Proficience Ceramco Ic

Clinical and Scientific
Perspectives on
an Integrated
Ceramic System
(Ceramco iC)

Christopher C. Y. Chu, Nels O. Ewoldsen, Christopher R. Kennedy and Veeraraghavan Sundar

Clinical cases courtesy of Michael A. Miyasaki, Todd C. Snyder, Joao Moraes, Juliano Vasconcellos,
Jurgen Gebhardt, Catherine Catanzaro, Michael DiPaulo, Nelson Ochoa and Nels O. Ewoldsen.

Abstract:
Dental restorations have been targeted at re-establishing function and recreating esthetics from their earliest
days. These same targets serve today as goals used to refine dental ceramics. The evolving design and
applications of these ceramics result from continuing collaboration between dentists, technicians, and materials
scientists, aimed at better clinical performance for patients. The development of Ceramco iC, a unique
integrated ceramic system offers a single set of materials to fabricate all these restorations. The immediate
advantages are enhanced reproducibility, excellent esthetics, a full spectrum of shades for prescription, as well
as reliable shade match in combination cases involving more than one type of restoration.
Clinical and Scientific Perspectives Ceramco iC

DENTSPLY Prosthetics
Introduction:
Dental restorations have been targeted at re-establishing function and recreating esthetics from their
earliest days. These same targets serve today as goals used to refine dental ceramics. The evolving
design and applications of these ceramics result from continuing collaboration between dentists,
technicians, and materials scientists, aimed at better clinical performance for patients
i
. Multiple
methods of fabricating dental restorations offer todays practitioner an expanded palette of esthetic
choices, backed by reliable processing methods. Some of these methods with a brief description and
advantages are outlined in Table 1.

Table 1: Types of Dental Restorations
Restoration Type How is it Created Advantages
Porcelain-Fused-to-Metal
(PFM)
Building up or stacking porcelain on a cast
metal substructure
Broadest range of
indications; clinical gold
standard for over half a
century.
Press-to-Metal (PTM)
Pressing an ingot of dental ceramic onto a
cast metal substructure
PFM Indications, plus
reproducible esthetics, and
precise contours and
margins
All-Ceramic (AC)
Pressing an ingot of dental ceramic into a
mould, with the ceramic itself (or a high
strength ceramic) serving as the
substructure.
Unparalleled esthetics and
translucency in single unit
applications.

The development of Ceramco iC, a unique integrated ceramic system offers a single set of materials to
fabricate all these restorations (Fig. 1). The immediate advantages are enhanced reproducibility,
excellent esthetics, a full spectrum of shades for prescription, as well as reliable shade match in
combination cases involving more than one type of restoration (Table 2). In this brochure, we present
the Ceramco iC system, its advantages, and treat some clinical aspects of the system.

Fig. 1: Esthetics of Ceramco iC restorations (Courtesy Juergen Gebhardt, MDT)
Restored with Ceramco iC Incisal Translucency

Ceramco iC: Enhanced Esthetics
The Ceramco iC system was designed to be highly esthetic. Shades corresponding to both the Vita Lumin
and the VitaPan 3D-Master guides are available. The colors and graded opacities of the components of
the integrated system, such as the opaque, opaceous dentin and dentin layers of the porcelain, as well
as ingots, are maintained within controlled ranges using advanced spectrophotometric techniques. This

control aids in reproducible esthetics across a wide variety of clinical situations (e.g. combination cases),
and less technique sensitivity. The development of phase-separating opal enamels, natural enamels,
chroma-rich modifiers and super-clear enamels have enhanced the esthetic possibilities of the system
(Fig. 2).

Table 2: Integrated Components of the Ceramco iC System
Restoration Type PFM Press to Metal All-Ceramic

Stains/Glazes
Enamels/Mamelons
Dentins/Modifiers
- Ingots
Opaques -
Alloys -
N/A Stump Shades
Restoration Type PFM Press to Metal All-Ceramic

Fig. 2: Highly esthetic Ceramco iC restorations (Courtesy Juergen Gebhardt, MDT)
Before Ceramco iC -Maxillary

Ceramco iC Mandibular Restored Smile

Ceramco iC: The Benefits of Engineered Microstructure
Leucite is a crystalline ceramic (KAlSi
2
O
6
) used primarily to modify thermal expansion properties of
glasses to match alloys routinely used in dentistry
ii
. Leucite containing glass-ceramics (porcelains) have
been in routine use in PFM restorations for over fifty years. Conventional PFM porcelains can be
routinely fired at temperatures higher than 900C. They contain high (35-55%) levels of leucite
iii
.


