborundum pol-
isher and the marginal fit is inspected.

65
The Ceramic Shoulder

Fig 8-11 The completed restoration

after polishing.

celain) is used. This reduces the fusion The fabrication of a ceramic shoulder is not
temperature of the corrective porcelain. Pos- an easy task. Therefore, we advise a method
sible minor inaccuracies are generally cor- that is precise as well as efficient and easy
rected in this fashion. After firing, the ceramic to adopt. Essential prerequisites for success
margin can be finished with an abrasive are well-defined and clean, right-angled finish
stone; the marginal fit is then checked lines (Fig 8-11).
(Fig 8-10).

66
\

9 Artificial Gingiva

In general, ceramists in commercial labora- without it. Artificial gingiva has been par-
tories work isolated from dentist and patient. ticularly useful with anterior teeth, where poor
Dental technology and dentistry are different design of interproximal space is the major
but complementary professions; the best cause of poor esthetics.
restorations originate from well-balanced Using the artificial gingiva, it is possible to
teamwork between the two. Most of the design interproximal areas with reduced
dental laboratories, including ours, are located compression on adjacent soft tissues and im-
some distance away from their dentist proved access for interproximal brushes for
customers. Communication is one of many the periodontally compromised patient.
elements that contribute to success. There- The junction from the tooth’s hard tissue to
fore, any technique that improves communica- the surrounding gingival soft tissues and the
tion in daily practice is helpful. faciocervical contour must be clearly visible.
Artificial gingiva is also an element we can- The contour of the cervical third can obvious-
not do without in daily laboratory procedures. ly be derived from the morphology of the
’ We have used this technique for many years periodontal vicinity (Fig 9-1).
now, and it is difficult to imagine dentistry

Fig 9-1 How do we visualize the

gingiva when the teeth have been
prepared for crown restorations? It is
almost impossible to assess the
topography of the sulcus and the
risk of gingival compression without
using artificial gingiva. (Tooth pre-
paration by Dr Luc Portalier.)

67
Artificial Gingiva

Fig 9-2 An impression is made of

the prepared teeth and the adjacent
soft tissue using a highly viscous
silicone compound.

Fig 9-3 The dies are separated

and ground to the desired shape.

Fig 9-4 The die has been prepared

and the finishing line is denuded
before the artificial gingiva is fabri-
cated.

68
 Fabrication of Removable Artificial Gingiva

Fig 9-5 A low-viscosity silicone is

injected with a syringe (ESPE-Pre-
mier) into the prepared openings.

Fig 9-6 The artificial gingiva after

the excess silicone has been removed
and the index has been lifted off the
cast.

Fabrication of Removable canals that can be used to inject a low-

viscosity silicone compound. After the index
Artificial Gingiva is repositioned on the working cast, the com-
First an index of the unprepared cast is made pound is injected with an impression syringe
using a high-viscosity silicone compound to fill the void (Fig 9-5). The compound sets,
(Fig 9-2). The soft tissues must be accurately the soft compound excess is cut off , and the
duplicated. Then the cast is separated, and index is lifted off the working cast (Fig 9-6).
the die is trimmed to show the finish line The gingiva is duplicated by the compound
(Fig 9-3); a 4-mm round tungsten grinder is representing the impression. The artificial
used. This grinder helps to provide sufficient gingiva is removed and excess silicone is cut
space beneath the cervical margin for the off using a pointed tungsten grinder or a pair
silicone (Fig 9-4). The lingual wall of the index of scissors (Figs 9-7 and 9-8). The entire pro-
is perforated several times to provide for cedure takes only a few minutes. The fabri-

69
Artificial Gingiva

Figs 9-7 and 9-8 All excess sili-

cone has been removed and the
artificial gingiva is trimmed.

Fig 9-9 The artificial gingiva is very

helpful during the porcelain build-up
stage; it facilitates a quick assess-
ment of form and cervical contour
and enables better adaptation of
crown margins to the adjacent tis-
sues.

70
 Fabrication of Removable Artificial Gingiva

Fig 9-10 An elastomeric detection paste is used to Fig 9-11 The crown is seated on the die; if any com-
identify regions of undesirable compression of the pression is present, it will bounce back.
periodontium.

cated gingiva is a considerable aid for defin-

ing the periodontal surrounding and its rela-
tion to esthetics (Figs 9-9 to 9-12). The
duplication of the soft tissues will differ from
the natural gingiva in volume by one tenth of
a millimeter due to shrinkage of the impres-
sion, but this is a negligible discrepancy in
relation to the benefit of the procedure. The
only risk is minor compression, which can
be compensated for by grinding back the
porcelain during a try-in of the unfinished
restoration.

Fig 9-12 After the crown has been lifted off the die. the
regions of compression are clearly marked and can be
eliminated.

71
10 Processing and Natural Layering of Metal
Ceramic

Every committed dental technician has celain, which overlies the transparent material.
studied sections of natural teeth in the at- The purpose behind studying these teeth is
tempt to mimic their internal structures. The to improve imitation of natural teeth (Figs 10-7
author is one of those who collect cross sec - and 10-8). However, these cross-sectioned
tions and photographs in order to study teeth are merely part of our studies and
nature as closely as possible. Sectioned teeth become significant only when the previous
best show the main characteristics that are observations can be applied in daily laboratory
significant for the fabrication of restorations in procedures. We therefore produced a cross-
dental porcelain, no matter if metal ceramic sectioned metal ceramic crown (Figs 10-9
or all-ceramic. and 10-10) fabricated with different kinds
From the sectioned natural teeth in Figs 10-1 of dentin porcelain, going from the most
to 10-4 the following conclusions can be saturated to the most opaque, where the
drawn: all teeth exhibit a distinct color satura- opaque determines the color of the por -
tion in their center that decreases toward the celain build-up. The dentin porcelain was
periphery. The cross sections of ceramic incrementally layered, thus decreasing the
teeth in Figs 10-5 and 10-6 show a central saturation: altogether three kinds of dentin
portion of high saturation representing the porcelains, and the enamel porcelain super -
pulp; a variety of dentin porcelain was used, imposed on the transparent porcelain. This
highly saturated in the center and less cross section of a metal ceramic crown is
saturated toward the periphery, all covered schematic but nicely illustrates that method.
by several layers of transparent and incisal We have always fabricated our restorations
porcelains. with the incremental build-up and lateral
There is a transparent zone beneath the segmentation techniques. These two methods
enamel that apparently facilitates the circula- are complementary and lead to very satisfy-
tion of light inside the tooth. This is a con- ing results (Figs 10-11 and 10-12). However,
tradiction to the traditional way of modeling in we do not use condensation (ie, the packing
dental ceramics. It is common practice to of the porcelain particles) to obtain higher
apply the transparent porcelain onto the density because all effects, layers, and
incisal surface. This results in well-shaped segmentations disappear and form just one
restorations seated on the working cast, but mix after condensation.
they do not look natural. In general, the core From basic knowledge of painting and
of the internal structure is sectioned by the color theory, we know that the three primary
dark background of the oral cavity behind. colors, if mixed in the correct quantities, yield
In Figs 10-5 and 10-6 the transparent layer black. This fact applies to painting as well as
is quite discernible because it underlies the dental porcelain, where gray is the result if
enamel porcelain. It conveys light, somewhat too many colors are mixed. Therefore, the
like a fiberoptic cable. Figure 10-5 clearly application of different porcelains adjacent to
depicts the formation of different layers at the each other (lateral segmentation technique)
periphery as well as the layer of incisal por- or layers of porcelain (layering technique) is

73
Processing and Natural Layering of Metal Ceramic

i *

74
 Processing and Natural Layering of Metal Ceramic

Figs 10-1 to 10-4 Two facts can be observed in these photographs of vertical cross sections of natural teeth. The
color is saturated in the center and becomes lighter at the margins. Furthermore, the zone of transparency is always
located beneath the enamel layer. The light circulates beneath the enamel, a phenomenon that is particularly distinct
in Figs 10-3 and 10- 4.

Figs 10-5 and 10-6 These all-ceramic teeth were fabricated according to the observations mentioned above on
natural teeth: (1) The teeth have been fabricated according to the build-up technique, ie, from saturated color in the
center to less saturated color at the periphery, and (2) the transparent material has been applied beneath a layer
of incisal porcelain. Light can circulate just as it does within natural teeth. The highly saturated color in the center
mimics the color of the pulp.

recommended in order to accomplish natural- distribution, thus resulting in a restoration of

looking rather than gray-appearing restora- impaired translucent appearance.
tions, reminiscent of the impressionists who Every ceramist and colorist is familiar with
used to work their brushes in a stippling man- the three dimensions of color: hue, satura-
ner (see chapter 1, “ Basic Terms of the tion, and brilliance. There is widespread con-
Phenomenon of Color "). Condensed porcelain fusion, though, about brilliance. Brilliance is
consequently means condensed particle the quality by which we distinguish a light col-

75
Processing and Natural Layering of Metal Ceramic

Figs 10-7 and 10-8 These sche-

matic drawings illustrate the principle
of a higher-saturated hue in the
center blending to a lower-saturated
one at the periphery. Figure 10-8
depicts the same principle for a
metal ceramic crown. It is advisable
to structure the layering of porcelain
according to this method in order
to find the correct color even under
conditions of minimum thickness.
(A) From the more saturated to
the lighter hue; (B) from the more
saturated to the lighter hue; (C)
metal substructure

or from a dark one. It is represented by the and less gray colors. Moreover, they provide
achromatic axis in the center of Munsell’s a large range of translucencies that are
cylinder, where white is at the top and black distinguishable not only by their brilliance but
at the bottom (see Fig 1-6). There is a scale by different hues as well (Fig 10-13):
of grays ranging gradually from black to - Slightly opalescent translucency (T1)
white and thus connecting the two extremes. - Slightly pink translucency (T2)
Black has zero brilliance whereas white - Slightly grayer translucency (T3)
shows maximum brilliance. - Highly transparent (T4)
If transparent and incisal porcelains are These nuances can also be found on the
used, which are nuanced merely in grada- palette of incisal porcelains. Consequently, it
tions of gray, only gray teeth can be the is simple for the ceramist to use these colors
result. For that reason, we prefer porcelain and subtleties without making the teeth un-
powders by Ivoclar. They contain more light necessarily gray (Fig 10-14).

76
 Processing and Natural Layering of Metal Ceramic

Fig 10-9 Again, a higher saturated hue can be seen in Fig 10-10 The same restoration as in Fig 10-9, prior to
the center and a lower saturated one at the periphery sectioning. The selected color 6D could be used
of a metal ceramic crown. The clearly discernible trans- although the thickness of the restoration did not exceed
parent material has been applied beneath the incisal 1 mm. The opaque core is not visible. The main objec -
porcelain. The dentin color saturation decreases toward tive of this method is to create a maximum sense of
the surface (thickness of the dentin layer is 1 mm). The depth in a restoration of minimum thickness.
overall thickness of the restoration is 1.5 mm (metal cop-
ing, opaque, porcelain).

Figs 10-11 and 10-12 Build-up and lateral segmentation techniques are complementary and result in very satisfy-
ing restorations. The object of study is an all-ceramic restoration. ( A) Vanilla-colored " halo-effect ,” B- HY7; ( B) transpa-
rent zone T4; (C) root portion B- HY3 + B- LB5; (D) transparent brown B -DB7; ( E ) vanilla-colored enamel cracks
101 + 104; (F) opalescent zones ID2 + D03; (G) gray-brown beneath a layer of enamel porcelain B-DB3.
 Processing and Natural Layering of Metal Ceramic

-
Fig 10 13 Transparent and trans-
lucent porcelains of the Ivoclar IPS
Classic assortment. This assortment
consists not only of colors of different
brilliance but of different hues, too.
Slightly opalescent transparent-
porcelain (T1), a more pink porcelain
.
(T2), a more gray porcelain (T3) and
a very transparent porcelain (T4).

Fig 10-14 For transparent material

and for the incisal porcelain also,
colors of different brilliance are
available. Thus it is possible to ex-
periment with these color nuances
without fabricating teeth that are un-
necessarily gray.

Another unique aspect of the ceramics by sion each step will be presented separately.
Ivoclar is the “maverick” set . This set consists Of course, full crown contour in porcelain is
of four specially selected basic colors fre- usually done as a one-step procedure with
quently found in natural teeth (Figs 10-15 to just one firing.
10-18). Each of the four is created stepwise in The main goal of the incremental build-up
three, five, and seven portions, desaturated technique is to create a sense of maximum
with a neutral powder, thus forming four color depth and concurrently minimum thickness.
groups (Figs 10-19 to 10-22). These mixtures The application of only one dentin porcelain
are ready for use and are nuanced like of a uniform degree of saturation “retards”
natural material. They can readily be used the light suddenly, whereas light is “ retard-
during the build-up of ceramic layers, begin- ed” gradually if the layering technique is
ning with higher saturated colors and finish- used; it enhances this sense of depth without
ing with less saturated colors; they may disclosing the opaque porcelain core.
further be used to provide a restoration with Firing of covering gold (Fig 10-25). This
a characteristic touch (Figs 10-11, 10-12, material is always applied when metal ceramic
10-23, and 10-24). restorations are fabricated in order to avoid
In order to illustrate clearly the layering any gray reflection from underneath the
technique and laboratory procedures of opaque (see Fig 10-26).
these powders, a metal ceramic crown for a Application of the first layer of highly
molar was fabricated. For better comprehen- saturated dentin porcelain and orange dentin

78

I
 Processing and Natural Layering of Metal Ceramic

Fig 10-15 The four basic colors of

the “ maverick ” porcelain set. These
colors are less saturated and offer
various possibilities.

Figs 10-16 to 10-18 These pure

and desaturated original colors often
correspond with nuances of natural
teeth.

«
*«•
%

79
Processing and Natural Layering of Metal Ceramic

T
M- 8-
HY HY3

j
M-
LB

rlMi
Figs 10-19 to 10-22 Each of the
four basic colors of the maverick set
is desaturated with a neutral powder
in a gradation of three, five, and
seven portions. The hue is always
identical; not so the saturation. With
regard to color selection, it is easier
for the ceramist to use these pre-
made reference colors than to mix
them by himself or herself. The
shade facets l-Y, l- LB, and l-HY are
translucent colors derived from the
basic colors. They are well suitable
as incisal colors (see chapter 13,
" Transparency and Translucency ").
 Processing and Natural Layering of Metal Ceramic

Fig 10-23 and 10-24 All-ceramic

teeth. The maverick powders exhibit
a minimal amount of saturation and
are the material of choice for cha-
racterizing incisal edges and creat-
ing micro effects.

Fig 10-25 The fabrication of metal ceramic crowns in- Fig 10-26 Because the covering gold was applied to
evitably involves the application of a covering gold layer. the substructure, the cervical margin has a yellow- gold
color. These areas would appear merely gray without
the covering gold coat.

porcelain onto the proximal and occlusal sur - celains by Ivoclar. However, the term opaque
faces (Fig 10-26). This simulates the color of does not seem to be appropriate; we prefer
the pulp, which acts iridescent in this region, the term “masking.” These masking dental
This first layer of dentin porcelain is applied porcelains are well balanced with regard to
onto the opaque and, because it is the most the effects they create (ie, covering the opaque
saturated hue, should encompass the coping without changing the appearance of the
entirely. It is thought to mask the substruc- restoration to opaque). Furthermore, they
ture, rendering it less “ penetrable” than the correspond with virtually every color of the
other layers of dentin porcelain. The applied Ivoclar set (for instance: opaque dentin mass
powder is one of the opaque dentin por - 1D, 1C, 1E, etc).

81
Processing and Natural Layering of Metal Ceramic

Fig 10-27 The firings have been performed in suc - Fig 10-28 The second and slightly less saturated den-
cessive order for this study object. Normally the follow- tin porcelain has been applied.
ing steps are carried out at the same time, of course;
usually one firing prior to the glaze bake will suffice. The
first layer of a saturated dentin porcelain has been
applied as has an orange dentin material onto the prox-
imal and occlusal surfaces.

This type of porcelain is particularly useful grain- size reduction of 23% for the IPS
in the case of inadequate reduction. In a powder. Mechanical condensation would have
situation of minimum space, these porcelains altered the desired surface roughness to a
allow masking of the substructure’s opaque smooth finish. This second layer of dentin
core without altering the basic color selected. porcelain now exhibits the selected dentin
In difficult situations with very little space, the color (eg, dentin 1D). It is the thickest of all
first layer is also the thickest. If in the past we three layers of dentin porcelain covering the
had to mask the substructure, and under- entire restoration.
reduction was the problem, opaque dentin Application of the third layer, a mix of basic
porcelains of a different color than the selected color dentin porcelain and 50% of the neutral
basic color were used. The substructure was dentin mass I- D1 (Fig 10-29). This layer is of
masked in this way, but two significant risks lowest saturation, allowing the highest degree
had to be taken. First, these porcelains were of light “penetration," because it is almost
too opaque and gave the restoration a “dull" translucent. The mix must fully cover the
appearance. Second, the overall color of the restoration yet thin out toward the periphery.
final restoration was not the selected basic Low-saturated dentin porcelain causes a color
color but exhibited exactly the color of the to appear lighter. It is therefore significant
opaque dentin porcelains. to maintain the thickness of the first, more
Application of the second, slightly less saturated layer. This third layer then compen-
saturated dentin porcelain (Fig 10-28). Note sates for color discrepancies and adapts well
there is neither cracking nor detachment in to the initially selected basic color.
the periphery, even though no condensation
was brought about. The cause for that is a

82
r
Processing and Natural Layering of Metal Ceramic

Fig 10-29 The third dentin layer, which exhibits the Fig 10- 30 The transparent porcelain has been ap-
highest saturation, has been applied. This layer is a mix plied, incorporating some characterizations that are
of basic color dentin porcelain and 50% of the neutral placed underneath the layer of incisal porcelain. These
dentin mass ID1. Therefore this layer is most penetrable colors are applied with the lateral segmentation techni-
by light. que.

Example: hue 1D (Figs 10-33 and 10-34) commercially available, it should be custom
mixed, always bearing in mind that the initial
- First dentin layer: opaque dentin mass 1D; dentin layer should exhibit a more saturated
thickness ± 1/4 of all three layers hue than the selected basic color. The other
- Second dentin layer: dentin mass 1D; dentin layers, which should exhibit less color
thickness ± 2/4 of all three layers saturation, consist of a mix of dentin porcelain
- Third dentin layer: dentin mass 1D, and the neutral mass I-D1. That material does
desaturated with 50% of a neutral mass; not change the color brilliance of a tooth at
thickness ± 1/4 of all three layers all. The technique is also applicable for the
Application of transparent porcelain and fabrication of all-ceramic inlays and onlays
characterization of colors according to lateral (Fig 10-32).
segmentation technique (Fig 10-30). This technique, commencing with an
Application of incisal porcelain according opaque core, involves an incremental build-
to lateral segmentation technique (Fig 10-31). up from highly saturated to less saturated
In order to complete my range of colors colors to create a restoration with a sense
and to achieve a restoration more vital in of maximum depth and minimal thickness.
appearance, custom-made incisal colors Furthermore, the incisal porcelain is super-
such as mother- of-pearl, opalescent, and imposed on the transparent porcelain, and
vanilla are applied (see. chapter 14 “Original masking dentin porcelain is used instead of
Colors in Dental Ceramics”). porcelains that are opaque and may
Following is a description of the technique deleteriously affect the restoration’s natural
we apply to build up and imitate natural-look- appearance.
ing teeth. If no low- saturated porcelain is Once again, we would like to emphasize

83
Processing and Natural Layering of Metal Ceramic

Fig 10-31 Modeling of the restoration is completed Fig 10- 32 The layering technique, progressing from
with the application of an opalescent incisal porcelain. the most saturated to the lightest color, can also be used
for ceramic inlays and onlays. This cross section of an
inlay clearly depicts the applied method.

Fig 10- 33 Build-up of a metal ceramic crown following Fig 10- 34 Layering of the transparent and incisal
the principle of layering from the highest saturation porcelains. ( A) Dentin core; ( B) transparent porcelain
to the lightest colors. ( A) Substructure; ( B) opaque; that has been applied beneath the incisal layer for
(C) opaque dentin; (D) orange to mimic the color of the reasons of light circulation; (C) incisal porcelain that is
pulp; this orange color is applied to the proximal sur- an equivalent to the enamel of a natural tooth.
face to act as an iridescent and create an orange reflec-
tion, thus imitating the pulp of a natural tooth; (E) dentin
porcelain, which masks the most saturated porcelain;
(F) basic material of the selected color; (G) dentin
porcelain that is desaturated with 50% of a neutral
mass.

84
 '

\ Processing and Natural Layering of Metal Ceramic

t -
Figs 10-35 and 10-36 A metal ceramic crown fabricated according to the layering technique and using the
shade 1A. Although the thickness of the restoration (metal, opaque, and porcelain) is only 1.5 mm, its color matches
the selected one well without allowing the opaque core to shine through.

.
that our conclusions are based on observa-
tions of nature, tooth sections, and natural
teeth. This technique may serve as an aid
in difficult cases. At first it may seem as if
this approach implies a certain amount of
coercion; however, this feeling disappears
once the technique has been assimilated in
laboratory practice and will consequently
result in close similarity to nature (Figs 10-35
to 10-42).

Fig 10-37 All-ceramic tooth for study. Every ceramist

who is prepared to learn and improve his or her skill
should work with cross sections. The authors regard
this method as compulsory for better comprehension.

85
Processing and Natural Layering of Metal Ceramic :

*
*

Figs 10-38 and 10-39 Metal ceram-

ic crown on tooth 21. (Courtesy of
Dr Michel Roge, Beziers, France.)

86

,
 Processing and Natural Layering of Metal Ceramic

Figs 10-40 and 10-41 Metal ceram-

ic fixed partial denture from tooth 13
to tooth 16 (replacement of tooth 15).
Note the rotation of the pontic of
tooth 15, which gives the fixed partial
denture a natural appearance.
(Courtesy of Dr Daniel Gleyzolle,
Avignon, France.)

Fig 10-42 Metal ceramic crown on

tooth 11. Note the incorporation of
enamel cracks, which adapts well
to the adjacent natural tooth 21.
(Courtesy of Dr Thierry Jeannin,
Orange, France.)

