Advanced Ceramics

Materials & Techniques

 Dental Ceramics

The terms ceramic and porcelain are often used interchangeably, but incorrectly.
Ceramic refers to any material composed of the arrays of metallic-oxygen bonds. These strong ionic
bonds result from the transfer of electrons from the metal to oxygen, and they are highly directional
(i.e., the bonds do not tolerate distortion). The metals and oxygen form vast arrays in a three-
dimensional crystalline lattice that makes up the ceramic particle. Because of the directionality of the
ionic bonds, ceramics are brittle and will fracture if distorted even slightly.
Porcelain, on the other hand, is a type of ceramic that results when feldspar (K2O-Al2O3-SiO2), silica
(SiO2), and alumina (Al2O3) are fired together with fluxes such as sodium carbonate (Na2CO3) or
potassium carbonate (K2CO3). During the firing, large areas of amorphous ceramic are formed, with
small islands of a crystalline phase called leucite (K[AlSi2O6]). Porcelains are often referred to as
feldspathic ceramics in dentistry, and they are the most esthetic but weakest of the ceramics.

All- Ceramic restorations have the following main advantages:

1. Superior esthetics: They can be made to match natural tooth structure accurately in terms of color,
surface texture, and translucency (similar to that of natural tooth structure).

2. High biocompatibility: good tissue response.

3. Chemically stable

Classifications of Dental Ceramics

A- According to Microstructure
B- According to Processing Technique

2
A- Microstructure:

Gracis et al. A new classification system for all-ceramic and ceramic-like restorative materials. Int J Prosthodont. 2015 May-
Jun;28(3):227-35.
3
 I- Glass- Matrix ceramics
A- Feldspathic porcelain
Traditional group of ceramics composed of clay (hydrated aluminosilicates), quartz and feldspar (K 2O or
Na2O)

Feldspar → firing → crystalline phase

flextural strength 60-70 Mpa

Fabrication Method

 Free hand layering :

Used as veneering material for metal or ceramic substructure (platinum foil or refractory die
technique)

Ex. IPS classic, ivoclar vivadent ; vitadur, vita VMK68

 Machiened:

- VITABLOCS, Vident - Monochromatic for inlays, onlays, veneers and full crowns

- VITABLOCS® TriLuxe- 3 different degrees of chroma & translucency. Suitable for partial crowns,
anterior and posterior crowns as well as veneers.

VITABLOCS® TriLuxe forte- 4 layers of different shade intensity.

VITABLOCS® Real Life- 3D block of dentine core and enamel jacket imitates the arched colour gradient
between dentine and incisal according to the natural tooth structure.

B- Synthetic ceramics
1- Leucite reinforced ceramic

↑ leucite volume → ↑ strength & hardness

50% glass by volume

Flexural strength is about 120 - 160 MPa.

Methods of fabrication:

 Free Hand layering:

4
Ex. IPS d.Sign, Ivoclar Vivadent;

Vita VM7, VM9, VM13, Vident; Noritake EX-3, Cerabien, Cerabien ZR, Noritake

 Pressing:

Eg. IPS empress, Ivoclar Vivadent

IPS Empress Esthetic ingots are available in 12 shades and 7 levels of translucency.

Indications:

- Inlays,Onlays , Veneers, anterior & posterior crowns, Implant superstructures for single-tooth
restorations

Contraindications

Bridges, Parafunctions , Conventional cementation, Very deep, sub-gingival preparations, Patients with
severely reduced residual dentition & Veneering of posterior crowns

5
  Machined:

Eg. IPS Empress CAD, Ivoclar Vivadent.

