Ceramics

REALITYS CHOICES
Ceramics
2005 REALITY Publishing Co. Vol. 19 The Ratings 113
1a. HeraCeram
Heraeus Kulzer
1b. IPS Empress
Ivoclar Vivadent
1c. Lava
3M ESPE
2a. Authentic
Microstar
2b. IPS D.Sign
Ivoclar Vivadent
2c. Omega 900
Vita/Vident
3a. Cerabien
Noritake
3b. Creation
Jensen
3c. EX-3
Noritake
3d. Vita VM7/VM9
Vita/Vident
4a. Ceramco 3
Dentsply Prosthetics
4b. OPC
Pentron
4c. Procera
Nobel Biocare
5a. Duceram LFC
5b. Vitadur Alpha
Vita/Vident
6a. Finesse
Dentsply Prostheticss
6b. IPS Eris
Ivoclar Vivadent
7a. Ceramco II
7b. Finesse All-Ceramic
8a. Duceragold
8b. Duceram Plus
8c. In-Ceram Spinell
Vita/Vident
Product Type Clinical Indications Cement Options
Fluorescence
Feldspathic
Pressed
low fusing
Feldspathic over
CAD/CAM zirconia
Feldspathic low
fusing
Pressed
PFM crowns & bridges
Anterior crowns on
pressed core veneers,
inlays, onlays
Crowns & bridges
pressed over metal
veneers, inlays, onlays
pressed over ceramic
Crowns & bridges w/Lava
coping veneers, inlays,
onlays w/o coping
Veneers, inlays, onlays
w/o metal
Veneers, inlays, onlays,
anterior crowns
Any cement for PFM
Resin cement for metal-free
Any cement when supported
with metal
Resin cement when all-ceramic
Not available for testing
Any cement w/Lava coping
Resin cement w/o coping
Any cement for PFM
Resin cement
HeraCeram
Heraeus Kulzer
Authentic
Microstar
Lava
3M ESPE
Omega 900
Vita/Vident
IPS Empress
Ivoclar Vivadent
Feldspathic
w/o metal
Any cement for PFM
IPS D.Sign
Ivoclar Vivadent
Synthetic
Synthetic
Synthetic
Feldspathic
Feldspathic
Veneering alumina
copings
Veneering alumina
& zirconia copings
w/o metal
w/o metal
Any cement w/alumina coping
Any cement w/coping
Any cement for PFM
Any cement for PFM
Cerabien
Noritake
Vita VM7/VM9
Vita/Vident
EX-3
Noritake
Creation
Jensen
Feldspathic
w/o metal
Any cement for PFM
Ceramco 3
Ceramics
2005 REALITY Publishing Co. Vol. 19 114 The Ratings
Product Type Clinical Indications Cement Options
Fluorescence
Pressed
Anterior crowns, inlays,
onlays, veneers
Resin cement Not available for testing
OPC
Pentron
CAD/CAM alumina
coping
Crowns Any cement w/alumina coping
Procera
Nobel Biocare
Hydrothermal
fluorine glass low
fusing
Final layer over any
conventional ceramic
Depends on restoration
substructure
Duceram LFC
Feldspathic w/
10% alumina
Veneering, alumina
copings, veneers, inlays,
onlays w/o coping
Any cement w/alumina coping
Resin cement when unsupported
Vitadur Alpha
Vita/Vident
Low fusing
w/ leucite
Crowns, inlays, veneers
all-ceramic
Any cement for PFM
Finesse
Fluorapatite glass
over lithium
disilicate
Crowns and anterior
bridges
Any cement,
but resin is preferred
IPS Eris
Ivoclar Vivadent
Feldspathic
w/o metal
Any cement for PFM
Ceramco II
Pressed
anterior crowns
Resin cement Not available for testing
Finesse All-Ceramic
Hydrothermal
low fusing
Veneers, inlays, crowns
over pressed cores
Any cement for PFM
Duceragold
Feldspathic
w/o metal
Any cement for PFM
Duceram Plus
Magnesium oxide
and alumina
Anterior crowns Resin cement
In-Ceram Spinell
Vita/Vident
Ceramics
Description
Feldspathic porcelain based on a newly developed synthetic, puri-
fied quartz glass product called PyroSYG, which is presumably an
essential part of the system to enhance transparency, brightness,
chroma, fluorescence, and opalescence. Also contains synthetic
leucite. Can be multi-fired and reported to still maintain its coef-
ficient of thermal expansion and fracture resistance. Due to a
simple firing procedure, it is possible to shorten the firing cycles
to speed up fabrication. It supposedly has a lower abrasive index
due to reduced surface roughness.
Among the different kits, there are 2 opaque sets. The powder
set is used for the spraying technique, while the paste set is used
for fast manual application. The Matrix Set is indicated for indi-
vidual characterization. Also available is a Dentin Incisal Set, a
Shoulder Margin Set and Stains-Set. Available in 16 Vita shades.
Clinical Indications
Veneer over metal Crowns and bridges.
Veneer over pressed ceramic cores Anterior crowns.
Unsupported Veneers, inlays, onlays, and
anterior crowns.
Ceramics
(4.2)
HeraCeram
Heraeus Kulzer
1
a
NEW
Can be applied to a variety of substructures or
used unsupported
Fluoresces close to tooth structure
How about a more creative name?
Short track record
Despite the continued emergence of indirect resin materials, the
vast majority of laboratory-fabricated esthetic restorations remain
ceramic in nature. And there is a dizzying number of ceramics that
have been developed to more closely match natural tooth structure
and eliminate the need for metal substructures.
While the materials have, no doubt, gotten much better, the
role of the laboratory technician has also expanded. Dentists now
rely more heavily on the expertise of the technician who works
daily with these materials, but the final responsibility for the
restoration remains with the clinician.
How Do You Choose the Ceramic That Best Meets
Your Patients Needs?
