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KARL F. LEINFELDER, D.D.S., M.S.
Background. Dental procedures play a vital role in the modern dental practice. Considerable research has addressed improvements in the properties of dental porcelains.
Clinical Implications. This article examines the trends in the scientific advances in dental porcelains. It highlights properties of the new low-fusing porcelains and describes indications for their use. New luting cements also are addressed.
throughout the centuries. Although it is impossible to know when porcelain was first used successfully, the Chinese began working with it as early as the 9th century. Around 1700, France and, somewhat later, England used refined porcelains for the fabrication of dinner plates and various artistic objects. In dentistry, it was Alexis Duchateau, a Parisian apothecary, who first used the material for the fabrication of denture bases in the 18th century.1 Several years later, Dubois de Chemant secured a patent for the sole right to manufacture denture teeth with porcelain.1 It was in 1949 that Dentist’s Supply Company of New York invented the process for vacuum-firing porcelain teeth.2,3 The use of a reduced pressure during vitrification resulted in artificial teeth that were considerably more dense and less opaque. Today, porcelain plays a vital role in restorative dentistry. Common uses include full coverage as crowns, inlays and onlays, porcelain bridges, veneering agents, castable ceramics and porcelain-fused-to-metal, or PFM, restorations. Based upon some interesting technology, porcelain can also be cast into molds in much the same way as conventional base metals or gold alloys. As demands for esthetic dental restorations continue, new technologies will improve the material properties and develop new methods for its use. Considerable research has been directed toward improving the properties of ceramic
Porcelain has been used in various forms
materials for dental purposes. While dental porcelains possess numerous positive attributes, they also exhibit a number of disadvantages (Box, “Advantages and Disadvantages of Dental Porcelain”).4 In general, the experienced clinician has learned to compensate for some of the disadvantages of porcelain. Unfortunately, low fracture resistance, potential for abrading structures against which it occludes and difficulty in resurfacing and polishing the glazed surface continue to be the biggest problems associated with this commonly used clinical material. This article examines current trends in the scientific advances of dental porcelain and its uses, and touches on management of the challenges inherent to porcelain.
All-ceramic systems are characterized by versatility and outstanding polishability. An allceramic system is designed to combine consistent shading, superior esthetics and low wear for PFM and all-ceramic restorations. The material is further characterized by a reduced potential for abrading opposing enamel as well as other materials with which it functionally occludes. All-ceramic systems are truly unique and different from all other systems and their materials currently available to the practitioner. This lowfusing porcelain has been designed so that it can be used with PFM and all-ceramic restorations. During the last several years, there has been a growing interest in metal-free ceramic restorations. Such systems inherently provide a greater
JADA, Vol. 131, June 2000 Copyright ©1998-2001 American Dental Association. All rights reserved.
