ALL CERAMICS

PRESENTED BY
RASHI TERI
FIRST YEAR MDS
DEPARTMENT OF PROSTHODONTICS
MMCDSR
 CONTENTS
 Introduction
 Definition
 History
 Classification
 Composition
 Different all ceramic restorations
 Case report
 Newer trends in all ceramics
 Conclusion
 References
 INTRODUCTION
 Ceramics is derived from the word keramos which in Greek means
pottery and in Sanskrit it means to burn.
 DEFINITION
 According to Phillip’s (12th edition)-

Dental ceramic is defined as an inorganic compound with non-metallic

properties typically consisting of oxygen and one or more metallic or semi
metallic elements (aluminium, calcium, lithium, magnesium, potassium, silicone,
sodium, tin, titanium and zirconium) that is formulated to produce the whole or
part of a ceramic-based dental prosthesis.
 According to GPT 9-

Compounds of one or more metals with a nonmetallic element, usually oxygen.

They are formed of chemical and biochemical stable substances that are strong,
hard, brittle, and inert nonconductors of thermal and electrical energy.
 HISTORY
 Fabrication of ceramic materials dates back to
23000 years.
 First introduced in dentistry in 1774 by a French
pharmacist Alexis Duchateau.
 First porcelain tooth material was used in 1789
by a French dentist De Chemant.
 Dental ceramics are attractive because of their
biocompatibility, long term color stability,
chemical durability, wear resistance and ability
to be formed in precise shapes but it requires
costly equipment and specialised training for lab
technicians.
ADA SPECIFICATION ISO SPECIFICATION
• Dental ceramic : 6872
• Dental ceramic : 69
• Dental porcelain teeth :
• Dental porcelain teeth : 45
22112
• Metal ceramic system : 38
• Metal ceramic system : 9693
 CLASSIFICATION
 Based on sintering temperature
 Based on translucency
 Based on fracture resistance
 Classification by microstructure
 Based on crystalline phase
 Based on processing of ceramic
 Based on framework
 Based on system used
 Based on application
 Based on indications
 Based on principal crystal phase
 BASED ON SINTERING
TEMPERATURE
CLASS APPLICATIONS SINTERING
TEMPERATURE
RANGE
High fusing Denture teeth, and fully >1300º C (>2372 F)
sintered alumina and
zirconia core ceramics
Medium fusing Denture teeth, presintered 1101º C – 1300º C (2013
zirconia F – 2372 F)
Low fusing Crown and bridge veneer 850º C - 1100º C (1562 F
ceramic – 2012 F)
Ultra low fusing Crown and bridge veneer < 850º C
ceramic
 BASED ON TRANSLUCENCY

 Transparent
 Translucent
 Opaque
 BASED ON FRACTURE RESISTANCE

 Low
 Medium
 High
 BASED ON
MICROSTRUCTURE
1. Amorphous glass
2. Crystalline
3. Crystalline particles in a glass
matrix
 BASED ON FABRICATION TECHNIQUES

• Sintering ( Metal Ceramics)

• Casting (Dicor)
• Heat pressed or Hot isostatically pressed (IPS Empress )
• Slip casting (Inceram )
• Machined (Cerec Vitablocs)
• Partial sintering and glass infiltration
• CAD CAM and copy milling
BASED ON CRYSTALLINE PHASE

• Alumina based (Optec HSP)

• Feldspar based (Conventional Ceramics)
• Leucite based (IPS Empress)
• Spinel based (Inceram Spinel)
 BASED ON COMPOSITION
• Pure alumina
• Pure zirconia
• Silica glass
• Spinel
• Leucite based
• Lithia based
 BASED ON CRYSTALLINE
NATURE
 Crystalline ceramics - eg
Feldspathic porcelain containing
Lucite(crystal phase)
 Non crystalline ceramics – eg
Glass
 BASED ON FIRING
TECHNIQUE
According to media employed :
 Air fired (at atmospheric pressure) –has porosity due to
air inclusion.
 Vacuum fired (at reduced pressure)- reduces porosity.
 Diffusible gas firing- helium, hydrogen and steam are
substituted for the ordinary furnance.
According to pre-setting :
 Temperature controlled method
 Temperature and time controlled method
 BASED ON FRAMEWORKS
 Alumina - interpertaining phase/ glass infused :-