87
 1
Processing and Natural Layering of Metal Ceramic

Table of Firing Temperatures must be specified. The following describes

the important points of reference:
It is difficult to specify exact temperatures
for firing procedures because different
• Porcelain: IPS classic and “ maverick ”
(Ivoclar)
i

porcelains require different manipulations. A

wide variety of furnaces and commercial pro-
•
•
Furnace: Ivoclar P90 (well calibrated)
No condensation of porcelain during pro-
ducts are available. Prior to a discussion cedures
about firing temperatures, some parameters
of considerable significance for our objective
• Creamy consistency of porcelain during
modeling

Programs Start Heating Drying Vacuum Vacuum Holding Final

temper- (rate/min) start end time temper-
ature ature

Opaque-wash 400° 80° 2 min 600° 950° 950°

Covering gold
(Keradec Wieland) 400° 60° 5 min 600° 820° 820°
Opaque 400° 80° 4 min 600° 950° 950°

Shoulder porcelain
1st and 2nd firing 400° 60° 5 min 600° 949° 1 min 950°
1st bisque bake 400° 60° 9 min 600° 919° 1 min 920°
2nd bisque bake 400° 60° 5 min 600° 899° 1 min 900°
Minimum glaze
400° 60° 2 min 1 min 890°
bake
Glaze and correc -
tion bake 400° 60° 5 min 600° 889° 1 min 890°

88
.

89
11 Tricks to Make Porcelain Layering Easier

Fabrication of a Multi-Span Fixed 1. Rapid modeling

2. Ability to maintain a constant degree of
Partial Denture moisture
3. No condensation of porcelain
In order to achieve a satisfactory esthetic
result , we prefer to split the fabrication pro-
cedure in several sections, ie, we focus on the
anterior region first. The procedure is staged Fabrication of Anterior Fixed
as follows: Partial Dentures
© First bake: fabrication of the anterior
segment (six teeth) Our attention must be focused entirely on the
(Fig 11-1) restoration at hand and the three parameters
© Second bake: fabrication of the posterior mentioned above must be permanently con-
segments and correction sidered. The ceramic layering begins with the
of the anterior segment labial surfaces in order to perfectly mimic the
(Fig 11-2) complex effects. After completion of the labial
(D Third bake: correction of the posterior surfaces we proceed to the lingual areas ,

segments and correction ThiS is all performed before the first firing
of the anterior segment if (Figs .5 and -|-|.6).
necessary (Fig 11-3) ^
it may pr0ve necessary in certain difficult
Glaze bake: vacuum firing for minor cases to bake the labial build-up first and
corrections; polishing for successively fire the lingual surface and then
completion perform final labial corrections.
If the restoration is to be a long- span fixed
partial denture, the application of the porcelain
in one step should be done for study pur-
poses only. In general, one- step layering is Layering and Firing
detrimental for the porcelain and may lower of the “ Dentifl” Core
the overall quality of the restoration. It re-
duces our ability to create effects that can on- A different approach is used in cases of
ly be created with internal staining. Therefore, unusually delicately characterized anterior
we prefer to section the fabrication procedure teeth: first the dentin porcelain is applied and
(Fig 11-4). all effects, even the transparent ones, are
Fabrication in stages has two advantages: created, then the unfinished restoration is
the procedure is easier and it enables the fired. Immediately afterwards we can assess
technician to create a highly esthetic restora- both color and function. This method of layer-
tion according to the following three signifi- ing allows for accurate control of the internal
cant parameters: (dentin) porcelain layers and correction if

91
 r

Tricks to Make Porcelain Layering Easier

Figs 11-1 to 11-13 Fabrication of a multi-span fixed

partial denture.

Fig 11-1 First the anterior segment (A) is modeled and

fired: first bake.

Fig 11- 2 The posterior segments ( B) are fabricated

in a second step while the anterior segment (A) is
simultaneously corrected: second bake.

Fig 11- 3 The third step involves correction of the

posterior segments ( A) while the contour of the anterior
segment (A) is touched-up if needed: third bake.

Fig 11- 4 Example of a metal ce-

ramic fixed partial denture that has
been fabricated according to the
above-mentioned procedures.

92
 Layering and Firing of the “Dentin" Core

Figs 11-5 and 11-6 Fabrication of crowns for anterior teeth in two steps: (1) build-up of all labial surfaces in
accordance to the layering technique and the principle of lateral segmentation; (2) build-up of the lingual surfaces.
Obviously, esthetics are of major significance concerning anterior teeth. Therefore, we must concentrate particularly
on the labial surfaces during the procedure. The entire esthetic result depends on the layering and the segmentation
of the labial surfaces. The ceramist should not concentrate on the lingual surface and functional aspects until this
important step is completed.

Figs 11-7 to 11-10 If anterior teeth are to be restored and delicate effects within the tooth are important, the first part
to be built up is the dentin core and all desired effects; even transparent porcelain is applied at this stage. A first
firing follows and in the second step the incisal porcelain can be applied.

93
Tricks to Make Porcelain Layering Easier

Fig 11-11 Fabrication of a metal ceramic restoration. Fig 11-12 After the bake of the dentire core with all
First the dentin core and the transparent zone are built effects and the transparent zone, the position and func -
up and fired. This method facilitates the perfect position- tion are inspected, as is the space that must ultimately
ing of porcelain layers within the restoration and proper be provided for the incisal build-up. (A) Layering of the
control after the firing. (A) Transparent porcelain; ( B) incisal porcelain; ( B) transparent porcelain applied
dentin porcelain; (C) mamelon effects; ( D) dentin por- beneath the incisal porcelain.
celains of different saturation and hue.

necessary. Only when the second firing is then becoming softer to almost liquid at com-
performed is the incisal porcelain applied, pletion. For this purpose, a premium-quality
thus completing the build-up (Figs 11-7 to liquid is used to maintain a creamy consisten-
11-10). This method is also used for the lighter cy of the ceramic and thus preventing a
hues and positioning of transparent zones breakdown of the build-up (Fig 11-13).
(Figs 11-11 and 11-12).

Another Trick: Grinding the

Density of Porcelain During Incisal Guidance
Layering Procedure
In order to correctly adjust and grind the
In order to facilitate the layering and to secure incisal guiding path of two antagonistic fixed
the porcelain slurry in its position during partial dentures, a 50- m aluminum paste
modeling, the initial material must be dense
^
(Fig 11-14) is applied to the questionable incisal
and compact. The successive layers, how- edges. All mandibular motions are simulated
ever, should be less dense and softer, other- in the articulator. The paste is abrasive and
wise the layer beneath could be subjected grinds the guiding area of the articulating
to undesirable shifting. Application will be motion (Fig 11-15). The points of contact must
facilitated considerably if the incisal porcelain be totally congruent. The roughened surface
is of an almost liquid consistency. In brief , the of the porcelain must be repolished after the
basic mass should be dense and compact, grinding process (Fig 11-16).

94
 Another Trick: Grinding the Incisal Guidance

Fig 11-13 A premium-quality liquid is used for the Fig 11-14 Water/aluminum paste mix, grain size 50 urn.
modeling procedure. It maintains a creamy consistency
and prevents breakdown of the build-up (liquid N,
Ivoclar).

Figs 11-15 and 11-16 The aluminum paste acts as an abrasive. It facilitates the optimum adjustment of functional
incisal sliding areas. Note that the porcelain must be repolished with diamond polishing paste to smooth the
roughened surface.

95
12 Lateral Segmentation and Enamel Cracks

In retrospect, my early ceramic restorations complex part of a metal ceramic restoration

were remarkably simpler regarding the build- certainly is the incisal third of an anterior tooth.
up of porcelain layers. In those days, applica- Details are more subtle and colors more
tion of the new material did not allow time to discrete and translucent in this region, thus
experiment with special effects. I doubted creating additional problems. The vital ap-
whether it would ever be feasible to imitate pearance of anterior crowns depends to a
nature and create the illusion of a natural great deal on the design of the incisal edge.
tooth with ceramic restorations. Willi Geller It seems to be the zone of the imperceptible
was the first dental technician whose work characterization. But here, too, the interplay
imitated naturalness close to " perfection.” of shape and color contributes to a natural
Willi Geller doubtlessly represented one of appearance (Fig 12-1).
the first who used his outstanding abilities of Lateral segmentation is a vertical build-up
observation and application to create restora- of ceramic segments varying in brilliance,
tions that closely matched the original. His translucency, and color. This method is used
lateral segmentation technique seems as if for older as well as younger patients.
directly derived from the layering technique.
Today it appears difficult to fabricate natural
restorations that seem to be “alive.” The most

Fig 12- 1 The most esthetic part of

human teeth is the maxillary incisal
edge. It represents the most intricate
area to be reproduced - the details
are more subtle and the shades are
more discrete and translucent.

97
Lateral Segmentation and Enamel Cracks

Restoration and Segmentation influence the light in a “ retarding ” manner.

However, these streaks are usually smaller
for Teeth of Older Patients and represent overlaid oxides to create
enamel cracks.
In the teeth of older patients, color and bril-
liance contrast quite distinctly, and enamel
cracks act as discernible demarcation for
each segment. When we prepare the different Restoration and Segmentation
mixtures for our palette with the intention for Teeth of Younger Patients
of using different incisal colors, the variety of
brilliance and hue becomes predictable : Lateral segmentation of teeth for younger
slighly blueish , more opalescent , grayish , or patients is identical to that for older patients,
more reddish (S1, S2, S3, S4 of the Ivoclar with the only change being amount. The
set). When a fixed partial denture for the nuances in color, brilliance, and translucency
anterior region is to be fabricated, I prefer are more subtle and discrete. Once the
to apply a slighly blueish incisal color to the restoration is completed, the segments will
proximal area. The grayest segments are no longer be distinguishable. A large number
located in the center. The segments with of effects, however, create a vital appearance
more opalescent , lighter incisal colors are of the porcelain.
located discretely in between. In order to When using this lateral segmentation techni-
imitate one single tooth, we reproduce only que, the positioning of the segments must
the different nuances and their location within not be similar to that of piano keys. Their
the tooth dimensions and widths are not determined
The transparent porcelain applied to the by a general rule, nor is their shape totally
incisal edge (see chapter 10, “ Processing parallel or right-angled. The restoration should
and Natural Build-up of Dental Porcelain”) is be logical but without the rigidity of a
a combination of various hues. We are not machine or an instrument.
reluctant to use a whole set of different trans-
parent porcelains (T1, T2 , T3, T4 by Ivoclar) ;
these respective porcelains are slightly pink ,
blueish , more gray, and somewhat opales- Segmentation of Posterior Teeth
cent , and they enable us to create a slight
lateral segmentation during application. The Lateral segmentation is also used for
Maverick transparent porcelain set serves as posterior teeth. The basic shape of the tooth
an aid , too. These subtle color additions do is established first (the occlusal surfaces or
not need to be conspicuous, but they supply occlusion itself are not yet considered). We
the ceramic restoration with a vital begin with the labial portion and work
appearance. gradually around the tooth (Figs 12-2 and
12-3) . When the modeling of the basic shape
is completed , we fabricate the occlusal sur -
faces and occlusal contacts.
Segments of Different Opacity This technique is appropriate particularly
for the fabrication of large fixed partial
During application of the incisal porcelain the dentures. While we focus initially on the direc -
translucency of the segments is usually tion of the restorative process and then
varied. It is possible to mix dentin porcelain apply, step by step, the ceramic segments, a
with 50% of a neutral porcelain (eg, ID1, constant coefficient of moisture must be
Ivoclar) or an opaque dentin porcelain with a maintained. During the fabrication of fixed
neutral one (ratio always 1 : 1) . These partial dentures, the problem of drying of the
segments are more opaque and mask and porcelain occurs. If we apply the ceramic

98
 Enamel Cracks

'

>

Figs 12-2 and 12-3 The layering of the incisal edges of fixed partial dentures and crowns is performed by means
of the lateral segmentation technique. First , we begin at the mesial side of the labial portion and proceed gradually
» around the tooth to the point where we started from. Layering according to this method offers one major advantage:
the ceramic material maintains a constant degree of moisture without any alteration. Moisture is thus gradually
transported during layering of the segments. If we succeed in maintaining this constant degree of moisture during
the entire process, a key step in achieving a pleasant esthetic result has been done.

in just one direction, it will be possible to Third criterion: forceful condensation should
maintain moisture while working our way be avoided; it would result in a color shift and
around the restoration. A constant degree of an undesirable mix-up of all effects previously
moisture is crucial for vital-appearing restora- created with great care. Furthermore, the
4
tions and high-quality porcelain. condensed porcelain would be of lower quali-
ty after firing, because the material would
appear less penetrable by light. According to
the “ rule of colors” in painting, shifting and
i Modeling Criteria for Porcelain mixing render the restoration grayer.
of Superior Optic Quality The above criteria are the keys to success.
If they are ignored, the inevitable result will be
Three criteria must be met for a successful a lifeless restoration.
imitation of the vital appearance of a natural
tooth.
First criterion: the porcelain must be homo- Enamel Cracks
geneous and not too liquid; the ceramic
slurry must retain a certain shape when lifted Thorough observation of natural teeth dis-
by the point of the brush (Fig 12-4). closes, particularly during shade selection
Second criterion: the porcelain must be procedures, the common characteristic of
applied as rapidly as possible to avoid dry- enamel cracks (Fig 12-5). These cracks are
ing. Nothing adversely affects porcelain more generally delicate and light-colored in young
than drying and repeated wetting; layering teeth, more numerous and darker-colored in
carried out in that manner results in a restora- older teeth.
i tion devoid of any vital appearance. It is necessary to mimic these minute

99
Lateral Segmentation and Enamel Cracks

Fig 12-4 The porcelain must be homogeneous and

have a creamy consistency. A constant degree of
moisture must be maintained throughout the applica-
tion procedure.

Fig 12-5 If this tooth were to be restored, it would be

necessary to incorporate numerous enamel cracks. The
largest cracks are at the transitions to the proximal sur-
faces. Note the differently angulated directions of the
cracks.

defects, otherwise the ceramic restoration schematic distribution of the ceramic is iden-
could be taken for the replica of a natural tical with the case. This may be different with
tooth merely by name and not because of another clinical case (Figs 12-8 and 12-9).
appearance. Cracks convey the illusion of A well-defined streak of brown is applied to
increased depth. The technique of lateral the incisal third. It consists of equal portions
segmentation makes the fabrication relatively of dentin porcelain 2A, an intense brown ID6
simple. and orange ID3. This is covered by a precise-
Figure 12-6 shows a central incisor with ly defined layer of gray underlaid with a trans-
numerous cracks and light discolorations. lucent gray T3. Two of the dentin porcelains
Every effect and color characteristic has are important: a particularly light dentin por-
been imitated. For the purpose of copying celain 2A in the center as well as a less light
tooth 11, it was unnecessary to stain the sur- but rather yellow dentin 1C in the cervical
face. When the shade was selected, every third. The distinctly defined marginal area is
feature of the cracks was recorded in a built up using shoulder porcelain M3 and M4
scheme (Fig 12-7). The incisal third shows (ratio 3/4 : 1/4).
darker and wider cracks than the proximal Inside the oral cavity these cracks function
portion. In the center, on the other hand, like a vehicle for light and the phenomenon
the cracks are white, creamy, and more of refraction renders them visible; light seems
delicate. to “ paint ” the walls of these microfissures.
In the subdivision of the porcelain being Figure 12-10 shows the influence of light on
used for our restoration, it is obvious that the these cracks: viewed from different angles

100
i
Enamel Cracks

Fig 12-6 Tooth 21 is to be restored.

The adjacent tooth shows numerous
enamel cracks. For reasons of per-
fect adaptation, the technique of
lateral segmentation should be used.

Scheme of
enamel cracks

F. delicate white

M
D

i
F. brown and wide
Fig 12-7 Scheme of characteristics
of enamel cracks.

<

101
Lateral Segmentation and Enamel Cracks

M3 M4 Distribution
3p 1p of powders

o 6B + o 03 x
1/ 4 3/4
Gray
zone
D 2 A + iD 6 + iD 3
6p 3p 1p

Brown
streak
Fig 12-8 Different porcelain powders
are chosen during the shade selec -
tion process.

Fig 12- 9 Positioning of the ceramic

powders especially selected for the
individual clinical case shown. The
distribution must be adapted to each
individual case.

Fig 12-10 Light moves according

to the angle of the segments, alter-
ing their appearance from wide to
less wide.

102
 Enamel Cracks

Fig 12-11 (left ) The crack appears

fine when viewed directly. It is a 90
°
angle to the surface of the glass.

Fig 12-12 (right) The crack appears

wider when viewed from an angle
more oblique to the crack.

Fig 12-13 Effect colors (metal oxides)

are applied to the stress- bearing
segment.

the cracks apparently vary in width. A photo- oxides are applied with the small, flat marten's
graph of a cracked glass may serve as an aid hair brush no. 2. Prior to each application it
for better understanding this effect that light is absolutely necessary to rinse and clean the
has on enamel cracks (Figs 12-11 and 12-12). brush (a fingernail may be used as a mini
This is the principle we must adhere to for the palette). It is advisable to create an almost
creation of cracks in porcelain. Instead of light invisible crack , otherwise the crown may
“painting” the walls of a crack, it is the ceramist appear unrealistic. The metal oxides are
who applies metal oxides to the walls of the applied to the stress-bearing segment, work-
stress-bearing segments (Fig 12-13). ing from the incisal edge to the cervical
Cracks created in porcelain are artificial region (Fig 12-16). There should be no second
and we have to use staining colors to attain application, because this would create too
these effects (Fig 12-14). Metal oxides are big a crack. To make a crack clearly visible,
prepared in a saturated mix (Fig 12-15). The the angle of the stress-bearing segment is

103
Lateral Segmentation and Enamel Cracks

Fig 12-14 A variety of widths can

serve as an aid to give the lateral
segments different angles.

Fig 12-15 The effect colors are toned down while they Fig 12-16 A small, flat brush is used for the staining.
are mixed. The saturation must be adapted to the crack. The crack is “painted" in an incisocervical direction.

increased (120°) (Fig 12-17), and a transpa- ed” and the semiopacity of the segment
rent segment is superimposed on the struc- conceals the wall that is covered by metal
ture to act as a filter, similar to a fiberoptic lens oxides. Consequently, the crack appears
and thus making the crack conspicuous. This more delicate. Working with a variety of seg-
type of wider crack is usually found in the ment angles requires little experience and
proximal portion of teeth. can be quite satisfying in the attempt to copy
When fine and discrete cracks are created, nature.
the angle of the stress-bearing segment should The clinical result of the presented case
be 90° (Fig 12-18). The porcelain applied to is one such satisfying example (Figs 12-19
that structure should be a masking layer and and 12- 20). All in all, it shows that if enamel
act like a filter. A mix of dentin porcelain or an cracks are a characteristic of natural teeth,
opaque “dentin” and a neutral porcelain is they should be included in the restorations
generally used. The penetrating light is “retard- (Figs 12-21 to 12-23).

104
 Enamel Cracks

Transparent
Incisal Segment Segment

Wide Crack

Fig 12-17 The stress-bearing seg-

ment here shows an angle of 135°
(ie, wide open); thus, the crack
appears wide. To make this charac -
teristic salient, a segment of transpa-
rent material must be superimposed
on the underlying staining colors.

Fig 12-18 If the crack is to be

delicate and discrete, the stress-
bearing segment must exhibit an
angle of 90°. The segment that
superimposes upon the staining
colors must be masking and must
“ retard” the light.

Fig 12-19 Tooth 21 has been

restored with a metal ceramic crown.
The crown, which has been fabricat-
ed according to the lateral segmen-
tation technique and with incorporated
enamel cracks, adapts perfectly
to adjacent tooth 11. (Courtesy of
Dr Thierry Jeannin, Orange, France.)

105
Lateral Segmentation and Enamel Cracks

Fig 12-20 This view makes ap-

parent the perfect mimicry of the
enamel cracks incorporated in the
metal ceramic crown.

Fig 12-21 Another study of the incorporation of

enamel cracks.

106
 Enamel Cracks

Fig 12-22 The flat brush allows ready characterization of a surface on the
stress-bearing segment. The lingual view reveals the depths of the cracks,
which are discernible on the abraded incisal edges.

Fig 12-23 Teeth 11, 12, 13, 21, and 23 have been restored with metal
ceramic crowns. (Clinical work by Dr Daniel Gleyzolle, Avignon, France.)

107
 f

13 Transparency and Translucency

Transparency and translucency must not be nuances of color and brilliance. Consequent-
confused. The use of these terms in com- ly, it would be incorrect to use just one incisal
munication between dentists and technicians color for all teeth (Figs 13-1 to 13-5).
requires that we be specific. The term trans- Transparency of a natural tooth . Natural
parency applies to material that allows light to teeth are rarely transparent; only very young
penetrate, while objects behind still appear teeth show transparent zones at their thin and
quite clear. No light is reflected on the surface long incisal edges, usually between the
of a transparent material. mamelons, at the far end of the incisal edge,
The term translucency characterizes a and at the mesial and distal proximal sur-
material that does not allow the object behind faces. This transparency changes from gray
to be readily visible. Light must thus be to dark blue (Fig 13-6).
reflected to a certain extent and the material However, there are transparent zones in
is of more opaque appearance. older patients’ teeth, too. In general, these
Enamel. A tooth is entirely covered by enamel. teeth show considerable wear because of a
The enamel is more or less translucent distinct overbite; this situation leads to very
depending on the patient ’s age. Therefore, it sharp-edged abrasion facets. This situation
is not logical to restore different teeth with the originates from the extreme overlap and the
same translucent incisal porcelain. In addi- functional stress of the incisal edges. Dentin
tion, incisal edges incorporate numerous has almost completely vanished at the edges,

Figs 13 1 and 13-2 Cross sections

*

of natural teeth. Note the consider -

able thickness of the enamel and the
minor translucency.

109
Transparency and Translucency

Figs 13-3 to 13-5 Cross sections of natural teeth. These teeth exhibit enamel of much higher translucency. The
dentin shows translucent zones, too. These zones are not regular; they appear mainly in the periphery of the crown
and in random display.

and the very thin enamel layer shows a glass- incisal color is used, most likely the entire
like appearance. The color ranges from gray restoration will be gray when completed. In
to dark blue and is produced by the dark- order to avoid this "gray" mistake, colored
ness of the oral cavity (Fig 13-7). transparent porcelain and multicolored incisal
Working with transparent and translucent porcelain of varying translucency should be
porcelains. Beginners in dental ceramics used.
often misuse transparent porcelain, which Working with transparent material . This
can impart a glasslike appearance that ex- material must always be applied beneath the
hibits too much gray. If, on top of that, a gray incisal porcelain, as explained in the discus-

Fig 13-6 The incisal edges of

anterior teeth in a young person show
numerous subtle characteristics and
appear very translucent.

