Review
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Wolfram Höland†,
Marcel Schweiger,
Ronny Watzke,
Arnd Peschke and
Heinrich Kappert
†
Author for correspondence
Research and Development,
Ivoclar Vivadent AG,
Bendererstr. 2, FL-9494 Schaan,
Liechtenstein
Tel.: +423 235 3373
Fax: +423 239 4373
wolfram.hoeland@
ivoclarvivadent.com
www.expert-reviews.com
Ceramics as biomaterials for
dental restoration
Expert Rev. Med. Devices 5(6), 729–745 (2008)
Sintered ceramics and glass–ceramics are widely used as biomaterials for dental restoration,
especially as dental inlays, onlays, veneers, crowns or bridges. Biomaterials were developed
either to veneer metal frameworks or to produce metal-free dental restorations. Different types
of glass–ceramics and ceramics are available and necessary today to fulfill customers’ needs
(patients, dentists and dental technicians) regarding the properties of the biomaterials and the
processing of the products. All of these different types of biomaterials already cover the entire
range of indications of dental restorations. Today, patients are increasingly interested in metal-
free restoration. Glass–ceramics are particularly suitable for fabricating inlays, crowns and small
bridges, as these materials achieve very strong, esthetic results. High-strength ceramics are
preferred in situations where the material is exposed to high masticatory forces.
Keywords : biomaterials • ceramics • clinical applications • dental restoration • glass–ceramics • metal-free
materials • optical properties • strength • toughness
Many review articles on the development and thoroughly tested for this purpose. A ceramic
application of ceramics in restorative dentistry coating or veneer was sintered onto the metal
mention the fact that the first feldspathic substructure to achieve an esthetic, tooth-like
enamel melts with quartz were produced appearance [9] . These PFM restorations con-
for fabricating restorative dental ceramics tinue to be popular today. Therefore, the first
for human medicine as early as in the 18th section of this publication is devoted to the
Century [1,2] . Dental crowns for anterior materials involved in the fabrication of these
teeth, or jacket crowns, were produced with restorations and the latest developments in
these feldspar materials [3,4] . Nevertheless, this veneering ceramics.
ceramic was highly susceptible to fracture and The second section deals with the metal-free
so never became widely used. In the 1960s, restorative solutions available today. The two
porcelain-fused-to-metal (PFM) systems were main groups, that is, sintered ceramics and glass–
developed, which were highly successful and ceramics, are discussed. Both types of materials
became very popular [5,6] . Since the mid-1980s, are presented together with their most important
restorative dental bio­m aterials have gained characteristics and applications. The fact that
popularity among patients as a result of the these two types of ceramics can be joined and
successful development and use of metal-free connected will also be addressed.
products for fixed dental restorations [7,8] . First, however, it is important to point out that
There are many reasons why people need dental the success of new biomaterials is measured by
inlays, crowns, veneers or bridges fabricated with their clinical performance. The level of the clini-
these restorative biomaterials. The cause may be cal success determines the degree of attractive-
of a medical (decay or periodontal reasons) or ness of the biomaterial for the patient. Therefore,
traumatic nature (accident). Other patients sim- the aim of any new development is clearly evi-
ply wish to change their smile to improve their dent. Modern ceramic systems are very reliable,
appearance. However, the demand for esthetic, esthetic materials but still show some restrictions
tooth-colored (‘invisible’) restorations increased in their spectrum of indications and there are
rapidly. No-one wants to cover up their mouth special clinical situations where they cannot be
when they smile. Until the mid 1980s, the stand- used. Future developments will aim to eliminate
ard biomaterial for restorative dental applications these limitations and clinical research has to be
was a ceramic supported by a metal framework. focused on the approval of new indications with
Biocompatible metal alloys were developed and an adequate level of evidence.
10.1586/17434440.5.6.729 © 2008 Expert Reviews Ltd ISSN 1743-4440 729
 Review Höland, Schweiger, Watzke, Peschke & Kappert
Before addressing the different types of materials and their spe-
cial characteristics (Table 1) and favorable processing properties,
the most important prerequisites for dental restorations should be
discussed. Restorative dental materials must meet the following
basic requirements:
• They must be durable and biocompatible;
• Their optical characteristics (translucency and color in particular)
must be comparable to those of natural teeth;
• Their mechanical properties (strength and toughness) must meet
the requirements of the indication range (the required strength
of an inlay is lower than that of a dental bridge).
Their wear behavior must be similar to that of natural teeth. As
a result, restorative dental materials are fundamentally different
from those required to make implants and bioactive ceramics for
bone replacements [10,11] .
Restorative dental materials can be divided into two different
groups: silicate glass–ceramics and high-performance ceramics.
Another possibility is a classification into materials with glassy
phases (glass–ceramics or glass–infiltrated ceramics) or materials
with nearly no glassy phase (sintered, polycrystalline materials, such
as zirconium oxide). Both types of materials are used for different
indication ranges [12] . For example, modern, high-performance
ceramics, such as aluminium and zirconium oxide, are used to
fabricate dental posts and high-strength bridges for load-bearing
areas of the mouth [13,14] . Silicate and glass–ceramics, however,
are used either to coat these high-strength ceramics to make them
appear more esthetic and lifelike [15,16] or alone for single-tooth
restorations and small bridges. At present, therefore, a large vari-
ety of materials for the different fields of restorative dentistry are
available to dentists, dental technicians and, above all, patients. In
this review, the most important biomaterials for restorative den-
tistry are separated into two groups: ceramics and glass–ceramics
for metal-reinforced restorations and ceramics and glass–ceramics
for metal-free restorations. As well as providing a survey of each
material category, the most recent and successful developments are
presented. Therefore, both an overview of the materials and their
indications and an outlook for the future will be offered.
The greatest driving force to develop materials for dental restora-
tion is to fulfill the patients’ needs. A great challenge was, and is,
the development of metal-free restorations with properties close
to natural teeth (with respect to translucency, color or abrasive
behavior) or even better mechanical properties and better durability
than natural tooth structures.
Metal-based restorations
At present, ceramics and glass–ceramics for PFM restorations
still account for 50% of the market throughout the world. These
ceramics are used to veneer metal-based crowns and bridges. As a
result, they still occupy a very important position in the market.
Ceramics & glass–ceramics sintered on metal frameworks
Most ceramics that are suitable for firing on dental alloys
have been developed on the basis of the classical SiO2 –Al 2O3 –
K 2O system, which is used primarily to produce household
730
ceramics and sanitary porcelains. The main crystal phases,
which should be mentioned in this context, include potassium
feldspar, KAlSi3O8 (K 2O·Al 2O3 ·6SiO2 ) and leucite, KAlSi 2O6
(K 2O·Al 2O3 ·4SiO2 ) [17] . Owing to this background, dental
ceramics are often still called dental porcelains. The following
composition range is typical for feldspathic veneering ceramics:
52–62 wt% SiO2, 11–16 Al2O3, 9–11 K 2O, 5–7 Na 2O with vari-
ous additional components, such as Li2O or B2O3 [18] . Ceramics of
this kind, which usually contain leucite as the main crystal phase,
have been presented by a number of authors [9,19,20] . In these
ceramics, the crystal phase is not formed by controlled nucleation
and crystallization as is the case in glass–ceramics. Rather, phase
formation takes place in a fast, disordered, almost uncontrolled
crystallization process. These ceramics may contain glass–ceramics
as additional components (see ‘Leucite-based ceramics’ section).
The most important silicate ceramics and their material systems
include VM13 (Vita Zahnfabrik GmbH, Germany) [21] , Super
Porcelain EX-3 (Noritake, Japan) [22] , Ceramco III (Dentsply,
USA) [23] , DuceramKiss (Degudent, Germany) and Imagine
Reflex (Wieland, Germany).
Leucite-based ceramics
In order to improve the properties of silicate ceramics and take
advantage of the principle of controlled crystallization found in
glass–ceramics, glass–ceramic components were built into feld-
spathic ceramics. Several review articles have been published on
the development and production of glass–ceramics [24–26] . The main
mechanism involved in the development of glass–ceramics is that of
the controlled nucleation and crystallization of glasses. As a result,
glass–ceramics contain at least one glass phase and one crystal phase.
Controlled surface crystallization and controlled bulk crystallization
represent the two most important methods in this context.
The IPS InLine® (Ivoclar Vivadent AG, Liechtenstein) was
developed on the basis of the knowledge gained in the produc-
tion of feldspathic ceramics and glass–ceramics. IPS InLine
contains both components that are used in the development of
glass–ceramics and also feldspar [27] . The material is classified as
a dental ceramic. Nevertheless, the most important aspect of this
material is the glass–ceramic component, which forms the crystals
of the leucite type (KAlSi2O6) through controlled surface crystal-
lization. Controlled heat treatment alone in the temperature–time
functions of these crystals causes crystals to form at the surface of
the glass grains in granulated glass from the SiO2–Al2O3 –K 2O base
system with additions of Na 2O, CaO, B2O3 and other oxides [28] .
The tetragonal modification of leucite crystals has a high linear
thermal coefficient of expansion [29] . As a result, the expansion
characteristics of the material can be adapted to those of the metal
substrate. Due to the formation of leucite crystals, the expansion
coefficient of the IPS InLine material is 12.6 ± 0.5 × 10 -6 K-1m/m
after two firings at 910°C. After four thermal treatments, it
registers 13.2 ± 0.5 × 10 -6 K-1m/m.
Metal–ceramic restorations involving biomaterials are fabricated
in several different steps, as well as including a number of materials
in the process: metals, an opaquer and different types of ceramics.
The individual ceramic materials are designed to fulfil the optical
Expert Rev. Med. Devices 5(6), (2008)
 Ceramics as biomaterials for dental restoration Review