With the proliferation in ceramic materials, choosing the one
product to meet your patients needs seems to be an insurmount-
able task. This is especially true if you consider that most dentists
are just the end users and not the fabricators of the restorations.
Nevertheless, dialogues with patients can quickly eliminate some
materials from consideration, while elevating others. For example,
if a patients highest need is the ultimate esthetic restoration from
an appearance standpoint and is willing to compromise on
strength, then a metal-free restoration assumes a higher position
on the decision tree.
On the other hand, if strength and track record are more
important to the patient, then selecting a proven ceramic that can
be applied reliably over a metal coping would be a prudent
approach.
These are the uses that we found could be used with the material
and may not always match the recommendations of the manufac-
turer. For this section, the term Anterior Crown applies to all
teeth except molars. In some instances, the same indication may
appear twice. For example, Anterior Crown may be an indica-
tion when the material is supported by a coping or when the
material is unsupported. This apparent contradiction merely
means that in some instances, the material should have substruc-
ture support (on a premolar), while in other situations, no support
is necessary (mandibular incisor).
What Do You Need to Know About the Terminology?
From a dentists point of view, the plethora of new terms can be a
confusing maze. From pressed ceramic to slip cast, the only men-
tion of these terms in this section will be in relationship to
describing specifics of preparation design and other clinically rele-
vant items such as cement selection.
Fluorescence
This test shows how the material appears as a veneer in vivo
under black light. Materials exhibiting fluorescence that does not
match that of natural teeth would not be a good choice in the
mouth of patients such as models, actors, etc. While most of the
manufacturers of ceramic materials chose not to participate in our
fluorescence testing by providing us with veneers of their materi-
als, we were able to procure veneers of some of the materials due
to the kind assistance of several commercial laboratories.
Product Listing
While there are many different uses to these products, we have
chosen to list them solely according to their rating by the Editorial
Team.
Description
Leucite-reinforced, pressed ceramic. Restorations are waxed and
invested in a special flask system. Different types of ceramic ingots
can be used in either the layered or shaded technique by pressing
the softened ceramic in a special furnace to fill the burned out
invested mold. The new Esthetic version presumably allows
enhanced esthetics with 11 new ingots, including two specifically
for bleached teeth, coordinated cut-back technique for more con-
trolled layering, and a better investment material.
Veneers, inlays, onlays, and anterior crowns.
Cement Options
Resin cement mandatory.
Ceramics
IPS Empress
Ivoclar Vivadent
www.ivoclarvivadent.us.com
(4.2)
1
b
The Standard for pressables
Even average technician can get great fits
Fracture propensity
Can encourage overpreparation
HeraCeram is a new ceramic that seems to be living
up to its billing of being able to be applied over a vari-
ety of metals due to its favorable thermal expansion
characteristics. Despite its quartz composition, it really
handles and behaves like a conventional feldspathic
porcelain. Since it can be used to veneer both metal
and pressed ceramic cores as well as by itself for
veneers, it is an excellent choice for combination cases,
although using it for metal-free bridges is still risky.
The esthetics of this material is very good, especially
the clear and opalescent enamels. And it fluoresces
very close to tooth structure (slightly brighter).
REALITY
Cement Options
Depends on its substructure. When used over metal, virtually any
cement will suffice. When used unsupported, a resin cement is
necessary.
Fluorescence
HeraCeram
Ceramics
IPS Empress, popularly known as just Empress, is quite
possibly the best known ceramic brand name in the
world and is still the standard against which all other
pressed ceramics are compared. It would be difficult to
find a dentist who at least had not heard about or used
Empress. Being the first pressed ceramic, it began a rev-
olution in esthetics that continues to grow and prosper.
Being on the market for over 15 years, it has stood
the test of time and still has many devoted advocates. It
is also quite possibly the most researched ceramic mate-
rial, with numerous studies completed over the years.
The overall results from these studies have helped in let-
ting us know the limitations to this material (as well as
most other non-alumina, non-zirconia ceramics), prima-
rily that it should not be used for molar crowns or
bridges. In addition, it has been found that Empress is
relatively kind to the opposing dentition when it comes
to wear.
Another significant finding is that the original stain-
ing technique was adequate for mid-level esthetics, but
cutting back the pressed coping and conventionally lay-
ering colors is definitely necessary if exemplary esthetics
is the goal. This modification in the technique was done
intuitively by the better ceramists and was the impetus
behind the Esthetic Line. When it is layered properly,
extremely esthetic restorations can be produced. Of
course, it requires more artistic skills to create these lay-
ered masterpieces compared to the easily achieved
staining technique.
The whole concept of waxing and pressing a ceramic
restoration seems to be easily mastered by most
ceramists. This ease of fabrication is probably the reason
that excellent fits can be achieved routinely with this
material.
There are, however, some chinks in the armor. The first
one relates more to the genre of ceramics for which
Empress was the originator, namely pressed. Due to the
space it requires and dentists desire to use it wherever
possible, there had been an unfortunate trend of prepar-
ing teeth for veneers with excessive reduction. In essence,
Empress was causing teeth to be prepared to meet the
needs of the material, instead of choosing a material to
meet the needs of the teeth and patient. Overpreparing
teeth lead to a backlash and a return to stacked porcelain
when less tooth reduction was indicated.
On the other hand, one evaluator reports success
with the new ingots for veneers as thin as 0.5mm. These
new ingots allow this thinness due to their improved
shading and translucency. And, depending on the shade
and the type of ingot, it fluoresces at a level either
slightly brighter or just brighter and with a yellowish
cast compared to tooth structure.
Another problem has been fractures, even when it is
used anterior to the molars. This is to be expected when
the sheer number of Empress restorations are taken into
account, but virtually every evaluator mentioned this
frailty. However, two evaluators report having done a
total of about 20 anterior, 3-unit bridges over a 10-year
time span with only one failure.
Finally, masking dark preparations and/or metal cores
is not a strength of Empress.
