Ceramics are defined as the art and science of making and using solid articles that have as their

essential
component inorganic nonmetallic materials [Kingery et al., 1976].
The word CERAMIC infers any material which is fabricated through the application of heat (Greek
‘keramos’ - burnt material). It is an inorganic compound with non-metallic properties typically
composed of metallic(or semimetallic) and non-metallic elements.
Ceramics are refractory, polycrystalline compounds, usually inorganic, including silicates, metallic
oxides, carbides and various refractory hydrides, sulfides, and selenides. Oxides such as Al2O3, MgO,
SiO2, and ZrO2 contain metallic and nonmetallic elements and ionic salts, such as NaCl, CsCl, and ZnS
[Park and Lakes, 1992]. Exceptions to the preceding include covalently bonded ceramics such as diamond
and carbonaceous structures such as graphite and pyrolized carbons [Park and Lakes, 1992].
Ceramics: compounds of one or more metals with a nonmetallic element, usually oxygen. They are
formed of chemical and biochemical stable substances that are strong, hard, brittle, and inert
nonconductors of thermal and electrical energy (GPT 8)

The term porcelain refers to a family of ceramic materials composed essentially of kaolin, quartz, and
feldspar, also fired at high temperature. Dental ceramics for ceramic-metal restorations belong to this
family and are commonly referred to as dental porcelains.

Indications of ceramics:
• Aesthetic alternative for discoloured teeth
• Badly or grossly carious teeth
• Traumatic fracture of incisal angles or cusps of teeth
• Congenital abnormalities
• Veneers
• Inlays or onlays
• Abutment retainers
• Denture as tooth material
• Splinting of mobile teeth with metal backing

Advantages
• Excellent biocompatibility
• Chemically inert
• Excellent esthetics due to
– Translucency.
– Good color stability
– Capability of being pigmented

Disadvantages
• Poor mechanical properties as the tensile strength is low, brittle and easy to fracture when flexed
or when quickly heated and cooled. Compared with ceramics, alloys used in dentistry are
generally very strong and resistant to fracture when subjected to different types of stresses.
• Causes abrasive wear of opposing teeth
• High shrinkage on fusing conventional ones
• Technique sensitive

Properties
• Dental ceramics exhibit fair to excellent flexure strength and fracture toughness. One of the
strongest ceramics, zirconium dioxide, has a flexure strength similar to that of steel, although the
fracture toughness of steel is far greater than that of zirconia.
Flexural Strength - Ground-75.8 Mpa glazed-141.1Mpa)
• Compresssive Strength – 170-331 MPa

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 • Tensile Strength - 25-34Mpa
• Elastic Modulus - 69-70 Gpa
• Thermal Co-efficient of expansion - 12-14 X 10-6 /oC
• Surface Hardness - 460 KHN (enamel 343 KHN)
• Specific gravity- 2.242 for fired porcelain
• 0.1% deformation is sufficient to fracture porcelain
• Appearance similar to natural tooth
• Insulating properties
– Low thermal conductivity
– Low electrical conductivity
– Low thermal diffusivity
• Corrosion resistant - Ceramics are more resistant to corrosion than plastics
• Highly biocompatible
• Solubility is less
• Generally do not react with most liquids, gases, alkalis, and acids.

Classification of ceramics:
Ceramics can he classified in one of four categories(Anusavice):
(1) silicate ceramics, (2) oxide ceramics, (3) nonoxide ceramics, and (4) glass-ceramics.

Silicate ceramics are characterized by an amorphous glass phase with a porous structure. The main
components are SiO2 with small additions of crystalline Al 203, MgO, ZrO2 and/or other oxides. Dental
porcelains fall into this category.

Oxide ceramics contain a principal crystalline phase (e.g., Al 203, MgO, Tho2, or ZrO2) with either no
glass phase or a small content of glass phase. Zirconia is of major dental importance because of its high
fracture toughness. Pure ZrO2 is not a useful dental ceramic because cracks occur during sintering as a
result of a phase transformation from the tetragonal to the monoclinic structure. This transformation can
be fully or partially suppressed by the addition of certain other oxides such as MgO, Y 2O3, CaO, and CeO.
One of the more recent ceramic materials for dental prostheses is Zr02 fully stabilized with yttria (Y 2O3);
this is sometimes designated as Y-CSZ. Multicomponent or mixed oxide structures may also be useful for
dental applications. Three examples of this class of ceramics include MgO.Al203 (spinel),
3Al203.2Si02(mullite), and Al203, TiO2, (AI2TiO5, or aluminum titanate). The spinel structure is used in a
glass-infiltrated ceramic (In-Ceram Spinell) when greater translucency is required compared with glass-
infiltrated alumina or zirconia.

Nonoxide ceramics are impractical for use in dentistry; the reasons for their impracticality vary but
usually involve either their high processing temperatures, complex processing methods, or unaesthetic
color and opacity. Such ceramics include borides, carbictes, nitrides, selenide, silicide, sialon and syalon

Glass-ceramics are partially crystallized glasses that are produced by nucleation and growth of crystals in
the glass matrix phase. An example of such a product that has been used in dentistry is Dicor glass-
ceramic, which was based on the growth of tetrasilicic fluormica crystals in a glass matrix. This material
was originally supplied as glass ingots (containing a nucleating agent) that were melted and cast into a
refractory mold and subsequently processed thermally to produce the crystal phase. Casting of glass
forms is no longer applied for producing dental prostheses, although certain glass-ceramics have heen
used for CAD-CAM processing systems.

According to Composition: Pure alumina(Procera), Pure zirconia, Silica glass, Leucite based glass
ceramic(IPS Empress), Lithia based glass ceramic(IPS Empress 2).

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According to microstructure
 Non-Crystalline Ceramics e.g.: Feldspathic porcelain
 Crystalline Ceramics e.g.: Aluminous porcelain, Glass-Ceramics

According to Sub-structure material: Cast Metal, Swaged metal(Captek), Glass ceramics(Dicor),

Sintered core ceramics(Hi-ceram) and CAD-CAM porcelain(Lava frame), sintered ceramic core

According to translucency: opaque, translucent, and transparent

According to type
 feldspathic porcelain,
 leucite-reinforced porcelain,
 aluminous porcelain,
 alumina
 glass-infiltrated alumina,
 glass-infiltrated spinel,
 glass-infiltrated zirconia
 glass-ceramic

According to use
 denture teeth,
 metalceramics,
 veneers,
 inlays,
 crowns,
 anterior bridges and posterior bridges

According to firing temperature

Anusavice, Science of dental materials , 11th edition
 High fusing- 13000c (23720F)
 Medium fusing- 1101-13000c(2013-20720F)
 Low fusing- 850-11000c(1562- 20120F)
 Ultra low fusing- <8500c(15620F)

Shillingburg, 3rd edition

 High fusing - 1290 to 1370 C
 Medium fusing – 1090 to 1260 C
 Low fusing – 870 to 1065 C

According to processing technique

 Conventional powder slurry ceramics. Eg:Optec HSP, Duceram LFC
 Castable ceramics. Eg: Dicor.
 Machinable ceramics. Eg: Cerec Vitablocs Mark I, Cerec Vitablocs Mark II, Dicor MGC
(Dentsply,L.D. Caulk Division), Celay blocks(Vident)
 Pressable ceramics. Eg: IPS Empress, Optec Pressable Ceramic.
 Infiltrated ceramics. Eg: In-Ceram.

According to application
1) Core porcelain

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 2) Body porcelain
3) Enamel porcelain

According to method of firing

1) Air fired (i.e. at atmospheric pressure)
2) Vacuum fired (i.e. below atmospheric pressure)
3) Diffusible gas firing

Composition
Dental ceramics may consist primarily of glasses, porcelains, glass-ceramics, or highly crystalline
structures.
Most dental ceramics are compounds of oxygen with lighter metals or semimetals (metalloids) that have
some properties of metals and nonmetals, but they are generally nonmetallic in nature.
Dental ceramics are nonmetallic, inorganic structures, primarily containing cornpounds of oxygen with
one or more metallic or semimetallic elements (aluminum, calcium, lithium, magnesium, phosphorus,
potassium, silicon, sodium, titanium, and zirconium). Ceramic structures composed of a single element
are rare. The diamond structure is a major ceramic of this type and the unit cell consists of carbon atoms,
each one sharing an electron with each of four surrounding carbon atoms. This structure is bonded by
strong covalent forces, which result in a high elastic modulus, high temperature stability in an oxygen-
free environment (up to at least 3700" C), and the highest hardness of any natural material.

Structure
Many dental ceramics contain a crystal phase and a glass phase based on the silica structure. This
structure is characterized by a Si-0 tetrahedron in which a Si 4+ cation is positioned at the center of a
tetrahedron with 0- anions at each of the four corners. The resulting structure is not close-packed, and it
has both covalent and ionic characteristics. The Si0 4 tetrahedra are linked together by sharing their
corners.

There are two useful concepts that help demystify dental ceramics by providing a structure within which
to organize thinking. First, there are only three main divisions to the spectrum of dental ceramics:
(1) predominantly glassy materials, (2) particle-filled glasses, and (3) polycrystalline ceramics
Defining characteristics are provided for each of these ceramic types.
Second, virtually any ceramic within this spectrum can be considered as being a ‘‘composite,’’ meaning a
composition of two or more distinct entities. Many seemingly different dental ceramics can be shown to
be similar or closely related to each other when reviewed within the framework of these two simplifying
concepts. Additionally, the rationale behind the development of ceramics of historic and recent interest
can be more easily understood. Two examples of the utility of these concepts include these statements:
(1) Highly esthetic dental ceramics are predominantly glassy, and higher strength substructure ceramics
are generally crystalline; and
(2) The history of development of substructure ceramics involves an increase in crystalline content to
fully polycrystalline.

Predominantly glassy ceramics

Dental ceramics that best mimic the optical properties of enamel and dentin are predominantly glassy
materials. Glasses are three-dimensional (3-D) networks of atoms having no regular pattern to the spacing
(distance and angle) between nearest or next nearest neighbors; thus, their structure is amorphous, or
without form. Glasses in dental ceramics derive principally from a group of mined minerals called
feldspar and are based on silica (silicon oxide) and alumina (aluminum oxide); hence, feldspathic
porcelains belong to a family called aluminosilicate glasses. Glasses based on feldspar are resistant to
crystallization (devitrification) during firing, have long firing ranges (resist slumping if temperatures rise
above optimal), and are biocompatible. In feldspathic glasses, the 3-D network of bridges formed by

4
silicon-oxygen-silicon bonds is broken up occasionally by modifying cations such as sodium and
potassium that provide charge balance to nonbridging oxygen atoms. Modifying cations alter important
properties of the glass, for example, by lowering firing temperatures or increasing thermal
expansion/contraction behavior.

Particle-filled glasses
Filler particles are added to the base glass composition to improve mechanical properties and to control
optical effects such as opalescence, color, and opacity. These fillers are usually crystalline but can also be
particles of a higher melting glass. Such compositions based on two or more distinct entities (phases) are
formally known as ‘‘composites,’’ a term often reserved in dentistry to mean resin-based composites.
Thinking about dental ceramics as being composites is a helpful and valid simplifying concept. Much
confusion is cleared up in organizing ceramics by the filler particles they contain (and how much), why
the particles were added, and how they got into the glass. The first fillers to be used in dental ceramics
contained particles of a crystalline mineral called leucite. This filler was added to create porcelains that
could be successfully fired onto metal substructures. Leucite has a high thermal expansion/contraction
coefficient (20×10-66/°C) compared with feldspathic glasses (8×10 -66/°C). Dental alloys have
expansion/contraction coefficients around 12 to 14 (×10 -66/°C). Adding about 17 to 25 mass% leucite
filler to the base dental glass creates porcelains that are thermally compatible during firing with dental
alloys. Metal-ceramic systems, first developed in 1962, are used to fabricate 70% to 80% of fixed
prostheses. Moderate strength increases can also be achieved with appropriate fillers added and uniformly
dispersed throughout the glass, a technique termed ‘‘dispersion strengthening.’’ The first successful
strengthened substructure ceramic was made of feldspathic glass filled with particles of aluminum oxide
(55 mass%). Leucite also is used for dispersion strengthening at concentrations of 40 to 55 mass%, which
is much higher than needed for metal-ceramics.

Commercial ceramics incorporating leucite fillers for strengthening include a group that are pressed into
molds at high temperature (OPC, Pentron [Wallingford, Connecticut]; Empress, Ivoclar- Vivadent
[Schaan, Liechtenstein]; and Finesse All-Ceramic, Dentsply Prosthetics [York, Pennsylvania]) and a
group provided as a powder for traditional porcelain build-up (OPC Plus, Pentron; Fortress; Mirage
Dental Systems [Kansas City, Kansas]).
Beyond thermal expansion/contraction behavior, there are two major benefits to leucite as a filler choice
for dental ceramics—the first intended and the second probably serendipitous. First, leucite was chosen
because its index of refraction is close to that of feldspathic glasses, an important match for maintaining
some translucency. Second, leucite etches at a much faster rate than the base glass, and it is this
‘‘selective etching’’ that creates a myriad of tiny features for resin cements to enter, creating a good
micromechanical bond.

Glass-ceramics (special subset of particle-filled glasses)

Crystalline filler particles can be added mechanically to the glass, for example by mixing together
crystalline and glass powders before firing. In a more recent approach, the filler particles are grown inside
the glass object (prosthesis or pellet for pressing into a mold) after the object has been formed. After
forming, the glass object is given a special heat treatment causing the precipitation and growth of
crystallites within the glass. Because these fillers are derived chemically from atoms of the glass itself, it
stands to reason that the composition of the remaining glass is altered as well during this process termed
‘‘ceraming.’’ Such particle-filled composites are called glass-ceramics.
The material Dicor (Dentsply), the first commercial glassceramic available for fixed prostheses, contained
filler particles of a type of crystalline mica (at 55 vol%). More recently, a glass-ceramic containing 70 vol
% crystalline lithium disilicate filler has been commercialized for dental use (Empress 2; Ivoclar-
Vivadent).