However, high levels of leucite with large crystal sizes have been associated with some undesirable
effects, such as an increased tendency to wear opposing dentition
iv
. Ceramco iC materials contain a
uniform and fine-grained leucite structure (Fig. 3).

Fig. 3: The uniform, engineered microstructure of Ceramco iC
Conventional Porcelain Ceramco iC engineered microstructure

The advantages of better engineered leucite levels and microstructures in state of the art dental ceramic
systems such as Ceramco iC, as observed by in-vitro studies and clinical observation are lowered wear to
opposing dentition and enhanced polishability
v
. In addition, modern engineered microstructures are
also associated with lower fusion temperatures for dental ceramics.

This ensures that thermal mismatch stresses, developed as the porcelain cools from its glass transition
temperature to room temperature, are minimized. A microstructural examination of the veneering
porcelain interfaces with ingots and opaques over metal reveals superior adhesion (Fig. 4).

Fig. 4: Engineered Interface Microstructures Ceramco iC enhance bonding
Porcelain-Ingot Interface Porcelain-Opaque-Metal Interface

Ceramco iC: Technical Profile
A review of the technical properties of the PFM, PTM and AC components of the Ceramco iC system
demonstrates that they meet and exceed appropriate international standards.

Table 3: Technical Profile of Ceramco iC Components
PFM PTM AC
Applicable
International
Standards: ISO
6872, 9693
Flexural Strength: 90
MPa
CTE: 12.0 /m/K
Bond Strength to
Alloy: 51MPa
MPa
CTE: 13.0 /m/K
Bond Strength to Alloy:
53MPa
MPa
CTE: 13.0 /m/K
Chemical Solubility:
33.1 g/cm
2


PFM PTM AC
15.1 g/cm
2

33.1 g/cm
2

Other
properties
Processing temp: 840C
Leucite Size: 1-5
Pressing Temp: 890C
Leucite Size: 1-5
Pressing Temp: 890C
Leucite Size: 1-5
Preparation
Conventional PFM:
Shoulder/Chamfer
Margin with 0.8-2mm
reduction and
rounded line angles
Conventional PFM:
Shoulder/ Chamfer
Margin with 0.8-2mm
reduction and rounded
line angles
Conventional All
Ceramic: Shoulder/Deep
Chamfer Margin with
1.5-2mm reduction and
rounded line angles
Shade Check
Shade Guide Shade Guide Shade Guide with
DENTSPLY All-Ceramic
Die Material
Placement
Conventional
Cementation
(SmartCem2) or
Adhesive Bonding
(Calibra)
Conventional
Cementation
(SmartCem2) or
Adhesive Bonding
(Calibra)
Adhesive Bonding
(Calibra)

In addition, the engineered leucite microstructure for Ceramco iC components detailed in the previous
section results in lower wear to opposing enamel, compared to conventional porcelains (Fig. 5). Taken
together, these in vitro results are predictors of clinical excellence.

Fig. 5: Lower Wear of Opposing Dentition of Ceramco iC compared to Conventional Systems

Data on File, test conducted at Creighton University, Dr. Mark Latta PI

Ceramco iC All-Ceramic: An Esthetic Evolution
Over ten years of experience has resulted in the development of the Ceramco iC all-ceramic
components. This class of materials uses surface or bulk nucleation mechanisms to create and grow
leucite crystals (25-45 wt%) in a feldspathic glass matrix
vi
. This leucite acts not only as a thermal
expansion modifier, but also as a dispersion strengthening phase (Fig. 4).

The pressing procedure in which ingots of these materials are injection molded into a lost-wax cavity
under medium pressure reduces the porosity and flaws common in hand-built porcelain veneering
layers. Consequently, these materials are significantly stronger (135MPa, 3-point bend flexural strength,
Table 3) compared to dental porcelains (<100MPa), and are tougher as well
vii
. They retain the esthetic

advantages of high transparency, and can be shaded in a manner similar to dental porcelains, by the
addition of inorganic oxide pigments.

An esthetic advantage the all-ceramic materials have offered, since their commercialization, is the
possibility of eliminating the metal substructure for single units. The two phase structure (leucite and
glass) makes it possible to acid-etch and silanate the interior surface of the crown. Using resin cements
and dentin bonding agents, a very strong and retentive bond is created with the prepared tooth
viii
.

