Seminar

On
Dental Ceramics-
All Ceramics
INTRODUCTION
Over the last 3 decades, a trend to shift toward metal-free restorations has
been observed in the dental field. To meet the increased demands of patients and
dentists for highly aesthetic, biocompatible, and long-lasting restorations, several
types of all ceramic systems have been developed.
Silicate and glass ceramics are used as a veneer for metal or all-ceramic
cores to optimize form and aesthetics.
In a monolithic application, small-sized restorations such as inlays, onlays,
laminate veneers, and crowns can also be fabricated. igh-strength ceramics such
as aluminum and zirconium o!ide ceramics were developed as a core material for
crowns and fi!ed dental prostheses "#$%s& to e!tend the indication ranges to the
high-load bearing areas.
'ost recently, monolithic zirconia restorations are increasingly promoted for
single crown and full-mouth rehabilitation, in particular for patients with
parafunctional habits.
HISTORY
The interest in nonmetallic and biocompatible restorative materials increased after
the introduction of the feldspathic porcelain crown in ()*3 by +and.
In (),-, 'c+ean pioneered the concept of adding aluminum o!ide to feldspathic
porcelain in an attempt to enhance mechanical properties. owever, the clinical
shortcomings ofthese materials, such as brittleness, crac. propagation, low tensile
strength, wear resistance, and marginal accuracy, discontinued its use.
In the early ())*s, the lost wa! press techni/ue was introduced to dentistry as an
innovative processing method for all-ceramic restorations.
The lithium disilicate ceramic was introduced as I%S 0mpress 1 "Ivoclar 2ivadent&
In ())3
4n array of 54$654' systems has evolved since #. $uret introduced the concept
in()7(
8ecently 54$654' capabilities creating separate core and veneer layers that
could then be 9oined with non-thermal methods are evolving and are of
particular interest for e!tended restorations.
TERMINOLOGIES
Alumina core: 4 ceramic containing sufficient crystalline alumina "4l
1
O
3
& to achieve
ade/uate strength and opacity when used for the production of a core for ceramic
9ac.et crowns.
Aluminous orcelain: 4 ceramic composed of a glass matri! phase and 3- vol: of
more of 4l
1
O
3
.
CAD-CAM ceramic: 4 machinable ceramic material formulated for the production of
inlays and crowns through the use of a computer aided design, computer aided
machining process.
Casta!le "ental ceramic: 4 dental ceramic specially formulated to be cast using a
lost wa! process.
Ceramic: 4 compound of metallic and nonmetallic elements.
Ceramic# "ental: 4 compound of metals "such as aluminium, calcium, lithium,
magnesium, potassium, sodium, tin, titanium, and zirconium& and non metals "such
as silicon, boron, fluorine, and o!ygen& that may be used as a single structural
component, such as when used in a 54$-54' inlay, or as one of several layers that
are used in the fabrication of a ceramic based prosthesis. $ental ceramics are
formulated to provide one or more of the following properties, castability, moldability,
in9ectability, color, opacity, translucency, machinability, abrasion resistance, strength
and toughness.
Ceramic $ac%et cro&n 'C(C): 4n all ceramic crown without a supporting metal
substrate that is made from a ceramic with a substantial crystal content "; -* vol:&
from which its higher strength and6or toughness is derived. These crowns are
distinguished from porcelain 9ac.et crowns that are made with porcelain to produce
an aesthetic porcelain margin as an alternative to a metal margin on a metal ceramic
crown.
Sinterin*: The process of heating closely pac.ed particles to achieve interparticle
bonding and sufficient diffusion to decrease the surface area or increase the density
of the structure. #or products such as In-5eram and In-5eram Spinel, surface
contact sintering and minimal density change are re/uired.
Sinel or Sinelle: 4 hard crystalline mineral "'g4l
1
O
<
& consisting of magnesium
and aluminium. 4lso, any of a group of mineral o!ides of ferrous iron, magnesium,
manganese or zinc.
Stain: 4 mi!ture of one or more pigmented metal o!ides and usually a low fusing
glass that when dispersed in an a/ueous slurry or monomer medium, applied to the
surface of porcelain or other specialized ceramic dried or light cured and fired, will
modify the shade of the ceramic based restoration. One product is supplied in a light
curable binder. These stain product are also called surface colorants or
characterization porcelains.
T+ermal comati!ilit,: The desirable condition of low transient and residual tensile
stress in porcelain ad9acent to a metal coping that is associated with a small
difference in the thermal contraction coefficients between the metal and the
veneering porcelains. The contraction coefficient of the metal should be slightly
greater than that of the porcelains so that residual a!ial and .noop compressive
stresses are produced. This condition will ensure the cooling of metal ceramic
prostheses without immediate crac. formation or delayed fracture caused by residual
tensile stresses in porcelain.
In"ications
for feldspathic porcelains-
= ighly esthetic veneers or anterior crowns in cases where color
mas.ing is not an issue
for leucite-reinforced ceramics-
= 0sthetic veneers and anterior crowns
= 4s a layering porcelain on leucite-reinforced, lithium disilicate,
alumina, or zirconia cores
for lithium disilicate ceramics-
= 2eneers
= %remolars and molars - inlays, onlays and crowns
= Three-unit bridges > anterior and premolar region
for zirconia-based ceramics -
= 4nterior and posterior crowns
= ?ru!ers > full-contour crowns
= 4nterior and posterior bridges "ma!imum (<-unit bridges, span depends on product and
number of abutments&
= 0ndodontically treated teeth
= Implant abutments
= Inlay bridges
= 'aryland bridges
= ?loc.-out of dar.ened tooth structure or cores
CERAMIC -ROCESSING METHODS
The processing stages of the ceramic core for production of ceramic prostheses are
summarized as follows@

The /uality of the final ceramic prosthesis is dependent on each stage of the fabrication
process.
CONDENSATION 'COM-ACTION)
The process of pac.ing the powder particles together and removing e!cess water is
.nown as condensation. %roper condensation gives dense pac.ing and reduce the
shrin.age of porcelain and minimize porosity in the fired porcelain.
5ondensation procedure is followed in application of core, dentin and enamel
porcelain either in porcelain 9ac.et crown or porcelain fused to metal.
The porcelain powder is mi!ed with distilled water or special li/uid supplied by the
manufacturer to form a thic. paste. Small portions of the paste are then applied to the
platinum matri! in 9ac.et crown preparation over the die until the desired shape of the crown
has been attained. 0!cess water is removed by blotting with a linen cloth or similar
absorbent material.
The remaining water serves as a binder for the powder so that the crown may be
properly shaped before firing. %owder consisting of a mi!ture of particle sizes compact more
easily than those with particles of one size only. This reduces the size of the spaces
between the particles and thus reduces firing shrin.age.
4 well compacted crown not only reduces firing shrin.age but also shows a regular
contraction over its entire surface.
Met+o"s o. con"ensation:
1) Vibration: 'ild vibration are used to densely pac. the wet powder upon the underlying
matri!. The e!cess water comes to the surface and its is blotted with a tissue paper.
2) Spatulation: 4 small spatula is used to apply and smoothen the wet porcelain. This
action brings e!cess water to the surface.
3) Wet brush technique: The mi! should be creamy and capable of being transferred in
small increments to the platinum matri! with hair brush.
5ondensed mass is gradually heated by first placing it in front of the muffle of a
preheated furnace and later inserting into the furnace.
/) Lo& !is0ue sta*e: The flu! begins to melt and flow in between the porcelain particles.
The mass attains some rigidity but very little cohesion. 4t this stage the material is
porous and undergoes minimum of shrin.age. The porcelain do not have translucency
and glaze.
1) Me"ium !is0ue sta*e: ere the flu! flows freely in between the particles the material is
still porous, but there is complete cohesion between the particles and most of the
shrin.age is complete. In this stage also there is lac. of translucencey and glaze.
2) Hi*+ !is0ue sta*e: ere with shrin.age is completed. There is very little porosity, the
mass has attained complete rigidity and smoothness, the body does not appear to be
glazed. 'ost of the addition and alterations are carried out after the porcelain has
attained medium bis/ue stage.
+ess the number of firing, higher is the strength and better the esthetics. Too many
firings give a life less, over translucent porcelain.
-ORCELAIN 3URNACE
The ordinary air fire porcelain furnace consists of a muffle, a pyrometer, a
thermocouple and in its most simple form a rheostat or variable transformer for control of
firing temperature and sophisticated automatic and programmable time and temperature
controller for the most modern furnaces.
The muffle is the heating unit providing necessary high temperature for ba.ing of
porcelain. The heating element is a coiled wire of platinum and is embedded into the
refractory material of the muffle. The muffle is provided with a door for easy access and to
prevent fluctuation of temperature due to heat loss.
The pyrometer is a millivoltmeter calibrated to read in degree of temperature. The
thermocouple consists of platinum wire 9oined at one end with another wire made of )*:
platinum and (*: rhodium. The 9oint is placed inside the muffle, this is .nown as hot
9unction of the thermocouple. The free ends of the thermocouple are attached to the
pyrometer outside the muffle. Ahen heat is generated inside the muffle, the dissimilar
metals of the thermocouple at the hot 9unction generates and electromotive force which
deflects the needle of the pyrometer indicating the calibrated temperature.
4s the electromotive force varies with variation in temperature inside the muffle, such
variations can be measured as temperature on the pyrometer. The temperature controller
regulates the current fed to the heating element inside the muffle thereby inducing increase
or decrease in muffle temperature.
The main problem in air fired furnace is the opacity of the porcelain due to porosity.
$ifferent methods and porcelain firings are@
(& 4ir firing
1& 2acuum firing
/) Air .irin*:
4ir inside a furnace is modulated to the same atmospheric pressure during this
procedure. There is more chances of air entrapment in porcelain. Ae will get more
porous, less translucent porcelain.
1) 4acuum .irin*:
%artial vacuum firing reduces air voids, so porosity is reduced, so better translucent
effect.
The air from the furnace is evacuated and this eliminating air from porous spaces
which collapses on itself. This is the best and widely used method.