Polycrystalline ceramics

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Polycrystalline ceramics have no glassy components; all of the atoms are densely packed into regular
arrays that are much more difficult to drive a crack through than atoms in the less dense and irregular
network found in glasses. Hence, polycrystalline ceramics are generally much tougher and stronger than
glassy ceramics. Polycrystalline ceramics are more difficult to process into complex shapes (eg. a
prosthesis) than are glassy ceramics. Well fitting prostheses made from polycrystalline ceramics were not
practical before the availability of computer-aided manufacturing. In general, these computer-aided
systems use a 3-D data set representing the prepared tooth or a wax model of the desired substructure.
This 3-D data set is used to create an enlarged die upon which ceramic powder is packed (Procera; Nobel
Biocare, Go¨ teborg, Sweden) or to machine an oversized part for firing by machining blocks of partially
fired ceramic powder (Cercon, Dentsply Prosthetics; Lava, 3M-ESPE [Seefeld, Germany]; Y-Z, Vita
Zahnfabrik [Bad Sa¨ ckingen, Germany]). These approaches rely upon well-characterized ceramic
powders for which firing shrinkages can be predicted accurately.
Polycrystalline ceramics tend to be relatively opaque compared with glassy ceramics; thus, these stronger
materials cannot be used for the whole wall thickness in esthetic areas of prostheses. These higher-
strength ceramics serve as substructure materials upon which glassy ceramics are veneered to achieve
pleasing esthetics. Laboratory measures of the relative translucency of commercial substructure ceramics
are available for a single-layer of materials and for those that are veneered. Although laboratory measures
of opacity have equated some polycrystalline ceramics to cast alloys, all ceramic substructures transmit
some light, whereas metals do not.

Substructure ceramics
The development of higher-strength ceramics for veneered all-ceramic prostheses can be represented as a
transition toward increases in the volume percentage of crystalline material with decreasingly less glass
and finally no glass. In 1965, McLean reported on the strengthening of a feldspathic glass via addition of
aluminum oxide particles, the same year that General Electric first applied that new technology
(dispersion strengthening of glasses) to high-tension power line insulators. In the late 1980s, a method
was developed to significantly increase the aluminum oxide content (from 55 mass% to 70 vol%) by first
lightly firing packed alumina powder and then infiltrating the still porous alumina compact with glass.
During the first light firing, adjacent alumina particles become bonded where they touch, forming a 3-D
network of linked particles. Infiltration involves a low-viscosity glass drawn into the porous alumina
network by capillary pressure, forming an interpenetrating 3-D composite (the alumina and glass being
continuous throughout the ceramic and neither representing an isolated ‘‘filler’’). Although, with only 70
vol% aluminum oxide, this ceramic (In-Ceram Alumina; Vita) has strength and fracture toughness
identical to many 100% polycrystalline alumina ceramics.

Composition
The various ingredients used in different formulations of ceramics are:
1. Silica (Quartz or Flint) – Filler
2. Kaolin (China clay) – Binder
3. Feldspar – Basic glass former
4. Nepheline, Syenite & Leucite
5. Water – Important glass modifier
6. Fluxes – Glass modifiers
7. Colour pigments
8. Opacifying agents
9. Stains and colour modifiers
10. Fluorescent agents
11. Glazes and Add-on porcelain
12. Alumina
13.Alternative Additives

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Silica : It is one of the most abundant elements on earth and can exist in many different forms such as
crystalline materials like crystalline Quartz, crystalline Cristobalite, crystalline Tridymite and amorphous
materials like Fused quartz, Agate, Jasper and Onyx.
Pure Quartz crystals (SiO2) are used for manufacturing dental porcelain. It is made by selecting
uniformly light-coloured pieces of quartz free from traces of iron which are ground or ball milled to the
finest grain size possible.
Quartz (crystalline silica) used in porcelain acts as a filler and strengthening agent. It also provides
greater translucency. Silica remains unchanged at the usual firing temperatures and hence contributes
stability to the mass during heating by providing a framework for other constituents. Fused silica is a
material whose high-melting temperature is attributed to the three-dimensional network of covalent bonds
between silica tetrahedra, which are the basic structural units of the glass network. Because it has a high
melting point, it also provides a high strength framework for other ingredients during firing and helps to
maintain the form (shape) of a freestanding object during firing. During subsequent firing, little or no
pyrochemical reaction occurs, but the glass phase softens and flows slightly. This softening allows
powder particles to coalesce together (sintering) and form a dense solid. Raw ingredients for low and
medium fusing porcelains are same as for the high fusing porcelain powders but in addition contain
balancing oxides / fluxes. These modify properties by interrupting glass network and hence are also
known as glass modifiers

Kaolin (White China Clay)

Essentially consists of the mineral Kaoliniteanhydrate aluminosilicate (Al 2O3, 2SiO2, 2H2O)
Its functions are:-
 It increases the mouldability of the plastic porcelain
 Acts as a binder and helps in maintaining the shape of the unfired porcelain during firing.
 At high temparature, it fuses and reacts with other ingredients to form the glassy matrix.
 On heating, reacts limitedly with feldspar and thereby provides rigidity
 Adheres to framework of quartz particles and shrinks considerably during firing
 Pure kaolin is white in color and reduces the translucency of porcelain, hence included only in
small concentrations of 4 to 5%.

Feldspars
These are a group of naturally occurring minerals, which are complex alkaline aluminium silicate.
They are found in many parts of the world, and in nature they break down under the action of water and
carbon dioxide to form kaolin and alkali carbonates. They have a crystalline structure and are opaque in
nature with an indefinite colour between gray and pink.
Types of feldspar :
 Albite (Soda feldspar) – Sodium alumina ( Na 2O Al2O3, 2SiO2, 2H2O) decreases fusion
temperature
 Orthoclase/microcline (Potash feldspar) – Potassium aluminium silicate (K2O Al 2O3 6SiO2)
increases the viscosity of glass.

Natural feldspars are never pure and the ratio of soda (Na 2O) to potash (K2O) may vary; which affects the
properties, in that the soda tends to lower the fusion temperature and the potash increases the viscosity of
the molten glass. Proper potash content decreases the danger of excessive pyroplastic flow during firing
of porcelain, which could otherwise result in rounding of the edges, loss of tooth form and or shape and
the obliteration of surface characteristics which contribute to a life like appearance.

Role of feldspar :
Glass phase formation: During firing, the feldspar fuses and forms a glassy phase that softens and flows
slightly allowing the porcelain powder particles to coalesce together. The glassy phase forms a

7
translucent glassy matrix between the other components in the dense solid. For dental porcelains, the
process by which the particles coalesce is called liquid-phase sintering, a process controlled by diffusion
between particles at a temperature sufficiently high to form a dense solid. The driving force for sintering
is the decrease in energy caused by a reduction in surface area. Three dental products (In- Ceram
Alumina, Spinell, and Zirconia) are slightly sintered to produce interconnected pore channels that are
necessary for subsequent glass infiltration.

Leucite formation: Another important property of feldspar is its tendency to form the crystalline mineral
leucite when melted. When feldspar is heated at temperatures between 1150°C and 1530°C, it undergoes
incongruent melting to form crystals of leucite in a liquid glass. Incongruent melting is the process by
which one material melts to form a liquid plus a different crystalline material. This tendency of feldspar
to form leucite during incongruent melting is used to advantage in the manufacture of porcelains for metal
bonding.
Many dental glasses do not contain leucite as a raw material. Since feldspar is not essential as a precursor
to the formation of leucite, as described earlier, these glasses are modified with addltions of leucite to
control their thermal contraction coefficients.
Feldspathic porcelains contain a variety of oxide components, including SiO 2 (52-62 wt%), Al203, (11 -16
wt%), K20 (9-11 wt%), Na2O (5-7 wt%), and certain additives, including Li 20 and B203.These ceramics
are called porcelains because they contain a glass matrix and one or more crystal phases. They cannot be
classified as glass-ceramics because crystal formation does not occur through controlled nucleation and
crystal formation and growth.
There are four types of veneering ceramics-these include (1) low-fusing ceramics (feldspar-based
porcelain and nepheline syenite-based porcelain); (2) ultra low-fusing ceramics (porcelains and glasses);
(3) stains, and (4) glazes (self-glaze and add-on glaze). The particle type and size of crystal particles, if
present, will greatly influence the potential abrasiveness of the ceramic prosthesis.

Nepheline Syenite
It is an ignesious rock, a syenite, and somewhat resembling granite in texture, hardness and
general appearance, essentially containing the minerals nepheline, potash feldspar and soda feldspar,
although in lesser variation than in natural feldspar. The use of nepheline syenite has been tried as a
replacement for feldspar. (Orlowski, 1944); however, it never became popular, probably due to greater
pyroplasticity when compared to feldspar.

Leucite
Is a potassium aluminum silicate mineral with a large coefficient of thermal expansion (20-
25ppm/oC) compared to feldspathic glasses (10ppm/ oC). It is an artificial crystal feldspathoid
(K2O.Al2O3.4SiO2) formed by the incongruent melting of feldspar (K2O.Al2O3. Al 2O3-4SiO2). In most
dental porcelains, the leucite crystals are created by transforming feldspar crystals into glass and leucite
crystals (precipitate) by a special heat treatment. When feldspar is heated at a temperature between
1150oC and 6530oC, it undergoes incongruent melting to form crystals of leucite in a liquid glass.
Special heat treatment
Feldspar Crystals Glass & Leucite Crystal
The leucite forms a refractory skeleton and the glass fills the spaces in between adding special qualities
required for dental porcelain.
Functions of Leucite :
 To raise the coefficient of thermal expansion (CTE) of porcelain and bring it closer to that of the
metal substrate; consequently increasing the hardness and fusion temperature. Leucite is a high
expansion (or high contraction) crystal phase whose volume fraction in the glass matrix can
greatly affect the CTE of porcelain. Adding leucite (35-40%) to porcelain creates high expansion
porcelain to match thermal expansion of the alloys used in dentistry (crown and ridges)
preventing a thermal mismatch, which could lower the strength.

8
  Strengthening of porcelain in high strength ceramics e.g. Optec HSP, Cerinate, & IPS Empress.
High Leucite percentage results in an increase in CTE, hardness, fusion temperature, abrasive
effect, and strength possibly due to stress being developed at the glass crystal interface during
cooling.

Glass Formation
When silica melts, it produces an extremely viscous liquid in which molecules can only move one
another very slowly. This is not conducive to crystallization, which requires a substantial and rapid
arrangement of molecules. Thus, if molten silica is cooled rapidly, the crystalline structure does not have
time to form before solidification; and the solid formed is more to likely be a glass (Vitreous Structure)
called Fused Quartz. This process of forming a glass is called ‘Vitrification’. Glass may be cooled very
slowly, to encourage crystallization; but because of the strength of the bonds and the complexity of the
structures, the rate of atomic diffusion is so slow that it solidifies with a liquid structure instead of a
crystalline structure; and hence it may also be described as a ‘supercooled liquid’.

Glass formers
Glass is basically composed of silica (SiO 2) with oxides of Sodium, Potassium, Calcium, Barium
etc. The principal anion in all glasses is O 2 ion, which forms very stable bonds with small multivalent
cations such as Silicon, Boron, Germanium or Phosphorus resulting in formation of random networks of
SiO4 tetrahedrals in glass. These ions are thus termed as Glass Formers. The essential component that
allows the formation of glass is silica, thus it is also called the network former. Oxides of Titanium, Zinc,
Lead and Aluminum can all take part in the formation of the glass network and produce stiff network
structures. However, for dental purposes only two glass forming oxides – Silicon and Boron oxides are
used to form the principle network (B 2O3 can form Boron Glasses). Although not on its own, under
certain circumstances Alumina (Al2O3), may also be regarded as a glass network forming oxide (when
used in conjunction with other oxides); for this reason it is termed a Glassy intermediate.

Devitrification
‘Vitrification’ in ceramic terms is the development of a liquid phase by reaction of melting,
which on cooling provides the glassy phase, resulting in a vitreous structure. However, a small amount of
crystallization always occurs during glass formation, although the rate of crystal growth is very low.
When a glass begins to crystallize, the process is called Devitrification. It may occur when the glass is
held at an elevated temperature in the molten form for a long time, allowing some reorganisation of the
molecules. The glass tends to take on a translucent appearance due to the scattering of light from the
surfaces of the newly formed small crystals. This is the basis of the formation of ‘glass-ceramics’
Alkalis such as soda (Na2O) and lime (CaO) lower the viscosity, and thus the glass transition
temperature, considerably, by causing extensive disruption of SiO 4 tetrahedral network. This slows the
production of glass and when too many of the glass forming SiO 4 tetrahedrals are disrupted; the glass may
crystallize or devitrify. Devitrification is often associated with high expansion glasses, (used in metal-
ceramics) since the usual way of increasing the thermal expansion of a glass is by introducing more
alkalis, particularly soda. Devitrification may be seen when cloudiness develops in dental porcelain and
this can be accentuated by repeated firing. Once the porcelain has devitrified, it becomes increasingly
difficult to form a glazed surface. In contrast to high expansion glasses, the regular or aluminous
porcelains are less susceptible to devitrification due to –
 their higher silica to alkali ratio
 lower soda content (Low thermal expansion)
 Their high combined alumina content which tends to neutralize the effect of excessive quantities
of Na+ ion.

