RECENT

ADVANCES IN
DENTAL
CERAMICS

DR. KIRAN AKSHAYAA. V,

1ST YEAR M.D.S,
DEPT. OF PROSTHODONTICS.
1
 Contents:
 Introduction
 Classification
 Metal – Ceramics
 Re-inforced Ceramic Core Systems
 Resin Bonded Ceramics
 Glass Ceramics
 Processing Methods
 Miscellaneous
 Conclusion
2

 References
Introduction

3
 Most bio compatible material
 Widely used for their appearance
 Limitations in strength of older ceramics
 Newer methods of processing and materials- over
the past decade.
 Over come the limitations

4
 Ideal Characteristics:

 Excellent mechanical and physical properties.

 Biocompatibility.
 Adequate marginal fit.
 Optimum esthetics.
 Both anterior and posterior features.

5
 Ceramics ?

 Keramos!
 Ceramics ≠≠ Porcelain
 Used
1. In dentistry
2. Beyond Dentistry

6
Basic Constituents:

7
 Consist mainly of
Glasses/Porcelains/Glass-ceramics/Highly crystalline
structures.
 Porcelains- primarily glass
 Controlled CTE Porcelains- Glasses + Crystalline
component
 Other ceramics- Entirely crystalline oxides.
 Network structure of Glass – ZACHARIASEN 1932
 Oxides – Network Modifiers
Reduce viscosity and increase CTE.

8
History:

9
10
 Classification:

Indications:

Anterior Posterior Crowns Veneers

Post and Stain and

Bridges
Cores Glaze

11
Composition

Pure Alumina Pure Zirconia Silica Glass

Leucite-Based Lithia-Based
Glass-Ceramic Glass-Ceramic

12
Processing Methods:

Partial
sintering
Sintering
and CAD/
glass CAM
infiltrati
on

Copy
Pressing
Milling

13
 Low-
Fusing

Firing
temperature

Medium- High-
Fusing Fusing
14
 Micro-Structure

Glass Crystalline Crystal-

Containing
Glass

15
 Translucency

Opaque Translucent Transparent

Fracture resistance

Abrasiveness
16
 Types Of Restoration:

Metal- Reinforce Resin-

Ceramic d ceramic Bonded
core Ceramics
systems
17
18
General Properties:

19
 Applications of Ceramics In Dentistry:

 Indirect Intracoronal
 Indirect Extracoronal
 Biomaterial- Implants
 Intraradicular post
 Denture Teeth

20
Metal-
Ceramics

21
 Metal-Ceramics
• Metal
Substructure
• Layers of ceramic
veneered
• Types of Bonding
Mechanisms
1. Mechanical
interlocking
2. Compressive forces
3. Van der Waals
forces
22
4. Chemical bonding.
Bond Failure and related advances:

Bond failure Types Leucite reinforcing

23
 New Gen Metal Ceramic Restorations:

 Optimised Leucite Crystalline Phase

 Larger multi-sized irregular leucite crystals --- smaller
regularly dispersed crystals(1-2µm)
 Prevents crack propagation
 Better CTE to match the alloy
 Reduced abrasion to the opposing teeth
 Other methods:
1. Glazing
24

2. Thermal Tempering
Reinforced
Ceramic
Core
Systems

25
 Alumina Reinforced Feldspathic Cores

 McLean and Hughes 1965

 40-50% of Alumina
 Crack Stoppers
 Flexural strength: 120-150 Mpa
 Better aesthetics
 Insufficient strength

26
 Glass-Infiltrated High strength Ceramic
Cores
 In-Ceram Alumina System (Vita Zahnfabrik, Bad
Sackingen, Germany) – Sadoun 1984
 Alumina+Feldspathic Glass = Alumina Glass-Infiltrated
Copings
 Flexural Strength – 600MPa
 Fracture Toughness 2.7 – 4.61 Mpa m1/2.

