ALL CERAMIC SYSTEMS

SYNOPSIS
• INTRODUCTION
• HISTORY OF CERAMICS
• CLASSIFICATION
• INDICATIONS AND CONTRAINDICATIONS
• GLASS CERAMICS
• ALUMINA CORE CERAMICS
• METHODS OF STRENGTHENING CERAMICS
• BONDING PROTOCOLS
• METHODS OF PROCESSING
• RECENT ADVANCEMENTS
• CONCLUSION
 Introduction

Ceramic (1850): of or relating to the manufacture of any product made essentially from
minerals by firing at a high temperature.

Ceram : to apply a heat treatment process that converts a specially formulated glass into a
fine-grained glass-ceramic material.

Ceramic products that are used primarily for crowns and bridges include alumina,
ceria-stabilized zirconia, glass-infiltrated alumina, glass infiltrated magnesia-alumina spinel,
glass-infiltrated alumina/zirconia, lithium disilicate glass ceramic, yttria-stabilized zirconia, and
various glasses and glazes.

Glossary of Prosthodontic Terms -9

HISTORY OF DENTAL CERAMICS
YEAR SCIENTIST INVENTION

1808 Fonzi, an Italian dentist “terrometallic”

porcelain tooth held in place by a platinum pin or frame.

1817 Planteau, a French dentist introduced porcelain teeth to theNUnited States

18251 Stockton & his nephew • Commercial production of porcelain teeth

844 • S.S. White Company with mass production of porcelain
denture teeth.

1903 Charles Land First ceramic crowns

to dentistry
1962 Weinstein et al. Patent identified the formulations of feldspathic porcelain that enabled the
systematic control of the sintering temperature and coefficient of thermal
expansion.
1963 VITA Zahnfabrik first commercial porcelain

1965 McLean and Hughes  A significant improvement in the fracture resistance of all-
porcelain crowns.
 Aluminous core ceramic consisting of a glass matrix

1984 Adair and Grossman Improvement in all ceramic systems developed by controlled
crystallization of a glass (Dicor)

1990  Pressable glass-ceramic (IPS Empress), containing

approximately 34% leucite by volume
 Yttri stabilized Zirconia in dentistry.

2010 Milled Zirconia Crowns

 Ceramics

Ceramic for all

Metal Ceramics
ceramic prosthesis

Glass ceramic Oxide Ceramics

 Leucite based  Alumina

IPS Empress
 Silica
 Dicor glass ceramic
 Magnesia
 Lithium Disilicate
IPS E.Max  Zirconia
 Processing method Principal crystal phase and/or matrix
 casting, phase
 sintering, • silica glass
 partial sintering and glass • leucitebased feldspathic porcelain
infiltration, • leucite-based glass-ceramic
Uses or Indications  slip casting and sintering, • Lithia disilicate–based glass-ceramic
• Anterior and  hot-isostatic pressing, • aluminous porcelain
posterior crown  CAD-CAM milling • Alumina
• Veneer  copy-milling • glass-infused alumina
• post and core • glass-infused spinel,
• fixed dental • glass infused alumina/zirconia
prosthesis Translucency • zirconia
• ceramic stain • Opaque
• glaze • Translucent
• Transparent
Classification of Dental Ceramics by Sintering Temperature
General Indications and Contraindications for Use of Dental Ceramics
Type Primary Application Secondary Applications Contraindications
Feldspathic porcelain Metal-ceramic veneers Single surface inlays/Low Inlays, onlays, crowns,
Anterior laminate veneers stress sites and bridges
High translucency needed (except as metal-ceramic
veneers)
Bruxism
Aluminous porcelain Core ceramic for anterior Low-stress premolar crowns Molar crowns
crowns Bridges
Bruxism
Leucite glass-ceramic Anterior single-unit Low-stress premolar inlays High-stress situations
crowns and crowns Bridges
Anterior laminate veneers High translucency needed Bruxism
Lithium disilicate Anterior and premolar Anterior laminate veneers High-stress posterior
glass-ceramic crowns Posterior three-unit bridges situations
Anterior three-unit bridges to second premolar Bridges involving molar
Premolar crowns teeth
Bruxism
 Alumina  Core ceramic for  Low-stress posterior  Anterior veneers
crowns bridges  High-stress posterior
 Low-stress anterior bridges
bridges  Bruxism