CERAMIC -ROSTHESES:
Aluminous -orcelain Cro&ns:
4nother method of bonding porcelain to metal ma.es use of tin o!ide coatings on
platinum foil. The ob9ective of this techni/ue is to improve the aesthetics by a replacement
of the thic.er metal coping with a thin platinum foil, thus allowing more room for porcelain.
The method consists of bonding aluminous porcelain to platinum foil copings. 4ttachment of
the porcelain is secured by electroplating the platinum foil with a thin layer of tin and then
o!idizing it in a furnance to provide a continuous film of tin o!ide for porcelain bonding. The
rationale is that the bonded foil will act as an inner s.in on the fit surface to reduce
subsurface porosity and formation of microcrac.s in the porcelain, thereby increasing the
fracture resistance of crowns and bridges. The clinical performance of these crowns has
been e!cellent for anterior teeth, but appro!imately (-: of these crowns fractured within 7
years after they were cemented to molar teeth with a glass ionomer cement.
?ased on a ())< survey, metal-ceramic crowns and bridges were used for
appro!imately )*: of all fi!ed restorations. owever, recent developments in ceramic
products with improved fracture resistance and e!cellent aesthetic capability have led to a
significant increase in the use of all-ceramic products. 5eramic crowns and bridges have
been in widespread use since the beginning of the twentieth century. The ceramics
employed in the conventional ceramic crown were high fusing feldspathic porcelains. The
relatively low strength of this type of porcelain prompted 'c+ean and ughes "(),-& to
develop an alumina-reinforced porcelain core material for the fabrication of ceramic crowns.
The alumina-reinforced crowns are generally regarded as providing slightly better
aesthetics for anterior teeth than are the metal-ceramic crowns that employ a metal coping.
owever, the strength of the core porcelain used for alumina-reinforced crowns is
inade/uate to warrant the use of these prostheses for posterior teeth. In fact 'c+ean
reported a fracture rate of molar aluminous porcelain crowns of appro!imately (-: after -
years.
Casta!le an" mac+ina!le Glass-Ceramics 'Dicor an" Dicor MGC)
Ahen used for posterior crowns, ceramic crowns are most susceptible to fracture.
Shown in #igure 1(-, "see also the color plate& is the stress distribution computed by finite
element analysis in a *.-mm-thic. molar $icor crown loaded on the occlusal surface, 9ust
within the marginal ridge area. The ma!imum tensile stress is located within the internal
surface directly below the point of applied force and 9ust above the -* m-thic. layer of resin
cement "see the arrow in fig. 1(.,&. this site represents the critical flaw responsible for crac.
initiation under an applied intraoral force. The location of initial crac. formation was
consistent with the location of ma!imum tensile stress predicted by the finite element
calculations as shown in figure 1(.,. an S0' image of a fractured clinical crown of $icor
glass-ceramic is shown in fig 1(.3. because of the smaller forces e!erted on anterior
crowns, the ris. for fracture of anterior crowns is significantly less than that for posterior
crowns.
The first commercially available castable ceramic material for dental use, $icor, was
developed by 5orning Blass wor.s and mar.eted by $entsply international. $icro is a
castable glass that is formed into an inlay, facial veneer, or full-crown restoration by a lost-
was casting process similar to that employed for metals. 4fter the glass casting core or
coping is recovered, the glass is sandblasted to remove resideual casting investment and
the sprues are gently cut away. The glass is then covered by a protective CembedmentC
material and sub9ected to a heat treatment that causes microscopic plateli.e crystals of
crystalline material "mica& to grow within the glass matri!. This crystal nucleation and crystal
growth process is called ceramming. Once the glass has been cerammed, it is fit on the
prepared dies, ground as necessary, and then coated with veneering porcelain "as shown in
fig. 1(.3& to match the shape and appearance of ad9acent teeth. $icor glass-ceramic is
capable of producing surprisingly good aesthetics, perhaps because of the CchameleonC
effect, where part of the color of the restoration is pic.ed up from the ad9acent teeth as well
as from the tinted cements used for luting the restorations.
$icor glass-ceramic contains about -- vol: of tetrasilicic fluormica crystals. The
ceramming process results in increased strength and toughness, increased resistance to
abrasion, thermal shoc. resistance, chemical durability, and decreased transluency. $icor
'B5 is a higher /uality product that is crystallized by the manufacturer and provided as
54$-54' blan.s or ingots. The 54$-54' ceramic $icor 'B5 contains 7* vol: of
tetrasilicic fluormica platelets, which are appro!imately 1m in diameter. The mechanical
properties of $icor 'B5 are similar to those of $icor glass-ceramaic, although it has less
translucency "contrast ratio of *.<( -*.<< versus *.-,, respectively&.
$icor has recently been discontinued presumably because of low tensile strength
and the need to color the prosthesis on the e!terior region rather that within the core region,
which would more closely resemble a natural tooth. 4lthough $icor is no longer sold, the
principles for selection are useful when products of similar mechanical and physical
properties are being considered. The advantages of $icor glass-ceramic were ease of
fabrication, improved aesthetics, minimal processing shrin.age, good marginal fit,
moderately high fle!ural strength, low thermal e!pansion e/ual to that of tooth structure, and
minimal abrasiveness to tooth enamel.
The disadvantages of $icor glass-ceramic were its limited use in low-stress areas
and its inability to be colored internally. 4s designed, it was colored with a thin outer layer of
shading porcelain and surface stain to ieve acceptable aesthetics. owever, $icor 'B5
ingots have been supplied in light and dar. shades, ma.ing it possible for technicians to
build depth of color into the fabrication process.
4lthough both of the $icor products were based on a glass-ceramic core that was
minimally abrasive to opposing tooth enamel, the re/uired shaduing or veneering porcelains
were more abrasive. 4esthetically, $icor crowns were more lifeli.e than metal-ceramic
crowns, which often e!hibit a metal collar, a gray shadow subginigivally, or poor
translucency. The life e!pectancy of $icor crowns in high-stress areas is not as good as that
of %0' crowns. Two veneering materials were used to improve the color of $icor crowns@
$icor %lus, which consisted a pigmented feldspathic porcelain veneer, and AilliDs Blass, a
veneer of 2itadur E aluminous porcelain.
Tooth preparation for glass-ceramic of this type is the same as that re/uired for
metal-ceramic prostheses e!cept that, for first and second molars a reduction of 1mm is
recommended. Occlusal surfaces and incisal edges must be reduced a minimum of (.-mm.
4!ial surfaces should be reduced a minimum of (.*mm. The preparation should be either a
shoulder with a rounded gingivoa!ial line angle or a heavy chamfer.
-ressa!le Glass-Ceramics:
4 glass-ceramic is a material that is formed into the desired shape as a glass, then
sub9ected to a heat treatment to induce partial devitrification "i.e., loss of glassy structure by
crystallization of the glass&. The crystalline particles, needles, or plates formed during this
ceramming process serve to interrupt the propagation of crac.s in the material when an
intraoral force is applied, thereby causing increased strength and toughness. The use of
glass-ceramics in dentistry was first proposed by 'ac5ulloch in (),3. e used a
continuous glass-molding process to produce denture teeth. e also suggested that it
should be possible to fabricate crowns and inlays by centrifugal casting of molten glass.
%ressure molding is used to ma.e small, intricate ob9ects. This method uses a
piston to force a heated ceramic ingot through a heated tube into a mol., where the ceramic
form cools and hardens to the shape of the mold. Ahen the ob9ect has solidified, the
refractory mold "investment& is bro.en apart and the ceramic piece is removed. It is then
debrided and either stained and glazed "certain inlays& or veneered with one or more layers
of a thermally compatible ceramic.
I%S 0mpress is a glass-ceramic provided as core ingots that are heated and pressed
until the ingot flows into a mold. It contains a higher concentration of leucite crystals that
increase the resistance to crac. propagation "fracture&. The hot-pressing process occurs
over a <- min period at a high temperature to produce the ceramic substructure. This crown
form can be either stained and glazed or build up using a conventional layering techni/ue.
The advantages of this ceramic are its lac. of metal, a translucent ceramic core, a
moderately high fle!ural strength "similar to that of Optimal %ressable ceramic&, e!cellent fit,
and e!cellent aesthetics. The disadvantages are its potential to fracture in posterior areas
and the need to use a resin cement to bond the crown micromechanically to tooth structure.
I%S 0mpress and I%S 0mpress1 are typical products representative of several other
leucite-reinforced and lithia disilicate-reinforced glass-ceramics, respectively. Some
properties of I%S 0mpress and I%S 0mpress1 glass-ceramic core materials are listed in
table. 1(.,. I%S 0mpress is a leucite-containing glass-ceramic that contains about 3- vol:
of leucite "F4ISI1O,& crystals, which increases the resistance to crac. propagation "fracture&.
The veneering ceramic also contains leucite crystals in a glass matri!. 4fter hot pressing,
divesting, and separation of the ceramic units the sprue segments, they are veneered with
porcelain containing leucite crystals in a glass matri!.
4 cross-sectional illustration of an I%S 0mpress crown is illustrated in fig. 1(.). The
I%S 0mpress1 is similar e!cept that the core consists of lithia disilicate crystals in a glass
matri! and the veneering ceramic contains apatite crystals. The very small apatite crystals
cause light scattering in a way that resemble by the structure and components of tooth
enamel. The coefficient of e!pansion of the apatite glass-ceramic veneering ceramic is ).7
ppm6
*
5, which is similar to that of I%S 0mpress1 core ceramic "(*., ppm6
*
5&. Obviously,
this veneering ceramic should not be used with the I%S 0mpress core ceramic that has a
much higher e!pansion coefficient "(-* ppm6
*
5&.
