Relative translucency of six all-ceramic systems.

Part II:
Core and veneer materials
Michael J. Heffernan, BDS, MS,a Steven A. Aquilino, DDS, MS,b
Ana M. Diaz-Arnold, DDS, MS,c Debra R. Haselton, DDS,d Clark M. Stanford, DDS, PhD,e and
Marcos A. Vargas, DDS, MSf
School of Dentistry and Dows Institute for Dental Research, University of Iowa,
Iowa City, Iowa

Statement of problem. All-ceramic core materials with various strengthening compositions have a range of
translucencies. It is unknown whether translucency differs when all-ceramic materials are fabricated similarly to
the clinical restoration with a veneered core material.
Purpose. This study compared the translucency of 6 all-ceramic materials veneered and glazed at clinically
appropriate thicknesses.
Material and methods. Core specimens (n ⫽ 5 per group) of Empress dentin, Empress 2 dentin, In-Ceram
Alumina, In-Ceram Spinell, In-Ceram Zirconia, and Procera AllCeram were fabricated as described in Part I of
this study and veneered with their corresponding dentin porcelain to a final thickness of 1.47 ⫾ 0.01 mm. These
specimens were compared with veneered Vitadur Alpha opaque dentin (as a standard), a clear glass disc (positive
control), and a high-noble metal-ceramic alloy (Porc. 52 SF) veneered with Vitadur Omega dentin (negative
control). Specimen reflectance was measured with an integrating sphere attached to a spectrophotometer across
the visible spectrum (380 to 700 nm); 0-degree illumination and diffuse viewing geometry were used. Measure-
ments were repeated after a glazing cycle. Contrast ratios were calculated from the luminous reflectance (Y) of the
specimens with a black (Yb) and a white backing (Yw) to give Yb/Yw with CIE illuminant D65 and a 2-degree
observer function (0.0 ⫽ transparent, 1.0 ⫽ opaque). One-way analysis of variance and Tukey’s multiple-
comparison test were used to analyze the data (P⬍.05).
Results. Significant differences in contrast ratios were found among the ceramic systems tested when they were
veneered (P⬍.0001) and after the glazing cycle (P⬍.0001). Significant changes in contrast ratios (P⬍.0001) also
were identified when the veneered specimens were glazed.
Conclusion. Within the limitations of this study, a range of translucency was identified in the veneered
all-ceramic systems tested. Such variability may affect their ability to match natural teeth. The glazing cycle
resulted in decreased opacity for all test materials except the completely opaque In-Ceram Zirconia and metal-
ceramic specimens. (J Prosthet Dent 2002;88:10-5.)

CLINICAL IMPLICATIONS
In this in vitro study on 6 different veneered and glazed all-ceramic core materials, a significant
range of translucency was found. The glaze cycle resulted in decreased capacity.

M odern ceramic systems rely on relatively opaque

core materials to provide strength. Many systems have
material contributes to the overall color of the restora-
tion,1 as well as its translucency.2
overlying veneer porcelains for esthetics, but the core A previous study3 identified a range of translucency in
the core materials of 6 contemporary all-ceramic sys-
a
Former postgraduate student, Department of Prosthodontics. Private tems: IPS Empress, IPS Empress 2, In-Ceram Alumina,
practice, London, England. In-Ceram Spinell, In-Ceram Zirconia, and Procera All-
b
Professor and Head, Department of Prosthodontics.
c
Associate Professor, Department of Family Dentistry. Ceram (Table I). The ultimate translucency of the core-
d
Assistant Professor, Department of Family Dentistry. and-veneer system is important for optimal esthetics.4
e
Associate Professor, Department of Prosthodontics; Director of Clin- Ceramic translucency can be affected by many proper-
ical Research, Dows Institute for Dental Research.
f
Associate Professor, Department of Operative Dentistry. ties, including thickness,3 crystalline structure,5-8 and
This research was sponsored by a 1998-99 American College of number of firings.9 Certain all-ceramic restorative mate-
Prosthodontists/ESPE Research Fellowship Award in Fixed Prosth- rials have been recommended based on the translucency
odontics, Chicago, Ill. It was presented before the American
of the teeth to be matched.4 The only measured results
College of Prosthodontists Annual Session, November 2001,
New Orleans, La., and awarded the Sharry Prize for Research are from preliminary studies (reported as abstracts) with
from the American College of Prosthodontics. questionable clinical relevance given that the all-ceramic

