INTRODUCTION A ceramic so white that it was comparable only to snow, so strong that vessels needed walls only 23 mm thick

and consequently light could shine through it. So continuous was the internal structure that a dish, if lightly struck would ring like a bell. his is porcelain! It could be said that the ceramic material known as porcelain holds a special place in dentistry because, not withstanding the many advances made in composites and glassionomers, it is still considered to produce aesthetically the most pleasing result. Its colour, translucency and vitality cannot as yet be matched by any material except other ceramics. Most ceramics for metal-ceramic restorations contain from 1 to ! vol" leucite as their ma#or crystalline phase, but changes in the leucite volume fraction can occur during thermal treatment of dental porcelains $Mackert and %vans, 1&&1a,b'. (eucite is a potassium alumino-silicate with a high thermal expansion coefficient $Mackert et al, 1&)*a'. Materials for all-ceramic restorations use a wider variety of crystalline phases as reinforcing agents and contain up to &+" by volume of crystalline phase. ,he nature, amount, and particle si-e distribution of the crystalline phase directly influence the mechanical and optical properties of the material $Morena et al, 1&)*b. /on et al, 1&&0'. ,he match between the refractive indices of the crystalline phase and glassy matrix is a key factor for controlling the translucency of the porcelain. 1imilarly, the match between the thermal expansion coefficients of the crystalline phase and glassy matrix is critical in controlling residual thermal stresses within the porcelain $Mackert, 1&))'. ,he first glass-ceramics were developed in the late 1& +s $1tookey, 1& &'. 2lass-ceramics are polycrystalline solids prepared by the controlled crystalli-ation of glasses3 $McMillan, 1&4&'. ,he crystalli-ation is achieved when the glass is submitted to a heat treatment during which crystal nucleation and growth are thermodynamically possible. 5roper control of the crystalli-ation heat treatment is necessary to ensure the nucleation of a sufficient number of crystals and their growth to an effective si-e. ,he dual nature of glassceramic materials confers upon them the esthetic, mechanical, and chemical 6ualities of ceramics as well as the ability to be cast and processed as glasses. ,hese characteristics are of great interest for dental applications. Machinability is another property desirable for the maximum utility of glassceramics as dental materials. ,he ability of glass-ceramics to be machined is closely related to the nature and particle si-e of the crystalline phase that develops during the crystalli-ation heat treatment $7tsumi and 1akka, 1&4+'. Machinable glass-ceramics for industrial as well as dental applications often contain mica as a ma#or crystalline phase. 8ot-pressed ceramics constitute another application of high technology to dentistry. ,his process relies on the application of external pressure at elevated temperatures to obtain sintering of the ceramic body. 8otpressed ceramics are also called 3heat-pressed3 ceramics. 8ot-pressing classically helps avoid large pores caused by non-uniform mixing. It also prevents extensive grain growth or secondary crystalli-ation, considering the temperature at which sintering is obtained. ,he mechanical properties of many ceramic systems are maximi-ed with high density and 1

small grain si-e. ,herefore, optimum properties can be obtained by hot-pressing techni6ues $/ingery et al, 1&4*'. In spite of their excellent esthetic 6ualities and their good biological compatibility, dental ceramics, like all ceramic materials, are brittle. ,hey are susceptible to fracture at the time of placement or during function.

HISTORICAL PERSPECTIVE 9eramics are the earliest group of inorganic materials to be structurally modified by man and his early history is principally traced through these materials. ,he origin of gla-ing techni6ues is probably the most interesting advancement. 9eramic ob#ects have been constructed for thousands of years. ,he earlier techni6ues usually consisted of shaping the item in clay or soil and then backing it to fuse the particles together. ,he initial attempts resulted primarily in coarse and some what porous products, such as goblets and other forms of pottery. (ater developments led to unite detailed stone ware items. 1440: ;icholas <ubais de 9hemant, a surgeon dentist of 5aris is credited with making porcelain dentures. 14&1: <echemont obtains both =rench and %nglish patent for dental porcelain. 14&!: >ohn ?oodforde manufactured porcelain pastes 1)+): 2iuseppangelo =on-i @n Italian dentist produced porcelain metal backed artificial teeth. 1) +: =irst commercial production of porcelain denture teeth by white. 1)*+: Introduction of tube tooth and pivot crown in %ngland. 1))&: 5orcelain inlays and #acket crowns introduced platinum matrix for fusing porcelain inlays and crowns developed by (and in 71@. 1&+A: <r. 8ugh @very Introduced new porcelain inlay techni6ue 1&+ : %lectric porcelain furnace 1&+): <r. @. %schneider Baked porcelain #acket crown 1&!A: 9asting of dental porcelain for inlays and crown by lost techni6ue. 1&! : <r. @lbert (% 2roCs used porcelain by high fusing method. >an @drianasen pioneered the techni6ue of building up porcelain with a brush. 1&0+: Dacuum firing of dental porcelain 1&0!: =luorescent dental porcelain introduced 1&*!: 2old alloy for porcelain bonding were used 1&*A: <evelopment of dental aluminous porcelain by Mc(ean and 8ughes 1&*): 7se of photosensitive glass ceramic in dentistry by Macclloch 1&40: 5alladium silver alloy introduced for porcelain fused to metal 1&4*: 5latinum bonded alumina crown was used by Mc(ean and 1eed. 1&)A: 8igh expansion core material by ECBrien 1&)0: =irst commercial castable dental glass ceramic ,he earliest gla-ing techni6ue was a 1ummerian invention made famous about 0+++ B9 as a %gyptian blue faience. More than 1+,+++ years ago stone age people also used ceramics. @s early as the second half of the eighteen century, =auchard and others attempted to use porcelain for dental applications. ,heir efforts, working in the demanding and potentially destructive intraoral environment, were largely unsuccessful. 5orcelain was, however, successfully used for dental prosthesis by the end of the 1)++s, when the techni6ue to fire all porcelain #acket crowns on a platinum matrix was first developed but it was not until the mid 1& +s that a dental porcelain was A