Glass Modifiers

9
 Can be defined as elements that interfere with the integrity of the SiO 2 (glass) network and alter
their three-dimensional state. Their functions are:
 to decrease the softening point
 decrease the viscosity (flux action increasing the flow)
Fluxes (low-fusing glasses) are often included to reduce the temperature required to sinter the porcelain
powder particles together at low enough temperatures so that the alloy to which it is fired does not melt or
sustain sag (flexural creep) deformation.
The main purpose of a flux is principally to lower the softening temperature of a glass by reducing the
amount of cross-linking between the oxygen and glass forming elements. E.g. Alkali metal ions such as
Na, K or Ca oxides. Other oxides - lithium oxide, magnesium oxide, phosphorous pentoxide
However, higher concentration of glass modifiers could result in :
 Reduced chemical durability (resistance to attack by water, acids and alkalis)
 In addition, if too many tetrahedra are disrupted, the glass may crystallize (devitrify) during
porcelain firing operations.
Manufacturers employ glass modifiers to produce dental porcelains with different firing temperatures
such as high medium and low and ultra low fusing ceramics.

Intermediate Oxides
Addition of glass modifiers to reduce the softening point also decreases the viscosity, resulting in
slump or pyroplastic flow; hence it is necessary to produce glasses with high viscosity as well as low
firing temperature. This can be done by the incorporation of an intermediate oxide such as alumina
(Al2O3), which cannot actually form a glass but can take part in the glass network and increases the
hardness and viscosity of glass.
Boric Oxide fluxes
Boric Oxide (B2 O3) although a powerful flux (glass modifier), it can also act as a glass former
and form its own glass network, producing Boron Glasses.
When added to a glass, it forms a separate lattice interspersed with the silica lattice, resulting in a
structure that is a three-dimensional continuos network of strong SiO 4 tetrahedral and BO3 triangles.
Bonds extend in only three directions compared to four in SiO 4, hence weaker stability. Glass formed of
boric oxide has comparitively lower melting point, less viscosity and higher expansion
An additional oxygen atom results in formation of strong BO 4 tetrahedral, which is low expansion, more
stable glass with good chemical resistance. Interruption of more rigid and stable SiO 4 network by the
boric oxide lattice leads to lowered softening point of glass
Hence, Boric oxide is used in quantities of about 12%, above which the less stable form BO 3
takes over. (This phenomenon is termed as boron anomaly).

Water
Although not an intentional addition, water is an important glass modifier. The hydronium ion,
H3O+ can replace Na+ or other metal ions in a ceramic that contains glass modifiers. This replacement is
responsible for the phenomenon of “slow crack growth” of ceramics that are exposed to tensile stresses
and stored in moist environment. It may also account for the occasional long-term failure of porcelain
restorations after several years of service.

Colouring and opacifying dental porcelain

The greatest colour problem encountered, with porcelain if not coloured is the slightly greenish
hue exhibited by all glasses. In addition, some porcelains assume a greenish hue after firing, and this
inherent greenness can be further accentuated by overfiring (over-vitrification). In order to dampen down
this effect and produce life-like dentine and enamel colors; the basic dental porcelain frit must be
coloured.
Colouring agents

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 • Pigmenting or coloring oxides are added to obtain various shades to simulate natural teeth. Metal
oxides added to glass used for porcelain manufacture and subjected to fritting process. The Frit so
obtained is highly color concentrated
• Colored glasses then finely ground and blended with unpigmented porcelain powder to obtain
proper hue and chroma
Dental porcelains colored by the addition of concentrated colour frits which are prepared by fritting high-
temperature resistant colouring pigments (generally metallic oxides) into the basic glass. The glass thus
obtained will be highly colour saturated and when ground to a fine powder, can be used in small amounts
to modify the uncoloured porcelain powder. The colour pigments used are :
Coloring pigments Color

Ferric oxide Gray

Copper oxide Green
Cobalt Salts Blue
Ferrous oxide, Nickel oxide Brown
Titanium oxide Yellowish brown
Manganese oxide Lavender
Chromium-tin,Chromium-alumina Pink
Indium Yellow / Ivory

Opacifying agents
The translucency of porcelain is not suitable to produce dentin colours in particular, which requires
greater opacity than that of enamel colors. Translucency of porcelain depends on whether a single phase
glass or a mixture of glasses is used. If a single phase glass frit is employed in which all constituents are
completely taken into solution, the resultant product is highly transparent. In case of fluxed feldspathic
porcelains, the degree of fusion and pyrochemical reactions are limited to an extent such that some
crystalline feldspar remains undissolved in the glassy matrix. This difference in the refractive indices of
the crystal and glass produces porcelain with opalescent or grayish blue translucency. Another method to
develop translucent gray or opalescent characteristics in porcelain is the use of a mixture of 2 or more
single phase glass frits of slightly different refractive indices. Translucency of porcelain can be further
decreased by using an opacifying agent.
An opacifying agent maybe incorporated, which generally consists of a metal oxide ground to a very fine
particle size (<5um) to prevent a speckled appearance in the porcelain.
The common metallic oxides used are:
 Cerium oxide
 Titanium oxide
 Tin oxide and
 Zirconium oxide (ZrO2) - most popularly used opacifying agent (usually added with the
concentrated color frit to the porcelain during final preparation).
• Difference between the refractive indices of the glass and the opacifier is the basic mechanism
behind opalescence
Stains & Colour Modifiers: The stains and colour modifiers supplied with dental porcelain are prepared
in much the same way as colour frits.
Stain is a mixture of one or more pigmented metal oxides, and usually composed of a low fusing
glass that when dispersed in an aqueous slurry or monomer medium applied to surface of porcelain or
other specialized ceramic, dried or light cured, and fired will modify the shade of the ceramic-based
restoration. It is more concentrated than a colour modifier and is generally used as a surface colorant or
to provide enamel check lines, decalcification spots etc. in the body of a porcelain jacket crown. These
stain products are also called as surface colourants or characterization porcelain.

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Stains in finely powdered form are mixed with water or glycerine. Wet mix is applied with a brush either
on to the surface of porcelain before glazing or built into the porcelain (internal staining)

Internal Staining
One method for ensuring that the applied characterizing stains will be permanent is to use them internally.
Internal staining and characterization can produce a very life-like result, when built into porcelain rather
than when it is merely applied to the surface. However, if unsuitable the porcelain has to be stripped
completely. It prevents direct damage to stains by surrounding chemical environment

Colour modifiers
Color modifiers on other hand are less concentrated than stains and are used to obtain gingival effects or
highlight body colors, best used at same temperature as the dental porcelain

Glazes & Add-On Porcelain

Glazes are low fusing uncoloured glass powders that are applied on the surface of a porcelain
restoration and fired at a maturing temperature lower than that of the restoration to produce a transparent
glossy layer on the surface. They are also referred to as Overglazes or Applied glazes. The purpose of
glazing is
 To seal the open pores on the surface of a fired porcelain.
 To impart an impervious smooth surface and develop greater translucency in the porcelain
restoration.
 To produce enamel like appearance after occlusal and morphologic corrections have been made
in porcelain restoration
 Removal or reduction in size and number of surface flaws after glazing markedly increases
strength of porcelain by preventing crack propagation
 Glaze is removed by grinding, transverse strength may be only half that of glazed porcelain
Glazing can be of two types
 Self glazing (autoglazing) and
 Add-on glazing

Self glaze
 After all the constituents of the porcelain frit have completely melted to form a single phase glass,
the porcelain is further heated to reach glazing point at which the surface becomes plastic and
flows to form a shiny continuous surface. This property is known, as Self-glazing and dental
porcelain can be easily self glazed, by careful control of temperature cycle during firing. Self-
glazing is exhibited by all porcelains except those containing high quantity of strengthening
agents such as alumina or opaquing materials. An external glaze layer is not applied but the
completed restoration itself is subjected to glazing

Add-on glazes
These are uncolored glasses whose fusing temperature has been lowered by addition of glass modifiers.
The Thermal expansion of an add-on glaze is also fractionally lower than the ceramic body to which it is
applied. This places glazed layer under compression and hence crazing or peeling of the surface is
avoided
Disadvantages
 Low chemical durability
 Difficult to apply evenly
 Almost impossible to attain a detailed surface characterization
 Too high temperatures or prolonged glazing result in increased pyroplastic flow of material and
hence rounding off of line angles and loss of surface characteristics

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  Over glazed surface - glassy and takes on greenish hue of a natural glass thereby defying the
natural enamel look

Add-on porcelains are similar to glaze porcelains except for addition of opacifiers and color pigments.
These are used sparingly for repairs, addition and simple corrections to tooth contour or contact points.
E.g: Illusions Add-on low fusing porcelains (World alloys & Ref. Inc, U.S.A). Firing temperature is
approximately 22° C lower than body porcelain's firing temperature, and porcelain should be vacuum
fired. It will maintain its form and remain stable should any subsequent bakes or glazing be needed
E.g CERAMCO II & CERAMCO II SILVER

MANUFACTURE & DISPENSING

Manufacture of porcelain
Pyrochemical reactions during manufacture of porcelain
When the ceramic raw materials are mixed together in a refractory crucible and heated to a
temperature well above their ultimate maturing (fusion) temperature, a series of reactions occur.
 After the water of crystallization is lost, the flux reacts with the outer layers of the grains of silica
(filler), kaolin (binder) and feldspar (basic glass former) and partly combines them together.
 The feldspar fuses and further intermingles with kaolin & quartz.
 The feldspar undergoes decomposition to form a glass and a crystalline material known as leucite.
 The molten glass begins to dissolve the kaolin and quartz.
 Continuous heating results in total dissolution of all components forming a homogenous glass.
 The fused mass is then quenched in water. The red-hot glass striking the cold water produces internal
stresses within the glass, to the extent considerable cracking and fracturing occurs.
 The glass immediately breaks up into fragments and this is termed the ‘frit’, used to describe the final
glass product. The process of blending, melting and quenching the glass components is termed
‘fritting’. The resultant frit is a brittle structure, which can be readily ground to a fine powder form
that can be used for fabrication of porcelain restorations. Although true porcelain is obtained when
the manufacturing process is stopped at stage4, most modern dental porcelains have been carried to
stage5 i.e. cooled and ground to a fine powder. When refired (during fabrication of ceramic
restoration) the particles gradually form a very viscous liquid, which flows together and the particles
coalesce (sintering). Dental porcelains shrink during firing. To control this shrinkage and obtain
high densities during sintering, an irregular particle system, ‘gap-grading’ is done in which a 3-fold
difference between grain sizes with at least three sizes of powder are used (Binns, 1970).

Dispensing of dental porcelain

The conventional dental porcelain material may be generally supplied as a kit containing
 Fine ceramic powders in different shades of enamel, dentin, core/opaque
 Special liquid or distilled water vehicle/medium for ceramic powder (binder)
 Stains and colour modifiers
 Glazes and Add-on porcelains.
 Two factors affecting the properties
o Manner and degree of condensation / compaction of powder
o Degree of firing and procedure followed to fuse mass

STEPS IN FABRICATION
Dental porcelain restorations are made by mixing ceramic powders of selected shades with
distilled water or a special liquid (binder) to form a plastic mass. This is condensed either directly on a
refractory die or a matrix (frame) and shaped into the desired form, then fused (sintered) in a furnace by
firing to develop a translucent tooth like material (fused porcelain).
Various methods of fabricating ceramic restorations vary according to different formulations available:
 Condensing and Sintering

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  Pressure molding & Sintering
 Casting & Ceramming
 Slip casting, Sintering & Glass infiltration
 Milling (Machining) by mechanical and digital systems.
However, fabrication of a conventional porcelain restoration is basically composed of the
following stages: Condensation – Sintering – Glazing – Cooling.

Condensation (Compaction)
Porcelain powder is built into shape using a liquid binder to hold the particles together. The
process of packing the particles together and removing the liquid binder is known as condensation. It is a
2-part process – Agitation of the particles & Removal of excess moisture. It is repetitious and the two
components are carried out alternatively until no further moisture comes to the surface.
Aim of condensation - pack particles as close as possible in order to reduce the amount of porosity and
shrinkage during firing
Two important factor determine effectiveness of condensation
• Size
• Shape
System uses three sizes of powder - gap grading system
• Shape of powder particles also governs packing density
• Round particles produce better packing compared with angular particles
• Most important factor in condensation is effect of surface tension
• As liquid is withdrawn, surface tension causes powder particles to pack closely together
Sufficient amount of liquid should be present so as to wet all powder particles

Several methods of condensation are employed

• (1) Vibration method
• (2) Spatulation method
• (3) Dry brush technique

The Vibration technique

This method used mild vibration to pack the wet powder densely on the underlying framework.
The excess water is blotted away with a clean tissue and condensation occurs towards the blotted area.
An electrically operated brush called the Vibra Brush can also be used in this technique, which although
very efficient, lacks the flexibility offered by the light weight hand held sable brush.

The Spatulation technique

The method uses a small spatula to apply and smoothen the wet porcelain in incremental layers.
The smoothing action brings the excess water to the surface where it is removed by blotting.

The Brush technique

This method employs the addition of dry porcelain powder on the surface to absorb the
moisture. The dry powder is placed by a brush to the side opposite from an increment of wet porcelain.
As the water is drawn towards the dry powder, the wet particles are pulled together.