Glass-infiltrated spinel Anterior crowns High translucency  Anterior bridges

needed  Posterior crowns and
bridges
 Bruxism

Glass-infiltrated alumina Anterior and posterior Anterior bridge  Anterior veneers

crowns substructures  Posterior crowns and
up to three units bridges
 High translucency needed
 Bruxism
Glass-infiltrated alumina/ Posterior crowns Anterior bridge  Anterior veneers and
zirconia Posterior bridge substructures crowns
substructures up to three units  Where high translucency
up to three units needed
 Bruxism
Zirconia (Y-TZP) Posterior crowns Anterior veneers, crowns,
(with veneering ceramic) Posterior bridge and bridges
substructures High translucency is
up to 5 units needed
Bruxism

Zirconia (Y-TZP) Posterior crowns and Posterior core-ceramic Anterior veneers, crowns,
(without veneering bridges bridges and bridges
ceramic) (limited clinical data High translucency is
available) needed
Bruxism

Ce-TZP/Al2O3 Posterior crowns and Anterior veneers, crowns,

bridge and bridges
substructures (no clinical High translucency is
data available) needed
Bruxism
Glass-ceramics
Devitrification of glass

 Castable glass(Dicor)
(Lost wax technique)

 glass casting core or coping obtained

 Coverage with protective ‘embedment’(Gypsum based materials)

Heat treatment

 Ceramming
Growth of tetrasilicic fluormica crystals

 Coated with veneering porcelain and a stain and glaze layer

• Dicor glass-ceramic was capable of producing
remarkably good esthetics, perhaps because of the
“chameleon” effect, in which part of the color of the
restoration was picked up from the adjacent teeth as
well as from the tinted cements used for luting the
restorations.
 Aluminous Core Ceramics (Aluminous Porcelain)
• High-strength ceramic core ( McLean and Hughes in 1965)
• Composed of aluminum oxide (alumina) crystals dispersed in a
glassy matrix.
• 40% stronger than those with traditional feldspathic
porcelain
Technique
Opaque inner core ( 50% by weight alumina)

core veneered by a combination of esthetic body and

enamel porcelains with 15% and 5% crystalline alumina
with matched thermal expansion

McLean, J. W., Operative Dent. 2:130-142, 1977).

 ZIRCONIA
Microstructure
Monoclinic phase of pure zirconia (ZrO2) Tetragonal and cubic crystal phase systems change with
stable at ambient temperature temperature.

zirconia is solidly dissolved in yttrium(Y), calcium (Ca), magnesium (Mg), cerium (Ce), or other ions with an ionic radius
larger than that of zirconium (Zr), and accordingly divided into
Partially stabilized zirconia (PSZ) Fully stabilized zirconia (FSZ)
• Tetragonal and cubic phases are mixed at room
• Cubic zirconia that includes no less than 8% yttrium
temperature when yttria is 3 to 8 mol%, and this
material is known as partially stabilized zirconia oxide(Y2O3), hence the term “fully” stabilized zirconia (FSZ).
• Does not exhibit the t/m transformation toughening
(PSZ).
phenomenon.
Methods for strengthening ceramics

1) Develop residual compressive stresses (CTE of veneering ceramic less than core)

2) Minimize the number of firing cycles (PFM Crowns, firing cycles CTE )

3)Ion exchange (Feldspatic porcelain,100 microns)

4) Thermal tempering (glass ceramics)

5) Adhesively bond the ceramic crowns

 Bonding protocols

• 37% phosphoric acid (Total Etch, Ivoclar Group, Schaan,

Vaduz, Liechtenstein) for15 s

• Bonding agent applied (Optibond FL, Kerr, Orange, CA,

USA) and light cured.

• light-shade luting resin cement (Variolink Esthetic LC,

Ivoclar) was applied to bond the lithium disilicate veneers.

• The excess cement was removed, and each restoration was

cured for 20 s on the facial, 20 s interproximal, 20 s mesial,
and 20 s distal
• 5 % hydrofluoric acid(Etchant) for 20 s,

• Application of silane(Coupling agent) for 60 s.

• Adhesive cement is placed in the restoration.

Rojas-Rueda, S.; Villalobos- Tinoco, J.; Conner, C.; Colvert, S.; Nurrohman, H.; Jurado, C.A. Bonding Protocols for Lithium
Disilicate Veneers: A Narrative Review and Case Study. Biomimetics 2025, 10, 188.
 PROCESSING METHODS
Condensation method (Powder/Liquid Building)

 Building a ceramic or metal core with

a powder/liquid(deionized water or
the manufacturer’s modeling liquid)-
Slurry

 Condensed by vibration to remove

excess liquid

 brush with vibration

 ultrasonic vibration
 spatulation

 Sintering of the core ceramic

 Veneering/glazing
Ceramic powder ,modelling liquid
 Hot-Pressed Ceramic

 Restoration fabricated in wax

 Using the lost-wax technique, plasticized ceramic ingot is pressed into a heated investment mold.

