CERAMICS

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CONTENTS

1.What are ceramics? 2.Evolution & history 3.Classification of dental ceramics 4. methods of strengthening ceramics 5. PFM 6. All- Ceramic Coventional slurry Castable ceramics Pressable ceramics Infiltrated ceramics Machinalble ceramics 7.Clinical significanc and selection criteria 8.Conclusion 9.References

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What are ceramics?

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DEFINITIONS
Ceramic is derived from Ceramics is taken from the Greek word keramos meaning burnt clay

ceramics: It is defined as any product made essentially from metal oxides and non-metallic material by firing at high temperature to achieve desirable properties

Porcelain : a ceramic material formed of infusible elements joined by lower fusing materials. Most dental porcelains are glasses and are used in fabrication of teeth for dentures, pontics & facings, crowns, inlays, onlays and other restorations. (G.P.T 7)
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HISTORY OF CERAMICS

Ceramic paintings and Vases

Denture teeth & Dentures -Duchateau 1774

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1728 Pierre Fauchard, a French dentist first proposed the use of porcelain in dentistry. He suggested the use of jewelers enamel to fabricate artificial teeth
1887 1903 -PJC by CH. Land (platinum foil technique)

1957 Vines and Sommelman Vaccum firing

1962 PFM Weinstein and Weinstein patented formulation of feldspathic porcelain

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1965 McLean and Hughes aluminium core porcelain

Evolution of all ceramic restorations :

1963- Vita Zahnfabrik gave the first commercial porcelain

1980 - In ceram-slip casting, castable ceramics Latest 1990s machinable ceramics(CAD\CAM)

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COMPOSITION

Feldspar - 75-85 %
Basic glass former Makes particles to coalesce together. This is called sintering.

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Kaolin / clay : 4-5 %

Binder Forms a sticky mass which allows unfired porcelain to be easily worked and molded. Its white in color and reduces translucency

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Quartz :13-14%
Basic filler It imparts more strength, firmness and translucency. It gives stability of mass during heating

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OTHER MINOR COMPONENTS

Fluxes- oxide Metallic pigments- colour matching
Brown- iron oxide Green-copper oxide Yellow brown- titanium oxide Blue cobalt oxide Pink chromium, tin oxide

stains and colour modifiers

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CLASSIFICATION

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Classification of ceramics :
1. By content :
- Regular feldspathic porcelain - Aluminous porcelain - Leucite reinforced porcelain - Glass infiltrated alumina - Glass infiltrated spinel

2. By their area of application :

-core porcelain -body dentin porcelain - gingival dentin porcelain -incisal enamel -Cervical porcelain

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3.By use : -core ceramic -veneer ceramic -margin ceramic -opaque ceramic -dentin ceramic -enamel ceramic -stain ceramic

4. By processing method : -sintering -casting - machining

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5. By their firing temperature :

-high fusing : 1300 c - medium fusing : 1100-13000 c -low fusing : 850 1100 c -ultra low fusing : less than 850C

6. By method of firing ;
- Air fired -vaccum fired - diffusable gas
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ADVANTAGES OF CERAMICS:
High abrasion resistance Excellent thermal and electrical insulators Excellent esthetic qualities Translucency Color stability Capacity of pigmentation Stain resistance Enhanced polishability High durable
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DISADVANTAGES:
Highly brittle Excessive wear of opposing teeth High firing shrinkage

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Why are Ceramics weak ?

1. Brittle Covalent bonds 2. Inherent flaws- eg. Sharp notches, surface scratches and defects

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Covalent bonds

Crack Growth

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Methods of strengthening brittle materials

1. Development of residual comressive stresses:
Ion exchange Thermal tempering Thermal compatibility

2. Interruption of crack propagation:

Addition of tougher material e.g. DICOR Change in crystalline structure e.g. particle stabilized zirconia
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Development of Residual Compressive Stresses

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Ion Exchange (Sometimes called Chemical tempering) In this process the potassium ions are exchanged for the sodium ions. By placing sodium containing glass in in a bath of molten potassium nitrate Larger

K+ ions (about 35%)

Smaller Na+ ions

Creating large compressive stresses 700Mpa/1,00,000psi

29-Apr-13 et al,1994 Anusavice

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Thermal tempering
1st stage
surface of the object while it is still hot, and in the softened (molten) state

2nd stage

by rapidly cooling (quenching) produces a skin of rigid glass surrounding a soft molten core.

molten core solidifies and , as it shrinks, creates residual tensile stresses in the core and residual compressive stresses within the 3rd stage outer surface

DeHoff and Anusavice ,1992

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Thermal compatibility (Thermal expansion coefficient mismatch) The metal and porcelain selected should have a slight mismatch in their thermal contraction coefficients.