In fact. 131. however. . the wear of enamel was less than that produced by gold alloys when tested under the same condition.4 DISADVANTAGES* Abrasive to antagonists Complex techniques needed (fabrication) enamel is presented in Figure 1. the differential of energy passed on through the two types of restorative materials is only about 10 percent. was less than all other materials against which it was compared. Leucite’s primary function in dental porcelain is to raise the coefficient of thermal expansion. ADVANTAGES Dimensional stability Insolubility in oral fluids Excellent color matching Tissue tolerance High wear resistance Difficult to adjust/polish (intraorally) May degrade supporting structure Low fracture resistance * Owing to the relatively low absorption potential of masticatory energy. All of these tests show that Finesse. It also permits the clinician to generate a highly polished surface at chairside. June 2000 Copyright ©1998-2001 American Dental Association. the volumetric wear loss of Finesse. around 940 C for conventional porcelain. is 760 C vs. The firing temperature for one newer low-fusing porcelain (Finesse). the lowfusing porcelain tested. Selecting a glass and varying the leucite content will alter certain physical properties. Vol. such as Finesse All-Ceramic (Dentsply Ceramco). low-fusing porcelain represents a major change in direction. are showing promise in combining the properties of esthetics and strength. dental porcelains consist of a leucite crystal-containing frit and at least one other frit to control various physical and mechanical properties. some clinicians have speculated that porcelains as compared to polymers may cause a higher rate of degradation at the bone-implant interface. One of the basic differences between this formulation and those that have been used for long periods of time is a significant reduction in the firing temperature. The leucite component forms a refractory skeleton and the glass fills the spaces in between. This 200degree differential has imparted a number of positive characteristics to the final restoration. for example. As can be seen.5 LOW-FUSING PORCELAIN AND ITS PROPERTIES Developed to offset the major disadvantages of traditional dental porcelains. consequently increasing the hardness and fusion temperatures. Specifically. While trials have been carried out in vitro. it has been difficult to combine this feature with that of high fracture resistance. However. a low-fusing porcelain. the correlation between laboratory and clinical data has been extremely high.9 The wear of the ceramic and gold materials by opposing Many of the greatly improved properties of low-fusing porcelains can be related to the changes made to the leucite component. As a rule. Leucite is an artificial crystal feldspathoid (potassium-aluminosilicate). thereby eliminating the need for reglazing after possible adjustments. In an investigation by Imai and colleagues at the University of Alabama. adding special properties required for dental porcelains. Newer systems.ADVANTAGES AND DISADVANTAGES OF DENTAL PORCELAIN. the wear or abrasion of the various materials (ceramic and gold alloy) followed the same pattern.5 it was shown that one low-fusing (Finesse) porcelain abraded the antagonist normal or polished enamel one-third less than did conventional porcelain. possesses advantageous characteristics as related to potential clinical behavior. Historically. The reduction of the fusion temperature allows for increased 48S opalescence in the enamel porcelain.6-8 Another clinical study confirmed the lower wear of low-fusing porcelain against opposing teeth and restorations. Perhaps more important. the leucite crystals are created by transforming feldspar crystals into glass and leucite crystals by a special heat treatment. the low-fusing porcelain offers considerably less potential for abrading any materials against which it occludes. All rights reserved. LEUCITE potential for optimizing esthetics. JADA. In most dental porcelains. A considerable amount of research on dental porcelains has resulted in the possibility of permitting variations in the leucite content.
including the dentins. places the porcelain in a state of compression. one brand of all-ceramic cores.7 0. enamels. For the purpose of maximizing crown strength and improved crack resistance. All rights reserved. Fluorescence adds to the vitality of a restoration and minimizes the metameric effect between teeth and restorative materials. Vol. some lowfusing repair porcelains are free of leucite.4 0. it is engineered with a coefficient of thermal expansion. ALL-CERAMIC CORES For clinicians who practice esthetic restorative dentistry. Natural teeth are fluorescent. Duceram Gold by Zahntechnik. First of all. of course. When tested in accordance with the International Standards 49S JADA.The leucite content of most high-fusing porcelains ranges somewhere between 35 and 40 percent. particularly in the field of ceramics. In other words. The all-ceramic core system is ideal since excellent bonding can be achieved between porcelain and core without the need to create a wash layer. Finesse by Dentsply Ceramco. certain lowfusing porcelains. are fluorescent. This entire process can be carried out in a conventional pressing furnace. the CTE of the core material is actually slightly higher. Illustrated are six ceramic cores fabricated at one time on a common base. The particle size and distribution also permit the pressed core to be ground easily without producing chipping in thin areas. which subsequently improves fracture resistance of the final restoration. The components of porcelain consist of agents that cause them to fluoresce. It is important that all the basic components of the porcelain. The formulation has been designed to employ optimum levels of finer and less leucite crystal for the purpose of maximizing the desirable characteristics of dental porcelain. 