The increased initial strength and the effects of adhesive bonding of all-ceramic restorations using resin
cements have ensured that this class of materials has a high clinical success rate when used for single
unit restorations in the anterior region: 95-98%, in 5-11 year ranges
ix
,
x
. The lower success rate (85%, 11
years) in the posterior has led to a contraindication for use behind the second bicuspid
xi
,
xii
. In the
following sections, we will examine clinical case reports that demonstrate the esthetic possibilities of
this system.

Advantage: iC
The Ceramco iC system improves upon previous generations of materials. Some of these advantages
are listed here.
Expanded range of indications for PFM, PTM and AC cases
Forty six shades in a single system (including shades corresponding to A-D, 3-D Master and
bleached)
All components of the iC system are inter-compatible, without any time-consuming adjustments
or mixtures.
Additionally, veneering with low-wear iC porcelain ensures significantly reduced wear against
opposing natural dentition.
It is possible to press a coping of this material and veneer it in a manner similar to a PFM coping.
This is currently not feasible with many other all-ceramic systems. Familiar incisal cutback and
surface staining may also be employed to color the core materials
xiii
.
Clinical esthetics are improved by using a resin composite die material to simulate the shade of
the prepared tooth while comparing the shade of the restoration.

Fig 6: Patient at presentation
Patchwork of Composite Restorations Conservative Preparations

Clinical Case Report 1 All Ceramic Crowns - Courtesy Dr. Nels Ewoldsen, DDS, MSD
The following clinical case report illustrates the ease of use of the Ceramco iC system for esthetic,
bonded all ceramic restorations. The patient presented with both esthetic deficiencies a patchwork of
prior composite restorations, and functional issues non-optimal OVD due to a collapsed bite from

anterior wear (Fig. 6). A diagnostic wax-up was used to present treatment options to the patient. After
informed consent was obtained, conservative chamfer preparations were created to receive bonded all-
ceramic iC restorations (Fig. 6). Subsequently, the patient was provisionalized using the Radica VLC
system. Bonded Radica mandibular provisionals were used to establish and test a new occlusal vertical
dimension, OVD (Fig 7).

Fig 7: Radica Provisionalization
Radica Provisionals Mandibular Radica OVD Build-Up

Teeth #6-#10 were now considered ready to receive all-ceramic restorations. These restorations were
created using pressed value series ingots, followed by staining in the D2 shade. The resulting
restorations showed a high level of esthetics. Minimal adjustment was required, being limited to contact
adjustment with a diamond strip. The preparations received Prime & Bond NT dual cure bonding agent
and silane treated restorations were bonded using Calibra esthetic resin cement (Fig. 8).

Fig 8: Ceramco iC restorations
Bonded Restorations Restored Smile

The patient expressed a high level of esthetic satisfaction with the results, especially in comparison with
the situation as presented (Fig. 9).

Clinical Case Report 2 Laminate Veneers - Courtesy Dr. Joao Moraes, T. P. D. Juliano
Vasconcellos
bonded ceramic laminate veneers. The patient, a 45 year old man, presented with tetracycline staining,
diastemata, and Class II malocclusion. The patient presented after an years orthodontic treatment in
the mandibular. He required maxillary reconstruction and smile lifting with a view to an improved
functional and esthetic situation post treatment. Better vertical to horizontal dimension ratios in the
crowns would enhance anterior esthetics. It was decided to enhance the esthetics of 8 anterior maxillary
units with refractory veneers. This course of treatment was selected due to its conservative (minimally
invasive) nature but excellent esthetic potential.

Fig 9: Ceramco iC All Ceramic - Before and After Images
Before After

A diagnostic wax-up was created to aid in treatment planning and illustrate expected outcomes (Fig. 10).
A try-in of the diagnostic wax-up confirmed both the patients and the treatment teams esthetic and
functional expectations.

Fig 10: Situation at Presentation
Before Diagnostic Wax-Up

Fig 11: Preparation and Provisionalization
Preparation Provisionalization


Relatively conservative veneer preparations were created to ensure esthetic outcomes, keeping in mind
the fact that under-preparation often militates against esthetics, especially with laminates. Modified
chamfer margins were used to enable clear designation of margins by the technical team.
Provisionalization was accomplished following the diagnostic wax-up guidance (Fig. 11) using a bis-acryl
resin (Luxatemp, DMG) and a VPS putty template (Zetalabor, Zhermack SpA).

