Materials used for CAD/CAM

The spectrum of materials utilized in computer-aided manufacturing is very broad. It includes

not only acrylics polymers but multiple ceramic materials and resin composites [1]. Each material
has different processing parameters, and, therefore, the whole system needs to be adjusted for a
specific material. The success of prosthetic treatment using CAD/CAM technology depends, to a
certain extent, on material selection but also on all steps of a treatment.

Dental Ceramics
There are various types of dental ceramics with respect to their chemical composition, method of
obtaining and structure. They can be classified into 3 groups: resin matrix ceramics (RMCs),
silicate ceramics and oxide ceramics.[4] All of the ceramic restorations made using the
CAD/CAM system can be used both in posterior and aesthetic segments and are becoming
increasingly popular every year. Their main advantages include biocompatibility, low plaque
adherence susceptibility and colour stability. All-ceramic CAD/CAM restorations demand a
rounded shoulder or a heavy chamfer around the circumference to increase fracture resistance
around prepared tooth.[2]

Type of Ceramics Brand, Manufacturer Clinical Application

Resin Matrix Ceramics Lava Ultimate, 3M-ESPE Onlays, inlays, veneers,
VITA Enamic, single
VITA-Zahnfabrik Cerasmart crowns, implant crowns
IPS e.max CAD
Lithium Silicate Ceramics VITA Suprinity PC Inlays, onlays, veneers,
crowns
Leucite-Reinforced Glass IPS Empress CAD, Ivoclar Veneers, inlays, onlays,
Ceramics Vivadent crowns
Zirconium Oxide Ceramics NobelProcera Zirconia, Nobel Single crowns, bridges,
Biocare mainly posterior
segment
Resin Matrix Ceramics

Resin matrix ceramics are characterized by technique sensitive milling properties and,
compared with silica-based ceramics, have a higher load capacity and better modulus of
elasticity [3]. The aesthetic aspect is also satisfying for resin matrix ceramics, which shows optical
properties similar to natural teeth. Resin-based ceramics can contain a polymer matrix with at
least 80% nanosized ceramic filler particles(e.g., Lava Ultimate by 3M-ESPE, Seefeld,Germany)
and hybrid ceramics made of a ceramic network infiltrated with a polymer using polymer-
infiltrated ceramic network (PICN)( (e.g., VITA Enamic by VITA-Zahnfabrik, Bad Säckingen,
Germany and Cerasmart by GC, Leuven, Belgium)technology. [2] Hybrid ceramics combine the
properties of both composites and ceramics, which leads to sufficient flexibility, optimal
distribution of chewing forces and high resistance to loads.

FIG: Lava Ultimate by 3M-ESPE FIG:VITA Enamic by VITA-Zahnfabrik

SOURCE-FIG0: SOURCE-FIG0:https://www.vita-
https://www.3m.com/3M/en_US zahnfabrik.com/en/VITA-
/p/dc/v000070610/ ENAMIC-HYBRID-CERAMIC-
103369,27568,223224.html

Silicate Ceramics

These are non-metallic inorganic ceramic materials that contain a glass phase. Among silica-
based ceramics, we can distinguish feldspathic and lithium silicate ceramics. Examples are
Vitablocs TriLuxe by Vita and IPS Empress CAD Multi by IvoclarVivadent. They can be
characterized by favourable optical aspects, such as high translucency and natural appearance.

FIG: Vitablocs TriLuxe

However, the presence of glass in their compositions contributes to the brittleness and low
fracture strength.[3] Silicate ceramics require hydrofluoric (HF) acid etching to enhance
micromechanical retention and adhesive bonding. After acid etching, the glassy matrix is
dissolved and crystalline phase is exposed, and thus, the surface of the ceramic becomes
available for the micromechanical interlocking of resin cement.[5]

Leucite-Reinforced Glass Ceramics

Leucite-reinforced ceramics are not recommended for crowns in the posterior segment due to
their lower mechanical properties compared to other glass ceramics . However, their aesthetic
qualities are sufficient, and the wear resistance of the enamel antagonist is similar to other glass
ceramic materials.[6]

Lithium Silicate Ceramics

First, lithium disilicate ceramic was introduced to the market in 1998 (IPS Empress 2). Its
chemical composition—a crystalline phase consisting of lithium disilicate and lithium
orthophosphate indicates higher fracture resistance without a negative influence on the
translucency of the material. Some sources claim that lithium silicate ceramics (e.g., IPS e.max
CAD by Ivoclar Vivadent, Celtra Duo by Dentsply Sirona) are the strongest of all the available
silicate ceramics with a flexural strength of around 407 MPa. [3] There is also a study which
indicates its superior colour stability in different staining solutions, such as coffee or cola,
compared to high-translucency zirconia, nanoceramic or hybrid ceramic.[4]

FIG: IPS e.max CAD

SOURCE-FIG0:
https://www.ivoclar.com/en_us/sho
p/p/ivoclardigital/ipsemaxcadprogr
amillhtc145/p/686586
 Oxide Ceramics

Oxide ceramics exhibit highly favourable mechanical properties, while their aesthetic qualities
are slightly worse than silicate ceramics due to their low translucency. They can be divided into
aluminium-oxide- and zirconium-oxide-based ceramics.[7] The oxide ceramics are divided into
two major groups:

1.Aluminium oxide ceramics

Described as glass-infiltrated aluminium oxide core ceramics (InCeram Alumina, VITA

Zahnfabrik, Bad Säckingen, Germany), they are characterised by a flexural strength of 500 Mpa.
They show satisfying results in long-term follow-ups, notwithstanding in recent years, when they
have mostly been replaced by more popular zirconia ceramics characterized by superior physical
properties [7].