In ceram blocks are fabricated by pressing the alumina based powder into a
block shape similar to vitablocs. These blocks are 75% in density and then
infused with different shades of glass to make it 100%
 Alumina - porous:-

Fabricated by porous blocks of material. Pressing alumina powder with a

binder into a mold produces the blocks.
 Partially stabilized zirconia- porous :-

Fabricated similar to alumina blocks. But there are various methods to press the
powder into a mold.
• Uni-axial- involves pressing from one direction
• Bi-axial- from 2 equal and opposite direction
• Isostatic- uniform pressing in all directions
 Partially stabilized zirconia- HIP blocks :-

Fully dense zirconia is produced by hot isostatic pressing.

Zirconia powder is pressed in a block or the mold, then vacuum sealed in air
tight bag and placed into fluid filled chamber. Pressure is applied evenly and
further it is sintered to produce zirconia of full density.
 ACCORDING TO SYSTEMS
 Metal ceramic systems

Cast metal systems and non cast systems

 All ceramic systems

o Conventional powder slurry ceramic (using

condensing and sintering)
1. Alumina reinforced porcelain
2. Magnesia reinforced porcelain
3. Leucite reinforced
4. Zirconia whisker fiber reinforced
5. Low fusing ceramics
o Castable ceramics ( using casting and ceramming)

1. Fluormicas
2. Apatite based glass ceramics
3. Other glass ceramics
o Machinable Ceramics
 Analogus systems (Pantograph systems- copying methods)

a. Copy milling/grinding techniques – Mechanical and Automated

b. Erosive techniques – Sono-erosion(ceramic restorations) and Spark erosion(metallic restorations)
 Digital Systems (CAD/CAM)

a. Direct
b. Indirect
o Pressable Ceramics (pressure molding and sintering)

a. Shrink free alumina reinforced ceramics

b. Leucite reinforced ceramics
c. Lithia reinforced glass ceramics
o Infiltrated Ceramics (slip casting, sintering and glass infiltration)

a. Alumina based
b. Spinel based
c. Zirconia based
 BASED ON INDICATIONS
 Inlays and onlays
 Esthetic laminates (veneers) over natural teeth
 Single (all ceramic) crowns
 Short and long span (all ceramic) FPD
 As veneer for cast metal crowns and bridges (metal ceramics)
 Artificial denture teeth (for complete denture and partial denture use)
 Ceramic post and cores
 Ceramic orthodontic brackets
 BASED ON APPLICATIONS
 Core porcelain
 Body or dentin or gingival
porcelain
 Enamel porcelain
 Translucent porcelain
 Modifier or colour frits
 BASED ON PRINCIPAL CRYSTAL PHASE
 Silica glass
 Leucite based feldspathic porcelain
 Leucite based glass ceramic
 Lithia disilicate based glass ceramic
 Aluminous porcelain alumina
 Glass infused alumina
 Glass infused spinel
 Glass infused zirconia
 Zirconia
 A NEW PROPOSED CLASSIFICATION SYSTEM

Gracis S, Thompson VP, Ferencz JL, Silva NR, Bonfante EA. A new classification system for all-ceramic and ceramic-
like restorative materials. International Journal of prosthodontics. 2015 May 1;28(3).
DIFFERENT ALL
CERAMIC
RESTORATIONS
 PORCELAIN JACKET CROWN
Traditional porcelain jacket crown
 Crowns made entirely of feldspathic porcelain. They are
constructed on a platinum foil matrix which is
subsequently removed.
 Platinum foil is adapted to the die with a wooden point,
which acts as a matrix. It supports the porcelain during
condensation and firing.
 They were very brittle, fractured easily and had poor
marginal adaptation. Thus, they are no longer used.
Porcelain jacket
crown with
platinum foil
matrix
Porcelain jacket crown with aluminous core
Presence of alumina crystals increased the core strength
by 40 to 50% but were still brittle and not indicated for
posterior teeth.
Leucite reinforced porcelain (OPTEC HSP)
It is a feldspathic porcelain with a higher leucite crystal content.
We use the same platinum foil matrix technique.
It is less opaque making it esthetic compared to aluminous porcelain.
It also has higher strength but not strong enough for posterior use.
Uses – inlays
- onlays
- veneers
- low stress crowns
 CASTABLE GLASS CERAMICS
 First commercially available castable glass ceramics for dental use
was Dicor developed by Corning glassworks and marketed by
Dentsply.
 They are supplied as glass ingots and contains 55 vol% tetrasilicic
fluormica crystals.
 The crowns are very esthetic because of greater translucency. It also
picks up colour from the adjacent teeth (chameleon effect) and also
from the underlying cement.
 Uses – inlays