 The incisal area is then cut back to create mamelons

 Application of various incisal porcelains to account for shrinkage (densification) during the firing cycle.

Helvey, Gregg. (2013). Classification of Dental Ceramics. Inside Dentistry. April 2013 .
 Machined Ceramics Cerec System
• Computer-integrated imaging and milling system, with the
restorations designed on the computer screen.
CAD/CAM System
• Recently introduced version of the CAD/ CAM software (Cerec 3D,
Sirona Dental Systems, Inc.) allows complete 3 D visualization of the
designed restoration with “virtual seating” capabilities

Cerec Omnicam computer-

assisted design/computer-
assisted manufacturing
(CAD/CAM) system optical impression

simulated mandibular movements to evaluate

approximation of occlusal structure
 • Silica-based ceramics, infiltration ceramics, lithium-disilicate
ceramics, and ox-ide high-performance ceramics.

• Lithium disilicate milled as lithium metasilicate

firing cycle(820°C)
controlled growth of the grain
Blocks available in different size(0.5- 5 microns)
ceramic systems
Lithium
disilicate

Milling

Completely milled restoration on

firing tray
Lithium disilicate crown
 CAD/CAM PROCESSING

previous gold
lithiummetasilicate external staining Postoperative view
crown was digitally
restoration was
scanned before
milled.
removal

CRYSTALLIZATION PROCESS
Rapid prototyping(Additive method) :

• Electrodeposition of powdered material is applied layer by layer to a conductive die through an electrical
current.

3D Printing
 Slip-Casting and the Glass Infiltration method

Alumina (In-Ceram® Alumina; Vident, Baldwin Park, CA, USA), spinel-toughened alumina (In-Ceram® Spinell; Vident, Baldwin Park,
CA) or zirconium dioxide-toughened alumina (12Ce-TZP-Al2O3; In- Ceram® Zirconia; Vident Baldwin Park, CA), yttria-stabilized
tetragonal zirconium dioxide polycrystalline

(a)Stone model; (B) Refractory models; (C) Slip preparation; (D) Slip application; (E) Sintered framework; (F) Glass application; (G) Glass infiltration firing;
(H) Final restoration.

olís Pinargote NW, Yanushevich O, Krikheli N, Smirnov A, Savilkin S, Grigoriev SN, Peretyagin P. Materials and Methods for All-Ceramic Dental Restorations Using Computer-Aided
Design (CAD) and Computer-Aided Manufacturing (CAM) Technologies-A Brief Review. Dent J (Basel). 2024 Feb 22;12(3):47. doi: 10.3390/dj12030047
 COPY MILLING
 Resin pattern (light cure composite material)of the restoration
fabricated.

 Pattern coated with indicating powder & Pattern scanned

mechanically

 Pattern shape transferred to prefabricated Alumina ceramic blank

 Copy milled Aluminous core

 Glass infilitration

 Veneering

Rinke, S., & Hüls, A. (1996). Copy-milled aluminous core ceramic crowns: A clinical report. The Journal of Prosthetic Dentistry, 76(4), 343–346.
Recent Advancements:

Prefabricated laser sintered Sectional Veneers

Prefabricated composite veneers or E. Max veneers are pre-shaped, pre-polished composite laminates available in
different shapes and sizes for direct bonding to the deserving tooth with a complementary shade-matched composite
resin

Preoperative Diagnostic wax up Prefabricated laser-sintered veneers

 veneer seated in position, finishing & polishing Post-operative retracted view

Novelli, Claudio, and Andrea Scribante. 2020. "Minimally Invasive Diastema Restoration with Prefabricated Sectional Veneers" Dentistry Journal 8,
no. 2: 60. https://doi.org/10.3390/dj8020060
Conclusion

The translucency and strength characteristics of lithium disilicate and lithium silicate restorations,

regardless of whether the preparation is non-retentive or retentive, mean that they are best delivered with

adhesive cements that require a bonding protocol.

This is primarily because adhesive cements are color-stable, don’t bleed through translucent

restorations, and offer exceptional connective strength .

References:

• Phillips’ science of dental materials / Kenneth J. Anusavice, Chiayi Shen, H. Ralph Rawls.—12th ed.

• Fundamentals of fixed prosthodontics /Herbert T Shillingburg,Fourth edition

• Contemporary fixed prosthodontics / Stephen F Rosenstiel ,Sixth edition