This mismatch leaves the porcelain in residual compression and provides additional strength for the restoration.

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Interruption of Crack Propagation

Methods q q

Dispersion Strengthening Transformation toughening

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Dispersion strengthening :
Ceramics in its glass phase can be strengthened by increasing a crystal content by adding material like:Leucite Lithia disilicate Alumina Magnesia alumina spinel The glass is toughened and strengthened, because the crack cannot penetrate these particles as easily as it can the glass. E.g. IPS Empress, InCeram Alumina

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Transformation toughening
crack cannot penetrate easily through stabilized particles. E.g. ZIRCONIA (ZRO2) is added with YTTRIA (Y2O3) to stabilize The zirconia tranforms :> 3 vol%

Unstable tetrahedral lattice

at 1150C

Stable monoclinic lattice

This increased volume places the crack under a state of compressive stress and crack propagation is arrested.

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In a study by Preis V et al they checked the wear performance of monolithic dental ceramics by ANNOVA method and found that the monolithic ceramic like zirconia had increase strength and, the zirconia showed no wear.

Quintessence Int. 2013 Feb 14. doi: 10.3290/j.qi.a29151. [Epub ahead of print] Wear performance of monolithic dental ceramics with different surface treatments. 29-Apr-13 29 Preis V, Weiser F, Handel G, Rosentritt M.

METAL CERAMIC RESTORATIONS

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METAL CERAMIC RESTORATIONS

Def: refers to partial or full crown made with a metal substructure, to which porcelain is bonded for aesthetic enhancement, via an intermediate metal oxide layer.
Porcelain fused to metal PFM Ceramo metal restoration Porcelain to metal PTM

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Need for fusing ceramic to metal

Main drawback of dental porcelain
Low tensile and shear strength. Brittle material very low elastic deformation - Brittle fracture.

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METAL CERAMIC RESTORATION

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ALLOYS USED IN METAL-CERAMIC RESTORATION

Noble metal alloy Low gold alloy Silver palladium alloy Base metal alloy (eg. Ni, Cr, Co)

According to noble metal content ,metal ceramics are broadly classified by the ADA (1984) 29-Apr-13

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BONDING MECHANISMS BETWEEN CERAMIC AND METAL

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Methods of attaching porcelain to metal The ceramo metallic bond is probably derived from three main components : Chemical bonding Molecular bonding Mechanical bonding Compression bonding
(Vickery & Badinelli 1968; McLean 1979, Cascone 1977).

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CHEMICAL BONDING
The potential of alloys to bond to porcelain is largely determined by the formation of adherent oxides during the degassing cycle.

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Casting

Heat degassing treatment

Finishing

Sandblasting Condesation of procelain

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Molecular bonding
The metal surface oxide acts as a permanent component of the bond like a sandwiched structure, where it is separately bonded to the metal substrate and to the porcelain

Wetting of the metallic substrate by the glassy porcelain by interatomic forces is facilitated. (McLean and Sced, 1976).

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Mechanical Bonding : Micro-abrasion or surface roughness produced by sandblasting can provide mechanical 'keying' and increase the surface area of porcelain attachment (mcLean and Sced 1976 ,Lugassy 1977 ).

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Compression Bonding : By the process of thermal contraction when an alloy with a slightly higher coefficient of thermal expansion than poreclain is used ,it causes the porcelain to contract (shrink or draw ) towards the coping when the restoration cools after firing

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Vander Waals Force : It is based on mutual attraction of charged molecules. Although their role is not significant in the actual bonding, they help in initiation of molecular/ chemical bond.

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Bonding of Porcelain to Metal by Atypical methods : Electro deposition . Other Methods : The Foil Crown Systems E.g.; Captek system, The Renaissance system, Ceplatec system, Sunrise Crown, Flex Bond , Platideck .

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Where do these bonds fail?

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Types of interfacial bond failure occurs at primarily three sites Along the interfacial region between opaque porcelain (P) and the interaction zone(I) the between porcelain and the metal substrate. Within the interaction zone. Between the metal and the interaction zone

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DRAWBACK

Unsatisfactory esthetic result due to metal exposure!!