REALITY
IPS Empress E01 (Ingot only)
IPS Empress Esthetic IPS Empress TC1 (Ingot only)
IPS Empress B1 (Enamel)
Fluorescence
Description
CAD/CAM system utilizing pre-sintered zirconia blanks for the
framework and matched feldspathic veneering ceramic. Zirconia is
characterized by its outstanding stability and biocompatibility, as
well as strength levels significantly higher than other all-ceramic
materials.
The master model is scanned using white-light triangulation
via a non-touch optical scanner. The scanned data is then used to
design the coping or framework "on-screen". Lava Scanner con-
sists of a non-contact optical scan system, a PC with a monitor,
and the Lava CAD Windows-based software, which displays the
model as a three-dimensional object. The data are sent to the
milling machine where chalk-like, pre-sintered zirconia oxide is
milled, after which the pattern goes through a specialized coloring
process where the framework is dyed one of seven shades or there
is an option of leaving it unaltered, which gives you a bright white
coping. The pattern is subsequently sintered through a precise
eight-hour heating and cooling cycle where it is reduced to its final
shape and size.
However, the frameworks cannot be etched or conventionally
silanated. Rocatec or CoJet treatment is recommended.
Lava Ceram is available in seven shoulder shades, 19 frame-
work modifiers, 19 dentin porcelains, and four enamels. There are
also two enamel effect porcelains, four transparent opal porcelains,
10 Magic shades, and 10 stains.
Veneer over Lava Crowns and bridges.
Lava Ceram (Unsupported) Veneers, inlays, onlays, and
anterior crowns.
Cement Options
When supported by a Lava framework, any cement can be
used. For unsupported Lava Ceram restorations, resin cement
is mandatory.
Fluorescence
Ceramics
Lava
3M ESPE
www.3mespe.com
(4.2)
1
c
NEW
Probably the strongest all-ceramic
Fit and esthetics are unmatched
Preparations must be ideal or your case will be
sent back
Fractures still reported
Lava Ceram Veneer
Lava Ceram over Lava Coping Lava Coping
Description
Second generation, low fusing, leucite-reinforced pressable ceram-
ic that can be stained, layered, or the combination of the two. It
can be pressed over ceramic ingots or metal.
The assortment includes regular and opaque dentins, incisals,
transparents and modifiers. The ingots are available in all of the
most commonly used Vita Shades and in four opacity levels rang-
ing from 20% to 70%.
Pressed to metal Crowns and bridges.
Pressed over ceramic ingots Veneers, inlays, onlays, and
anterior crowns.
Cement Options
Depends on its substructure. When pressed over metal, virtually
any cement will suffice. When pressed over ceramic, a resin
cement is necessary.
Fluorescence
Not available for testing.
Ceramics
(4.1)
Authentic
Microstar
2
a
NEW
Can be pressed over ceramic or metal
56 different ingots to choose from
Still cant use for thin veneers
Still need metal for bridges
Lava seems like a tremendous breakthrough in all-
ceramic restorations. Not only is it extremely strong,
but it also fits very well and looks great. Since Lava
Ceram can also be used unsupported, it can be used
very successfully for combination cases. The excellent
esthetics is partially due to the fact that the framework
is shaded, which gives it a significant advantage over
the more typical white opaque copings of other sys-
tems. There is also a good selection of bleached
shades. It fluoresces at a level higher than and with a
yellow cast compared to tooth structure, especially
Lava Ceram without the backing of Lava, which has no
fluorescence at all. In other words, when Lava Ceram is
applied to Lava, the brightness of the former is toned
down by the latter.
However, evaluators have reported on a few frac-
tures, mainly with the veneering material. There is still
a limitation on double abutment bridges and the num-
ber of milling labs due to the steep capital investment.
And your preparations need to be exemplarycham-
fers and rounded shoulders only. At least two of our
evaluators had cases rejected due to preparations that
were not ideal.
REALITY
Description
High fusing synthetic feldspathic porcelain created by Dr. Robert
Winter and Don Cornell. Features a unique combination of fluo-
rapatite and leucite crystals to imitate the optical properties of
natural teeth. The fluorapatite crystals have similar size and shape
to the hydroapatite crystals found in natural tooth structure and
affect light in a similar way. The leucite crystals presumably
increase the coefficient of thermal expansion making the ceramic
compatible with the underlying metal substructure. A recent study
found that it caused the least amount of wear of opposing enam-
el compared to six other ceramics.
The Kit is available in the 10 most popular Chromascop shades
or the 8 most popular A-D shades and can be used individually.
The technician can presumably achieve bright colors and high
translucency without adding opacifying agents. Has six matched
alloys for ceramometal use. Deep Dentin is used to intensify the
chroma in limited thickness areas, Impulse is ready-mixed modi-
fiers, Stains are in paste form, Essence stains are in powder form,
Gingiva is to simulate soft tissue, and Bleach is obviously for teeth
which have been whitened. There is also a special refractory die
process to be utilized with a direct build up technique.
Unsupported Veneers, inlays, onlays, and anterior
crowns.
Cement Options
necessary.
Fluorescence
Ceramics
Excellent translucency for veneers
Low enamel wear
Fluoresces brighter than tooth structure
Technique sensitive for ceramist
IPS d.Sign
Ivoclar Vivadent
(4.1)
2
b
If there is such a thing as a do it all pressable,
Authentic would be that material. It can be a stained
veneer, layered veneer, inlay, onlay, full crown,
pressed over metal crown or bridge, the latter being
full coverage, winged, inlay-retained, or encapsulat-
ed/embedded. In other words, it can be used in almost
any situation except when veneers need to be very
thin. Because of the versatility, it would be a good
choice for combination cases. With a wide selection of
incisals and ingot opacities, its a well-designed esthet-
ic system. From a ceramists perspective, firing
temperatures need to be increased about 10C from
recommendations, but the material itself is very for-
giving.