IPS Empress CAD Multi, Ivoclar Vivadent. Combination of shade transition, translucency, and
fluorescence allows for creation of highly esthetic restorations very easily

2- Lithium disilicate based

The crystalline phase, lithium disilicate (Li2Si2O5) makes up about 70% of the volume of the glass
ceramic.

flexural strength ranges from 360-400 MPa

Methods of fabrication:

 Pressable forms:

Eg. IPS e.max Press, Ivoclar Vivadent

Multi & impulse ingots:

Multi impulse

Description Bleach BL and A–D shades. 3 values, 2 opal

& uses lifelike shade progression from the dentin thin veneers, veneers, partial
to the incisal areas and single crowns

monolithic restorations (veneers, anterior,

posterior and hybrid abutment crowns)

Character- Glazing Staining, cut-back or layering

ization
Staining or cut-back

6
 E-max press ingots

HT LT MT MO HO

Description minimally invasive A1, A2, A3, Crowns (full & substructures Severly
full-contour B1, BL2, BL3 partial contour) for vital or discolored or
& uses
restorations,inlays, and BL4 slightly titanium
Anterior region
onlays veneers. Crowns (full discolored abutments
& partial) teeth

characterization staining staining or staining or cut- layering layering

cut-back back

 Machined:

Eg. IPS e.max CAD, Ivoclar Vivadent.

Indications: Veneers – Inlays – Onlays – Partial crowns – Crowns in the anterior and posterior region –
Implant superstructures for single-tooth restorations (anterior and posterior region) – Primary
telescopic crowns

Contraindications: Full veneers on molar crowns – Very deep sub gingival preparations – Patients with
substantially reduced residual dentition – Bruxism – Any other use not listed in the indications.

IPS e.max CAD is processed in a "soft" intermediate state in which the material demonstrates its
characteristic bluish color.

In this way, manual adjustments or cut back can be quickly and efficiently carried out and the accuracy
of fit can be checked.

This is followed by a crystallization process (approx. 20 min), in which the material obtains its final
strength of 360 MPa and the desired esthetic properties

IPS e.max CAD Abutment Solutions are designed for the fabrication of implant-supported hybrid
structures for single teeth using CAD/CAM technology. The hybrid components are individually milled
from lithium disilicate meso-blocks (LS2) and bonded to a titanium base.

• MO for hybrid abutments and LT for hybrid abutment crowns.

7
• Types of IPS e-max CAD blocks & Processing techniques

3- Zirconia Lithium Silicate (ZLS)

ZLS ceramics consist of a dual microstructure:

- Very fine lithium metasilicate(average size: 0.5–0.7 μm) and lithium disilicate crystals (4-8 times
smaller

- Glassy matrix containing zirconium oxide in solution.

 Suprinity - VITA

Zirconia reinforced lithium silicates (approx. 10 % by wt)

- 3-point flexural strength of over 494MPa.

8
- Optimized edge stability compared to lithium disilicate

- Simple processing, good polishing characteristics and high firing stability

- Brilliant esthetics based on integrated translucency, opalescence and fluorescence

- 2 translucencies: Translucent (T): for crowns & implant abutment crowns (staining or cut-back)

High translucency (HT): inlays, onlays, partial crowns & veneers (staining)

VITA VM 11: a low fusing fine-structure feldspathic ceramic for individualizing ZLS crown substructures
with perfectly matched CTE values to minimize stress & ensure good bonding and veneering reliability
that is free of warping

 Celtra Duo, Dentsply

- Choice of flexural strength:

370 MPa (Greater than Lithium disilicate in less time)

210 MPa (75% higher strength than leucite glass ceramics achieved in the same time)

- Correctly shaded restoration post-milling.

- No crystallization step required (Saves time and reduces remakes)

Indications: Anterior & posterior single crowns, single-tooth implant superstructures, inlays, onlays and
veneers

 Obsidian, Glidewell Laboratories

Lithium silicate ceramic

- Pressed-to-metal, chair-side milled and all-ceramic versions available.

- indicated for the fabrication of full-contour crowns, inlays and onlays.

- Flexural strength of 385 MPa.

- Available in the 14 most popular VITA® shade

9
C- Glass infiltrated:
Methods of fabrication

- Slip casting - Machining

1- Alumina (eg, In-Ceram Alumina, Vita):

- The composition, according to the manufacturer, is Al2O3 (82%), La2O3 (12%), SiO2 (4.5%), CaO
(0.8%), and other oxides (0.7%).