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ALL CERAMICS metal free ceramics

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CLASSIFICATION
1. CONVENTIONAL POWDER & SLURRY CERAMICS
HI-CERAM ( ALUMINA REINFORCED) OPTEC HSP(LEUCITE REINFORCED) DUCERAM LFC

2. CASTABLE ALL CERAMIC RESTORATIONS

Di-Cor Cerestore

3. PRESSABLE ALL CERAMIC RESTORATIONS

IPS EMPRESS IPS EMPRESS 2

4. INFILTRATED CERAMICS

In ceram Alumina In ceram spinel In ceram zirconia

CAD/CAM Technology
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5. MACHINABLE ALL CERAMIC RESTORATIONS

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CONVENTIONAL POWDER & SLURRY CERAMICS

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ALUMINOUS PORCELAIN JACKET CROWN ( HI CERAM )

-McLean and Hughes in 1965, introduced porcelain jacket crown with aluminous core to improve the strength of traditional PJC. -Increased content of alumina Al203 ( 40-50%)

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PROCESSING- Platinum foil technique

Master model with dies

Platinum foil adapted to die

Finished Cores

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 PROPERTIES : Compressive strength: 3,16000 psi Transverse strength : 20000 psi Shear strength : 21 000 psi Modulus of rupture : 15000 psi

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OTHER TYPES: OPTEC HSP(LEUCITE REINFORCED) DUCERAM LFC

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 ADVANTAGES : -Lack of metal or opaque substructure -Good translucency -Moderate flexural strength DISADVANTAGES: -Potential fracture of posterior teeth -Increased leucite content leads to high invitro wear of teeth

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STUDIES
1. Mc lean 1979 Five year failure rate 2% for anteriors 15% for posteriors
2. Seiber et al 1981 :light reflection better than porcelain fused to metal

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CASTABLE CERAMIC RESTORATIONS

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DI-COR
Composition : TETRA SILICIC FLUOROMICA GLASS CERAMIC.

Mica crystals

Feldspathic porcelain

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Wax pattern

Spruing

Investing

Burnout 450 0Cfor 1\2 hr 17500C for 1\2hr

Centrifugal casting 26000 f

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Divesting

Cast glass coping

Ceramming
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Ceramming

Ceramming oven

Crystallised glass coping

Cerramming done from room temparature- 19000 f for 1 hrs and sustained for 6hrs in order to form tetra silicic flouro mica crystals

Conventional porcelain application & Firing

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Finished crown
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PROPERTIES : CHAMELEON LAYER Flexural strength 81 6.8 Mpa Strength-440-505 Khn Marginal adaptation :

Weaver et al 1988 conducted a study on 10 dicor crowns

Marginal opening 57 9 m . Biocompatibility : Less bacterial counts Reason : smooth surface, low surface tension, fluoride content.

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Esthetics :

Gross man and Adiar : Hue and chroma of metal ceramics and Castable ceramics matched natural teeth. Value of only Castable ceramics matched natural teeth.

Presence of mica crystals scatter light similar to enamel rods.

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Survival rate : Kenneth et al 1999 - 14yr study Crowns 82%

Cores

100%

Inlay and onlay 90% Partial coverage 92%

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A FEM Study was done to check the stress distribution in a 0.5 mm thick molar DICOR crown loaded on the occlusal surface. The maximum principal tensile stress is located directly below the point of occlusal loading within the internal surface of the crown

Esiquivel JF, ceramic design concept based on stress distribution: compend contin educ dent,21: 649-653
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PRESSABLE CERAMICS

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Also called injection molded glass ceramic, leucite reinforced hot pressed glass ceramic

TYPES:1.IPS EMPRESS Leucite reinforced 2.IPS EMPRESS 2 Lithium disilicate reinforced

Leucite content Conventio nal Porcelain Dicor Glassceramic IPS Empress Pressable ceramic

30-35%
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50-60%

80-85%
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Supplied in pre-cerammed and pre-coloured ingots

Processing

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Wax pattern

Investing

Burn out 8500 C

Ceramic ingot & Al plunger

Pressing under vaccum 11500C 26 min hold

Sprue removal

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IPS Empress Flexural strength Upto 150 MPa

IPS Empress 2 (frame work) > 400 Mpa

Clinical survival :
Deniz G in 2002 : 95% survival 2-4 years Marginal adaptation : Shearer et al in 1996 : better marginal adaptation with hot pressed ceramics than aluminous core material.
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INFILTERED CERAMICS

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INFILTERED CERAMICS

In-ceram Alumina

In-ceram Spinell

In-ceram Zirconia

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PROCESSING: by SLIP CAST TECHNIQUE

painted on refractory die

Ultra sonic device for slip making Additional layer

Al2O3 slip 10 hrs 1120 0C- 2hrs

Finished crowns
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Glass infiltration 4hrs 11000C

Shrinkage of dies
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Four year clinical study of glass-infiltrated, sintered alumina crowns

Probster et al found after a four year clinical study that the Strength of In-Ceram > IPS Empress < PFM