requirements of the different areas of the natural tooth. For exam- ceramic. It has the favorable characteristics of a good flexural
ple, a ceramic for simulating the appearance of the dentin portions strength of 80 MPa, good chemical durability (both according
(opaque, much chroma) of a tooth has different characteristics from to International Standards Organization [ISO] 6872) and an
those required in the translucent incisal region. adjusted thermal expansion of 12.0 ± 0.5 × 10 -6 K-1m/m. Due to
First, we would like to discuss the metals. The materials used the fluoroapatite crystals, the glass–ceramic possesses additional
in these applications include high-gold, palladium–silver and special optical features that are produced by a combination of
cobalt–chromium alloys, which show good biocompatibility [30] . different effects, including tooth color, translucency, brightness
Their expansion coefficient usually ranges between 13.8 × 10 -6 and opacity (which is also perceived as giving warmth to color).
K-1m/m and 16.2 × 10 -6 K-1m/m. After the metal framework has These optical properties provide the material with a tooth-like
been cast, the restoration is heat treated to form metal oxides on appearance. As a result, this glass–ceramic can be used to encase
the surface of the alloy. These oxides form the basis for the bond the metal frameworks of anterior restorations. However, it is also
with the ceramic layer, which is sintered to the metal as the first suitable for use in long-span bridges (Figure 1) .
inorganic component. This material is called an opaquer, as it
masks the metal. Furthermore, it establishes excellent prerequi- Ceramics & glass–ceramics pressed on metal
sites for applying the subsequent dental ceramics. The ceramics This review of metal-reinforced biomaterials would not be com-
from the composition range of 59.5–65.5 wt% SiO2, 13–18 Al2O3, plete if we did not mention the latest developments in this field:
10–14 K 2O, 4–8 Na 2O, which form the dentin and incisal parts silicate ceramics and glass–ceramics that are pressed onto metal
of the tooth are fired to the opaquer at a temperature of 930°C. alloys. Building on the fundamental knowledge of the chemical
In this process, the three types of materials are successfully fused and physical nature of glasses and glass–ceramics, and particu-
together. The IPS InLine ceramic is characterized by the pre- larly the favorable viscous flow properties of these materials at
viously mentioned thermal expansion and its flexural strength high temperatures [17,24,25,43] , researchers in the 1980s developed
of 80 ± 20 MPa, as well as its very good chemical durability. glass–ceramics using controlled nucleation and crystallization
Therefore, it fulfills the relevant dental standards [31,32] . methods [44] . The materials were transformed into a viscous state
The material is particularly suitable for veneering the metal and then pressed into the desired shape to produce dental resto-
frameworks of crowns and long-span posterior bridges. An exam- rations in dental laboratories. The first glass–ceramics that were
ple of one such clinical application is provided in the ‘Ceramics processed by taking advantage of the viscous flow principle are
and glass–ceramics PoM’ section, where the convenient technique discussed later.
of pressing ceramics onto dental metal alloys is presented. While these pioneering developments to harness the viscous
flow process were taking place, the idea to adapt this technique
Leucite–apatite glass–ceramics for veneering metal frameworks was born. Soon, a method was
As mentioned, research into the development of glass–ceramics has discovered that allowed these materials to be pressed onto cast
focused generally on the mechanisms of bulk crystallization and of metal substructures. The leucite ceramics from the following sys-
controlled surface crystallization for the formation of leucite crys- tems produce a successful bond when they are pressed onto metal
tals in particular. The combination of these methods was relatively frameworks: Authentic® (Ceramay), Ceramco® Press (Dentsply),
unknown [33–36] and had not been investigated in the development Super Porcelain EX-3 PRESS (Noritake).
of dental products. However, in order to
achieve both high expansion and strength
A B C
of the metal-reinforced ceramics and favor-
able optical properties, new possibilities had
to be explored. For this purpose, the surface
crystallization and the bulk crystallization
methods were combined [24,37,38] . As a result,
leucite crystals were precipitated by the mech-
anism of surface crystallization and needle-
like fluoroapatite crystals (Ca5[PO4]3F) were
formed through bulk crystallization in a glass
in the composition range of 49–58 wt%
SiO2, 11–21 Al2O3, 9–23 K 2O, 1–10 Na2O,
2–12  CaO, 0.5–6  P2O5 and 0.2–2  F.
Controlled nucleation always preceded
these crystallization processes [39–42] .
This glass–ceramic, used in a product Figure 1. Long-span, six-unit ceramic fused to metal bridge (IPS d.SIGN®), clinical
called IPS d.SIGN , is sintered to a frame-
® situation. (A) Preparation of the teeth. (B) The same bridge on the dental technician’s
work coated with an opaquer in a similar gypsum model before. (C) Cemented bridge.
Dentist: A Stiefenhofer; dental laboratory: Arteco.
way to the aforementioned IPS InLine

