Tfie International Journal of Periodontics & Restorative Dentistry

587

A New All-Ceramic Post and

Core System: Clinical, Technical,
and In Vitro Results

Yoshiyuki Kokehoshi, DDS, DDSo'/Heinz Luthy, PhD"/ Root-fiiied teetfi witfi fracfured
Roger Noet DMD"'/Arnold Wohlwend, CDT""/ or discolored coronal ospecfs
Peter Schärer, DMD, MS"'" invoriably need fo be resfored
Roof-filied feeth with fracfured or discoiored coranai aspecfs invariably need by crowns. Often as a result of
to be restored by crowns. The prepared abutment taoth Is usuaily reinforced by mechanical reasons, fhe pre-
a metaiilc post and core sysfem. The grayish discoicratian af the root, and con- pared abutment tocth must be
sequentiy at the gingiva, caused by the metai coior may be an enormaus reinforced by o posf and cere
esthetic disadvantage in the anterior teeth, in 1993 ceramic posts made ofzir- system. Metai posts (ie, plotinum
conia were introduced by the authors, aiiawing a new aii-ceramic concept for
oiloys or titonium) ore most
nonvitai abutment feefh. A new ceramic posf and core system has now been
deveioped with fhe idea of further improving esfhetic appearance. In this sys- commoniy used because of
tem the core material is heaf pressed directly onto the zirconia post. This articie fheir favorable pfiysicai proper-
describes the moferiai ond the fabrication procedures (chairside and in the fies and excellent biocompofi-
laboratory) of the system. Ciinicoi results are presented. The retention of fhe bility. Untorfunoteiy, fheir mefaliic
core materioi is evaiuated by in vitro tests. (Inf J Periodont Rest Dent color ieods fo o groyish discol-
1998:18:587-593.)
orafion of tfie root, and conse-
quently of the gingiva. This may
'Visiting Professor. Crown and Bridge Prosthodonfics. Nifion be an enormous esfhefic disad-
Universitv SofiQol of Dentistry, Tokyo. Japan.
vontage in ffie anferior feetfi.
"Professor, Ciinic of Fixed and Removable Prosth odontic s and
Dental Moferiais Science, Center for Dentai and Oral iviedicine. One solution for improving es-
University of Zurich, Zurich. Switzerland. thetio appearance is the use of
"Senior Lecturer, Ciinic of Fixed and Removable Prosffiodontics a nonmetallic post, ie. ceramic;
and Denfai Materials Science. Center for Dental and Oral
fwiedicine. University of Zuricfi. Zuiicn. Swifzeriand.
unfii reoenfiy. however, posfs
" H e a d of Denfai Tecfinology. Clinic of Fixed and Removabie composed of ceramic materials
Prosffiodonfics and Dentai Maferiais Science. Center for Denfai could nof be used becouse of
ond Oral Medicine. University of Zurich, Zurich. Switzerland. their insufficient mechonicoi
"Professor and Chairmon. Clinic of Fixed and Removabie
Prosf hodontics and Denfai Materials Science. Center for Denfai
properties and thie complicated
and Orai Medicine. University of Zurich. Zuricfi, Swifzeriand. multistep oiinical protocol that is
invoived.i'^ in 1993 Lüffiy et al'
Reprinf requests: Prof Heinz Luthy, Cenfer for Denfai and Oral developed post ond core
Medicine. Universify ot Zuricfi. Piatfenstrasse 11.6028 Zuricfi,
Swifzeriand.
materiais made cf tetragcnol
e-mail: luetfiy@zzmi<.unizh.cfi zirccnia poiycrystals (ZrO;-TZP)