REALITY
IPS d.Sign
IPS d.Sign to metal
Ceramics
Omega 900 is a good low fusing porcelain and one of
the first introduced after Duceram LFC. It has a homo-
geneous distribution of glass and crystal phase in the
structure, has good abrasion properties, causes low
wear of opposing dentition, and is easy to polish chair-
side after making adjustments. It has a good track
record, with no reported problems with fractures,
delaminations, or cracks. Also matches Vitas 3D shade
system, but it fluoresces at a much higher level than
tooth structure.
REALITY
Description
Low fusing feldspathic porcelain that is presumably compatible
with a wide variety of metals. Due to its smaller particle size (3
microns), it supposedly has a denser structure and lower wear on
the opposing dentition and is inherently stronger due to uniform
leucite distribution. At least one study has found it is kinder to
opposing enamel compared to Ceramco II, but exhibits behavior
in this regard similar to Finesse. Its yellow-orange glass is stated to
produce warm tones and high translucency.
It is packaged in standard sets with paste or powder opaque.
Also offered in a professional set which includes Translucents,
Opal Translucents, Cervicals, Luminaries, Gingival, and Nuance
powders.
Unsupported Veneers, inlays, onlays, and anterior
crowns.
Cement Options
necessary.
Fluorescence
Low wear on opposing teeth
Easily polished chairside
Not meant for veneering ceramic cores
Fluoresces at a higher level than teeth
(4.1)
Omega 900
Vita/Vident
2
c
IPS d.Sign is a versatile system that is capable of pro-
ducing very esthetic restorations. One evaluator
routinely uses it over Captek and describes the results
as incredible, although it also excels over most other
metals too. It offers great translucency, which makes
veneers very life-like. Ceramist can build in a lot of
color in thin layers and the fit is laudatorythis makes
it a good choice for very conservative veneers.
However, it tends to be technique sensitive and the col-
ors are unique to this system. In addition, one evaluator
has noticed a small number of fractured veneers. It also
fluoresces at a higher level than tooth structure, except
when it is applied over metal, its brightness is toned
down to a close match with tooth structure.
REALITY
Omega 900
Ceramics
Description
Specifically developed for veneering alumina substructures, espe-
cially Procera. It features a full shade selection including 18 base,
17 margin, 19 opacious body, 18 body, 4 cervical, and 3 enamel
shades.
Only indicated for veneering alumina frameworksnot designed
to be used as a stand-alone product.
Cement Options
With an alumina framework, virtually any cement can be used.
Fluorescence
Will please the most discriminating dentists
and patients
Can match even in-between shades
Only applicable for alumina and zirconia
frameworks
Cannot be used for combination cases
NEW
Cerabien
Noritake
(4.0)
3
a
Cerabien
Cerabien can produce very esthetic restora-
tions. There is even a version made for zirconia
copings that applied over Lava framework will
impress even the most discerning eyes.
However, it does require a ceramist who can
handle its intricacies. The internal and external
shading modifiers are excellent and the porce-
lains allow easy internal characterization. The
use of shades NP1.5 and NP2.5 to allow shades
between A1 and A2 and A2 and A3 respectively
are nice options for precise shade matching.
The disadvantage is that it is not formulated for
use on refractory material or platinum foil for
veneers. This means that it is not the material of
choice for combination cases. And its fluores-
cence is slightly brighter than tooth structure.
REALITY
Ceramics
Creation has long been considered the ultimate
esthetic porcelain, with the kit giving the ceramist all
the tools to create life-like restorations, especially
when it comes to veneers and single anterior crowns,
although it is not considered a production porcelain
it is more a boutique porcelain because of the complex
layering performed by some ceramists. However, its
strength has been questioned, bringing to the fore-
front that classic decision between appearance and
function. With its high hardness, it is also probably not
the material to use in patients who brux. One evalua-
tor only uses it for shoulders on PFM crowns due to its
high chroma. In addition, the dentin powders are
keyed only to the classic Vita Lumin shade guidecon-
version computations are required for matching
prescriptions written using Vita 3D. And, probably due
to its high hardness, it is not as highly polishable com-
pared to others in this category. On the other hand, it
fluoresces at a level very close to tooth structure.
REALITY
Description
Conventional feldspathic porcelain created by Willi Geller. A
recent study found it had the most resistance to wear and was the
hardest compared to eight other porcelains. Designed to be used
in a multi-layered buildup technique. Dentin shades tend to have
a higher chroma than some other brands of porcelain and are less
translucent than other systems in order to maintain the value. This
presumably gives the technician freedom to use more translucent
materials over the body, which provides vitality and depth.
Moreover, because of the higher chroma and greater opacity of
Dentin powders, thinner layers can be used. The kit comes with
four standard enamels: S-57, S-58, S-59, and S-60. Each has a dif-
ferent value ranging from white to gray. They can be used in
various concentrations to achieve different effects. For example,
S-57 (highest value) can be used on the ridges or cusp tips of a
restoration to brighten the area. Another would be to use S-60
(lowest value) on a light shade like A-2, which would create a gray
incisal effect. Powders are said to handle well, offer exact shade
matching, and simulate many of the same optical properties found
in teeth.
Unsupported Veneers, inlays, onlays, and anterior crowns.
Cement Options
necessary.
Fluorescence
The ultimate esthetic ceramic
High chroma allows thinner layers where
space is limited
Very hardnot indicated for bruxers
No shades matched to 3D shade guide
(4.0)
Creation
Jensen
3
b
Creation
Ceramics
Description
High-fusing, synthetic leucite-reinforced feldspathic porcelain
with a very fine particle size. Its coefficient of thermal expansion
presumably remains stable during repeated firings. It is supposed-
ly compatible with precious, semi-precious, non-precious and
silver-free alloys. It is also stated to produce less wear to opposing
teeth.
Among the different kits available, there are 16 body shades.