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 Review Höland, Schweiger, Watzke, Peschke & Kappert
A though some initial problems were encountered with this technique,
B canine tooth and the second molar, the author decided to restore the
C
Figure 2. Press-on-metal technique. (A) Clinical situation:
preparation of teeth 23 and 27. (B) Long-span, five-unit (teeth
23–27) press-on-metal (PoM) bridge (IPS InLine® PoM) on mirror,
23 with a ceramic shoulder for higher esthetics in the visible
region. (C) The same bridge in clinical situation after cementation
on to teeth 23 and 27.
Dentist: R Watzke; dental technician: A Ritter.
The product category of ceramics that are suitable for pressing on
metal will be discussed on the basis of the IPS InLine press-on-metal
ceramic (Ivoclar Vivadent AG). The main advantage of the PoM
technique compared with that of sintering glass–ceramics on an opa-
quer is the fact that it allows dense materials to be fused together as a
result of the virtually homogenous heat distribution and the viscous
flow process. This joining technique heightens the process reliability
for the dental technician in the fabrication of dental restorations,
and ultimately benefits the patient. At the same time, this pressing
732
technique considerably speeds up work in commercial laboratories
through the possibility of full anatomical design and pressing. Even
these have now been resolved. The coefficient of thermal expansion
(CTE) of compatible alloys has to be in the range of 13.8–14.5 × 10-6
K-1m/m. Today, the PoM technique can be used to fabricate dental
restorations ranging from crowns to multi-unit bridges (Figure 2) .
In the clinical case (Figure 2), the patient has lost three adjacent
teeth (24, 25, 26) of the left side of the upper jaw. This huge distance
poses a prosthetic challenge. It could be restored by means of den-
tal implants, a removable partial denture or a bridge (fixed partial
denture). However, owing to the missing bone structure no dental
implants could be inserted easily. A possible bone augmentation was
declined by the patient, and because of the high-quality rating of the
distance of three teeth by means of a ceramic PoM bridge [45,46] . A
high-strength metal framework was used because of the good in vivo
and in vitro long-term survival results of long-span and multiple unit
bridges [47–60] . To save time in manufacturing the bridge, the dental
technician decided to press the ceramic to the framework altogether
instead of veneering it with different ceramic pastes step-by-step
(IPS d.SIGN presented in Figure 1). To achieve better esthetics in
the visible region a ceramic shoulder on the canine crown was used
to hide the metal framework (dark appearance cervical). The indi-
vidualization of the ceramic PoM bridge was performed by painting
the restoration. After try-in of the bridge and controlling esthetics
and function, it was cemented conventionally.
This case study shows the huge mechanical and esthetic poten-
tial of this material combination. This kind of fixed partial den-
ture is only possible using metal frameworks and they offer a very
beneficial and convenient therapy for the patient [61] .
Figure 2B clearly shows that the abutment crowns and the three pon-
tics are completely encased within ceramic. Since the dental ceramic
has a somewhat lower CTE than the opaquer, which in turn has a
lower coefficient than the metal alloy, the stresses within the material
are controlled, which strengthens the ceramic. This phenomenon
of controlling stresses has been addressed in various publications.
Nevertheless, the strength of the bond between the materials is the
most important factor in this context. Measuring methods and bond
strength parameters are prescribed for establishing the nature of the
bond, the most important being described in [62,63] .
Metal-free restorations
The development of metal-free dental restorations has always
been a focal issue of dental research and development efforts,
starting with the development of the jacket crown mentioned
earlier. In the meantime, additional research has been conducted
into improving the strength of metal-free restoratives and achiev-
ing tooth-like optical characteristics. The latest materials fulfil
these demands and, therefore, offer patients highly sophisticated,
esthetic and reliable solutions (Table 2) . At the same time, the pro-
cessing techniques have been further developed to enhance the
effectiveness of the products, save time and heighten reliability.
As a result of these efforts, leucite-based ceramics were reinforced
with crystalline Al2O3 [73,74] .
Expert Rev. Med. Devices 5(6), (2008)
 Ceramics as biomaterials for dental restoration
Table 1. Summary of clinical advantages and risks for different restoration categories.
Advantages
Metal–ceramic restorations
• High strength because of the metal framework [61]
• Frameworks with 5 or more units are possible (long span) [57]
• Many studies have proved the clinical long-term
performance [47–60]
• Better esthetics in comparison with full-metal restorations [64]
• Wear behavior similar to natural enamel [65–68]
• Possible repairing of chipped or delaminated veneering
material [69,70]
• Good marginal fit [71,72]
• Pressing the ceramic to the framework is time saving (e.g., IPS
InLine® PoM)
• Individualization by means of different colored and translucent
ceramic pastes (e.g., IPS d.SIGN®)
Machinable leucite-type glass–ceramic restorations
• Only one appointment necessary
• No provisional restoration necessary
• No impression necessary
• Time- and cost-saving procedure
• Longevity
• Esthetics
• Preservation of tooth structure
• No dental technician/laboratory necessary
Full-ceramic restorations (high-strength and high-toughness sintered ceramics veneered with glass–ceramics)
• High strength because of the framework [198–201]
• Fewer inhomogeneities within the framework because of the
preformed ceramic milling blocks
• Esthetically because of the veneering material
• Biocompatibility [208]
• CAD/CAM framework saves manufacturing time for the
dental technicians
• Minimally invasive preparation of the tooth (inlay retained) [191–197]
• Wear behavior similar to natural teeth [68,209]
• Reparations of chipped or delaminated veneering material possible [210]
• Good marginal fit [211]
• Pressing the ceramic to the framework is time saving (IPS e.max®
ZirCAD and ZirPress)
• Individualization by means of different colored and translucent
ceramic pastes (IPS e.max ZirCAD and Ceram®)
CAD: Computer-aided design; CAM: Computer-aided manufacture; CTE: Coefficient of thermal expansion; PoM: Pressed-on-metal.
Furthermore, composites involving ceramic and glass were pro-
duced (VITA In-ceram® ALUMINA, SPINELL and ZIRCONIA;
VITA Zahnfabrik). For this purpose, open-pored, sintered ceram-
ics were infiltrated with glass. The strength of these specialized
composites was considerably higher than that of feldspathic ceram-
ics. At the same time, the optical properties were improved com-
pared with those of the opaque sintered ceramics. The presintered
ceramic framework contained predominantly alumina (Al2O3),
spinell (MgAl2O4) or zirconia (ZrO2 ; CeO2 stabilized type) as
the crystalline phase. A low-viscosity glass containing La 2O3 was
used to infiltrate the open-pored ceramics [75–80] .
At the same time as these developments were taking place,
research into the glass–ceramic systems and the development
of high-strength polycrystalline ceramics was underway. The
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Review
Disadvantages/risks
• Different materials fused together
• Different CTEs
• Susceptible to chipping or delamination of veneering
material [48,59]
• Esthetics not as good compared with full-ceramic restorations
• Casting the framework is time consuming
• Inhomogeneities within the metal framework because of the
casting process
• Possible allergy towards metal ingredients
• Today, gold alloy used as the framework material is expensive
• Individualization just by means of painting the uniformly
translucent ceramic
• Veneering of the framework step-by-step is time consuming
• Expensive equipment
• Additional extra oral work for the dentist
• Limitations with regard to individualization/painting
• Multiple units