developed with a coefficient of thermal expansion similar to that of existing dental casting alloys.

TERMINOLOGIES Alumina core: @ ceramic containing sufficient crystalline alumina $@l !EA' to achieve ade6uate strength and opacity when used for the production of a core for ceramic #acket crowns. Aluminous porcelain: @ ceramic composed of a glass matrix phase and A vol" of more of @l!EA. CAD CAM ceramic: @ machinable ceramic material formulated for the production of inlays and crowns through the use of a computer aided design, computer aided machining process. Cas!a"le #en!al ceramic: @ dental ceramic specially formulated to be cast using a lost wax process. Ceramic: @ compound of metallic and nonmetallic elements. Ceramic$ #en!al: @ compound of metals $such as aluminium, calcium, lithium, magnesium, potassium, sodium, tin, titanium, and -irconium' and non metals $such as silicon, boron, fluorine, and oxygen' that may be used as a single structural component, such as when used in a 9@<-9@M inlay, or as one of several layers that are used in the fabrication of a ceramic based prosthesis. <ental ceramics are formulated to provide one or more of the following properties, castability, moldability, in#ectability, color, opacity, translucency, machinability, abrasion resistance, strength and toughness. Note: @ll porcelains and glass ceramics are ceramics, but not all ceramics are porcelains or glass ceramics. Ceramic %ac&e! cro'n (C)C*: @n all ceramic crown without a supporting metal substrate that is made from a ceramic with a substantial crystal content $F + vol"' from which its higher strength andGor toughness is derived. ,hese crowns are distinguished from porcelain #acket crowns that are made with porcelain to produce an aesthetic porcelain margin as an alternative to a metal margin on a metal ceramic crown. Sin!erin+: ,he process of heating closely packed particles to achieve interparticle bonding and sufficient diffusion to decrease the surface area or increase the density of the structure. =or products such as In-9eram and In 9eram 1pinel, surface contact sintering and minimal density change are re6uired. Spinel or Spinelle: @ hard crystalline mineral $Mg@l !E0' consisting of magnesium and aluminium. @lso, any of a group of mineral oxides of ferrous iron, magnesium, manganese or -inc.

S!ain: @ mixture of one or more pigmented metal oxides and usually a low fusing glass that when dispersed in an a6ueous slurry or monomer medium, applied to the surface of porcelain or other speciali-ed ceramic dried or light cured and fired, will modify the shade of the ceramic based restoration. Ene product is supplied in a light curable binder. ,hese stain product are also called surface colorants or characteri-ation porcelains. T,ermal compa!i"ili!-: ,he desirable condition of low transient and residual tensile stress in porcelain ad#acent to a metal coping that is associated with a small difference in the thermal contraction coefficients between the metal and the veneering porcelains. ,he contraction coefficient of the metal should be slightly greater than that of the porcelains so that residual axial and knoop compressive stresses are produced. ,his condition will ensure the cooling of metal ceramic prostheses without immediate crack formation or delayed fracture caused by residual tensile stresses in porcelain.

CLASSI.ICATION O. CERAMICS: 1. /- con!en! : - Hegular feldspathic porcelain - @luminous porcelain - (eucite reinforced porcelain - 2lass infiltrated alumina - 2lass infiltrated spinel 2. /- use: - @rtificial teeth - 9ore ceramic - Deneer ceramic 3. /- processin+ me!,o# : - 1intering - 9asting - Machining 4. /- !,eir 0irin+ !empera!ure : - 8igh fusing : 1A++ c - Medium fusing : 11++-1A+++ c - (ow fusing : ) + 11++ c - 7ltra low fusing : less than ) +9 5. /- me!,o# o0 0irin+ 1 - @ir fired - Daccum fired - <iffusable gas 6. /- !,eir area o0 applica!ion : - 9ore porcelain - Body dentin porcelain - 2ingival dentin porcelain - Incisal enamel COMPOSITION O. CERAMICS: 1. .el#spar: ?hen mixed with metal oxides and fired, it forms a glass phase that is able to soften and flow slightly ,his softening of glass allows porcelain particles to coalesce together. ,his is called sintering 1een in concentration of 4 -) ". 2. 2aolin 3 cla-: It acts as the binder. ?hen mixed with water , it forms a sticky mass which allows unfired porcelain to be easily worked and molded. En heating it reacts with feldspar and gives rigidity. Its white in color and reduces translucency .so its added only in concentration of 0- ". 4