Sintering or Firing of Dental Porcelain

Is defined as a process of heating closely packed particles to achieve interparticle bonding and sufficient
diffusion to decrease the surface area or increase density of the structure. The partial fusion or compaction
of glass is often referred to as sintering. During the process of sintering, the points at which the
individual particles are in contact (grain boundaries) soften and fuse at sufficiently high temperatures.
This process relies on diffusion, which is greatly accelerated by elevated temperatures.
During firing following changes occur

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  Loss of water- Excess water is partially removed by slightly warming mix before placed in
preheated furnace. This prevents sudden production of steam that could result in voids or
fractures. After mass is placed in furnace, both free and combined water are lost until a
temperature of 480oc is reached.
 With further rise in temperature, a continuous mass is formed, there occurs a decrease in volume
referred to as firing shrinkage - 32-37% for low fusing and 28.34% for high fusing.
 At the end of high bisque stage, if the porcelain was held in the furnace for a greater length of
time, the surface porcelain would undergo pyroplastic flow, i.e. the matte surface would
disappear and a smooth shiny or glossy surface would result (self-glaze). This occurs at
temperatures of 955-1065oc. After mass has been fired, it is cooled very slowly because rapid
cooling results in surface cracking and crazing
Different media can be employed for firing
1. Air Firing Procedure: In Air-fired porcelain, sintering of particles causes the viscous sintered
glass to gradually fill up the voids, trapping the air, which fails to escape. Porcelains placed in air
furnace, furnace atmosphere occupies the void spaces in porcelain mixes. Once softening of glass
begins, grains of porcelain start fusing at their contact points. Surface tension causes some of
porosity to be swept out via grain boundaries, but some of it gets entrapped by flowing ceramic
around air voids. With increase in temperature, void spaces containing air assume spherical
appearance under influence of surface tension. Further rise in temperature increases pressure of
entrapped air and bubbles enlarge. Cooling decreases pressure and size of bubble. Surface of air-
fired porcelain is generally devoid of bubbles. A very slow maturing period at a temperature
below the final maturing temperature should be allowed for the escape of maximum amount of
entrapped air.
2. Vacuum Firing- Used to reduce porosity in dental porcelains. It works on basis of removing air
from interstitial spaces before surface sealing occurs. Vacuum removes most of air from
interstitial spaces. With increase in temperature and because of surface tension, remaining air
spaces assume a spherical appearance. When air at normal atmospheric pressure is allowed to
enter furnace, it exerts a compressive effect on surface skin, which further compresses internal
voids to one tenth of their original size. This results in a very dense porcelain, with very few
remaining bubbles and that too of extremely small size.
Advantages over air-fired porcelains:
o Improved esthetics
o Better handling properties
o Reduced porosity
Limitations of vacuum firing – Large bubbles trapped due to poor condensation technique cannot
be reduced in size to any significant degree and can be seen as blistering of the material.
3. Diffusible gas firing- Diffusible gas like helium, hydrogen or steam is substituted for ordinary
furnace temperature. Air is driven out of porcelain powder bed and replaced by diffusible gas.
With these gases, interstitial spaces do not enlarge under influence of increasing temperature, but
decrease in size or disappear. This occurs because these gases diffuse outward through porcelain
or actually dissolve in porcelain

Stages of maturity
Firing of dental porcelain consists of 3 stages of maturity. The common expression used for
describing the surface appearance of un-glazed porcelain is “bisque” or biscuit since this gives a fairly
accurate picture of its surface texture.

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STAGES OF MATURITY
Low Bisque Medium Bisque High Bisque
Characteristic Grains of porcelain start to Flow of glass grains increase Firing shrinkage is complete,
features soften and coalesce at the and the residual entrapped and has adequate strength, for
contact points furnace air become sphere any corrections by grinding
shaped. prior to glazing.
Particle cohesion Incomplete Considerable Complete
Porosity Highly porous, and easily Reduced although still porous Slight / Absent depending on
absorbs water soluble dye material used
Shrinkage Minimal Majority or definite Complete
Strength Weak & friable Moderate High
Surface texture Porous Still porous & matte surface Completely sealed (egg shell
appearance) i.e., relatively
smooth surface with a light
sheen
Colour & Opaque Less opaque and colour Colour & translucency
Translucency developed developed

The basic two types of porcelain restorations are :

1. Metal ceramic retsorations
2. All ceramic restorations

METAL CERAMIC RESTORATIONS

• Ceramco crown/porcelain veneer crown/porcelain fused to gold/porcelain fused to metal
• Metal casting/coping and ceramic fused to the metal coping
• More resistant to fracture than PJC

Metal-ceramic systems for dental restorations have been available since the 1960s. They rely on the
application and firing of a veneering ceramic onto a metal substructure to produce an esthetically
acceptable restoration. Veneering ceramics for metal-ceramic restorations -commonly named feldspathic
porcelains- are usually leucite-based. Feldspar-derived glass alone exhibits a low coefficient of thermal
expansion, around 8.6 × 10-6/°K. The addition of leucite to feldspar glass led to the production of
veneering ceramics with a coefficient of thermal expansion compatible with that of the metal
substructure. This results in a high coefficient of thermal expansion (20 to 25 × 10-6/°K). The
transformation has been reported to start at temperatures as low as 400 °C in feldspathic dental porcelains.
Feldspathic dental porcelains usually contain between 15 and 25 vol % leucite. This amount is adjusted so
that the coefficient of thermal contraction of the porcelain is slightly lower than that of the metal, in order
to place the ceramic under slight compression. Veneering ceramics for dental restorations are classically
sintered under vacuum in order to reduce the porosity of the final product. Unfortunately, pores are not
the only defects found in veneering ceramics, cracks and inclusions are also present.
The mechanical properties of feldspathic porcelains are the lowest of ceramic materials used in dentistry
and dominated by the large amount of glassy phase.

The structural performance of metal ceramic systems remains far better than for any all-ceramic system.
Bulk failure and porcelain cracking affect approximately 5% to 10% of single-unit prostheses by around 6
years.
Success rates are generally higher for anterior than for posterior single-unit prostheses. Conversely,
structural problems related to the porcelain can be as low as _3% to 4% at 10 years for metal-ceramic
prostheses (nontitanium), and _74% can still be in service at 15 years with the majority of problems being

16
biologic (secondary caries, periodontal disease, and endodontic failures). Porcelain survival on titanium
substructures has not been nearly as good, even at 6 years, due to inherent problems at the titanium–
porcelain interface.

Process for producing metal coping

1. Electrodeposition of gold or other metal on a duplicate die
2. Burnishing and heat treating metal foils on a die
3. CAD CAM processing of a metal ingot
4. Casting metal/alloy through lost wax technique

• To bond a ceramic veneer to cast alloy copings, a ceramic must have a fusion temperature well
above its sintering temperature and, it also must have a coefficient of thermal contraction that
closely matched to that of the alloys. A metal oxide is necessary to promote chemical bonding of
the ceramic veneer to the metal substrate. Foil coping may or may not require a metal may or may
not require a metal oxide or a bonding agent to ensure retention of the veneering ceramic.
• The gold alloys developed for porcelain bonding have higher melting ranges higher than typical
gold alloys for cast metal prostheses, the higher melting ranges are necessary to prevent sag,
creep, or melting of the coping during porcelain firing. These gold alloys for cast metal
prostheses, the higher melting ranges are needed to prevent sag, creep, or melting of the coping
during porcelain firing. These gold alloys contain small amounts (about 1%) of base metals such
as iron, indium, and tin. The base metal forms a surface oxide is responsible for development of a
bond with porcelain. This porcelain- metal bond is primarily chemical in nature and is capable of
forming even when the metal surface is smooth and little opportunity exists for mechanical
interlocking.
• If undesirable residual tensile stresses in the porcelain are to be avoided , both the metal and
ceramic have thermal contraction profiles on cooling that are closely matched or with metal
exhibiting slightly higher contraction. If the contraction differences are large, stresses may occur
that weaken both porcelain and the bond. For example a difference in the coefficient of thermal
contraction of 1.7 ppm /0c can produce a shear stress of 280Mpa (39,800psi) in porcelain next to
the gold-porcelain interface when the porcelain is cooled from 954 0C (17500F) to room
temperature. Because the shear resistance to failure is far less than 280Mpa, these thermal
stresses could cause spontaneous bond failure.
• High tensile stresses are known to develop in porcelain veneers from a contraction coefficient
mismatch between alloys and porcelain. The tensile stress induced within porcelain due to
occlusal forces would be added to the residual thermal tensile stresses. However, when metal and
porcelain veneers exhibit similar contraction curves and an average contraction coefficient of
0.5ppm/0C or less( between the porcelain glass transition temperature and room temperature),
fracture is unlikely to occur except in the time of extreme stress concentration or extremely high
intraoral stresses. The metal-ceramic combination is known as thermally compatible systems.
Many prostheses made from metal and porcelain materials having contraction coefficient
difference of 0.5 to 1.0ppm/0C are known to survive for many years. These results are explainable
by survival probability analyses assume that maximum biting forces on anterior crown rarely
exceed 890N (200lb) and maximum force on posterior crown rarely exceed 2224N (500lb). The
maximum clenching force ever recorded for posterior teeth as 4337 N (975lb) sustained for 2
minutes. Most patients generate typical bite force of 400 to 800N (90 to 180lb) between molar
teeth and much lower forces between premolars and anterior. Thus rather small number of
patients have bite force capabilities that are likely to cause fracture of metal-ceramic crowns or
bridges when residual thermal incompatibility stresses are present.
• Another equally important property of metal-ceramic system is that the alloy should have high
proportional limit and particularly, a high modulus of elasticity. Alloy with high modulus of
elasticity also share a greater proportion of stress compared with the adjacent porcelain. The

17
 metal framework must not melt during porcelain firing and also must resist high- temperature
“sag” deformation. Sag or flexural creep can only occur at high temperature. It does not occur at
oral temperatures.
• The casting should be carefully cleaned to ensure a strong bond to porcelain , for example, an
alloy such as Olympia (Heraeus Kulzer) , gold palladium , silver free alloy , is heated in porcelain
furnace to a temperature of 1038 0C ( 19000F) to burn off any remaining impurities and form a
thin oxide layer. This so called degassing treatment does not actually degas the interior structures
of the alloys, but it does produce an oxide layer on the alloy that is essential for the formation of
porcelain-metal bond.
• The clean metal surface cannot be overemphasized. The surface may be cleansed adequately by
finishing the clean ceramic-bonded stones or sintered diamonds, which are used exclusively for
finishing. Final sand blasting with high purity alumina abrasive ensures that the porcelain is
bonded to a clean and mechanically retentive surface.
• Opaque porcelain is condensed with a thickness of approximately 0.3mm and is then fired to its
maturing temperature. Translucent porcelain is then applied and the tooth form is built. Porcelain
powder is applied by condensation method. Several cycles of porcelain application and firing is
necessary to complete the prosthesis. A final glaze is then obtained.

Metal ceramic crowns based on burnished foil copings

 Captek system
 Renaissance crown

Captek system (Precious Chemicals Company, Altamonte Springs, FL)

Capillary casting technology
Principle - Capillary attraction to produce a gold composite metal
Composite alloy composed of 2 distinct alloy phases. The finished metal coping may be described as
composite material consists of gold matrix reinforced with small particles of Pt- Pd-Au alloy. The inner
and outer surface contains 97% Au. The grain size is 15- 20µm. Has no nonprecious metals, which
eliminates the possibility of toxicity. The final framework is a high-gold, oxide-free alloy. It produces
thin metal copings for single crowns and framework for FPD with a maximum span length of 18mm (that
allows space for two pontics).
• Available as Captek P and G
• Malleable Captek metal strips are burnished on a refractory die to fabricate the metal coping of a
meatl- ceramic crown without the use of a melting and casting process.
• Starting with the master model of the prepared tooth or teeth, a Captek refractory die is poured.
The Capsil relief liquid is sprayed onto the stone die to reduce the surface tension, allowing
Capsil impression material or Capvest refractory die material to flow freely and to reduce bubbles
and imperfections. After the die spacer is applied to the master die, undercuts are blocked out.
The master die is placed in the proper sized duplicating flask, and Capsil silicone material is
poured into the flask around the master die. The impression creates a mold into which the
refractory material is poured to produce refractory dies. The master die is removed form hardened
silicone, and an accurate high-temperature refractory is poured in the new silicone mold.
• The refractory die heat-treated, the margins are marked with a red pencil and an adhesive
( Captek Adhesive) is applied to the die. The adhesive aids the adhesion of the Captek material to
the die and enhances capillary attraction.
• The next step requires the application of Captek P, a highly malleable gold platinum and
palladium alloys. This internal reinforcing skeleton provides a three dimensional network of
capillaries that will be eventually filled by Captek material forming a composite high gold metal
alloy. This layer is burnished on the die, and after the margins are trimmed, it is sintered in a
porcelain furnace on the recommended Captek thermal processing cycle.

18
 • This capillary structure is next infused with molten gold that is supplied by Captek P material.
The Captek P material is pressed in place using uniform firm pressure so it conforms to the shape
of the die. Excessive pressure or pulling of the material will cause it to break or tear. After
trimming away the excess material, any voids are filled with trimming of Captek P segments.
• The crown and bridge units are now ready for firing. The pieces are heated at rate 55 0 to
800C/minute to the recommended firing temperature, The Captek G metal strip contains 97.5wt%
gold, and 2.5wt% silver. The coping and / or bridge components are fired again in furnace
according to recommended Captek firing cycle. After processing, Captek G forms a high gold
metal alloy composite through capillary attraction. The capillary action is used as the joining
method of hard particles and resilient particles of metal present in the final coping. The gold
melts , yet the Captek P structurally remains stable. The Captek P reacts like a metal sponge and
draws liquid gold completely into it. The Captek composite metal coping is now complete and
ready for refractory die removal. The coping is divested , and the margins are finished . For the
production of FPD’s, Captek pontics are used. These specially designed pontics that are precast
using metal- ceramic alloy and plated with pure gold.
• The copings and pontics are coated with a mixture of a powder and liquid (Capbond ) , which will
provide a thin covering of gold material to enhance areas of Captek P that have been ground
during adjustment . The Capbond will also provide a gold colour that is identical to that or areas
that have not been ground.
• Capcon liquid and powder are applied to areas between pontic and abutment, as well as pontic
surface area. The powder contains alloy of gold , platinum and palladium to provide the same
base material structure as Captek P. Capcon absorbs through capillary attraction , the Capfil
material in tha same way as Captek G is absorbed into Captek P , producing a gold connecting
area that enhances tha colour of the pontic surface. Capcon is also used to enhance the buccal or
labial; pontic areas of Captek preformed pontic.
• The units are veneered with two thin layers of opaque porcelain, and other porcelain layers .
Before the opaque layer is applied, The finished Captek coping has a thickness of 0.25mm. Thus
this technique provides a much thinner coping thickness than traditional cast metals (0.5mm) and
will provide additional space for veneering porcelain. The marginal adaptation is dependent on
the skill of the technician in trimming the burnished material. Unlike traditional cast metals that
provided an atomic bonding to opaque porcelain through an external oxide layer. Captek metal
achieves bonding through a combination of surface interlocking and residual stresses produced by
slight differences in thermal expansion coefficient.