The core microstructure of I%S 0mpress1 glass ceramic is /uite different from that of
I%S 0mpress, as evidenced by the 7* vol: of elongated lithia disilicate crystals in I%S
0mpress1. The primary crystal particles in I%S 0mpress1 are *.- to <m in length. 4 smaller
concentration of lithium orthophosphate crystals "+i1 Si1 O-& appro!imately *.( to *.3m in
diameter has also been reported "oland et al., 1***&. The microstructural difference
between I%S 0mpress and I%S empress1 results in a slight decrease in translucency for I%S
5mpress1 "*.--& "olland et al., 1***&. 4s is the case for most pressable glass-ceramics,
the advantages of I%S empress and I%S 0mpress1 glass-ceramic core materials are their
potential for accurate fit, e!cellent transluency and overall aesthetics, and a metal-free
structure. $isadvantages are their low to moderately high fle!ural strength and fracture
toughness. These properties limit their use to conservative designs in low to moderate
stress environments. Shown in fig. 1(-(*, 1(-(( and 1(-(1 are three-unit glass-ceramic
#%$s made from a lithia-disilicate-based core material. The #%$ shown in fig. 1(-(1 was
made without a veneering ceramic to enhance the fracture resistnce. 4 summary of
important properties is presented in Table 1(-7 for a variety of dental ceramics. 4 list of
pressable ceramics and their veneering ceramics is summarized.
O%5 and O%5 3B are two pressable ceramics that are similar in nature to I%S
0mpress and I%S 0mpress1, respectively. O%5 is a leucite-containing ceramic and O%5
3B contains lithia disilicate crystals. The ultralow-fusing temperature of the veneering
porcelain suggests a low level of wear of opposing enamel. owever, insufficient clinical
data are available to support this hypothesis.
In-5eram 4lumina, In-5eram Spinell, and In-5eram Girconia
In-5eram is supplied as one of three core ceramics@ "(& In-5eram spinell "1& in-
5eram 4lumina, and "3& in-5eram Girconia. 4 slurry of one of these materials is slip-cast on
a porous refractory die and heated in a furnace to produce a partially sintered coping or
framewor.. The partially sintered core is infiltrated with glass at ((**
*
5 for < hr to eliminate
porosity and to strengthen the slip-cast core. The initial sintering process for the alumina
core produces a minimal shrin.age because the temperature and time are sufficient only to
cause bonding between particles and to produce a desired level of sintering. Thus the
marginal adaptation and fit of this core material should be ade/uate because little shrin.age
occurs. The fle!ural strength "modulus or rupture& values of the glass-infiltrated core
materials are appro!imately 3-* 'pa for in-5eram spinell "I5S&, -** 'pa for In-5eram
4lumina "I54&and 7** 'pa for In-5eram Girconia "I5G& compared with strengths of (** to
<** 'pa for $icor, Optec %ressable 5eramic, I%S 0mpress and I%S 0mpress1. $espite the
relatively high strength of these materials, failures can still occur in single crowns as well as
#%$s.
?ecause of the variation in strength, the primary indications for these core ceramics
vary as shown in Table 1(-). #or e!ample, I5S is indicated for use as anterior single-unit
inlays, onlays, crowns, and veneers, I54 is indicated for anterior and posterior crowns and
anterior three-unit #%$s. ?ecause of its high level of opacity, I5G is not recommended for
anterior prostheses. owever, because of its e!tremely high strength and fracture
toughness, it can be used for posterior crowns and posterior #%$s. 4s suggested in
chapter <, it is essential that the gingival embrasure areas of ceramic #%$ connectors be
designed with a large radius of curvature to minimize the stress-raiser effect in areas of
moderate to high tensile stress. The connectors also should be sufficiently thic. to minimize
stresses during loading. #or 0mpress and 0mpress1 ceramics used in molar areas, the
connector height should be at least <mm.
3 tables@ %age Eo. ,37 to ,3)
Hntil in-5eram was introduced, aluminous porcelain had not been used successfully
to produce #%$s because of low fle!ural strength and high sintering shrin.age. Thus the
principal indications for aluminous porcelain crowns were the restoration of ma!illary anterior
crowns when aesthetics was important and their use in patients with allergies to metals. Its
advantages and disadvantages are summerized in the following.
4 schematic drawing of an In-5eram crown is shown in #ig 1(.(3 The same diagram
can be used to illustrate crowns made with In-5eram Spinell "I5S& and In-5eram Girconia
"I5G&, which will be discussed below. The three In-5eram ceramics are glass-infiltrated core
materials used for single anterior crowns "all three products&, posterior crowns "In-5eram
4lumina and in-5eram Girconia&, anterior three-unit #%$s "In-5eram 4lumina&, and three-
unit posteriro bridges "In-5eram Girconia&.
The most translucent of the three ceramics- In-5eramics, In-5eram Spinell, was
introduced as an alternative to in-5eram 4lumina. This ceramic has a lower fle!ural
strength, but its increased translucency provides improved aesthetics in clinical situations in
which the ad9acent teeth or restorations are /uite translucent. The core of I5S is 'g4l (O<
and that for I5G is a mi!ture of 4l1O3 and GrO1. These core ceramics are also infiltrated with
glass, and they are fabricated in a manner similar to that for I54, although the firing
temperatures and times may be different.
The final I54 core consists pf 7* wt: alumina infiltrated with 3* wt: sodium
lanthanum glass. The final I5S core consists of glass-infiltrated magnesium spindl
"'g4l1O<&. I5G contains appro!imately 3*wt: zirconia and 7* wt: alumina. The power-
li/uid slurry is slip cast onto a porous die that absorbs water from the slurry, thereby
densifying the agglomeration of particles onto the die. Steps for fabricating in-5eram
prostheses are as follows@ "(& prepare teeth with an occlusal reduction of (.- to 1.*mm and a
heavy circumferential chamfer "(.1mm&, "1& ma.e an impression and pour two dies, "3& apply
4l1O3 on a porous duplicate die, "<& heat at (1*
*
5 for 1 hours to dry 4l1O3 , "-& sinter the
coping for (* hours at ((1*
*
5, ",& apply a sodium lanthanum glass slurry mi!ture on the
coping, "7& fire for < hours at ((1*
*
5 to allow infiltration of glass, "3& trim e!cess glass
from the coping with diamond burs, ")& build up the core with dentin and enamel porcelain,
"(*& fire in the oven, grind in the anatomy and occlusion, finish, and glaze.
The advantages of I54 include a moderately high fle!ural strength and fracture
toughness, a metal-free structure, and an ability to be used successfully with conventional
luting agents "Type ( cements&. The collective advantages of the three glass-infiltrated core
materials are their lac. of metal, relatively high fle!ural strength and toughness, and ability to
be successfully cemented using any cement.
In spite of this high fle!ural strength "<1) 'pa&, the Aeibull modulus of I5S is /uite
low "-.7&, which is indicative of a large scatter in the distribution of strength values relative to
the probability of fracture. "Tinschert et al., 1***&. Its marginal adaptation may not be as
good as that achieved with other ceramic products. In one study the mean marginal
discrepancies were 33 m for %rocera 4ll 5eram, ,3 m for I%S 0mpress, and (,(m for In-
5eram 4lumina. Other drawbac.s of I54 include its relatively high degree of opacity,
inability to be etched, techni/ue sensitivity, and the relatively great amount of s.illed labor
re/uired. These disadvantages apply also to In-5eram Girconia. 5ompared with I5', the
opacities of I54 and I5G core ceramics are much greater.
4lthough these newer core ceramics have e!cellent fracture resistance inproper
design of the connector area of a #%$ can significantly reduce the fracture resistance and
clinical survivability of the prosthesis. Shown in fig. 1(-(< is the stress distribution in a three-
unit #%$, which shows relatively high principal tensile stress "red area& at the tissue side of
the interpro!imal connector when an occlusal load of 1-* E is applied to the occlusal surface
of the pontic.
In summary, In-5eram Spinell "I5S& is a glass-infiltrated core ceramic that offers
greater translucency for crowns than either the I54 or I5G core ceramics. owever, I54
has lower strength and toughness compared with I54 and I5G. Thus the use of I5S is
limited to anterior inlays, onlyas, veneers, and anterior crowns. 4lthough I5G is the
strongest and toughest of the three core ceramics, its use is limited to posterior crowns and
#%$s because of its high level of core opacity. I5G is a much stronger and tougher material
and has greater opacity than I54.
-rocera AllCeram:
The %rocera 4ll5eram crown is composed of densely sintered, high-purity aluminum
o!ide core combined with a compatible all5eram veneering porcelain. This ceramic material
contains )).): alumina, and its hardness is one of the highest among the ceramics used in
dentistry. %rocera 4ll5eram can be used for anterior and posterior crowns, veneers, onlays,
and inlyas.
4 uni/ue feature of the %rocera system is the ability of the %rocera Scanner to scan
the surface of the prepared tooth and transmit the data to the milling unit to produce an
enlarged die through a 54$-54' process. The core ceramic form is dry pressed onto the
die, and the core ceramic is then sintered and veneered. Thus the usual (-:-1*:
shrin.age of the core ceramic during sintering will be compensated by constructing an
oversized ceramic pattern, which will shrin. during sintering to the desired size to accurately
fit the prepared tooth.
CAD-CAM Ceramics:
4s shown in the ceramic classification chart in all-ceramic cores can be
produced by processes of condensation and sintering, casting and ceramming,
hotpressing and sintering, sintering and glass infiltration, and 54$-54' processing
for the 5erec $4?-54' system the internal surface of inlays, onlays, or crowns is
ground with diamond dis.s or other instruments to the dimensions obtained from a
scanned inage of the preparation. for some systems, the e!ternal surface must be
ground manually, although some recent 54$-54' systems are capable of forming
the e!ternal surface as well.