• Difficult to scan and design
• Teeth have to be powdered for intraoral scanning
• Different materials fused together
• Different CTEs [212]
• Chipping or delamination of veneering material [213]
• Fewer long-term studies than for ceramic fused-to-metal
restorations (mostly short-term evaluations and case
reports) [202–206]
• Short-time experience of durability of long-span
restorations [203–206]
• Individualization only by means of painting the uniformly
translucent ceramic veneering of the framework step-by-step
is very time consuming
developments in glass–ceramics and polycrystalline ceramics
for restorative dental applications are described in the following
sections. Apart from the materials, engineering aspects and the
properties of the materials the processing techniques and various
clinical applications in particular should be discussed.
Moldable & machinable glass–ceramics for single units
The initial developments in the field of glass–ceramics were used
for technical purposes [81,82] . Today, a wide range of glass–ceram-
ics are available for use in the home, in technical and medical
fields, and of course in dentistry [24] . Early developments of glass–
ceramic dental restoratives involved mica glass–ceramics [83–88] .
This glass–ceramic was processed by means of centrifugal cast-
ing. Crowns and inlays were produced with this technique. The
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 Review Höland, Schweiger, Watzke, Peschke & Kappert
translucency of the ceramic was controlled by precipitating disc-
shaped tetrasilicic mica. However, this process was overlapped
by a surface reaction of the glass–ceramics with the investment
material and the precipitation of enstatite-type crystals. After
removing this surface layer, the materials appeared more trans-
lucent. Apart from the centrifugal casting technique, machining
methods can be used to shape this material.
Molding technology
The development of the molding technique represented a signifi-
cant advance in the processing of dental ceramics. The technique
for molding leucite glass–ceramics to produce dental restora-
tions was developed by adapting the knowledge gained from
casting metals to the viscous flow principle [89,90] . The molding
procedure is conducted at 1080°C in a special, automatically
controlled furnace. Leucite crystals are formed through a con-
trolled surface crystallization processes in the SiO2–Al2O3 –K 2O
materials system. This type of surface crystallization is related
to the precipitation of crystals on each individual glass granule
and, therefore, this surface crystallization mechanism is quite dif-
ferent from the enstatite formation on mica glass–ceramics [91] .
The precipitation of the crystals increases the strength of the
glass–ceramic. Consequently, the IPS Empress® product exhibits
flexural strength of 120–180 MPa in biaxial tests [1,92,93] . Apart
from showing high strength, which renders the material suitable
for the fabrication of crowns, the glass–ceramic demonstrates a
CTE of 15–18.5 × 10 -6 K-1m/m, very good chemical durability
and outstanding optical properties, which are similar to those of
natural teeth. Studies have shown that the biomaterial also pos-
sesses wear properties that are close to those of natural teeth [94] .
In a clinical study covering 11 years, a survival rate of 95.2%
was recorded for anterior crowns and 84.4% for posterior crowns
(based on Kaplan–Meier methodology) [95] . Studies on inlays
and onlays spanning 8 years showed a survival rate of 92% [96] .
Equally high success rates were achieved in 6-year studies on
inlays and onlays [97] . The largest study, involving more than 100
clinical cases, showed a success rate of more than 90% [98] . In
general, clinical success is closely linked to the use of a suitable
cementation technique. In this context, adhesive cementation
seems to be the most promising method [99] . Nevertheless, in
comparisons between adhesive and conventional cementation
procedures, success rates of about 98% were achieved [100] . The
particularly esthetic properties of IPS Empress materials mean
that they are recommended for the fabrication of anterior res-
torations [101,95] and any type of inlay, onlay or veneer (in the
anterior or posterior region) [102–106] .
The IPS Empress glass–ceramics, in conjunction with the
dedicated furnace, have become firmly established in restorative
dentistry for the fabrication of dental restorations, such as inlays,
onlays and crowns [15,107–109] . From 1991 to 2007, 33 million
dental restorations were produced with this system (one unit
represents one inlay or one crown) [110] . A new system called
IPS Empress Esthetic, which offers improved optical properties
and optimized microstructure compared with the classical IPS
Empress system, was introduced in 2005. The optical properties
734
of this system provide almost ‘invisible’ restorations because the
translucency of the material is tuned to that of the tooth structure
and, therefore, allows a sort of ‘chameleon effect’.
Machinable materials
Apart from being molded, the leucite glass–ceramic of the IPS
Empress type (product name: IPS Empress CAD; previously
known as: IPS ProCAD) can be machined to produce inlays,
onlays and crowns. Initially, the developers were surprised by
the machinability of these leucite glass–ceramics using diamond
milling tools and a special milling strategy. Up to that time, the
machining properties of glass–ceramics were thought to be the
result of the precipitation of mica crystals in the material [111,112] .
However, machinable ceramics that contained feldspar crystals
in the glass matrix (Vitablocs® Mark I and II [CEREC, VITA
Zahnfabrik GmbH]) were also available since 1991. The extru-
sion technique was used to integrate these crystals in the matrix,
thereby causing internal stresses that made the material suitable
for machining [113] .
Nevertheless, these glass–ceramics that contained crystals in
the glass matrix were difficult to machine. Fortunately, a glass–
ceramic featuring a composition similar to that of IPS Empress
was found to be suitable for milling purposes. The leucite crystals
in this glass–ceramic grow according to a certain process, which
prevents the material from becoming too brittle. Therefore, this
glass–ceramic shows optimum machining properties. In addition,
a multicolored computer aided design (CAD)/computer aided
manufacturing (CAM) block was developed with this material.
As a result, the color transitions and shading, as well as the dif-
ferent levels of translucency that are found in natural teeth, can
now be reproduced faithfully [114,115] .
The IPS Empress CAD glass–ceramic is milled with Cerec®
equipment (Sirona, Germany) [116–119] . Before the restoration is
machined, a 3D image of the clinical situation is captured with
an intraoral camera [120,121] . Since the 1980s, the technology for
machining dental restorations has been improved systematically
to produce highly accurate results. Improvements of the machin-
ing technology from the beginning to today allows a precise fit
onto the tooth with hardly any marginal gaps [118, 122–129] .
Milling can be done either by the dental technician ‘lab-side’
or by the dentist ‘chair-side’. This method is a very interesting,
fast and reliable alternative to labor-intensive conventional tech-
niques. The teeth can be restored in a single appointment and,
therefore, there is no need for provisional restorations. The clinical
performance and longevity of this kind of CEREC restoration are
well documented [130–146] and the esthetic results are convincing.
Owing to the reliability of adhesive luting techniques there is
no need for mechanical retention for these kinds of restorations;
therefore, they offer an opportunity to preserve tooth structure.
Figure 3 shows part of the procedure generating an IPS Empress
CAD restoration machined with the CEREC 3D equipment. The
molar showed an extensive defect, received a composite build-up
and was prepared for an inlay restoration strictly according to the
extension of the defect. The location was scanned with an intraoral
scanner to generate a 3D model of the clinical situation. By means
Expert Rev. Med. Devices 5(6), (2008)
 Ceramics as biomaterials for dental restoration Review