10 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 88 NUMBER 1

HEFFERNAN ET AL THE JOURNAL OF PROSTHETIC DENTISTRY

Table I. Core and veneer mate rials and manufacturers

Thickness Thickness
Core material (mm) Veneer material (mm) Manufacturer

IPS Empress dentin 0.8 Empress dentin body 0.7 Ivoclar Williams, Ivoclar North America, Amherst, N.Y.
IPS Empress 2 0.8 Empress 2 dentin body 0.7
In-Ceram Alumina 0.5 Vitadur Alpha dentin 1.0 Vita Zahnfabrik, Bad Säckingen, Germany
In-Ceram Spinell 0.5 Vitadur Alpha dentin 1.0
In-Ceram Zirconia 0.5 Vitadur Alpha dentin 1.0
Procera All Ceram 0.5 AllCeram dentin 1.0 Core: Nobel Biocare AB, Göteborg, Sweden, Veneer:
Ducera Dental GmbH and Co KG, Rosbach, Germany
Porc. 52-SF alloy 0.5 Vita Omega 900 dentin 1.0 Core: WE Mowrey Co, St. Paul, Minn. Veneer: Vita
(control) Zahnfabrik
Glass slide (control) 2.0 0.0 McDonald Optical Dispensary, Iowa City, Iowa
Vitadur Alpha dentin 0.5 Vitadur Alpha dentin 1.0 Vita Zahnfabrik
(standard)

systems were not veneered or of the thickness recom-

mended by the manufacturers.10,11
No studies were found that compared the translu-
cency of all-ceramic systems veneered in a manner sim-
ilar to the final clinical restoration. This investigation
evaluated the translucency of veneered and glazed all-
ceramic specimens fabricated to a clinically appropriate
thickness. The 6 systems cited above were tested. Of
special interest was the effect of an additional firing cycle
on opacity.

MATERIAL AND METHODS

Fabrication of the core materials was described in a
previous article.3 Veneering was performed in accor-
dance with each manufacturer’s recommendations. All
specimens (n ⫽ 5 per group) were fabricated with the
use of veneering porcelain corresponding to shade A2
Vita Lumin Vacuum.
After an initial wash firing, Empress veneering porce-
lain was added to each Empress core specimen. Speci-
mens were seated in a fluoropolymer resin matrix (Tef-
lon; DuPont Corp, Wilmington, Del.) approximately 13
mm in diameter and 1.6 mm deep. Veneering porcelain
slurry was condensed and hand-vibrated; excess mois-
ture was removed with absorbent paper tissue to mini-
mize porosity. The base of the fluoropolymer resin mold
was raised to remove each veneered specimen (Fig. 1).
Group specimens were fired together according to the
manufacturer’s guidelines. The addition of porcelain
and a second, manufacturer-recommended dentin firing
cycle was required to compensate for peripheral shrink-
age of the initial veneering porcelain. Empress glazing
paste was mixed with glazing and staining liquid I (Ivo-
clar Williams) and applied to the porcelain veneer sur-
face before the glaze firing cycle.
Empress 2 dentin body was mixed and added to the
core as described above. After the initial foundation fir-
ing, 2 of the 5 specimens fractured completely through
the core base. The remaining 3 specimens were allowed
Fig. 1. Core specimen with veneer porcelain raised from
Teflon matrix.
to cool, and an additional firing was performed to re-
build to the deficient veneer circumference. The 3 spec-
imens were fired with the recommended glazing cycle
after an application of Empress 2 glazing material.
In-Ceram, Procera, and Vitadur Alpha dentin cores
were veneered with their respective porcelains, as described
for Empress. Vitadur Alpha porcelain was added to the
In-Ceram cores with 2 dentin firings and a glaze cycle (no
glazing fluid required). Opaque liner and liquid were ap-
plied to Procera cores and fired; 2 firings of AllCeram den-
tin porcelain then were performed.
A veneering layer of Vitadur Alpha dentin was applied
to the Vitadur Alpha controls. The metal-ceramic alloy
was air-particle abraded and steam-cleaned and then un-
derwent an oxidation cycle. The alloy was opaqued with
metal-ceramic opaque (Vita Zahnfabrik) and fired. Vita-
dur Omega dentin porcelain was added, and 2 dentin-
firing cycles were performed.
A glass disc was included as a positive control. Be-
cause no 1.5-mm–thick disc was available from the man-
ufacturer, a 2-mm–thick disc was used. The contrast
ratio was measured with the as-delivered polish and
again after airborne particle abrasion with 50-␮m alumi-