4 milling operation within a 5erec 54$-54' unit "Siemens
4.tiengesellschaft, ?ensheim, Bermany &. The ceramic loc. is being ground by a
diamond-coated dis. whose translational movements are guided by computer-
controlled input. 4 cerec 54$-54' ceramic bloc. is shown in #igure 1(-(, before
milling, at an intermediate milling stage, and after completion of the milling operation
for an inlay. These ceramics are supplied as small bloc.s that can be gound into
inlays and veneers in a computer-driven 54E-54' system. 2itablocs 'F II are
feldspathic procelains that are used in the same way as is $icor B5 "machinable
glass-ceramic&. The disadvantages of 54$-54' restorations include the need for
costly e/uipment, the lac. of computer-controlled processing support for occlusal
ad9ustment, and the techni/ue-sensitive nature of surface imaging re/uired for the
prepared teeth. 4dvantages include negligible porosity levels in the 54$-54' core
ceramics, the freedom from ma.ing an impression, reduced assistant time
associated with impression procedures, the need for only a single patient
appointment "with the 5erec system&, and good patient acceptance. 4 list of 54$-
54' and copy-milled ceramics is given in Table 1(-(*.
4n advantage of 54$-54' ceramics is that one can select a core ceramic
either for strength and fracture resistance, for low abrasiveness, or for translucency.
for e!ample, the e!tensive wear of opposing enamel that occurs when it is opposed
by a feldspathic porcelain surface in the absence of posterior occlusion can be
minimized by selscting a core ceramic that is minimally abrasive to enamel.
Cercon an" La5a 6irconia Core Ceramics:
The cercon Girconia system "$estsply 5eramco, ?urlington, EI& consists of
the following procedures for production of zirconia-based prostheses. 4fter preparing
the teeth "1.*mm incisal or occlusal reduction and (.- mm a!ial reduction&, an
impression is made and sent tot he laboratory, where it is poured with a model
material. 4 wa! pattern appro!imately *.3 mm in thic.ness is made for each coping
on the holding appliance on the left side of the scanning and milling unit "5ercon
?rain&. 4 presintered Girconia blan. is attached to the right side of the ?rain unit.
"5ercon ?rain&. 4 presintered zirconia blan. is attached to the right side of the ?rain
unit. The blan. has an attached barcode, which contains the enlargement factor and
other milling parameters for computer control or the milling procedure 4fter the unit is
activated, parameters for computer control of the milling procedure 4fter the unit is
activated, the pattern in scanned and the blan. is rough-milled and fine-milled on
occlusal.
Ceramic
7loc%
Ceramic t,e
Ceramic
5eneer
In"ications Manu.acturer
5er4dapt ighly sintered 4l
1
O
3
4ll cream Implant
superstructure
Eobel ?iocare
5ercon ?ase %resintered GrO
1
J
postsintered after
milling
5oercion
5ream S
5rowns and
#%$s
$entsply 5eramco
$5- Fristen +eucite-base Triceram 5rowns $5S $ental
4B60sprident
$5- Gir.on %resintered GrO
1
hot
isostatic
postcompaction
2itadur $
Triceram
5rowns and
#%$s
$5S $ental
4B62ita60sprident
$enzir %resintered GrO
1
J

hot
isostatic
postcompaction
0mpress1 5rowns and
#%$s
$ecim, Ivoclar
+424 #rame GrO
1
J presintered
and postsntered
+424
5eram
5rowns and
#%$s
3' 0S%0
%ro5ad +eucite-based 'althechni
.
2eneers,
inlays, onlays,
and crowns
Ivoclar
%rocera
4ll5eram
4l
1
O
3
J presintered
and postsintered
4ll5eram 5rowns and
#%$s
Eobel ?iocare
Synthoceram 4l
1
O
3
J reinforcedJ
pressed and
postsintered
Sintagon 5rowns 0lephant
2ita?locs 'ar.
II
#eldspathic
porcelain bloc.
'altechni. 2eneers,
inlays, onlays,
and crowns
2ident
2ita?loc.s
4lumina
Sintered 4l
1
O
3
J
followed by glass
infiltration
2itadur
4lpha
5rowns and
#%$s
5rowns and #%$s 2ident
2ita?locs
Spinell
Sintered
'gO-4l
1
O
3
spinel
followed by glass
infiltration
2itadur
4lpha
5rowns 2ident
2ita?locs
Girconia
Sintered 4l
1
O
3
6GrO
1
followed by glass
infiltration
2itadur
4lpha
5rowns and
#%$s
2ident
Gircogon GrO
1
J presintered
and postsintered
Gircogon 5rowns 0lephant

4nd gingival aspects in an enlarged size to compensate for the 1*:
shrin.age that will occur during subse/uent sintering at (3,*
*
5. the processing
times for milling are appro!imately 3- for a crown and 3* min for a four > unit fi!ed
#%$. The milled are appro!imately 3- min for a crown and 3* min for a four- unit
fi!ed #%$. The milled prosthesis is removed from the and the remaining e!traneous
e!tension are removed. The zircon coping or framewor. is then placed in the 5ercon
furnace and fired at (3-*
*
5 for appro!imately , hours to fully sinter the yttria-
stabilized zirconia core coping or framewor.. The sintering shrin.age is achieved
uniformly and linearly in three > dimensional space by the in targeted process of
scanning, enlarging the pattern design, controlled milling and sintering.
4fter any subse/uent trimming with a water > cooled, hinge- speed diamond
bur the finished ceramic core framewor. is then veneered with a veneering ceramic
"5ercon 5eram S& and stain ceramic
4ll-ceramic prostheses represent the most aesthetically pleasing, but also the
most fracture-prone prostheses. owever, with ade/uate tooth reduction, an
e!cellent /uality impression, a s.illed technician, and a ceramic with reasonably high
fle!ure strength "1-* '%a& and fracture toughness " 1.-'pa.m
(61
&, reasonably high
success rates can be achieved. The material that has the greatest potential fracture
toughness ") '%a.m
K
& and fle!ural strength that has the greatest potential fracture
toughness ") '%a.m
K
& and fle!ural strength ";)** '%a& is pure tetragonal stabilized
zirconia "GrO
1
&. Tinschert et al "1**lb& reported that the fracture resistance of three-
unit ceramic #%$s "(173 E& made of 5ercon zirconia core ceramic "$entspy
5eramco& was more than twice as great as the values reported for In-5eram
4lumina "-(< E& and 0mpress1 ",1( E&. Shown in #igure is a comparison of the
force re/uired to fracture three-unit #%$s cemented to dies with zinc phosphate
cement. The zirconia product "5ercon& would be e!pected to e!hibit less fracture
resistance in this case, but clinical data are needed to confirm this hypotehsis.
To ensure ma!imum survival times, ade/uate occlusal tooth reduction is
essential for posterior teeth. Optimal clinical performance of some ceramic products
re/uire a minimal occlusal reduction of 1 mm for molar tooth preparations. If the
ceramic will be supported by a material with high elastic modulus such as a ceramic
or metal post or an amalgam build-up, less occlusal reduction "(.- mm& may be
possible without compromising the survivability of the crowns. #or patients e!hibiting
e!treme brusism, either metal or metal-ceramic prostheses should be used.
METHODS O3 STRENGTHENING CERAMICS:
Minimi8e t+e e..ect o. stress Raisers
Ahy do dental ceramic prostheses fail to e!hibit the strengths that we would
e!pect from the high bond forces between atomsL The answer is that numerous
minute scratches and other defects are present on the surfaces of these materials.
These surface flaws behave as sharp notches whose tips may be as narrow as the
spacing between several atoms in the material. These stress concentration areas at
the tip of each surface flaw can increase the localized stress to the theoretical
strength of the material even though a relatively low average stress e!ists throughout
the bul. of the structure. Ahen the induced mechanical stress e!ceeds the actual
strength of the material, the bonds at the notch tip brea., forming a crac.. This
stress concentration phenomenon e!plains how materials fail at stresses far below
their theoretical strength.
Stress raisers are discontinuities the ceramic and metal-ceramic structures
and in other brittle materials that cause a stress concentration in these areas. The
design of ceramic dental restorations should also avoid stress raisers in the ceramic.
4brupt changes in shape or thic.ness in the ceramic contour can act as stress
raisers and ma.e the restoration more prone to failure. Thus the incisal line angles
on an anterior tooth prepared for a ceramic crown should be well rounded.
In ceramic crowns, several conditions can cause stress concentration.
5reases or folds of the platinum foil or gold foil substrate that become embedded in
the porcelain leave notches that act as stress raisers. Sharp line angles in the
preparation also create areas of stress concentration in the restoration. +arge
changes in porcelain thic.ness, a factor also determined by the tooth preparation,
can create areas of stress concentration.
4 small particle of porcelain along the internal porcelain margin of a crown
also induces locally high tensile stresses. 4 stray particle that is fused within the
inner surface of a shoulder porcelain margin of a metal-ceramic crown can cause
localized tensile stress concentrations in porcelain when an occlusal force is applied
to the crown.
0ven though a metal-ceramic restoration is generally stronger than most
ceramic crowns of the same size and shape, care must be ta.en to avoid sub9ecting
the porcelain in a %#' to loading the produces large localized stresses. If the
occlusion is not ad9usted properly on a porcelain surface, contact points rather than
contact areas will greatly increase the localized stresses in the porcelain surface as
well as within the internal surface of the crown.
#racture mechanics is a science that allows scientists to analyze the influence
of flaw6stress interactions on the probability of crac. propagation through an elastic
brittle solid. The principles of linear elastic fracture mechanics were developed in the
()-*s by Irwin "()-7&. This pioneering research on fracture phenomena was based
on earlier investigations by Briffth "()1(& and Orowan "()<<, ()<), ()--&. Irwin
found that when a brittle material was sub9ected to tensile stresses, specific crac.
shapes in certain locations were associated with greatly increased stress levels. e
also recognized the importance of determining the fracture toughness of these
materials as a measure of their ability to resist fracture. The fracture toughness "F
I5
&
of a material represents the resistance of a material to rapid crac. propagation. In
contrast, the strength of a material depends primarily on the size of the initiating
crac. that is present. The strength of dental ceramics and other restorative materials
is controlled by the size of the crac.s or defects that are introduced during
processing, production and handling. In this chapter a description is given of the
processing methods used to produce ceramic prostheses and the potential of these
methods to introduce flaws or crac.s that may limit their clinical survival.