A B

C D

Figure 3. Generation of an IPS Empress computer aided design (CAD) restoration. (A) Large defect on an upper molar prepared
to receive an Empress CAD CEREC restoration. (B) Digital 3D model of the prepared tooth. (C) Design of the virtual inlay. (D) Empress
CAD Inlay adhesively luted and polished.
Dentist: A Peschke.

of the CEREC 3 CAD software, an anatomically correct inlay was
designed and milled out of a solid block. The inlay was adhesively
luted using a composite cement and polished intraoraly. All steps
were made in one appointment within approximately 2 h and the
esthetic and functional results were very good.
These kinds of restorations show survival rates of 89% after
18  years [131], and thus are comparable to the results found
with conventional ceramic inlays and cast gold inlay and onlay
restorations [147,148] .
High-strength glass–ceramics for single units
& three‑unit bridges
Molding technology for single units & three-unit bridges
Once these glass–ceramics were being used successfully to fab-
ricate anterior restorations, a demand arose for similar materials
that could be used to produce posterior restorations. For this
purpose, the strength and toughness of these glass–ceramics had
to be increased. Unfortunately, another materials system had to
be found, as leucite glass–ceramics cannot achieve strengths of
more than 200 MPa. An initial increase in strength was attained
with a product from the SiO2 –ZrO2 –P2O5 system containing
Li12ZrSi6O15 crystals. The flexural strength of this glass–ceramic
was above 250  MPa; however, the material was very opaque.
Subsequently, more translucent products were developed with
strengths of 120 MPa, which were suitable for pressing onto ZrO2
posts due to adjusted CTE of 9.5 × 10 -6 K-1 m/m [149,150] .
Significantly higher strengths of 350 MPa were achieved with
glass–ceramics of the SiO2–Li2O–K 2O–ZnO–P2O5–Al2O3–La2O3
system by precipitating lithium disilicate (Li2Si2O5) crystals. The
IPS Empress 2 glass–ceramic is characterized by an interlocking
microstructure made up of disk-shaped, needle-like crystals. Its
crystal content of up to 70% volume is considerably higher than that
of leucite materials [151–154] . The IPS Empress 2 type glass–ceramic
is moldable, as leucite glass–ceramics, but at a lower temperature of
920°C. The linear CTE is 10.6 ± 0.5 × 10-6 K-1m/m.
Once the crown copings and bridge frameworks have been
fabricated with the lithium disilicate glass–ceramic, they are
coated with an apatite glass–ceramic, which is subsequently sin-
tered. This improves the optical properties of the restoration and
enhances its tooth-like appearance.