Renaissance crown
(Unikorn Ltd, Tel Aviv, Israel)
• Developed by Shoher and Whiteman
• Delivered in a fluted shape
• Swaged with a swaging instrument and burnished on a die
• Flame sintered
• Coping then veneered with porcelain and fired

Bonding of porcelain to metal

The primary requirement for the success of metal- ceramic prosthesis is the development of durable bond
between porcelain and alloy. Once such bond is achieved there is an opportunity to introduce stresses in
the prosthesis during porcelain firing procedure. An unfavorable stress distribution during the cooling
process will result in crack of the porcelain and delayed fracture can also occur. For a successful metal-
ceramic prosthesis, both a strong interface bond and thermal compatibility are required.
Theories of metal ceramic bonding

19
1)mechanical interlocking between porcelain and metal- Interlocking of ceramics by Micro abrasions on
metal surface. Air abrasion enhances wettability, provides mechanical locking, increases the surface area.
Bonding agent enhances bond strength
2) chemical bonding across the metal- porcelain interface- Although chemical bonding is generally
regarded to be responsible for metal porcelain adherence, evidence exists that, for few systems ,
mechanical interlocking may be provide the principal bond. The oxidation behavior of these alloys largely
determines their potential for bonding with porcelain. These alloys that form adherent oxides during
degassing cycle also form good bond to porcelain, whereas these alloys with poorly adherent oxides form
poor bonds. Some palladium-silver alloys form no external oxide layer but rather oxidize internally . It is
for these alloys that mechanical bonding is needed. Trace elements – tin, indium, gallium, iron forms
oxide layer. In Base metal alloys– chromium oxide formation- readily bonds to porcelain

ALL-CERAMIC SYSTEMS
Driven by a debatable need for metal-free restorations, the evolution of all-ceramic systems for dental
restorations has been remarkable in last three decades. Processing techniques novel to dentistry have been
developed, such as heat-pressing, slip-casting, and Computer Aided Design-Computer- Aided Machining
(CAD-CAM). Concurrently, all-ceramic materials have been developed to match dental requirements,
offering increasingly greater performance from a mechanical standpoint. As opposed to metal-ceramics,
all-ceramics contain a significantly greater amount of crystalline phase, from about 35 to about 99 vol %.
This higher level of crystallinity is responsible for an improvement in mechanical properties through
various mechanisms, such as crystalline reinforcement or stress induced transformation. Unfortunately,
higher crystallinity is also associated with higher opacity, which is not always desirable for dental
ceramics. As an example, zirconia ceramics such as 3Y-TZP (3 mol % Yttria-stabilized Tetragonal
Zirconia Polycrystals) offer unsurpassed mechanical properties but are also the most opaque of all-
ceramic materials currently available. However, crystallinity is only one of many intrinsic factors
contributing to materials performance. Other factors such as crystal size and geometry, modulus of
elasticity, phase transformation and thermal expansion mismatch between crystal and glassy phase play a
crucial role in determining the final mechanical response of the ceramic.
It should also be kept in mind that when it comes to all-ceramic systems, extrinsic factors such as working
conditions play a major role in the long-term performance of the material. The oral environment
assembles a set of challenging working conditions that include humidity, acidic or basic pH, cyclic
loading and peak loads that can reach extremely high levels when hard objects are accidentally
encountered during mastication. A humid environment is susceptible to lead to stress corrosion and
catastrophic failure in ceramic materials including a glassy phase. The same is true for some highly
crystalline materials such as 3Y-TZP, which has been shown to undergo microstructural degradation in a
humid environment at relatively low temperatures. It is therefore generally accepted that tests performed
in a humid environment and under cyclic loading are needed to provide valuable information on the long-
term performance of dental ceramics.
Esthetic advantages are real when the completely light-blocking metal is replaced, even by an opaque
ceramic. All-ceramic systems can provide a better esthetic result for a wider range of patients than can
metal-ceramics because a wide range of translucency-opacity (or ‘‘value’’ in the Munsell color system)
can be achieved with commercially available ceramic systems.
Other advantages relate as much to soft tissue health as to esthetics. Lesser amounts of plaque and
adherence molecules are recovered from ceramic surfaces than from gold alloys or amalgam, and intra-
oral plaque of a qualitatively healthier composition can form on ceramic surfaces.
It often is acceptable to leave the margin of all-ceramic prostheses supragingival or at the gingival
margin, with the added benefit of more predictable and less traumatic impression making. Emergence
profiles are less likely to be over-contoured, as is often the result with metal-ceramic prostheses due to
efforts to provide a thicker layer of porcelain to mask the opaque-metal surface.

20
  Conventional powder slurry ceramics. These products are supplied as powders to which the
technician adds water to produce a slurry, which is built up in layers on a die material to form the
contours of the restoration. The powders are available in various shades and translucencies, and
are supplied with characterizing stains and glazes. Eg:Optec HSP, Duceram LFC
Optec HSP material (Jeneric/Pentron, Inc.)- Leucite-reinforced feldspathic porcelain containing up to 45
vol% tetragonal leucite. The manufacturer disperses the leucite crystals in a glassy matrix by controlling
their nucleation and crystal growth during the initial production of the porcelain powder. The greater
leucite content of Optec HSP porcelain compared with conventional feldspathic porcelain for metal-
ceramics leads to a higher modulus of rupture and compressive strength. Because of its increased
strength, Optec HSP does not require a core when used to fabricate all-ceramic restorations, as is
necessary with aluminous porcelain PJCs.
The large amount of leucite in the material contributes to a high thermal contraction coefficient (Katz,
1989). After heat treatment of Optec HSP for one hour at temperatures ranging from 705 to 980°C, a
second metastable phase identified as sanidine (KAlSi3O8) forms at the expense of the glassy matrix
(Vaidyanathan et al, 1989). The crystallization of sanidine is associated with a modification of the optical
properties of the material from translucent to opaque. The body and incisal porcelains are pigmented to
provide the desired shade and translucency. However, sanidine does not appear when the porcelain is
heated to 980°C, since sanidine is metastable in the temperature range 500-925°C. The precipitation of
sanidine has been reported as well upon isothermal heat treatment of conventional feldspathic porcelain
for metal-ceramics (Mackert et al, 1986b; Mackert, 1988; Barreiro et al, 1989).
The leucite and glassy components are fused together during the baking process (at 1020 C). The buildup
and contouring of the crown is accomplished using the powder-slurry technique on a special
semipermeable die material. Optec HSP does not require special processing equipment beyond what is
used for ceramo-metal restorations. These restorations fit accurately; however, their increased leucite
content contributes to
the relatively high in vitro wear of opposing teeth, as reported in a recent laboratory study.
Duceram LFC. This is a relatively new category of restorative material, referred to as "hydrothermal low-
fusing ceramic." It is composed of an amorphous glass containing hydroxyl ions. The manufacturer
claims'` that this noncrystalline structure has greater density, higher flexural strength, greater fracture
resistance and lower hardness than feldspathic porcelain (causing less abrasion against tooth structure
than leucite-containing systems). The higher flexural strength results from an ion exchange mechanism of
hydroxyl ions, which is said to also promote a healing of surface microcracks. The lower hardness results
from the absence of leucite crystals in this material.
Duceram LFC is used for the fabrication of ceramic inlays, veneers and full-contour crowns. The
restoration is made in two layers. The base layer is Duceram Metal Ceramic (a leucite-containing
porcelain); it is placed on a refractory die using standard powder-slurry techniques and then baked at 930
C. Over the base layer, Duceram LFC is applied using the powder-slurry technique and baked at a
relatively low temperature (660 C). The material is supplied in a variety of shades and can be surface-
characterized with compatible stains and modifiers. The fabrication process requires no special laboratory
techniques or equipment.
However, the results of a one year clinical study recently conducted for the manufacturer seem to indicate
that the material wears at a rate equivalent to that of natural tooth enamel (Shotwell J, Beard CC, Lang B,
Lang BR, unpublished data, 1990).

Aluminous core porcelain is a typical example of strengthening by dispersion of a crystalline phase

(McLean and Kedge, 1987). Alumina has a high modulus of elasticity (350 GPa) and high fracture
toughness (3.5 to 4 MPa.m05). Its dispersion in a glassy matrix of similar thermal expansion coefficient
leads to significant strengthening of the core. The first aluminous core porcelains contained 40 to 50%
alumina by weight (McLean and Hughes, 1965). The core was baked on a platinum foil and later
veneered with matched-expansion porcelain. Hi-Ceram (Vident, Baldwin Park, CA) is a more recent

21
development of this technique. Aluminous core porcelain is now baked directly onto a refractory die
(McLean et al, 1994).

Mirage II (Myron International, Kansas City, KS) is a conventional feldspathic porcelain in which
tetragonal zirconia fibers have been included. Zirconia undergoes a crystallographic transformation from
monoclinic to tetragonal at 1173°C. Partial stabilization can be obtained by using various oxides such as
CaO, MgO, Y2O3, and CeO, which allows the high-temperature tetragonal phase to be retained at room
temperature. The transformation of partially stabilized tetragonal zirconia into the stable monoclinic form
can also occur under stress and is associated with a slight particle volume increase. The result of this
transformation is that compressive stresses are established on the crack surface, thereby arresting its
growth. This mechanism is called transformation toughening.
The addition of yttria-stabilized zirconia to a conventional feldspathic porcelain has been shown to
produce substantial improvements in fracture toughness, strength, and thermal shock resistance (Morena
et al 1986a; Kon et al, 1990). However, other properties, such as translucency and fusion temperature, can
be adversely affected. The modulus of rupture of commercially available zirconia-reinforced feldspathic
dental porcelain (Mirage II) is not significantly different from that of conventional feldspathic porcelain
(Seghi et al, 1990b).

Castable glass- ceramics(Dicor)

The first commercially available castable ceramic material for dental use, Dicor , was developed by
Corning Glass Works and marketed by Dentsply international. It is a polycrystalline glass-ceramic
material, initially formed as a glass and subsequently heat-treated under controlled crystallization
conditions to produce a glass-ceramic material. The fabrication method uses lost-wax and centrifugal
casting techniques similar to those used to fabricate alloy castings. A full-contour transparent glass crown
is cast at 1350 C, then is heat-treated at 1075 C for 10 hours. This heat treatment (known as "ceramming")
causes partial crystallization (55 percent) of tetrasilic micalike crystals. This crystal nucleation and
growth process is called ceramming. The crystals function in two ways: they create a relatively opaque
material out of the initially transparent crown, and they significantly increase the fracture resistance and
strength of the ceramic. These crystals are also less abrasive to opposing tooth structure than the leucite
crystals found in traditional feldspathic porcelains. Once the glass has been cerammed it is fit on the
prepared die, ground as necessary, and then coated with veneering porcelain. To achieve the appropriate
shade, the colorant stains are baked on the surface of the glass-ceramic material. There has been some
evidence that the stain layer might be lost during occlusal adjustment, during routine dental prophylaxis
or through the use of acidulated fluoride gels. To match the shape and appearance of the adjacent teeth.
Dicor glass ceramic is capable of producing surprisingly good aesthetics , perhaps because of the
chameleon effect , where part of the colour of the restoration is picked up from the adjacent teeth as well
as from the tinted cements used for luting the restoration.
Dentsply (Trubyte Division) has introduced Dicor Plus, which is a shaded feldspathic porcelain veneer
applied to the Dicor substrate. However, as Dicor Plus is a feldspathic porcelain that contains leucite, it is
expected that these restorations will be as abrasive to teeth as other feldspathic porcelains.
Dicor crowns and veneers have been demonstrated to fit accurately in clinical and laboratory studies. The
process requires a special high-temperature, electric- heated casting unit.
Short-term clinical studies verify the efficacy of the Dicor system for use in veneers and inlays. Failure
rates as high as 8 percent (fracture of the restorations) have been reported. Failure rates as high as 35
percent for full-coverage Dicor crowns not bonded to the underlying tooth structure have been reported.
Dicor has recently been discontinued presumably because of the low tensile strength and need to colour
the prosthesis in the exterior region rather than within the core region , which would closely resemble a
natural tooth.

Advantages

22
Ease of fabrication ,
Improved aesthetics, more lifelike than metal-ceramic crown
Minimal processing shrinkage,
Good marginal fit,
Moderately high flexural strength ,
Low thermal expansion equal to that of tooth structure, minimal abrasiveness to tooth enamel.

Disadvantages
Limited use in lower- stress areas and its inability to be coloured internally. However Dicor MGC ingots
have been supplied in light and dark shades ,making it possible for technicians to build depth in colour
into the fabrication process. Although both of the Dicor products were based on a glass-ceramic core that
was minimally abrasive to the opposing tooth enamel , the required shading or veneering porcelains were
more abrasive.