110
 Transparency and Translucency

Fig 13-7 (left) An older tooth restored in ceramic with

distinct, sharp wear facets because of a considerable
overlap of the anterior teeth. The incisal edge, which is
subjected to functional loading and therefore extremely
thin, exhibits very transparent zones. The incisal por-
celain is of a gray tinge and very translucent (2/3 neutral
powder + 1/3 incisal powder).
(right) A rather bright tooth (all-ceramic restoration). The
zones of transparency are quite conspicuous, too. The
entire surface was built up using only one incisal
porcelain.

Figs 13-8 and 13-9 All-ceramic restorations showing a distinct, dark blue, transparent seam (see chapter 14,
“ Original Colors in Dental Ceramics”). The incisal porcelain is semitranslucent (incisal powder S1 1/3 + 2/3 neutral
powder).

sion of the layering technique. Yet the trans- rent porcelain (see chapter 14, “Original
parent zone varies in thickness. If the trans- Colors in Dental Ceramics”). If the material
parent layer is meant to be a distinct feature, must imitate the appearance of a transparent
greater amounts must be applied in a precise- incisal edge, it should not be applied over a
ly specified manner. For example, the teeth of large surface area onto the dentin porcelain.
young patients with fine incisal edges are It would be advisable to cover the build-up
clearly transparent. In such cases, the trans- with a layer of semitranslucent enamel por -
parent material must be applied in an exact celain (Figs 13-8 and 13-9).
manner. We prefer a material that reflects In cases where transparency is desired
gray (T4 IPS/lvoclar) or a dark blue transpa- to be inconspicuous (ie, only slightly visible

111
Transparency and Translucency

V i
•

i
*

Fig 13-10 All-ceramic restorations. Figs 13-11 and 13-12 The same tooth as in Fig 13-10, illuminated from
The transparent porcelain has been behind. These figures clearly show that a pure incisal porcelain super -
applied under the pure incisal imposed on the transparent porcelain can mask the transparent zone on
porcelain. the facial side. Light can now freely circulate inside the tooth.

underneath the enamel), I prefer to use a generally is 2/3 incisal to 1/3 neutral powder
range of differently colored transparent or 1/2 to 1/2 or 1/3 to 2/3 incisal to neutral to
porcelains and not just one of gray color if obtain even more translucency. The translucent
possible. These layers that cover the dentin colors of the Maverick set are particularly
porcelain thin out to the central region. The good to work with. These basic colors, which
incisal porcelain instead should be less are mixed with a neutral powder at a ratio of
translucent and applied unaltered (S1, S2, 1 : 7, are well dosed and serve as an aid
S3, S4, S5) (Figs 13-10 to 13-12). to creating incisal color with yellow, honey-
Use of translucent material for incisal edges. colored, light-colored, and dark-colored reflec-
As we have discussed before, relating to the tions (Fig 13-13). This set of translucent colors,
layering technique, it is not desirable to choose which will be custom-made if needed, will
a single gray for the incisal build-up; rather a always have to be a mix of a neutral powder
colored material should be chosen. Admit- with an "intense” or dentin powder.
tedly, however, a tooth’s translucency is not These translucent colors fully cover the
always identical. Therefore, translucent colors tooth, thus increasing the sense of depth
should be used that match the color of a (Figs 13-14 and 13-15). However, this techni-
tooth to be restored. Our preferred set (S1, que requires remarkable experience in the
S2, S3, S4, S5) is reduced in saturation and field of dental ceramics. The student should
altered to a higher translucency by mixing use only "homeopathic” amounts in the
with the neutral powder ID1. The mixing ratio beginning to avoid early discouragement.

112
 Transparency and Translucency

Fig 13-13 Translucent colors of the

Maverick kit: honey, yellow, light
brown, and dark brown. These trans-
lucent colors can be used for incisal
edges as well as for subtle charac-
terizations.

Figs 13-14 and 13-15 Further stud-

ies of all-ceramic objects which
illustrate the possibilities transparent
and translucent zones can offer. The
extent of these zones depends on
the shape and size of the tooth and
the patient ’s age.

113
14 Original Colors in Dental Ceramics

At times even the most comprehensive- ® Transparent , dark blue porcelain. My

appearing set of dental porcelain colors may set of translucent powders does not supply a
require a custom mix. The painter ’s palette is dark blue. This particular color proves very
infinite, and the one a ceramist uses is enor- useful when incisal edges of high transparen-
mous, too. For this reason, I have standard- cy are built up (teeth of younger patients
ized certain colors. These colors are con- generally show this feature). The color is ap-
sidered indispensable. plied sparingly in quite distinct streaks con-
© Slightly milky, opalescent porcelain. fined to the incisal region (Fig 14-3). For
This porcelain is used quite frequently today. delicate situations, where subtlety and preci-
Many teeth exhibit opalescent zones, par - sion are required, this effect may be secured
ticularly lighter colors. This well dosed color by an advanced firing procedure, while the
(Fig 14-1) is suitable to be used as dentin restoration will later be completed with an
porcelain for the dentin core and as incisal additional firing. The amount of this porcelain
porcelain for milky-white incisal edges. This should not be too great in order to avoid any
opalescent material must contain a sufficient undesirable effects. The mixing ratio is:
amount of white without creating too opaque - 4 portions of blue powder ID9
an impression (Fig 14-2). This material is also - 3 portions of gray powder ID8.
used to form the summit of the cusp ridges (D Translucent , sun-colored porcelain. In
and the mamelons. The mixing ratio of this certain cases this golden-yellow porcelain
material is as follows: can be of great help, especially if a transpa-
- 6 portions of the neutral powder ID1 rent T4 that is too gray is to be replaced.
- 1 portion of the white powder ID2. Usually, it is applied beneath the incisal layer,

Fig 14-1 Four very useful original col-

ors for daily practice. From left: trans-
lucent dark blue powder, opalescent
white powder, mother-of -pearl-like in-
cisal powder, translucent sun-colored
powder (1-mm- thick samples).

115
Original Colors in Dental Ceramics

Fig 14-2 Note the dominant, slightly

milky/cloudy, opalescent shade of
these all-ceramic restorations. With
these powders we can fabricate
restorations that are brighter than
the most brilliant color of the Ivoclar
shade guide, without creating a
restoration that is too opaque. Note
the translucent, dark blue porcelain
that was applied on the incisal
edges in the background.

Fig 14-3 The blue translucency of

the incisal edges of this young pa-
tient ’s teeth is conspicuous. In cases
like this, the application of this trans-
lucent, dark blue porcelain is quite
suitable.

thus light can circulate inside the layer and a porcelain is suitable as covering material for
gray tinge is avoided. We can use the same the incisal region, and its color is relatively
material as a translucent powder to define the common in teeth of middle-aged or older pa-
"halo effect " at incisal edges (Fig 14- 4). The tients. This color, rarely found in ceramic
mixing ratio of this translucent material is: powder kits, serves indisputably as an aid. Its
- 8 portions of neutral powder ID1 fabrication, though, is considerably more dif -
- 1 portion of orange powder ID5. ficult. The mixing ratio is as follows:
© Mother-of-pearl-like incisal porcelain. - 5 portions ID1 (neutral) + 1 portion ID2
This material is used most frequently. (white)
Thorough observation of natural teeth prove - 3 portions ID8 (gray) + 2 portions ID7
the use of this specific powder indispensable. (pink)
This color corresponds to that of the internal - 2 portions ID9 (blue).
surface of an oyster shell (Fig 14-5). The Fabrication of these colors required numer-

116
 Original Colors in Dental Ceramics

Fig 14- 4 Metal ceramic crown on

tooth 21. In order to create a “halo-
effect " on the incisal edge, the
translucent sun-colored porcelain
was used. It was applied beneath
the incisal layer so that light can free-
ly circulate, but also for coverage of
the gray tinge of the transparent
porcelain T4.

Fig 14-5 These natural teeth show

the strong, mother-of -pearl-like shade
of the incisal edge, which resembles
the inner surface of an oyster We
have to use just this color to copy
nature.

ous experiments (Fig 14-6). This facilitates eva-

luation and measuring whether it is
equivalent to a ceramic layer that is
predominantly used in most cases. In daily
laboratory practice it is difficult to measure
the correct quantity. Consequently, the
material can neither be mixed instantly nor
be stored.
If the mix is insufficiently homogeneous, it
is likely to incorporate undesirable and un-
intended effects. My color palette, soon to be
commercially available, will be a time saver.

117
Original Colors in Dental Ceramics

Fig 14-6 Much experimenting was

done to accomplish a method of
mixing for these powders.

118
15 Porcelain Inlays and Onlays

In 1886, a certain Mr Land introduced ceramic once they are cemented. The absence of
as a material for dental applications. The metal creates unmatched esthetics and
reason and the objective was the fabrication reduces the problem of metamerism. A whole
of a porcelain jacket crown that was fired new generation of reinforced porcelains with
onto a platinum foil matrix . During the follow- nonmetal or aluminum substructures has
ing period of 15 years, porcelain inlays and identical properties (see chapter 16, “ Leucite-
onlays were subjects of somewhat enthusi- Reinforced Ceramic”).
astic acceptance that dwindled only after Here again it is necessary to work with nu-
numerous cases of failure because of fractur- merous nuances and subtle colors in order to
ing of the conventionally cemented (zinc obtain satisfactory results. An inlay fabricated
phosphate) restorations and after Taggaret ’ s with one single dentin or incisal porcelain
invention of the lost-wax principle and casting would appear totally lifeless after cementation.
technique. The interaction of shape and color becomes
The first inlays and onlays made of dental even more obvious regarding successful
ceramic were fabricated as early as a hun- restorations of this kind (Fig 15-1) .
dred years ago. As a matter of fact, they
preceded gold inlays but fell into oblivion for
many decades. The development of precise
refractory dies, the acid-etch technique used General Criteria for Preparation
for enamel and porcelain, silanation of of Ceramic Inlays and Onlays
adhesive polymers, and the development of
glass ionomer cement and new porcelain In contrast to cavity preparations for gold
materials rehabilitated their clinical indication inlays or onlays, the cavity preparation for
recently. These restorations now provide in- porcelain inlays and onlays should not have
creased reliability and undeniable esthetic axial walls that are too parallel (Fig 15- 2) . The
qualities. friction exhibited by the inlay during try- in and
In chapter 10 it is described how interesting cementation should be gentle; silanation and
sectioned teeth can be; collecting cross sec - adhesive cementation provide sufficient reten-
tions and photographs of teeth can serve as tion. No bevel or chamfer is prepared at the
an aid in the attempt to imitate nature. These cervical margins, but a groove is prepared in-
cross sections (they represent quite valuable stead with a round bur (Figs 15-3 to 15-6).
material for instruction purposes) enabled the That depression provides an extension of the
development of our layering technique, which corrodible enamel surface. No undercuts or
uses more saturated colors in the center and 90° line angles at the cavity floor should
less saturated ones at the surface. It can be exist (Fig 15-4) .
used to fabricate both porcelain inlays and
onlays. Their amazingly fine adaptation to
natural teeth is a frequent cause for surprise,

119
Porcelain Inlays and Onlays

Fig 15-1 Two inlays on teeth 35

and 36 These inlays have been
integrated in demineralized teeth of
a skull. The objective of this study
was not to fabricate monochromatic
inlays and virtually restore the teeth
the way they looked before The mam
reason was to experiment with colors
and shape in order to reconstruct a
certain lifelike appearance.

Fig 15-2 Preparation for a ceramic inlay. In contrast to Fig 15-3 The margin formation should result in a semi-
gold inlays, where the axial walls must be as parallel as circular groove.
possible in order to provide for the necessary friction
the internal angles are much wider for ceramic inlays
( A). Friction is not the most important criterion, because
we relate to adhesive techniques of cementation Con-
sequently, the preparation has to be modified

120
 Preparing the Working Cast

Fig 15 4 ( A) A semicircular formation of the finish line.

*

(B ) The cavity floor should be rounded (ie, there should

be no 90° angles).

Fig 15- 5 The circumferential groove is best prepared

with a round diamond (C) This semicircular groove,
which must be placed in the enamel ( A), increases the
portion of the enamel surface that can be used for the
etching procedure, thus also increasing adhesive reten-
tion. Furthermore this preparation creates a satisfying
transition between enamel and porcelain The latter is
particularly significant if a transparent porcelain will be
used for the margins of the inlay

Fig 15- 6 Cross section of a natural tooth. ( B ) Semi-

circular groove in the enamel layer ( A)

Preparing the Working Cast using the Cosmotech investment (GC Inter-
national). I prefer this particular investment
After the impression is prepared in the usual because of its precision and surface hard-
manner and the working cast is fabricated ness. Only an investment material that is
using the Pindex system , we denude the of absolute resistance can reproduce even
margins if needed . A crayon is used to mark the most minute detail of the finish line with
the finish line and the preparation is thinly the required accuracy. The refractory die is
coated twice with an ivory-colored die spacer fabricated by means of the Pindex system
(Fig 15-7). This primary cast serves for trial using nonflammable pins by Optec (Fig 15-8) .
seatings of the inlays after the firing. An initial These pins will withstand the necessary fir -
check reassesses the occlusal situation and ings unaltered and may be helpful for con-
contact points. This first cast is duplicated densation, because they can act as a handle

121
Porcelain Inlays and Onlays

Fig 15- 7 The finish line is marked with a crayon, and

two coats of ivory-colored die spacer (Symphyse,
Marseilles, France) are applied to the inlay cavity.

Fig 15- 8 A refractory die model (Cosmotech . GC Inter -

national) is cast by means of the Pindex system; non-
flammable Optec pins are used .

Fig 15-9 A nonflammable pencil is used to mark the

preparation margin of the inlay cavity on the die. A
clearly visible finish line is very useful for successive
firings

when holding the die with tweezers. The Thermal Processing

refractory dies are separated and the finish
line is trimmed if necessary.
of the Investment
The Cosmotech investment is white. Its color
Prior to the first steps of the procedure, the
is an important detail, because it helps one to
investment must undergo thermal treatment:
detect any mistake regarding color during
a drying out period of 1 hour at 700°C should
the initial check after the firing. Investment
be allowed in a preheating oven. After all
material of a more intense color can influence
gases, particularly ammonium gases that are
the result and be the source of mistakes.
detrimental to the longevity of ceramic fur-
naces, have evaporated, the dies are removed
from the oven and bench-cooled. The margin
is then marked with a nonflammable pen; the

122
 Modeling of a Medium-Sized Inlay

Figs 15-10 and 15-11 Wash bake Transparent porcelain T4 is applied uniformly to the prepared portion of the die.
The application should be extended beyond the finish line The slurry is applied with maximum condensation ( A )
Transparent porcelain T4; (B ) transparent porcelain applied beyond the prepared portion

marking is important especially with regard to the covered area slightly over the margin.
the firings of the porcelain (Fig 15-9). This thin layer is thought to reinforce the
As a second step and completion of the angles of the preparation and to supply a
thermal treatment, a firing sequence is per- protective layer for the successive modeling
formed. The die is placed in a ceramic fur- of the porcelain, because ceramic tends to
nace and vacuum fired. The initial temper - dry out rapidly (Figs 15-10 and 15-11).
ature of 700°C is raised at a rate of 55°C per The transparent layer should be as thin as
minute to a final 1,000°C, which should be possible, avoiding the application of too much
maintained for 5 minutes. All inlay restora- porcelain to the internal line angles. In order
tions fired on refractory dies require several to attain sufficient impregnation of the por-
firings, and it is impossible to fabricate por- celain, you should condense maximally. The
celain inlays with just one bake. The attempt inlay must be dried prior to the firing for
to fire too much bulk of porcelain at a time will approximately 10 minutes according to a
inevitably result in detachment of the porcelain program similar to a bisque bake. After the
from the investment material. Therefore, the firing the transparent layer should be virtual-
modeling procedure is preferably subdivided ly undetectable. Neither microfractures nor
into several steps, and an extended firing cycle detachments of the porcelain should exist.
will generate better results. Second bake - firing the “ intense” por-
celain. During this bake the first layer of por-
celain is applied. This must be the most
Modeling of a Medium-Sized saturated and most basic of all layers accord-
Inlay ing to the layering technique. After moisten-
ing the die with distilled water, an orange
First bake - wash bake. This significant step porcelain is applied to the floor of the cavity
involves an attempt to produce a perfect bond in order to mimic the color of the pulp. This
between the porcelain and the investment substance acts as an iridescent. The kind of
material. Transparent porcelain T4 is applied orange to be selected depends on the pa-
to the prepared portion of the die, extending tient ' s age. Orange-brown ID4 is suitable for

123
Porcelain Inlays and Onlays

Figs 15-12 to 15-14 Pnor to the firing

of the “intense ' porcelain, an intense
orange is applied to the floor of the
cavity ( A). This material should mimic
the color of the pulp and is the most
saturated of the colors. The thick-
ness of the layer depends on the
depth of the cavity The deeper the
cavity, the more intense the orange,
and vice versa.

124
 Modeling ol a Medium-Sized Inlay

Figs 15-15 and 15-16 Firing of the " intense" porcelain. The intense orange (MV. Maverick kit), is applied to the floor
of the cavity ( B ) All margins are covered with transparent porcelain T4 without extending the application over the
finish line ( A) This should create an optimal color transition from the ceramic to the enamel surface. In the center,
the porcelain is cut through to the cavity floor. This cut effects a directed firing shrinkage from the center to the
periphery, thus preventing a detachment of the material from the cavity walls.

all teeth of middle-aged or older patients, and bake medium- sized inlays at one time
whereas "straw-colored,” orange ID3 suits without an intermediate firing of the dentin
the teeth of younger patients. The amount of porcelain. Occlusal surfaces are completed
orange depends on cavity depth . The according to conventional procedures. The
deeper the cavity the more intense the occlusal fissures are carved in the unbaked
orange should be, and vice versa (Figs 15-12 porcelain using a fissure-spatula, not a rotary
to 15-14). instrument.
A masking dentin porcelain is applied to Utmost precision and care is exercised
the upper region of the cavity (dentin-opaque when modeling the inlay in slight supraocclu-
by Ivoclar), and for completion, the transpa- sion in order to compensate for firing shrinkage
rent material T4 is used again thinly all along (Figs 15-17 and 15-18) . After firing, occlusal
the margin to finish the build-up. However, adjustment by selective grinding must be
this time the area of application is not extend- performed to conform to the individual situa-
ed over the cavosurface junction. The trans- tion.
parent porcelain T4 should create an optimal By means of simultaneous firing of dentin,
transition of colors from porcelain to the incisal, and transparent porcelains, the final
enamel surface (Figs 15-15 and 15-16). contour of the inlay is virtually established.
Once the “intense" material is applied, the The articulator is used to detect and adjust
porcelain must be cut in a mesiodistal direc- premature contacts if necessary. The fissures
tion through to the floor of the cavity. This cut are wider than usual, and often cusp ridges
causes a controlled shrinkage from the center are not quite correct (Fig 15-19). Only one
to the periphery during the bake, thus pre- additional firing will be necessary.
venting a detachment of the porcelain from .
Correction bake This sequence of the
the cavity walls. Allow the die to dry for 10 firing procedure should complete the final
minutes before the saturation bake. The firing contour, eliminate small defects, fill in voids
cycle is identical to the wash bake. and microfractures, and narrow the fissures.
Firing of the completed inlay. I build up These corrections are made using incisal

125
Porcelain Inlays and Onlays

Figs 15-17 and 15-18 In just one single step, the modeling of the inlay is completed, including the use of numerous
subtle color nuances. According to the principle of layering (ie, saturated color in the center and lightest color at the
periphery), layer by layer of dentin porcelain is applied. With a spatula the fissures are carved into the still-plastic
porcelain. ( A) Glossy areas; (B) opalescent areas; (C) mother-of -pearl-like areas; ( D) cusp summits colored with
opaque dentin porcelain

porcelains that are vanilla-, mother - of - pearl-

colored, opalescent, etc.
Thorough observation of a patient ’s natural
teeth readily discloses these innumerable
nuances. Even though these effects may be
minute it would be a misconception to look at
them as mere caricaturistic details. Equilibrium
of these numerous nuances gives the inlay its
natural appearance. Once again, the inter-
action of shape and color creates an "alive”
impression (Figs 15-20 and 15- 21).
Only after this firing sequence, when the
occlusal fissures have been narrowed, is the
grinding for occlusal adjustment performed.
Now that the basic shape is accomplished,
we can study the surface structure (Fig 15-22)
Fig 15-19 Inlay after the bake. Note; the orange color
acts as an iridescent , and the minute color nuances are and its macrogeography and microgeography
discernible. The margins of the inlay are precisely using the polishing kit (see chapter 19, "Ana-
where the nonflammable pencil has marked the finish lysis of the Surface Structure - Polishing ”).
line.
It helps to refer to photographs, extracted
teeth , and working casts.
The inlay is then placed in the furnace to
attain a low gloss. Provided there is sufficient
space, minor corrections of the porcelain can
be made. Then the inlay is vacuum fired. It is
removed from the muffle and is polished to a
high gloss (Fig 15-23) (see chapter 19).

126
 Modeling of a Medium - Sized Inlay

Figs 15-20 and 15- 21 Correction bake The correction bake completes the form, remedies deficiencies, and fills in
possible cracks, it also serves to narrow the fissures. 1hese corrections are made with incisal powders colored vanilla,
mother - of - pearl, or opalescent . ( A) Correction with opaque dentin powders; ( B ) opalescent corrections; (C) correc -
tion with dentin and transparent powder . ( D) mother of - pearl-colored corrections

Fig 15- 22 Inlay after the correction bake The main Fig 15-23 The finished ceramic inlay after polishing.
interest is focused on the surface structure after the This last step must be performed with the inlay seated
occlusal and functional relations have been inspected . on the die to prevent fractures.

