crown & bridge:‫اسم المادة‬ 2020-2019 ‫العام الدراسي‬ ‫ بغداد‬/ ‫كلیة التقنیات الصحیة والطبیة‬

‫ الرابعة‬: ‫المرحلة‬ )) ‫(( تقریر علمي‬ ‫قسم تقنیات صناعة األسنان‬

]‫باقر حسين منعم‬ :‫اسم الطالب‬

All ceramic restoration :‫عنوان التقریر‬

Introduction
The term ceramic refers to any product made from a nonmetallic inorganic
material usually processed by firing at a high temperature to achieve desirable
properties. The more restrictive term porcelain refers to a specific compositional
range of ceramic materials originally made by mixing kaolin (hydrated
aluminosilicate), quartz (silica), and feldspars (potassium and sodium
aluminosilicates), and firing at high temperature.
 All-ceramic crowns developed from a desire to restore heavily broken down
anterior teeth to a form and function that was aesthetically pleasing. Prior
to the development of contemporary tooth-coloured direct restorative
materials, and in place of gold or amalgam restorations, anterior teeth
could be restored using all-ceramic restorations.
 All ceramic crown presents the best quality and most beautiful prosthodontic
teeth restoration. These crowns are made fully of ceramic(fig 1). Their use
has increased for the cases when one tooth or more are missing, in the
frontal as well as in the lateral regions of the jaw. When several all ceramic
crowns are connected this presents an all ceramic dental bridge.

(fig .1)
Constituents
 Major components: Feldspar, Quartz, Kaolin
 Other components: Oxides of sodium, Potassium, Calcium, Aluminum,
Magnesium, Lithium etc.
 For colors : Oxides of Indium, Chromium, Tin, Iron, Cobalt, Cerium.

CLASSIFICATION OF DENTAL CERAMICS

 Dental ceramics can be classified according to their applications,
fabrication method, crystalline phase or fusing temperature

 Classification by Application :
(1) Ceramics for metal-ceramic crowns and fixed partial prostheses.
(2) all-ceramic crowns (inlays, onlays, veneers, and fixed partial prostheses).
(3) Ceramic orthodontic brackets.
(4) Dental implant abutments,
(5) Ceramic denture teeth.
Sintering: is the process of firing the compacted ceramic powder at high
temperature to ensure optimal densification.
 Classification by Fabrication Method:
(1) Soft-machined .
(2) Soft-machined & glass-infiltrated .
(3) Hard-machined .
(4) Slip-cast .
(5) Heat-pressed.
(6) Sintered .
(7) (7)CAD/CAM machining.
 Classification Based on firing temperature :
1. High - fusing : 1,290 to 1,370 ° C ( 2,350 to 2.500T )
2. Medium - fusing : 1,090 to 1,260cc ( 2,000 to 2.300T )
3. Low - fusing : 870 to 1,065DC ( 1,600 to 1,950 ° F )

o Materials used for making all ceramic crowns

Even though presently the all ceramic industry has an impressive progress and
there are many materials used in making this kind of prosthodontics, the
materials proved to be the best and most commonly used are zirconium ceramics
and lithium disilicate ceramics. This way we get a crown made of materials very
similar to glass, light and transparent, and resistant as much as a natural tooth.
Zirconium has very distinguished mechanical properties, it is extremely white and
is one of the strongest materials. At the very beginning, it was used in space
technology, and later it finds application in some branches of medicine, for
example, in orthopedic surgery (heads of the hip prosthetics) and in dentistry.
Zirconium is a very hard ceramic and because of its hardness it is most suitable for
making lateral dental bridges. It has a bit weaker aesthetic properties when
compared to lithium disilicate ceramics. Ceramic implants are also being made
from the zirconium.

The aesthetic properties of lithium disilicate ceramics are still impeccable and it is
recommended to be used for all frontal teeth from 3 to 3.
Advanatges
 Superior esthetic
 Excellent translucency
 Good tissue response
 Conservative reduction of facial surface
 Appearance of restoration influenced by color of luting agent
 Biocompatibility
 Superior hardness that provides the restoration its wear resistance
 Resist the degradation in oral fluids Low thermal diffusivity

Disadvanatges
 Absence of metal substructure Reduced strength of the restoration
 Significant tooth reduction is necessary proximal & lingual surface
 Difficulty in obtaining well fitting margin
 Not effective as retainer for fixed
 Wear observed on functional surface natural tooth
 Wear may occur on functional surfaces of natural teeth that oppose
porcelain restoration