www.expert-reviews.com 735
 Review Höland, Schweiger, Watzke, Peschke & Kappert
A Its fracture toughness, stated as the established fracture toughness
B note, as the crystal content is higher than 60% volume. As a result,
Figure 4. IPS e.max® CAD LT restoration fabricated with
computer aided design/computer aided manufacture
technology (CEREC) in the chairside mode. (A) Try-in of a full
crown in its lithium metasilicate state. (B) The same crown after
final firing (shaded and glazed) and cemented.
Dentist: A Peschke.
Clinical studies have shown that lithium disilicate glass–
ceramics of the IPS Empress 2 type are suitable for fabricat-
ing crown copings and bridge frameworks. Nevertheless, as far
as bridges are concerned, the uses of this material should be
restricted to fabricating three-unit bridges for the anterior region
up to the second premolars, as the chewing forces in this area
are lower than in the posterior region [155–157] . In addition, it is
very important to observe the design requirements of the bridge
framework. For example, the dimensions of the connectors of
the individual bridge units must measure 4 × 4 mm 2 [158] . These
specifications are important to observe, as the breaking load of
a lithium glass–ceramic bridge is between 1000 and 2000 N,
and therefore much lower than that of a high-strength sintered
ceramic restoration [159] .
The 3G™ OPC® product (Pentron Ceramic Inc., USA) is
also composed of lithium disilicate glass–ceramic. It is derived
from the SiO2–Li2O–BaO–CaO system. Its main characteristics
include high strength and molding processing [301] .
An improved lithium disilicate glass–ceramic was developed
in the SiO2 –Li 2O–K 2O–P2O5 –Al 2O3 –ZrO2 system. It showed
increased flexural strength and controlled translucency and
shade [160–164] . This glass–ceramic, which is sold under the name
736
of IPS e.max® Press, has a flexural strength of more than 440 MPa.
(K IC) value, was determined as 2.3–2.9 MPa·m1/2 [162,165,166] .
This lithium glass–ceramic can be pressed into different shapes
using the molding technique, hence the name IPS e.max Press.
As the microstructure of the lithium disilicate glass–ceramic end
product has a very high crystal content and the crystals are noncleav-
able, an induced fracture propagates around these crystals [165] . The
deflection of the crack is responsible for increasing the toughness
of the glass–ceramic.
The exceptional translucent properties of the lithium disilicate
glass–ceramic are achieved by adjusting the index of refraction of
the crystal phase to that of the glass matrix. This is important to
this material can be produced in different levels of translucency,
depending on the clinical requirements.
As with the IPS Empress 2, the IPS e.max glass–ceramic can
be coated with fluoroapatite glass–ceramic (IPS e.max Ceram) to
improve its optical properties and enhance its wear behavior [167] .
IPS e.max Ceram has a flexuaral strength of 90 ± 10 MPa, a good
chemical durability (both according to ISO 6872) and a CTE
of 9.5 × 10 -6 K-1 m/m, which matches the framework materials
lithium disilicate glass–ceramic and zirconium dioxide ceramic.
The fluoroapatite crystals allow the adjustment of translucency
and brightness in order to achieve a natural esthetic.
The results of clinical studies on the lithium disilicate glass–
ceramic IPS. e.max Press show that the framework of only one
restoration out of 121 crowns and 18 bridges placed adhesively and
using glass ionomer cement fractured in the first 23 months [168] .
The results of 5-year studies revealed that a success rate of 96.7%
can be achieved if the specified dimensions, and those of the
connectors of 4 × 4 mm 2 in particular, are observed [169] .
Machinable glass–ceramics for single units
The goal in the development of IPS e.max glass–ceramics was
to produce a material that could be molded (IPS e.max Press)
or machined, thereby offering dentists and dental technicians a
choice between two fabrication methods. This goal was achieved
by introducing an intermediate fabrication step. As the lithium
disilicate final product is very difficult to mill in chair-side mill-
ing, units such as CEREC 3 (Sirona) and alternative options were
explored. As a result, an intermediate product, a lithium metasili-
cate glass–ceramic, was produced. This product called IPS e.max
CAD has a bluish color. The material is easy to machine in this
intermediate stage but has poor chemical resistance. Therefore,
after it has been machined, the lithium metasilicate glass–ceramic
is heat treated for a second time at 850°C. In this process, it is
transformed into lithium disilicate glass–ceramic, which dem-
onstrates tooth-like color, excellent chemical durability of under
100 µg/cm2 (according to dental standard measurements) and
high strength of 360 ± 60 MPa and toughness of 2 MPa·m1/2.
An example of this glass–ceramic, which initially has a blu-
ish tinge in its lithium metasilicate state, is shown in Figure 4 .
Beside the facilitation of the milling process, it is also easier for
the dentist to accomplish occlusal or proximal adjustments of the
Expert Rev. Med. Devices 5(6), (2008)
 Ceramics as biomaterials for dental restoration Review

restoration during try-in. After final adjustments it is possible to
individualize the restoration with shades and to glaze it before
terminal firing. This allows predicable functional and esthetic
results (Figure 4B) .
These materials are rather new and, therefore, the clinical data
are limited. However, preliminary results of prospective clinical
trials are promising, indicating low failure rates and good wear
behavior [170,171] .
an induced crack transforms the ceramic from a tetragonal to a
monocline modification (martensitic transformation), which is
connected to an increase in volume; therefore, crack propaga-
tion is inhibited. Consequently, we could call this mechanism
stress-induced transformation strengthening.
A

High-strength & high-toughness polycrystalline ceramics

veneered with glass–ceramics
Long before high-performance ceramics were used extensively in
the fabrication of dental crowns and bridges, ZrO2 was used to
create dental posts [150,152] . These ceramics were fused to glass–
ceramics using molding principles that intimately bonded the core
build-up with the post (Metal-based restorations).
In order to enable metal-free restorations to be used in all areas
of the mouth, even the posterior region, and for all types of resto-
rations, even bridges, high-performance ceramics featuring high
B
strength and high toughness had to be further developed and
adapted. First and foremost, suitable fabrication methods had
to be developed. Generally, a high-strength ceramic is used to
produce the framework, which is veneered with a silicate ceramic.
In the production of high-strength ceramics for the fabrication of
crown copings and bridge frameworks, Al2O3 and ZrO2 ceramics
are used predominantly. Machining is the preferred method for
fabricating dental restorations with these materials.
The previously mentioned CEREC milling system, which is
used to machine glass–ceramics, leucite ceramics and feldspathic
composites, is also suitable for cutting high-performance ceram-
ics in a presintered, open-pored state. In addition, a number
of milling systems have established themselves on the dental C
market for this purpose. The most important systems include
Procera® (Nobel Biocare, Göteborg, Sweden), Cercon® (Degussa
Dental, Hanau, Germany), LAVA™ (Espe Dental AG, Seefeld,
Germany), DCS® (DCS-Dental, Allschwil, Switzerland), Decim®
(Skelleftea, Sweden), Cicero® (Cicero Dental BV, Netherlands),
KaVOEverest® (KaVO EWL, Leutkirch, Germany), Ceramill®
(Amman Girrbach, Germany), ZirkonZahn® (Steger, Italy) and
Hint-ELs® (Hint-ELs, Germany).
Here we present an overview of the Al2O3 and ZrO2 materials
and a discussion of the special applications of ZrO2 ceramics.
Al2O3 ceramics in the form of Procera have been used to fabricate
crowns since 1991. Even bridges can be fabricated by sintering
together three different parts, which are fabricated from this mate-
rial (Procera alumina bridge). In addition, the Procera products Figure 5. Application of the veneering ceramic: molding/
include ZrO2 ceramics for the fabrication of bridges. The clinical pressing. (A) Teeth preparation (24 and 26) for a hybrid (crown
suitability of these products has been proven [172–174] . and inlay retained) full-ceramic three-unit bridge (IPS e.max®
A high-strength and high-toughness ceramic of the 3Y2O3 –ZrO2 ZirCAD and Zir Press), attend to the minimally invasive
type for the fabrication of dental restorations is available on the preparation of the premolar. (B) Hybrid full-ceramic bridge on
mirror, the high-strength IPS e.max ZirCAD ceramic is visible as
market. This material exhibits high flexural strength and tough- white framework, the margin is pressed with a glass–ceramic to
ness of 900–1200 MPa and a K IC value of 4–5 MPa·m1/2 (deter- achieve the best adhesion to tooth structure by means of luting
mined according to the single-edge V-notched beam [SEVNB] composite. (C) Adhesively luted hybrid full-ceramic bridge (IPS
method). The toughening mechanism of this ceramic has been e.max ZirCAD and Zir Press) in clinical situation.
thoroughly examined and discussed [175–179] . In this mechanism, Dentist: R Watzke; dental technician: F Perkon.