Volume IS. Number 6,199S


Fig 1 Zlrconia posts (CosmoPost).
that have a high tiexural
strength (1,400 MPa) and on
optimal esthetic appearance.
The cores were O rings luted to
the posts (cementation tech-
nique). Based on this work,
Meyenberg et ai'' introduced a
new clinicol all-ceramic con-
c e p t for nonvital abutment
teeth using zirconia ceromic
posts and cores. It has been
shown that light transmission inta
and through the posts is excel-
lent.''-^ The ciinical results are
very promising.'' At the same
time, ceramic posts made
ot ZrOj and composite core
materials were commercially
The International Journol of Periodontics & ResfarativG Dentistry
Fig 2 Set of burs (Ivoctor).
introduced,''•^ A castable
ceromic ottached to the zirco-
nia post wos also reported.^
In 1997 the ivociar com-
pany introduced o ceramic
cere material that con be
heat pressed directly onto zir-
conia posts (IPS Empress
Cosmo Ingot). This new glass-
ceramio moteriai—not to be
confused with the usual IPS
Empress glass-ceramic, which
has a different chemicai com-
position—has a thermolinear
expansion coefficient (TEC)
that is adapted to the TEC of
zirconia. The heaf pressing
technology employed is the
Fig 3 Glass-ceramic ingots (IPS Empress
Cosmo Ingot) used for the heat pressing
techniaue.
same as the technology ol-
ready estabiished (IPS Empress)
tor the fabrication ot inlays,
orowns, ond veneers; this tech-
nology is desoribed else-
This paper describes the
material and the fabrication
procedures (chairside and in
fhe iaboratory) of fhe newiy
deveioped ceromic post and
core system. The in vitro etfect ot
surface condifioning and ther-
macyciing of this new maferiai
was evaiuated, and the dafo
were compared wifh fhe ce-
mentofion fechnique men-
tioned above.
 589

Materials and clinical

procedure

Newly commercially available

cylindre-conical pests made of
tetragonal zircenia pelycrystais
(ZrOj-TZP) stobiiized by 3 mai%
YjOj (CesmoPost, Ivociar) were
used. Figure 1 shows the posts Fig 4 Zircania posts inserted into pre- Fig 5 Impression of the posts mode with
tinaf are now avoiiobie (1,4 and pared root canals. o high-precisian impression materiaL
1,7 mm in diameter), ond Fig 2
shows the cerrespending burs.
The glass-ceramic ingot (Fig 3)
developed for fhe heat pressing
technique (IPS Empress Cesme
Ingef, Ivoclor) is cempesed ef:
58.5% SiO^ by weight, 15.5% ZrO^
by weight. 4,0% P^O^ by weight,
and 8,0% U p by weight, with 14
additives such as NOjO, K^O,
AI2O3, and F, Besides SiOj, only
synthetic raw materials ore Fig ó Wax pattern of the cores made Fig 7 Post-core assembiies after heat
used. Ne feldspar was used for on the working model according to the pressing.
opposing dentition.
the gioss melt. The micrestruc-
ture of the gloss-ceramic after
heot pressing was free of leucite
crysfais.The crystailine port een- For single units, the direct record and an impression of the
sisted mainly ef B-LÍ3pO4 with a cere build-up technique wifh a opposing dentition is taken
diameter ef 0,2 te 0.5 [¡m. As a resin pattern materioi pressed chairside.
ZrOj-containing crystal phase, onto the zirconia pest, fellewed Wqx patterns (Fig ó) of the
LijZrSi^O^g crystois occurred by the cere preparation, is a cores qre fabricated, sprued,
(Schweiger M, ef ai, unpubiished traditional and well known pro- invested, and pressed (Fig 7).
dafa, 1997), The cenventionqi cedure. The technician presses The cere size offer pressing is
heat pressing precedure (iPS the Empress moteriai directly slighfiy bigger than fhe eriginal
Empress) described elsewhere^'' onto the zirconia post without resin or wax cere, Therefere, the
is used fer pressing the inget making a master modei. ceramic cere hos fo be
onto the post. The indirect method is usu- etched in 2% hydrofiuoric ocid
For the clinical precedure, olly used when more than ene solution in an ultrasonic both
fhe zireenia past is selected tooth has to be reconstructed for approximafeiy 7 min for
öfter root canol preparotien ot the same time. The zirconia better fit in the conol inlay The
according to the diometer of posts are inserted into the reef etched surtaee is sondblasted
the root conol, ond a try-in fel- canals (Fig 4) and a precisian im- with giass beods under o pres-
iews. A direcf er indireet ciinicoi pression (Fig 5) is taken. If neces- sure of twe bars ond steam
method con be used. sary an occlusai registration bite cleaned.