- onlays
- veneers
- low stress crowns
Fabrication :
Pattern is constructed in wax and then invested in a refractory material.

After wax burnout, Dicor glass nuggets are melted and cast into the mold in
centrifugal casting machine.

The glass casting is carefully recovered from the investment by sandblasting and
the sprues are gently cut.

The glass restotation is then covered with an embedment material to prepare for
ceramming.

Ceramming is a heat treatment process by which glass is strengthened, which

enhances growth of mica crystals thus increasing the strength and esthetics.

Cerammed glass is built up with special veneer porcelain and then fired to
complete the restoration.
 HEAT PRESSED CERAMICS
 Supplied in ingots of various compositions and
fabricated by injection molding.
 Heat pressed glass ceramics includes :
Leucite reinforced (IPS Empress)
Lithium disilicate reinforced (IPS Empress 2)
 Heat pressed veneering ceramics (IPS ZirPress) used as
a pressed layer over machined zirconia cores.
 Uses – inlays, onlays, low stress crowns, small 3 unit
FPDs
 Advantages – better fit and better esthetics
 Disadvantages – need for costly equipment, potential of
fracture in posterior areas
Fabrication :
Wax pattern of restorations are invested in refractory material and heated to
850ºC in a furnance to burn off wax and create mold space.

It is transferred to pressing furnance where ceramic ingot and an alumina

plunger is inserted into the sprue under air pressure of 1500 psi

The restoration is retrieved from the flask

Compatible veneering porcelain is added to the core to build up the final

restoration.
IPS EMPRESS IPS EMPRESS 2
 It is leucite reinforced heat pressed glass  It is lithium disilicate reinforced glass
ceramics. ceramics.
 Consists 35 to 40% by volume of leucite  Consists 65 to 70% by volume of
crystals. interlocked elongated lithia disilicate
 Pressing temperature 1075 to 1180ºC. crystal.
 Pressing temperature 920ºC.
 Low flexural strength limiting its use to
single unit restorations of anterior region.  Higher flexural strength, making it
suitable for 3 unit FPD in anterior region
that can extend to second premolar.
 GLASS INFILTRATED CERAMICS
 Also called slip cast ceramics.
 Types :

1. Glass infiltrated alumina core( In Ceram alumina)

2. Glass infiltrated spinel core(In Ceram spinel)
3. Glass infiltrated zirconia core (In Ceram zirconia)
 Supplied as – oxide powder with mixing liquids

- glass powder
- veneering powder and liquid
Glass infiltrated alumina core
 The core is made up of 70% alumina and 30% glass.
 Indications– anterior and posterior crowns, short span anterior fixed dental prosthesis.

Glass infiltrated spinel core

 Material of choice for anterior crowns and for stress free zones.
 Not used in posterior crowns, FPDs and severely discoloured tooth.

Glass infiltrated zirconia

 Strongest of the three, with 30wt% zirconia and 70wt% alumina.
 Indications – posterior crowns, short span posterior FPDs and severey discoloured
tooth.
 Not used in esthetic zones.
Fabrication :
Die is required firstly

Preparing the slip – alumina powder is added to mixing liquid and mixing done with help of special ultrasonic
instrument(Vitasonic).

Slip is applied on die using slip cast method, water from slurry is absorbed by die leaving a dense layer of alumina
on surface until sufficient thickness is maintained.