- Flexural strengths range is 450 MPa

- Indications: crown copings in the anterior and posterior region, three-unit FPD frameworks in the
anterior region

2- Alumina and magnesium (eg, In-Ceram Spinell, Vita):

- Spinell (MgAl2O4) is a natural mineral

- Flexural strengths range from 350 MPa

- The highest translucency of all oxide ceramics and is thus recommended for highly aesthetic anterior
crown copings

3- Alumina and zirconia (eg, In-Ceram Zirconia, Vita)

- The composition is Al2O3 (62%), ZnO (20%), La2O3 (12%), SiO2 (4.5%), CaO (0.8%), and other oxides
(0.7%).

- Flexural strengths up to 650 Mpa

- Indications: crown copings and three-unit FPD frameworks in the anterior and posterior region. Due to
superior masking ability it is suitable for discoloured abutment teeth

II- Polycrystalline Ceramics

Nonmetallic inorganic ceramic materials that do not contain any glass phase

• Alumina

• Stabilized zirconia

• Zirconia toughened Alumina

• Alumina toughened zirconia

10
1- Stabilized zirconia:
Strength of 1120 MPa

Pure zirconia is found in three allotropic forms (cubic, tetragonal & monoclinic)

Transformation toughening: The tetragonal to monoclinic transformation is accompanied by a shear

strain and large (4%) volume increase. Volume increase can close cracks, leading to large increases in
fracture toughness of the material.

Monoclinic and tetragonal states represent partially stabilized zirconia while cubic state represents fully
stabilized zirconia.

Tetragonal zirconia has the highest strength & fracture toughness

11
Fabrication of Zirconia

Cold Non-sintered (Green

Sintering e’o t Hot iso-static
Zir. powder compression Pre-sintered Zir comp. Fully sintered Zir
iso-static stage)

- Green Stage & pre-sintered stage: Frameworks are milled in enlarged form to compensate for
sintering shrinkage

Easier, less time consuming than fully sintered

Less expensive

- fully sintered stage:

↑ fracture resistance

↑ heat generation → structural change

Time consuming

Zirconia Is hard to mill (wear of diamond burs)

More expensive

fabrication of Zirconia

Multi-layer Monolithic

free-hand
full anatomical
Zirconia (translucent
press-over zirconia).
Charecterization by
internal & external
CAD-On staining

12
Monolithic: Full Anatomical Zirconia (Translucent Zirconia)
Prettau ® Zirconia - Zirconzhan

Partially stabilized with yttrium and enriched with aluminium.

Flexural strength: 1000-1200 MPa.

Indications:

- Partial and single crowns

- Inlays, onlays and veneers

- Bridges with up to 14 elements (occlusally screwed or cemented)

All indications can be manufactured fully anatomically or reduced for veneering with ceramics

PRETTAU® ANTERIOR® - Zirkonzahn

Indications:

- Partial and single crowns

- Inlays, onlays and veneers

- Bridges with max. 3 elements

Flexural strength of 670 MPa.

Higher translucency through optimized microstructure of zirconia.

BruxZir® Solid Zirconia - Glidewell

- flexural strength of 900 MPa

Monolithic zirconia crown, bridge, screw-retained implant crown, full-arch fixed implant solution, inlay
or onlay with no porcelain overlay.

BruxZir® Anterior Solid Zirconia - Glidewell

- flexural strength of 650 MPa with translucency and color similar to natural dentition.

- Indications: single-unit crowns and 3-unit bridges with one pontic.

- Preparation requirements are more conservative than competitors in its class with only 0.8 mm of
reduction required though 1.25 mm is ideal.

13
InCoris TZI full-contour, translucent zirconia blocks - Sirona

- indicated for full-contour crowns, bridges, and screw-retained implant crowns.

- Made of solid zirconia with no porcelain overlay, they are virtually chip-proof.