131. . The core fabrication process consists of investing the wax pattern. stains and even the glazing agents. IPS Empress by Ivoclar North America. such as Finesse.3 0. Most importantly. This particular characteristic contributes to optimal physical properties and also the desired level of translucency. fluorescence is an important physical property. Opalescence The ceramic core of low-fusing porcelain is unique in a number of ways. these leucite-free porcelains also have some disadvantages. they also will emit visible light when exposed to ultraviolet light. they deform on multiple firings at different temperatures. This condition. Ceramco II is manufactured by Dentsply Ceramco. also contributes to the vitality of a restoration. This characteristic not only enhances the integrity of the restoration. Combining this feature with color-correlated dentin and core further enhances natural esthetics. Such formulations work well as a low-temperature add-on and they are less abrasive.1 0. contain 8 to 10 percent leucite. but it virtually erases the seam between core and porcelain. they emit visible light when exposed to ultraviolet light. the glass matrix of Finesse.6 0. matched to that of the Finesse low-fusing porcelain.0 Ceramco II Duceram Gold IPS Empress Finesse Figure 1.2 0. Unfortunately. thereby permitting optimal esthetics. As an example. Opalescence is the ability of a translucent material to appear blue in reflected light and orange-yellow in transmitted light. thus. Relative wear of various ceramic restorative systems against enamel. contains fine leucite crystals that are uniform in both size and distribution. or CTE. Interestingly.5 0. However. burning out and forcing the ceramic core material into the evacuated mold (Figure 2). The core material examined was highly stable under oral conditions. FLUORESCENCE AND OPALESCENCE VOLUMETRIC WEAR LOSS AGAINST EN AMEL (x102 millimeters) 0. June 2000 Copyright ©1998-2001 American Dental Association.
gold-platinum-palladium alloys. Lingual view. Specifically. the results lain can mimic the proper opacdemonstrated that the level of ity and translucency ratio comweight change was significantly monly associated with natural less than the maximum set by teeth or ceramic restorations the standard. the level of esthetics associated with PFMs has been less than ideal. Vol. A clinical study showed little wear on opposing teeth with low-fusing porcelain-to-metal crowns. For example. its overall properties are insufficient for certain types of restorative systems. 1999). Buccal view. palladium-gold alloys and lowexpansion nonprecious alloys.000 mg/cm2. many of the laboratory-fabricated restorations are someFigure 3. Low-fusing porcechemical durability. In fact. A series of cores fabricated by means of a pressing process. While bonding has been improved to the point that fracturing is relatively uncommon. June 2000 . unpublished data. palladium alloys. is shown in Figure 3. During that period. Based upon careful laboratory studies (Dentsply Ceramco. B. A slightly lower CTE than the metal to which it is bonded puts the ceramic veneer into a state of compression during the cooling process. the Figure 2. When zinc phosphate cement is used to lute all-ceramic restorations. This in turn maximizes resistance to fracture. translucent in A. A low-fusing porcelain (Finesse. it can be used successfully for PFM restorations.weight change was only 38 milligrams/ square centimeter as compared to an acceptable level of 2. 131. falls far short for porcelain restorations. A typical example of a three-unit bridge constructed of Finesse. More often than not.9 LUTING AGENTS B The development of new materials such as all-ceramic restorations has brought about a substantially different attitude concerning luting agents. a low-fusing porcelain fused to a gold-based metal alloy. during mastication energy is transmit- 50S JADA. While zinc phosphate cement has been the standard for nearly a century. bulk fractures can be expected. Dentsply Ceramco) fused to a gold metal substrate what less —a typical example of this material’s potential. tremendous effort has gone into the improvement of the systems originally offered to the profession. By carefully controlling the coefficient of thermal expansion of low-fusing porcelain. which has been quite successful for metal-based restorations. it has been demonstrated that a type of low-fusing porcelain can be successfully bonded to gold-based alloys. comparison to conventional all-ceramic Organization standards for restorations. this traditional cement. PORCELAINFUSED-TOMETAL RESTORATIONS PFM restorations have been used extensively by dental clinicians for nearly 40 years. A without a metal substrate.
