Beruflich Dokumente
Kultur Dokumente
Escuela de Odontología
Clínica Integral del Adulto I
SISTEMAS CERÁMICOS EN
PRÓTESIS FIJA UNITARIA
Roberto Cáceres | Felipe Opazo | Pablo Ríos | Cristian Rosas | Cristian Vera
Porcelanas modernas o
Porcelanas convencionales
vitrocerámicas
Composición básica
• Óxido de magnesio
• Óxido de zirconio
SISTEMAS CERÁMICOS EN PFU
Cerámica reforzada,
Núcleo altamente resistente
Sistema IPS Empress
Vitrocerámica suministrada en forma de lingotes
enucleados, que son calentados a 1150ºC durante 45
minutos, y luego comprimidos, fluyendo dentro de un
molde.
Técnica de Laboratorio: Sustitución de cera perdida.
40% 60%
Leucita Disilicato de litio
Sistema IPS Empress
99%
óxido de aluminio.
72%
óxido de aluminio.
67%
óxido de aluminio.
28% óxido de 33% zirconia
magnesio
Sistema In-Ceram (Vita)
In-Ceram Alumina
Fuente: Invisible, Restauraciones estéticas cerámicas
Sistema Procera All-Ceram
Bloques prefabricados de cerámica con base de óxido
de aluminio, son tallados en forma mecanizada sobre
troquel de mayor tamaño (23%), se envía a horno a
500ºC para remover cofia del troquel, y finalmente a
horno de 1640ºC para sinterización final con
contracción.
Técnica de Laboratorio: Tecnología asistida por computador
(CAD-CAM)
99%
óxido de aluminio.
Sistema Procera All-Ceram
95%
óxido de zirconio.
5%
óxido de itrio
Sistema Cercon Zirconia
• Translucidez
• Resistencia a la fractura
• Módulo de elasticidad
• Tratamiento de superficie
• Éxito en el tiempo
Comples
Técnica 3D Complex
Translucidez
Fuente:Restauración
IPS Empress Esthetic Manual Guide
terminada
Conclusión
Translucidez
Propiedad física de la materia que permite el paso de
la luz dispersando los rayos luminosos. La translucidez
es considerada como la situación intermedia entre lo
opaco y lo transparente (Bruguera, 2008)
0 1
rece
the m
ging
invo
class
Sistemas cerámicos están entre 0,65 y 1,00 resto
Figure 1. All-ceramic and metal-ceramic crowns. Translucent unlayered (left to right): Dicor (Dentsply, not o
York, Pa.; no longer on the market), IPS Empress Esthetic (Ivoclar Vivadent, Amherst, N.Y.), OPC (Pen- redu
tron Ceramics, Somerset, N.J.). Opaque layered: In-Ceram Alumina (Vita Zahnfabrik, Bad Säckingen, skill
Germany), In-Ceram Spinel (Vita Zahnfabrik), Procera Zirconia (Nobel Biocare, Göteborg, Sweden).
Metal-ceramic crown with porcelain labial margin and conventional metal-ceramic crown. cian
Translucidez
Fig.HEFFERNAN ET AL specimens on black-and-white backing with reflected ligh
2. Glazed, veneered
Heffernan et al. 0,64 0,72 0,68 0,74 0,67 0,72 1,00 0,86 -
0,72 0,64
0,67
1,00 1,00
SistemaCristales
In-Ceram Zirconia
de Alumina y óxido de zirconio
Sistema Cercon Zirconia
Cristales de óxido de zirconio
Translucidez
2. Efecto del grosor del material
Heffernan analizó un mismo material en diferentes
grosores de núcleo, resultando diferencias significativas
de translucidez.
IPS Empress 0,5 mm IPS Empress 0,8 mm
0,64 0,72
IPS Empress 2 0,5 mm IPS Empress 2 0,8 mm
0,68 0,74
“ Mientras mayor grosor, menor translucidez ”
Translucidez
3. Efecto del bizcochado
La opacidad se incrementa después del bizcochado.
Razones:
- Incremento en grosor
- Interfase núcleo y porcelana de recubrimiento
- Porosidad de las capas
- Ciclo de cocción
4. Efecto del glaseado
En los estudios de Heffernan y Chen, se demostró que
el glaseado disminuye levemente la translucidez.
Translucidez
Grosor: 0,5 mm Alta translucidez
0,64
0,67 0,68
0,72
0,86
1,00
1,00
Sistema In-Ceram Alumina
Cristales de óxido de magnesio
SistemaCristales
Cercon Zirconia
de óxido de zirconio
Conclusiones
Sistemas con
Sistemas con alta Sistemas con baja
moderada
resistencia resistencia
resistencia
Medición: GPa
Módulo de elasticidad
Análisis de estudios
Sistema
Albakry (2002) Ban (2007) White (2005)
cerámico
IPS Empress 65 GPa 92 GPa 71 GPa
IPS Empress 2 103 GPa - -
Procera - 420 GPa -
In-Ceram Spinell - 185 GPa -
In-Ceram
- 280 GPa -
Alumina
In-Ceram
- 258 GPa -
Zirconia
Cercon Zirconia - 210 GPa 224 GPa
Módulo de elasticidad
Conclusiones
Medición
Fuente: G. A. A. Borges, et al. (2003). `Effect of etching and airborne particle abrasion on the microstructure of different dental ceramics.'. The Journal of prosthetic dentistry 89(5):479-488.
