Dental Ceramics : What Is This Stuff Anyway? J.

Robert Kelly JADA 2008;139;4S-7S The following resources related to this article are available online at ( this information is current as of March 27, 2012):
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Articles constituting the body of this JADA supplement answer these questions: What good are they? What factors control success? Why ceramics anyway? T SIMPLIFYING CONCEPTS IN UNDERSTANDING CERAMICS Two concepts help demystify dental ceramics. d The history of the development of substructure ceramics involves an increase in crystalline content ranging from approximately 55 percent crystalline to fully polycrystalline.” Copyright © 2008 American Dental Association. Second. I discuss predominantly glassbased ceramics in more detail elsewhere. filler concentration and type. ceramics fall into three main composition categories (Figure 1)1. Robert Kelly. All rights reserved.2 Often. These fillers usually are crystalline. First. Particles can be added mechanically during manufacturing as powder or be precipitated within the starting glass by special nucleation and growth heating treatments. such as strength and thermal expansion and contraction behavior. meaning a composition of two or more entities. . so it makes little sense to introduce them according to trade name (which is why I have not included them in Figure 2). they can generalize the concept to include dental ceramics in which the matrix usually is a glass that is lightly filled or heavily filled with particles (crystalline particles or glass particles that melt at high temperatures). color and opacity. it is these filler particles that are dissolved during etching to create micromechanical retentive features enabling bonding. 2012 his introduction describes concepts that are useful in sorting out what dental ceramics are and how different ceramics perform different functions. in the second case. and higher-strength substructure ceramics generally are crystalline. the matrix is aluminum oxide or zirconium oxide. dentists can consider virtually any ceramic within this spectrum to be a composite. Most veneering materials come paired with their appropriate substructure ceramic. Although dentists usually reserve the term “composite” for particle-filled resins. DDS. which contain no glass. and process used to 4S JADA.2: d predominantly glass.Dental ceramics What is this stuff anyway? J. but they also can be particles of high-melting glasses that are stable at the firing temperatures of the on March 27.” Figure 23 (page 6S) presents many commercially available ceramics from the particle-filled glass and polycrystalline categories according to the matrix. September 2008 make the restoration.ada. Vol. DMedSc Guest Editor Downloaded from jada. Dental ceramics that best mimic the optical properties of enamel and dentin have a high glass content. such materials are termed “glass-ceramics. d polycrystalline.ada. Many commercially important ceramics can be understood within the context of these concepts. 139 http://jada. d particle-filled glass. For polycrystalline ceramics.1 Particle-filled glass. Manufacturers add filler particles to the base glass composition to improve mechanical properties. Dentists can apply these concepts directly to gain insights into two general facts regarding dental ceramics: d Highly esthetic dental ceramics have a high glass content. Manufacturers use small amounts of filler particles to control optical effects such as opalescence. Predominantly glass. and the fillers are not particles but modifying atoms called “dopants.