JULY 2002 11
THE JOURNAL OF PROSTHETIC DENTISTRY HEFFERNAN ET AL

Table II. One-way ANOVA for contrast ratios of veneered specimens

Sum of
ANOVA table df squares Mean square F value P value*

Treatment (between columns) 8 1.260 0.1575 2243 ⬍.0001

Residual (within columns) 30 0.002107 0.00007022
Total 38 1.262
*Tukey’s multiple-comparison test was applied to reveal differences.

Table III. Tukey’s multiple-comparison test for contrast ratios of veneered and glazed specimens
No. of Contrast ratio: Contrast ratio:
Material specimens veneered glazed P value*

Glass 1 0.27 ⫾ 0.000 0.06 ⫾ 0.000 ⬍.001

Vitadur Alpha 5 0.73 ⫾ 0.013 0.71 ⫾ 0.009 ⬍.01

兩 兩
IPS Empress (0.8 mm) 5 0.78 ⫾ 0.008 0.75 ⫾ 0.006 ⬍.05
In-Ceram Spinell 5 0.78 ⫾ 0.008 0.76 ⫾ 0.017 ⬍.01
Empress 2 (0.8 mm)
Procera AllCeram
3
5
0.78 ⫾ 0.006
0.83 ⫾ 0.010
0.77 ⫾ 0.000
0.80 ⫾ 0.018 兩 ⬎.05
⬍.001
In-Ceram Alumina 5 0.91 ⫾ 0.005 0.90 ⫾ 0.009 ⬎.05
In-Ceram Zirconia
52 SF alloy
5
1
1.00 ⫾ 0.008
1.00 ⫾ 0.000 兩 1.00 ⫾ 0.006
1.00 ⫾ 0.000 兩 ⬎.05
⬎.05
*P ⬍ .05 indicates significant difference in contrast ratio from veneered to glazed specimen. Vertical lines connect ceramic systems that were not significantly
different.

num oxide at 2 bar (used to create a matte finish similar RESULTS

to that of the other test specimens).
Core specimens in the previous study3 were 0.5 mm
thick, except for additional Empress and Empress 2
specimens fabricated to the manufacturer-recom-
mended thickness of 0.8 mm. After veneering porcelain
was applied in this study, a final thickness of 1.5 mm was
achieved for all specimens (except the glass disc). Wet
silicone carbide paper (120-, 240-, and 400-grit) and
airborne particle abrasion with 50-␮m aluminum oxide
at 2 bar pressure were used to produce a uniform matte
finish. Thickness was controlled with a digital microme-
ter (Mitutoyo Manufacturing Company Ltd, Kawasaki,
Japan).
Contrast ratios were measured from the luminous
reflectance (Y) of the specimens with a black (Yb) and a
white backing (Yw) to give Yb/Yw. Luminous reflec-
tance was measured 3 times for each specimen after ve-
neering and again after the glazing cycle. The 3 mea-
surements for each specimen with each backing were
averaged. The mean of the luminous reflectance of the
black backing was divided by the mean of the luminous
reflectance of the white backing for each specimen to
give the mean contrast ratio.
One-way analysis of variance (ANOVA) was used
to identify significantly different contrast ratios within
the groups of veneered and glazed materials. Tukey’s
multiple-comparison test was used to determine which
groups differed. All statistical tests were performed at
the 95% confidence level (␣⫽.05).
One-way ANOVA identified significant differences in
the contrast ratios of veneered materials (P⬍.0001;
Table II). Tukey’s multiple-comparison test revealed no
significant difference in the contrast ratios of Empress,
In-Ceram Spinell, and Empress 2 specimens (Table III).
Procera was slightly more opaque than the aforemen-
tioned materials but more translucent than In-Ceram
Alumina. In-Ceram Zirconia and the veneered metal-
ceramic alloy were completely opaque.
Significant differences also were found in the contrast
ratios of glazed specimens (ANOVA, P⬍.0001; Table IV).
Although Empress specimens were more translucent than
In-Ceram Spinell specimens, the Tukey test showed the
difference to be nonsignificant (Table III). A nonsignif-
icant difference between Procera and Empress 2 speci-
mens after glazing also was identified.
The contrast ratios of glazed and veneered speci-
mens were compared to determine whether an addi-
tional firing affected the degree of translucency. There
was a significant difference between glazed and non-
glazed specimens (P⬍.0001; Table V). The glass disc
and Vitadur Alpha, Empress, In-Ceram Spinell, and
Procera specimens were found to be significantly
more translucent than their corresponding air-particle
abraded specimens (Table III). There was, however,
no significant difference in the opacity of glazed and
nonglazed Empress 2, In-Ceram Alumina, In-Ceram
Zirconia, and metal-ceramic specimens.