Volume 18, Number 6,1998

590
Fig 8 Naturai appearance of fhe
cemented posts at the maxillary left
central and lateral incisors compared
with a vitai abutment af the canine.
The ceramic post core is
tried in chairside ond the post
iength and fit is checked rqdio-
graphicoiiy If the fit is good, the
internai surfoce of the ceramic
core is etched vi/ifh an etching
gei containing 4% to 5% HF (for
instance. Ceramic Etcfiing Gei,
Ivociar). The core is cleoned by
steam cleoner or phosphoric
acid, and then silone is applied
over the etched loyer. The
ceramic post core is cemented
with o chemicai (eg. Panavia
21, Kuraray) or dual cure iuting
cement (eg, Varioiini<. ivociar)
applied v/ith a dentin bonding
system.
Affer finai preporation for on
oll-ceromic crov^/n (Fig 8), o
detinitive impression is made. For
cementation of the finqi resfora-
tion (Fig 9), duol cure resin
The International Jautnai of Periodohtics & Restorative Dentistry
Fig 9 Finished Empress crowns ready
to be lufed on the ceramic cores.
cement wifh a dentin bonding
system is again used. Figure 10
shows the final clinicai result with
on qii-ceromic restorotion.
Clinical results
Gver q period of more than 2
years the authors inserted 24 zir-
conia posts (CosmoPosts) wifh
heat-pressed cores (iPS Empress
Cosmo Ingots) in lo patients (12
incisors, 2 canines, and 10 pre-
molars). The overage observa-
tion period was 15 months, rang-
ing from 3 to 28 monthis. Aii posts
and cores were restored with oli-
cerqmic crowns (iPS Empress).
No faiiures have been observed
fo dofe,The esthetic resuits have
been evaiuated as exceiient,
especially when compared to
Fig W Final clinical result with ail-
ceramic restoration.
the conventionai mefqi post
and core systems ourrentiy avqii-
abie, Aii pafienfs were delighted
with this type of esthetic en-
honcing procedure.
Retention
The second part of the study
determined the infiuence of fhe
zirconia pest surface condition-
ing (os received trom the monu-
focturer versus sandbiasfed)
and thermocyciing on the re-
tention of fhe new core ma-
terial heat pressed in cylihdricol
torm onto the posts. The dato
were compared with ttiose ob-
toined from fhe groups fhot
received the nonpressed tech-
nique (cementation): these
groups served as reterences.
 591

Industrially fobricated cylin-

dricol (1.4-mm diameter, 17-mm
length) TZP posts were used, A
speciol tetlon-coated jig de-
scribed elsewhere^' was used to
position the posts in the center
of a ring. The posts were inserted
Into the jig and wox patterns
were added around them. The
Fig f2 (above) Post-core assemblies
standard Empress EP 500 fur- are cemented.
noce (Ivoclar) wos used to heot
press the IPS Empress Cosmo
Ingots according to the manu-
facturer's instructions. The final
cylindrical core dimension was
1,4 mm high x 0,8 mm in diam- Fig JI (left) Post-core assembiies after
efer Four expérimentai groups heat pressing.
(exp 1 to 4, n = 12) of post-core
assembiies were prepared.
Figure 11 shows post-core
assemblies after heat pressing.
Table 1 Experimental conditions
Prior to core pressing, the posts
of groups 2 and 4 were sand- Post surface Core Thermocyciing
blasted with AI2O3 (50-|jm parti- As Sand- Haaf
Group reoeived blasted pressed Cemented Mone IO,OOOx
cle size). Prior to testing, oli
Exp 1 •
groups of posts were stored in
Ref 1 • • •
water at 37''C for 1 day Groups Exp 2 • • •
3 and 4 were subsequentiy Ref 2 • • •
subjected to thermocyciing Exp 3 • • •
(10,000x) in water (5755°G) for Exp 4
333 hours (Tabie 1), Exp= experimental group; iîef = reference group
For the reterence groups, the
core system was based on one
zirconio O ring attached to the
zirconia post (Fig 12). Two refer-
ence groups (ref 1 and 2) of
post-core assemblies (n = 12)
were prepared. Each ring (1,76-
mm inner diameter; 1,4-mm
height) wos luted to the post
with composite resin (Panovia)
using the tefion jig mentioned
above to position the post in the
center of the ring. The final

Volume 18, Number 6,1998

592

292 + 65

•• •• • y•
231 + 60 r,r,.f + s,l

Ceramic ring 171 + 51

• • •
(pressed or cemented)
108 + 41
ir

-Axial stiafl supporf

_L1 M
Exp1 Ref 1
Exp 2 Ref 2 Exp 3
M Exp 4

Fig 13 Testing devioe used for measurement of oore reten- Fig 14 Expérimentai resuits. (Exp = expérimentai group; Ref=
tion (pressed or cemented). referenoe group.)