Types of all ceramic

.1Leucite Reinforced Pressable Porcelain Crowns
Originally introduced 15 years ago, IPS Empress pressable crowns have a
flexural strength of 160MPa and have proven to be durable and to provide
excellent aesthetics. With this system, it is possible for clinicians to achieve
restorations that closely replicate natural teeth. A die-shade guide is used to
determine the shade of the tooth preparation, helping to decide the right tooth
shade. This information allows the technician to select the correct ingot when
pressing the crown. IPS Empress crowns have a high translucency which
helps to transmit the shade from adjacent teeth so it is possible to obtain an
exact shade match even for more difficult cases.
2- Lithium Disilicate Porcelain Crowns

This type of crown is made from biocompatible lithium disilicate ceramic glass ingots.
IPS e.max crowns have the quality of being resilient to fracturing, with a flexural
strength of 400MPa – three times stronger than Empress. These crowns can either be
pressed or milled to offer good fit as well as function. They make it possible to create
full-contour restorations or to layer enamel porcelain using IPS e.max Ceram, which is a
comprehensive layering ceramic that provides highly aesthetic results.

. 3 Solid or Monolithic Zirconia

Solid or monolithic full-contour zirconia crowns are highly effective for use with posterior
restorations as they are extremely strong, with a flexural strength of 1200MPa.
CAD/CAM-fabricated crowns provide a very precise fit and are virtually unbreakable.
The shades of this type of crown have improved considerably over time, and they can
now closely match neighboring teeth when placed. Because of the smoothness of their
surface and high durability, this type of crown can be a good choice for patients who
have bruxism. If any occlusal corrections are needed during the fitting, monolithic
zirconia can easily be polished using conventional low-speed polishing materials.
Conventional PFMs can have issues with opaque showing through when adjusted, but
this is not a problem with monolithic zirconia as the shade is the same throughout the
crown.

4. H i g h T r a n s l u c e n t Z i r c o n i a
High translucent zirconia can be used for posterior crowns and is
particularly suitable for anterior crowns. It has a flexural strength between
590 and 720 MPa and offers lifelike translucency. This material is highly
biocompatible, promoting a healthy response with the surrounding tissue. It
also offers good aesthetics as it transmits the color of adjacent teeth once
placed in the mouth, thus blending in well with natural teeth. High-
translucent zirconia can be used in monolithic restorations or can be
layered. The way in which the material is processed creates its effect in
translucency, minimizing the effects of impurities and structural defects.
  Fabrication techniques of all ceramic restoration

Several processing techniques are available:

1. Sintered all-ceramic materials:
a) Alumina-Based Ceramic.
Feldspathic Porcelain. B) Lucite-Reinforce
2. Heat-Pressed All-Ceramic Materials
a. Lucite-Base Ceramic
Ceramic ingots are pressed between 1150o and 1180oC (under a pressure of 0.3-
0.4 Mpa). This temperature is held for about 20 mints in a specially designed
automatic press furnace. The flextural these ceramic (120 Mpa) is about double
than that of feldspathic porcelains.
b. Lithium Disilicate-Based Materials
They are heat-pressed in the 890o to 920oC
Using the same equipment as for the Leucite-based ceramics
The main advantage is good flexural strength (350 MPa) and
fracture toughness (3.2 MPa m).
c. Lithium phosphate-Based Ceramic

3. SLIP-CAST ALL-CERAMIC
 The starting media in slip cast that is an aqueous suspension of fine alumina particles in
water with dispersing agents .
 The slip is applied onto a porous refractory die , which absorbs the water from the slip
and lead to condensation of the slip on the die .
 This is then fired at high temperature (1150) .
 Classification of slip cast ceramic
(1) In ceramic spinal : contains a magnesium spine as the major crystalline
phase which improve the translucency of the final restoration its used in
inlay , single anterior and posterior crown
(2) In ceramic alumina : contain aluminum oxide , its used in single anterior
and posterior or unit and 3 unit anterior bridge .
(3) In ceramic zirconia : contains zirconium oxide and is said to provide the
highest strength , it is used in single anterior and posterior unit and 3 units
anterior and posterior bridge .

Contraindication :
(1) Insufficient quantities of hard tooth substance .
(2) Inadequate preparations .
(3) Bruxism .