- flexural strength of 950 Mpa.

Incoris TZI C
- inCoris TZI C blocks consist of translucent, dyed zirconia in classical colors (A-D).
- can be polished or veneered after milling and sintering
- Classic sintering and speed sintering

- Indicated for Full anatomical crowns and bridges in the anterior and posterior tooth region (up to 9
units and no more than 2 pontics).

Ceramill Zolid FX Multilayer

Polychromatic, HT zirconia with interfering shade break lines, translucency gradients & nesting concept
to ensure matching of VITA shades
Indications:
- Fully anatomical crowns and bridges;anterior or posterior(max. 3 units)
- Telescope and conical crowns
- Veneers, Inlays, Onlays

Can be characterized by:

- Staining of full anatomical restoration
- Immersion + staining of full anatomical restoration
- layering

Dental Direkt Cube X

- 5% yttria oxide → stabilization of 53% cubic and 47 % tetragonal crystals.
- Highly biocompatible cubic zirconia combines the strength of zirconia (720 MPa’s) and the
translucency of lithium disilicate.
- Indicated for single tooth and 3-unit bridgework for any position in the arch.

14
 III- Resin-Matrix Ceramics
The rationale to develop resin-matrix ceramic materials was to:
1- Obtain a material that more closely simulates the modulus of elasticity of dentin when compared to
traditional ceramics.
2- Develop a material easier to mill and adjust than glass-matrix ceramics (eg, synthetic ceramics of the
lithium disilicate family) or polycrystalline ceramics.
3- Facilitate repair or modification with composite resin.

Resin-matrix
ceramic

Glass ceramic in a Zirconia-silica

resin ceramic in a resin
Resin nano-ceramic
interpenetrating interpenetrating
matrix matrix

A- Resin nano-ceramic
1- Lava Ultimate, 3M ESPE

It consists of a highly cured resin matrix reinforced with approximately 80% by weight nanoceramic
(silica, zirconia) particles and zirconia-silica nano-clusters

Flexural strength of 200 MPa.

Indications:

Inlays, onlays, and veneers.

Not indicated for any type of crowns (de-bonding risk)

2- CERASMART Flexible nano-ceramic- GC

Flexural strength: 238 MPa.

Superior gloss value, opalescence and florescence

15
Intraoral repair

Unsurpassed marginal integrity

- Indications: Inlays/ Onlays/ Veneers/ Crowns/ Implant supported crowns

3- Crystal Ultra hybrid nano-ceramic

Flexural Strength of 175 Mpa

Compressive strength of 500 Mpa

- indicated for use as a dental restoration including inlays, onlays, veneers, crowns and bridges.

B- Glass ceramic in a resin interpenetrating matrix

Enamic- Vita

- Dual network: (86% feldspathic wt & 14% polymer wt ).

- Flexural strength: 150-160 MPa

- Indications: Crowns on implants/ Crowns on prepared teeth / Onlays/Inlays/ Veneers/ hybrid

abutment (titanium base + mesostructure)/ hybrid abutment crown.

- Contraindications: Bridges/ Parafunctions (e.g. bruxism)

C- Zirconia-silica ceramic in a resin interpenetrating matrix

1- Shofu Block HC, Shofu

Its inorganic content comprises more than 60% by weight.

Indications: Inlays / onlays/ laminate veneers/ full crowns for anterior and posterior teeth/ implant
supported restorations.

