Anlise de falha e previso de tempo de vida de

prteses totalmente cermicas

Prof. Paulo Francisco Cesar
Universidade de So Paulo
Faculdade de Odontologia
Departmento de Biomateriais e Biologia Oral

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paulofc@usp.br

Outline:
1. What are the options?

2. Material of choice

3. Clinical failures

4. The future

1. What are the options?

1. What are the options?

Brands

Porcelains

VM7, VM9, VM13 (Vita), d.Sign (Ivoclar), Super-Porcelain

EX-3/Cerabien (Noritake), Duceram Kiss (Degudent).

Glass-ceramics

E.Max Sistem: leucite or lithium disilicate (Ivoclar).

Glass-infiltrated composites

In-Ceram Sistem from Vita (Al, Zr, Spinell).

Polycrystalline ceramics

In-Ceram2000 (Vita), Lava (3M), Cercon (DeguDent),

Everest (Kavo), Zeno (Wiedland).

1. What are the options?

Porcelains
Glass-ceramics
Glass-infiltrated composites
Polycrystalline ceramics

 Porcelains

Borba, 2010

 Porcelains
1

Alberto Calazans

 Glass-ceramics (leucite or lithium disilicate)

Gonzaga, 2007

 Glass-infiltrated composite

 Polycrystalline

Alumina

Y-TZP

Borba, 2010

a) Leque
de
2. Material
of choice

opes

b) O material de escolha

c) Novas perspectivas

2. Material of choice
Veneers

Inlays /Onlays
Crowns

Fixed partial dentures

Abutments
Large infra-structures for implants

 Veneers

Porcelains or Glass-ceramics

Dr. Alexandre Cesar

Porcelains

Inlay/Onlay
1

Porcelains or Glass-ceramics
2

Glass-ceramics
1

2
3

 Crowns
High translucency:

coping+veneering ceramic

Glass-ceramics (coping+veneering ceramic or monolithic)

Dr. Walter Miranda

Glass-ceramics (monolithic)

Dr. Jamil Shibli

Glass-ceramic (monolithic)

Dr. Jamil Shibli

Glass-ceramic (monolithic)

Dr. Jamil Shibli

 Crowns

Low translucency
1

Dr. Alexandre Cesar

Y-TZP

 Fixed partial dentures

Y-TZP

Cercon/Dentstply

 Abutments

Y-TZP

Dr. Susanne Scherrer (Univ of Geneva)

Dr. Jamil Shibli

 Large infra-structures over implants

Lohbauer et al., 2010

Lohbauer et al., 2010

 Failed from a stress concentrating zone at the

tip of the zirconia framework (origin);

Crack moved in a downward direction;

A secondary edge chip on the palatal exposed

zirconia framework was incidental and not
related to the final failure.

Lohbauer et al., 2010

 Large infra-structures over implants

Dr. Susanne Scherrer (Univ. of Geneva)

 Large infra-structures over implants

1

Metal

Dr. Alexandre Cesar

3. Clinical Failures

Dr. Susanne Scherrer

3. Clinical failures
Secondary caries/marginal discoloration/
wear of cement line/ minor edge chippings
Dr. Susanne Scherrer

Debonding

Fractures
Veneers/Inlay/Onlay/Crowns

Fixed partial dentures (FPDs)

 Secondary caries/marginal discoloration/wear of cement line/minor edge chippings

 Secondary caries/marginal discoloration/wear of cement line/ minor edge chippings

Due to the posterior location of the restorations, these timedependent degradation processes were not of concern clinically
and were only observed by the examiners.

 Debonding

Evaluation of tensile retention of Y-TZP crowns after long-term aging: effect of the core
substrate and crown surface conditioning.
Amaral R, Rippe M, Oliveira BG, Cesar PF, Bottino MA, Valandro LF.
Oper Dent. 2014 Nov-Dec;39(6):619-26.

Evaluation of Tensile Retention of Y-TZP Crowns Cemented on Resin Composite Cores: Effect
of the Cement and Y-TZP Surface Conditioning.

Rippe M, Amaral R, Oliveira F, Cesar PF, Scotti R, Valandro L, Bottino M.

Oper Dent. 2015 Jan-Feb;40(1):E1-E10.

 After 42 months one

occurred in each group;

debonding

No effect of resin cement: Panavia 21

versus Multilink.