12 VOLUME 88 NUMBER 1
HEFFERNAN ET AL THE JOURNAL OF PROSTHETIC DENTISTRY

Table IV. One-way ANOVA for contrast ratios of glazed specimens

Sum of Mean
ANOVA table df squares squares F value P value*

Treatment (between columns) 8 2.043 0.2553 2236 ⬍.0001

Residual (within columns) 30 0.003280 0.0001093
Total 38 2.046
*Tukey’s multiple-comparison test was applied to reveal differences.

Table V. One-way ANOVA for contrast ratios of veneered and glazed specimens
Sum of Mean
ANOVA table df squares square F value P value*

Treatment (between columns) 17 3.324 0.1955 2178 ⬍.0001

Residual (within columns) 60 0.005387 0.0000898
Total 77 3.330
*Tukey’s multiple comparison test was applied to reveal differences.

Table VI. Recommendations for selection of crown material based on translucency of natural teeth
In-Ceram Procera In-Ceram In-Ceram
Natural teeth Spinell Empress Empress 2 AllCeram Alumina Zirconia Metal-ceramic

Low value, high translucency ✔ ✔ ✔

Average value and translucency ✔ ✔ ✔ ✔
Opaque, high value ✔ ✔ ✔

DISCUSSION there was a noted difference in the degree of resultant

The opacity of all core specimens3 increased after they
were veneered. The possible reasons for this increase
include the structure of the veneering porcelain (varied
crystalline contents), increased specimen thickness, re-
flectance at the interface between core and veneering
porcelain, porosity between the layers, and any changes
in the constituent core material with additional firing
cycles.
Although there was no significant difference in the
overall thickness of the veneered groups (apart from the
glass disc), the difference in contrast ratios may be at-
tributable to the thickness of the veneering porcelain on
the specimens. Empress and Empress 2 specimens were
given 0.7 mm of veneering porcelain to achieve the clin-
ically appropriate thickness of 1.5 mm with a 0.8-mm
core. In-Ceram and Procera specimens were given 1 mm
of veneering porcelain to achieve a final thickness of 1.5
mm with a 0.5-mm core. Differences in translucency
groupings after veneering may be due to differences in
the optical properties of the various veneering porcelains
or to a change in the light transmission of each core-and-
veneer material after the firing cycles (Table III).
All specimens were finished in a similar fashion to
allow comparisons among groups. A glazing cycle was
performed to evaluate the effect of additional firing on
translucency and to create a clinically meaningful assess-
ment of the systems. Although manufacturer recom-
mendations were followed with regard to glazing cycles,
glaze on visual examination. This difference may have
affected the measurement of contrast ratios. A signifi-
cant (though slight) reduction in contrast ratios was
identified after glazing for all test materials except Em-
press 2, In-Ceram Alumina, In-Ceram Zirconia, and the
metal-ceramic control (Table III). This decrease may
have been the result of reduced scattering from the
glazed surface compared to the air-abraded finish of the
core-and-veneer specimens. The effect of surface finish is
evident in results for the glass disc. When highly pol-
ished, its contrast ratio was 0.06; after air-particle abra-
sion, its translucency decreased 4-fold to 0.27 (Table
III). The degree of glaze may have accounted for the
change in translucency.
It has been suggested that ceramic core composition
may be affected by additional firing,4 which may increase
the leucite content and, hence, the opacity of metal-
ceramic porcelain. The high alumina content of some
all-ceramic core materials, however, allows repeated fir-
ings without loss of translucency.9 This suggests that, in
this study, the opacity of the core may not have changed.
Instead, the reported effects may have been caused by
the surface texture or constituents and thickness of the
veneering materials.
Although the sample size was small (n ⫽ 5), there was
excellent homogeneity in contrast ratios within the test
groups. Two Empress 2 specimens fractured during the
veneering process. When the contrast ratio was calcu-