2- Paradigm MZ-100 Blocks, 3M ESP

- 85% ultrafine zirconia-silica ceramic particles in a polymer matrix (bisGMA), TEGDMA

- Flexural strength: 150 MPa

- Indicated for: Inlays, Onlays, Veneers & Full Crowns

- Can be characterized with light cured composite & resin stain

16
Selection of a suitable ceramic material for each individual restoration design

17
Restoration Preparation design Ceramic material Bonding
Inlay Lithium disilicate Self-etch or
- Zirconia reinforced self
lithium silicate adhesive
- Resin matrix ceramic dual cured
- Leucite- reinforced resin
cement
Onlay - Lithium disilicate Self-etch or
- Zirconia reinforced self
lithium silicate adhesive
- Resin matrix ceramic dual cured
- Leucite- reinforced resin
cement
Endocrown Axial walls less than 2 mm thick should be removed. - Lithium disilicate Self-etch or
The depth of the cavity should be at least 3 mm - Zirconia reinforced self
Occlusal reduction of 2 mm in axial direction lithium silicates adhesive
- Butt-joint design: A circular butt-margin 1mm - Resin matrix ceramic dual cured
resin
cement

- Ferrule design: Circumferential shoulder finish line 1mm width

Ferrule of 1.5-2mm
Supra gingival finish line or DME

Partial - Lithium disilicate Self-etch or

coverage - Zirconia reinforced self
crown lithium silicates adhesive
- Resin matrix ceramic dual cured
resin
cement

18
Laminate - Feldspathic porcelain Total etch
veneers & - Leucite- reinforced light cured
thin - Lithium disilicate resin
veneers - zirconia reinforced cement
lithium silicate
- Resin matrix ceramic

Occlusal - Lithium disilicate Selective

veneers - zirconia reinforced etching,
(table tops) lithium silicate dual cured
- Resin matrix resin
ceramic cement
- layered zirconia
- translucent
zirconia

Resin Anterior teeth preparation: - Lithium disilicate Total

bonded Lingual reduction 0.5mm - zirconia reinforced ,Selective
bridges Supragingival Chamfer finish line 0.5 mm lithium silicate etching,
Cingulum rest (Counter sink) 1 mm diameter, 0.5 mm depth - Resin matrix dual cured
Proximal reduction 2 mm height, 2 mm width, 0.5 mm depth. ceramic resin
Posterior teeth Preparation - layered zirconia cement
180° wraparound retainers for ideal design, Retainers may be extended to include - translucent
coverage of the palatal and lingual cusps and a proportion of the occlusal surface to zirconia
increase the surface area and improve retention
Inlay- - Lithium disilicate Selective
retained - zirconia reinforced etching,
bridges lithium silicate dual cured
- Resin matrix resin
ceramic cement
- layered zirconia
- translucent

19
 zirconia
Full  Single crowns, up self
coverage to 3 unit bridge: adhesive,
crowns & Lithium disilicate dual cured
bridges Zirconia reinforced resin
lithium silicates cement
Resin infiltrated ceramics
(enamic)
 More than 3 unit
bridge
Layered zirconia
Translucent zirconia

Finish-line design:
Deep chamfer
Rounded shoulder
Recently: knife-edge is suggested by some manufacturer

20
Implant- • Lithium disilicate - Temporary
supported • Zirconia resin
prosthesis reinforced lithium cement
silicate
• Resin infiltrated
ceramics (enamic,
celtra duo)
• Layered &
translucent
zirconia

In case of • Translucent Self etch,

Para- zirconia (Bruxier ) dual cured
functional • Layered zirconia resin
habits (IPS e-max zir- cement
press over e-max
CAD)

21
 Surface treatment of different ceramic materials:

Ferencz et al 2014.High-strength ceramics: interdisciplinary perspective.

Quintessence PublishingMehta / Shetty – 2010. Bonding to Zirconia: elucidating

the confusion

Feldspathi Leucite reinforced Lithium disilicate & alumina zirconia Resin infilterated
cporcelain ZLS ceramics

Sandblasting - - 50μm Al- 1bar 50μm Al- 50μm Al- 1.5 bar -
3bar
Or 30μm silica-coated

alumina particles

(Rocatec Soft or
CoJet)

Acid 5% HF- 120 s 5% HF- 60 s 5% HF- 20 s - - 5%HF-60s

etching

Silanization Apply 60 s Apply 60 s Apply 60 s Apply 60 s Zir- primer Resin primer

Special - Selective Infiltration

surface ttt Etching (SIE)

- hot etching