There is a NP shade kit which contains two Noritake original
shades (NP1.5 & NP2.5), with the 1.5 between A1 and A2, while
the 2.5 is between A2 and A3. Both have slightly reddish hues.
The system also comes in two bleach shades NW 0 and NW 0.5.
Note that the full kit does not contain Paste Opaque porcelain.
Cement Options
necessary.
Fluorescence
Can make ceramometal look like all-ceramic
Very smooth surface texture
Learning curve
Not for the novice
EX-3 appears to be a rising product that may be hard
to beat for veneers and PFM restorations. Has a very
smooth surface texture and matches Noritakes other
porcelains used for alumina and zirconia, which makes
combination cases easier. It also has a comprehensive
coloring system, including a nice intrinsic staining con-
cept. However, this material is not for the novice
ceramist, since there is a substantial learning curve to
understanding the shading system and capabilities,
especially to be able to create 3D effects as opposed to
stacking ceramic masses. Nevertheless, when this
obstacle is conquered, the ceramometal results can vir-
tually duplicate those of all-ceramic. On the other
hand, it fluoresces at a level much higher than tooth
structure.
REALITY
NEW
EX-3
Noritake
(4.0)
3
c
EX-3
Ceramics
Description
Veneering porcelains for alumina (VM7) and zirconia (VM9)
frameworks. Reported to be very kind to opposing teeth. The
basic layering technique consists of two porcelains Base Dentine
and Enamel. The Base Dentines presumably enhance the chroma
and opacity, so the material can be used in thinner areas where
chroma is needed, but where there is not enough room for the
dentin layer. There are several effects that can be achieved with the
use of Effect Liners, Effect Chromas, Effect Enamels, Mamelons,
Effect Pearl and Effect Opal porcelains.
Only indicated for veneering alumina or zirconia frameworks
not designed to be used as a stand-alone product.
Cement Options
With an alumina or zirconia framework, virtually any cement can
be used.
Fluorescence
Low wear on opposing teeth
Exceptional esthetics
Needs supporting substructure
Not for combination cases
VM7 and VM9 are basically the same products with a
slight tweaking for the two different types of copings.
It is capable of producing very esthetic restorations.
One evaluator, however, felt it could present some
technical challenges to the ceramist. And it fluoresces
at a level higher than tooth structure.
REALITY
(4.0)
Vita VM7/VM9
Vita/Vident
3
d
NEW
Vita VM9
Ceramics
Description
Third generation natural feldspathic porcelain system. It offers 24
esthetic shades, including eight Illumine bleach white shades.
Shade-coordinated with Finesse All-Ceramic so combined cases
(PFM & all-ceramic) will presumably be difficult to detect.
Ceramco 3 is more opacious than Ceramco II. It has better
infinite optical properties, which makes it more suitable for metal-
ceramic restorations at a minimal thickness. Being less translucent
than Ceramco II, it is less suitable for veneering non-discolored
teeth. However, it provides a polychromatic appearance for
veneering lightly discolored teeth. Ceramco 3 is more suitable for
masking dentin than Ceramco II.
It also has better handling, better polishing, and better firing
than Ceramco II. Ceramco 3 has more esthetic qualities built into
it. The lab tech can impart the requested shades more easily. The
improved strength is important, with no reported fractures or
other failures.
Cement Options
necessary.
Fluorescence
Predictable
Good bleach shades
Fluoresces darker and more yellow than tooth
structure
No dedicated veneer powders
Ceramco 3 carries on a legacy that is about as close to
a brand identification as it gets in this category. The
primary advantage of this version over its siblings
seems to be an extension of the shade range with
refined colors, which are quite accurate. Especially
appreciated are the white bleached shades. From the
ceramists view, the powders are colored, making it far
easier to see boundaries between different layers (e.g.
body, opacious dentin, incisal, mamelon characteriza-
tion, etc.) prior to firing. This could be a big advantage
for novices.
Its powders are also keyed to the Vita 3D Master
shade guide, an attractive feature for clinicians who
have adopted this shade matching system. And its very
fine grain size makes it highly polishable. This is a
good, reliable, predictable middle-of-the-road product
that wont disappoint you, but probably wont terribly
impress you either. On the other hand, it does not have
a set of powders specifically designed for porcelain
veneers, as does its immediate older sibling, which
would be a better choice in a case involving a combi-
nation of veneers and crowns. And it fluoresces darker
and with a yellowish cast compared to tooth structure.
REALITY
Ceramco 3
(3.9)
4
a
Ceramco 3
Ceramics
Description
Pressed ceramic with a reduced size of leucite crystals, which
improves the crystalline component, thereby increasing strength.
It addresses the esthetic considerations of all-ceramic restorations
with a shaded translucent pressed core and layering porcelains.
The core and powders are made from similar ceramic materials
and are color coordinated to compliment each other.
Anterior crowns, inlays, onlays, and veneers.
Cement Options
Resin cement is mandatory.
Fluorescence
Good track record
Labs like it
Hard to grow up in the shadow of Empress
No snob appeal
OPC (Optimal Pressable Ceramic) followed Empress
in the pressable arena and has always been trying
ever since to get some respect. And, by all accounts,
its a pretty good material, with esthetic results that
can be compared to Empress. Its track record as far
as strength is concerned is equal if not better than
that of Empress. Indeed, one study found OPC was
stronger than Empress. And the shaded translucent
cores fit as well if not better than those of Empress.
There is also a low wear veneering porcelain, which
presumably is kinder to the opposing dentition.
Since it can be used for a variety of restorations, its
a good choice for combination cases. From a lab
perspective, it seems to be an easy system to learn.