JULY 2002 13
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. Glazed, veneered specimens on black-and-white backing with reflected light.
Fig. 3. Glazed, veneered specimens on black-and-white backing with transmitted and reflected light.
lated for the remaining specimens, minimal deviation in
luminous reflectance was found between the 3 remain-
ing specimens and the Empress 2 sample in the previous
core study.3 Comparison of the results was therefore
possible.
Contrast ratio variations after veneering and glazing re-
sulted in 3 approximate groupings of decreasing translu-
cency: (1) Empress, In-Ceram Spinell, Empress 2, and
Procera; (2) In-Ceram Alumina; and (3) In-Ceram Zirco-
nia and the metal-ceramic material (52 SF veneered with
Vita Omega porcelain). This variation may have been due
to differences in core crystal volume and the refractive in-
dex. Reduced crystalline content and a crystal refractive
index close to that of the matrix cause less scattering of
light.8 Compared to In-Ceram and Procera, Empress and
Empress 2 have a lower crystal content within the matrix.
Leucite (used to strengthen Empress) and lithium disilicate
(used to strengthen Empress 2) have refractive indices of
14
HEFFERNAN ET AL
1.51 and 1.55,6 respectively— close to that of the porcelain
matrix of 1.50.5 In contrast, zirconium oxide has refractive
index of 2.20, alumina of 1.76, and spinell of 1.72.7 The
thinner core of the In-Ceram specimens, however, com-
pensated for the opacity caused by a greater difference in
the refractive index of the In-Ceram crystalline core to the
matrix.
The controls used in this study allowed a tangible
comparison of translucency. Although the glass disc was
thicker than any of the veneered specimens, it was still
13 times more translucent (Table III). This result indi-
cates that the ceramic materials tested are relatively
opaque. All-ceramic materials have been advocated
largely on the basis of improved esthetics over metal-
ceramic restorations. Interestingly, In-Ceram Zirconia
specimens and the metal-ceramic negative control ex-
hibited similar opacity. If examined clinically, some of
the other systems might also be indistinguishable from
VOLUME 88 NUMBER 1
HEFFERNAN ET AL
metal-ceramic restorations. Finally, Vitadur Alpha was
used as a standard for the effect of “high-strength” cores
on opacity. Although significant differences in contrast
ratios were identified throughout the study, some of the
more translucent materials (In-Ceram Spinell, Empress,
and Empress 2) exhibited an opacity similar to that of
feldspathic porcelain (Table III).
On a natural tooth, the body and gingival third
should be evaluated for opacity; the incisal tip is capable
of good translucent effects for both metal-ceramic and
all-ceramic restorations. Kelly et al4 made recommenda-
tions for matching all-ceramic materials to teeth of dif-
ferent opacity and value. The results of the present study
suggest that teeth with low value and high translucency
might be most closely restored with Empress, In-Ceram
Spinell, or Empress 2. In-Ceram Spinell, Empress, Em-
press 2, and Procera would be appropriate for teeth of
average value and translucency. As Kelly et al4 note,
more opaque, high-value teeth could be restored with
opaque substrates such as In-Ceram Alumina or metal-
ceramic restorations. This study indicates that In-Ceram
Zirconia would also be feasible, because its opacity was
similar to that of the metal-ceramic (Table VI).
It is unclear whether the statistically significant differ-