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 In-Ceram Spinell
 Magnesium Aluminate MgAl2O4.
 Translucent
 Flexural Strength – 377MPa
 Onlay Inlays

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 In-Ceram Zirconia
 Glass infiltrated Alumina + 35% partialy stabilised
tetragonal Zirconia
 Flexural Strength – 421 – 800 Mpa
 Fracture toughness 6-8 Mpa m1/2
 Opaque

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 Pure Alumina Core

 Procera AllCeram (Nobel Biocare, Stockholm, Sweden)

 Anderson & Ogen 1993
 Densely sintered 99.5 % pure alumina
 15- 20% Shrinkage – Compensated
 Flexural Strength – 487 – 699 Mpa
 Fracture Toughness – 4,48 – 6 Mpa m1/2

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 Digitised
Impression & Coping
Software

Coping ceramic
Dry pressed
Coping returned
Sintered 1600-
1700°C

Negligible Glassy
Phase

Veneered with
feldspathic porcelains 31
 TechCeram
 Special Die
 Fine Particle Pure Alumina – Sprayed – Oxygen/Acetylene
Flame
 Splat Form – 0.3 – 0.4 mm
 Reduced Shrinkage
 80 – 90 % density
 Sintering - 1170°C
 Flexural Strength – 300 Mpa

32
 High Density Zirconia Cores

 Yttrium Tetragonal Zirconia Poly Crystals

 Orthopaedics, Endo posts, Implant Abutments

• 2680°C -
Cubic 2370°C

• 2370°C -
Tetragonal 1170°C

• 1170°C
Monoclinic – Room 33

temp
 Crack Shielding
 Flexural Strength – 900 – 1200 Mpa
 Fracture Toughness – 9 – 10 Mpa m1/2

3-5%
Volume
Increase
Tetragonal Monoclinic

Grinding
Cooling 34

Impact
 Stabilising Oxides:
1. MgO
2. Cao
3. CeO2
4. Al 2O 3
5. Y2O3
 Low Temperature Degradation
Best Resistance: 1450°C + 1 hr Dwell time

35
 Monolithic Zirconia

 Most posterior regions

 Good toughness; poor aesthetics
 Aesthetics: Overcome by birefringence phenomenon
 TZ Incoris ( Dentsply – Sirona)
 Ceramill Zolid White (Amann Girrbach)
 Zenostar Zirconia (Wieland)

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 Nanostructured Zirconia

• 3 mol % Y2O3 Stabilised

ZrHP – TZP
nano • Avg. Grain Size: 150nm

• 10 mol % CeO2
NANOZR Stabilised TZP + 30vol%
Al 2O 3
• Avg. Grain Size: 0.49 µm
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 Han et al: NANOZR implants – Close bone – implant
contact
 Komasa et al: NANOZR implant + Alkali treatment =
Improved Hard tissue formation
 Tanaka et al: Veneered Ce – TZP/A nanocomposite
framework for 3 unit FDP; 15 pts.; Pre-treatment and Post-
treatment BOP & Pocket Depth = at 36 months 95.5%
survival rate

38
 Novel fabrication method for zirconia restorations:
Bonding strength of machinable ceramic to zirconia
with resin cements
 Novel Method

CAD/CAM CAD/CAM Better results

Zirconia Core Ceramic Veneer than PFM

ResiCem (RE),
Panavia (PA),
and Multilink
(ML)
Kuriyama S, Terui Y, Higuchi D, Goto D, Hotta Y, Manabe A, Miyazaki T. Novel fabrication method for zirconia restorations: Bonding strength 39
of machinable ceramic to zirconia with resin cements. Dental materials journal. 2011:1105140147-.
 A systematic review of the survival and
complication rates of zirconia‐ceramic and metal‐
ceramic single crowns
 Zirconia‐ceramic implant‐supported SCs are a valid
treatment alternative to metal‐ceramic SCs, with similar
incidence of biological complications and less aesthetic
problems. The amount of ceramic chipping was similar
between the material groups; yet, significantly more
zirconia crowns failed due to material fractures.