127
Porcelain Inlays and Onlays

Modeling of Smaller Inlays Glaze bake. Low gloss is required. The inlay
is vacuum fired and the glaze bake is done
Small inlays can be fabricated much quicker. concurrently with the correction bake. The
The firing cycle is reduced, so that only two low gloss should be preserved throughout
bakes will remain. the procedure. After the firing , polishing is
First bake - wash bake. The transparent performed with the restoration seated on the
porcelain T4 is used; this is inevitable if the refractory die to avoid undue pressure exer-
modeling is to be performed on a refractory tion and protect the inlay from fracturing.
die. This very thin film of porcelain should be
virtually invisible after the firing.
Second bake - firing the “ intense” por - Modeling of Large Onlays
celain. An orange porcelain is applied to the
center. It should mimic the color of the pulp. Very large onlays are not to be built up at one
This material should be thicker in the center time. First only the dentin porcelain, which is
of the occlusal surface, thinning out to the thought to form the dentin core of the onlay,
margins. If we adhere to this recommenda- is applied. This first layer is fired (Figs 15-24
tion, the orange material will be iridescent. to 15- 27) . Very large restorations, which are
The transparent porcelain is applied at the built up on refractory dies to prevent the
margins, always bearing in mind not to ex- detachment of the porcelain from the invest-
tend over the finish line; once the inlay is ment , are fabricated in this manner. This
cleaned of all investment , it may be difficult to method is recommendable for metal ceramic
correct these overcontoured areas. A mask- restorations of anterior teeth as well (see
ing dentin porcelain (opaque dentin) is ap- chapter 11, “ Tricks to Make Porcelain Layer-
plied to the most superficial portions of the ing Easier ”). It helps control the application of
cavity if necessary. the dentin porcelain and also helps one
After the application of the “ intense” evaluate the effects and characterizations
material, the ceramic is cut in the center. This deep within that layer. Even control of the
entire sequence of the procedure is identical occlusion is possible by means of selective
to what has been described for medium- sized grinding of the occlusal contacts.
inlays. A variety of porcelain powders is used
Firing the completed inlay. The inlay is built to form the dentin core with the layering
up at one time. Again the layering technique technique. The palette of colors, which we
is used - from saturated to less saturated established earlier, already contains a number
porcelain powders, where a maximum of of nuanced colors. In more opalescent ,
subtle vanilla-, mother- of -pearl-, and gold- yellowish , vanilla-colored , and mother - of -
colored ceramic powders is used. The inlay pearl-like regions, as well as for the cusp-
is more overcontoured than a metal ceramic cones an opaque dentin porcelain is applied
restoration would be, the reason being a (Fig 15- 26). All of these small details under-
disproportion of the appropriate thickness lying the transparent and incisal porcelain
inside the inlay cavity, and the fragility of the layers contribute to a more vital and natural
margins. appearance (Figs 15- 28 and 15- 29) . The
When the inlay is removed from the onlay is placed in the furnace for 9 minutes
furnace, its occlusal anatomy should be to be dried, and a conventional dentin bake
almost established without any detachment is carried out.
of the porcelain. Small inlays usually show After the firing, the surface must be ground
less dimensional discrepancy. The occlusion to a matte finish to facilitate and improve
is inspected and the surface structure is bonding to the successively applied transpa-
established . Detected voids are filled in, and rent and incisal porcelains. With the applica-
the floor of fissures may be characterized. tion of additional effects and the incisal

128
 Modeling of Large Onlays

Fig 15*24 Wash bake of a large-

sized onlay ( A ) Transparent powder
T4, ( B ) transparent powder extended
over the cavity margins.

Fig 15-25 Firing of the " intense”

porcelain. The ceramic material must
be cut m the center to control
shrinkage An opaque dentin ( B )
is applied to the highest points of
the cavity The margins receive a
layer of transparent porcelain ( A).
(C) Intense orange MY

Fig 15-26 Very large onlays should

preferably be modeled only with
dentin and effect porcelain, which
represent the dentin core ot the
onlay. Very large restorations, which
are built up on refractory dies to
prevent the detachment of the
porcelain from the investment , are
fabricated in this manner. ( A) Cusp
summit with opaque dentin; ( B ) trans-
parent margins; (C) slightly saturated
dentin powder ; ( D) opalescent
region; ( E ) more saturated dentin
powder in the center.

129
Porcelain Inlays and Onlays

Fig 15-27 Modeling ol the onlay

is completed with the applica-
tion of the incisal and effect
powders. The colors we used are
from the IPS Classic and Maverick
kit by Ivoclar. (A) Intense orange
MY; ( B ) opalescent area 101 + T4
(C) cusp summits of opaque dentin
powder ; (D) incisal porcelain of vary-
ing brilliance; (E ) vanilla-colored areas
B-LB5; (F) gray-brown powder B-DB3;
(G ) yellow areas BY3

Figs 15-28 and 15-29 Cross section

of an onlay in order to illustrate the
layering technique and the principle
of saturated colors in the center and
decreasing saturation toward the
periphery. Note the enamel super -
imposed on the transparent porcelain.
This is a very ‘useful example to
demonstrate all the various charac-
terizations as well as the interplay of
shape and color. ( A) Opalescent
areas ID2 -f D1C; ( B ) brown metal
oxide 107, (C) incisal powder S1. ( D)
transparent margins T4; ( E ) orange
dentin powder M-HY; ( F ) dentin
powder 1C; (G ) dentin powder 1C +
vanilla-colored powder

130
 Removal of the Inveslment

Fig 15-30 Onlay after the glaze

bake: low gloss achieved Now the
onlay can be polished to a high
gloss

porcelain, the modeling is completed Gold inlays must exhibit strong friction; this
(Fig 15- 27). At the end of the entire pro- is not so with ceramic inlays, because they
cedure, the onlay is treated in the same man- attain a tight seal by silanation and adhesive
ner as described for small and medium- sized cementation. Too much friction would incor -
inlays (Fig 15 - 30) . porate an additional risk at try-in. If you
encounter a case of problematic friction that
is difficult to localize, use a blue friction paste
Removal of the Investment included in the Empress (Ivoclar) kit. The
paste must cover the underside of the inlay.
Removal of the investment is a difficult but Thus, after trial seating of the restoration, the
important step. In order to guard against frac- areas of tightness are readily discernible and
turing, the inlay, which is seated on the refrac- can be reduced. For this task, a dissecting
tory die, is invested in silicone compound; the microscope with considerable magnification
marginal region is covered (Fig 15-31). As should be used.
soon as the compound has set , the invest- Occlusal conditions cannot be inspected
ment can be removed with an air abrasion during trial seatings of ceramic inlays and
unit, abrasive glass beads, and the pressure onlays; this is done after cementation
of 3 bar. Thus, the fragile margins as well as (Fig 15-33) . To do so at an earlier stage may
the whole restoration will be protected. The put the restoration at risk.
underside of the onlay has a gentle, matte After the last inspection of the marginal fit
gloss, and even the finest detail at the and occlusion in the articulator, the inlay is
margins will be preserved after air abrasion completed. Now the etching must be done.
because of the silicone (Fig 15-32) . An etching gel is used that contains hydro-
Inspection of the marginal fit. The use fluoric and sulphuric acid (Symphyse.
of the investment material (Cosmotech, GC Marseilles, France). The gel is applied to the
International) facilitates precise dental ceramic underside of the inlay and allowed to stand
restorations. Possible overcontouring can be for 3 minutes. Accidental application to the
corrected with abrasive stones. This correc- occlusal surface must be avoided by all
tion is made easier if the margins have been means. The inlay is rinsed thoroughly with a
marked with a special nonflammable pen. strong spray to remove the gel. It is placed on

131
Porcelain Inlays and Onlays

Fig 15-31 Inlay on the refractory die

invested in a silicone compound.
As soon as the silicone compound
has set. the investment material is
removed with an air abrasion unit
without endangering the margin of
the restoration or the risk of fracture.
Air abrasion is performed with glass
beads and 3 bar of pressure. The
silicone is later removed with a
scalpel.

Fig 15- 32 Underside of a ceramic onlay. Note the Fig 15-33 The occlusal view reveals all subtleties of
orange-colored material mimicking the color of the pulp characterization , which provide an “alive appearance.
and the margins of transparent powder.

a nonflammable cotton-wool pad and placed firings are required. This high- quality integra-
in the furnace for 15 minutes at 550°C. After tion in the patient ’s mouth is the sum of im-
this treatment, which removes all acid portant parameters: the interaction of color
residue, the inlay is ready for adhesive and shape, good teamwork, and a mutual
cementation. understanding between dentist and dental
The fabrication of ceramic inlays is quite an technician.
exciting procedure. The dental technician
must precisely follow the procedures in order
to create a successful inlay (Figs 15-34 to
15-39). The single step of the procedure is
not particularly time consuming , but multiple

132
 Removal of the Investment

Fig 15- 34 Porcelain onlay on tooth

35. Note the delicate fissures
(Courtesy of Dr Bernard Touati,
Paris, France.)

Fig 15-35 Porcelain onlay on tooth

26. Very satisfying mimicry with natural
teeth. (Courtesy of Dr Bernard
.
Touati Paris, France.)

Fig 15- 36 Porcelain onlay on tooth

35 Note the opalescent and vanilla-
colored areas. Good color adapta-
tion with regard to the enamel of
the natural teeth. (Courtesy of Dr
Bernard Touati, Paris, France.)

133
Porcelain Inlays and Onlays

Fig 15-37 Porcelain inlay on tooth

16 This poor color is a result of the
application of too strong " intense'
colors beneath the incisal layers. If it
is difficult to evaluate the influence of
the underlying colors, the applica -
tion of transparent powders at the
margins is not recommended.

Fig 15-38 Porcelain inlays on teeth

.
44 and 45 immediately after adhesive
cementation. The margins are still
visible.

Fig 15-39 After the final polishing

inside the patient ' s mouth, the con
spicuous margins become indis-
cernible. The color transitions are
very satisfactory. This work is an apt
example of successful teamwork and
mutual understanding between den-
tist and dental technician

134
 Natural Appearing Fissures

Natural-Appearing Fissures
Restorations with fissures that strongly re-
semble wide and straight canals are a famil-
iar sight. They do not exhibit the slightest sim-
ilarity to natural occlusal fissures. To remedy
this deficiency, esthetic and functional aspects
must be coupled . If we study natural teeth
(which should always be at hand) , certain
irregularities can be observed. The fissures
are not arranged in a straight-line pattern;
they are curvy and go up and down, not
unlike a sine curve (Fig 15- 40). Standard
restorations are all too often recognized as
“ prostheses" ; they are too regular in form ,
color, and fissures. Once integrated in the
mouth, the result can be rather disappoint-
ing. Therefore, we must struggle against rigid
methods that produce stereotyped restora-
tions. We must try to approach nature as
closely as possible, because nature has pur -
posefully created irregularities in symmetry.
A small, flat -edged spatula which is bent at
its rounded end is the instrument for model-
ing fissures in porcelain. Playful use of this Fig 15- 40 If we study occlusal surfaces of natural
spatula and the creamy porcelain mix teeth, we can observe that fissures are not arranged in
a straight -line pattern On the contrary they are curvy
creates occlusal surfaces that look ‘alive.” We and go up and down, not unlike a sine curve. This is
pick into the fossae of the main fissures, come caused by the ridges of the two cusps.
back to the surface, go down to the floor of
the fissure again, and finally smooth the
fissure at its summit. This pattern of move-
ments forms small enamel ridges that create
vitality (Figs 15- 41 to 15- 43). The acute point
can be used to narrow the fissures at this
stage (Fig 15- 44). Meanwhile, occlusal con-
cepts must not be neglected; they are of first
priority. It is not time-consuming to create
occlusal surfaces that way; it is significant ,
though, to maintain moisture and plasticity so
that the porcelain is not prone to cracking.
After the modeling procedure, the somewhat
dry porcelain is brushed with a flexible brush
(particularly the occlusal surface) in the direc -
tion of the fissures (Fig 15-45).
During the first bake the porcelain shrinks;
small portions will shift dimensionally. The
fissures will look natural thereafter. In par-
ticular. the floor of the fissures will be distinctly
visible without the use of even the smallest

135
Porcelain Inlays and Onlays

Fig 15-41 Spatula tor the formation of natural-looking

fissures ( A ). It is a small , flat- edged spatula that is bent
at its rounded end. With this spatula, ( le. its rounded
end), we pick into the fossae and preform the shape of
cusps out of the porcelain

Fig 15-42 Cross section of a metal ceramic crown ( B ).

The spatula is used to fabricate natural-looking fissures.

Fig 15- 43 The fissure is formed in the ceramic slurry.

Note the degree of moisture on the material.

Fig 15-44 The acute point of the modeling brush is

suitable for narrowing the fissures and creating small
enamel ridges.
Fig 15-45 When the modeling is finished, the occlusal
surface is smoothed with a very flexible brush, always
working parallel to the fissure direction. At this stage it
is important that the porcelain be somewhat dried.

136
 Natural Appearing Fissures

Fig 15 - 46 During the second firing the fissures can be Fig 15 - 47 The crown is placed on a nonflammable
narrowed with the point of a modeling brush To mix the cotton- wool pad. We allow an extended drying period
powder we use a high- viscosity liquid ( glazing liquid). (4 minutes) in order to completely remove the high *

This should prevent the correction porcelain from dry- viscosity liquid.
ing out prematurely.

grinder. Thus, we obtain natural-looking fis- As we have seen, fissures of ceramic

sures without the need to use rotary in- restorations can look natural (Figs 15- 48 to
struments. 15-53). The use of rotary instruments should
During the second bake, the fissures can be strictly avoided.
be narrowed with the point of a modeling
brush (Figs 15-46 and 15- 47) .

137
Porcelain Inlays and Onlays

Fig 15-48 Metal ceramic crowns

Note the natural - looking fissures The
interplay of shape and color is clearly
visible.

Figs 15- 49 and 15-50 Porcelain onlays. The natural looking fissures are delicate.

Fig 15-51 Empress ceramic restora-

tions on teeth 13, 14, and 15. (Courte-
sy of Dr Michel Canazzi. Caderousse,
France.)

138
 Natural - Appearing Fissures

Figs 15-52 and 15-53 Fourteen

metal ceramic crowns in situ (Cour -
tesy of Dr Luc Portalier. Aix en Pro-
vence, France )

139
140
16 Leucite-Reinforced Ceramic

Currently, there are some exciting new devel- restoration (the necessary extended drying
opments in our profession; the properties cycles would consume time, because we
of materials and the applied techniques could not afford to leave the furnace). Fur -
are constantly improving. New nonmetal thermore, there is no risk of warpage, which
porcelains, which are reinforced with leucite, often occurs when working with refractory die
possess incomparable esthetic qualities. The models, where application of proximal con-
absence of metal, or aluminum substructures tacts or correction of color and occlusion re-
eliminates even the slightest hint of reflection quires reinvestment for several successive
within the restoration. Light can circulate firings.
inside and even penetrate the restoration,
which is very similar to what happens inside
a natural tooth. Furthermore, the phenomenon
of metamerism , well known in the field of IPS Empress: A New
metal ceramics, will be reduced. Technology in Dental Ceramics
All these characteristics contribute to the
success of porcelain restorations and help to History
make the ceramist ’s task easier. These new
porcelains may also help provide a satisfying The Greek word " keramos” means pottery or
prosthodontic result for patients who demand " fired matter.” Humankind has known about
a highly esthetic restoration. fire for 400,000 years, and the first specimens
Empress System (Ivoclar). In June 1990, of “ fired matter ” are dated from 23,000 BC.
a new system was introduced to our labora- From the first simple objects made of soil and
tory : IPS Empress by Ivoclar. This unique clay, the use of “ fired matter ” changed and
system is particularly satisfying because of its developed with experience, from the Stone
simple and uncomplicated method of pro- Age to space technology and to the high
cessing. There is no need to alter established technology of the twentieth century.
laboratory procedures, because this new The French chemist Duchateau is said to
system proves very similar to the lost - wax have first used porcelain as a dental material
technique. It is also possible to make use of in 1776. The Parisian dentist Dubois de Che-
the layering technique. But most of all, we mant developed this idea further, and in 1788
can adhere to the principle to begin the the first artificial teeth made of porcelain were
build-up with a colored ceramic core, thus produced. At the beginning of this century
influencing the color of a restoration from the the porcelain “ jacket " crown as a prosth-
inside (see chapter 10, " Processing and odontic restoration for severely damaged
Natural Layering of Metal Ceramic"). teeth was introduced by C.H . Land. This kind
In addition, a significant advantage lies in of restoration was widely used until the
the fact that there is no need to fabricate and advent of porcelain-fused-to-metal crowns in
work with a refractory die while modeling the the 1960s.

141
Leucite-Reinforced Ceramic

Thanks to new technologies and materials, The application of glass ceramic as a

the all-ceramic crown was revived in the early dental material was attempted in 1968 by
1980s, because metal ceramic crowns did MacCulloch. However, it took 20 more years
not measure up to increased esthetic until the companies of Corning and Dentsply
demands. were able to bring the first commercially avail-
The forerunner of these nonmetal ceramic able product on the market . The introduction
crowns may well have been the Dicor and of "castable” ceramic was undoubtedly a
Cerestore Systems. The potential for esthetic significant step in the history of dental ceramic.
restorations using these systems initiated the It created remarkable interest among experts,
introduction of other ceramic systems with which was reflected in the large number of
which crowns, inlays, and veneers could be publications. At about the same time, research-
fabricated on refractory dies; the systems ers at the University'of Zurich tried to develop
were marketed under names such as For- heat-pressed ceramic as a prosthodontic
tune, Hi-Ceram, Mirage, and Optec. material, which was later marketed by Ivoclar.
The Achilles’ heel of ceramic materials is Investigations in literature (a prerequisite for
brittleness and, consequently, a tendency to patent registration) later revealed that this
fracture. It was assumed that atomic bonds idea had been published as early as 1936.
would provide adequate strength. However, The systematic development of a specific
this expectation cannot be fulfilled in practice, type of glass ceramic not only helped ac-
because of the phenomenon of microscopic complish objectives like improvement of
surface defects, which propagate under stress strength and esthetics, it also perfected a
and ultimately lead to gross fractures. system with a simplified method of fabrica-
One of the current developments for tion. A 3-year clinical trial phase confirmed
decreasing the tendency to fracture is the in- expectations. The following pages present
corporation of fibers. However, their fabrica- the materials and the applied method.
tion and application in the field of dental
ceramics are still in the initial stage.
Another approach for minimizing the pro-
pagation of microfractures and thus improv-
ing porcelain strength is glass ceramics.
Characteristic for this material is the controlled
crystallization of glass. The process forms a
two- phase crystalline material with a relatively
high proportion of a vitreous matrix . Because
of nucleus formation and crystal growth,
microcrystals are formed throughout the
entire glass matrix if the correct temperature
is maintained. These nuclei are either a latent
function within the glass or intentionally in-
troduced and finely dispersed.
The heterogeneous structure of the material
and/or the generation of compressive stress
at the phase interfaces results in a consider -
able increase of strength and decrease of
tendency to fracture.
Thanks to these major advantages of the
new technology, a large variety of applica-
tions has been created for vitreous materials,
including dental technology.

142
 The Material

The Material Composition of the basic glass ( wt /%)

Oxide Melt 1 Melt 2
General View
Si02 63.0 61.0
A colorless base material that exhibits suffi- AI2O3 17.7 14.3
cient transparency and minimum porosity is K 20 11.2 10.1
necessary to produce an all-ceramic restora- Na20 4.6 8.0
tion. Furthermore, the material should have B2O3 0.6 0.6
the following properties: Ce02 0.4 0.9
- Simple processing CaO 1.6 3.3
- Exact duplication of the wax models and BaO 0.7 1.5
high stability of form during further firing Ti02 0.2 0.3
cycles (eg, staining, glazing)
- Adequate strength under consideration
of a safety margin to withstand functional
loading by masticatory forces
Chemical stability under intraoral condi-
tions

Composition Microstructure
Porcelain that meets the requirements men- The characteristic features of a ceramic
tioned above is manufactured from two basic material are specified in particular by its
glass melts labeled Ti4 + . The ceramic system structure, both at the atomic level and at the
comprises the following materials: microscopic level.
- Pressed ceramic for the staining At the atomic level, ceramic material is
- Pressed ceramic for the layering tech- characterized by two types of bonds: ionic
nique and covalent. The ionic bond is characterized
- Surface stains by an exchange of electrons. The atom that
- Corrective porcelain gives up an electron to a neighboring atom
- Layer ceramic is positively charged, whereas the other atom
- Glazing powder receiving the electron consequently assumes
The different materials are manufactured a negative charge. Opposite charges attract ,
from the basic glass or mixtures of the glass and the atoms are bound to one another.
with additives such as color pigments, fluores- With the covalent bond, the electrons (one or
cent substances, or elements to achieve a more than one) are shared by neighboring
higher melting point (see the following table) . atoms (Figs 16-1 and 16-2).
The basic glass is melted in a continuous Although the electrostatic attraction between
crucible furnace at 1,450°C. After the first neighboring atoms is reduced compared to
firing and to ensure homogeneity, the melt is the ionic bond, covalent bonds demonstrate
quenched, dried, ground, and remelted. By an atomic orientation that limits the move-
means of a tempering process (temperature/ ment of atoms. The hardest known material,
time) , the amorphous glass is transformed the diamond, consists of carbon atoms in a
into glass ceramic. Parameters of this pro- covalent bond.
cess can be varied, thus optimizing the Regardless of the type of bond, the atoms
material characteristics and ensuring that are able to form groups. Any such configura-
they comply with the requirements of the tion that is a regular pattern throughout the
system components. body of the material is referred to as a crystal.
The identical combination of atoms can form

143
Leucite- Reinforced Ceramic

Figs 16-1 and 16-2 (left ) Principle of ionic bond, (right ) Principle of covalent bond.

either an amorphous or a crystalline structure. This brittleness is the cause for an addi-
This depends on whether the atoms have tional characteristic: ceramic material can
sufficient time for orientation during the for - bear compressive stress rather than tensile
mation process. If , for instance, silicon diox- stress or shearing forces. Compressive loads
ide is fused and then cooled slowly, the SiC>2 tend to close developing microfractures
molecules form a macroscopic lattice of whereas tensile or shearing loads will widen
cristobalite crystals. If the same material is them.
cooled rapidly, allowing the molecules no Ceramic material would be much more
time for orientation, then the product is an resistant if defects created during fabrication
amorphous substance: glass. or by mechanical strain could be avoided.
The abundance of atomic structures as well Stress is concentrated particularly upon these
as the numerous possibilities of combining or defects. Because porcelain does not provide
exchanging chemical elements provide a vir- sufficient elasticity to compensate for such
tually unlimited variety of ceramic substances, stress, the critical limit mentioned before is
all of radically different properties. The atomic easily exceeded. Consequently, the ceramic
structure of porcelain supplies the material breaks (Figs 16-3 and 16- 4) .
with high chemical resistance to intraoral In order to increase the strength of vitreous
conditions. The strength of the atomic bond objects, we can apply methods that reduce
is also responsible for a high fusing point, the effects of microfractures and defects in
great hardness, and strength. the surface of the material. One of these
Unfortunately, this stability of bonds simul- methods is the "hardening " of glass. The
taneously prevents a sliding movement of the material is heated to the temperature of trans-
atoms within the structure. For that reason, formation and then cooled rapidly by blowing
the material cannot be deformed by external cold air over the surface. During this process
forces at room temperature. Consequently, to the surface of the glass cools down quickly
a certain limit porcelain has extraordinary while the layer beneath contracts further. In-
dimensional stability under loading; beyond evitably, the result is compressive stress at
that limit , the linkage collapses suddenly and the surface and tensile stress within the ob-
the material fractures. ject. The tensile stress within the inferior layer

144
 The Material

Figs 16- 3 and 16- 4 (above) Crack

propagation in brittle materials.
( below ) Crack propagation in plastic,
elastic, and ductile materials.

compensates the surface stress. This pressure Controlled Crystallization:

effect closes the microfractures in the glass, Theoretic Fundamentals
thus preventing their propagation. The
danger of fracture rises only when the tensile
component outweighs the compressive one Crystallization was once one of the most un-
(Fig 16-5). During the glaze bake, compressive desirable phenomena in the production of
stress may develop in the porcelain. This glass. Later it was appreciated as a benefit
happens when the coefficient of thermal ex- with regard to industrial use: the new glass
pansion of the glazing material is smaller ceramics (or vitro ceramics) were devel-
than that of the underlying porcelain. oped.
The concept of creating compressive stress The accidentally occurring crystallization
can be transferred to the microscopic field. If (ie, the failures that appeared during glass
crystals are produced that possess higher manufacture) demonstrated a wide variety of
thermal expansion than the surrounding different sizes of crystals. In homogeneous
glass matrix, the matrix is subjected to com- glass, a condition is sometimes found where
pressive stress at the periphery of these a critical size of the nuclei is exceeded and a
crystals. The larger the difference of expan- nucleus grows to uncontrollable size. The
sion between the glass and the crystalline controlled crystallization is distinguished from
phase, the better the strength. This is the the sporadic crystal growth by the following
principle of material reinforcement that the criteria:
Empress system capitalizes on.