it is manufacturing. tight control over particle sizes and packing ABBREVIATION KEY. 2012 Copyright © 2008 American Dental Association. Ivoclar Vivadent. Both of these approaches amounts of plaque and adherence molecules from rely on well-characterized ceramic powders (that is. Emergence profiles are less The systems use this 3-D data set to create an likely to be overcontoured. Vita Zahnfabrik). acceptable to leave margins of all-ceramic prosIn general. Pa. Glasses containing 35 to 70 percent filler particles for strength can be moderately esthetic as Polycrystalline. Predominantly glass-based percent alumina and ceramics are lightly filled with colorants and opacifiers to mimic natural esthetics and are the weakest 30 percent zirconia. Another family of particle-filled glass is unique in that it is a three-dimensional (3-D) interpenetrating-phase composite. Often. Sweden) is packed laboratory technicians to provide a thicker layer or to machine an oversized part for firing by of porcelain to mask the opaque-metal surface in machining blocks of partially fired ceramic areas that often are underprepared. St. all of the atoms are packed into regular crystalline arrays through which it is predicted accurately. Schematic representation of three basic classes of dental ceramics.. Vol. magnesium aluminate spinel or a mixture of 70 Figure 1. Amherst. polycrystalline ceramics metal-ceramic systems.The family of ceramics containing high concentrations of lithium disilicate crystals is an example of a glass-ceramic (IPS e. 139 http://jada. Researchers report recovering smaller YZ.1 powder (ZirCAD. density) for which firing shrinkages can be JADA. which are used to create strong substructures and frameworks via computer-aided design/ computer-aided manufacturing processes. Completely polycrystalline ceramics (no Polycrystalline ceramics glass).2. on March 27. ceramics. Bad Säckingen. Cercon ZirMost ceramics are superior to metals with conia.3 much more difficult to drive a crack than it is All-ceramic versus metal-ceramic systems. Paul. September 2008 5S Downloaded from jada. these computer-aided systems use a theses supragingival or at the gingival margin. Nobel Biocare. as is often the result enlarged die upon which ceramic powder (Prowith metal-ceramic prostheses owing to efforts by cera. Vita In-Ceram bility. Well-fitting prostheses All-ceramic systems have no metal framework to made from polycrystalline ceramics were not be masked or metal margins exposed that propractical before the availability of computer-aided duce an unattractive appearance. Göteborg. impression-making. N. .Y. Vita Zahnfabrik. always are veneered. but generally they are veneered. The filler is alumina. Ivoclar Vivadent. atoms in the less dense and irregular network All-ceramic systems can provide a better esthetic result for a wider range of patients than can found in glasses. 3-D data set representing either the prepared resulting in more predictable and less traumatic tooth or a wax model of the desired substructure. Lava Zirrespect to corrosion. contain no glass.ada. 3-D: Three-dimensional. because a wider range of generally are much tougher and stronger than translucency and opacity (value) can be achieved. 3M ESPE. Dentsply Prosthetics. galvanism and biocompaticonia.).ada. Hence. glass-based ceramics. All rights reserved. Germany). in which the filler particles and glass are both continuous in space (In-Ceram..max Press and IPS e.max CAD. full-thickness restorations.

Kan. and 53 percent of metal-ceramic restorations have been reported to be in service at 30 years. This forgiving restorative system has survival rates of about 74 percent at 15 years..max ZirCAD Lava September 2008 majority of problems being biological (that is. Such evidence is among the highest available for making clinical practice decisions. Vita Zahnfabrik.J. Vol.4-6 In addition. IPS e. Vita Zahnfabrik. Paul. Procera Zirconia Yttrium. intraoral plaque of a qualitatively healthier composition can form on ceramic surfaces. N.MATRIX Esthetic Ceramics High Glass Content (Particle-Filled Glass) Aluminosilicate Glass (Feldspathic or Synthetic) FILLER High-Melting Glasses.max ZirCAD. Calif. Mirage Dental Systems. N. Vita YZ Cubes. Sirona Dental Systems GmbH. Ivoclar Vivadent. York. Dr. Albite (about 40%) PROCESS CEREC 3 TRADE NAME Vitablocs Mark II CEREC 3 IPS Empress CAD IPS Empress Esthetic OPC Cerinate Fortress Leucite (40%-50%) Pressed Powder Structural Ceramics Low Glass Content (Particle-Filled Glass) Special Silicate Glasses (High Lithium or Lanthanum) Lithium Disilicate (70%) Alumina.max CAD IPS e. Minn.7-9 Clinical success. OPC. Fortress. This literature is at the level of systematic reviews of numerous studies of systems indicated for inlays. the clinician must have a high level of knowledge both to maximize the esthetic result and to choose materials appropriately for structural longevity. Alumina/Zirconia (70%) inLab Pressed inLab or Dental Laboratory IPS e. Pa. Nepheline. Kansas City. Organizational chart of dental ceramics for all-ceramic systems according to matrix material. Why ceramics? Long-lived esthetics and bio- Copyright © 2008 American Dental on March 27. onlays and anterior single-unit restorations.. Cercon Zirconia. 2012 No Glass Content (Polycrystalline) Alumina DOPANT Magnesium (3%) (Control Grain Growth) inLab CAD/CAM inLab CAD/CAM Vita AL Cubes Procera Vita YZ Cubes IPS e. Pentron Ceramics.ada. Bad Säckingen. Göteborg. Berlin. Germany. Many practitioners may be unaware of the metal-ceramic systems their laboratories use. Metal-ceramic systems are wellenough developed that little special knowledge is required for their routine use.Y..max CAD and IPS e. with the 6S JADA. (Adapted with permission of Quintessenz Verlags-GmbH. Aluminum (3%-5%) (Transformation Toughening) Figure 2. Sweden. Spinel. Vitablocs Mark II. Fewer systems and less evidence are available for the restoration of molars and for multiunit prostheses involving molars. IPS e.4-6 Nevertheless. .. All rights reserved. periodontal disease and endodontic failures). 139 http://jada. Procera. CEREC 3 is manufactured by Sirona Dental Systems GmbH. Somerset. Cerium. IPS Empress CAD and IPS Empress Esthetic. Santa Maria. In-Ceram Alumina. Germany.. Amherst. from Kelly.max Press. filler or dopant (atomic-level filler) and fabrication process.3) ceramic surfaces than from gold alloys or amalgam. Dentsply Prosthetics. secondary caries. Cerinate. Factors for clinical success. Donovan11 shares the peer-reviewed literature and practical experience in exploring how to incorporate allceramic systems into dental practice.max Press In-Ceram Alumina In-Ceram Spinell In-Ceram Zirconia Downloaded from jada. Nobel Biocare. Procera. Vita Zahnfabrik.. Vita AL Cubes. Ivoclar Vivadent. St. Della Bona and I10 review the clinical literature regarding the performance of commercially available all-ceramic systems. Cercon Zirconia. to use all-ceramic systems successfully. Vita Zahnfabrik. but any system generally will be as suitable for anterior single-unit restorations as it is for posterior multiunit prostheses. Dr. InLab. 3M ESPE. Nobel Biocare. Den-Mat. Bensheim. Ivoclar Vivadent. In this supplement.ada. Spinell and Zirconia. Lava Zirconia.