As part of the laboratory procedure, a wash firing using Ceramco iC opaceous dentin (Shade A2) was
initiated to mask the underlying staining. A mixture of A2 opaceous dentin and HC4 high chroma
modifier was added at the next firing to imbue depth of color in the cervical areas. In the next firings, a
mix of B3 and A2 dentin was used. Enamel shades Violet, Extra Light, Super Clear and Opal Enamel Clear
were subsequently fired on to add depth of translucency, followed by a glaze firing. The result was a
vital and natural looking set of laminate veneers (Fig. 12).

The veneers were tried in for position and contour. Only minor modifications (using water cooled
diamond tools) were necessary. The ceramic veneers with etched with 5% hydrofluoric acid, and
subsequently silanated in preparation for placement. A self adhesive resin cement system (RelyX ARC,
Shade A2, 3M ESPE) was used to bond the veneers in place. A harmonious and natural smile resulted.
The treatment sequence was completed efficiently in a 5-day span. The patient was very satisfied with
the natural smile resulting, as were we.

Fig 12: Laboratory Steps
Laminate Veneers Initial Firings Venee Restorations

Fig 13: Final Restorations
Retracted Natural Smile

Clinical Case Report 3 Ceramic Inlay Courtesy Dr. Todd C. Snyder
bonded all-ceramic inlay.


Fig. 14: Situation at Presentation and Preparation
Resin Restoration on #13 Initial cavity preparation with caries indicator

The patient, a forty four year old female, presented with a chief complaint of an old restoration with
sensitivity on tooth # 13. Her medical history was unremarkable and there were no contraindications to
dental treatment. Tooth #13 had been restored with a composite resin restoration. The restoration had
signs of wear, marginal breakdown and the tooth itself had a crack on the distal margin (Fig. 14).

The adjacent amalgam is to be replaced at a subsequent visit. Treatment options were discussed with
the patient and it was decided to replace the existing restoration with a durable esthetic all ceramic
restoration (Ceramco IC, Dentsply Prosthetics) that would not compromise the existing appearance of
the tooth.

The existing restoration was removed and the conservative preparation was created. Due to the depth
of the existing restoration and recurrent decay a caries indicator was used (Fig. 14). Upon removing the
recurrent decay a glass ionomer base was placed to protect the pulpal floor (Fig. 15). The crack on the
mesial was determined to be too small to necessitate treatment as the amount of tooth structure that
would have to be removed to place an indirect material would reduce too much tooth structure thus
compromising the integrity of the tooth more than adhering the tooth together with a bonded inlay.

Fig. 15: Preparation Details and Impression
GI Base with Prep Design VPS Impression

The ideal depth was created with the base being reduced slightly, along with the axial walls diverging 6-
10, to allow for proper line of draw without compromising the existing tooth structure. Figure 12
shows the initial clean out of the composite restoration, along with some interproximal bleeding from
inflammation, as well as the caries indicator. Figure 15 shows the glass ionomer base placed along with
ideal preparation design, as well as the VPS impressions of the case illustrating the conservative
preparation requirements. The provisional restoration was fabricated out of bis-acryl provisional
material (Fig. 16).


Fig. 16: Provisional and Restoration on model
Bis-Acryl Provisional Restoration on Model

The Ceramco iC restoration material was chosen for the inlay based on the fact that it is a durable
conservative esthetic system. The translucency of the all-ceramic ingots and the dentin and enamel
components of the veneering porcelain provide for an extended range of shade matching possibilities.
The system also provides for laboratory efficiencies. The restoration on a model is shown below, as well
as in the try-in phase to verify contours (Fig. 16). The All Ceramic restoration was placed with a dual cure
resin cement and a self-etched adhesive bonding agent.

The completed case is shown below (Fig. 17). We were able to restore the overall strength of the tooth
while keeping the same esthetic appearance of the tooth, and conservatively augment the tooth
without compromising gingival health or destroying additional tooth structure. The patient was very
pleased with the results. The marginal adaptation and excellent soft tissue response achieved with the
system chosen enabled the satisfactory completion of the case.

Fig. 17: Completed Case
Completed Case Close-Up of Completed Case

Clinical Case Report 4 Multiunit Maxillary Restoration Courtesy Dr. Michael A. Miyasaki
The following clinical case report illustrates esthetic results of the Ceramco iC system for a multiple unit
reconstruction.

