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i T O Y
A Review of _ :
All-Ceramic
In this article, we describe derived from the Greek word stoneware and pottery are still
five categories of all-ceramic "keramos" meaning "burnt made from impure clays, sand
systems: stuff." and feldspar minerals, and are
- conventional (powder-slurry) baked in ovens called kilns.
ceramics; V These objects are made by first
castable ceramics; pulverizing the raw materials
-machinable ceramics; I n dentistry, we use into fine particles or powders,
-pressable ceramics; then adding water to obtain a
infiltrated ceramics. three different consistency suitable for shap-
types of porcelain ing and molding. The "green"
CERAMIC VS. PORCE- (unbaked) objects are dried and
LAIN: WHAT'S THE
DIFFERENCE? compositions, depend- are placed in a kiln and heated
to sufficiently high tempera-
Ceramics. Ceramics are usu- ing on their application. tures to make the individual
ally defined in terms of what particles coalesce into a solid
they are not: nonmetallic (not A mass. The coalescence of the
metals) and inorganic (not particles is often referred to as
resins). To distinguish them Although the methods of ob- "sintering," and the process
from rocks and minerals, the taining and purifying the raw usually results in a net shrink-
vast majority of which are also materials and the technology of age and strengthening of the
inorganic and nonmetallic, ce- fabricating these raw materials solid mass.
ramics are additionally defined into useful objects have been The newer types of ceramic
as man-made solid objects significantly advanced since dental restorative materials
formed by baking raw materi- ancient times, some methods used for all-ceramic crowns, ve-
als (minerals) at high tempera- and techniques have not neers and inlays are either
tures. The term "ceramics" is changed. For example, variations of feldspathic porce-
lain (for example, Optec HSP, gins as a mixture of powders of and/or other alumino-silicate
Jeneric/Pentron; In-Ceram, feldspar, clay and quartz. This is crystals) embedded in a silicate
Vident; Cerec, Vident; Celay, referred to as high-temperature glass (a noncrystalline, amor-
Vident; IPS Empress, Ivoclar porcelain in some dental materi- phous matrix). The relative
North America; and Optec als textbooks.4 amounts of crystal and glass de-
Pressable Ceramic, Jeneric/ - Feldspathic dental porcelain, pend on the specific type of
Pentron) or are made of entirely used for ceramo-metal restora- porcelain in question. Leucite (a
different compositions (for ex- tions, begins as a mixture of reaction product of potassium
ample, Dicor, Dentsply, L.D. powders of potassium feldspar feldspar and glass) is a particu-
Caulk Division; Duceram LFC, and glass. This type of porcelain larly important component in
Degussa Corp.). The dental porcelain because
methods used for fabri- it affects the optical prop-
cating some of these erties, thermal expan-
restorations are quite sion, strength and hard-
different from those ness of the porcelain
used for ceramo-metal (Figure 2).
restorations and porce-
lain jacket crown, or CERAMICS AS
the fracture resistance of dental the baking procedure, the fit of CLASSIFICATION OF ALL-
CERAMIC SYSTEMS
porcelain provided the impetus finished aluminous crowns is
for fusing it to a metal sub- generally much poorer than The following general types of
strate. For additional strength, that of ceramo-metal crowns. all-ceramic systems are current-
small crystals can be dispersed Although aluminous crowns are ly available:
within the ceramic structure to considered more lifelike in ap- - Conventional powder-
impede the propagation of pearance than their ceramo- slurry ceramics. These prod-
cracks. metal counterparts, their suc- ucts are supplied as powders to
The abrasive wear of oppos- cessful fabrication is extremely which the technician adds
ing tooth structure is a serious technique-sensitive. The clinical water to produce a slurry,
clinical problem. The amount of fracture reported for these which is built up in layers on a
wear is influenced by the hard- types of restorations is relative- die material to form the con-
ness of the ceramic material ly high: 2 percent for anterior tours of the restoration. The
and its surface roughness as it crowns8 and 15 percent for pos- powders are available in vari-
functions against natural tooth terior crowns.9 ous shades and translucencies,
structure. The effects of abra- and are supplied with charac-
sive wear are particularly no- terizing stains and glazes.
ticeable and destructive when - Castable ceramics. These
Optec HSP 146 MPa'0 Higher thanl that of Special die No core material; i-
(Jeneric/
Pentron)
conventional feld-
spathic porcelain due
material form thranluoency
and
shade throughout; etch-
to high leucite corntent5 ablebohding
for to
tooth
Duceram LFC 110 MPa13 Close to hardness of Special die Low fiusing tempera-
(Degussa) natural tooth owing material ture; can be charac-
to absence of leuicite terized with suirface
stains
r ~~~~~~~~~~~~~~~~~~~~~~~~~k
Dlcor 152 MPal Same as that of tooth Special invest- Surface stains (aes-
Cerec Vltablocs 93 MPa26 Similar to that of con- Siemens Cerec Regarding all mate-
Mark I (Vident) 9ventional feldspathic CAD-CAM rials in this group:
porcelainr System; milling ~ Can be character-
of a ceramic ized with surface
ingot from a digi- stainis; the stains
tized optical scan may be lost to abra-
sion
Cerec 152 MPa26 Similar to that of Same as above - The gap between
Vitablocs Mark eaamel27 the restoration and
ll (Vident) tooth is wider than
that in other all-ce-
ramic systems; wear
Dicor MGC 216 MPa28 Between those of Same as above of the resin cement
(Dentspiy, L.D. Cerec Vitablocs Mark in this gap may have
Caulk Division) I aDd Cerec Vitablocs clinical significance
Mark 1127 - Etchable for bond-
ing to tooth struc-
Celay (Vident) Same as Same as that of Cerec Celay Copy- tuire
that of Vitablocs Mark 1130 Milling System;
Cerec milling of a ce-
Vitablocs ramic ingot from
Mark I130 a direct pattern
UPS Empress 126 MklPa Possibly higher than Special o-ven, die Core material is
(Ivoclar North
America)
i6itially; that of conventiojnal feld- material and shaded and translui-
160-182 spaxthic porcelain owing molding proce- cent; etchable for
M:Pa after to increased leuzcite dure bonding to tooth
heat treat- content after heat
ment24 treatment
Optec PF.ssatie 165 MPa37 Same as above Same as above Same as above
Ceramic
(JenedcAPeronb)
In-Ceram 450 Mpa17'20 Same as that of conr- Special die mate- Core material is more
(Vident) 0ventionial feldspathic rial, high-tem- opaque than other
porcelain perature oven types; not etchable
for bonding to tooth
* ft*Wu~estength re f various iatW.M
PRESSABLE CERAMICS
Figure 6. Crowns made from In-Ceram (Vident) (photographs courtesy of Dr. Carlos Moglianesi).