REALITY
Description
CAD/CAM all-ceramic coping system consisting of a pressed and
densely sintered, high purity (99.5%) aluminum oxide. It is then
veneered with various porcelains such as Cerabien, Creation AV,
or Vitadur Alpha, although NobelRondo has recently been intro-
duced to be the matched ceramic. Preparations should have
chamfer or rounded shoulder margins and be deep enough for the
coping, which can now be produced in 0.4mm and 0.6mm thick-
nesses plus the veneering porcelain (1.0mm). Recommended
posterior occlusal reduction is 2.0mm. Without adequate reduc-
tion, esthetics will suffer. Your impression is sent to a lab with a
special scanner, which then transmits the information to the pro-
duction lab via modem. It is there that the coping is milled. It is
then sent back to the original lab for conventional buildup of the
veneering porcelain. If your lab is not skilled in this area, esthetics
will be mediocre.
Crowns. While veneers and bridges (using the new zirconia mate-
rial) are now being recommended, it is not being promoted for
inlays and onlays.
The original CAD/CAM lab system
Can fit very well when scanned properly
Esthetics not as good as others
Accuracy of scanning is not automatic
(3.9)
OPC
Pentron
4
b
(3.9)
Procera
Nobel Biocare
4
c
Ceramics
Cement Options
Due to its high strength, you presumably can use any cement you
choose, although acceptable bond strength with Panavia 21 has
been reported.
Fluorescence
Procera is the original, lab-based, CAD/CAM system.
As such, there was plenty of enthusiasm for it when it
was introduced, but the buzz has largely shifted
over to Lava. Nevertheless, Procera has the track
record, which overall, has been good. Most studies
have given it high marks on strength, even on molars,
and shown that the marginal fit of the coping to be
clinically acceptable. The fit, however, is dependent on
the skill of the technician who scans the casethis is
not automatic and consistent result. Gap width has
been measured to be 60.
Our experience shows Procera can be reasonably
esthetic, with the core able to block out dark teeth and
metal implant abutments. The 0.4mm coping definite-
ly is better from an esthetic point of view, but the
0.6mm should still be used for molar crowns for the
added strength. Margins need to be slightly subgingi-
valthis is not a material that can readily adapt to the
supragingival contact lens effect. More translucent
crowns such as IPS Empress will probably be more
esthetic when the tooth substrate is not very dark. And
this system is not known for its bleach shades.
Despite its strength, however, at least three evalua-
tors have reported fractured crowns. One evaluator
reported that the crowns always seem to fit too loose.
Another evaluator finds it works well on implants.
Radiographically, the crowns can look odd due to the
differences in radiopacities between the coping and
veneering material.
REALITY
Description
Low fusing ceramic with a unique fluorine glass with an extreme-
ly low firing temperature (670C). It gets harder in the mouth
instead of weakening supposedly due to an ion exchange that
occurs between the porcelain and the oral fluids. And it is not
affected by multiple firings.
Final external layer of porcelain over any conventional ceramic.
Cement Options
Depends on the type of restoration on which it is being applied
since it is not designed to be used as a stand-alone product.
Fluorescence
The original low fusing porcelain
Very smooth surface
Can it really heal itself?
Not etchable
Duceram LFC
(3.8)
5
a
Ceramics
Duceram LFC is the original low fusing ceramic that is
not only supposed to be kinder to opposing teeth, but
with the added claim of being able to heal itself in the
mouth. However, at least one study has found the low
fusing does not automatically mean low wear, while
another study found LFC caused less wear on an oppos-
ing enamel specimen in a wear machine compared to
three other ceramics, but was still not as wear-friendly
as gold. One evaluator reported LFC itself had rather
high wear in the occlusal contact area.
Regardless of these studies, when a rotary instru-
ment is applied to LFC, it actually melts the surface and
then, in a way, it reglazes automatically. In addition, its
surface is very smooth due to its extremely small parti-
cle size, similar to a microfill composite. But whether it
really can heal flaws itself through ion exchange is still
debatable.
Unfortunately, not all is good with LFC. It presum-
ably does not etch well and, therefore, cannot be used
by itself for bonded restorations. For this application, a
thin coping of conventional porcelain must first be
fired, over which the LFC is applied. With ceramomet-
al, body porcelain still is baked over the metal coping,
while the LFC is again applied on the surface in a thin
layer.
From a clinical perspective, it can produce good
esthetics.
REALITY
Description
Conventional feldspathic porcelain with 10% aluminous oxide
content for extra strength. Matches the Vita Classic and 3D
shade guides. Includes Translucent, Intensive, Cervical, Dentine
Modifier, and window porcelains. It has a wide range of inten-
sive porcelains for color effects, particularly in the enamel and
incisal areas.
Veneer over alumina-based copings Crowns and bridges.
Unsupported Veneers, inlays, onlays,
and anterior crowns.
Cement Options
Any cement when used as a veneering porcelain over a high strength
coping. When used unsupported, resin cement is mandatory.
Fluorescence
Rates high in esthetics
Versatilecan be used in combination cases
Not kindest to opposing teeth
May not be best for refractory veneers
(3.8)
Vitadur Alpha
Vita/Vident
5
b
NEW
Ceramics
Vitadur Alpha is still one of the most esthetic porce-
lains, with a wide range of dentin colors, good
opacious dentins, and a natural high value incisal halo.
It has very nice optical properties, especially with
respect to incisal edge characterization, and is quite
polishable. Works particularly well when trying to cre-
ate or match teeth with pronounced opalescent
characteristics in the enamel. Because it can be used
over alumina or metal substructures or unsupported, it
would be a good choice for combination cases.
However, one evaluator was not enthusiastic about
using it for refractory-type veneers while another rou-
tinely used it in this application. In addition, its wear of
opposing teeth is higher than others in this category.
REALITY
Description
Low fusing porcelain containing 8%10% leucite. Designed with
less leucite and finer crystal structure compared to conventional
porcelain. Can be used on metal (including titanium) and on
Finesse All-Ceramic. The lower fusing temperature presumably
allows for increased opalescence in the enamel porcelains.
Opaquers, opaceous dentins, dentins and margins are available in
18 shades. There is a full range of 16 Vita shades plus the A0/i1
and B0/i2 shades, with the latter two mainly for bleached teeth.