cemented core hod the same Results refenficn of fhe glass-ceramic

dimensions as the final heot-
pressed core. Reference groups
1 and 2 received the same
treatments as experimentoi
groups 1 and 2, respectively. The
expérimentai conditions for
experimenfal groups 1 fo 4 and
reference groups 1 and 2 ore
summarized in Toble 1. Each
pasf-core ossembly was seoted
in o speciaily designed test
base, vi/hiich was placed in a uni-
versal testing machine (Fig 13).
Tfie pasts were forced out of fhe
assembiy with a hardened steei
compression rod at a crosshead
speed cf 5 mm/min. Separafion
loads were recorded on an xy-
piotter. Data were analyzed by
analysis of varianoe (P< 0.001).
The retention results of experi-
mental groups 1 fo 4 ond of ref-
erence grcups 1 and 2 are
shown in Fig 14. Fcr unfreafed
(as-received) posf surfaces the
heaf pressing technique re-
suited in a significantiy higher
mean core retention vaiue than
for tfie cemenfotion technique
(exp 1 versus ref 1). For sand-
blasfed posf surfaces there was
no difference in retention be-
tween the two techniques (exp
2 versus ref 2). Comparing the
some post surfaoe ccndifioning
(exp 1 versus exp 3, and exp 2
versus exp 4), severe thermocy-
cling (10,000x) had no sfatisfi-
caliy negofive effecf on fhe
core. After thermccycling, sond-
biasted posf surfaces (exp 4)
showed a significanfly higher
retention rote than os-reoeived
post surfaces (exp 3).
Discussion
The in vitro resuits of this study
showed that frcm the point of
view of oore retention the new
heat pressing teohnique is ot
least as good as the cementa-
tion technique using O rings.'^
With the iatter, there is more
ciinicai experience ovailabie (A
years) (Meyenberg K, perscnai
communication, 1997) thon fcr
fhe heaf pressing fechnique (2

The Internafianal Journal of Periodontics & Restorafive Denfisfry

 593

years) (this work), but bosed on
this study one can reosonobly
expect similar suocess with the
tieat pressing technique.
The heat pressing technoi-
ogy ailows tor the first time the
fabricotion ot post-core systems
entirely in ceramic; with an all-
ceramic crown this ieads to an
optimal esthetic appearance
(excellent light transmission) of
the final restoration. For fhe
pressing technique there is no
need to buy new equipment,
provided that the standard
Empress turnooe is already
ovoiioble.The system ailows the
direct core buildup technique
for single units and the indirect
method when more than one
References
1. Kwiatkov/ski Si. Geiier W. A prelirrinary
consideration of fhe glass ceramic
Oowei post ond core. Int J Prostho-
dant 1989:2:51-55.
2. Kern M, Knode H. Stiftkernaufbouten
aus In-Ceram-direkte und indirekte
Methode. Quintessenz Zohntech
1991:17:917-925
3. Lüthy H, Schärer R Gauckier L New
materials in dentistry: Zirconia posts.
Abstroct IV-2, Monte Veritö Con-
ference on Biocompotibie Moteriois
Systems. Ascono, Switzerland. 11-14
October 1993.
4. tvleyenberg K, Lüfhy 1-1, Scharer R
Zirconia posts: A new all-ceramic
c o n c e p t for nonvitai abutment
teeth.J Esfhet Dent 1995:7:73-80.
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European perspective. J Esthet Denf
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7. Simon M. Neue Perspektiven zur val-
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Aufbou devitaler Zähne. Quintessenz
1995:40:1085-1101.
8. Akagawo S, Hota V. Fusing of
castable ceromics to the sintered
zirconium body. J Jpn Prosthadont
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9. Wohiwend A, Schärer P Die Empress
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Verbiendschalen. Quintessenz
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10. Dong JK, Lüthy H, Wahlwend A,
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Prosfhodont 1992:5:9-10.
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tooth has to be reconstructed ó. Sandhaus S. Posche K. Tenon radicu-

iaire en zircone pour io réoiisotion
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Acknowledgments
The outhors vjould iike to thank Ivociar
for providing materials and technical
support. We are also grateful for the
supporf of stotf members at the olinic of
Crown ond Bridge Prosfhodonfios ond
Dental Materiols, University of Zurich
Schooi of Dentistry The assistance of Mr
Olivier Loeffei v/ith materiai testing and
of Mrs Madeieine Schumacher with
dentai teohnicion work was very much
oppreoioted.

Voiume 18, Number ó, 1998