The patient, a forty-nine year old female, presented with a chief complaint of not liking her smile,
because the color, length and chipping of the teeth. She wanted a beautiful smile. Her medical history
is currently unremarkable, but she did have a history of acid reflux which is now controlled and there
were no other contraindications to dental treatment. Fig. 18 is an illustration of the anterior teeth
showing the wear, discoloration and the lingual acid erosion. It was apparent that any restorations we
placed should protect the teeth and be conservative in nature due to the extent of the lingual erosion.


At our first consultation the patient was unsure if the teeth should be any longer in length and whiter as
we recommended so we offered to place acrylic over the unprepared teeth, in order to allow her to
preview her new smile. We made a diagnostic wax-up and over this made a VPS putty stent (Figure 19,
Aquasil Ultra, DENTSPLY Caulk, Milford DE).

Fig. 18 Preoperative Situation
Pre-Operative Smile Lingual Erosion

Fig 19- Treatment Planning
The Wax-Up Putty Stent Fabricated Over The Wax-Up

When the patient returned we filled the stent with a bis-acryl temporary material (Integrity Temporary
C&B Material, Dentsply Caulk, Milford, DE) and placed the stent over the teeth, again unprepared (figure
19), and the patient was allowed to wear this for a week. When the overlay was first placed the patient
commented that the teeth looked too long and too white, but I reassured the patient that changes could
be made before the final restorations were fabricated. A week later the patient asked if the teeth
should be longer and whiter.

Fig. 19: Acrylic Overlay and Preparation Guide
Patient with the acrylic overlay Half of arch prepared and showing tooth #4
with implant supported crown


At this point the patient was very anxious to begin treatment and we discussed the various treatment
options from direct composite restorations, PFM crowns, and minimally invasive all porcelain crowns
and onlays and it was the last that was selected. Dentsply Prosthetics Ceramco iC was selected for the
ten esthetic all ceramic restorations consisting of crowns and onlays on teeth #4-13. The Ceramco iC
restoration material was chosen for the inlay based on the fact that it is a durable conservative esthetic
system. The translucency of the all-ceramic ingots and the dentin and enamel components of the
veneering porcelain provide for an extended range of shade matching possibilities.

Figure 19 also demonstrates one side of the arch prepared and the other side of the arch still covered
with acrylic so we could visualize the position of the final restorations and minimize tooth structure
removed during preparation. Figure 20 shows the full arch prepared and the areas of the gingival that
were lasered. The multiple restorations were impressed with the VPS (Aquasil Ultra, Dentsply Caulk).
Nicely defined margins were captured on the first try (Fig. 20).

Fig. 20: Preparation and Impression
Conservative Preparations Multiple Tooth Impression with Aquasil VPS

Fig. 21 illustrates the well fitting lab fabricated restorations. The interproximal contacts have been
perfected on the models to ensure easy delivery of the restorations.

Fig. 21: Restorations on the Model
Anterior View of Restorations Occlusal View of Restorations

During cementation care to prevent contamination of the preparations during cementation as well any
interproximal adjustments makes the rubber dam placement (Figure 22) of utmost importance. Having
the rubber dam prevents the lips and tongues from causing contamination or dislodgement of the
restorations and allows for placement of the ten restorations simultaneously during cementation. These
all Ceramic restorations were placed with an esthetic resin cement and a dual cure bonding agent
(Calibra with Prime and Bond NT, Dentsply Caulk, Milford DE). The patient was thrilled with the final
result that made the teeth smoother, whiter and longer giving her the smile she had wanted for decades
(Figure 22).

Fig. 22: Cementation and Final Results
Cementation with use of rubber dam for control
and proper isolation
Patient was thrilled with completed case

Summary
The Ceramco iC system offers an excellent esthetic alternative to clinical practitioners interested in
metal-free restorative systems. It is in line with the current development of several esthetic dental
restorative alternatives, and can offer clinical practitioners, dental laboratories, and patients enhanced
intraoral function, along with enhanced esthetics.