145
Leucite- Reinforced Ceramic

1600
r
+30 +20 +10 0 -10 - 20 - 30 - 40 - 50 - 60 -70 - 80 m kp / nW
I I

Fig 16-5 Inherent stress distribution

within " hardened " glass.

r-
1400
1200
0
1000
o
800
I
600 I
400 Fig 16-6 Formation of glass ceramic,
according to Stookey
200 ( green = crystallization temperature;
^ 2 yellow = nucleation temperature).
/ = working phase, II = nucleation,
III - crystallization.

- Nucleus formation rate is high and regular temperature Ti over time ti, the nuclei are
throughout the entire glass matrix formed.
- Crystals are small and of uniform size 3. After completion of ti, the temperature is
(only a few micrometers) advanced further to level T2 (crystalliza-
Characteristic for glass ceramic is the pres- tion temperature). At temperature T2,
ence of small concentrations of crystallization crystallization occurs over time t2, and
or mineralization nuclei (eg, fluorides, phos- glass is transformed into glass ceramic.
phates, titandioxides). Mere visual investigation shows distinct dif -
The primary process of any controlled ferences between the glass samples and the
crystallization within the glass is the separa- tempered glass. The samples made of glass
tion of microphases during the cooling are transparent, whereas the ones made of
period of the melt . The progression of such tempered glass are cloudy.
a process has been thoroughly investigated
and described by W. Vogel. Typical steps in
the transformation of glass into glass ceramic
(Fig 16-6) are:
1. Glass is melted, ground, and cooled
down.
2. The object is heated to the temperature
Ti (temperature of nucleus formation): at
146
 The Material

Structure Analysis posefully and intentionally to achieve increased

fracture resistance in ceramic material.
In the field of ceramics, ceramography (which
is analogous to the metallographic methodo-
logy) is used to analyze microscopic struc - Crystal Identification
ture. by Radiographic Analysis
In order to permit differentiation of the Radiographic methods can aid in identifying
crystal phases, selective etching is performed. minerals or mineral components based on
Generally 0.1% to 0.5% hydrofluoric acid (HF) their microstructure. Using a Guinier-IV-camera
is used. By means of controlled variation of (made by Nonius, Delft) and Cu- K8- radiation
acid concentration and/or the etching time, it was possible to analyze an x- ray diffraction
the crystalline phases and their microstruc- spectrum of a powder that was obtained from
ture can be investigated. two melts of the basic ceramic. The qualitative
Because the dimension of the crystals is determination of the crystalline phases was
in the order of micrometers and our major performed by comparing all d-values to the
interest is the microstructure, scanning elec - data of the ASTM card index .
tron microscopy is used. The scanning pro-
The x-ray-diffraction spectra for the basic
cedure reveals that untempered glass has no glass show a structure that is x-ray amorphous.
structure. Tempered basic glass, on the other The tempered glass, in contrast, shows an
hand, shows a specific microstructure after x- ray spectrum of a low leucite if it is com-
etching (0.5% HF, for 1 minute) : pared to the ASTM card index (Fig 16-7).
• Crystals with a lamellar microstructure
are found embedded in an amorphous
These tests on the coefficient of thermal
expansion provide further indication for the
matrix . leucite crystal formation. While the coefficient
Based on the composition of glass, which of basic glass is 10 |.im/(m • °K) , it is 17 urn/
consists mainly of Si02 - AI2O3 - K 2O, the (m • °K) for tempered glass (Fig 16- 8).
formation of a low leucite is very likely For leucite a value of 20 n,m/(m • °K) is men-
(K 2O - AI2O3 - 4 Si02). The microstructure tioned. This could explain the increased
found in the tempered glass is very similar coefficient of thermal expansion for the for-
to the low leucite crystals discovered by mation of leucite.
Barreiro. Small quantities of additives (< 5%)
mixed to the basic glass result in pressed Strength
ceramic. The microstructure has changed;
the crystallites are apparently smaller and As previously described, prevention of crack
more densely dispersed. propagation plays a central role for the
Microfractures within the crystals are im- strength of porcelain. A homogeneous, mono-
mediately apparent. This phenomenon is ex- lithic material fails to inhibit crack propaga-
plained not only by a different coefficient of tion. This cannot be prevented and will result
thermal expansion between the leucite and in spontaneous fracturing. In a heterogene-
the matrix glass but even moreso by contrac- ous substance, different phases can prevent
tion. This contraction occurs concurrent to a crack formation. The result is an increased
phase change from high leucite to low leucite resistance to fracture.
during the cooling process. A multiple-phase, heterogeneous porcelain
Bowen described that the propagation of exhibits anisotropic stress after cooling down
microfractures in a material is prevented when (Fig 16-9). On the one hand, leucite crystals
the tip of a crack enters a microfracture. Both are subject to stronger contraction after cool-
ends of a microfracture are then rounded ing down compared to the glass matrix
and smoothed as a result of the successive because of higher thermal expansion. On the
firing. Such microfractures are created pur- other hand, the transformation from a cubical

147
Leucite-Reinforced Ceramic

aipua
'

*l \V -
1 «
I A

•i ! ' t M SH A W
*m
Louc 1 to JCPDS 15- 47 Cu Kal

0
T i
—20 . j 14- 1 y IJIJI A i k.ii .
i
40 GO 30
l ll 111 1
100
I\
120
—— 1 r
1 ill
“T*

160 >
4f

Fig 16-7 X - ray diffraction spectra.

2A = amorphous basic glass ; 1B,
2B = tempered glass.

'1.9 r •IB*'-?
dt lft IVOCLfl
*
..
.

•
4

.3
.i

. i

» < • >
—* »
. .
—600—*— »
—.
» 4 >
0
OATUM
JOB

VIRSUCHSN
41)0

* 5eg_.
300

iV 3 .»» ’
toCl
?O0

Korr
>
—
1 K - S /K 060104 29.8
29.1
1388 -
Bp28 V 0276 i:
|4
0
MM
Fig 16-8 TEC -diagram: basic glass
( red) , tempered glass (green).

high leucite to a tetragonal low leucite during causes a simultaneous partial disconnection
this thermal contraction leads to a volume (separation) of glass matrix and leucite
reduction in the order of 1.2%. During this crystals. The initial balance between the
cooling period the two phases (leucite crystals forces changes to a dominance of the com-
and glass matrix) remain in intimate contact. pressive portion (Fig 16-10) . The compressive
As the material solidifies, tangential com- strength of the glass matrix is sufficiently high
pressive stress in the glass matrix and radial to “ freeze” compressive stress at the phase
tensile stress in the leucite develop. These interface. According to this model, a latently
stresses are initially balanced. existing compressive stress can decrease
The final phase of contraction leads to crack the spontaneous formation of microfractures.
formation within the leucite, because tensile Furthermore, a dispersive structure at the
stress wins out over tensile strength. This phase interface leads to a diversion of

148
 The Material

Fig 16-9 Radial and tangential stress

produced by different TEC of glass
and leucite. ( A) Glass (green) and
leucite ( red ) in heated plastic condi -
tion. (B) Contraction of glass and
leucite during cooling period without
adhesion. (C) Cooling with adhesion
produces tangential compressive
stress in the glass and radial tensile
stress in the leucite. (According to
Prasad, et al; a leucite > a glass.

Fig 16-10 Tangential compressive

stress - radial tensile stress. Stress
condition in completed Empress
restoration. The microfractures in the
leucite " release" the tensile stress.

microfractures, thus diminishing the fracture ditions secure great stability (Fig 16-11).
energy. Another example is modern reinforced con-
Latently present microfractures with round- crete, where elements of steel create com-
ed tips can limit or even prevent crack pro- pressive stress within the concrete. By using
pagation. the tensile strength of steel and the com-
This technique can be seen as the in- pressive strength of concrete combined,
genious and ancient concept of architectural both of superior quality, constructions can be
arch construction transferred into microscopic built that withstand enormous strain.
dimensions and thereby realized a structural-
ly reinforced dental porcelain. The compres- (This section contributed by
sive forces are substantially stronger than the Gerhard Beham , chemist , department for
gravitational forces of the bricks. These con- research and development , Ivoclar Corp.)

149
Leucite-Reinforced Ceramic

Fig 16-11 Compressive stress at the

phase interface of the glass matrix
{ green = radial tensile stress) and
leucite crystals ( red = tangential
compression) is comparable with the
construction principle of an arch.
>
According to Mackert ; a leucite a
glass.

Working Procedures elements are removed and the muffle is

prepared for the pressing procedure.
The Muffle
The Press Furnace
Crowns, inlays, and veneers are all modeled
in wax (Fig 16-12) . Similar to the technique of Heat pressing of glass ceramic requires a
metal casting , the wax modeling must be special furnace for a controlled process; this
invested in a specific refractory investment unit has been based on the Programat P 90
material (Fig 16-13). A specially designed (Fig 16-14). The following functions are still
muffle system is required for the investment of identical:
the wax-up and the placement of the ceramic - Stand- by temperature
ingots. - Rate of heat rise
The completed wax-up is sprued and safe- - Final temperature
ly attached to the cylindrical crucible former. - Vacuum on
A prefabricated paper investment ring is - Vacuum off
placed on the base of the special crucible - Holding temperature
former. A supplied stabilizing ring is then In order to heat press glass ceramic, the
attached to the top of the construction. Thus, following elements were added or altered:
a cylindric form is created that is filled with - Enlargement of the heat dome
the investment . - Installation of a pneumatic pressure
When the material has hardened, the set- system
ting expansion will later facilitate devesting of - Addition of reducing valve and mano-
the base. The muffle is placed in the furnace, meter for optimal pressure control
which is heated to 850°C. The rate of Further control of the process is accom-
temperature rise is 3°C to 6°C per minute. plished with an inductive displacement trans-
After 90 minutes at 850°C, the stabilizing ducer mounted on the pneumatic plunger.

150
 Working Procedures

Fig 16-12 Restorations are first modeled in wax to full Fig 16-13 The waxed-up restorations are invested using
crown contour as for the metal casting technique. The a specially developed investment material. Its excellent
entire procedure is performed using only one working expansion control allows crowns of superb precision to
model. be fabricated.

This important sensor monitors the pressing

procedure and sends an electronic signal
that determines the automatic operation of
the program. As soon as the pressing is
finished, the voids formed by the wax burn-
out are filled. The plunger ceases its motion.
This step is controlled by a specific micro-
processor.
In order to ensure the complete formation
of all distinct line angles, a certain pressure
maintenance time is programmed. This prob-
lem can arise when a thin-walled mold such
as a facial veneer is to be pressed.

Fig 16-14 Press furnace, based on the well- tested Pro-

gramat P.90.

151
Leucite-Reinforced Ceramic

Fig 16-15 The prepared muffles are placed in a con-

ventional preheating oven. The program corresponds
to that of the metal casting technique. The rate of heat
rise is 6°C per minute to 280°C, which is maintained for
60 minutes. Then the oven is heated to a final temperature
of 850°C, which is held for another 60 minutes. It is
recommendable that this program be run at night . The
ingot and the plunger must be placed in the oven as
well; it is important to have them heated at the same
time as the muffles.

Pressing Technique plied for transfer and support of the ceramic

ingots and the plunger. In general, the
Preparation preheating and burn- out procedures are run
at night (Fig 16-15).
The impression is cast and a master model is
made just as for the metal casting technique. pressing Procedure
For the fabrication of crowns, inlays, and
facial veneers, a thin coat of die spacer is The main switch activates the press furnace.
applied to the gypsum cast in order to pro- The temperature rises to the desired level
vide sufficient space for the luting agent. Fur- (700°C). At this moment the muffle is moved
thermore, the die spacer may smooth out from the preheating oven into the center
possible rough areas originating from the depression of the furnace. One or two ingots
preparation. are transferred from the preheating oven and
The wax model is built up and attached to placed into the muffle also. Eventually, the
the cylindrical crucible former using 3 -mm- heat- soaked aluminum-oxide plunger is placed
thick wire wax . Ultimately, the special invest- in the muffle and the furnace is closed
ment material is poured into the muffle. This (Figs 16-16 and 16-17).
must be done strictly according to the The “start ” button is pressed and the auto-
manufacturer ’s directions. Mixing of the in- matic program begins: the vacuum starts
vestment with vacuum and pressure applied and the temperature rises at a rate of 60°C
may prevent porosities. per minute; the furnace is heated until it
Approximately 1 hour later, the crucible reaches the press temperature of 1,100°C.
former is removed and the muffle is placed Once this level is achieved, it will be main-
together with the ceramic ingots and the tained for 20 minutes. Proper heat distribu-
aluminum-oxide plunger in a preheating oven tion is thereby attained, which ensures the
at a temperature of 850°C. The rate of desired temperature inside the mold. The
temperature rise is 3°C to 6°C per minute. pressing procedure starts automatically.
This temperature is maintained for a minimum Usually, pressing is performed under 3.5 bar
of 90 minutes. A special refractory tray is sup- of pressure. The pressure is adjusted by

152
 The IPS Die Material in Dentin Colors

Figs 16-16 and 16-17 One to two ingots are removed from the oven and placed in the muffle. Ultimately, the
aluminum oxide plunger is inserted into the muffle and the press furnace is closed.

means of a reducing valve placed at the The programs 1 to 19 and 20 to 39 can be

reverse side and displayed on a manometer stored and secured by a code.
located on the front plate of the furnace. The After the muffle is bench-cooled, the ob-
distance the plunger has traveled is indicated jects are devested. The plunger is separated
on the display with the symbol W. As soon with a diamond separating disk at the points
as the plunger travels less than 0.3 mm in of orientation that have been marked on the
3 minutes, the program " pressure holding paper investment ring with wax prior to in-
time" (N) is activated (Figs 16-18 to 16-22). vesting (Figs 16- 23 and 16- 24). After separat-
When the sequence pressure holding time ing, the ceramic objects must be cleaned of
has been performed, the pressing procedure the remaining investment. This is carefully
is completed. Heat and vacuum are shut off ; performed using glass beads and low-pres-
an audible signal indicates the end of the sure air abrasion (3 bar) .
program. The furnace is opened manually
and the muffle is allowed to bench-cool to
room temperature. In order to make the pro- The IPS Die Material in Dentin
cess adaptable to different materials, the
following functions can be programmed by
Colors
pressing the button P (program) : A particularly favorable aspect of all-ceramic
- Stand- by systems is translucency. It facilitates a near
temperature B 200°C - 850°C perfect imitation of a natural tooth by reproduc-
- Heating rate T 5°C - 80°C/min ing the color of the prepared die. When
- Press temperature T 200 C - 1,200 C
- Pressure
° ° restoring discolored teeth or teeth with metal
cores, selection of the luting agent becomes
maintenance N 1 - 30 min significant . A special IPS die material, which
- Holding time H 1 - 60 min is available in nine different dentin colors, is
- Vacuum on V1 0 - 1,200°C therefore an essential component of the new
- Vacuum off V2 0 - 1,200°C technique (Figs 16-25 to 16-27).
When the preparation is finished, the color
selection is made with a special shade guide.

153
Leucite-Reinforced Ceramic

Figs 16-18 to 16-22 The pressing procedure is carried out with less than 0.3 mm per 3 minutes.

154
 The IPS Die Material in Dentin Colors

A B

u
_r B
1“

A
:n

Figs 16- 23 and 16-24 Devesting of the pressed ceramic objects is perhaps the most intricate step of the Empress
technique. A particular method has been developed for this purpose. Prior to investing, two wax marks are placed
on the paper cylinder. The first mark is made 3 to 4 mm below the wax models ( A) , the second mark is made above
the wax-ups at the level of the plunger; the marking creates notches in the investment (C). After the pressing, the
muffle (B) is cut with an oscillating saw exactly where the notches are. A disk of investment material ( B) , which com-
prises the pressed ceramic objects, is thus obtained. With four separating cuts the disk is reduced to a cube (B).
Care must be exercised to work a safe distance away from the plunger ( A). Gross removal of the investment is readily
achieved with plastic beads and air abrasion (4 bar). When the ceramic objects are emerging from the investment ,
the pressure is reduced to 3 bar. The abrasive particles must be directed tangentially to the pressed restorations to
prevent fracturing.

The dental technician receives the impres- ing of Metal Ceramic”) . This technique
sion and the selected color of the prepared creates a sense of depth despite thin por-
tooth. Using a light-cured die material , an ap- celain layers and metal framework.
propriate IPS resin die can be formed. Empress ceramic offers a simpler solution,
By means of staining as well as layer - because there is no metal or aluminum sub-
ing, the color of the natural teeth can be structure; thus there is more reflection from
mimicked. The die can also serve as an aid the core. It is therefore not necessary to apply
to handling the crown while coloring or several layers of dentin porcelain to achieve
building up the contour. The die is removed this sense of depth. The dentin core itself suf -
prior to each firing and repositioned after fices to create the desired effect , because the
cooling off . light can penetrate without being reflected by
the natural tooth.
The color selected for the ceramic ingot
Shade Selection of the Ceramic must be as close as possible to the natural
Ingot for the Layering Technique tooth, however a slightly more saturated hue
may be chosen. The more important the
The scheme we adhere to when working with build-up of the incisal region, the less saturated
metal ceramic is to begin with a saturated the selected color should be. It should be
color in the center and advance to the kept in mind that it may seem relatively simple
periphery with less saturated ones (see to select hue and saturation, but it is much
chapter 10, “ Processing and Natural Layer- more difficult to determine color brilliance.

155
Leucite-Reinforced Ceramic
f

Fig 16- 25 For the build-up of the

special resin die, light-curing resin is f
used.

Fig 16-26 The die material is avail-

able in nine different colors. The
dentist selects the color of the die
according to this shade guide.

Fig 16-27 The pressed porcelain

crown serves as an aid for duplicat -
ing the original prepared tooth in
light -curing resin. The ceramist is
thus able to evaluate the color of the
prepared tooth and take the result
into consideration during the build-
up. In addition, the resin die serves
as a handle, making staining and
layering procedures easier.

156
 The IPS Die Material in Dentin Colors

Fig 16-28 Ingots of varying trans-

parencies used for modeling.

For this reason, when working with the As described previously, the first step is the
Empress system, it is important not to select fabrication of a special working die that has
a color that is too gray, because it will later be the same color as the one selected by the
impossible to correct the brilliance. In most dentist. The crown is seated on this die and
cases, the pressed core represents two thirds colored. It is important to remove the special
of the entire restoration. resin die before the firing. After cooling off ,
the crown is reseated, the color match is
checked, and the staining process is con-
Staining Technique tinued. The die should be coated with a drop
of glycerine to prevent the incorporation of air
In order to supply color to the crown of a at the fitting surface, as this would cause
molar, inlay, or facial veneer, the surface can
refraction and hence change the color.
be stained. For this purpose, ceramic ingots
The technique of staining the surface (ie, a
of different transparencies can be used
mere superficial coloring) is less esthetic and
(Fig 16-28). Transparency is more significant
less innovative, although it can prove quite
with inlays or facial veneers than with crowns;
helpful with posterior teeth where accurate
the latter rely more on opacity.
contour and occlusal relations are important .
The surface stains are supplied accord-
Furthermore, this technique is much easier
ing to the colors of teeth; this makes repro-
for student ceramists to use.
duction of natural colors considerably easier
(Fig 16- 29). A range of 15 surface stains can
reproduce all colors of teeth. Moreover, there Layering Technique
are eight "intense” staining pastes for cha-
racterization. In order to stain the ceramic The layering technique is interesting and in-
objects in the desired manner, three to five novative because the color emerges from
coats of surface stain must be applied and deep inside, based on the dentin core.
successively vacuum-fired for 2 minutes at Ceramic ingots are precolored according to
850°C. A glaze bake completes the firing the shade guide by Ivoclar or Vita (Fig 16-31) .
cycle. The different steps of fabrication of a This system does not limit the ceramist 's
premolar crown are depicted in Fig 16-30. creativity. In order to imitate the vital ap-

157
Leucite-Reinforced Ceramic

Fig 16-29 Stains are marketed in a

ready-to-use creamy consistency. The
tubes clearly show their colors, which
corresponds to the shade guides of
Vita and Ivoclar.