Holloway J. which are designed to provide interested clinicians with the background to begin integrating all-ceramic restorations into their routine practice. ed. Listgarten MA. 7. Donovan September 2008 7S Copyright © 2008 American Dental Association. Bruch M. 12. Dent Mater 1993..Y.139(suppl 9):19S-24S. A meta-analysis of durability data on conventional fixed bridges. Microbial accumulation and vitality on different restorative materials. Factors essential for successful all-ceramic restorations. Käyser AF. Urano M. Kawai K. Weiger R. Lai CH.compatibility are the promise of all-ceramic systems.16(3):283-289. Denry IL. JADA 2008. Prevotella intermedia and Bacteroides forsythus in plaque subjacent to bridge pontics.48(2):viii. 8. Morris HF. Kelly has served as a consultant for and received research funding from Ivoclar Vivadent. 06030-1615. Crit Rev Oral Biol Med 1996. CONCLUSION All-ceramic systems are no longer experimental or suitable only for specialty practices. Kelly JR.69(1):1-8. Longevity and quality of FPDs: a retrospective study of restorations 30. The clinical success of all-ceramic restorations. 513-530. Porphyromonas gingivalis. Vol. Bad Säckingen. State of the Art of CAD/CAM Restorations: 20 Years of CEREC. Kelly JR. Oper Dent 2001. 5. 2. Berlin: Quintessenz Verlags-GmbH. Conn. Comparison of the performance on prosthodontic criteria of several alternative alloys used for fixed crown and partial denture restorations: Department of Veterans Affairs Cooperative Studies project 147. N..139(suppl 9):14S-18S.22(6):448-452. Clinical data and years of experience form the basis of the articles in this supplement. Adherence of plaque components to different restorative materials. Dental ceramics: current thinking and trends.9(5):312-316. 139 http://jada. Int J Prosthodont 2003. Tidehag P.uchc. Disclosure. Department of Reconstructive Sciences. Kelly. University of Connecticut Health Center. 4. Anderson RJ. Community Dent Oral Epidemiol 1994. 9. 3. 10. J Prosthet Dent”. 6. Sabella LR. 1. Dent Clin North Am 2004. Tillberg A. Spear F. 2006:29-38. Wang JC. Machinable ceramics. 2012 JADA. All rights reserved.26(4):396-400. Drs. Janes GR. Germany. Which all-ceramic system is optimal for anterior esthetics? JADA 2008. Amherst. Spear and Holloway12 describe how the use of all-ceramic restorations has become routine and provide an overview of indications for their use. 20. Molin M. Kelly JR. Dr. Hahn on March 27. and Vita Zahnfabrik. Della Bona A. e-mail “kelly@nso1.7(2):134-143. Address reprint requests to Dr. Netuschil L. van ’t Hof MA. JADA 2008. 263 Farmington Ave. In: Mörmann WH.25(4):330-333.139(suppl 9):8S-13S. and 10 years after insertion. Farmington. J Clin Periodontol 1998. Holm C. Kelly is a professor. Creugers NH. Downloaded from jada. 11.ada. He also is the guest editor of this supplement. Recent advances in ceramics for dentistry.ada. . ■ Dr.

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