Two veneering materials were used to improve the colour of Dicor crown , Dicor Plus , which are
considered pigmented feldspathic porcelain veneer, and Will’s Glass, a veneer of Vitadur N aluminous
porcelain.

Tooth preparation for glass ceramic of this type is the same as that required for metal-ceramic prostheses
except that, for first and second molars reduction of 2mm is recommended. Occlusal surfaces and incisal
edges must be reduced a minimum of 1.5mm. Axial surfaces should be reduced a minimum of 1.0mm .
The preparation should be either shoulder with rounded gingivoaxial line angle or a heavy chamfer.

Cerapearl (Kyocera, San Diego, CA) is a castable glass ceramic in which the main crystalline phase is
oxyapatite, transformable into hydroxyapatite when exposed to moisture (Hobo and Iwata, 1985).
Refractive index, density, hardness, thermal expansion, thermal conductivity similar to natural enamel

 Pressable ceramics. Also supplied as ceramic ingots, these products are melted at high
temperatures and pressed into a mold created using the lost-wax technique. The pressed form can
be made to full contour, or can be used as a substrate for conventional feldspathic porcelain
buildup. Eg: IPS Empress, Optec Pressable Ceramic.

IPS Empress (Ivoclar USA, Amherst, NY) is a leucite-containing porcelain. IPS Empress is a glass –
ceramic provided as core ingots that are heated and pressed until ingot flows into the mold. It contains
higher concentration of leucite crystals that increase the resistance of crack propagation( fracture). The
hot pressing process that occurs over 45 min period at high temperature to produce the ceramic
substructure. This crown form can be either stained and glazed or built up using a conventional layering
technique.

The ceramic ingot is placed under the plunger, the entire assembly is heated to 1150 C and the plunger
presses the molten ceramic into the specialized refractory mold (under a pressure of 0.3 to 0.4 MPa) that
has an alumina plunger, made by the lost-wax technique. This temperature is held for 20 minutes in a
specially designed automatic press furnace (Dong et al, 1992). The ceramic ingots are available in
different shades. They are produced by sintering at 1200°C and contain leucite crystals obtained by
surface crystallization (Holand et al 1995). The leucite crystals are further dispersed by the hot-pressing
step.
The final shade of the crown is adjusted by staining or veneering. In the veneering technique, the original
wax-up is cut back by about 0.3 millimeters. After molding and baking as described, feldspathic porcelain
is added to the surface to obtain full contour and the correct shade.
The flexural strength has been shown to improve under subsequent heat treatments as a result of the
growth of additional leucite crystals. For example, the flexure strength of the heat pressed material is in

23
the range of 126 MPa; with subsequent heat treatments, the strength increases to the 160- to 182-MPa
range.
One short-term clinical study has been published that reports no clinical fractures of 10 IPS Empress
inlays; however, one-third of the restorations showed a marginal gap after one and half years of
evaluation.
The final microstructure of IPS Empress exhibits 40% by volume of tetragonal leucite. The leucite
crystals measure 1-5 um and are dispersed in a glassy matrix. Two finishing techniques can be used with
IPS Empress: a staining technique or a layering technique involving the application of veneering
porcelain.
The two techniques lead to comparable mean flexure strength values for the resulting porcelain composite
(Luthy et al, 1993). The thermal expansion coefficient of the IPS Empress material for the veneering
technique (14.9 x 10"6/°C) is lower than that of the material for the staining technique (18 x 10~6/°C) to
be compatible with the thermal expansion coefficient of the veneering porcelain. The flexural strength of
IPS Empress material was significantly improved after additional firings (Dong et al, 1992). The strength
increase is attributed to a good dispersion of the fine leucite crystals as well as the tangential compressive
stresses arising from the thermal contraction mismatch between the leucite crystals and the glassy matrix.

The advantage of these ceramics are its lack of metal, a translucent ceramic core, a moderately high
flerxural strength ( similar to that of Optimal Pressable Ceramic), excellent fit, and excellent aesthetics.
The disadvantages are its potential to fracture in the posterior areas and the need to use a resin cement to
bond the crown micromechanically to tooth structure.

The core microstructure of IPS Empress2 glass ceramic is quite different from that of IPS Empress, it is
made from lithium disilicate framework with an apatite layered ceramic. The Glass ceramic ingots are
made from lithium silicate glass crystals with crystal content of more than 60%. The primary crystal
particles in IPSEmpress2 are 0.5 to 4µm in length. A smaller concentration of lithium orthophosphate
crystals ( Li2Si205) approximately 0.1 to 0.3µm in diameter has also been reported ( Holand etal 2000)
Apatite crystals incorporated responsible for improved optical properties, chameleon effect of leucite
glass ceramic material. The microstructural difference between IPS Empress and IPS Empress2 results in
slight decrease in translucency of IPS Empress2 ( 0.55) ( British Standard 5612: 1978) compared with
that of IPS Empress( 0.58).

OPC and OPC 3G are the two pressable ceramics that are similar in nature to IPS Empress and
IPSEmpress2 respectively. OPC is a leucite-containing ceramic and OPC3G contains Lithia disilicate
crystals.

Properties of two pressable glass ceramics

Property IPS Empress IPS Empress 2

Flexural strength( Mpa) 112± 10 400±40
Fracture toughness( Mpa.m1/2) 1.3±0.1 3.3±0.3
Thermal expansion coefficient 15±0.25 10.6±0.25
( ppm/0C)
Chemical durability(µg/cm2) 100-200 50
Pressing temperature( 0C) 1180 920
Veneering temperature(0C) 910 800

Optec Pressable Ceramic: Optec OPC is also a type of feldspathic porcelain with increased leucite
content, processed by molding under pressure and heat. The OPC system can be used for full-contour
restorations (inlays, veneers, full crowns). Alternatively, it can be used as a core material, which is

24
veneered using conventional powder- slurry techniques with a high-leucite-content feldspathic porcelain,
similar to Optec HSP porcelain. The manufacturer claims that the crystalline leucite particle size has been
reduced and the leucite content increased, resulting in an overall increase in flexural strength of OPC of
165MPa. There are no published clinical studies of Optec OPC; however, because of its high leucite
content, it can be expected that this porcelain's abrasion against natural teeth will be higher than that of
conventional feldspathic porcelain.
Both Optec OPC and IPS Empress produce strong, translucent, dense and etchable ceramic restorations.
The materials are especially useful in fabricating ceramic veneers. Both systems require special
equipment (pressing oven and die material) to fabricate the restorations.

Alceram (Innotek Dental Corp, Lakewood, CO) is a material for injection-molded technology and
contains a magnesium spinel (MgAl2O4) as the major crystalline phase (McLean and Kedge, 1987). This
system was initially introduced as the "shrink-free" Cerestore system, which relied on the conversion of
alumina and magnesium oxide to a magnesium aluminate spinel. One of the recognized advantages of this
system was the excellent marginal fit of the restorations (Wohlwend et al, 1989).

Infiltrated ceramics. Developed by a French scientist and dentist Dr. Micheal Sadorun (1980)
These products are supplied as two components: a powder (aluminum oxide or spinel), which is
fabricated into a porous substrate, and a glass, which is infiltrated at high temperature into the porous
substrate. The infiltrated ceramic is then veneered using the conventional feldspathic porcelain technique.
Eg: In-Ceram.

ln-Ceram (Vident, Baldwin Park, CA) is a slip-cast aluminous porcelain. This ceramic material is
composed of an infiltrated core veneered with a feldspathic porcelain. The core is initially extremely
porous, and is composed of either aluminum oxide or spinel (a composition containing aluminum oxide
and magnesium oxide). This porous structure is subsequently infiltrated with molten glass. The spinel
cores are more translucent than the aluminum oxide cores, but some strength has been sacrificed for the
translucency.
The alumina-based slip is applied to a gypsum refractory die designed to shrink during firing. The
alumina content of the slip is more than 90%, with a particle size between 0.5 and 3.5 micrometers. After
being fired for four hours at 1100°C, the porous alumina coping is shaped and infiltrated with a
lanthanum-containing glass during a second firing at 1150°C for four hours. After removal of the excess
glass, the restoration is veneered with matched expansion veneer porcelain (Probster and Diehl, 1992).
This processing technique is unique in dentistry and leads to a high-strength material due to the presence
of densely packed alumina particles and the reduction of porosity.
In ceram is supplied in one of the core ceramics 1) In-ceram Spinell 2) In ceram Alumina, 3) In-ceram
Zirconia. The core is made from fine grained particles that are mixed with water to form a suspension
referred to as a "slip". The slip is then placed on a gypsum die and baked at 1120 C for 10 hours to
produce the opaque, porous core. At this stage, the material is very fragile and must be handled carefully.
Next, an appropriate shade of glass powder is applied to the core, which is baked again at 1100 C for four
hours. During this process, the molten glass infiltrates the porous alumina core by capillary action. This
confers the selected shade to the core (although it remains fairly opaque), and increases the strength of the
core to about 20 times its original strength. The aluminum oxide or spinel crystals limit crack propagation
and the glass infiltration reduces porosity. Vitadur N (Vident) aluminous veneering porcelain is then
applied using conventional powder- slurry techniques to create the proper shade and contour. The
restorations produced with aluminum-oxide-infiltrated cores have extremely high flexure strength (in the
450 MPa range); this is the strongest all-ceramic dental restoration presently available.
The core of aluminum oxide or spinel is so dense that traditional internal surface etching to improve the
bond to tooth structure is not possible. (The manufacturer recommends sandblasting and the use of a resin
cement such as Panavia 21TC [J. Morita] for final cementation). These restorations provide an accurate
fit. Because of the opaque alumina core, the translucency of the final restoration may not be as lifelike as

25
that seen with other systems. This material requires specialized equipment to fabricate a restoration. In a 2
and half year clinical study of 61 full-coverage single units and 15 multiple-unit bridges," researchers
reported that no single units fractured, and two of the 15 bridges failed because of fractured abutments.

In-ceram alumina, In-ceram spinell, and In-ceram zirconia

In-Ceram Spinell contains a magnesium spinel (MgAl2O4) as the major crystalline phase with traces of
alpha-alumina, which seems to improve the translucency of the final restoration. The most translucent of
the three ceramics, In-Ceram spinell was introduced as an alternative to In-Ceram Alumina. This ceramic
has low flexural strength , but it has increased translucency provides improved aesthetics in clinical
situations in which adjacent teeth or restoration are quite translucent. The core of In-Ceram Spinell is
MgAl204 and In-Ceram Zirconia is a mixture of Al 203 and ZrO2. These core ceramics are also infiltrated
with glass , and fabricated in a manner similar to that of In-Ceram Alumina although the firing
temperature and time may vary. In-Ceram Zirconia contains approximately 30wt% zirconia and 70wt%
alumina. The powder liquid slurry is slip cast onto a porous die that absorbs waterform the slurry and
thereby densifying the agglomeration of particles onto the die. The final In-Ceram Alunina consists of
70wt% alumina infiltrated with 30wt% sodium lanthanum glass.

The flexural strength ( modulus of rupture) values of the glass infiltrated core material are approximately
350Mpa for In-Ceram Spinell , 500Mpa for In-Ceram Alumina and 700 Mpa for In-Ceram Zirconia
compared witH the strength of 100 to 400 Mpa for Dicor, Optec Pressable Ceramic, IPS Empress, IPS
Empress2. Because of the variation in strength, the primary indication for these core materials include
In-Ceram Spinell : anterior crown ,inlays, onlays and veneers. In-Ceram Alumina: anterior posterior
crowns and anterior FPD’s . In-Ceram Zirconia: posterior crowns and posterior FPD’s ..

Advantages of In-Ceram Alumina include moderately high flexural strength and fracture toughness, a
metal free structure and ability to be used successfully with conventional luting agents. The collective
advantage of the three glass infiltrated core materials are lack of metal, relatively high flexural strength
and toughness and the ability to be successfully cemented using any cement.
Disadvantages the Weilbull modulus of In-Ceram Alumina is quite low ( 5.7) which is indicative of large
scatter in the distribution of strength, adaptation may not be as good as achieved with other ceramic
products. In-Ceram Alumina has high degree of opacity, inability to be etched, it is technique sensitive,
and requires relative amount of skilled labour.

It is essential that gingival embrasure area of ceramic FPD’s connectors be designed with a large radius of
curvature to minimize the stress- raiser effect in areas of moderate to high tensile stress. The connector
should be sufficiently thick to minimize stress during loading . For IPS Empress and Empress2 ceramic
used in molar areas , the connector height should be at least 4mm.

Steps for fabricating In-Ceram prosthesis is as follows 1) prepare the teeth with an occlusal reduction
of 1.5 to 2mm and a heavy circumferential chamfer 2) make an impression and pour two dies 3) apply
Al203 on a porous duplicate die 4) heat at 120 0C for 2 hours to dry Al 203 5) sinter the coping for 10 hours
at 11200C 6) apply sodium lanthanum glass slurry mixture on the coping 7) fire for 4 hours at 1120 0C to
allow Infiltration of glass 8) trim excess glass from the coping with diamond bur 9) build up the core with
dentin and enamel porcelain 10) Fire in the oven, grind in the anatomy and occlusion , finish and glaze.