Fig 16-30 Prior to the application of

the stain, the restoration is built up to
full contour (left ). The crown is first
pressed with transparent ingots
(middle) and then stained (right).

158
 The IPS Die Material in Dentin Colors

Fig 16-31 The layering technique

requires ceramic ingots that are
precolored according to the shade
guides of Vita and Ivoclar.

pearance of natural teeth, this technique can is clear: all these details are predetermined
be used for very simple tasks as well as for (Fig 16-34).
complex build-ups. The dentin core can be premodeled in wax.
A prerequisite for sufficient resistance to When the ceramist specifies the color, he
fracture is the harmonious adjustment between knows exactly where to leave some space for
the layered ceramic and the pressed ceram- effects. Fie can fabricate a dentin core that
ic. The coefficient of thermal expansion of the represents only one third of shape and func-
layered ceramic is inferior to that of the pressed tion of the tooth to be restored. Fte can also
ceramic. Therefore, during the cooling off adapt the dentin core to the shape of the
after the firing, compressive stress develops tooth and the age of the patient, which will
at the interface of the pressed ceramic, which mostly be the case for anterior teeth. The
compensates the tensile stress under ap- easy (and reasonable) way is to establish
plication of load (Figs 16-32 and 16-33) . these details in wax rather than to shape the
Fabrication of the dentin core. An essen- pressed material later by grinding or milling
tial property of this material is that the core (Figs 16-35 and 16-36). The prepared dies
provides the basic color, because there is no are coated with beige-colored die spacer to
metal or aluminum substructure. It is essential prevent the color of the semitranslucent core
to use a variety of incisal porcelains and from exerting too much influence. One or two
stains to mimic natural teeth. coats of die spacer can be applied depend-
There is one condition that should not be ing on the dentist ’s preference and the type
overlooked: full contour must already be of preparation (Fig 16-37).
established in wax. The contour of the cer-
vical third or the proximal portion, for in-
stance (the latter is particularly significant
because it determines the interproximal
space) , is not altered during the ensuing fir-
ings. Knowing the difficulties that exist in
forming these parts of metal ceramic restora-
tions, especially for anterior teeth , the emi-
nent advantage of the discussed technique

159
Leucite-Reinforced Ceramic

Intraoral forces

Fracture

Figs 16-32 and 16-33 (above) Added

tensile stress causes fracture. Func -
tional (occlusal) loads can cause
crowns without compressive pre -
stress or that are not subjected to
tensile stress to fracture, ( below )
Compressive stress reduces tensile
stress. Crowns with compressive pre-
stress are more resistant to func -
tional (occlusal) loading. According
to Anusavice.

Fig 16-34 One advantage of the

layering technique is the ability to
form the proximal contour and the
embrasure at the dentin core stage.

160
 The IPS Die Material in Dentin Colors

Fig 16-35 Study of the shape of a dentin core ( A) . Any Fig 16- 36 The material marked (C) has been applied
tooth, and subsequently every restoration, is an individual for the wash and effect bake. The small amounts ensure
case for which the cross section should be individually that this can be rapidly performed. These layers are
adapted. ( B ) The incisal edge with regard to the layering applied beneath the incisal layer ( B ).
technique. There is no strict rule. Regardless of whether
the layer is thin or thick , if the ceramist has to apply only
a thin layer, his work will be done quicker and easier,
provided the basic color has already been determined
by the dentin core.

Fig 16-37 A coat of beige-colored die spacer has been

applied to the die in order to protect the porcelain crown
from too much undesirable color influence when seated.
(Die spacer varnish by Symphyse, Marseilles, France.)

161
 T

Leucite-Reinforced Ceramic

Fig 16-38 The quality of the investment as well as our

ability to manipulate expansion facilitate restorations of
perfect fit.

Fig 16-39 The pressing procedure requires one piece

of 3 - mm wax wire.

Fig 16-40 Four restorations (of identical color) can be

placed in the muffle at a time.

The wax-up of the dentin core slightly After the wax model has been completed
resembles that of a metal substructure. On and the cervical margin inspected with a
the one hand, we can work on a traditionally magnifying glass, a 3-mm-thick wax wire is
prepared primary model; on the other hand, attached to the free end of the model
we can refer to a wax-up that is as precise as perpendicular to the tooth axis (Fig 16-39) .
possible. The wax models are placed on the base.
The accuracy of the pressed core depends Not more than four pieces should be pressed
on skillful manipulation of the wax as well as simultaneously; furthermore, they must be
exact dosage of the investment. Because of of identical color. The length of the sprue
our ability to manipulate expansion, it is pos- should not exceed 3 mm (Fig 16- 40). The
sible to achieve a high degree of accuracy muffle is made of paper with the upper end
(Fig 16-38). strengthened by a removable plastic ring.

162
 The IPS Die Material in Dentin Colors

Fig 16-41 Each pressing procedure

requires preheating of an aluminum-
oxide plunger and the correspond-
ing ingots, together with the muffle.

Figs 16- 42 and 16- 43 The pressing sprues are removed with a diamond disk. The same instrument may be used
to refine details on the incisal edges without breaking the porcelain. The attachment points are smoothed with an
abrasive stone (see chapter 19) .

Inside the muffle, points of orientation are Programming of the preheating oven is
marked with wax: one above the wax similar to that used for the metal casting
models, the other below the level of the sprue technique and the usual casting ring. The
former. These marks, which are in a negative muffles are placed, together with the casting
position to the muffle, prove useful in estimat- rings for metal casting, in the preheating
ing the position of the pressed ceramic oven overnight .
objects. When the bulk of the investment is The precolored ceramic ingots and the
later removed with a saw, the restoration will aluminum oxide plunger are placed together
thus be protected. The investing is done in the preheating oven (Fig 16- 41). The press-
traditionally: the muffle is placed into a pres- ing procedure is simple. The press furnace is
sure curing vessel for 20 minutes, thus pre- heated to 700°C. The muffle is moved from
venting the incorporation of air. the preheating oven into the center of the

163
Leucite- Reinforced Ceramic

-Checker
tch : 249»

Fig 16- 44 To fully seat the pressed Fig 16-45 The first porcelain layer can be applied. Attention must be paid
crowns on the dies, a special to the shape of the dentin core. It requires only a relatively thin layer to
friction paste is used. The die is establish full crown contour.
coated with a thin film of the paste.
Multiple repositioning of the restora-
tion creates undesirable interferences
that must be eliminated.

furnace. One or two ceramic ingots are Layering. After the porcelain cores have
placed into the muffle. Eventually, the pre- been reseated on the dies, they are treated
heated plunger is inserted into the muffle. with low-pressure air abrasion using aluminum
The programmed operation takes approx- oxide and are steamed for degreasing. The
imately 35 minutes. After cooling off , only the cleaned ceramic cores are ready for the
investment needs to be removed. porcelain layering (Fig 16- 45).
It is strongly recommended that a hammer
not be used for devesting. Instead, a saw
• First bake (wash and effect bake). The
first step is a wash and effect firing se-
should be used to recover the pressed bulk quence. It should create a strong bond
with the crowns from the investment ; only a between the two different materials,
small amount of investment should remain which possess compatible coefficients of
around the crowns. Air abrasion with a pres- thermal expansion.
sure of 4 bar and plastic beads will clean the A neutral ceramic powder is mixed with a
restoration thoroughly; the interior surface is metal oxide liquid. The mix is applied in a thin
treated only with a pressure of 3 bar. coat to the entire surface of the porcelain
The sprues are separated with a diamond core. At the same time, attention must be
disk. The remaining excess at the attachment paid to the dentin effects and the free
points is removed with an abrasive stone margins (Figs 16-46 and 16- 47). In the case
(Figs 16- 42 and 16- 43) . The porcelain cores of insufficient space, it is possible to create
are then cleaned. If friction is too tight or certain effects by surface staining. This method
slight undercuts appear, the surfaces must is recommended for facial veneers.
be adjusted by grinding. Again, magnifying The firing is performed in a ceramic furnace,
glasses and friction paste are used for this and the program is similar to that of a bisque
inspection (Fig 16- 44). bake for metal ceramic. A slow cooling is the

164
 The IPS Die Material in Dentin Colors

Fig 16- 46 The powders are mixed

with glazing liquid for the wash and
effect bake. This measure increases
the refractive index of light and
renders the colors more conspicuous.

Fig 16-47 A dentin core cross section. The dentin core Fig 16-48 Restorations after the wash and effect bake.
( A) is already covered by successive layers for the wash Attention should be paid to the subtle shade effects that
and effect bake (C). The incisal edge ( B ) should have have been incorporated beneath the enamel layer.
been built up according to the layering technique.

only measure that must be ensured. Not applied has only the thickness of the
before the temperature is reduced to 300°C enamel layer of a natural tooth .
can the crown be removed from the furnace This can be done following the principle of
(Fig 16- 48). lateral segmentation (Fig 16-49) . The ceramic
• Second bake. Prior to completion of the
build-up, the crown must be degreased
should not be overcontoured, because the
thin porcelain layer will only be subject to
once more by steam cleaning. The last light refraction. The programming of the
step of the modeling is performed quick- furnace is identical to the wash and effect
ly because the amount that needs to be bake.

165
Leucite-Reinforced Ceramic

Fig 16- 49 The incisal third ( B) is modeled according to

the lateral segmentation technique if the Empress
system is used. ( A) The dentin core.

Fig 16-50 For the glaze bake the restorations are placed
on a nonflammable cotton-wool pad.

Fig 16-51 Empress crowns after polishing.

In general, one glaze bake is sufficient after those on natural teeth (eg, discoloration
the bisque bake. The contour that is obtained at the floor of fissures, discoloration at
after the second bake represents the final proximal surfaces and at the cervical
contour of the restoration. area). For the glaze bake, the restoration
• Third bake (minimum glaze bake) . The
restoration is only slightly colored because
is placed on a nonflammable cotton-wool
pad (Fig 16-50) and air-fired at a tempera-
the effects have already been established ture slightly lower than that in the preced-
at earlier stages. Surface staining can ing programs. Ultimately, the restoration
only create superficial effects, similar to is polished (Fig 16-51; see chapter 19) .

166
 The IPS Die Material in Dentin Colors

Figs 16-52 and 16- 53 Functional relations and occlusal contacts can be established in wax when posterior teeth
are to be restored.

Figs 16-54 and 16-55 After thorough studies of function, all important occlusal contacts or dentin cones can be
preserved. The wax model can be sufficiently reduced so that enough space will be provided for the layering tech-
nique. The pressed dentin core exhibits an established dimensional stability while the occlusal relations and contacts
are fully preserved.

The Dentin Core for Restorations restoration will inevitably be reduced, thus
of Posterior Teeth sufficient space will be created for the
enamel porcelain. It may appear that our
Functional and occlusal aspects must be striving for occlusal reproduction has been in
assessed carefully when posterior teeth are vain, because we have to reduce now, but
to be restored. It is important to study func- this is not so! All occlusal contacts should be
tion in order to accurately restore morphology preserved and only as much wax as absolute-
and occlusal relations. ly necessary should be removed from
When using the layering technique, the around these points. They are preserved in

167
Leucite-Reinforced Ceramic

f & M
(M
— f

Figs 16-56 and 16-57 With restorations of anterior teeth, the occlusal contacts ( A) and the incisal guidance (B) can
both be built up in wax. They will be preserved through the firing cycle of the layered ceramic build-up.

their original contour, but after the reduction proximal spaces, occlusal relations, and in-
they look similar to dentin cones. cisal guidance. The dentist can adjust the
During fabrication of the restoration, the incisal guidance perfectly by grinding in the
enamel is applied incrementally without cover - mouth. The occlusal contacts and the incisal
ing the occlusal contacts. There will be no guidance are preserved in their exact form;
firing shrinkage, and the occlusion, adjusted no deformation occurs through firing, which
beforehand, is preserved accurately. The saves much work. These fixed markings are
dentin color is covered by the surrounding of great help for the ceramist and become
incisal porcelain and thus “camouflaged.” inconspicuous after the application of the
This approach is thus interesting for the incisal porcelain once the crowns are com-
ceramist who has experienced difficulties pleted.
in achieving accurate occlusal relations For esthetic reasons it is possible to per -
despite the bake and subsequent shrinkage form a trial seating prior to the firing. For this
(Figs 16-52 to 16-55). purpose the full contour of the enamel is
established in colored wax (Figs 16-60 and
The Dentin Core 16-61). The dentist then inspects the marginal
for Anterior Restorations fit , functional aspects (thanks to the mark-
ings), shape, and color. This technique offers
It is also advisable to establish a wax-up in a variety of solutions for the ambitious techni-
complete contour for maxillary anterior restora- cian who strives for excellent results.
tions. The incisal guidance can be readily
studied in the articulator (Figs 16-56 and
16-57). In order to facilitate the layering
technique, the restoration is reduced while
the occlusal contacts and the guiding paths
are preserved (Figs 16-58 and 16-59) . After
the dentin-colored restorations are pressed,
a try-in can be performed to inspect the inter-

168
 The IPS Die Material in Dentin Colors

Fig 16-58 Sagittal cross section of a pressed ceramic Fig 16-59 Lingual view of the pressed core. The incisal
core. The lingual contact was intentionally preserved. region was completely waxed-up prior to the pressing.
Thus, we can also preserve the occlusal relations that ( A) Lingual occlusal contact . ( B) Region restored by
have been established during the wax-up in the articulator. means of the layering technique. The dentin core is
( A) Occlusal contact of the pressed core. (B) The con- stable. After the layering bake, shrinkage may occur: the
tour that remains to be built up with the layering tech - material within the build- up can be controlled before the
nique. If the contour has been reduced in the same firing.
manner as shown, the layer can be rapidly rebuilt.

Figs 16-60 and 16-61 For inspection purposes of marginal adaptation, function, and esthetics, the pressed dentin
cores can be trial seated in the patient ' s mouth, using colored wax , after the wax-up of the enamel layer.
Leucite-Reinforced Ceramic

Fig 16- 62 The preparation for a tooth to be restored Fig 16- 63 The shoulder must not be absolutely regular
with an Empress crown resembles that of a porcelain but circumferential. Areas that lack clear shoulder
“ jacket ” crown. The shoulder must be rounded at the definition must be corrected to prevent fracture of the
transition from the floor of the shoulder to the vertical pressed crown (B ). Furthermore, too much variation in
portion of the tooth . The finish line ( A - B -C) , on the other width of the shoulder ( A and B) is undesirable for a
hand, must be a clean, right - angled edge to provide for material subjected to multiple firings.
a perfect marginal fit of the crown.

Fig 16-64 Occlusal view of a tooth preparation for an

Empress crown. The width may vary but it must be Fig 16-65 The angle of a full shoulder can vary from
circumferential. ( A) The labial portion should be 1 to 90 to 135° at the finish line. Because of great stability
°
1.5 mm wide. (C and D) With regard to the proximal of the reinforced porcelain, prominent angles must be
portion it is difficult to provide for more than absolutely avoided ( B, C, D). The surface of the prepared tooth
necessary, because the pulp is in close proximity should be smoothed in all areas except for the well -
(0.6 mm) . (B ) The lingual portion should be 1 mm wide. defined edge of the finish line ( A).

170
 The IPS Die Material in Dentin Colors

Tooth Preparation
for Pressed Ceramic Restorations
(Figs 16-62 to 16-70)

For pressed ceramic restorations, either a 90°

shoulder preparation with rounded line angles
or a 135° chamfer preparation is imperative.
The preparation should have rounded edges.
A thickness of 1.5 mm to 2 mm (occlusal or
incisal) must be ensured. The width of the
shoulder should be 1 to 1.5 mm (labial and
proximal) and at least 1 mm (lingual). Thick-
ness of the remaining dentin should not be
less than 0.6 mm. The preparation margin
must be right-angled to ensure a perfect
marginal fit . On the lingual surface, minimum Fig 16-66 This is an example of how the preparation
thickness is 1 mm. Less than that would in- for a pressed crown should not be performed.
crease the crown’s fracture potential, par-
ticularly in occlusal regions.
Figures 16-71 to 16- 89 show clinical results
using the pressed ceramic technique.

Figs 16-67 and 16-68 Adequate preparations that are suitable for pressed ceramic. Rounded preparation (C);
rounded shoulder ( A): clean, right- angled finish line ( B ) .

171
Leucite-Reinforced Ceramic

Fig 16-69 Excellent preparations for pressed ceramic

crowns. Preparation of vital teeth for a 48-year - old
patient . (Preparations courtesy of Dr Thierry Jeannin,
Orange, France.)

Fig 16-70 Minimum thickness of the lingual portion for

an Empress restoration is 1 mm (C). Insufficient reduc -
tion of tooth structure, particularly regarding occlusal
contacts, may result in fracturing of the restoration.

Fig 16-71 Empress ceramic crown on tooth 11. This is Fig 16-72 Empress ceramic crowns on teeth 11 and 21.
the very first restoration fabricated in our laboratory (Courtesy of Dr Michel Canazzi, Caderousse, France.)
using the new technique. (Courtesy of Dr Michel Canazzi,
Caderousse, France.)

Figs 16- 73 and 16-74 Optec ceramic crowns on teeth 11, 12, 21, and 22. (Courtesy of Dr Novak , Avignon, France.)

172
 The IPS Die Material in Dentin Colors

Figs 16-75 and 16-76 Empress ceramic crown on tooth 11 and two lingual veneers on teeth 21 and 12, (Courtesy
of Dr Luc Portalier, Aix-en- Provence, France. )

Fig 16-77 Empress ceramic crown on tooth 11. (Cour- Fig 16- 78 Empress ceramic crown on tooth 21. The
tesy of Dr Yeche, Avignon, France.) surface structure is not correctly reproduced; light
reflection differs in comparison to the adjacent tooth.
(Courtesy of Dr Daniel Gleyzolle, Avignon, France.)
Fig 16-79 Four Empress ceramic crowns on teeth 11,
12, 21, and 22. The teeth are restored with a ceramic
post and core. Even though only one porcelain powder
was used for the layering of these crowns, the result is
satisfying. (Courtesy of Dr Daniel Gleyzolle, Avignon, Fig 16- 80 Empress ceramic crowns on tooth 12. (Cour-
France.) tesy of Dr Thierry Jeannin, Orange, France.)

173
Leucite-Reinforced Ceramic

# 1 &

T )

Figs 16-81 to 16- 83 Empress ce-

ramic crowns on teeth 11, 12, 13, 21,
and 22. (Courtesy of Dr Thierry
Jeannin, Orange, France.)

174
 The IPS Die Material in Dentin Colors

Figs 16- 84 to 16-86 Empress ce-

ramic crowns on teeth 11 and 21.
(Courtesy of Dr Michel Canazzi,
Caderousse, France.)

175
Leucite-Reinforced Ceramic

. .
/
*i
*
/
i V
*
K
.\ 1 > \ 1 •I ' »

;. t

t
/ V

O' Vk
f

«c>

Figs 16-87 to 16- 89 Empress ce-

ramic crowns on teeth 12, 11, and
22. (Courtesy of Dr Michel Canazzi,
Caderousse, France.)

176
 17 Post and Core in Ceramics

Empress porcelain in general offers max- positioned mesially and distally with sufficient
imum esthetic potential for the restoration distance in between. Light can thus circulate
of vital teeth. At times, however, it may be through the core (Fig 17-1).
necessary to first restore a tooth with a post © Fabrication of metal substructures for
and core. A metal post and core impairs ceramic post and core for lateral incisors.
the esthetic properties of porcelain materials For small and narrow teeth it is not possible
because of the reflection of light by the metal. to position two cones mesially and distally.
For that reason, we fabricate a post and core Consequently, only one cone is planned to
using dentin porcelain that is supported by a suit the substructure. Here again the rich-
mini-substructure consisting of metal. mond plateau should be as thin as possible
When we first experimented, we simply in order to provide space for the circumferen-
coated the metal with opaque porcelain. This tial shoulder (Fiq 17-2).
prevented gray reflections but still the light © Fabrication of metal substructures for
was “ retarded.” Clinical results were satisfac- a ceramic post and core for premolars.
tory and very similar to metal ceramic restora- Substructures for premolars are fabricated in
tions with all their disadvantages; the major a manner nearly identical to that for maxillary
problem was metamerism. canines and central incisors. The difference
Today we fabricate post and core restora- is that the two cones are positioned in a facio-
tions differently. First we fabricate a metal mini- lingual direction. Again enough space must
substructure to support the porcelain. The be left for the circumferential shoulder
casting of these substructures is identical to (Fig 17-3).
that for metal ceramic frameworks. We build © Fabrication of metal substructures for
up the contour of the core using a saturated a ceramic post and core for molars. A post
dentin porcelain. This should mimic the color and core for molars frequently requires the
of the prepared tooth or that of the pulp. positioning of an additional retaining element,
These small substructures are quickly fabricat- which may prove difficult. The posts and the
ed, and so is the modeling. The fabrication is richmond plateau are fabricated in the afore-
performed as follows. mentioned manner. The retaining element
© Fabrication of metal substructures for must be removable and made of metal to sup-
ceramic post and core for maxillary canines port the porcelain. Two cones are positioned
and central incisors. The post as well as the in the facial portion, leaving sufficient space
base of the core, both supporting the two for the circumferential shoulder (Fig 17-4) .
vertical cones, are made of metal. The cones
are fabricated with standardized 0.1-mm-thick
wire. The richmond plateau should be as thin
as possible. It is always slightly retracted from
the finish line, thus providing space for a cir-
cumferential shoulder. The two cones are

179
 Post and Core in Ceramics

Figs 17-1 to 17-4 Ceramic post and

core fabrication for porcelain jacket
crowns.

Figs 17-1 Ceramic post and core for

a maxillary central incisor. ( A ) Root:
(B) metal substructure with two rein-
forcing cones placed mesially and
distally; (C) porcelain (dentin mate-
rial). The periphery of the substruc -
ture should be porcelain to avoic
gray reflections.

Fig 17-2 Ceramic post and core for

maxillary lateral incisors and for
mandibular incisors. Fabrication is
identical to that described in Fig 17-1
except for the fact that only one rein-
forcing cone is used.