The brittle fracture behavior of ceramics and their low tensile strengths
compared with those predicted from bonds between atoms can be understood by
considering stress concentrations around surface flaws. 4s ceramics tends to have
no mechanism for plastically deforming without fracture as do metals, crac.s may
propagate through a ceramic material at low average stress levels. 4s a result,
ceramics and glasses have tensile strengths that are much lower than their
compressive strengths in the oral environment, tensile stresses are usually created
by bending forces, and the ma!imum tensile stress created by the bending forces
occurs at the surface of a prosthesis. It is for this reason that surface flaws are of
particular importance in determining the strength of ceramics.
4s the crac. propagates through the material, the stress concentration is
maintained at the crac., a pore, or a crystalline particle, which reduces the localized
stress. The removal of surface flaws or the reduction of their size and number can
produce a very large increase in strength. 8educing the depth of surface flaws in the
surface of a ceramic is one of the reasons that polishing and glazing of dental
porcelain is so important. The fracture resistance of ceramic prostheses can be
increased through one or more of the following si! options@ "(& select stronger and
tougher ceramicsJ "1& develop residual compressive stresses within the surface of
the material by thermal tempering, "3& develop residual compressive stress within
interfacial regions of wea.er, less tough ceramic layers by properly matching thermal
e!pansion coefficients, "<& reduce the tensile stress in the ceramic by appropriate
selection of stiffer supporting materials, "-& minimize the number of porcelain firing
cycles, ",& design the ceramic #%$ prosthesis with greater bul. and broader radii of
curvature to minimize the magnitude of tensile stresses and stress concentrations of
curvature to minimize the magnitude of tensile stresses and stress concentrations
during function, and "7& adhesively bond ceramic crowns to tooth structure.
De5elo Resi"ual Comressi5e Stresses:
One method of strengthening glasses and ceramics is the introduction of
residual compressive stresses within the veneering ceramic. 5onsider three layers
of porcelain@ the outer two of the same composition and thermal contraction co-
efficient and the middle layer of a different composition and a higher thermal
contraction coefficient. Suppose that the layers are bonded together and the bonded
structure is allowed to cool to room temperature. The inner layer has a higher
coefficient of thermal contraction and thus contracts more as it cools. ence, on
cooling to room temperature, the inner layer produces compressive stresses in the
outer layers as previously described for thermal tempering. This three-layer laminate
techni/ue is used by 5orning Blass wor.s to manufacture dinnerware.
4 similar condition can develop in a veneering porcelain bonding to an alloy
coping used for metal-ceramic crowns and #%$s and ad9acent ceramic layers in all-
ceramic prostheses. The metal and porcelain should be selected with a slight
mismatch in their thermal contraction coefficients "the metal thermal contraction
coefficients "the metal thermal contraction coefficient being slightly larger& so that the
metal contracts slightly more than the porcelain on cooling from the firing
temperature to room temperature. This mismatch leaves the porcelain in residual
compression and provides additional strength for the prosthesis. 0!amples of how
residual tensile stresses can wea.en a metal-ceramic crown or #%$ and how
residual compressive stresses can wea.en a metal-ceramic crown or #%$ and how
residual compressive stresses can increase fracture resistance are shown in #igure.
The same principle applies to ceramic prostheses in which the thermal
contraction coefficient of the core ceramic is slightly greater than that of the
veneering ceramic "such as opaceous dentin or body6gingival porcelain&.
The fabrication of metal-ceramic and all-ceramic prostheses usually involves
processing at high temperature, and the process of cooling to room temperature
affords the opportunity to ta.e advantage of mismatches in coefficients of thermal
contraction of ad9acent materials in the ceramic structure. Ideally, the porcelain
should sustain slight compression in the final restoration. This ob9ective is
accomplished by selecting an alloy that contracts slightly more than the porcelain on
cooling to room temperature.
4 further, yet fundamentally different, method of strengthening glasses and
ceramics is to reinforce them with a dispersed phase of a different material that is
capable of hindering a crac. from propagating through the material. There are two
different types of dispersions used to interrupt crac. propagation. One type relies on
the toughness of the particle to absorb energy from the crac. and deplete its driving
force for propagation. The other relies on a crystal structural change under stress to
absorb energy from the crac.. These methods of strengthening are described
below.
Minimi8e t+e Num!er o. .irin* c,cles:
The purpose of porcelain firing procedures is to densely sinter the particles of
powder together and to produce a relatively smooth, glassy layer "glaze& on the
surface. In some cases, a stain layer is applied for shade ad9ustment or for
characterization such as stain lines or fine crac.s. Several chemical reactions occur
over time at porcelain firing temperatures and of particular importance are increases
in the concentration of crystalline leucite in the porcelain designed for fabrication of
metal-ceramic restorations. +eucite, F1O-4l
1
O
3
<SiO
1
, is a highe-e!pansion crystal
phase, which can greatly affect the thermal contraction coefficient of the porcelain.
5hanges in the leucite content caused by multiple firings can alter the thermal
contraction coefficient of the porcelain. Some porcelains undergo an increase in
leucite crystals after multiple firings that will increase their thermal e!pansion
coefficients. If the e!pansion coefficient increases above the value for the metal, the
e!pansion mismatch between the porcelain and the metal can produce stresses
during cooling that are sufficient to cause immediate or delayed crac. formation in
the porcelain.
Minimi8e Tensile Stress T+rou*+ Otimal Desi*n o. Ceramic -rost+eses:
Tougher and stronger ceramics can sustain higher tensile stresses before
crac.s develops in areas of tensile stress. 5onventional feldspathic porcelains
should not be used as the core of ceramic crowns, especially in posterior areas,
because occlusal forces can easily sub9ect them to tensile stresses that e!ceed the
tensile strength of the core ceramic. Of ma9or concern are tensile stresses that are
concentrated within the inner surface of posterior ceramic crowns. Sharp line angles
in the preparation also will create areas of stress concentration in the restoration,
primarily where a tensile component of bending stress develops. 4 small particle of
ceramic along the internal porcelain margin of a crown will also induce locally high
tensile stresses. Thus the ceramic surface that will be cemented to the prepared
tooth or foundation material should be e!amined carefully when it is delivered from
the laboratory. #urthermore, when grinding of this surface is re/uired for ad9ustment
of fit, one should use the finest grit abrasive that will accomplish the tas..
?ecause the forces on anterior teeth are relatively small, the low to moderate
tensile stresses produced can be supported by ceramic crowns more safely.
owever, if there is a great amount of vertical overlap "overbite& with only a
moderate amount of horizontal overlap "over9et&, high tensile stresses can be
produced. 'etal-ceramic crowns use a metal coping as the foundation of the
restoration to which the porcelain is fused. The stiff, metal coping minimizes fle!ure
of the porcelain structure of the crown that is associated with tensile stresses.
'ost dental restorations containing ceramics should be designed in such a
way as to overcome their wea.nesses, that is their relatively low tensile strength,
their brittleness, and their susceptibility to flaws in the presence of surface flaws.
The design should avoid e!posure of the ceramic to high tensile stresses. It
should also avoid stress concentration at sharp angles or mar.ed changes in
thic.ness. One way to reduce tensile stresses on the cemented surface in the
occlusal region of ceramic inlays or crowns is to use the ma!imum occlusal
thic.ness possible. owever, within practical limits of tooth reduction, this
thic.ness is typically 1.* mm.
4luminous porcelain crowns are contraindicated for restoring posterior teeth
because occlusal forces can induce tensile stresses, which are often concentrated
near the internal surface of the crown. 'etal-ceramic crowns use a metal coping
as the foundation of the restoration to which the porcelain is fused. In an attempt
to overcome these stresses, the strong, stiff, yet ductile metal coping minimizes
fle!ure of the porcelain structure of the crown that is associated with tensile
stresses. ?oth the bonded platinum foil aluminous porcelain corwn techni/ue and
the swaged gold alloy foil techni/ue are also based on this same concept.
The tensile stresses in a ceramic #%$ can be reduced by using a greater
connector height and by broadening the radius of curvature of the gingival
embrasure portion of the interpro!imal connector. owever, a connector height
greater than < mm ma.es the anatomic form in the buccal area of a posterior #%$
too bul.y and unaesthetic.
Ion E9c+an*e:
The techni/ue of ion e!change is one of the more sophisticated and
effective methods of introducing residual compressive stresses into the surface of
a ceramic. The ion-e!change process is sometimes called chemical tempering
"4nusavice et al, ())1& and can involve the sodium ion since sodium is a common
constituent of a variety of glasses and has a relatively small ionic diameter. If a
sodium-containing glass article is placed in a bath of molten potassium nitrate,
potassium ions in the bath e!change places with some of the sodium ions in the
surface of the glass article and remain in place after cooling. Since the potassium
ion is about 3-: larger than the sodium ion, the s/ueezing of the potasium ion
into the place formerly occupied by the sodium ion creates very large residual
compressive stresses.
The product B5 Tuf-5oat "B5 5orp., To.yo, Iapan& was a potassium-rich
slurry that could be easily applied to a ceramic surface and, when heated to <-*
*
5 for 3* min "in any standard porcelain furnace& caused a sufficient. Increases of
(**: or more in fle!ural strength have been achieved with several porcelain
products that contained a significant concentration of small sodium ions. owever,
the depth of the compression zone is less than (** m "anusavic et al. ())<&.
Therefore this strengthening effect could be lost if the porcelain or glass - ceramic
surface is ground, worn, or eroded by long - term e!posure to certain inorganic
acids.
T+ermal Temerin*:
%erhaps the most common method for strengthening glass is by thermal
tempering thermal tempering creates residual surface compressive stresses. ?y
rapidly cooling " /uenching& the surface of the ob9ect while it is hot and in the
softened "molten& state. This rapid cooling produces a s.in of rigid glass
surrounding a soft "molten& core 4s the molten core solidifies, it tends to shrin.,
but the outer s.in remains rigid. The pull of the solidifying molten core, as it
shrin.s, creates residual tensile stresses in the core and residual compressive
stresses within the outer surface.
Thermal tempering is used to strengthen glass for uses such as automobile
windows and windshields, sliding glass doors, and diving mas.s. Often, 9ets of air
directed at the molten glass surface accomplish the rapid cooling of the outer s.in.