I Dr. Ring ME. Consumer interest in esthetic dentistry will continue to grow in the 21st century. Mazer RB. the esthetics are excellent. Mechanisms involved in securing dense. 27514. J Dent Res 1957. An investigation of the dynamic mechanical properties of dental root form implants (master’s thesis). vitrified ceramics from preshaped partly crystalline bodies. low-fusing porcelain is considerably less abrasive to those structures against which it occludes than other ceramic systems. School of Dentistry. Semmelman JO. 7. therefore. Address reprint requests to Dr. 4. Fukushima S. The ability to bond not only to the surface of the tooth but also to the internal surface of the ceramic restoration reduces this potential appreciably. Leinfelder is professor emeritus. Clin Res Associates Newsletter 1999. 9. Such a cement should not only bond to the surfaces of the preparation through the hybridizing process but also to the internal surfaces of the ceramic restoration by means of silanation and acid etching. Suzuki S. It is important. 131.36:950-6. Low-fusing porcelainmetal crowns. In vitro evaluation of OCA wear resistance of posterior composites. The fractures associated with the early all-ceramic crowns could be attributed to this phenomenon. Suzuki S. 8. Leinfelder KF. In vitro wear device for determining posterior composite wear. the principles associated with these recently developed systems make it considerably easier for clinicians to achieve their esthetic restorative goals. the cement should exhibit sufficient flexural strength. Al-Malik MA.41:304-9. Leinfelder KF. New dental porcelain systems that combine esthetics with strength and function will assist dental professionals in meeting the increased consumer demand for lifelike teeth that perform like one’s natural enamel and dentin. Department of Biomaterials. function and strength. 5. Fonvielle FP. Vines RF. Semmelman JO. Vol. to select a luting agent that exhibits the appropriate properties. 1991. Chapel Hill. the energy is distributed in localized regions at the restoration-preparation interface.78(special issue):112. June 2000 Copyright ©1998-2001 American Dental Association. University of Alabama School of Dentistry. veneers and bridges. Ala. the masticatory energies are distributed more uniformly.11:246-51. Quintessence Int 1989. inlays and onlays. Furthermore.23(2):1-2. Leinfelder KF. In vitro enamel wear of modified porcelains (abstract 50). N. CONCLUSIONS The combination of compositebased resin luting systems and low-fusing porcelains has marked a major milestone in the area of esthetic restorative dentistry. When used in conjunction with a pressable core system and no metal substrate. 3. J Dent Res 1999.130:1347-53. These two materials make it readily possible to fabricate restorations of great beauty. 1. Imai Y. J Am Ceram Soc 1958. In the case of zinc phosphate cement. 51S . JADA 1999. Lee PW.. Other desirable properties include color stability and sufficient release of fluoride to offer protection against secondary caries. JADA.C. 2. fractures within the ceramic restoration are reduced significantly. The application of high levels of stress in localized zones then predisposes the restoration to fracture. Dent Mater 1995. Dentistry: An illustrated history. Beaudreau RW. These porcelains possess excellent opalescence and fluorescence and can be readily polished without reglazing. 6. Finally. New systems have been designed in which low-fusing porcelain can be used for PFM and all-ceramic restorations.20:755-61. Christensen R. 1985:180. Birmingham. Consequently. This luting agent should possess dual-cure potential as well as multiple viscosities for use with different types of restorations. When all contact surfaces are bonded as a single structure.: University of Alabama. Kawai K. All rights reserved. Newer composite-based resins such as Calabra (Dentsply Caulk) show promise in fulfilling these requirements. They are designed for the construction of crowns. Vines RF. An in vitro device for predicting clinical wear. Birmingham.ted through the bolus and into the restoration itself. Leinfelder at 207 Helmsdale Dr. Although inherently wear-resistant. Densification of dental porcelain. flexural modulus and fracture toughness. New York: Mosby.
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