www.expert-reviews.com 737
 Review Höland, Schweiger, Watzke, Peschke & Kappert

High-performance ceramics are predominantly machined

to produce dental restorations (finished product or presintered
A
open-pored product) or processed through sonoerosion [180]
or electrophoresis precipitation [302,303] . Milling is the most
frequently used processing technique. Two possibilities are
available: machining of the finished product or machining of
a presintered, open-pored ceramic. In the first case, high-per-
formance computer numerical control machines are required
(e.g., DCS and Decim). Nevertheless, as the ZrO2 ceramic is
very strong and tough it is very difficult to mill. Therefore,
processing systems have been designed to machine open-pored
intermediate products, which are subsequently sintered to pro- B
duce the finished product. As the volume of the work pieces
shrinks in the firing process, oversized restorations have to be
cut from the intermediate product, which take into account
this shrinkage. The LAVA and Cercon systems, for example,
use this technique.
The 3Y2O3 –ZrO2 ceramic of the LAVA system is reported to
show strength values of approximately 930 MPa (three-point
bending) and a K IC value of 5 MPa·m1/2 after the sintering pro-
C
cess. If the open-pored ZrO2 material is infiltrated with color-
ing liquids, its strength does not decrease [181,182] . The clinical
suitability of ZrO2 bridges made with the LAVA system has
been confirmed in scientific investigations. In these studies, the
frameworks were veneered with a silicate ceramic. Tribochemical
activation took place with SiO2 [183,184] .
Users of the Cercon system (TZP ceramic and feldspathic
layering material Cercon S) are advised to observe the recom-
mended dimensions of the connectors in three- to five-unit
bridges. These connector diameters should not fall short of Figure 6. Application of the veneering ceramic: sintering.
the following minimum values: 2.7 mm for three-unit bridges, (A) Clinical situation of the prepared teeth (14–16). (B) The same
4.0 mm for four-unit bridges and 4.9 mm for five-unit bridges. bridge (IPS e.max ZirCAD veneered with Ceram) on the dental
This precaution reduces the risk of below critical crack growth. technicians gypsum model. (C) Three-unit full-ceramic bridge
The restorations are expected to last approximately 20 years. The (IPS e.max® ZirCAD veneered with Ceram®) in clinical situation
(teeth 14–16).
recommended dimensions of ZrO2 frameworks are smaller than Dentist: A Stiefenhofer; dental technician: F Perkon.
those of lithium disilicate glass–ceramics [185,186] .
To enhance the IPS e.max materials system discussed previ- The IPS e.max Ceram glass–ceramic exhibits strength of
ously, a high-strength and high-toughness ceramic was developed, 90 ± 10 MPa, a linear CTE of 9.5 ± 0.25 × 10 -6 K-1m/m and
which is also veneered with fluoroapatite glass–ceramics [167,187] . very good chemical durability according to ISO 6872. IPS e.max
Therefore, a system of biomaterials was created that covers the Ceram is sintered on ZrO2 at a temperature of 760°C.
entire spectrum of indications for dental restorations, ranging IPS e.max ZirPress is molded at 910 °C. It demonstrates strength
from inlays, which are the most frequently produced restora- of 110 ± 10 MPa, a linear CTE of 9.75 ± 0.25 × 10-6 K-1m/m and
tions, to restorations for the anterior and posterior region of the very good chemical durability according to ISO 6872.
mouth. The high-strength 3Y2O3 –ZrO2 ceramic is called IPS In its porous state, the ZrO2 material is milled using the CEREC
e.max ZirCAD. It is veneered with the fluoroapatite glass–ceram- equipment and then densely sintered in the dental laboratory in
ics IPS e.max Ceram or IPS e.max ZirPress. Both fluoroapatite a special furnace, called Sintramat®, at 1500°C with a holding
glass–ceramics were developed in the SiO2–Al2O3 –Na 2O–K 2O– time of 30 min. After this processing step, the ceramic has the
ZnO–CaO–P2O5 –F system and contain needle-like fluoroapa- following properties: flexural strength of 900 ± 50 MPa, a linear
tite crystals. The solid-state reaction involved in the formation CTE of 10.75 ± 0.25 × 10 -6 K-1 m/m and very good chemical
of needle-like fluoroapatite glass–ceramics has been studied in durability (according to ISO 6872). The strengthening mecha-
detail in transmission electron microscopy (TEM) and nuclear nism of ZrO2 is based on the previously mentioned martensitic
magnetic resonance investigations. The growth of these crystals transformation [175,189,190] . After the ceramic has been machined
along the c-axis and the defect-free interface between the crystals and sintered, the dental technician has two options for applying
and the glass matrix have been analyzed with high-resolution the veneering ceramic: molding/pressing or sintering. The choice
TEM [188] . of the method depends on the final product and its geometry and