Dentins and opaceous dentins are also available in the new whiter,
brighter shades A01/i3 and B01/i4. The opal enamels are also
available in four bleach shades.
Veneer over Finesse All-Ceramic Anterior crowns, veneers,
inlays, and onlays.
Cement Options
With a metal substructure, virtually any cement can be used. With
a Finesse All-Ceramic substructure, resin cement is mandatory.
Fluorescence
Kind to opposing teeth
Easy to use as an add-on material
Too translucent for some
Technically demanding for lab
Finesse
(3.7)
6
a
Finesse
Ceramics
Finesse followed Duceram LFC in the low fusing, kind-
to-opposing-teeth market. But unlike LFC, it is not just
designed as the final layer but as the total veneering
porcelain either over metal or Finesse All-Ceramic sub-
structure. While some of the evaluators have had
reasonably good success with it esthetically, others
have found it to be too translucent, which can make
restorations appear too grey, and the bleach shades
are also very white and stark. On the other hand, its
softer surface is definitely appealing and allows it to
be adjusted and polished with comparative ease, but
one evaluator now uses it exclusively as an add-on
material due to its low fusing temperature. In this
respect, it is easy to use. However, for full-blown
restorations, it is a technique sensitive material from
the laboratory standpoint, requiring meticulous atten-
tion to mixing, oven temperature calibration and
maintenance, etc. And it fluoresces with a bright yel-
low cast.
REALITY
Description
Lithium disilicate substructure, which is veneered with a fluorap-
atite glass-ceramic. Characteristics of the low-fusing, highly stable
material include reduced firing temperatures as well as homoge-
nous composition for easy polishing and finishing. Available in a
full range of Chromascop and Vita 3-D shades. It offers a full
range of occlusal dentin, mamelon and opal effect materials for
more individualized characterizations and four ultra-light bleach
shades. In addition, Dentin, Incisal, Impulse, and Transparent
materials enable fabrication of restorations that reportedly blend
well with surrounding dentin.
Anterior and posterior crowns and three-unit bridges that have
one pontic and do not extend beyond the second premolar.
Cement Options
Although it can be conventionally cemented, bonding with a resin
cement is preferred.
Fluorescence
Strength appears to be good
Wide variety of shades
Not as strong as zirconia-based materials
Greek goddess of strife and discord?
(3.7)
IPS Eris
Ivoclar Vivadent
6
b
IPS Eris
Ceramics
Description
Conventional feldspathic porcelain system that is compatible with
a wide range of metals. The Ultra-Pake pre-mixed opaque system
presumably gives complete, uniform coverage of the metal in a
very thin layer. The effects of the opaque modifiers can be seen as
they are brushed on wet so there are no unexpected surprises after
the opaque is baked. Ultra-Escent crystals sprinkled over thin lay-
ers of opaque create a light refractive opaque surface to mimic
natural teeth.
Body and opal incisals supposedly give accurate shades and
look very natural when used over properly modified opaque.
Opaceous dentin and color modifiers are incorporated to control
color in thin areas and provide special effects. The transparent
porcelain is very clear and provides a nice, natural look. The Edge
shoulder porcelain combines the convenience of pre-mixed pastes
in syringes with a quick-drying, quick-hardening carrier to deliv-
er clean lift-off with sharp, accurate margins. For labs using high
silver alloys, Ceramco II silver porcelain is recommended to avoid
discoloration.
Cement Options
necessary.
Fluorescence
The standard for PFMs over the years
Forgiving for both dentist and ceramist
Not the tops in esthetics anymore
More abrasive to enamel
As the replacement for the ill-fated IPS Empress2, IPS
Eris (which is the name for the Greek goddess of dis-
cord and strifecould they not have found a more
positive name?) has tried to make us forget its prede-
cessor. In this regard, its done a pretty good job, since
Eris has performed well clinically and at least one study
confirms its clinical success with very few reported fail-
ures. However, the same study found that it lost its
gloss within two years. When it comes to bridges, one
evaluator reports four failures out of 30 over five
years.
While one evaluator considers that it could be one
of esthetic dentistrys best kept secrets, one evaluator
does not believe it matches up well against Lava or
even Cercon (which did not make our list). In other
words, with alumina, zirconia, and pressed to metal
technique, where does lithium disilicate fit?
It is especially good with combination veneer,
crown, and bridge cases, although when it comes to
veneers, you would just use the veneering porcelain. It
does, however, require a full shoulder preparation,
which may be too aggressive in some situations. One
evaluator also thought Eris was somewhat too opaque.
The majority opinion is that esthetics is acceptable,
especially if a patient wanted a posterior crown with-
out metal and the tooth already has a pre-existing
crown with an aggressive preparation. For anterior
use, the patient would have to compromise on esthet-
ics in favor of strength. And it fluoresces at a level
slighter higher than tooth structure.
REALITY
Ceramco II
(3.6)
7
a
Ceramics
Ceramco II has performed admirably for many years
as the standard ceramic for routine PFMs. It is consid-
ered a production-type porcelain due to its forgiving
nature, it does not require exception shade matching,
and it is less expensive than most others in this catego-
ry. Although more opaque than other ceramics, it has
still been a successful and durable veneer material,
although if the veneer is thin, you have to be very care-
ful when seating or it has a tendency to fracture. In
addition, it is very forgiving in terms of its compatibili-
ty with a wide variety of alloys for substructures. The
main disadvantage is that it does not seem to allow the
finest of detail in internal shading and fabrication of
the ultimate porcelain restoration. It also has been
shown to be more abrasive against enamel compared
to a low fusing porcelain such as Finesse.