If one observes the rear window of an automobile through polarized sunglasses, it
is usually possible to discern a regular pattern of spots over the entire window.
This pattern of spots corresponds to the arrangement of the air 9ets employed by
the manufacturer in the tempering process. #or dental applications, it is more
effective to /uench hot glass phase ceramics in silicone oil or other special li/uids
rather than using air 9est that may not uniformly cool the surface. This thermal
tempering treatment induces a protective region of compressive stress within the
surface " $eoff and anusavic,())1&
Disersion Stren*t+enin*
4 further, yet fundamentally different, method of strengthening glasses and
ceramics is to reinforce them with a dispersed phase of a different material that is
capable of hindering a crac. from propagating through the material. This process
is referred to as dispersion strengthening. 4lmost all of the newer higher- strength
ceramics derive there improved fracture resistance from the crac.- bloc.ing ability
of the crystalline particles. Increasing the crystal containing primarily can
strengthen dental ceramics containing primarily a glass phase can be
strengthened by increasing the crystal content of leucite "F
1
O.4l
1
O
3
.<SiO
1
& lithia
dislocate "+i
1
O.1SiO
1
&, alumina " 4l
1
O
3
& magnesia - alumina spinel "'gO. 4l
1
O
3
&,
zirconia "GrO
1
&, and other types of crystals. Some crystal phase additions are not
as effective as others in toughening the ceramics. Toughening depends on the
crystal type, its size, its volume fraction, the interpartics. Toughening, and its
relative thermal e!pansion coefficient relative to the glass matri!. #or e!ample, the
fracture toughness "F
I5
& of soda lime silica glass is *.7- 'pa . m
(61
If one
disperses 7* vol: of terasilicic flourmill crystals in the glass."$icor 'B5 glass -
ceramic&, the toughness increases only to (.- 'pa. m
(61
. owever, by dispersing
7* vol: if lithia dislocate crystals in the glass matri! " I%S 0mpress1&, F
I5
increased to 3.3 'pa. '
(61
" oland and ?eall, 1**1&.
Ahen a tough, crystalline material such as alumina " 4l
1
O
3
& is added to a
glass the is toughened and strengthened because the crac. cannot pass through
the alumina Mparticles as easily as it can pass through the glass matri!. This
techni/ue has found application in dentistry in the development of alimonies
porcelains " 4l
1
O
3
particles in a glassy porcelain matri!& for porcelain 9ac.et
crowns. 'ost dental ceramics that heave a glassy matri! utilize reinforcement of
the glass by a disposed crystalline substance.
Tinschert et al "1**lb& evaluated the mean strength and standard deviation
values for several ceramics. This mean strength values were as followsJ "'pa N
S$& were 5erec 'ar. II, 3,.3N(1.1J In 5eram 4lumina, <1).3 N 37.1J I%S
0mpress. 33.) N ((.3J 2itadur 4lpha 5ore, (3(.* N ).-J 2itadur 4lpha $entin, ,*.7
N ,.3J 2ita 2'F ,3, 31.7N (*.*@ and Girconia-TG%, )(3.* N -*.1. There was no
statistically significant difference among the fle!ure strength of 5erec 'ar. II,
$icro, I%S 0mpress, 2itadur 4lpha $entin, and 2ita 2'F ,3 ceramics "%;*.*-&.
The highest Aeibull moduli were associated with 5erec 'ar. II and Girconia-TG%
ceramics "13., and (3.<&. $icor glass-ceramic and In-5eram 4lumina had the
lowest values of Aeibull modules "m& "-.- and -.7&, whereas intermediate values
were observed for I%S 0mpress, 2ita 2'F ,3, 2itadur 4lpha $entin, and 2itadur
4lpha 5ore ceramics "3.,, 3.), (*.* and (3.* respectively&.
0!cept for In-5eram 4lumina, 2itadur 4lpha, and Girconia-TG% core
ceramics, the investigated ceramic materials fabricated under the condition of a
dental laboratory were not stronger or more structurally reliable than 2ita 2'F ,3
veneering porcelain. Only 5erec 'ar. II and Girconia-TG% specimens, which were
prepared from an industrially optimized ceramic material, e!hibited m values
greater than (3. ence, we conclude that industrially prepared ceramics are more
structurally reliable materials for dental applications, although 54$-54'
procedures may induce surface and subsurface flaws that may offset this benefit.
Trans.ormation Tou*+enin*:
Ahen small, tough crystals are homogeneously distributed in a glass, the
ceramic structure is toughened and strengthened because crac.s cannot
penetrate the fine particles as easily as they can penetrate the glass. $ental
ceramics are strengthened and toughened by a variety of dispersed crystalline
phases including alumina "2itadur 4lpha, %rocera 4ll5eram, In-5eram alumina&,
leucite "Optec S%, I%S 0mpress, O%5&, tetrasilicic fluormica "$icor, $icor 'B5&,
lithia disilicate "O%5 3B, I%S 0mpress1&, and magnesia-alumina spinel "In-5eram
spinell&. In contrast, dental ceramics based primarily on zirconia crystals "5ercon
and +ava& undergo transformation toughening that involves a transformation of
GrO
1
from a tetragonal crystal phase to a monoclinic phase at the tips of crac.s
that are in regions of tensile stress. The unit cells for tetragonal and monoclinic
lattices are shown.
Ahen pure GrO
1
is heated to a temperature between (<7*
*
and 1*(*
*
5
and it is cooled, its crystal structure begins to change from a tetragonal to a
monoclinic phase at appro!imately ((-*
*
5. $uring cooling to room temperature,
a volume increase of several percentage points occurs when it transforms from
the tetragonal to monoclinic crystal structure. This polymorphic transformation can
be prevented with certain additives such as 3 mol: yttrium o!ide "yttria or O
1
O
3
&.
This material is designated as GrO
1
. TG% "tetragonal zirconia polycrystals&. The
volume increase in this case is constrained if the zirconia crystals are sufficiently
small and the microstructure is strong enough to resist the resulting stresses. This
material is e!tremely strong "fle!ural strength of appro!imately )** '%a& and
tough "fracture tougheness, FI5, of appro!imately ) '%a& and tough "fracture
tougheness, FI5, of appro!imately ) 'pam
(61
&.
The toughening mechanism of crac. shielding results from the controlled
transformation of the metastable tetragonal phase to the stable monoclinic phase.
Several types of crac. shielding processes are possible, including microcrac.ing,
ductile zone formation, and transformation zone formation. ?y controlling the
composition, particle size, and the temperature versus time cycle, zirconia can be
densified by sintering at a high temperature and the tetragonal structure can be
maintained as individual grains or precipitates as it is cooled to room temperature.
The tetragonal phase is not stable at room temperature, and it can transform to
the monoclinic phase with a corresponding volume increase under certain
conditions. Ahen sufficient stress develops in the tetragonal structure and a crac.
in the area begins to propagate, the metastable tetragonal crystals "grains& or
precipitates ne!t to the crac. tip can transform to the stable monoclinic form. In
this process a 3 vol: e!pansion of the GrO
1
crystals or precipitates occurs that
place the crac. under a state of compressive stress and crac. progression is
arrested. #or this crac. to advance further, additional tensile stress would be
re/uired. ?ecause of this strengthening and toughening mechanism, the yttria-
stablilized zirconia ceramic is sometimes referred to as ceramic steel.
A!rasi5eness o. Dental Ceramics:
4 review of the factors and material characteristics that cause e!cessive
wear of enamel by ceramic prostheses is e!tremely important to optimize the
performance of ceramic-based prostheses. 5eramics are generally considered
the most biocompatible, durable, and aesthetic materials available for
rehabilitation of teeth, occlusal function, and facial appearance. 5urrently
available products e!hibit variable mechanical properties "hardeness, fle!ure
strength, fracture toughness, and elastic modulus&, physical properties "inde! of
refraction, color parameters, translucency, chemical durability, and thermally
compatible e!pansion coefficients for the substrates. In spite of their overall
e!cellence in meeting the ideal re/uirements of a prosthetic material, dental
ceramics have one ma9or drawbac.. These materials can cause catastrophic
wear of opposing tooth structure under certain conditions. The most e!treme
damage occurs when a roughened surface contacts tooth enamel or dentin under
high occlusal forces, which may occur because of bru!ing, premaguided
disclusion is ensured, the wear of opposing enamel and dentin will be greatly
reduced. In addition, if the occluding ceramic surface area is periodically
refinished after occlusal ad9ustment or fre/uent e!posure to carbonated beverages
and6or acidulated phosphate fluoride, the abrasive wear of opposing tooth
structure is further reduced.
4brasive wear mechanisms for dental restorative materials and tooth
enamel include "(& adhesion "metal and composites&, in which localized bonding of
two surfaces occurs, resulting in pullout and transfer of matter from one surface to
the other, and "1& microfracture "ceramics and enamel&, which results from
gouging, asperties, impact, and contact stresses that cause crac.s or localized
fracture. #or ceramic and enamel, two-phase brittle strucutres are involved. The
ceramic onsists of a glass matri! that contains variable levels and sizes of
crystals. Tooth enamel consists of a small volume fraction of organic phase matri!
and a high volume fraction of hydro!yapatite crystals. The wear of either material
depends on the ease with which crac.s can propagate through the structure. If
microscopic crac.s are forced to pass around the crystal particles rather than
through them, the material will usually be more fracture and crac.s through the
glass phase, the particles are less fracture resistant than the glass matri!, or
e!cessive voids or other defects e!ist along the pathway. The relative
strengthening effect is dependent on several factors, including the strength of the
glass and crystal phases, the size and spacing of crystalline paricles, the
inferfacial bond strength of the crystal-glass interphase region, and the type and
magnitude of residual stresses in the structure. These factors are beyond the
control of the dentist, although the dentist and laboratory technician can select
ceramics that are highly fracture-resistant.