Pjetursson BE, Valente NA, Strasding M, Zwahlen M, Liu S, Sailer I. A systematic review of the survival and complication rates of 40
zirconia‐ceramic and metal‐ceramic single crowns. Clinical oral implants research. 2018 Oct;29:199-214.
Resin
Bonded
Ceramics

41
 All Ceramic Crown – Dentin Bonding – Resin Bonded
Luting Material
 Tooth preparation Minimal
 Resin – Ceramic Bonding
Hydrofluoric Acid etching
Gritblasting Aluminium Oxide
 Chemical Bond – Silane Coatings
 Superior Fracture resistance
 Marquis – Crack Healing
 Nathanson – Stressed molecules together

42
Glass
Ceramics

43
 Poly crystalline solids
 Crystallisation process:
1. Nucleation
2. Crystallisation
 Internal nucleation- nucleating agents
 Strength, machinability, Transparency, Thermal shock
resistance.

44
 Mica-Based Dental Glass-Ceramics

 MacCulloch – 1968 – porcelain denture teeth

 Dicor – 1984 Corning Glass Works and Dentsply
International.
 45% glass + 55% crystalline tetrasilicic fluormica.
 Lost wax technique + glass castings.
 Dicor Machinable Glass – Ceramics:
70% tetrasilicic fluormica – CAD/CAM blanks or ingots
Discontinued – Low tensile strength
45
 Vitablock Mark II

 Vita Zahnfabrik - 1991

 Second gen.
 Sanidine – Crystalline phase
 Fine grained powders.
 Nearly pore free ceramic
 Flexural strength – 130 Mpa to 160 Mpa
 CEREC 3 & InLab
 Monochromatic 46
 Vitabloc Esthetic Line

 Translucent Version
 Increased Glass content

47
 Vita bloc TriLuxe

 Graded Variation in color saturation

48
 Leucite-Based Dental Glass-Ceramics
ProCAD
 CAD/CAM leucite reinforced glass-ceramics
 Flexural Strength – 135- 160 MPA
 Fracture toughness – 1.3 Mpa m1/2
 ProCAD Glaze

49
 IPS Empress

 Ivoclar Vivadent – 1990

 Custom – made leucite containing ceramic ingots
 Hot pressing technique
 40% vol 1-5 µm tetragonal leucite in a glassy matrix
 Prone for fracture

50
 Empress Esthetic/ Empress CAD

 Hot pressing & CAD/CAM

 Leucite reinforced glass-ceramics
 Flexural strength – 160MPA
 Fracture toughness – 1.6 – 1.8 Mpa m1/2

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 Lithium Disilicate Ceramics

 Currently Strongest and toughest.

 IPS Empress II (1998, Ivoclar Vivadent)
 Lost wax + Hot pressing
 60% Lithium Disilicate
 Veneered with apatite-containing glass-ceramics
 Failure rates 9-50%: 24 -60 months

52
 IPS E.Max Press

 Higher Flexural strength: 400 MPA

 Fracture Toughness: upto 3 Mpa m1/2
 LD ingot – Hot-pressing technique
 High Accuracy fit

53
 IPS E. Max CAD

 CAD/CAM soft milling (2006)

 Adjustable shade and translucency
 A-D shades
 Colorant ions: Vanadium – Blue/Yellow
Cerium – Yellow
Manganese – Brown
 Medium Opacity/High Translucency/Low Translucency

54
 Blue State Completed
Milling
(Li Met-Sil) Restoration

Heat
Lithium Glass Lithium
Phase Meta-Sil
Disilicate
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 Color match of machinable lithium disilicate
ceramics: Effects of cement color and thickness

 15 1.5 mm thick A1 LT LDS Blocks

 Multilink Automix white opaque, Multilink Automix yellow,
Nexus3 white opaque, Nexus3 white, Nexus3 yellow
 300 mm, 100 mm, 50 mm Thickness
 Luted to a roughened Ag-Pd alloy foundation restoration block
 Nexus3 white opaque cement of 100 mm or 300 mm yielded
shade matches below the clinical perceptible threshold
(DE<2.6)

56

Niu E, Agustin M, Douglas RD. Color match of machinable lithium disilicate ceramics: Effects of cement color and thickness. The
Journal of prosthetic dentistry. 2014 Jan 1;111(1):42-50.
 IPS E.Max

