1) Aluminous porcelain crowns

Introduced by - McLean and Hughes (1965). Advocated using aluminous porcelain, which is
composed of aluminum oxide crystals dispersed in a glassy matrix. Their recommendation was
based on the use of alumina reinforced porcelain in the electrical industry and the fact that
alumina has increase fracture toughness and hardness. The increased content of alumina crystals
(40 to 50 percent) in the core strengthened the porcelain by interruption of crack propagation.

Platinum Foil Matrix Condensation and Firing - The platinum foil matrix is carefully removed
from the die and the core porcelain is carefully condensed on to it. It is then placed in the furnace
and fired. After cooling, the rest of the body is built up using dentin, enamel and other
porcelains.

Advantages: Better in esthetics compared to metal ceramic that employs a metal coping.

Disadvantages: Strength is inadequate to be used for posterior teeth .Mclean has reported a
fracture rate of molar aluminous porcelain crown of approximately 15% after 5 years.

2) Dicor and Dicor MGC

Castable and machinable glass ceramics.

First commercially available castable ceramic is dicor, developed by Corning glass works and
manufactured by Dentsply international. Indicated for onlays,facial veneers,full crown
restorations. Dicor is a Glass ceramic that is formed by lost wax casting technique into the
desired shape as a glass and subsequently heat-treated under controlled conditions to induce
crystallization. This crystallization inducing process, which involves crystal nucleation and
growth is referred to as ceramming and is accompanied by a small and controlled volume
change.

Fabrication of a Dicor Crown

To understand the salient features of this material the step-by-step construction of a crown will
be described:

1) The crown pattern is first constructed in wax and then invested in investment material like a
regular cast metal crown.

2) After burning out the wax, nuggets of Dicor glass is melted and cast into the mould in a
centrifugal casting machine.

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

4) The glass restoration is then covered with a protective 'embedment material' to prepare it for
the next stage called ceramming.

5) Ceramming is a heat treatment process by which the glass is strengthened. Ceramming results
in the development of microscopic crystals of mica, which improve the strength of the glass. It
also reduces the transparency of the glass making it more opaque and less glass like.

6) The cerammed glass is now built up with dentin and enamel (special veneering porcelain),
condensed and fired to complete the restoration.

Surface stains and colored luting cements are employed to improve upon the esthetics. DICOR
restorations are highly esthetic because their translucency closely matches that of natural tooth
enamel. The resistance of DICOR to chemicals and staining agents is more than the conventional
feldspathic porcelains. Little wear of the cast ceramic or the opposing dentition occurs when
using DICOR restorations. DICOR is chemically inert and has shown to pass all the
biocompatibility tests. The periodontal tissue reaction to DICOR is quite favourable because
there is no opaque porcelains to mask the metal substructure. Little discomfort occurs on contact
with hot or cold foods because of its extremely low thermal conductivity.

Other advantages-

1) Ease of fabrication
2) Minimal processing shrinkage
3) Good marginal fit
4) Moderately high flexural strength
5) Low thermal expansion

Disadvantages

1) Limited use in low stress area

2) Inability to be coloured internally.

3) IPS Impress

This is a Pressable glass ceramics. Introduced by MAC CULLOCH IN 1968. IPS empress is a
glass ceramic available as ingots, which can be heated and pressed until the ingots flows into a
mold. It contains higher concentration of leucite crystals that increase the resistance to crack
propagation. It can be stained, glazed or built up by layering technique. The fabrication of a
dental crown according to layering technique is characterized by wax up of a model that is
invested in a special investing material, the wax is burnt-out, it is placed in a EP500 press
furnace after a muffle has been preheated (Ivoclar Company Limited, Schaan, Liechtenstein). A
glass-ceramic ingot is pressed into the mould of the crown at 1180oC according to the viscous
flow process for 45 mins. It is then cooled, divested and finished. Then the ceramic incisal
materials are applied for layering technique and glaze are applied. These materials are sintered at
about 910 to 870oC respectively.

Advantages

1) No metal component
2) Translucent ceramic core
3) Moderately high flexural strength
4) Excellent fit
5) Excellent esthetics

Disadvantages
1) Potential to fracture(in posterior)
2) Requires a resin cement to micromechanically bond to the tooth structure

4) Glass infiltrated alumina

It makes use of aluminous core that is infiltrated with a glass at 1100C for 4 hours to
achieve high strength and reduce porosity substructure that can support crowns and bridges.
The glass infiltration process compensates for firing shrinkage. A slurry of material is slip
 cast on porous refractory die and heated in a furnace to produce a partially sintered coping.
The alumina is built up to form a core for the ceramic tooth. The aluminous core is then
placed in the IN-CERAMET furnace and sintered. Indications veneers, onlays , inlays ,
anterior ,posterior crowns and FPDs

5) IN CERAM ALUMINA
Core consists of 70 % alumina infiltrated with 30 % Na lanthanum glass .