The microfracture mechanism is the dominant mechanism responsible for
surface brea.down of ceramics and the subse/uent damage that a roughened
ceramic surface can cause to tooth enamel surfaces. eEamel is also susceptible
to this .ind of microfracture through four specific mechanisms@ "(& asperities
e!tending from the ceramic surface that produce high localized stresses and
microfractureJ "1& gouging that results from high stresses and large hardness
differences between two surfaces or particles e!tending from these surfacesJ "3&
impact or erosion that occurs through the action of abrasive particles carried in a
following li/uid such as salivaJ and "<& contact stress microfracture that increases
localized tensile stress and also enhances the damage caused by asperties,
gouging, and impact or erosion. ?ecause of microfracture mechanisms, it may be
necessary to polish the ceramic surface periodically to reduce the height of
asperities and to minimize enamel wear rates. Of ma9or concern is the potential
catastrophic damage that can be incurred by enamel in contact with polycrystalline
asperities having high fracture toughness "F
I5
& values such as alumina "3.--<.*
'pa.m
(61
& or cerium-stabilized zirconia "(*-(, 'pam
(61
&, yttrium-stabilized zirconia
",-)- 'pa.m
(61
&, or cerium--stabilized zirconia "(*-, 'pa.m
(61
&. In contrast glass
has a fracture toughness of only *.7- 'pa.m
(61
and should cause less gouging,
contact stress, and impact damage within contacting enamel surfaces.
The abrasiveness of ceramics against enamel is affected by numerous
factors and properties of the crystal phase particle and the glass matri! "if
present&. These include hardness, tensile strength, fracture toughness, fatigue
resistance, particle glass bonding, particle-glass interface integrity, chemical
durability, e!posure fre/uency to corrosive chemical agents "acidulated phosphate
fluoride, carbonated beverages&, abrasiveness of foods, residual stress,
subsurface /uality "voids or other imperfections&, magnitude and orientation of
applied forces, chewing and bru!ing fre/uency, contacting area, lubrication by
saliva, and wear fre/uency. Thus it is understandable why the hardness of the
ceramic is not a good predictor of the potential wear of enamel surfaces by a
ceramic. owever, the larger the hardness difference between two sliding
surfaces, the greater is the degree of gouging.
:ear o. ceramics Comare" &it+ ot+er Materials
To minimize enamel abrasion by a contacting ceramic structure, we should
use a ceramic that e!hibits uniform surface microfracture at the same rate as tooth
enamel under the same conditions of loading, antagonist structure, food
substance abrasiveness, applied forces, and degree of lubrication. The
brea.down of the ceramic surface should be uniform so that asperities such as
large crystalline inclusions do not pro9ect out from the surface.
These asperities produce high stress concentration areas within the
opposing enamel surface that lead to gouging, troughing, and greater localized
microfracture of the enamel structure. If such nonumiform surface wear of
ceramics occurs duraing oral function, the only solutions available to reduce
enamel wear are to reduce the occlusal load by occlusal ad9ustement or to polish
the ceramic surface periodically to reduce stress concentrations and the height of
these asperities.
Some of the new ultralow-fusing ceramics have a wide range of thermal
e!pansion coefficients as listed. These are appro!imate values estimated for
several low-fusing ceramic products produced by the $ucera company@
$uceragold "73*
*
5& and $uceram +#5 "$entsply 5eramco& were introduced
between ())( and ())1. $uceram +#5 is classified as a hydrothermal ceramic
that was claimed to develop a hydrothermal layer appro!imately (m thic. vitro.
In theory, this property allows a protective layer to seal microscopic surface
crac.s. Its veneer is a low-fusing ceramic that minimizes shrin.age of the core
ceramic during subse/uent firings. $uceram +#5 and $uceragold do not contain
large leucite crystals and therby retain a stable thermal e!pansion coefficient over
several firings. The opalescence the fluorescence are also easier to achieve than
for conventional low-fusing fieldspathic porcelains because of the ability to
maintain very small crystal particles "<**--**nm&. ?ecause of its high e!pansion
coefficient, $uceragold is intended as a veneer for high-e!pansion, low-fusing
porcelains, were subse/uently developed as veneering ceramics for titanium
metals and %rocera 4ll5eram "Eobel ?iocare, Boteborg, Sewden& core ceramics,
respectively. Ti5eram is another ultralow-fusing ceramic and has a firing
temperature of appro!imately 7<*
*
5. The initial veneering porcelain for %rocera
4ll5eram was 2itadur E "2ita Gahnfabri., ?ad Sac.ingen, Bermany&, a large-
particle aluminous porcelain. 5urrently, 4ll5eram porcelain "$egussa $ental& is
used. #inesse, an ultralow-fusing ceramic "P7,*
*
5& that contains larger leucite
crystals, was introduced by $entsply 5eramco, Inc. "0. Aindsor, EI&. 2ita
Omega )** "2ita Gahnfabri.& is another ultralow-fusing ceramic. #or 54$-54'
processing, dicor 'B5 glass-ceramic "5aul.6$entsply, 'ilford, $0&, 2ita 'F I
ceramic "2ita Gahnfabri.&, and 2ita 'F II ceramic "2ita Gahnfabri.& bloc.s are
available, which also offer a small-particle distribution of crystals that may reduce
wear of opposing enamel surfaces.
It is not .nown what effect, if any, thermal mismatch differences will produce
on the surface /uality of these ceramics. 'icrocrac.ing can lead to surface flaws,
loss of surface material, and increased wear of enamel. owever, this effect
should only occur when a gross mismatch occurs between a core ceramic and its
veneering ceramic.
?ased on a study of abrasion by a -**-g slurry of glass "$erand and
2ereby, ()))&, (**g alumina "(** m&, and (1*g water, the mean wear depths "in
microns& after a specified time period for several ceramics and tooth enamel were
as follows@ enamel "1<.3&, #inesse "1*.3&, 2itadur 4lpha "(,.3&, %rocera "(-.3&,
$entsply 5eramco II "(3.,&, 2ita Omega "(3.(&, Ti-5eram "(1.(&, I%S 0mpress
"((.3&, $uceragold "((.-&, and 5reation "(*.3&. The enamel wear was significantly
greater than that of all ceramics tested. The wear depth of 2itadur 4lpha was
significantly than that of all ceramics tested. The wear depth of 2itadur 4plha was
significantly greater than that for I%S 0mpress, $uceragodl, and 5reation
ceramics. It is clear that the relative wear rate of enamel by a highly abrasive
medium is greater than that of most porcelains.
:ear o. Enamel !, Ceramic -ro"ucts an" ot+er restorati5e materials
4nother factor that can increase wear of ceramics against enamel is the
non-uniform distribution or clustering of crystals. I%S 0mpress after hot-pressing
at (3*
*
5 e!hibits clusters of relatively large "--(* m& leucite crystals "F4ISi
1
O
,
&
with crac.s between the crystal agglomerates. This non-interloc.ing arrangement
of elucite crystals also occurs in the veneering ceramic after it is sintered at )(*
*
5.
in contrast, I%S 0mpress1 core ceramic e!hibits a uniform dispersion of smaller
lithia disilicate "+iSi
1
O
<
& crystals after hot pressing at )1*
*
5 and veneering at 3**
*
5.
One should e!pect greater wear of enamel by I%S 0mpress compared with
I%S 0mpress1. I%S 0mpress ceramic contains 3- - vol: of leucite crystals that
are formed in a noninterloc.ing particle cluster pattern "oland et al, 1***&. The
core microstructrue of I%S 0mpress1 is /uite different from that of I%S 0mpress,
evidenced by elongated lithia disilicate crystals *.- to < m in length and a smaller
concentration of lithium orthophosphate crystals "+i
1
Si
1
O
-
& appro!imately *.( to *.3
m in diameter "oland et al, 1***&.
Studies of ultralow-fusing ceramics have generally revealed significantly
lower enamel wear rates than those produced by conventional low-fusing
porcelains. owever, the results of a recent study suggest that one of these
ceramics, $uceram +#5, caused significantly more enamel wear "*.()7 mm
3
&,
presumably because of the higher void volume within the surface layer of
$uceram "'agne et al, ()))&. In this study, the combined enamel6ceramic wear
rates were significantly greater for $uceram +#5 "*.3,3 mm
3
&. 2eneering
ceramics contain either large crystalline filler particles or a glass structure with no
crystals or very small crystals.
Similarly, the results from another in vitro study "4l-iyasat et al, ()))& of
enamel wear "after 1-,*** simulated chewing cycles& by ceramics using a corn
meal slurry "three-body condition& revealed greater relative wear depth in enamel
by $uceram +#5 "*.7<mm& and 2itadur 4lpha "*.3* mm& compared with 2ita
5erec '. II "*.<3 mm&. The e!planation given for the higher wear rate of enamel
by $uceram +#5 was the presence of porosities within the surface of the ceramic.
This result for $uceram +#5 is in contrast with two-body wear data "al-iyasat et
al, ())3a& that indicated significantly less enamel wear by $uceram +#5 also 2ita
'. II "*.,- mm& and a gold alloy "*.*) mm& and 2ita Omega porcelain "*.), mm&.
The wear 2itadur 4lpha porcelain "*.)3 mm& and in distilled water without an
abrasive food medium "*.-< mm after 1-,*** simulated chewing cycles&
compared with 2itadur 4lpha porcelain "*.)3 mm& and 2ita Omega porcelain "*.),
mm&. The wear rate of enamel by gold alloy was significantly less than by the four
ceramics.
One would e!pect the latter types of ceramics to cause minimal wear of
enamel. 'etzler et al "()))& reported that the relative enamel loss was less for
two lower fusing ceramics, #inesse "*.-,& and 2ita Omega )** "*.,*&, compared
with $entsply 5eramco II porcelain "*.3-&, large-particle leucite-based porcelain.
Fre9ci et al "())<& reported significantly lower estimated --year enamel
wear rates for amalgam "-* m& and a new 5erec 54$-54' ceramic ")- m&,
2ita 5erec '. II 27F, compared with the original 2ita 5erec '. I ceramic "11-
m&. In comparison, the wear of enamel by enamel was (*7 m. ac.er et al
"()),& found considerably lower enamel wear rates for a gold-palladium alloy ")
m& compared with 4ll5eram veneer ceramic ",* m& and $entsply 5eramco
porcelain "13* m&.