 IPS E.Max ZirPress

 IPS E.Max ZirCAD
 IPS E.Max Ceram

57
Zirconia Reinforced Nanocrystalline Glass
Ceramics
 Zirconia nanoparticles + Amorphous silicate matrix

58
59
Processing
Methods:

60
Sintering

61
 Heat + pressure = Compaction of powders without melting
 Solid or porous mass
 Volume Shrinkage: 30 -40%
 Vacuum Firing: 5.6 – 0.56%
 Microporostities, Inhomogenesities
 Fan et al:
ZTA : Increased temperature – Better mechanical
properties; tetragonal to monoclinic

62
63
Partial
Sintering

64
 Hierarchial Porous network
 Three levels of pores
 Chen et al YB2C2 by partial sintering:
High porosity 57.17% - 75.26%
High compressive strength 9.32 – 34.78 MPa

65
Glass
Infiltration

66
 Alumina – titania substrates + lanthania – rich glass
 Fracture toughness – 2.6 Mpa m1/2
 Fracture strength – 218 – 254 MPA
 High Density 94 – 99%

67
Slip
Casting
And
Sintering

68
 Aqueous porcelain slip + refractory die
 Reduced porosity, defects
 Increased fracture toughness
 In-Ceram Zirconia bulk composites
 Kim et al dental zirconia implants: surface cracks
 Kim et al dense zirconia compacts: cold isostatic pressed +
sintered at 1450°C 2 hrs = highly dense zirconia compacts.

69
Hot
Isostatic
Pressing

70
 Wohlwens & Scharer (1990)
 Lost wax technique + Alumina plugger
(1150°C) (0.3 – 0.4 Mpa)
 Eliminates pores + casting defects
 Gionea et al: Zirconia powders at 500°C 2 hrs – pure cubic
phase & good optical and mechanical properties

71
CAD/
CAM
Milling

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73
Development of silicon nitride ceramic for
CAD/CAM restoration
 Partially sintered Si3N4 ceramic blocks were prepared by
heating at 1,400°C for 2 h under N2 gas. After full sintering at
1,650o C for 2 h, the linear shrinkage value was recorded at
19.88±0.56%. The flexural strength and fracture toughness were
measured, the results were 891.21±37.25 MPa and 6.33±0.30
MPa•m1/2, respectively. These results showed that flexural
strength and fracture toughness of Si3N4 were more than 800
MPa and 5 MPa•m1/2, the white Si3N4 developed in this study
can be used to fabricate multi-unit dental restorations According
to ISO 6872.
Krajangta N, Sarinnaphakorn L, Didron PP, Wasanapiarnpong T. Development of silicon nitride ceramic for 74
CAD/CAM restoration. Dental Materials Journal. 2020 Jul 30;39(4):633-8.
CEREC
SYSTEM

75
 Siemens (now Sirona) – 1985: CEREC
 Ceramic Reconstruction
 CEREC 3: 2000
 3D Software Prepare, Design &
 Only chairside Fabricate
No Imp., Temporaries,
Lab Support

High Cost
Technique Sensitive

76
• CEREC InLab (2002)
• Multi – Unit Restoration

Stone Model
Laser Scanner
3D Image
Rest. Designed

Milled 77
LAVA
SYSTEM

78
79
CELAY
SYSTEM

80
 Copy milling
 Resin Analogues
 Inlay/Onlay
 Higher Flexural Strength after Glass Infiltration

81
ADDITIVE
MANUFA
CTURING

82
 Selective Laser Direct 3D Stereolithiograph
Sintering/Melting Printing y
• BEGO • Inkjet Printer • Ceramic
Medifacturing • Direct printing – Particles +
• Laser beam Ceramic Resin
sinters thin Suspension Components
layers from a • Green bodies • Resin = Shape
container filled with high • Removed during
with powder resolution sintering
• Each layer =
Cross section of
CAD