Fabrication of a Porcelain other layers of porcelain are applied. For

Post and Core reasons of better integration, the margin of
the post and core is built up in porcelain (ap-
proximately 0.3 mm). This masks the gray
The ceramic substructure is not built up with reflections stemming from the richmond
just any porcelain. First we must select the plateau (see Figs 17-1 to 17-4).
color of the porcelain in the patient 's mouth. If the Empress system is used, such ce-
If the tooth is destroyed as far as the gingival ramic post and core restorations are a good
crest , an orange porcelain is chosen in order option. Esthetic qualities are preserved by
to mimic the pulp deep inside. The ceramic the almost unimpeded circulation of light.
layering for a post and core is performed in The metal cones reduce light penetration
the same manner as for metal ceramic by only 10% to 15% (Fig 17-5). However,
restorations. The metal is treated, opaque is these metal cones supply the much-needed
applied for masking, and successively all mechanical strength to the post and core.

180
 Fabrication of a Porcelain Post and Core

Fig 17- 3 Ceramic post and core for

premolars. ( A) Root; ( B ) metal sub-
structure with reinforcing cones
placed facially and lingually; (C) por -
celain (dentin material).

Fig 17-4 Ceramic post and core for

molars showing an additional retain-
ing element. ( A) Root; ( B ) metal
substructure with two reinforcing
cones placed facially; (C) porcelain
(dentin material); ( D) additional
(metal) post that is separately attach-
ed to the root and the core.

181
Post and Core in Ceramics

Fig 17-6 Four Empress ceramic crowns on four ceram

ic post and core structures. Light penetrability is satisfac
tory.

Fig 17-5 Ceramic post and core for maxillary lateral in-
cisor in situ. The metal cones decrease light penetrabili-
ty only by 10% to 15%.

Fig 17-7 Fabrication of a ceramic post and core struc- Fig 17-8 Opaque applied to the substructure.
ture for tooth 11. The metal substructure has two reinforc-
ing cones and one coat of covering gold.

182
 Fabrication of a Porcelain Post and Core

Fig 17-9 Two firings are necessary to give the dentin Fig 17-10 Lingual view of the ceramic post and core.
porcelain core the correct shape. Note the circumferential shoulder for the all-ceramic
crown.

Fig 17-11 Occlusal view of a ceramic post and core for

tooth 24 with a facial and a lingual metal cone.

Fig 17-12 Buccal view of the ceramic post and core.

The yellow-orange color should simulate the color of the
pulp, which acts iridescent inside the restoration. This
effect is quite similar to that found in natural teeth.

Fig 17-13 Ceramic post and core in situ. (Courtesy of

Dr Luc Portalier, Aix-en- Provence, France.)

183
 18 Facial Veneers

With modern dental techniques we are able Our first facial veneers were produced on
to offer a variety of restorative solutions to our refractory dies according to the method for
patients. The fabrication of porcelain veneers inlay fabrication. Instantly, we could boast very
is certainly one of the most pioneering satisfying results. The porcelain used was
methods. To change a smile, to mask con- traditional (IPS Ivoclar) (Figs 18-1 to 18-8) .
spicuous discolorations, to correct malaligned The great disadvantages, however, were the
teeth with just a few millimeters of porcelain is extended periods of preheating and cooling.
a difficult and challenging task for the dentist In addition, it was impossible to perform a
as well as for the dental technician. How correction bake after the investment had been
satisfying, on the other hand, when the work removed. A genuine problem is that during
is successfully completed! The fabrication of fabrication there is no control of the opacity
esthetic veneers requires profound knowl- of the porcelain, especially if strong discolora-
edge about the use and color of porcelain, tions are to be masked. Investment material,
and it is certainly one of the most intricate of which is white or gray, will not be a proper
restorations. guideline as to what color would be underly-
ing a restoration.

Fig 18-1 Preparation for 20 veneers

(note the delicate preparation). If dis-
colorations are to be masked, a
thickness of only a few tenths of a
millimeter is supplied for the layer.
Ceramic: Classic IPS and Maverick,
Ivoclar. (Preparations courtesy of
Dr Luc Portalier, Aix-en-Provence,
France.)

185
Facial Veneers

Figs 18-2 to 18-6 Clinical result of resin-bonded veneers.

As soon as these restorations are recovered ceramic system for facial veneers, too. It offers
from the investment, their brittleness requires better manipulation and makes color control
extremely careful handling in order to prevent considerably easier. Currently, we use only
fracturing. Another problem is the establish- the layering technique with the Empress
ment of correct proximal contacts, because it system . This requires preparations according
is usually impossible to separate the single to the principle of conservation of tooth struc -
die on the special refractory model. ture; the incisal reduction for anterior teeth is
These combined problems naturally in- 1 mm. The most common preparation techni-
fluenced our decision to use the Empress ques are shown in Figs 18-9 to 18-12.

186
 Facial Veneers

Figs 18-7 and 18-8 Two ceramic veneers on teeth 22 and 12. Ceramic: Classic IPS and Maverick , Ivoclar.

Fig 18-9 Sagittal cross section of a tooth ( B) and a Fig 18-10 Labial view of a preparation for a ceramic
veneer ( A). Note the space created at the incisal edge veneer. The preparation is performed according to the
for the layering. principle of conservation of tooth structure; the reduc -
tion is ultra- thin. The finish line presents a groove. (B )
The area of incisal reduction (approximately 1 to 1.5 mm).

Figs 18-11 and 18-12 Preparation for a veneer. (Courtesy of Dr Luc Portalier, Aix- en-Provence, France.)

187
 Facial Veneers

Figs 18-13 and 18-14 Preparations

for Empress veneers and Empress
crowns. The esthetics can be
evaluated at the wax model stage.

The Empress Method wax is eliminated to 100%. During the pre-

for Porcelain Facial Veneers heating of the mold, the wax must be totally
eliminated, so that no residue can be in-
corporated into the later pressed ceramic.
Fabrication of the wax models. After two While the wax-up is performed, we can study
coats of beige-colored die spacer have been the functional relations in the articulator ; at
applied to the dies, wax veneers are fabricated this stage the correct incisal guidance is
on the working cast. It is usually impossible established. If the veneers are too thin, we
to separate the dies, because the proximal slightly overcontour the wax-up prior to
contacts have not been included in the pre- investing. A thickness of 1 mm is sufficient for
paration. During the establishment of the the pressing procedure. A 3-mm sprue is
contour, an esthetic wax-up method is used attached to the incisal edge (Fig 18-15) . Four
(Figs 18-13 and 18-14). The special burn-out veneers can be placed in one Empress muffle

188
 The Empress Method for Porcelain Facial Veneers

Fig 18-15 Prior to investing, a 3 -mm-thick sprue is Fig 18-16 When a veneer is fabricated, the pressed
attached to the incisal edge. core ( A) is seated on the special die ( B) before grinding
for reduction. The veneer is much more safely manipulat-
ed in that manner; moreover, the peril of fracturing is
decreased.

at a time. Investing is done in the traditional underlying color. Furthermore, it serves as

manner. At the inner side of the muffle, marks protective support for reduction and polish-
should be placed for orientation. This tech- ing procedures (Fig 18-16) .
nique can protect the veneers against damage The reduction of a veneer means it is
during devesting. ground and reduced to the thickness of a
Inspection of the marginal fit of the natural tooth’s enamel layer. If the veneer was
pressed veneers. The moment the veneers intentionally overcontoured prior to the press-
are devested and have been subjected to ing, the entire surface must now be reduced.
glass bead air abrasion using low pressure, It is possible to reduce up to five tenths of a
they are reseated on the die. The accuracy of millimeter without endangering the veneer to
the marginal adaptation should be inspected fracture. The material is readily and rapidly
with special care by means of a magnifying ground using the abrasive stones and green
glass. The IPS Empress friction paste can be polishing points. The cervical one third is
used to locate areas of too much friction. reduced, too; it should be reduced by 1 mm
Using a brush, the paste is applied to the die. as well. The layering by increments and in-
The veneer is reseated, and these areas of corporation of effects is important particularly
extreme friction can be readily detected and in these areas because here we can provide
eliminated. a maximum of subtlety and transparency.
Fabrication of a resin die. After adaptation When the reduction procedure is finished,
of the veneers on the (gypsum) die, an addi- the form of the veneer virtually equals the
tional one, made of resin, is fabricated. The form of a tooth’s dentin core (Figs 18-17 and
color of the resin must match that of the natural 18-18).
tooth to be restored. This step is important Wash and effect bake. The veneer is steam
because the color of the very thin veneer is cleaned carefully, avoiding against the
easily and significantly influenced by any slightest thermal shock. The veneer is reposi-

189
 Facial Veneers

c
B B

Fig 18-17 Sagittal cross section of a ceramic veneer Fig 18-18 The pressed core ( B) is reduced in order to
on a natural tooth (A). The thickness of the veneer can provide space for the layering technique. This layer
be reduced to 0.6 mm in the center (C). The veneer covers the veneer completely from the incisal region to
covering the incisal third should be 1 to 1.5 mm thick the cervical margin. The reduction of the incisal third of
( B). This is the area for layering and the incorporation of a natural tooth facilitates the build-up in layers and the
effects. incorporation of effects.

tioned on the special die made of a soft resin core is pressed at 1,170°C, the ceramic build-
that represents the color of the prepared up is fired at 900°C. This leaves a safety
natural tooth. A layer of neutral porcelain margin of 270°C, thus preventing deforma-
material is applied to the entire surface. Effects tion.
can be incorporated at this stage in the After each firing, the veneer must be
marginal region. If the veneer is very thin, no degreased and steam cleaned. The build-up
porcelain is applied because this could result of the porcelain is also quickly performed:
in overcontouring; the dentin core is simply tenths of a millimeter provide sufficient thick-
colored. These effect colors do not require ness of the layer. Lateral segmentation may
space; they are applied between the dentin be used for the incisal third and new effects
core and the build-up of the incisal edge. The incorporated. One thing is important: the
Empress ceramic system does not require layer must thin out toward the finish line.
thick layers to obtain satisfactory results: When the layering is completed and
tenths of a millimeter are enough to provide the modeling is finished, the veneer is placed
the material with a natural appearance on the resin die again. The contacts are
(Figs 18-19 to 18- 23). slightly overcontoured and the built-up
Layering bake. The wash bake is per- porcelain is gently condensed. Packing the
formed rapidly. After the firing and the ensu- particles densely can prevent detachment of
ing slow cooling off , no deformation will be the porcelain. A soft brush removes excess
detected, not even in the extremely thin (ie, porcelain while the veneer remains securely
0.5 mm) regions. The reason for that is the dif- seated on the die (Fig 18-24). The layer
ference in temperature: while the Empress applied during the layering procedure fully

190
 The Empress Method for Porcelain Facial Veneers

Fig 18-19 Horizontal cross section of an Empress Fig 18-20 Vertical cross section of an Empress ceram-
ceramic veneer. The thickness of the veneer is 0.6 mm. ic crown. Here too, as for the veneer, only a thin layer
Note the thin ceramic layer applied by means of the of ceramic is necessary. The layering is rapidly per-
layering technique. formed and shrinkage is virtually zero. This technique of
build-up is suitable for teeth where effects are unimpor -
tant.

Fig 18-21 This section also shows the minimal thick-

ness of the ceramic layer. It is important that the core of
the pressed ceramic restoration be sufficiently thick to
increase the crown’ s resistance to fracture.

Fig 18-22 The layering is more

important in this section, but the
core does not suffer a decrease in
strength. At times, several layers are
needed to attain special effects and
colors. The ceramic layers always
cover the core completely.
Fig 18-23 This premolar was rapidly built up, because
only little space was needed for the layering. Yet it was
possible to apply orange effects to the occlusal surface
and to use saturated dentin porcelain for the cervical
third.

191
Facial Veneers

covers the veneer but thins out apically. For

the firing, the veneer is placed on a non-
flammable cotton-wool pad. The program of
the firing cycle is as follows: drying-out for
6 minutes; heating to maximum temperature
of 900°C within 60 minutes (at this tempera-
ture the vacuum is reduced for 1 minute).
The firing is performed with vacuum.
Glaze bake and minimum gloss. In
general, one bake suffices after the build-up:
the applied porcelain is of minimum thick-
ness. After the veneer has been removed
from the furnace, shape and function are in-
spected as per conventional restorations. At
this stage macrostructures and microstructures
Fig 18-24 After the veneer ( A) has been modeled on
are established. The veneer may be addi-
the working model, it is reseated on a special resin die tionally colored, if needed.
(B). The proximal contacts are slightly overcontoured. To perform the glaze bake, the veneer is
With a very soft brush, the applied porcelain is brushed placed on the nonflammable cotton-wool pad
in an apical direction. The careful removal of excessive
porcelain is thus readily performed down to the marginal and put into the furnace. It is then air-fired at
region. a temperature of 890°C (see chapter 19.
"Analysis of the Surface Structure - Polish-

Fig 18-26 Esthetic value of veneers depends mainly

Fig 18-25 Completed ceramic veneers on teeth 12 to on the penetrability of light. The Empress ceramic core
23, 33 to 43, after polishing. The polishing is done with provides sufficient potential to mask discolorations with-
the veneer securely seated on the die. out rendering the entire restoration too opaque.
 The Empress Method for Porcelain Facial Veneers

-J t :
V 1

/ /

\ i/', li 1»
*I

1 \
v/ %
/

c.
* ^ •> jjy*

Figs 18-27 and 18- 28 Preparations

tor 12 veneers. (Courtesy of Dr
Thierry Jeannin, Orange, France).

ing”). The veneer is allowed to cool slowly entire process of fabrication, color control is
after it has been recovered from the furnace. easy; this consequently prevents failure. More-
It is reseated on the resin die and polished to over, the dosage of the Empress material is
a high gloss (Figs 18-25 and 18- 26). perfect. It masks all discolorations with a
This technique is simple enough to be minimum thickness of the material. Ultimately,
applied in laboratory practice. Each step this material exhibits great esthetic qualities,
is traditional and certain working habits need and we can mimic the appearance of a
not be changed. No fatiguing work is involved, natural tooth with a thickness of only a few
as is the case with refractory dies. During the tenths of a millimeter (Figs 18-27 to 18-34).

193
 Facial Veneers

S'
•5 .7 r •'
- i S
1
— ,i
1 *
"
' •
' ^
* V'Vf- *
<
» v;
:•TV
«
«

>
- -r
*

f
I 2?
4»
*«
\ « \ %
7 N
(

\ V «1 F
•
t
k

* *
f >

r
# *
f
2 » I'\
* .
*
\
* '
«

~+l :i+
V

"
i .v * ; i

Figs 18-29 to 18-31 Empress ve-

neers fabricated according to the
layering technique. Most of them
exhibit only a 0.6 - to 0.8-mm-layer
thickness. Note the subtle color
effects in the incisal one third.

194
 The Empress Method for Porcelain Facial Veneers

Fig 18-32 These restorations for

posterior teeth on the left-hand side
are made of Empress ceramic as
well as metal ceramic. Teeth 24, 26,
and 35: Empress ceramic. Teeth 25,
34. 36, and 37: metal ceramic.

Fig 18-33 Mandibular arch viewed

from above: Empress veneers on
teeth 31, 32, 33, 41, 42, and 43.
Empress ceramic crown on tooth 34.
Porcelain inlay on tooth 44. Metal
ceramic crowns on teeth 35, 36, 37,
45. 46, and 47.

Fig 18-34 Empress veneers on teeth

21. 22, 23, 11, 12, 13, and 14. To give
tooth 14 a longer appearance,
the entire occlusal surface was inten-
tionally restored in ceramic. Thus,
the correct vertical dimension was
reconstructed. Empres ceramic
crowns on teeth 24 and 26. Metal
ceramic crowns on teeth 25, 15, and
16. (Courtesy of Dr Thierry Jeannin,
Orange, France.)

195
-
19 Analysis of the Surface Structure - Polishing

Polishing of porcelain is becoming an increas- Observation and Application

ingly common practice in dental laboratories.
It requires profound knowledge and analytic of Information
understanding of the surface structure of
natural teeth as well as accurate methods. Polishing of porcelain creates a natural-look-
If we carefully observe the oral cavity of a ing surface structure. A certain rate of attrition
patient, it is easy to detect differences in form that took many years to develop can be
and symmetry between each and every achieved in a few minutes by polishing. Teeth
tooth. A patient ’s smile, which apparently is of younger patients show numerous lines,
very regular, reveals itself to be a mere com- particularly growth lines. The geography of
bination of a variety of minute irregularities, the surface shows more complexity and less
malalignments, occlusal disorders - in short, gloss (Fig 19-3). This is completely different
a conglomerate of particularities that con- from middle-aged or older patients: macro-
tribute to a natural, pleasing smile (Figs 19-1 geography becomes less distinct, growth
and 19-2). lines disappear and gloss increases (Figs 19-4
The surface structure of natural teeth, too, and 19-5).
is made up of small irregularities, which we When the color of a restoration is com-
call macrogeography and microgeography. municated to the dental laboratory, the type
Light is reflected from a tooth’s surface as it of surface structure should always be con-
is from the facets of a diamond. There are veyed (some lines, a few, or none at all) , and
distinct differences in the surface structure of gloss, too (high or low gloss, dull appearance).
teeth depending on the patient’s age, posi- Gloss can be classified in degrees:
tion of a tooth, morphology, and even the
hardness of the enamel. The surface geo-
graphy of the enamel is subjected to nu-
•
•
Very glossy: 9/10 or 10/10
Medium gloss: 7/10 or 8/10
merous changes throughout a person’s life. • Little gloss: 5/10 or 6/10
Therefore, it is essential to restore this macro- If dentist and dental technician are distant
geography and microgeography. Conse- from each other, this classification can help
quently, the surface structure of porcelain or communication.
other cosmetic material must be adapted to Another important medium for communica-
the adjacent natural teeth. The successful tion is photography. By means of a slide pro-
integration of a ceramic restoration (or other jector, the tooth that is to be imitated can be
cosmetic dental material) depends largely studied. This may lead to an exact replica of
(among other reasons) on the surface struc - the surface structure, but characteristics,
ture and a well-adapted gloss. gradations, and the adjacent gingiva can be
considered, too (Fig 19-6). Photography is an
eminent source of information although it is
much less reliable regarding color of teeth.

197
 Analysis of the Surface Structure - Polishing

Figs 19-1 and 19-2 If patients are

observed attentively when smiling,
one can discern that it is not the
symmetric aspects of teeth that cha-
racterize an individual smile. Small
irregularities, malalignments, and dif -
ferent surface structures contribute
significantly to a natural smile.

Fig 19-3 Surface structure of a

young patient ’s teeth. Numerous
growth lines and the complex geo-
graphy of the surface are visible.

198
 Observation and Application of Information

Fig 19- 4 Teeth of a middle- aged

patient. The macrogeography is less
distinct, the growth lines vanish, and
gloss increases.

Fig 19-5 Considerable magnification

facilitates thorough studies of the
microgeography and the regions of
light reflection.

Fig 19-6 In order to improve our skill and to avoid

getting lost in the maze of individual interpretation, the
use of a slide projector and photographs of natural teeth
can prove very helpful (D.A.S.-system, NTmes Cedex,
France).

199
 Analysis of the Surface Structure - Polishing

Fig 19-7 The occlusal surfaces ex-

hibit subtle structures, too.

Figs 19-8 and 19-9 Study of a metal

ceramic restoration. The surface
structure of teeth is quite different
depending on tooth position. If teeth
are located in a more lingual posi-
tion, they are thus more guarded,
and consequently they show more
lines and a matte finish. Those in
a more facial position are more ex-
posed, smoother, and exhibit more
gloss.

200
 Observation and Application of Information

Furthermore, it is possible to study extracted

teeth and register their contour and macro-
geography and microgeography.
If we try ro reconstruct the exact surface
structure of the tooth to be restored, it is
necessary not to neglect the occlusal sur-
faces (Fig 19-7). For even more accurate
investigations, it is sometimes helpful to
standardize teeth and place them in a study
cast. The metal ceramic restorations in
Figs 19-8 and 19-9 were fabricated after the
surface structure had been studied
thoroughly but also according to studies of
color and characteristics; they are used as
models. The surface structure of teeth
depends on their position; if teeth are located
in a more lingual position, they are more
guarded, and consequently they show more
lines and a matte gloss. Those in more facial
position are simply more exposed, smoother,
and exhibit more gloss.
This also applies to total reconstructions.
The surface structure of maxillary anterior
teeth is distinguished from that of mandibular
teeth, which are less smooth and less glossy
Fig 19-10 The mandibular incisors still exhibit growth
because they are protected by the maxilla. lines because they are guarded against natural wear.
The maxillary central incisor in Fig 19-10 is The maxillary incisors, on the other hand, show a sur-
virtually polished (an older patient), whereas face that is smoother and more glossy.

Fig 19-11 Growth lines are not

always of identical appearance, but
they are related to a precise pattern.

201
 Analysis of the Surface Structure - Polishing

Figs 19-12 and 19-13 The reflec -

tion of light is more intense on a
smooth surface than it is on a ser-
rated one; the light rebounds.

Fig 19-12 ( X ) Light beam; (Y) par-

tial reflection; (Z) refraction; (A) smooth
surface; (B) glass pane.

Fig 19-13 ( X ) Light beam; (Y) diffu-

sion; (A) serrated surface; ( B) glass
pane.

Fig 19-14 Different kinds of reflec -

tions in a certain combination on ser-
rated (A) and smooth ( B) surfaces
supply a natural appearance to ce-
ramic. ( X) Reflection on a smooth
surface; (A) ceramic ; (B) surface
structure.