Advantages

1) Less shrinkage
2) Less porosity
3) Better marginal adaptation and fit
4) Good flexural strength

6) IN CERAM SPINELL
Core consists of glass infiltrated Mg spinel. INCERAM SPINELL is twice as translucent as
INCERAM ALUMINA because the refractive index of its crystalline phase is closer to that of
glass and it has less porosity. ICS has lower strength and toughness compared to ICA and ICZ
Indicaton anterior inlays, onlays , veneers and anterior crowns

7) IN CERAM ZIRCONIA
Core consists of 30 % zirconia and 70 % alumina. The stabilized zirconia crystal is 3% to 5%
larger, thus in places of micro cracks this process can seal the cracks. Flexural strength of
INCERAM ZIRCONIA is twice as that of alumina. The highest strength at 800 Mpa.(toughest of
the three core ceramics). Indication- mainly for posterior crowns and FPDs.
Most opaque than ICA and ICS

8) PROCERA ALL CERAMIC

Composed of densely sintered high purity Aluminium oxide . Core + all ceram
veneering porcelain. Contains 99% alumina. It is one of the hardest among the ceramics
(lower only to zirconia). Core is formed by the help of procera scanner which scan the
 surface of the prepared tooth and transmit the data to the milling unit. Enlarged die is
formed
The three main parts of the PROCERA system are:
A scanner, A personal computer & A modem or disk for transmission of data to the
workstation.

FABRICATING PROCEDURE:

The die of the prepared tooth is first mechanically scanned. The scanner has a ball tip that reads
the die shape by circular scanning. When scanning is completed the technician can design the
coping on the computer monitor. Various programs are offered to the operator such as for
designing of the crown, its desired shape and preparation margins. 15 to 25% shrinkage of the
aluminum oxide ceramic material is expected during sintering process. This is compensated by
enlarging the design in the computer files. The data collected are then transferred to a PROCERA
workstation via modem. The master cast need not be sent out of the dentist office. At the
workstation an enlarged die model is precision milled by a computer-controlled milling machine.
Aluminium oxide powder is then pressed onto the die using very high pressure. This enormous
pressure give the material a high packing density. On sintering at a very high temperature
(1550C) the coping shrinks to the original dimension. For veneering , a special ceramic material
with co-efficient of thermal expansion adjusted to aluminium oxide has been developed for the
PROCERA technique.

9) CAD CAM CERAMICS

(Computer Assisted Design-Computer Aided Manufacturing)

In 1971, FRANCOIS DURET introduced it in restorative dentistry. Provides an alternative method to

produce metal, ceramic or composite restoration without need for 2 / more appointment. Although CAD
CAM for metal crown is not commonly used. Milled or ground metal block more widely used.

The popular CAD-CAM systems used in dentistry are:

CELAY system

CEREC system

DCS Precident system

PROCERA system
CAD CAM FABRICATION METHOD

A ceramic block is inserted into the machine and is milled using diamonds. CAD/CAM
restorative materials are currently available in many shades and translucencies, including
multiple shades within one dense gradated restorative block. The material used depends on
functional and esthetic demands and on whether a chairside or laboratory CAD/CAM restoration
is fabricated.

For chairside CAD/CAM restorations, an esthetic, strong material requiring minimal post-milling
esthetic adjustment to minimize chairside time is needed. Ceramic blocks for laboratory-milled
restorations are available as zirconia (zirconium oxide) and lithium disilicate glass blocks.
Leucite-reinforced glass ceramics (IPS Empress CAD, Ivoclar Vivadent; Paradigm C, 3M ESPE
and lithium disilicate glass ceramics (IPS e.max, Ivoclar Vivadent) can be used for chairside and
laboratory CAD/CAM single restorations.

Composite-resin blocks are also available (Paradigm MZ100, 3M ESPE)

CEREC

It is a tried-and-tested, compact CAD/CAM system for chairside applications.

This system enables the direct chair side placement of ceramic restoration without auxiliary
laboratory support.

The CEREC was first introduced in 1986. It consisted of a mobile unite containing a small
camera, a computer with scan and 3-axis-of rotation milling machine.

CEREC CAD/CAM machine is used to produce full ceramic restorations in one patient visit.

The CEREC technique consist of:

Three-dimensional scanning of the cavity or taking an optical impression.

Immediate data transformation.

Axial milling which is integrated into a mobile unit.

FABRICANTING PROCEDURE:

Following the preparation phase the assistant takes a conventional impression and then produces
a partial model. This model is then clamped into the holder of the milling unit, where it is
scanned by the built-in laser (duration: approx.5 minutes). The design process is performed on a
separate PC in the dental practice. The actual production of the ceramic restoration takes place in
the milling unit. Although the CEREC Scan restorations are produced indirectly they can still be
completed in a single treatment session. The production process can be delegated to an assistant
or dental technician in the practice laboratory.

ADVANTAGES
Negligible porosity
No impression needed
Reduced assistant time
Single patient appointment
Good patient acceptance
Accuracy
Aids prep visualization

DISADVANTAGS
Costly equipment

Lack occlusal adjustment by processor

 Technique sensitive

High learning curve

High production required to cover capital investment

REFERENCES:
1)Phillips science of dental material --- Anusavice, XI edition

2) Restorative dental materialCraig,Powers XI edition.

3) Contemporary fixed prosthodonticsRosenstiel, Land and Fujimoto

4) Fundamentals of fixed prosthodonticShillingberg III edi.

5) Fixed prosthodontics.DCNA2004 vol48,no 2.