3. Clinical Failures
Fractures
Inlay/Onlay/Crowns

Zhang et al., 2014

Zhang et al., 2014

Inlay/Onlay/Crown
Defects on the cementation surface

Dicor crown in a premolar

Thompson et al., 1994

Zhang et al., 2014

Inlay/Onlay/Crowns

Marginal defects

Procera crowns (alumina coping + veneering porcelain)

Quinn et al., 2005

 Fractographic Analysis of 13 incisors, 3

premolars and 11 molars;

All fractures initiated in the cervical margin of

the crowns and usually from the proximal
area close to the most coronally placed

curvature of the margin.

Oilo et al., 2014

Cesar, 2012

Cesar, 2012

Zhang et al., 2014

Inlay/Onlay/Crown

Kim et al., 1999

Cone cracks (NO attrition)

Post-indentation half-surface (top) and section view

(bottom), monolith porcelain specimen (Vita Mark II,
Vita Zahnfabrik) loaded axially in cyclic fatigue. Note
deep-penetrating cone cracks from inner contact zone.

Zhang et al., 2009

Inlay/Onlay/Crown

Cone cracks (NO attrition)

Fardim, 2013

Inlay/Onlay/Crown

Cone crakcs (NO attrition)

Fardim, 2013

Inlay/Onlay/Crown

Cone crakcs (NO attrition)

Fardim, 2013

Inlay/Onlay/Crown

Cone cracks (NO attrition)

Fardim, 2013

Zhang et al., 2014

Inlay/Onlay/Crowns

Partial cone cracks (WITH attrition)

Kim et al., 2008

Kim et al., 2010

Optical micrographs showing

(a) surface (top) and side view
(bottom) sliding wear track on
Y-TZP surface caused by WC
sphere of radius r=1.5 mm
under normal load of 1000 N.

Inlay/Onlay/Crown

Dr. Jamil Shibli

Partial cone cracks (WITH attrition)

In vivo

In vitro

Zhang et al., 2014

Inlay/Onlay/Crown
Chipping

Fracture of the porcelain layer (AllCeram) over

Procera Alumina after 4 years.

Scherrer et al., 2007

Scherrer et al., 2007

Inlay/Onlay/Crown
Chipping

Porcelain fused to metal fractured after 2 months.

Courtesy Susanne Scherrer

compression curl

Courtesy Susanne Scherrer

Compression
curl

2 blunt contacts

Courtesy Susanne Scherrer

Courtesy Susanne Scherrer

Belli et al., 2014

 In the chipping area a small bubble within the

veneering material (size 1 x 0.2 mm) is visible;
The chipping occurred 7 months after insertion

2009 Jun;5(5):1668-77

Koenig et al., 2007

Chipping/incisal edge

Fracture

Chipping/cervical area

Multiple cracks

Quintessence Int 2014;45:369376

InCeram Alumina + Veneering porcelain

 Critical crack initiated at the incisal contact area and

propagated gingivally;

The estimated stresses were lower than the measured

strength of the veneer materials;

Contact damage, fatigue, and processing flaws within the

veneer lead to chipping of veneering porcelain in anterior
lithium disilicate and glass-infiltrated alumina crowns.

Qian et al., 2014

 Fractography: Y-TZP coping veneered with glass-ceramic.

Authors: Rodrigo Souza, Susana Salalar-Marocho and Paulo Cesar
Age: 22 years;

Gender: female;
No parafunctional habits;
Metal post;

Luting cement: U100 (3M);

Lifetime: 1 year;
Slow cooling;

Y-TZP Coping: Lava (3M);

Veneering ceram: Emax Ceram;

 Cohesive fracture veneering ceramic

Adhesive fracture (delamination)

exposing the Y-TZP coping

(Mesial)

Arrest lines

 Origin is here (occlusal).

Arrest lines indicate direction of crack propagation.

 Roughness of occlusal surface (buccal cusp).

Area without loss of glaze

layer (but a bit porous)

Multiple
damage.

areas

of

Wear of the glaze layer.

occlusal

 Multiple hackle lines.

 Origin

Conclusion
Origin on occlusal surface;
Relationship with cumulative damage on glaze layer;
Delamination was observed;
Problem with coping design.