Slip cast alumina coping dried at 120ºC for 2 hours and then sintered for 10 hours at 1120ºC.

Next is glass infiltration where glass powder mixed with distilled water is applied on sintered coping and fired at
1110ºC on platinum foil. Glass melts and infiltrates through capillary action.

Excess glass trimmed using special burs followed by sandblasting.

Lastly built up done using special veneering ceramics.

 YTTRIA STABILIZED ZIRCONIA CERAMICS
 Zirconia is the oxide of zirconium metal. It has the
highest strength because it undergoes transformation Monoclinic
Tetragonal
Monoclinic
(high
toughening. (stable) temperature (on cooling)
)
 Addition of yttria oxide or magnesium oxide maintains
that high temperature form and is known as yttria
stabilized zirconia polycrystal. This multiphase ceramic
material is known as partrially stabilised zirconia.
 Dental zirconia is extremely hard, dense, strong and
highly opaque.
 Indications –
Anterior and posterior crowns
Implant abutment / crowns
3 unit inlay and onlay bridges
Some cases of cantilever bridges
When stress is applied on zirconia in
beginning of crack formation, it reverts
to monoclinic form which increases the
volume. This increase, introduces
compressive stresses around the crack
and slows the growth. Therefore,
zirconium oxide is also called ‘ceramic
steel’.
2 methods are available to process the ceramic blocks :
 Hard machining
 Soft or green machining

Hard machining – used to machine fully sintered ceramic but can

result in significant tool wear and residual flaws at the ceramic
surface reducing its survival rate.
Soft machining – used to machine partially sintered cermaics. It
requires milling of an enlarged restoration to compensate for
sintering shrinkage.
Yttria is the most commonly used dopant stabilizing cubic phase of zirconia because of :
 high ionic conductivity at elevated temperature
 high chemical inertness
 thermal stability
 hardness.

Properties of zirconia:
 High refractive index
 High hardness
 High melting point
 High spatial and thermal stability at elevated temperature
 Low coefficient of thermal expansion so good resistance to thermal shock
 Moderate to high thermal conductivity
 MACHINED CERAMICS
 To overcome problems like technique sensitive, labor intensive and time consumption, machined
ceramics came into existence.
 It includes CAD/CAM and copy milling system.

CAD/CAM SYSTEMS
 CAD/CAM systems can design and produce restorations out of blocks of ceramics with aid of a
computer.
 Some examples include Cerec(Sirona), SironaInLab, Everest(Kavo), Cercon(Dentsply),Lava(3M
ESPE), Zeno(Weiland), 5-tec(Zirkonzahn), etc.
 Essentials of CAD/CAM systems :

Scanner or digitizer – virtual impression

Computer – virtual design(CAD)
Milling station – produces the restoration or framework
Ceramic blanks – raw material for restoration
Furnance – for postsintering, ceramming,etc.
COPY MILLED SYSTEMS
 In this a wax pattern of restoration is scanned and a replica is milled out of ceramic blank.
 Commercially available systems include - Celay, Cercon and Ceramill system.
 Fabrication –

Stone die prepared from impression and pattern of wax is created on it.

Pattern fixed on left side of machine and presintered zirconia is attached on right side.

Pattern on left side is scanned and right side mills out 30% enlarged replica of the same.

Milled structure is removed and final adjustments are done.

It is then sintered followed by built up by compatible veneering porcelain.

 MONOLITHIC RESTORATIONS
 It is a restoration made entirely of the same material, making it much stronger.
 It includes monolithic lithium disilicate and monolithic zirconia.
 Monolithic lithium disilicate – IPS e.max has improved fit, improved esthetics and
improved durability.
 Monolithic zirconia – there is no chipping or fracture as the crown is much stronger.
Esthetic alternative to PFM and cast gold restorations. Recommended in bruxers,
implant restorations and areas with limited occlusal space.
 Commercial names BruxZir, Lava plus high translucency zirconia.
 MATERIAL SELECTION
Anterior area - single crowns
 with normal colour abutments and the need to imitate high-translucency teeth: lithium disilicate and
feldspathic ceramics
 with dark abutments or low-translucency teeth: PFM
 in case of bruxers: monolithic lithium disilicate superficially colored restorations.