83
84
SELECTI
ON
CRITERI
A

85
 Parafunctional habits
 Skill of preparation
 Aesthetics
 Region of restoration

86
INDICATI
ONS

87
88
Tooth
Preparatio
n
Guidlines

89
 TYPE OF AXIAL INCISAL MARGINS
/
MATERIAL OCCLUS
AL
Glass-Infiltrated High 1.5 mm Std rounded
strength Ceramic shoulder margin
Cores
Pure Alumina Cores 1.5 – 2 1–2 Rounded
mm mm Shoulder

High – Density 1–2 1.5 – 2 Chamfer Margin

Zirconia Cores mm mm

Glass - Ceramics 1 mm 1.5 – 2

mm
90
Survival
Rate All-
Ceramic
Restoratio
n

91
92
FIELDS
FOR
ADVANC
EMENT

93
Future Trends in
Ceramics
94
CONCLU
SION

95
 The future of all-ceramic materials is bright. Further
improvements in chemical composition, internal structure,
grain-size decreasing to nano dimensions and improved
protocols for industrial production and laboratory
processing, all of them will for sure lead to a material with
extraordinary features fulfilling the esthetic, mechanical
and biocompatible demands.

96
 REFERENCES:

 Anusavice, Shen, & Rawls. (2014). Philip's Science of Dental Materials.

New Delhi: Reed Elsevier India Private Limited.
 McCabe J F, W. A. (2009). Applied Dental Materials. Wiley.
 O'Brien, W. (2008). Dental Materials and their Selection.
Quintessence.
 Sakaguchi R L, P. J. (2014). Craig's Restorative Dental Materials 13th
Ed. Reed Elsevier India.
 Pollington S, van Noort R. An update of ceramics in dentistry. Int J Clin
Dent. 2009 Nov 1;2(4):283-307.
 Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials
97
for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
 Fu L, Engqvist H, Xia W. Glass–ceramics in dentistry: A review.
Materials. 2020 Jan;13(5):1049.
 Bajraktarova-Valjakova E, Korunoska-Stevkovska V, Kapusevska
B, Gigovski N, Bajraktarova-Misevska C, Grozdanov A.
Contemporary dental ceramic materials, a review: chemical
composition, physical and mechanical properties, indications for
use. Open access Macedonian journal of medical sciences. 2018
Sep 25;6(9):1742.
 Denry I, Kelly JR. Emerging ceramic-based materials for dentistry.
Journal of dental research. 2014 Dec;93(12):1235-42.
 Arena A, Prete F, Rambaldi E, Bignozzi MC, Monaco C, Di Fiore A,
Chevalier J. Nanostructured zirconia-based ceramics and
composites in dentistry: a state-of-the-art review. Nanomaterials.
2019 Oct;9(10):1393.
 SILVA LH, LIMA ED, MIRANDA RB, Favero SS, Lohbauer U, Cesar
PF. Dental ceramics: a review of new materials and processing 98

methods. Brazilian oral research. 2017 Aug 28;31.

 Pjetursson BE, Valente NA, Strasding M, Zwahlen M, Liu S,
Sailer I. A systematic review of the survival and complication
rates of zirconia‐ceramic and metal‐ceramic single crowns.
Clinical oral implants research. 2018 Oct;29:199-214.
 Krajangta N, Sarinnaphakorn L, Didron PP, Wasanapiarnpong
T. Development of silicon nitride ceramic for CAD/CAM
restoration. Dental Materials Journal. 2020 Jul 30;39(4):633-8.
 Kuriyama S, Terui Y, Higuchi D, Goto D, Hotta Y, Manabe A,
Miyazaki T. Novel fabrication method for zirconia restorations:
Bonding strength of machinable ceramic to zirconia with resin
cements. Dental materials journal. 2011:1105140147-.
 Niu E, Agustin M, Douglas RD. Color match of machinable
lithium disilicate ceramics: Effects of cement color and
thickness. The Journal of prosthetic dentistry. 2014 Jan
1;111(1):42-50. 99
 Niu E, Agustin M, Douglas RD. Color match of
machinable lithium disilicate ceramics: Effects of
cement color and thickness. The Journal of prosthetic
dentistry. 2014 Jan 1;111(1):42-50.

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