REALITY
Description
Leucite-reinforced, pressed ceramic core material engineered with
a coefficient of thermal expansion matched to Finesse low-fusing
porcelain using a layering technique. This should create an ideal
bond between the porcelain and core without the need to create a
wash layer, saving time and enhancing the integrity of the restora-
tion. It is available in 18 Vita shades (including A0 and B0). For
bleached teeth, there are new shades in porcelain and ingots:
A0/i1, B0/i2, A01/i3 and B01/i4 shades.
Veneers, inlays, onlays, and anterior crowns.
Cement Options
Resin cement mandatory.
Fluorescence
Finesse All-Ceramic is an Empress wannabe, with
probably the only advantage being the presumption
that the Finesse low-fusing porcelain that is applied on
the pressed copings is softer and kinder to the oppos-
ing dentition. Esthetics has the potential to be very
good, but two evaluators reported a fairly high inci-
dence of fractures. There is also a recent 3-year study
that found a fracture rate of 7%, although the same
study reported 98% of the restorations had an excel-
lent esthetic result.
REALITY
(3.6)
Finesse All Ceramic
7
b
Less abrasive when veneered with Finesse
Matched system with Finesse low-fusing
Empress wannabe
High fracture rate
Description
Second generation, conventional feldspathic porcelain. It has a
low glass point, which makes it compatible with most refractory
die materials for the production of crowns, inlays, and veneers.
The relatively lower firing temperature presumably creates a more
favorable surface texture. The assortment of porcelains comes in a
modular arrangement, which includes fluorescing powder and
paste opaquers, standard as well as opal enamels, standard as well
as fluorescing dentins, and a full array of color modifiers. Each set
of porcelains can be purchased separately or as a whole system.
Ceramics
Description
Low-fusing hydrothermal ceramic with a relatively high firing
temperature (800
o
C). Presumably reacts with saliva to form a sili-
ca-hydroxyl layer on the ceramic that is softer, less abrasive, and
gentler to the opposing dentition. It also supposedly continuous-
ly heals surface flaws, thereby strengthening the restoration.
Compatible with Type IV gold alloys plus Cergo pressable ceram-
ic. Shades are keyed to the Vita.
Veneer over Cergo Veneers, inlays, onlays, and anterior crowns.
Cement Options
cement will suffice. When used with Cergo, a resin cement is nec-
essary.
Fluorescence
Duceragold is the porcelain developed and designed
to be coupled with Degunorm alloy to form the
Golden Gate system of combining gold with porce-
lain. As such, it does have attributes such as having a
smooth surface texture, adequate esthetics, and a rela-
tively low firing temperature. Now, there are more
alloys that match this porcelain, along with Cergo
pressable ceramic. While using a hydrothermal ceramic
seems to make sense, clinical evidence of superiority
over other low-wear porcelains still needs to be shown.
REALITY
Duceram Plus
(3.5)
8
b
NEW
Duceragold
(3.5)
8
a
Track record
Translucency makes it a good choice for
veneers
Surface texture not as good as newer generation
Fluoresces much higher than tooth structure
Can be used with metal or ceramic cores
Makes you feel better using it
Hydrothermal superiority unproven clinically
Uniqueness of Golden Gate has passed
Ceramics
Cement Options
necessary.
Fluorescence
Duceram Plus has been an extremely lifelike and nat-
ural-appearing porcelain, especially when used for
veneers, where its translucency really shines. It has
stood the test of time and is still performing well. It
will not disappoint even clinicians who are more dis-
cerning. For the ceramist, it is very production friendly
yet esthetic. Matches same family of porcelains for alu-
mina and zirconia, which makes combination cases
easier. Has a comprehensive coloring system. However,
surface texture isnt as a good as the newer generation
of finer grain porcelains. And it fluoresces at a level
much higher than tooth structure.
REALITY
Description
A sibling of the original In-Ceram Alumina, it utilizes a translu-
cent magnesium oxide and alumina core. It is still reportedly
stronger than other, translucent-core all-ceramic materials.
Anterior crowns and veneers when more aggressive tooth reduc-
tion is necessary, although anterior 3-unit bridges may also be
possible. However, it also cannot be reliably etched, leaving its
bond strength dependent on aggressive sandblasting. Rocatec can
also be used to enhance bondability.
Cement Options
Resin cement is mandatory.
Fluorescence
Translucent = esthetic
Good track records
Only moderately stronger than pressables
Not etchable
(3.5)
In-Ceram Spinell
Vita/Vident
8
c
Duceram Plus
In-Ceram Spinell
Ceramics
In-Ceram Spinell gives the option of using a reason-
ably high strength substructure (stronger than most if
not all pressables) that it is nicely translucent. It is cer-
tainly not as strong as alumina or zirconia-based
copings, but you would use it when esthetic demands
take precedence over ultimate strength. This includes
anterior 3-unit bridges. It also fits quite well. It would
typically be veneered with Vitadur Alpha. While it may
remind you of the Dicor debacle, our clinical results
have failed to show a high fracture rate. As a matter of
fact, its track record has been quite exemplary.
However, it does require adequate reduction, which
restricts its use for veneers. Nevertheless, one evaluator
reported good success with veneers bonded using
Panavia F (do not use silane). It fluoresces at a level
higher than tooth structure.
REALITY
Cercon
Cerinate
Den-Mat
Cergogold
Colorlogic
Fortress
Mirage
In-Ceram Alumina
Vita/Vident
In-Ceram Zirconia
Vita/Vident
Mirage
Mirage
Mirage II
Mirage
StylePress
Metalor
OTHER PRODUCTS IN THIS CATEGORY
WE GREATLY APPRECIATE THE FOLLOWING LABS FOR PROVIDING SOME OF THE
VENEERS FOR FLUORESCENCE TESTING:
ProWest Dental Laboratory
Dale Mercer, General Manager
#500, 816 7th Ave S.W.
Calgary, Alberta T2P 1A1
Canada
1-866-466-5277
www.prowestdentallab.com
Rego Dental Laboratory
Nelson Rego
8233 Firestone Blvd
Downey, CA 90241
562-861-0846
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