Fabrication procedure :
(1) The master cast is duplicated with special elastomer , the special plaster die .
(2) Duplicate the working die with elastomeric impression material and pour with special
refractory die material .
(3) Any undercut must be block out first , and two coats of die spacer must be applied ,
when the die material has fully set (2hours) , remove the die , mark the margin .
(4) Mix the appropriate shade of alumina slip with ultrasonic agitation , place the mixture
under a vacuum , brush applied it to plaster die , and shape it with a blade , trimming
back to the margins carefully .
(5) The slip is fired in a special furnace initially throught a prolonged drying cycle (120C)
that drive the die material , which shrink away from the core then alumina is fired at
1120 C .
(6) Paint a coat of the appropriate shade of glass mixture onto the surface of the core and
fire at 1100 (2012F) , As the glass melt , it is draw into the interstices of the alumina by
capillary action , producing a dense composite structure with excellent strength
properties .
(7) Remove excess glass from the core by grinding and airborne particle abrasion . Body and
incisal porcelain is applied to the core in a manner similar to that for metal-ceramic
crowns .
4. MACHINABLE ALL-CERAMIC MATERIALS
Procera Allceram
It is a densely sintered high purity aluminum oxide core material.
The ceramic material composed 99.9% alumina and one of the hardest ceramic
around.
Procera scanner is used to scan the surface of prepared tooth and core is
prepared by transmitting the data to milling unit using CAD-CAM technology
(Computer Aided Design and Computer Aided Manufacturing process).
After coping is made veneering of ceramic material over the coping is done by
ceramist using advanced powder technology.
Used for anterior crowns, posterior crowns, veneers, onlays, inlays.

Zirconia Ceramics
In 2002 zirconia based machinable ceramic was introduced.
The materials consists of zirconia polycrystals stabilized by addition of 3Y-TZP
(yittria stabilized tetragonal zirconia polycrysals ceramic).
Partially sintered blocks are machined by CAD- CAM system and later sintered at
1350oC for 2 hrs.
Highest flexural strength and fracture toughness of all available materials, e.g.
CERCON, Lava
  FABRICATION OF CERAMIC RESTORATIONS •

The fabrication of conventional porcelain restoration is by:

1. Condensation
2. Sintering
3. Glazing
4. Cooling
CONDENSATION
• Padding or packing of wet porcelain into position
• The movement of particles is generated by vibration, spatulation or whipping
brush technique and spray opaquing
CONDENSATION :
 Build - up of Cervical Porcelain
 Build - up of Body Porcelain
 Cut - back
 Build - up of Enamel Porcelain
Condensation methods :
 Manual condensation
 ultrasonic condensation
 Advantages of ultrasonic condensation:
1. Reduces the fluid content of layered ceramics; resulting in denser and
more vibrant porcelain mass
2. Enhances translucency and the shade qualities of the fired ceramic.
3. Shrinkage can be reduced to below 5%
4. Time-saving as it reduces the number of compensatory firing cycles
SINTERING / FIRING: Process of heating closely packs particles to achieve inter
particle bonding and sufficient diffusion to decrease the surface area or increase
density of the structure.
• Process of partial fusion of compact glass
Steps:
• Pre-heating the furnace
• Condensed mass placed
• Green porcelain is fired
Pre-heating (Drying): Placing the porcelain object on a tray in front of a preheated
fumace at 650C for 5min for low fusing porcelain and at 480C for 11 min for high
fusing porcelains till reaching the green or teathery state.
• Significance:
• Removal of excess water allowing the porcelain object to gain its green
strength.
• Preventing sudden production of steam that could result in voids or fractures

Stages of Maturity of Porcelain

Bisque bake
A series stages of maturation in the firing of ceramic materials depending on the
degree of pyrochemical reaction and sintering shrinkage occurring before
vitrification (glazing).
• Low bisque : Surface of porcelain is very porous and will easily absorb water.
• Medium bisque : Surface is stil porous but the flow of the glass grains is
increased and entrapped air. will become sphere shaped.
• High bisque : Surface is completely sealed and presents a smooth texture.
Overfired porcelain become milky or cloudy in appearance - Devitrification.
GLAZING: Produces smooth, shiny and impervious outer layer, also effective in
reducing crack propagation.
2 ways: • Add-on glazing • Self glazing most preferned technique

COOLING:
• Carried out slowly
• Rapid cooling results in cracking or fracture of glass and loss of strength. * After
firing, placed under a glass cover to protect it from air current and contamination
by dirt.
Cementation and Finishing Of All- Ceramic Restorations o Ceramic crowns may be
cemented with zinc phosphate, glass ionomer. or a dual- polymerizing resin
cement such as Enforce with Fluoride. o Ceramic crowns that have been etched
internally and bonded with a composite resin cement are 50% stronger than
similar crowns cemented with zinc phosphate cement.
References:
 Contemporary Fixed Prosthodontics , Fifth edition .
 https://www.makeitemax.com/all-ceramics/ips-emax-system/
IPS+Empress+Esthetic+-+Dentist.pdf
 https://www.dentalaegis.com/id/2012/01/monolithic-zirconia-crowns-
and-bridges
http://www.dentistrytoday.com/restorative/9715-use-of-high-
translucency-zirconia-in-the-aesthetic-zone
 Craig Retorative Dental Materials , 2012 .

 https://www.slideshare.net/mobile/hrudi21/all-ceramic-restorations
 https://www.slideshare.net/mobile/cdindal/all-ceramic-restorations-
45603038
 https://www.slideshare.net/mobile/nithin_87/all-ceramics-dental