One short-term clinical translucent, dense and etchable 1100 C for four hours. During
study35 has been published that ceramic restorations. The mate- this process, the molten glass
reports no clinical fractures of
restoration may not be as life- an ion exchange mechanism in- greater clinical wear. Dicor
like as that seen with other sys- volving hydroxyl ions. This is (without the Dicor Plus veneer)
tems (Figure 6). This material said to decrease surface mi- and Duceram would be expected
requires specialized equipment croflaws and increase fracture to create minimal or no wear
to fabricate a restoration. resistance. against natural tooth structure.
In a 21/2-year clinical study of Fabrication techniques.
61 full-coverage single units With the exception of Optec SUMMARY
and 15 multiple-unit bridges," HSP and the Duceram system, We have discussed five cate-
researchers reported that no the all-ceramic systems use spe- gories of all-ceramic systems re-
single units fractured, and two cialized equipment and tech- garding their processing tech-
of the 15 bridges failed because niques. This could be considered niques, strength and wear
of fractured abutments. a disadvantage because of the characteristics. These systems
added cost of fabrication to the are all currently in use by den-
COMPARISON OF THE technician. tal laboratories for the fabrica-
ALL-CERAMIC SYSTEMS
Marginal fit. With the ex- tion of all-ceramic restorations.
Strength. All the systems ap- ception of the machined ceramic The table compares the physical
pear to have adequate strength restorations, the fit of the all-ce- properties of these systems (as
for single units. Although the determined by in vitro studies).
7. McLean JW, Hughes TH. The reinforce- er restorations. Chicago: Quintessence; 1991.
ment of dental porcelain with ceramic oxides. Br 27. Grossman DG. Biaxial flexure strength of
Dent J 1965;119:251-67. CAD/CAM materials (IADR Abstract no. 1341).
8. McLean JW. Perspectives of dental ceram- J Dent Res 1991;70:433.
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International Symposium on dental ceramics. conservative ceramic restorations using copy-
Chicago: Quintessence; 1984:13 40. milling technology. Quintessence Dent Technol
9. American Dental Association. Recent devel- 1994;17:19-25.
opments in materials and processes for ceramic 29. Gladys S, Van Meerbeek B, Inokoshi S, et
Dr. Rosenblum Is a Dr. Schulman IIs pro- crowns. JADA 1985;10(4):548-9. al. Clinical and semiquantitative marginal anal-
clinical associate pro- feaaor and &assSociete 10. Vaidyanathan TK, Vaidyanathan J, ysis of four tooth-coloured inlay systems at 3
fessor, Depa e or head, Division of Prasad A. Properties of a new dental porcelain. years. J Dent 1995;23(6):329-38.
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Blomaterils and Prosthodontic 11. Anusavice KJ. Recent developments in re- Three year clinical evaluation of CAD/CAM
Deparbtmnt of Sciences (Dartltal storative dental ceramics. JADA 1993;124:72-84. restorations. J Esthet Dent 1992;4(5):173-6.
General and Hospital Materials), Neww York 12. Optec HSP laboratory technique manual. 31. Heymann HO, Bayne SC, Sturdevant JR,
Dentisry, Unhivrsity University Coilt wge of
Wallingford, Conn.: Jeneric-Pentron Inc.; 1988. Wilder AD, Roberson TM. The clinical perfor-
of Medicine and
13. Komma 0. Hydrothermal dental ceramic mance of CAD-CAM-generated ceramic inlays:
Dentistry, Nowsv York. systems. Technical report. Rosbach, Germany: a four-year study. JADA 1996;127:1171-81.
Dentisr of New Ducera Dental Company; 1993. 32. Behnm G. IPS Empress: a new ceramic
Jers, Newak 14. Dickenson AJG. A comparison of the technology. Ivoclar Vivadent report no. 6.
Addrss rapunt re- Cerestore and Dicor systems. In: Proceedings of
quedst to Dr.
has been a the International Symposium: Alternatives to
Amherst, N.Y.: Ivoclar-Williams-Vivadent; 1990.
33. Holland W, Frank M. Materials science of
Rosenblum at great amouamt the use of traditional Porcelain. Amsterdam, Empress Glass Ceramics. Ivoclar-Vivadent re-
UMDNJ, University of attentior The Netherlands. 1986:1-24. port no. 10. Amherst, N.Y.: Ivoclar-Williams-
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given to re-