Journal of Oral Rehabilitation Volume 23, Issue 3, pages 147151, March 1996 29-Apr-13

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MACHINABLE CERAMICS

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Application of CAD/ CAM techniques was actively pursued by three groups of researches :-

France- by Henson International

Switzerland- University of Zurich and Brains, Brandestini Instruments United states of America- University of Minnesota
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From 1988, machined ceramics came into being. there are 2 major systems for the fabrication of this technique 1. Analogous systems: -Copy milling / grinding technique 2.digital systems: -cad-cam technology

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Copy milling / grinding technique

Fabrication of proto type Replica of inlay/crown is made. Its fixed on copying device Transferred on to chosen material

Materials used: Composite ---sono erosion--sonotrodes ceramic----- sono erosionsonotrodes metal-------spark erosion---dielectric fluid

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CELAY SYSTEM
Switzerland-------1992 High precision manually operated Key duplication Blue light cured resin

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Advantage : recreation of all surfaces.

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DIGITAL SYSTEMS: CAD-CAM(10-15mins)

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Mormann and Brandestini was the first ones to use cad- cam device in 1988.the first model which came was called : CEREC 1 CEREC 2 CEREC 3 CEREC 3D
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Cerec 1

West germany-----siemens group. Ceramic reconstruction system.

Consists of:
video camera(scan head). Electronic image processor with memory Digital processor. Miniature Milling machine.

Short comings:
Occlusal anatomy to be developed Inaccuracies in fit Poor esthetics
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-CEREC

2 : ( 1994) -They had better image processing systems . -it also has a cylindrical diamond stone which is able to finish off undercuts at buccal extensions -occlusal anatomy could be produced here

Disadvanatages- has many parts ,so the operator had to move around -impression not good -marginal fit not good
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CEREC 3 :
Different parts could be magnified in detail More finer details noted Operator can record multiple images in seconds. Creates a virtual cast for entire quadrant. Additional step bur----enhances precision. Disadvantage: not capable of producing margins of restoration

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CEREC 3-D marginal fit good contacts can be chosen 3 dimensionally movable camera

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3D cerec

Scanning and designing

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3 dimensional viewing

Milling

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PROCERA SYSTEM
ANDERSON. M. & ODEN. A Nobel Biocare + sandvik hard materials Powder technology + cad/cam technology

Contact scanner

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Ceramic Dental Implants

Ceramic implants are white it has an obvious aesthetic advantage over titanium as it is indistinguishable from natural teeth. The high corrosion resistance of the material means that there is virtually no danger of corrosion with ceramic implants. Ceramic implants offer patients another more comfortable option.
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Are ceramic implants a viable alternative to titanium implants?

1. No difference was found in the rate of osseointegration between the different implant materials in animal experiments. 2. Alumina implants did not perform satisfactorily and therefore, based on this review, are not a viable alternative to titanium implants. 3. Zirconia, however, has the potential to be a successful implant material

Clin Oral Implants Res. 2009 Sep;20 Suppl 4:32-47. Are ceramic implants a viable alternative to titanium implants? A systematic literature review. Andreiotelli M, Wenz HJ, Kohal RJ. 29-Apr-13 91

CLINICAL APPLICATION
CORRECT DIAGNOSIS

JUDGEMENT OF DENTIST

SKILLED LAB TECHNICIAN

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TWO DIRECTIONS TO GO IN.

Use of In ceram alumina and In ceram Zirconia when strength is required along with opacity

Use of IPS Empress, All ceram when higher translucency is required asstrength is lower

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CONCLUSION
There are ample of ceramic materials available. Successful application of these materials will depend upon clinicians ability to select appropriate material, manufacturing technique, and cementation or bonding procedures to match intraoral conditions and esthetic requirments.

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REFERENCES

1.CONTEMPORARY FIXED PROSTHODONTICS -ROSENSTIEL 2.PHILLIPS SCIENCE OF DENTAL MATERIALS -ANUSAVICE 3.FUNDAMENTALS OF FIXED PROSTHODONTICS -SCHILLINGBURG 4.CONTEMPORARY ESTHETIC DENTISTRY: -BRUCE J.CRISPIN 5.ESTHETIC DENTISTRY: AN ARTISTS SCIENCE -RATNADEEP PATIL
6.JPD 1996;75:18-32 7.JPD 2004;91:136-43

8.OPERATIVE DENTISTRY 1990;15:61-70

9.QUINT INT 1991;22:257-262 10.QUINT INT 2005;36:141-147
29-Apr-13 11.INT J PERIODONT REST DENT 1998;18:587-593 95

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