Courtesy Rodrigo Souza

Courtesy Rodrigo Souza

Courtesy Rodrigo Souza

 Fracture rates (%) of the venering porcelain applied over Y-TZP in clinical trials
Continued...
Study
Larsson
Rinke
Zembic
Ortorp
Vigolo
Lops
Burke
Sailer
Schmitter
Schmitt
Molin
Sagirkaya
Pelaez
Salido

Year
2013
2013
2012
2012
2012
2013
2013
2007
2012
2012
2008
2012
2012
2012

Koenig et al., 2007

%Fracture
88.9
28.8
0
3
7.7
10.8
24.2
15
26.7
28
0
0.9
10
29.1

Beuer
Tinschert
Rinke
Sailer
Edelhoff
Beuer
Schmitt
Papaspyridakos
Raigrodski
Pospiech
Esquivel-Upshaw
Tsumita
Cehreli
Ohlmann
Bornemann
Ohlmann
Larsson

2010
2008
2013
2009
2008
2009
2010
2012
2006
2003
2013
2010
2009
2012
2003
2008
2006

7.4
6
5.8
33.4
9.5
0
5.9
31.3
25
2.6
16.7
14.3
0
20
3.3
13
54

 grade 1 = small chip that does not demand any action, except polishing.

grade 2 = moderate chip that can be repaired.

grade 3 = large chip that leads to replacement of the prosthesis.

Heintze & Rousson 2010

 Technologies to overcome the problem of chipping

Pressing the veneering ceramic over Y-TZP

CAD-on system

Rapid layer technique

 Pressing the veneering ceramic over Y-TZP

http://sayakaattitude.blogspot.com/2011/07/emax-zirpress-2.html

Arajo et al., 2015

Arajo et al., 2015

Arajo et al., 2015

Sintered

Flexural strength
(MPa)

51.3 4.9c

Sintered
+
Fibers

65.2 4.4b

Hot-pressed

67.1 7.9b

Hot-pressed
+
Fibers

76.5 11.0a

Arajo et al., 2015

Sintered

Sintered + Fibers

Hot-Pressed

Hot-Pressed + Fibers

Arajo et al., 2015

POROSITY (%)

Sintered: 4.0 1.1b

Hot-Pressed : 0.3 0.2c

Sintered + Fibers: 10.4 4.5a

Hot-Pressed + Fibers: 2.6 2.4b,c

Arajo et al., 2015

 CAD-on system

Source: www.ivoclar.com

 Rapid layer techique

http://www.vita-zahnfabrik.com/

http://www.vita-zahnfabrik.com/

http://www.vita-zahnfabrik.com/

3. Clinical failures
Fractures
FPDs

Zhang et al., 2014

 Fractures
FPDs

Zhang et al., 2014

Borba et al., 2015, accepted in Dent Mater

 Fractures
FPDs

CC
HL

Borba et al., 2015, accepted in Dent Mater

FRACTURE ORIGIN AT THE INTERFACE

(ALUMINA + VM7)

Borba, 2010

Dent Mater. 2008 Aug;24(8):1077-82

 Primary fractures in clinically failed Y-TZP-based

FPDs initiated from the veneer surfaces.
Interfacial delamination in glass veneer/zirconia
core bilayer dental ceramic structures controlled

the secondary fracture initiation sites and failure

stresses in Y-TZP-based fixed partial dentures.

Taskonak et al., 2008

 Proper treatment planning is needed to ensure an adequate connector

height of 4 mm or more on allceramic prostheses made with a lithia
disilicatebased core ceramic.

4. The future

4. The future

Monolithic zirconia
Lithium silicate with zirconia particles

Interpenetrating ceramic-resin composite network

 Monolithic zirconia (Lava Plus, 3M)

Edmara Bergamo, Master Thesis, 2015

Advisor: Altair Cury (Unicamp/Brazil)

Edmara Bergamo, Master Thesis, 2015

Advisor: Altair Cury (Unicamp/Brazil)

CONTROL
AGED

Edmara Bergamo, Master Thesis, 2015

Advisor: Altair Cury (Unicamp/Brazil)

Edmara Bergamo, Master Thesis, 2015

Advisor: Altair Cury (Unicamp/Brazil)

 Lithium silicate with zirconia particles (Suprinity, Vita)

Nathlia Carvalho, Master Thesis, 2014

Advisor: Renata Melo (UNESP/Brazil)

Source: Vita

 Interpenetrating ceramic-resin composite network (Enamic, Vita)

Nathlia Carvalho, Master Thesis, 2014

Advisor: Renata Melo (UNESP/Brazil)
Source: Vita

 Lithium silicate (Suprinity)

Monolithic Y-TZP

Denry & Kelly, 2014

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