Tratamiento de superficie
Procera All-Ceram
En otros estudios, se demostró que ninguno de los tratamientos de
superficie produce resistencias adhesivas mayores que una superficie
no tratada.
Fuente: G. A. A. Borges, et al. (2003). `Effect of etching and airborne particle abrasion on the microstructure of different dental ceramics.'. The Journal of prosthetic dentistry 89(5):479-488.
Tratamiento de superficie journal of dentistry 37 (2
In-Ceram Alumina
Borges y cols, concluyó que el aire abrasivo modifica
levemente la morfología característica de este sistema. El
grabado ácido no modifica la morfología.
j o u r n a l o f d e n t i s t r y 3 7 ( 2 0 0 9 ) 8 4 8j o– u
85 n a l o f d e n t i s t r y 3 7 ( 2 0 0 9 ) 8 4 8 – 8 853
r6 56 853
In-Ceram Alumina
Por otra parte, Ersu (2009) concluyó que si bien hay mínimas
modifcaciones superficiales, la resistencia adhesiva no aumenta
con aire abrasivo, microarenado ni grabado ácido.
j o u r n a l o f d e n t i s t r y 3 7 ( 2 0 0 9 ) 8 4 8j o– u
85 n a l o f d e n t i s t r y 3 7 ( 2 0 0 9 ) 8 4 8 – 8 853
r6 56 853
Fuente: G. A. A. Borges, et al. (2003). `Effect of etching and airborne particle abrasion on the microstructure of different dental ceramics.'. The Journal of prosthetic dentistry 89(5):479-488.
for the clinical success of ceramic restorations. Adhesive resin The
Fig.
Fig. 3 –3Fig.
– SEM
SEM photographs
3 photographs
– SEM photographsof In-Ceram
of In-Ceram
of In-CeramAlumina
Alumina Aluminasurfaces
surfaces of untreated;
surfaces
of A, A,
ofuntreated; B, sandblasted;
A, untreated;
B, sandblasted; C, airborne
B, sandblasted;
C, airborne particle
C, airborne
particle abrasion;
particle
abrasion; D, D, D,
abrasion;
hydrofluoric
hydrofluoric acid
hydrofluoric
acid etch;
etch;
acid E, CO
E,etch;
CO laser irradiation (original magnification 1000T).
2 laser
E,2 CO irradiation
2 laser irradiation
(original
(original
magnification
magnification
1000T).1000T).
Tratamiento de superficie
Fig. 3 – SEM photographs of In-Ceram Alumina surfaces of A, untreated; B, sandblasted; C, airborne particle abrasion;
hydrofluoric acid etch; E, CO2 laser irradiation (original magnification 1000T).
forfor
thethe
forclinical
clinical success
the clinical
success successof ceramic
of ceramic of ceramic restorations.
restorations.
restorations.Adhesive
Adhesive Adhesive
resinresin TheThe
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cements
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for all-ceramic restorations
restorations
restorations to laser
to to laser treatment
treatment
laser treatment did did
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40
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compared
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Tratamiento de superficie
Fig. 3 – SEM photographs of In-Ceram Alumina surfaces of A, untreated; B, sandblasted; C, airborne particle abrasion;
hydrofluoric acid etch; E, CO2 laser irradiation (original magnification 1000T).
forfor
thethe
forclinical
clinical success
the clinical
success successof ceramic
of ceramic of ceramic restorations.
restorations.
restorations. Adhesive
Adhesive Adhesive
resinresin TheThe
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hypothesis
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hypothesis partially
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accepted, suchsuch
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such that,
COthat,
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2 2
cements
cements areare
cements recommended
recommended
are recommended for for all-ceramic
all-ceramic
for all-ceramic restorations
restorations
restorations to laser
to to laser treatment
treatment
laser treatment did did
did not notnot increase
increase increasethethe
the surface surface roughness
surface
roughnessroughness
on any onon anyany
40
ensure
ensure clinical
ensure
clinical success.
clinical
success. for
40 Resin
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of
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however, Therevealed
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increased was
increased
bond bond
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bond strength
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strength such that
In-Ceram Spinell
cannot
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cannot achieved
achieved
be achieved
withcements
with the the
with are methods
methods
methods
the recommended
commonly
commonly commonly for
used usedall-ceramic
with withwith
used restorations
compared
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compared to
otherother
with laser
treatments,
other treatment
treatments,
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especially
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especially
on IZ. IZ. IZ.the surface roughness o
on on
40
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41–43
investigate
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etching,
etching, AB AB
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andand and
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laser
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strengths
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onconventional
and
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investigate
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Also,
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and
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etching,
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41,42
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41,42
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41,42
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in
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differing
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isfailures
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41–43
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methods
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offailures
the
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methods of of
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surface
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and CO laser
and2bond
andbond irradiation
strength
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determined.