202
 Observation and Application of Information

Fig 19-15 Surface structure and light reflection. Light Fig 19-16 Surface structure and light reflection. In
is reflected particularly in bulging and curved areas of fissures and concavities, light reflection is much less
the teeth, which are generally very smooth. significant. The result is a double light reflection between
concave and convex areas.

the mandibular incisors show some growth After thorough studies of the macrogeo-
lines. These mandibular teeth are guarded graphy and microgeography, it is decided to
against mechanical and natural wear and incorporate growth lines into the first fixed
therefore are not as smooth and glossy. partial denture (that for the younger patient).
Growth lines are neither identical nor of the We draw the line pattern with a gray pencil,
same shape or dimension (Fig 19-11); they then we use a long, slightly tapered square-
are arranged in a precise pattern. By simply tipped diamond of medium or fine grit to
pressing articulating paper with the fingertips recontour the growth lines. The instrument is
onto the surface of the gypsum cast, the pat- moved tangentially to the surface, touching
tern is rendered prominently. the porcelain over a length of 2 to 3 mm
Why should we attempt to establish a (Figs 19-17 to 19-19). We work from one side
natural-appearing surface? Take the example to the other with no backward motion, follow-
of two fixed partial dentures, one for a younger ing the marked pattern. The lingual side is
patient, the other for an older patient. treated likewise. Articulating paper is used to
Regions that are the most prominent and, inspect the result (Figs 19- 20 and 19-21).
consequently, most susceptible to natural When the macrogeography and microgeo-
and mechanical wear, are polished to a high graphy are established, the concavities are
gloss. Concave areas that are more pro- polished to a low gloss. This is done by plac-
tected and show more growth lines are ing the work into the furnace without apply-
polished to a low gloss. Figures 19-12 to 19-14 ing a low-fusing porcelain. The restoration can
illustrate clearly our objective: reflection is be air-fired or vacuum-fired. It may be per-
much more intense on a smooth surface than formed during a correction bake, too. We
on a serrated surface where the light re- must keep in mind, however, that we want to
bounds. In fact, this combination of different attain a low glaze and avoid too much firing.
surface structures creates the desirable play The final gloss should be 1/10 or 1/20 short
of reflections of light (Figs 19-15 and 19-16). of the maximum gloss (Fig 19-22).

203
 Analysis of the Surface Structure - Polishing

Fig 19-18 The pattern of the growth lines is marked

with a pencil on the porcelain surface.

Fig 19-17 Using an pencil and articulating paper, the

distinct features of the porcelain surface are marked.
Shape, transition lines, and macrogeography and micro-
geography can be studied.

It is difficult to specify an exact firing

temperature. Ceramists neither use the same
furnace or porcelain material, nor do they
follow the same method of layering. This
leads to different results after the firing
despite identical temperatures. Also, we do
not condense the porcelain. We only try to
establish a low gloss that is approximately
1/10 to 1/20 below the high gloss.
As soon as the restoration is recovered from
the furnace, polishing is started. Carborun-
dum stones of the appropriate grit and shape
Fig 19-19 The growth lines are
created mechanically with a slightly (tapered or flame- shaped) are used for labial
tapered round-tip diamond. The in- or lingual surfaces (Fig 19-23); carborundum
strument is moved tangentially to the disks are used for the proximal surfaces
surface, touching the porcelain over
a length of 2 to 3 mm. (Fig 19-24). The proximal surfaces, the cer-
vical margin, and the underside of the
restoration must be perfectly smooth to pre-
vent plaque accumulation. A large- diameter
abrasive instrument is used to finish the most
exposed areas, such as protruding regions
and transitions. Working at low speed on all
surfaces of the restoration can create natural-
looking wear. This wide grinding wheel is
strictly used on convex surfaces (Fig 19-25); a
smaller-diameter grinder would remove undue
amounts of the surface (Fig 19-26).
After this sequence of selective polishing
(in this case less important because of the

204
 Observation and Application of Information

Figs 19-20 and 19-21 Articulating paper is used to inspect the growth-line pattern.

Fig 19-22 A fixed partial denture after the minimum Fig 19-23 A flame-shaped abrasive stone is used for
glaze bake. This gloss should be 1/10 to 2/10 short of the polishing. The same instrument is used for the occlusal
maximum gloss. and the lingual surfaces.

Fig 19-24 The proximal surfaces are finished with

silicone disks. These surfaces must be absolutely
smooth to prevent plaque accumulation.

205
 Analysis of the Surface Structure - Polishing

Fig 19-25 Wide silicone and felt

wheels are used on all convex sur-
faces. ( A) Porcelain; ( B) large- dia-
meter felt wheel, diamond paste: (Y)
convex surfaces show more gloss
than concave ones.

Fig 19-26 An abrasive wheel of

smaller diameter would polish not
only the convex surfaces but the
concave ones, too. Thus, we obtain
neither the desired double reflection
nor the double gloss. (A) Ceramic;
( B) small-diameter felt wheel with
diamond paste; (Y) the concave and
the convex surfaces will show equal
gloss.

patient’s youth), the high gloss is attained. If a fixed partial denture for an older patient
We use identically shaped felt polishers in is to be fabricated, the polishing sequence is
combination with high-quality diamond paste even more important because we have to
(Fig 19- 27). Polishing of the desired surfaces consider a greater number of smooth sur-
creates more gloss, and more reflection as faces. The following instruments should be
well, on convex surfaces. Ultimately, this will used to design the macrogeography and
result in a magnificent play of light between microgeography:
these two levels of gloss. Light on a porcelain - A flame-shaped, tapered diamond is used
surface acts in the same way as on natural to form depressions (ie, small concavities);
teeth (Fig 19-28). If a traditional glaze bake the same instrument can be used on the
were performed, this play of light reflections interproximal space (Fig 19-29).
would not exist: the degree of gloss between - An inverted cone diamond is used to
concave and convex areas would be identical. recontour lines or emphasize the cemen-

206
 Observation and Application of Information

Fig 19-27 Polishing of the ceramic with felt wheel and Fig 19-28 Completed restoration. The light acts on the
diamond polishing paste in order to give the restoration ceramic just as on the surface of natural teeth.
a high gloss. The diamond paste should be white and
have a fine grain to avoid contamination and roughen-
ing of the porcelain.

Fig 19-29 Fixed partial denture for an older patient. Fig 19-30 An inverted cone diamond is used to recon-
Treatment of the surface with a flame- shaped diamond tour lines or emphasize the cementoenamel junction of
creates the macrogeography. the restoration.

toenamel junction of the restoration restoration are polished. The same procedure
(Fig 19-30). is performed to create a high gloss, with dia-
For reasons of accuracy, a magnifying glass mond paste and felt polisher used at a slight-
should always be used. Photographs, con- ly higher speed (Figs 19-34 and 19-35) .
siderably magnified, are of great help. The The finished restoration will exhibit a satis-
restoration is now placed in the furnace in fying play of light reflection (Fig 19-36). These
order to create a low gloss (glazing of the surfaces, which are very smooth in prominent
concave surfaces). Polishing can then be areas, prove the high esthetic quality of
done using abrasive stones. This procedure porcelain. It is necessary to use fine-grain
is very important because restored teeth for porcelain. (IPS Ivoclar has reduced the grain
older patients must have smoother surfaces size by 23 /o.) This refined powder facilitates
(Figs 19-31 to 19-33). The proximal and °
the modeling of fine surface structures and
cervical surfaces and the underside of the provides the restoration with higher stability

207
 Analysis of the Surface Structure - Polishing

Figs 19-31 to 19-33 The porcelain surfaces are polished

after the minimum glaze bake with a variety of abrasive
silicone points. This restoration for an older patient re -
quires even more polishing.

Figs 19-34 and 19-35 A high gloss is achieved with

diamond polishing paste and felt polishers (felt wheel or
flame- shaped, depending on the surface).

Fig 19-36 The finished restoration and the “ play of

double light reflection”: a low gloss on the concave and
a high gloss on the convex surfaces.

208
 Observation and Application of Information

Figs 19-37 and 19-38 Correction bake and minimum glaze bake are carried out simultaneously (vacuum-firing).
When the restoration is recovered from the furnace, only the corrected areas need to be repolished and a high gloss
must be achieved.

but less shrinkage and brittleness. The entire into the dental arch because of improved
coloration is created inside the porcelain itself light reflection. This example emphasizes the
according to the layering technique and significance of gloss and quality of surface
lateral segmentation. structure. It is less detrimental to misjudge the
Finally, we would like to emphasize the hue by one quarter than to give the restora-
advantage of performing two firings. Figures tion a poor surface structure.
19-37 and 19-38 showe that a correction In conclusion, the key words for successful
bake and a minimum glaze bake can be car- mimicking of surface structure are observa-
ried out simultaneously (vacuum-firing in this tion, high and low gloss and, in addition, the
case). This is enormously time- saving com- play of light reflection. Instruments that are
pared to the traditional method of performing appropriate as well as efficient make the
correction and glaze bakes separately. objective simpler and more comfortable,
As can be seen in Figs 19-39 and 19-40, the rendering any additional manipulation redun-
surface structure of the metal ceramic restora- dant. These instruments (together with the
tion on tooth 11 is not of satisfactory quality. technique) are available in a kit standardized
During the trial seating procedure, poor light by the author (Fig 19-41): the selected in-
reflection was noticeable. After corrective struments are coordinated according to their
polishing, this crown fits considerably better grain size.

209
 •M

Analysis of the Surface Structure - Polishing

Fig 19-39 Tooth 11 is restored with

a metal ceramic crown, the surface
structure and degree of gloss are
unsatisfactory. The restoration is
conspicuous because of the dis-
crepancy in light reflection to natural
teeth.

Fig 19-40 After corrective polish-

ing and glazing, it is possible to
integrate the crown into the dental
arch. This example clearly shows the
significance of surface structure.

Fig 19- 41 The polishing kit by

Ivoclar, small version.

210
My two colleagues, Jean- Marie
Milesi and Jean- Frangois Zalejski.

This work would be most incomplete with- function, and accuracy. Therefore, our leit-
out emphasizing strongly the significance of motif must be: to question the achieved day
a team whose contributions are absolutely in, day out , in order to go beyond our pos-
indispensable in the quest for naturalness, sibilities and knowledge.

211
212
References

Abendroth U. Das Herstellen von Kronen aus gieBbarer Hegenbarth EA . Creative Ceramic Color : A Practical
Dicorglaskeramik. Dent Labor 1985; 33: 1281 - 1286. System. Chicago: Quintessence, 1989.
Adair PJ. Dental constructs and tools and production Itten J. Art de la Couleur. Paris: Editions Dessair et Tolra,
thereof . EP 00 22655. 1986. 1967.
Adair PJ, Grossman DG . The castable ceramic crown. Kedge M . Lateral, segmental buildup. In: Preston JD
Int J Periodont Rest Dent 1984; 4: 33 - 45. (ed). Perspectives in Dental Ceramics: Proceedings of
Aliard Y. L’Empress: Une Nouvelle Ceramique Sans the Fourth International Symposium on Ceramics.
Armature [thesis] . Lyon: University of Lyon. Chicago: Quintessence, 1988: 369 - 373.
Anusavice KJ. Stress distribution in atypical crown Klug HP X- ray Diffraction Procedures for Polycrystalline
designs. In: Preston JD (ed). Perspectives in Dental and Amorphoium Materials. New York: John Wiley and
Ceramics: Proceedings of the Fourth International Sons.
Symposium on Ceramics. Chicago: Quintessence, Knellessen C, Degrange M . Les inlays onlays en vitro-
1988: 175 - 191. ceramique vers une nouvelle forme de dentisterie res-
ASTM , Kartei: ICPDS 15 - 47. Philadelphia: American tauratrice. Cahiers Prothese 1987; 60.
Society for Testing Material. Kuwata M . Theory and Practice for Ceramo Metal Res-
Barreiro MM . Phase identification in dental porcelains torations. Chicago: Quintessence, 1980.
Lejoyeux J. Prothese Complete Tome 2, ed 4. Paris: Edi-
'
for ceramo - metallic restorations. Dent Mater 1989; 5:
51 - 57. tions Maloine, 1986.
Beham G. Recherche et developpement [Report No. Mac Culloch WT. Advances in dental ceramics. Brit
6]. Schaan: Departement de la Prothese, 1990. Dent J 1968; 123: 361 - 365.
Bottger, H , Bosenbauer KA , Pospiech P Vergleichende Mackert JR. Effects of thermally induced changes on
rasterelektronenmikroskopische Randspaltmessungen porcelain-metal compatibility. In: Preston JD (ed). Per -
von verblendeten und unverblendeten Metallkronen spectives in Dental Ceramics: Proceedings of the
und Dicorglaskeramikkronen. Zahnarztl Welt 1988; 95: Fourth International Symposium on Ceramics. Chicago:
445 - 450. Quintessence, 1988: 53 - 64.
Bourelly G , Prasad A. Le procede Optec HSP Concepts Muia PJ. The Four Dimensional Tooth Color System.
et mise en oeuvre au Laboratoire. Cahiers Prothese Chicago: Quintessence, 1982.
1989; 68. Muterthies K . Esthetic Approach to Metal Ceramic Res-
Bowen KH. Moderne keramische Werkstoffe. Spektrum torations for the Mandibular Anterior Region. London:
Wissenschaft 1986; 12: 140 - 149. Quintessence, 1990.
Cavel WT, Kelsey WP III , Barkmeier WW, Blankenau RJ. N . N . Verfahren zur Herstellung von Gegenstanden aus
A pilot study of the clinical evaluation of castable cera- Porzellan und dgl. Patentschrift 157210. Deutsches
mic inlays and a dual - cure resin cement. Quintessence Reich, 1937.
Int 1988; 19: 257 - 262. Parramon J - M . La Couleur et le Peintre. Paris: Editions
Chiche GJ, PinaultA. Essentials of Dental Ceramics: An Bordas, 1985.
Artistic Approach. Chicago: Year Book, 1988. Pichard C. Infrastructure ajouree. Cahiers Prothese
Rouffignac M de, Cooman J. Reconstitution ceramo- 1982; 40.
metalliques. des dents depulpees destinees a recevoir Prasad A , Day GP, Tobey RG. A new dimension for
des coiffes sans alliage. RFPD Actuates 1990 Nov; 21. evaluation of porcelain- alloy compatibility. In: Preston
Dubois de Chemant N . Sur les advantages des nouvel- JD (ed). Perspectives in Dental Ceramics: Proceedings
les dents et rateliers arteficiels, incorruptables et sans of the Fourth International Symposium on Ceramics.
odeur. London et Paris, 1788. Chicago: Quintessence, 1988: 65 - 74.
Glocker R. Materialprufung mit Rontgenstrahlen. Berlin: Roge M , Preston JD. Couleur, lumiere et perception de
Springer Verlag, 1958. la forme. Odontologia 1987; Dec : 357 - 362.
Grossmann DG. Tetrasilic mica glass ceramic method, Shillingburg HT, Jacobi R , Brackett SE . Fundamentals
US patent 3,732,087. 1973. of Tooth Preparations for Cast Metal and Porcelain Res-
torations. Chicago: Quintessence, 1987.

213
References

Simon J, Feuillerat B, Rivoire G, Kraft J - L. Le polissage Ubassy G. Analyse der anatomischen Oberflachenbe-
technique de finition des elements ceramiques. Cahiers schaffenheit. Dent Labor 1990; 4: 493.
Prothese 1987; 60. Ubassy G. Les Cires Colorees. RFPD Actuates 1989; 2.
Soom U. Glaskeramik. Spezialanwendung: nichtmetal - Ubassy G. Les felures d’email. Prothese Dent 1989; 31: 7.
lische gegossene Fullungen im Seitenzahnbereich.
Vidal R, Dejou J, Deyez O. Les onlays de ceramique
Schweiz Mschr Zahnheilk 1987; 97: 1409 - 1416. conventionelle, une solution esthetique durable. Cahiers
Stookey SD. Catalyzed crystallization of glass in theory Prothese 1987; 60.
and practice. Glastechn Ber 1959; 32 K : 1 - 8. Vogel W. Struktur und Kristallisation der Glaser. Leipzig:
Touati B, Bersay L . Emaillage des dents au moyen de VEB Deutscher Verlag fur Grundstoff - lndustrie, 1971.
facettes de vitroceramique. Cahiers Prothese 1987; 60. Wohlwend A , Strub JR , Scharer P Metal ceramic and
Touati B. Le collage des inlays onlays de ceramique. all- porcelain restorations: current considerations. Int J
Rev Odont Stomatol 1988; 1. Prosthodont 1989; 2: 13 - 26.
Touati B, Pissis P L ’inlay colie en resine composite. Wohlwend A. Verfahren und Ofen zur Herstellung von
Cahiers Prothese 1984 ; 48. Zahnersatzteilen. Europaische Patentanmeldung 0231
Touati B, Pissis P, Miara P Restaurations unitaires col - 773. 1987.
lees et concept des preparations pelliculaires. Cahiers Yamamoto M . Metal- Ceramics: Principles and Methods
Prothese 1985; 52. of Makoto Yamamoto. Chicago: Quintessence, 1985.

214
Index
A Equipment 150
Atlas of the Munsell Color System 21
Esthetics,
dentolabial 25 - 28
B facial 25 - 28
incisal edge 97
"Blinder " 45
relations within 25 - 28
C smile 25 - 28
veneers 39
Cast, working preparation of 121
Ceramic, F
composition 143
Fissures, occlusal
crystal structure, radiographic analysis 147 natural tooth 135
crystallization, controlled 145 porcelain restorations 135
history of dental use 141
IPS Empress 141 G
Ivoclar 76, 78, 88, 141 - 176
layering, 73 - 89, 91 - 95, 99, 155. 164 Geller, Willi 97
" tricks of the trade" 91 - 95 Gingiva, artifical, 67 - 71
Leucite- reinforced 141 - 176 removable 69
microstructure 143 Gold coat 57
analysis 147 Grinding 94
post and core 179 - 183
canines 179 H
fabrication 180 Halo effect 46
incisors 179
metal substructure for 179 I
molars 179 Incisal guidance 94
premolars 179 Inlays,
shoulder 61 - 66 ceramic, 119 - 140
See also Porcelain. baking 123, 125, 128
Color, firing 123, 125, 128
additive synthesis 20 lifelike 120
.
brilliance 21, 49 75 modeling 123, 128
chroma 22 preparation criteria 119
dentin 36, 44 marginal fit 131
grays 23 porcelain, 119 - 140
hue 21, 76 baking 123, 125, 128
incisal edge 43, 97 firing 123, 125, 128
instruments for application 51 - 55 lifelike 120
language of 21 modeling 123, 128
luminosity 49 preparation criteria 119
"maverick " 43, 78, 112 Instruments 51 - 55
opalescent 37 Investment, casting,
original porcelain 115 - 118 criteria for 121
polychromy 21 removal 131
porcelain 42, 115 - 118 thermal processing 122
Rule of Colors 99
saturation 22 L
shade selection conditions 41 - 47
substractive synthesis 20 - 21 Land, C.H. 141
value 21, 49, 75 Light ,
visual perception 31 absorption 18 - 19
Communication 33, 49, 197 reflection 18 - 19
Crown, metal ceramic, fabrication 78, 91, 99 refraction 17, 19
" white" 17
D
Dentin, translucency 110 M
Dentin, core, Models, wax, 31 - 40
fabrication 159 contour perception 32
for anterior restorations 168 detail perception 32
for posterior restorations 167 educational advantages 31
Denture, partial, fixed, fabrication 188
anterior, fabrication 91, 98 occlusal perception 33, 38
multi- span, fabrication 91 psychological advantages 33 - 34
Dies, visual perception 31, 33
dentin colored 153 volume perception 33
preparation 61 Munsell, Albert Henri 21
resin, fabrication 189 Munsell system 21, 22
Dubois de Chemant, Nicolas 141
Duchateau, Alexis 141 N
E .
Newton Isaac 17
Empress system 141 - 176, 179, 185 - 195 O
Enamel 109
Enamel cracks, Onlays,
shade selection for 99 ceramic, 119 - 140
simulation in crowns 99 baking 128

215
Index

firing 128 shade selection 41 - 47, 155

modeling 128 shoulder 61 - 66
preparation criteria 119 strength 142, 147
porcelain, 119 - 140 translucent ,
baking 128 .
color 44 73, 76
sun-colored 115
firing 128
modeling 128 working 110
preparation criteria 119 transparent,
. .
color 44 73 76
dark blue 115
P working 110
Patients. .
working procedures 150
layering 157
older, pressing 152
segmentation for 98
staining 157
tooth geography 197
See also Ceramic.
younger,
segmentation for 98 R
tooth geography 197
Personality 25 - 28 Rule of Colors 99
Pigments, S
“ painting ” with 20
primary 20 Shade guides,
secondary 20 porcelain 42
tertiary 20 three - dimensional 49
Pindex system 121 Shoulder, ceramic 61 - 66
Porcelain, Spectrum .
.
build- up 35 - 37, 73, 77 83. complementary colors 18
physical data 17, 19
dentin 78, 82
.
incisal edge 76, 98 99 primary colors 18
secondary colors 18
incremental 73
.
lateral segmentation 73 83, 97 - 107, 98 T
occlusal surface 81
proximal surface 81 Tooth,
vertical 97 appearance characteristics 47
coat breakdown 42 ceramic,
composition 143 incisal edge 111 - 112
crystal structure, radiographic analysis 147 internal structure 73, 85
crystallization, controlled 145 translucent 112
density 94 transparent 112
dentin 57, 91 transparent seam 111
firing 88, 91 growth lines 197
firing temperatures 88 natural,
gloss classification 197 incisal edge 110
gold coat for 57 internal structure 73, 109
history of dental use 141 transparency 109
IPS Empress 141 porcelain,
instruments for 51 - 55 incisal edge 111, 112
"intense" 123 internal structure 73, 85
. . .
Ivoclar 76 78 88 141 176 - translucent 112
lateral segmentation 73 77 . transparent 112
. . .
layering 73 - 89, 91 - 95 99 155 164 . transparent seam 111
posterior, segmentation of 98
“ tricks of the trade" 91 - 95
Leucite- reinforced 141 176- preparation, pressed ceramic restorations 171
light reflection 209 shade selection,
masking 81 conditions 41 - 47
microstructure, 143 enamel cracks 99
analysis 147 Translucency 109 - 113
milky opalescent 115 Transparency 109 - 113
modeling criteria 99
V
mother - of - pearl incisal 115
opaque 57 - 60 Veneers,
application 57 ceramic 185 - 195, 188
color 42 esthetics 39
modification 59 facial 185 - 195, 188
“ wash" 57 gloss 193
original colors, 115 - 118 marginal fit 189
polishing, 197 porcelain 185 - 195, 188
observation of results 197 pressed 189
procedures 204 resin- bonded 186
requirement communication 197 wash and bake 189
surface structure 197 - 211
post and core, 179 - 183 W
canines 179 Wax , colored, 31 - 40
fabrication 180 educational advantages 31
incisors 179 psychological advantages 33. 34
metal substructure for 179 veneer esthetics 39
molars 179 visual perception with 31, 33
premolars 179
pressed, tooth preparation 171 Y
properties needed 143 Young, (physicist) 17
shade guides 42, 49

216