Anterior area - replacement of missing teeth

 with normal colour abutments: lithium disilicate
 with dark abutments: PFM.

Posterior area - single crowns

 with normal colour abutments and the need to imitate high-translucency teeth: monolithic lithium disilicate
 with dark abutments or low-translucency teeth: PFM or zirconia.

Posterior area - replacement of missing teeth

 for the fabrication of a three-unit bridge: PFM or zirconia;
Bovera
 for M.
theAll-ceramic
fabricationmaterial
of a selection: how to
bridge with choose
more in everyday
than practice.
three units: PFM Int J Esthet Dent. 2016 Jan 1;11(2):265-9 .
 CEMENTING OF CERAMIC RESTORATIONS
 Resin based and glass ionomer based cements are used for cementing.
 In all ceramic restorations underlying cement influence the esthetics of the restoration.
 Clinicians advocate use of resin luting cement because of the following :
Generates high bond strength
Improves esthetics
Improves translucency
Improves fracture resistance and long term survival
Reduces water access to inner ceramic surface
Etching blunts the tips of microcracks within ceramic inhibiting crack propagation.
 REPAIR OF CERAMIC RESTORATIONS
 Repair is difficult intraorally and can be done on temporary basis till a new
restoration is fabricated using composite.
 Process starts with etching of the broken restoration followed by application of
bonding agent which is light cured. This followed by application of composite.
After trimming and shaping, final glaze coat is applied.
 CERAMIC POSTS
 With increasing esthetic demand ceramic posts are
in trend.
 Types :

1. Prefabricated ceramic posts with composite

resin cores
2. Prefabricated ceramic posts with pressed
ceramic cores (CosmoPost- Ivoclar)
3. Copymilled ceramic(zirconia) post and core
 CERAMIC VENEERS, INLAYS AND ONLAYS
 Ceramic veneers is a more conservative
approach but is technique sensitive as acid base
luting cements play a key role in overall
appearance.
 Ceramic veneers are used primarily for esthetic
improvement of stains or hypoplastic anterior
teeth.
 Resin bonded acid etched ceramic inlays and
onlays are also used for posterior restorations.
 ZIRCONIA IMPLANTS AND ABUTMENTS
 Indications– esthetic consideration, sensitivity or
allergy to titanium.
 Advantages –
Esthetic
Biocompatible
Immediate placement therefore less resorption
Fits into original socket
Faster recovery time
Little or no postoperative complications
 CERAMICS AND TOPICAL
FLUORIDES
 Acidulated phosphate fluoride (APF), one of the most commonly used fluoride
gels, is known to etch glass by selective leaching of sodium ions, thereby
disrupting the silica network.
 When glazed feldspathic porcelain is exposed to 1.23% APF or by 8% stannous
fluoride, a surface roughness is produced within 4 min. Obviously this
roughness leads to staining, plaque accumulation, and further breakdown of the
structure.
 However, the use of lower concentrations, such as 0.4% stannous fluoride and
2% sodium fluoride, has no significant effect on the ceramic surface. Dentists
should be aware of these long-term clinical effects of fluorides on ceramic
restorations.
 If such a gel is used, the surface of the restoration should be protected with
petroleum jelly, cocoa butter, or wax.
RESTORATION OF A SINGLE CENTRAL INCISOR
WITH AN ALL-CERAMIC CROWN: A CASE REPORT

Pre-op view of discoloured composite Palatal view of a large defective composite

restoration on tooth # 21 restoration in tooth # 21
Silicone putty matrix formed on study model Tooth preparation with equi-gingival margins
and used in intra- oral fabrication of the in enamel. Note smooth preparation with no
temporary crown sharp angles
Silicone putty matrix with Initial form and colour of acrylic resin
methylmethacrylate acrylic resin being temporary crown as matrix is removed
applied over the tooth
Internal surface of Empress Internal surface of crown after
crown being etched with 9% etch. Note white precipitate
hydrofluoric acid which needs to be removed