2.Zirconium oxide ceramics

Commercial CAD/CAM zirconium oxide ceramics are present in the form of yttria stabilized
tetragonal zirconia polycrystal (Y-TZP) in products such as Lava Plus (3M, ESPE) or Kavo
Everest (KaVo Dental) . In the product range of IPS e.max ZirCAD (Ivoclar Vivadent), we can
find Y-TZP stabilized by a 3,4 or 5% addition of yttrium oxide (3Y-TZP, 4Y-TZP or 5Y-TZP).
The mechanical properties are dependent on the chemical composition. For example, the flexural
strength of ZirCad products decreases with the addition of yttrium oxide.[8]

FIG: IPS e.max ZirCAD FIG: InCeram Alumina

SOURCE-FIG0: SOURCE-FIG0: VITA In-Ceram

https://www.ivoclar.com/en_us/shop/p/ivoclardigi YZ for In Lab
tal/ipsemaxcadprogramillhtc145/p/686586
Polymer-Based Materials

Due to its mechanical properties and biocompatibility, poly(methyl methacrylate) (PMMA) was
[9]
introduced as a CAD/CAM material for manufacturing protheses . Moreover, PMMA resin is
among the oldest acrylic materials used in dentistry. The PMMA in CAD/CAM blocks occurs in
cross-linked form (eg. Telio CAD, Ivoclar Vivadent), unlike conventional dental application
where it is subjected to photocuring. The highly cross-linked nature of those materials puts them
before conventionally polymerized interim resins in terms of durability and processing ease [10].

Comparison of physical properties of different CAD-CAM materials[3]:

Material Product, Flexural Hardness Elastic Composition

Type Manufacturer Strength (HV) Modulus
(MPa) (GPa)
Composites VITA 80 2.8 Acrylate
-
CAD-Temp, polymer with
Vita Zahnfabrik microparticle
filler
Aluminium VITA In-Ceram 419 2035 410 Al2O3 (82
oxide ALUMINA, wt.%),La2O3
ceramics Vita Zahnfabrik (12 wt.%),
SiO2 (4.5 wt.
%),CaO (0.8
wt.%),
other oxides
(0.7 wt.%)
Zirconium IPS e.max 1200 - 206.3 3 mol%
oxide zirCAD, Ivoclar Yttria-
ceramics Vivadent stabilized
tetragonal
zirconia
polycrystals
(3Y-TZP
Lithium IPS e.max CAD, 353.1 617 102.7 SiO2, Li2O,
silicate Ivoclar K2O, P2O5,
ceramics Vivadent SiO2, ZnO
PMMA Polident 114 26 2.77 PMMA,
PMMA, pigment
Polident
Resin-based Lava Ultimate, 200 96 12 Polymerizable
ceramics 3M resin,
dispersed
nanometric
colloidal
silica, ZrO2
spherical
particles
PEEK PEEK,OPTIMA™, 165 3.70 PEEK
-
Invibio
1. Beuer, F.; Schweiger, J.; Edelhoff, D. Digital dentistry: An overview of recent
developments for CAD/CAM generated restorations. Br. Dent. J. 2008, 204, 505–511. [
2. Skorulska A, Piszko P, Rybak Z, Szymonowicz M, Dobrzyński M. Review on Polymer,
Ceramic and Composite Materials for CAD/CAM Indirect Restorations in Dentistry—
Application, Mechanical Characteristics and Comparison. Materials. 2021
Jan;14(7):1592.
3. Blatz, M.B.; Conejo, J. The Current State of Chairside Digital Dentistry and Materials.
Dent. Clin. N. Am. 2019, 63, 175–197.
4. Ruse, N.D.; Sadoun, M.J. Resin-composite blocks for dental CAD/CAM applications. J.
Dent. Res. 2014, 93, 1232–1234.
5. Kurtulmus-Yilmaz, S.; Cengiz, E.; Ongun, S.; Karakaya, I. The Effect of Surface
Treatments on the Mechanical and Optical Behaviors of CAD/CAM Restorative
Materials. J. Prosthodont. 2019, 28, e496–e503.
6. Mayinger, F.; Lümkemann, N.; Musik, M.; Eichberger, M.; Stawarczyk, B. Comparison
of mechanical properties of different reinforced glass-ceramics. J. Prosthet. Dent. 2020,
1–8
7. Conejo, J.; Nueesch, R.; Vonderheide, M.; Blatz, M.B. Clinical Performance of All-
Ceramic Dental Restorations. Curr. Oral Heal. Reports 2017, 4, 112–123.
8. Raigrodski, A.J. Clinical and laboratory considerations for the use of CAD/CAM Y-TZP-
based restorations. Pract. Proced. Aesthet. Dent. 2003, 15, 469–476; quiz 477.
9. Alt, V.; Hannig, M.; Wöstmann, B.; Balkenhol, M. Fracture strength of temporary fixed
partial dentures: CAD/CAM versus directly fabricated restorations. Dent. Mater. 2011,
27, 339–347.
10. Alp, G.; Murat, S.; Yilmaz, B. Comparison of Flexural Strength of Different CAD/CAM
PMMA-Based Polymers. J. Prosthodont. 2019, 28, e491–e495.