Supplementary Armamentarium Recommendations
Custom Trays: Triad VLC custom trays (DENTSPLY Trubyte)
Diagnostic Restoration: Radica Provisional/Diagnostic System (DENTSPLY Ceramco)
Impression Material: Aquasil Ultra VPS (DENTSPLY Caulk), Genie VPS (Sultan HC)
Anesthetic: DENTSPLY Benzocaine Oral Anesthetic Gel, 2% Xylocaine DENTAL with
epinephrine, 1:50,000 , 3% Polocaine for longer procedures (DENTSPLY Professional)
Prep Kit: Midwest Carbide 2158 Carbide, Midwest Diamonds: KS0 Cylinder, KS3 Cylinder, KS5
Teardrop, 878K Taper Modified Bevel, 858 Needle, 392 UltraNeedle Interproximal. Alternatively:
Depth Cutter #834 (471443), Cylinder Flat #837 (471092), Tissue Protective, end-cutting Cylinder
Bevel #899 (10839), and Taper Round #856 (471210) form a heavy chamfer prep kit. (DENTSPLY
Professional)
Cords: Ultrapak (Ultradent), SulPak, Ultrax (Sultan HC)
Desensitization: Calm-it densitizer (DENTSPLY Caulk)
Provisional Restoration: Lab- Radica Provisional/ Diagnostic System (DENTSPLY Ceramco),
Chairside- Integrity Temporary C&B (DENTSPLY Caulk), or VersaTemp (Sultan HC)

Provisional Cementation: Integrity Temp-Grip (DENTSPLY Caulk), or SensiTemp NEZO (Sultan
HC)
Conventional Cementation: SmartCem 2 (DENTSPLY Caulk)
Adhesive Bonding: Prime and Bond NT unit dose, Calibra Esthetic LC resin cement
Curing Light: SmartLite PS (DENTSPLY Caulk)
Polishing: Dialite System (Brasseler USA)
Endodontic Treatment Access: Midwest KS3 diamond bur, Ultracoarse 2801 round diamond bur
(DENTSPLY Professional)

REFERENCES

i
Kelly JR, 1997, Ceramics in Restorative and Prosthetic Dentistry, Ann. Rev. Mater. Sci.,, v27, p443-68.
ii
Gonzaga CC, Okada CY, Santos AL, Goulart EP, Sundar V, Cesar PF, Miranda WG Jr, and Yoshimura HN,
2002, Microstructure of Dental Porcelains, J. Dent. Res., v81(4), No. 1857.
iii
Piche PW, O'Brien WJ, Groh CL, Boenke KM, 1994,Leucite content of selected dental porcelains, J
Biomed Mater Res. , May;28(5):603-9
iv
Imai Y, Suzuki S, Fukushima S., 2000, Enamel wear of modified porcelains, Am J Dent., Dec;13(6):315-
23.
v
Wright MD, Driscoll CF, Romberg E, Thompson GA, 2002, Comparison of three porcelain polishing kits
for ultra-low fusing dental porcelain, J. Dent. Res., v81(4), No. 3832.
vi
Beham G, 1990, IPS Empress: A New Ceramic Technology, Ivoclar-Vivadent Report 6, 3, Ivoclar AG,
Schaan, Frstentum Liechtenstein.
vii
Gorman CM, McDevitt WE, Hill RG., 2000, Comparison of two heat-pressed all-ceramic dental
materials, Dent Mater., Nov;16(6):389-95.
viii
Sheykholeslam Z, Buonocore MG, 1972, Bonding of resins to phosphoric acid-etched enamel surfaces
of permanent and deciduous teeth, J Dent Res., Nov-Dec;51(6):1572-6.
ix
Probster L, Geis-Gerstorfer J, Kirchner E, Kanjantra P., 1997, In vitro evaluation of a glass-ceramic
restorative material., J Oral Rehabil., Sep;24(9):636-45.
x
Barnes D, Gingell JC, George D, Adachi E, Jefferies S, Sundar V., Clinical evaluation of an all-ceramic
restorative system: 24-month report, Am J Dent. 2006 Aug;19(4):206-10.
xi
Fradeani M, Redemagni M, 2002, An 11-year clinical evaluation of leucite-reinforced glass-ceramic
crowns: a retrospective study, Quintessence Int., Jul-Aug;33(7):503-10.
xii
Malament KA, Socransky SS, Thompson V, Rekow D., 2003, Survival of glass-ceramic materials and
involved clinical risk: variables affecting long-term survival, Pract Proced Aesthet Dent., Suppl:5-11.
xiii
Berland LF, 1999, Building a better cosmetic practice, Dent Today, Jun;18(6):56-8, 60-1.

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