Machinable ceramics- Prefired blocks of feldspathic or glass ceramics

Composition : Modified feldspathic porcelain or special pure alumino silicate composition
Properties :Excellent fracture and wear resistance, Pore free, Possess both crystalline and non crystalline
phase
These products are supplied as ceramic ingots in various shades and are used in computer- aided design-
computer-aided manufacturing, or CAD-CAM, procedures. For Cerec CAD-CAM system the internal
surface of inlays, onlays , or crowns is ground with diamond disks or other instruments to the dimension

26
obtained from a scanned image of the preparation. For some systems the external surface must be ground
manually , although some recent CAD-CAM systems are capable of forming the external surface as well.
The machined restoration can be stained and glazed to obtain the desired characterization. The ceramic
ingots used in CAD-CAM restorations do not require further high-temperature processing. They are
placed in a machining apparatus to produce the desired contours. This is followed by occlusal adjustment
and then polishing, etching and bonding the restoration to the prepared tooth. The different types of
ceramic ingots used in the process are: Cerec Vitablocs Mark I, Cerec Vitablocs Mark II, Dicor MGC
(Dentsply,L.D. Caulk Division), Celay blocks(Vident).
Cerec Vitablocs Mark I: This is a feldspathic porcelain, which was the first composition used with the
Cerec system (Siemens). It has a large particle size – 10-50 um. It is similar in composition, strength and
wear properties to feldspathic porcelain used for porcelain-fused-to metal restorations.

Cerec Vitablocs Mark II: This is a feldspathic porcelain reinforced with Aluminium oxide- increased
strength, and has a finer grain size (4 um) than the Mark I compositions; an in vitro evaluation shows that
this produces less abrasive wear of the opposing tooth structure. Vita Mark II contains sanidine
(KAlSi3O8) as a major crystalline phase within a glassy matrix. The presence of sanidine could explain
the lack of translucency of this material.
Presently, the main identified weakness of the Cerec system is the marginal fit of the restorations

Dicor MGC (Dentsply, L.D. Caulk Division). This is a machinable glass ceramic provided as CAD-CAM
blanks and ingots and composed of fluorosilicic mica crystals in a glass matrix. Mica particles size - 2
um. It has greater flexural strength than the castable Dicor and the Cerec compositions. This material is
softer than conventional feldspathic porcelain and produces less abrasive wear of the opposing tooth
structure than Cerec Mark I and more wear than Cerec Mark II in an in vitro study. Available as Dicor
MGC light and Dicor MGC dark.
Colorants have been added to match tooth color. The glass-ceramic contains 70 vol% of the crystalline
phase (Grossman, 1991). Manufacturer's control over the processing of this material and the higher
volume percent of the crystalline phase could explain the improved mechanical properties of Dicor MGC
compared with conventional Dicor glass-ceramic. The use of adhesive resin based cements has been
shown to improve the fracture resistance of all-ceramic crowns (Eden and Kacicz, 1987; Grossman and
Nelson, 1987). Other studies have shown that the overall fracture resistance of Dicor MGC was
independent of cement film thickness (Scherrer et al., 1994). Presently, the main identified weakness of
the Cerec system is the marginal fit of the restorations (Anusavice, 1993).
The mechanical properties of Dicor MGC are similar to those of Dicor glass-ceramic, although it has less
translucency ( contrast ratio 0.41 to 0.44 versus 0.56 respectively.)

MGC-F (corning Inc): Tetrasilic mica glass ceramic with enhanced fluorescence and machinability

CAD-CAM Ceramics: A ceramic restoration fabricated by use of a computer aided design & computer
aided milling. CAD/CAM technologies introduced to the dental profession in 1971
Fabrication involves five steps:
– Computerised surface digitization
– Computer aided designing
– Computer aided milling
– Computer aided esthetics
– Computer aided finishing

Various surface digitization techniques

– Laser scanning computed tomography
– Magnetic resonance imaging
– Ultrasound scanning

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 – Contact profilometry
– Laser technique and contact digitization - most promising
CAD-CAM technique for fabricating a ceramic restorations
Cavity preparation is scanned using 3D miniature video camera. A Small micro processor unit stores the
3D pattern depicted on screen. Microprocessor develops 3-D restorations from the 2D constructions. The
Electronic information is transferred numerically to miniature 3 axis milling device. Driven by a water
turbine unit, milling device generates a precision fitting restorations from a standard ceramic block
An advantage of CAD-CAM ceramics is that one can select a core ceramic either for strength and fracture
resistance , for low abrasiveness , or for translucency . For example, the extensive wear opposing enamel
that occurs when it is opposed by example , the extensive wear of opposing enamel that occur when it is
opposed by a feldspathic porcelain surface in the absence of posterior occlusion can be minimized by
selecting a core ceramic that is minimally abrasive to enamel.

Cerec system (Sirona Dental, Bensheim, Germany) - Computer-assisted CERamic REConstruction

ADVANTAGES
1. Time savings
2. Stronger porcelain - Milled ceramic is stronger than hand layered and pressed
3. Esthetics - Homogenous porcelain blends in better than other porcelains

Cerec 1 System
The CEREC was first introduced in 1986. It consisted of a mobile unit containing :
1. A small camera
2. A computer with scan and
3. 3-axis-of rotation milling machine
The Old milling machine water-pressure driven “hydro” version
Clinical shortcoming
• Occlusal anatomy had to be developed by the clinician using flame shaped, fine particle diamond
instrument and conventional porcelain polishing procedures
• Inaccuracy of fit or large interfacial gaps
• Clinical fracture
• Relatively poor esthetics

Cerec 2 system: Mormann and Brandestini – 1994. It consists of a mobile unit containing small camera,
computer with scan and 3-axis-of-rotation milling machine
• better and smoother cutting of ceramic - better fitting restorations
• Upgrading of software - allows machining of occlusal surface

CEREC 3
• Phenomenally accurate, computerized single visit porcelain
• Veneer, Inlay/Onlay, 3/4 and full Crown tooth restoration system
• A powdered image of the tooth from a cad/cam 3D camera sent to milling machine
• According to the general CEREC principle, an Optical impression is used as “worksheet” to
construct restoration in /on any single tooth- from a single class I or class V restoration to any
partial or full crown.
Fabrication procedure: The prepared and surrounding tooth surfaces are coated with CEREC powder (to
obtain an opaque reflective surface (few m thick only). An image of the preparation is then
simultaneously projected onto the screen. The operator now checks the preparation and its three-
dimensional representation for corrections or modifications to be made, if necessary. Once the appropriate
optical orientation is generated, the operator can 'freeze-frame' the preparation into a static image. After
all data have been supplied, the computer selects size of the ceramic block required.

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CICERO SYSTEM
• Developed for production of ceramic fused to metal restorations
• Unique feature produces crowns, FPD’s and inlays with different layers such as metal and dentin
and incisal porcelains
• Crown fabrication consists of optically digitizing a gypsum die
• Designing crown layer buildup
• Subsequently pressing, sintering, and milling consecutive layers of shaded high-strength alumina-
based core material, layer of dentin porcelain, final layer of incisal porcelain
• Allows efficient production of all-ceramic restorations without compromising esthetics or
function 

Copy milling : A process of milling a structure using a device that traces the surface of a metal, ceramic
or a polymer pattern and transfers the traced spatial positions to a cutting station. It involves Mechanical
shaping of industrially prefabricated ceramic. Copy milling includes fabrication of a prototype usually via
impression making and model preparations. Based on the model, a replica of inlay / crown is made and
fixed in copying device and transferred 1:1 into the chosen material such as ceramic

Celay: The Celay system (Mikrona Technologie, Spreitenbach, Switzerland) uses a copy-milling
technique to manufacture ceramic inlays or onlays from resin analogs. The Celay system is a mechanical
device based on pantographic tracing of a resin inlay or onlay fabricated directly onto the prepared tooth
or onto the master die (Eidenbenz et al 1994). As with the Cerec system, the starting material is a ceramic
blank available in different shades. One ceramic material currently available for use with the Celay
system is Vita-Celay (Vident, Baldwin Park, CA). This material contains sanidine as the major crystalline
phase within a glassy matrix. Recently, ln-Ceram pre-sintered slip-cast alumina blocks (Vident, Baldwin
Park, CA) have been machined with the Celay copy-milling system used to generate copings for crowns
and fixed partial dentures (McLaren and Sorensen, 1995). The alumina copings were further infiltrated
with glass following the conventional ln-Ceram technique, resulting in a final marginal accuracy within
50 um.
This material is a fine-grained feldspathic porcelain that is said to reduce the wear of antagonist tooth
structure; however, there are no clinical studies to substantiate this claim. The manufacturer claims that
this material is identical in composition to Cerec Vitablocs Mark II (E. Perry, Celay product manager,
Vident Inc., personal communication, 1996). On this basis, it would be expected that the physical and
clinical properties of Celay are also identical to those of Cerec Vitablocs Mark II.
Two main features:
 A Hand-operated contacting probe that traces external contour of acrylic or wax inlay, previously
fabricated directly in mouth
 A milling arm, following the probe by means of a pantographic arm with eight degrees of
freedom, that cuts a copy of the ‘pro-inlay’ from a porcelain or glass-ceramic block

The Initial cut is carried out using a relatively coarse (126µm) diamond-tipped wheel under liquid
coolant. The cut is repeated with liner wheel (64µm) to smooth the surface. Fine anatomical detail
achieved using conical and cylindrical diamond points. Marginal fit ranges from 50 to 80µm. Material
used are ceramic blanks -,vita mark II. Also In ceram spinel, In ceram alumina

All the aforementioned systems can be characterized with stains after milling and occlusal adjustment.
Functionally correct occlusal surfaces can be milled
Machinable ceramics have been evaluated in some limited clinical studies. These studies have shown that
the gap between the restoration and tooth structure is considerably wider than that in other types of all-
ceramic restorations. This gap can be filled in with composite resin cements, but the cement itself is
subject to wear. This wear may be self limiting after three to four years. Clinical fracture seems to be
related to insufficient depth of tooth preparation and inadequate bonding to the tooth structure during

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cementation. There is a good fit with adequate preparation and no additional equipment required in the
laboratory.

Procera All Ceram

Developed by Anderson M and Oden A in 1993. It is composed of densely sintered, high purity
aluminum oxide core combined with a compatible All Ceram veneering porcelain. This ceramic material
contains 99.9% alumina, its hardness is one of the highest among the ceramics used in dentistry. Procera
All Ceramic is used in anterior and posterior crowns, veneers, onlays, and inlays.
A unique feature of Procera system is the ability of the Procera Scanner to scan the surface of the
prepared tooth and transmit the data to the milling unit to produce an enlarged die through CADCAM
process. High purity alumina powder is pressed onto the die under very high pressure, milled to required
shape and fired at a high temperatures (1550°C) to form a Procera coping
Thus the usual 15% to 20% shrinkage of the core ceramic during sintering will be compensated by
constructing an oversized ceramic pattern, which will shrink during sintering to desired size to accurately
fit prepared tooth. Body and incisal porcelains are applied in conventional manner.

Cercon and lava Zirconia Core ceramic

Cercon Zirconia systems consist of the following procedures for production of zirconia –based
prostheses. After preparing, the teeth ( 2mm incisal or occlusal reduction and 1-5mm axial reduction), an
impression is made and sent to the laboratory , where it is poured with model material. A wax pattern
approximately 0.8mm in thickness is made for each coping or crown areas of the framework of a FPD.
The wax pattern is anchored on the holding appliance on the left side of the scanning and milling
unit( Cercon Brain). A presintered zirconia blank is attached to the right side of the Brain unit. The blank
has an attached barcode, which contains the enlargement factor and other milling parameters for computer
control of the milling procedure. After the unit is activated , the pattern is scanned and the blank is rough
milled and fine-milled on occlusal and gingival aspect in an enlarged size to compensate for the 20%
shrinkage that will occur during subsequent sintering at 1350 0C . the processing times for milling are
approximately 35 mins for a crown and 80 min for four unit fixed FPD. The milled prosthesis is removed
from the unit , and the remaining extraneous extensions are removed. The zirconia coping or framework
is then placed in Cercon furnace and fired at 1350 0C for approximately 6 hours to fully sinter the yttria-
stabilized zirconia coping or framework. The sintering shrinkage is achieved uniformly and linearly in
three dimensional space by integrated process of scanning , enlarging the pattern design , controlled
milling , and sintering.
After any subsequent trimming the water-cooled , high speed diamond bur , the finished ceramic core
framework is then veneered with a veneering ceramic ( Cercon Ceram S) and stain ceramic.

Lava dental crowns present an innovative computer-aided design/computer-aided manufacturing

(CAD/CAM) technology to produce an all-ceramic crown on a zirconia base.  Lava dental crowns were
created by the need for all-ceramic dental restorations in the posterior region, which is an increasingly
important aspect of dental care.  Until Lava dental crowns, there were no real suitable ceramics or
economic processing procedures available.  With the new LAVA system, it will be possible to satisfy
these demands in the future.
The Lava system is based on the machining of pre-sintered zirconia, which, due to its outstanding
mechanical properties, its biocompatibility, and its excellent esthetics in combination with a specially
designed veneer ceramic, is the ideal candidate for these applications. 
Pre-sintering is the process of heating of a compact at a temperature below the normal final sintering
temperature to increase the ease of handling or shaping the compact.  Zirconia is a high-tech ceramic
material that is characterized by its outstanding stability and biocompatibility, as well as strength levels
that are significantly higher than other all-ceramic materials.  In addition to strength, Lava all-ceramic
system restorations display excellent esthetics and precise fit characteristics.  In combination with a

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corresponding CAD/CAM unit, the use of an easy-to-machine pre-sintered ceramic material allows for
the first time a reliable, fully-automated and thus, fast manufacturing of the Lava Dental Crown. 
The advantages of Lava Dental Crown is summarized:
Excellent esthetics and translucency
Outstanding marginal fit
Superior strength of zirconia with high fracture resistance
8 shades of zirconia framework
Ideal for 3-unit bridge applications
Successful 3-year clinical trial
The esthetics and biocompatibility of Lava restorations represent the optimum in all-ceramic systems. 
Many cosmetic dentists today are shifting towards the use of Lava Dental Crowns.  They are surprised by
the results - Excellent clinical margin, fit and stability, and superior aesthetics.  Preparations require
removal of less tooth structure, and cementation can be accomplished using proven, conventional
techniques.