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and shearlead
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distributions.
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b
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Éxito en el
•C
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Fig. 6 Final restoration after six months showing excellent cervical aesthetics with invisible f
equigingival margins
o
•C
preparation is generally more aggressive • A good underlying substrate colour e
and into dentine (~1.2 mm labially and • Tooth preparation margins on enamel g
~2 mm incisally). This also allows for for predictable resin bonding s
adequate porcelain thickness to provide • Ability to place rubber dam for opti- g
increased strength and to develop the mal moisture control during bonding w
Éxito en el tiempo
En base a estudios prospectivos de entre 2 a 10 años,
establece el porcentaje de éxito o rango de
supervivencia.
Medición: Rango de supervivencia de Kaplan-Meier.
Indice de
Indice de Indice de
Años de supervivencia
Estudio supervivencia supervivencia
seguimiento dientes
promedio dientes anteriores
posteriores
2. Y.-M. M. Chen, et al. (2008). `Translucency and biaxial flexural strength of four ceramic core materials.'. Dental materials : official publication of the Academy of Dental Materials 24(11):
1506-1511.
3. M. Albakry, et al. (2003). `Biaxial flexural strength, elastic moduli, and x-ray diffraction characterization of three pressable all-ceramic materials.'. The Journal of prosthetic dentistry 89(4):
374-380.
4. W. C. Wagner & T. M. Chu (1996). `Biaxial flexural strength and indentation fracture toughness of three new dental core ceramics.'. The Journal of prosthetic dentistry 76(2):140-144.
5. H. Yilmaz, et al. (2007). `Flexural strength and fracture toughness of dental core ceramics.'. The Journal of prosthetic dentistry 98(2):120-128.
6. M. Guazzato, et al. (2002). `Mechanical properties of In-Ceram Alumina and In-Ceram Zirconia.'. The International journal of prosthodontics 15(4):339-346.
7. J. Tinschert, et al. (2000). `Structural reliability of alumina-, feldspar-, leucite-, mica- and zirconia-based ceramics.'. Journal of dentistry 28(7):529-535.
8. A. S. Rizkalla & D. W. Jones (2004). `Mechanical properties of commercial high strength ceramic core materials.'. Dental materials : official publication of the Academy of Dental Materials 20
(2):207-212.
9. S. Ban (2008). `Reliability and properties of core materials for all-ceramic dental restorations'. Japanese Dental Science Review 44(1):3-21.
10. S. N. White, et al. (2005). `Flexural strength of a layered zirconia and porcelain dental all-ceramic system.'. The Journal of prosthetic dentistry 94(2):125-131.
11. S. M. Torres, et al. (2009). `The effect of surface treatments on the micro-shear bond strength of a resin luting agent and four all-ceramic systems.'. Operative dentistry 34(4):399-407.
12. G. A. A. Borges, et al. (2003). `Effect of etching and airborne particle abrasion on the microstructure of different dental ceramics.'. The Journal of prosthetic dentistry 89(5):479-488.
13. A. Odén, et al. (1998). `Five-year clinical evaluation of Procera AllCeram crowns.'. The Journal of prosthetic dentistry 80(4):450-456.
14. M. Fradeani, et al. (2005). `Five-year follow-up with Procera all-ceramic crowns.'. Quintessence internati
onal (Berlin, Germany : 1985) 36(2):105-113.
15. M. H. Walter, et al. (2006). `Six-year clinical performance of all-ceramic crowns with alumina cores.'. The International journal of prosthodontics 19(2):162-163.
16. J . A. Sorensen, et al. (1998). `IPS Empress crown system: three-year clinical trial results.'. Journal of the California Dental Association 26(2):130-136.
17. O. El-Mowafy & J.-F. F. Brochu (2002). `Longevity and clinical performance of IPS-Empress ceramic restorations-a literature review.'. Journal (Canadian Dental Association) 68(4):233-237.
18. S. Toksavul & M. Toman (2007). `A short-term clinical evaluation of IPS Empress 2 crowns.'. The International journal of prosthodontics 20(2):168-172.
19. M. Valenti & A. Valenti (2009). `Retrospective survival analysis of 261 lithium disilicate crowns in a private general practice.'. Quintessence international (Berlin, Germany : 1985) 40(7):
573-579.
20. A. Wassermann, et al. (2006). `Clinical long-term results of VITA In-Ceram Classic crowns and fixed partial dentures: A systematic literature review.'. The International journal of
prosthodontics 19(4):355-363.