Removal of precipitate with 36% Well etched, clean, internal

phosphoric acid. This should be surface after removal of white
agitated with a microbrush
Etching of the entire tooth surface Etched tooth surface
for 30 seconds with 36% phosphoric
acid

Cleaning of excess cement after Final restoration 10 days after

polymerisation with sickle scaler cementation
(a) Preoperative intraoral picture: Ellis‘ and Davey's Class II fracture of maxillary left central incisor with inadequate
overjet and overbite, (b) Preparation of maxillary left central incisor for single-unit all-ceramic post–core–crown
restoration, (c) Computer-aided designing and computer-aided manufacturing software designed three-dimensional
image of zirconia ceramic restoration, (d) Postoperative view of cemented restoration, (e) Periapical radiograph
following cementation of single-unit all-ceramic restoration .
 NEWER TRENDS IN CERAMICS
Lisi Press (GC)
 Next gen. lithium disilicate
 Unsurpassed strength due to high density micronization
 Bright and good esthetics
 Excellent marginal adaptation
 Highly versatile to use

Translucent zirconia (katana)

 4 layer structure- Enamel layer (35%),Transition layer 1
(15%),Transition layer 2 (15%),Body (dentin) layer (35%)
 This innovative multi layered technology creates the smooth
transition of color gradiation similar to natural tooth
Celtra Press System (Dentsply Sirona)
 New generation of high strength glass ceramics, Zirconia reinforced
lithium silicate
 Optimize balance of translucency and opalescence
 Reduced crystal size serves to increase flexural strength
 Fine microstructure for processing speed efficiencies

Hybrid ceramics(Vita Enamic, Vita Zahnfabrik, Bad Säckingen,

Germany)
 Hybrid ceramics seek to combine the optical and mechanical properties
of ceramics and composite resins by embedding nano-ceramic particles
in a very hard polymer matrix
 The mixture can be handled like composite and cured
 Good maleability and polishability, and it allows dentists to efficiently
fabricate single-tooth restorations in only one appointment.
 Additional benefits include dentin-like elasticity and low antagonist
abrasion
Ceromer
 An acronym for "ceramic optimized polymer"
 Biocompatible, metal free which exhibits the strength and potential wear resistance of
metal supported restorations and can be effectively adjusted and polished chair-side
Procera AllCeram
Impression is poured and conventional die is scanned by contact scanner.
Computer aided designing is done and sent via internet
Enlarged die is milled via CAM process
Powder dry pressed and then sintered followed by veneering
Uses – anterior and posterior crowns
inlays and onlays
 CONCLUSION
 Dental ceramic technology is one of the fastest growing areas of dental material
research and development.
 This increase has been attributed to patients’ demand for good aesthetics and an
improvement in the materials’ mechanical and aesthetic properties as well as to
required minimally invasive tooth preparation and the methods of fabrication.
 These restorations offer extremely good esthetics. But these restorations are technique
sensitive and expensive.
 Careful case selection and proper tooth preparation is important.
 Careful manipulation and fabrication of the restoration is to be mastered by the
technician to achieve the best possible results.
 The success of ceramic restorations depends on several factors, such as selection of
material, restoration design, occlusion, and cementation media.
 REFERENCES
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and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
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Grozdanov A. Contemporary dental ceramic materials, a review: chemical composition, physical and mechanical
properties, indications for use. Open access Macedonian journal of medical sciences. 2018 Sep 24;6(9):1742-55.
 Gracis S, Thompson VP, Ferencz JL, Silva NR, Bonfante EA. A new classification system for all-ceramic and ceramic-
like restorative materials. International Journal of prosthodontics. 2015 May 1;28(3).
 Bovera M. All-ceramic material selection: how to choose in everyday practice. Int J Esthet Dent. 2016 Jan
1;11(2):265-9.
 MIZRAHI B. RESTORATION OF A SINGLE CENTRAL INCISOR WITH AN ALL-CERAMIC CROWN: A CASE
REPORT. International dentistry. 2008;10(3):1-38.
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restoration. Journal of Conservative Dentistry. 2011 Jan 1;14(1):86.
THANK YOU