ences in translucency found in this in vitro study would
impact the clinical appreciation of translucency. Glazed
specimens are shown in Figures 2 and 3 with reflected light
alone and reflected and transmitted light, respectively. The
visual degree of opacity can be appreciated with the various
specimens over a black and white backing. In-Ceram Alu-
mina with contrast ratio of 0.9 still allowed transmittance
of light (Fig. 3). It is also possible to appreciate the slight
variation in translucency between most of the all-ceramic
systems except In-Ceram Zirconia and the metal-ceramic,
which were opaque. With reflected light (and probably in
the clinical setting), this difference might be less obvious
(Fig. 2). Further study is required to determine what
amount of change in translucency the human eye can de-
tect.
CONCLUSIONS
Within the limitations of this in vitro study on 6 all-
ceramic systems, a statistically significant difference in
JULY 2002
THE JOURNAL OF PROSTHETIC DENTISTRY
the translucency of veneered specimens was identified. A
glazing cycle decreased the measured opacity for all ve-
neered materials except the completely opaque In-Ce-
ram Zirconia and metal-ceramic specimens. The addi-
tional firing also resulted in a significant difference in
translucency rankings.
We acknowledge the financial support of the ACP/ESPE Fellow-
ship Award and the following manufacturers for their donation of
materials: Ivoclar North America Inc (Amherst, N.Y.); Vident (Brea,
Calif.); and Procera Sandvik AB (Stockholm, Sweden, via Dr Carlos
Munoz, Loma Linda University, Loma Linda, Calif.).
REFERENCES
1. Crispin BJ, Okamoto SK, Globe H. Effect of porcelain crown substructures
on visually perceivable value. J Prosthet Dent 1991;66:209-12.
2. McLean JW. The science and art of dental ceramics: aesthetics of dental
porcelains. Monograph III. New Orleans: Louisiana State University
School of Dentistry; 1976. p. 1-41.
3. Heffernan MJ, Aquilino SA, Diaz-Arnold AM, Haselton DR, Stanford CM,
Vargas MA. Relative translucency of six all-ceramic systems. Part I: core
materials. J Prosthet Dent 2002;88:4-9.
4. Kelly JR, Nishimura I, Campbell S. Ceramics in dentistry: historical roots
and current perspectives. J Prosthet Dent 1996;75:18-32.
5. Binns D. The chemical and physical properties of dental porcelain. In:
McLean JW, editor. Proceedings of the First International Symposium on
Ceramics. Chicago: Quintessence; 1983. p. 45.
6. Ding Y, Jiang S, Luo T, Miura Y, Peyghambarian N. Lithium disilicate
crystalline slab waveguides from surface crystallised glass. Electronics
Letters 1999;35:504-5.
7. Kingery WD, Bowen HK, Uhlmann DR. Introduction to ceramics. 2nd ed.
New York: John Wiley and Sons; 1976. p. 646-89.
8. Clarke FJ. Measurement of color of human teeth. In: McLean JW, editor.
Proceedings of the First International Symposium on Ceramics. Chicago:
Quintessence; 1983. p. 441-90.
9. McLean JW. New dental ceramics and esthetics. J Esthet Dent 1995;7:
141-9.
10. Nagai SI, Furukawa K, Ishibashi K, et al. Optical evaluation of the trans-
lucency of In-Ceram core material [abstract]. J Dent Res 1996;75:248.
11. Lund PS, Campbell SD, Giordano RA. Translucency of core and veneer
materials for all-ceramic crowns [abstract]. J Dent Res 1996;75:285.
Reprint requests to:
DR MICHAEL J. HEFFERNAN
90 HARLEY ST
LONDON W1G 7HS
UNITED KINGDOM
FAX: (44)20-7224 4158
E-MAIL: mheffernan@ureach.com
Copyright © 2002 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/2002/$35.00 ⫹ 0 10/1/126795
doi:10.1067/mpr.2002.126795
15