RECENT ADVANCES
IPS e.max
• Includes lithium disilicate , high-strength zirconium oxide
• Thin veneers to 10-unit bridges
• Esthethics and strength suitable for Press technique and CAD-CAM

IPS SIGN d(Ivoclar)

• Feldspar free fluorapatite glass ceramic system for use with metal
• Fluorapatite glass are intended to allow natural teeth to be imitated very closely
• 5 different ceramic alloys for use with IPS SIGN- high gold, pd based, Pd-Ag and Co-Cr based
alloys

Finesse® All-Ceramic (DENTSPLY Ceramco)

• Material: Leucite-reinforced glass-ceramic
• Recommended Use: Single crowns (to the 2nd bicuspid), veneers, inlays and onlays.
• Lab Processing: "Pressing"-lost wax injection molding, 930oC, 20min.
• Properties: Flexural Strength~125MPa, Fracture
• Esthetics: Inherently fluorescent, Ideal transparency range from FC (Clear) to FOP (Opaceous).
• Placement: Adhesive bonding

Hybrid ceramics : (estenia)

• Combination of ceramic and composite
• 92 wt% filler loading
• Particle size 0.02µm-2µm
• Indications –
– Jacket crown
– Inlay
– Onlay
– Crown and bridge
• Physical properties higher conventional

Paradigm MZ 100
• Most recently introduced machinable material
• Polymer ceramic based on Z 100 composite chemistry
• Maximize degree of cross linking
• Paradigm has 85% zirconia silica filler

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 Advantages :
- Negligible porosity
- Good patient acceptance
Disadvantages :
- Need for costly equipment
- Technique sensitive nature of surface imaging required for prepared teeth
- Lack of computer controlled processing support for occlusal adjustment

Ormocer : In 1999, “ormocer” Acronym for “organically modified ceramic” developed by Fraunhofer
Silicate Research Institute in Germany
Unlike conventional polymers, ormocer has inorganic backbone of SiO 2 functionalized with
polymerisable organic units
Organic Polymer : Methacrylate units responsible for cross linking, polarity, hardness and optical
properties

Inorganic filler (Quartz, ceramic) : Responsible for thermal expansion, chemical and thermal stability.
Advantages of low thermal conductivity, wear resistance minimal monomer release, easy handling,
outstanding biocompatibility and esthetics

Survival literature for all-ceramic restorations

Veneers
Ceramics are particularly well suited for veneer restorations. With limited exceptions, porcelain veneers
fabricated from a wide variety of ceramics have failure rates (loss of retention or fracture) of <5% as
reported from eleven studies of generally 3 years to 5 years duration. Materials and clinical and
performance issues related to the use of ceramic veneers are well covered in two relatively recent review
articles.

Inlays and onlays

The most extensively studied ceramic inlay/onlay restorations are those fabricated via the Cerec
computer-aided design/computer-aided machining system (Sirona; A.G., Bensheim, Germany). Two
ceramics were available when most published studies were initiated: a felspathic porcelain (Mark I; Vita)
and a mica-filled glass (Dicor; Dentsply). Systematic analysis of 15 clinical trials found a mean survival
rate of 97.4% over 4.2 years with excellent color stability and wear. An 8-year follow-up of 16 patients,
each receiving two inlays, reported that 3 of the 32 restorations fractured. Cerec inlays and onlays (200
restorations) provided in a private practice were reported to have a survival rate (Kaplan-Meier) of 90.4%
over 10 years with failures being due to ceramic fracture (53%), tooth fracture (20%), and endodontic
problems (7%). One of the leucite reinforced pressed ceramics has also been relatively well studied as an
inlay/onlay material (Empress, Ivoclar). A literature review of six clinical trials reported that survival
rates ranged from 96% at 4.5 years to 91% at 7 years.

Single-unit crowns
Four ceramic systems have received notable attention in peer-reviewed literature: (1) a leucite-reinforced
glass (Empress, Ivoclar), (2) a glassinfiltrated alumina (In-Ceram Alumina, Vita), (3) a glass-infiltrated
magnesium aluminate spinell (In-Ceram Spinell, Vita), and (4) a polycrystalline alumina (Procera, Nobel
Biocare). In most cases, fracture rates seem to be lower for anterior crowns than for molar crowns, with
the lowest failure rates for posterior restorations being reported for the high fracture toughness/high
strength alumina-like and alumina materials (In-Ceram Alumina and Procera). The glass-infiltrated
material based on magnesium aluminate spinell (a more translucent, but lower strength cousin of the
glass-infiltrated alumina) seems to be indicated for anterior restorations. One 5-year study of 40 anterior
crowns reported a 97.5% survival rate (Kaplan-Meier). Data for anterior versus posterior leucite-
reinforced crowns seem to trend toward higher survival for anterior teeth, but this can be non significant

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statistically, and one contrary study exists. This confusion is likely due to in part to the inclusion of
premolar crowns in the ‘‘posterior’’ category and the relatively low number of failing crowns and studied
restorations (ie, low statistical power). In a review of six clinical trials, the survival rate for leucite-
reinforced crowns (Empress, Ivoclar) ranged from 92% to 99% at 3 to 3.5 years.
Studies of crowns having substructures of the higher toughness/strength alumina-based ceramics (In-
Ceram Alumina, Vita; Procera, Nobel Biocare) report generally similar results for both materials. No bulk
fracture was reported for 28 anterior and 68 posterior In-Ceram crowns at 4 years. In a private practice
setting, 223 In-Ceram crowns had a survival rate of 96% after 3 years, with anterior crowns trending
toward higher survival (98%) than premolars or molars (94%). In a 4-year university trial of 80 In- Ceram
crowns (73% anterior, 27% posterior), one molar crown fractured and the marginal ridge of one premolar
crown chipped. Of 97 Procera alumina crowns followed for 5 years, three crowns experienced bulk
fracture, and two had some loss of veneering porcelain. The 5- and 10-year survival rates reported in
another study of Procera crowns were 98% and 92%, respectively.

Multi-unit prostheses
Two all-ceramic systems have been recommended by their manufacturer for anterior three-unit
prostheses: a glass-infiltrated alumina (In-Ceram Alumina, Vita) and lithium disilicate glass-ceramics
(Empress 2, Ivoclar; G3, Pentron). In a study of 18 In-Ceram Alumina prostheses (64% cantilevered two-
unit and 36% three-unit) with 62% involving a posterior tooth, the survival rate (Kaplan-Meier) was 93%
at 5 years and 83% after
10 years. There do not yet seem to be peer-reviewed publications regarding the clinical performance of
multi-unit prostheses fabricated with lithium disilicate glass-ceramics.
Two other all-ceramic systems are being recommended for posterior three-unit prostheses by their
manufacturers: a glass-infiltrated alumina/ zirconia (In-Ceram Zirconia, Vita) and transformation
toughened polycrystalline zirconia (Cercon, Dentsply Prosthetics; Lava, 3M-ESPE; Y-Z, Vita). Ongoing
trials of zirconia prostheses are heavily focused on posterior multi-unit prostheses, including studies at the
University of Zurich (58 posterior prostheses; three-unit, four-unit, and one five-unit), Saarland
University (38 posterior multi-unit prostheses), University of Gottingen (62 posterior prostheses; three-
unit and four-unit), and the Louisiana State University (20 posterior three-unit prostheses). Although
results from these trials have yet to be fully published, updates have been presented at international
research meetings with no instances of bulk fracture reported. The longest trial, at the University of
Zurich, recently completed the 3-year recall for all active patients.

Practical aspects
Choosing a system by translucency (value)
Many leaders in the use of all-ceramic and metal-ceramic systems recommend choosing a system based
on the value (Munsell lightnessdarkness scale) of the dentition being restored. Opaque teeth (often
whitish) are best matched using an opaque substructure; this includes many of the highly crystalline
ceramics and metal-ceramic systems. Highly translucent teeth (often grayish) are difficult to match unless
the substructure allows more light transmission than is characteristic of metals and opaque ceramics. Most
systems allow the incorporation of internal coloration, variations in incisal translucency, and the addition
of opalescence. If an all ceramic system is to be chosen, consideration should be given to the structural
indications developed from clinical data and manufacturer recommendations.

Etching and bonding

One classic piece of research demonstrated that the first commercial glass-ceramic crowns (Dicor,
Dentsply) had a much higher survival rate (Kaplan-Meier) over 16 years if they had been etched and
cemented with a resin cement rather than being non-etched and cemented with a zinc phosphate cement.
The improved clinical survival of later feldspathic ceramics having roughly similar strengths and
toughness to Dicor (eg, Empress, Ivoclar; Mark II, Vita) is widely thought to be at least partially due to
their ability to be etched and form strong bonds with resin cements. For ceramics other than Dicor, a

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possible relationship between bonding and clinical success remains conjecture, but this concept has led to
the technique being almost universally applied.
Mechanical bonding enhanced by preparing surface by
– Grinding
– Abrasion with diamond rotary
– Airborne particle abrasion with aluminium oxide
– Etching –
• hydrofluoric acid
• Acidulated phosphate fluoride
• Phosphoric acid
The first requirement for forming a micromechanical bond is the presence of small components within the
ceramic that can be selectively attacked by acids (etched) at a higher rate than surrounding ceramic. The
selective etching of crystalline leucite, leaving behind microscopic glassy crypts, is the most common
dental example. A second requirement for good bond formation relates to the size of the structure(s)
formed by etching and how well they are still attached to the remaining bulk ceramic. For example, some
selective etching of In-Ceram Alumina is possible, but the scale of roughness that develops is insufficient
for good bond formation. Polycrystalline ceramics can be etched, revealing the boundary between
crystalline grains, but these etched grain boundaries provide little micromechanical retention.
Capability of HF to alter ceramic surface depends on ceramic microstructure and composition. Ceramics
that contains glass phase can be etched with HF, whereas ceramics made of aluminous core cannot be
etched sufficiently. HF creates a surface pattern for micromechanical retention by preferential dissolution
of the glass phase. Tribochemical application of a silica layer bymeans of sandblasting (ROCATEC
system, 3M ESPE, Germany) followed by silane application done for inceram ceramics

Chemical bonding is possible with virtually all dental ceramics but only with the use of resin cements
containing special adhesive molecules. Silane coupling agents are commoly used. They have bifunctional
molecules that improves wettability by forming covalent bonds with ceramic and resin cement.
Commonly consists of gamma- methacryloxypropyl trimethoxysilane(MPTS). Bond is formed between
methoxy silane groups of gamma MPTS and OH group of porcelain surface.

Glazing versus polishing

Auto glazing (firing in air) and polishing are two options for finishing the surface of esthetic porcelains.
These techniques received recent attention in a review of a number of studies comparing prepared
surfaces using visual, microscopic, and profilometry measures. All studies agree that glazing can produce
a smooth porcelain surface. However, polishing can produce as smooth a surface that can be more
esthetically similar to natural enamel.
Many authorities favor polishing given that a higher level of control is possible over final surface finish
and that an added firing can add problems and time to the delivery appointment.

Repair
Approaches to the repair of porcelains have recently been reviewed. Repair often offers a cost-effective
alternative to replacement. Repair involves the bonding of resin-based products to remaining porcelain.
The porcelain-resin bond is formed by etching the surface to create micromechanical attachment features
and by the application of silane coupling agents to provide some chemical interaction between the silicon-
based ceramic and carbon-based resins. It is reported that porcelain repair systems form durable bonds to
fractured porcelain and exposed metal surfaces.

All ceramic prostheses represents the most aesthetically pleasing , but also the most fracture prone
prostheses. However, the adequate tooth reduction , an excellent quality impression , a skilled technician ,
and a ceramic with reasonably high flexural strength( ≥ 250 Mpa) and fracture toughness ( ≥2.5
Mpa.m1/2), reasonably high success rates can be achieved. The material that has the greatest potential

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fracture toughness ( 9 Mpa.m1/2 ) and flexural strength ( > 900Mpa) is pure tetragonal stabilized zirconia (
ZrO2). Tinschert et al ( 200lb) reported that the fracture resistance of three- unit ceramic FPD’s ( 1278 N)
made of Cercon zirconia core ceramic was more than twice as great as the values repoted for In-Ceram
Alumina ( 514 N) and Empress 2 ( 621).

To ensure maximum survival times, adequate occlusal tooth reduction is essential for posterior teeth.
Optimal clinical performance of some ceramic products require a minimal occlusal reduction of 2mm for
molar tooth preparation . If the ceramic will be supported by material with high elastic modulus such as a
ceramic or metal post or an amalgam build- up, less occlusal reduction (1.5mm) may be possible without
compromising the survivability of the crowns. For patients exhibiting extreme bruxism either metal or
metal –ceramic prostheses of these materials .

REFERENCES

• Kenneth J. Anusavice, Phillips’ Science of Dental Materials, 11 th edition , 2003,India,Elsevier

Publishers,655-719
• John M. Powers, Ronald L. Sakaguchi , Craig’s Restorative Dental Materials, 12 th edition ,
2006,India, Elsevier Publishers,443-477 
• William J. O’Brien, Dental Materials and their selection, 3 rd edition ,2002,Canada,Quintessence
books,210-224
• Jack L. Ferracane, Materials in Dentistry , 2 nd edition, 1995,U.S.A,Lippincott Williams and
Wilkins,158-165 
• Kelly J R et al, Ceramics in dentistry: Historical roots and current perspectives, J Prosth Dent
1996: 75; 18-31
• Rosenblum MA, Schulman A, review of all ceramic restorations, JADA 1997:128:297-307
• Robert Kelly J, dental ceramics-current thinking and trends, Dental clinics of north America,
2004, 48(2): 513-544

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