738 Expert Rev. Med. Devices 5(6), (2008)

 Ceramics as biomaterials for dental restoration Review

on the working procedures used in the laboratory. Figure 5 (mold-
ing/pressing) and Figure 6 (sintering) show the results achieved
with both of these techniques. The fact that minimally invasive
preparation is required and that the materials are optimally fused
in the molding technique must be highlighted (Figure 5B) .
Only this kind of high-strength and high-toughness polycrys-
talline ceramics veneered with glass–ceramics restoration offer
such esthetic solutions with the opportunity to save as much tooth
structure as possible.
In the clinical case (Figure 5), the patient has lost the second pre-
molar (25) due to endodontic reasons. To replace the tooth there
are two possibilities, either a single dental implant or a fixed partial
denture. Owing to the small degree of damage to the first premolar,
the author decided to restore the second premolar by means of a
hybrid-inlay and crown-retained fixed partial denture [191–197] . A
high-strength zirconia framework was used because of good in vitro
and short-term in vivo survival results [198–206] . The zirconia frame-
work is designed and milled in a CAD/CAM process. This saves
time for the dental technician during the whole manufacturing
process. To achieve a good esthetic result, the opaque framework
is veneered with glass ceramic by means of the press-on technique
instead of veneering it with different ceramic pastes step-by-step
(as with IPS e.max ZirCAD veneered with Ceram presented in
Figure 6 ). This guaranteed that the glass ceramic surrounded the
framework completely and, therefore, formed the marginal edge.
On that condition the full ceramic bridge could be luted adhe-
sively. The individualization of the ceramic bridge was performed
by painting it. After try-in of the hybrid, full-ceramic bridge and
controlling for esthetics and function, it was luted adhesively.
Clinical studies have shown a survival rate of the framework
material of 99.1% and the veneering material of 97.1% after
34 months. Additional clinical results confirm the excellent bio-
compatibility of the restorations in a multicomponent composite
system made of sintered ceramics and glass–ceramics. A defect-free
bond can be achieved by carefully observing the experimental
parameters in the joining of the glass–ceramic with the high-
performance ceramic [207] . However, if uncontrolled stresses do
occur, the glass–ceramic may chip or delaminate. Therefore, the
procedure must be conducted with great care. Table 1 shows the
advantages and risks for full-ceramic restorations.
In order to expand the application range of the materials system,
it was supplemented with colored infiltration liquids. These liq-
uids impart ZrO2 frameworks with dental shades. Furthermore,
initial fundamental research results involving ZrO2 ceramics
have shown that it is possible to produce ZrO2 ceramics in dental
shades. The content of the coloring ions is very low but highly
effective in imparting color [207] .
Expert commentary & five-year view
In the field of materials development, a number of avenues have
been explored in an effort to produce materials that simulate the
characteristics of natural teeth. In the process, special attention
has been paid to increasing the strength and toughness values
to the point that they exceed those of natural teeth, allowing
the materials to be used in the fabrication of sophisticated and
esthetic bridgework. Dental materials are generally divided into
the following categories: materials for small or large restorations
and materials for anterior or posterior teeth.
The indications table (Table 2) clearly shows that the different types
of glass–ceramics and high-strength ceramics available today already
cover the entire range of indications of dental restorations. In some
cases, the information in this indications table is based on long-term
clinical experience with the different groups of materials.
The most important finding of the present publication, which
will play a significant role in the next 5 years, is the fact that the
trend towards the development, fabrication and use of metal-free
restorations will continue to grow. Nevertheless, it is to be expected
that metal-reinforced restorations (especially long-span bridges)

Table 2. Indication of ceramics and glass–ceramics as biomaterials for dental restoration.

Clinical indication Ceramics and glass–ceramics Leucite Lithium disilicate Oxide ceramics
fused to metal framework glass–ceramics glass–ceramics
Copings – – + +
Inlays – + *
+ *
–
Onlays (partial coverage) – + *
+ *
–
Veneers – + *
+ *
–
Anterior crowns + +* + +
Posterior crowns + + *
+ +
Three-unit anterior bridges (up to + – + +
second premolar)
Three-unit posterior bridges + – – +
Bridges > 3 units + – – +
Inlay-retained bridges – – – +*
*
Adhesive cementation required.
+: Recommended.
– : Not indicated.

www.expert-reviews.com 739
 Review Höland, Schweiger, Watzke, Peschke & Kappert

will retain their place alongside restorative biomaterials. Glass– Acknowledgement

ceramics are particularly suitable for fabricating inlays, crowns and
small bridges, as these materials achieve very strong, esthetic results.
High-strength ceramics are preferred in situations where the mate-
rial is exposed to high masticatory forces. In the field of ceramics,
developments are concentrating on the coloring of the materials to
enhance their smooth integration in the natural dentition.
The processing technologies to watch in the future include sin-
tering, molding and machining. The trend towards machining
techniques continues to develop strongly. Therefore, comprehen-
sive clinical studies and extensive training of dentists and dental
technicians are required.
Dedicated to Volker M Rheinberger on the occasion of his 60th birthday.
Financial & competing interests disclosure
The authors are all employed by Ivoclar Vivadent AG; an international
supplier of systems for the dental practice and the dental laboratory. The
authors have no other relevant affiliations or financial involvement with
any organization or entity with a financial interest in or financial conflict
with the subject matter or materials discussed in the manuscript apart from
those disclosed.
No writing assistance was utilized in the production of this review
manuscript.

Key issues
• Clinical studies to identify the indications of biomaterials for restorative dental applications are ongoing.
• Joining and connecting of different materials achieves the best possible mechanical and optical properties and long-term service life of
dental restorations.
• Optimization of processing techniques will enable efficient and precision fabrication of restorations.
• Training of professional staff to handle and use materials properly is necessary.
• Continuation of the trend towards completely treating the patient in few or, if possible, in one appointment is anticipated.
• Development and use of minimally invasive techniques in restorative dentistry will hopefully become a reality.

10 Hench LL, Bioceramics: from concept to 19 Lindemann W. Kristalline Phasen in

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Affiliations
Wolfram Höland, Prof. Dr. rer. nat. habil.
Research and Development, Ivoclar
Vivadent AG, Bendererstr. 2, FL-9494
Schaan, Liechtenstein
Tel.: +423 235 3373
Fax: +423 239 4373
wolfram.hoeland@ivoclarvivadent.com
• Marcel Schweiger, Dipl. Ing.
Head of Ceramic Development, Ivoclar
Vivadent AG, Bendererstrasse 2, FL-9494
Schaan, Liechtenstein
Tel.: +423 235 3481
Fax: +423 239 4481
marcel.schweiger@ivoclarvivadent.com
• Ronny Watzke
Dentist, Dental Clinic, Research and
Development, Ivoclar Vivadent AG,
Bendererstr. 2, FL-9494 Schaan,
Liechtenstein
Tel.: +423 235 3207
Fax: +423 239 4207
ronny.watzke@ivoclarvivadent.com
Arnd Peschke, Dr. med. dent.
Head of Dental Clinic, Research and
Development, Ivoclar Vivadent AG,
Bendererstr. 2, FL-9494 Schaan,
Liechtenstein
Tel.: +423 235 3665
Fax: +423 239 4665
arnd.peschke@ivoclarvivadent.com
Heinrich Kappert, Prof. Dr. rer. nat.
Research and Development, Ivoclar
Vivadent AG, Bendererstr. 2, FL-9494
Schaan, Liechtenstein
Tel.: +423 235 3436
Fax: +423 239 4436
heinrich.kappert@ivoclarvivadent.com
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