Iagger et al "())-& reported the following wear depths of dentin after
e!posure to wear by restorative materials@ amalgam "* m&, microfilled composite
"7 m&, gold alloy "(,.7 m&, conventional composite "3(.7 m&, and 2itadur E
aluminous porcelain "(** m&. these results indicate that direct filling materials
are less abrasive to dentin than aluminous porcelain. This result is not surprising.
Ahat is of importance of importance is the significant potential benefit of amalgam
and microfilled composite as the least abrasive restorative materials fr situations in
which dentin is e!posed.
4l-iyasat et al "())3b& investigated the effect of a carbonated beverage
"5oca 5ola& on the wear of human enamel and three dental ceramics@ 2itadur
4lpha "feldspathic porcelain&, $uceram +#5 "ultralow-fusing porcelain&, and 2ita
'ar. II, a machinable ceramic. Tooth and ceramic specimens were tested in a
wear machine under a load of <* E, at 3* cycles per minute, for a total of 1-,***
cycles. The test was performed in distilled water or with intermittent e!posure to a
carbonated beverage "5oca 5ola&. Ahen tested in water 4lpha porcelain caused
significantly more enamel wear and also e!hibited greater wear than $uceram
+#5 and 2ita 'ar. II. owever, after e!posure to the carbonated beverage, the
enamel wear produced by $uceram +#5 did not differ significantly from that
produced by 4lpha porcelain. 2ita 'ar. II produced the least amount of enamel
wear. 0!posure to the carbonated beverage significantly increased the enamel
wear. The wear of $uceram +#5 and vita 'ar. II increased with e!posure to the
carbonated beverage. It was produced by $uceram +#5 and 2ita 'ar. II
ceramics. Overall, 2ita 'ar. II was the most resistant to wear and also
significantly less abrasive than 2itadur 4lpha porcelain.
Re"ucin* A!rasi5eness o. Ceramics !, -olis+in* an" Gla8in*:
In theory, the smoothest surface should cause the least wear damage to
opposing surfaces. $epending on the initial surface roughness of the ceramic
surface, glazing the surface may not ade/uately decrease the surface roughness
since the glassy layer may be of insufficient thic.ness to fill in scratches and
grooves within the ground surface. Thus, under certain conditions, polishing or
polishing followed by glazing may be re/uired.
Iagger and arrison "())<& reported that the amount of enamel wear
produced by both glazed "13.3 m& and unglazed 2itadur E aluminous porcelain
"1) m& was similarJ howeverJ the wear produced by polished porcelain "(1m&
was substantially less. %olished or glazed porcelain caused significantly less wear
than unglazed porcelain. %olishing was accomplished with 3' Sofle! dis.s and
Shofurubber points.
4fter 1-,*** cycles of abrasion testing of various porcelain surface on
human enamel in vitro, 4l-iyasat et al "())7& reported no significant difference
between the enamel wear of glazed and polished groups, but wear produced by
the unglazed groups was significantly higher "%Q*.*-&. Si!ty pairs of tooth-
porcelain specimens were tested under load in distilled water with and without
intermittent e!posure to a carbonated beverage. Aear of enamel and 2itadur
4lpha porcelain specimens was determined after -,***, -*,*** and 1-,***
cycles. 0!posure to carbonated 5oca 5oal and schweppes beverages
significantly increased the amount of enamel wear produced by all porcelain
surfaces "% Q*.**(&. The finish of the porcelain surface did not influence its wear
resistance under these conditions.
Gui"elines .or Minimi8in* E9cessi5e :ear o. Enamel !, Dental ceramics:
To minimize the wear of enamel by dental ceramics, the following steps
should be ta.en@ "(& ensure cuspid-guided disclusion@ "1& eliminate occlusal
prematurities@ "3& use metal in functional bru!ing areasJ "<& if occlusion in ceramic,
use ultralow-fusing ceramics "-& polish functional ceramic surfacesJ ",& repolish
ceramic surfaces periodicallyJ and "7& read9ust occlusion periodically if needed.
Some ultralow-fusing ceramics are less abrasive than traditional low-fusing
ceramics, but few clinical studies have been reported on any of these materials to
validate the in virto findings. 5aution should be e!ercised in selecting these new
ceramics for use since they e!hibit widely variable e!pansion co-efficients and
may not be thermally compatible with certain ceramic core materials or metal
substrates. 'alocclusion is li.ely the ma9or wear-causing factor that must be
avoided to achieve acceptable wear performance with any ceramic product.
%olishing is preferred over glazing as a procedure to reduce abrasion
damage of enamel. 5eramic surfaces should be refinished periodically after acid
e!posure especially acidulated phosphate fluoride. The Shofu porcelain polishing
.it followed with diamond paste or Sof+e! discs "3'& without a diamond paste
follow up are useful as effective finishing products.
5eramic and opposing surfaces should be e!amined periodically for
evidence of e!cessive wear. Occlusal ad9ustment and polishing of the ceramic
surfaces should be performed to reduce the ris. for further surface degradation.
Eoble metal surfaces are especially indicated for individuals who e!hibit evidence
of severe bru!ing since the wear rates of gold alloys are very low compared with
the wear damage caused by either traditional ceramics or recent lower-fusing
ceramics.
4 rough ceramic surface that is in hyperocclusion with opposing enamel is
very li.ely to cause great abrasive wear of tooth surfaces. to minimize the ris. of
such wear damage to tooth enamel or other surfaces, the smoothest possible
ceramic surface should be produced. This can be accomplished by "(& polishing
only, "1& polishing followed by glazing, or "3& glazing only. The second choice is
preferred. Blazing is recommended whenever possible before cementation of a
prosthesis. if this is not possible, polishing along is acceptable. owever, glazing
of a very rough ceramic surface may not sufficiently reduce the surface roughness
to minimize wear damage. It is clear that a glazed rough, nonglazed surface
because the more-abrasive crystalline particles tend to be covered by the
lessabrasive glass phase.
it is not always possible to polish a ceramic surface in the clinic. ?ecause
of the heat generated during the polishing of ceramic-based prostheses that
re/uire e!tensive polishing, the temperature increase of pulpal tissue may lead to
irreversible pulpitis. This is especially true when the tooth has been greatly
reduced in size and the pulp chamber is within *.- mm of the e!ternal surface of
the prepared tooth.
There are several clear indications for polished ceramic surfaces. %olishing
of ceramic prostheses should be performed when they cannot be autoglazed.
%olishing of ceramic restorations that have functional occlusal pathways or
subgingival e!tensions will ensure optimal smoothness. 4ll 54$-54' inlays or
other ceramic prostheses that will not receive veneering ceramic should also be
polished.
Intraoral instrumentation can produce a smoother surface than an
autoglazing procedure. ighly polished porcelain may also be naturally glazed or
overglazed without significantly increasing the surface roughness. Increased time
or cycles of glazing with decrease surface roughness.
%olishing instruments should be selected according to type of ceramic, type
of restoration, and level of smoothness desired. If the crown was ground with a
(** m grit diamond, the first polishing abrasive should be 7- m or less. If the
abrasive is too fine, more time will be needed to polish the surface.
ulterstrom and ?ergman "())3& found that two of the best polishing
systems are Sof-+e! dis.s "3' $ental& and Shofu %orcelain +aminate %olishing
Fit followed by diamond paste. #or the Sof-+e! dis.s, one should start with a dis.
that is the most effective at removing the initial grinding patterns. If the abrasive
grit size on the dis. is too small, it will ta.e too long to decrease the roughness. If
the grit size on the dis. is too small, it will ta.e too long to decrease the
roughness. If the grit size is too large "e.g., e!tra-coarse or coarse&, the surface
will become rougher. 4lso, if the polishing procedure is performed in the mouth,
care should be ta.en to avoid heat build-up. Sof-+e! Sof-+e! dis. are made to be
used in a wet environment, so water coolant should be used whenever possible.
CONCLUSION
The future of ceramics for dentistry is clearly open to new technologies. owever, the
greatest challenge in developing all-ceramic compositions or processing methods suitable
for dental applications is satisfying strength as well as esthetics, while ceramic materials for
industrial applications generally do not need to meet esthetic re/uirements. It is now
established that at least a five-year evaluation period has to be completed before a long-
term prognosis can be proposed. The metal-ceramic techni/ue is still the most commonly
used procedure in restorative dentistry, and the success of new all ceramic systems will
depend as much on developmental as on analytical research.
References
References
1. Applied Dental materials - Mc Cabe; 9
th
Edition.
2. Philips Science of Dental Materials 11
th
Edition.
. Crai! restorati"e dental materials 1 th edition.
#. Ceramics in dentistr$% &istorical roots and c'rrent perspecti"es- (. Robert )ell$;
PR*S+&E+ DE,+ 199-;./%10-2.
/. E"ol'tion of dental ceramics in the t1entieth cent'r$- (ohn 2. Mc3ean; ( Prosthet
Dent 2441;0/%-1--.
-. Ceramic materials in dentistr$% historical e"ol'tion and c'rrent practice - (R )ell$;
A'stralian Dental (o'rnal 2411; /-%51 S'ppl6% 0#79-
.. Dental ceramics% An 'pdate - Ar"ind Sheno$; ( Conser" Dent. 2414 *ct-Dec; 15#6%
19/724.
0. (ADA 2440;195s'ppl #6%#S-.S Dental Ceramics %(. Robert )ell$.
9. Dental ceramics% c'rrent thin8in! and trends ; (. Robert )ell$ ; Dent Clin , Am #0
5244#6 /17/4
14. (ADA 2411;1#25s'ppl 26%1#S-19S Daniel Edelhoff and *li"er 9ri: All Ceramics
indications% A case series
11. All-Ceramic S$stems% 3aborator$ and Clinical Performance Petra C. ;'ess DC,A
// 524116 7/2.