3. 4uar!5: It imparts more strength, firmness and translucency. It gives stability of mass during heating by providing a frame work.1A-10" GLA6ES: It decreases pores on the surface of fired porcelain. ,his increases strength by decreasing the crack propagation. if gla-e is removed by grinding, the transverse strength is half of gla-ed porcelain. 78 Sel0 +la5in+: %xternal gla-e layer is not applied here. ,he completed restorations is sub#ected to gla-ing here. 98 A## on +la5es: %xternal gla-e layer is applied here. ,hey are uncolored glasses whose fusing temperature is lowered by the addition of glass modifiers. Disa#:an!a+es: (ow chemical durability, difficulty to apply evenly, difficult to get exact surface characteristics. ;8 Colourin+ a+en!s: ,hese coloring pigments are produced by fusing metallic oxides together with fine glass and feldspar -%x : iron G nickel oxides- brown , copper oxidesgreen, titanium oxide yellowish brown, cobalt oxide blue.

7. Opaci0-in+ a+en!s: a. Epacifying agents consists of a metal oxide ground to a very fine particle si-e. ex :cerium oxide, titanium oxide, -irconium oxide most popular. 8. S!ains: ,hese powder is mixed with water and the wet mix is applied with brush to the surface of porcelain before gla-ing. Internal staining is preferred as it gives life like results and prevents direct damage to stains by surrounding environment. 9. Glass 0ormer: 2lass formers are silica. 1. 9rystalline 6uart2. 9rystalline cristobalite 3. 9rystalline tridymite 4. ;on crystalline fused silica ,he vitreous matrix is made of silicate glass. 1ilica forms sio0 ions with oxygen and is thus highly charged and fills the space between 0 oxygen atoms.the tetrahydra must permit sharing of oxygen atoms to permit the formation of sio0 groups thus resulting in polymeri-ation and a three dimensional network. 10. Glass mo#i0iers : 5otassium oxide, 1odium oxide, 9alcium oxide are used as glass modifiers ,hey act as fluxes by lowering the softening temperature of a glass

?hen sodium oxide is introduced, instead of bridging the atoms together, it contributes a oxygen atom which act as a non bridging oxygen and as a result a gap is produced in the sio0 network. 1o the silica tetrahydra thus obtained is able to move more easily at lower temperature than the earlier network. 11. In!erme#ia!e o<i#es : 2lass modifiers reduces the viscousity of porcelain. It needs a high viscosity as well as low firing temperature. ,his is done by the addition of @luminium oxide and boric oxides.

,he composition of the ceramic generally corresponds to that of the glasses in table, except for an increased alkali content. ,he addition of greater 6uantities of soda, potash, andGor leucite is necessary to increase the thermal expansion to a level compatible with the metal coping. ,he opa6ue porcelains also contain relatively large amounts of metallic oxide opacifiers to conceal the underlying metal and to minimi-e the thickness of the opa6ue layer. ,he high contraction porcelains have a greater tendency to devitrify because of their alkali content. ,hey should not be sub#ected to repeated firing, because this may increase the risk for cloudiness within the porcelain, as well as changes in the thermal contraction behavior. ,hus it is obvious that a proper matching of the properties of the alloy and porcelain is imperative to success. 9riteria and test methods for determining metal porcelain compatibility have been suggested. ,esting methods are focused on the measurement of coefficients of thermal expansion and contraction, thermal shock resistance, and the strength of the bond, which are discussed later. 9onventional dental porcelain is a vitreous ceramic based on a silica $1iE!' network and potash feldspar $/!E.@l!EA.*1iE!' or soda feldspar $;a!E.@l!EA.*1iE!' or both. 5igments, opacifiers, and glasses are added to control the fusion temperature, sintering temperature, thermal contraction coefficient, and solubility. ,he feldspars used for dental porcelains are relatively pure and colorless. ,hus pigments must be added to produce the hues of natural teeth or the color appearance of tooth-colored restorative materials that may exist in ad#acent teeth. 1ilica $1iE!' can exist in four different forms: crystalline 6uart-, crystalline cristobalite, crystalline tridymite, and noncrystalline fused silica. =used silica is a material whose high-melting temperature is attributed to the three - dimensional network of covalent bonds between silica tetrahedral, which are the basic structural the temperature re6uired to sinter the porcelain powder particles together at low enough temperatures so that the allow to which it is fired does not melt or sustain sag $flextural creep'. Glass Mo#i0iers: ,he sintering temperature of crystalline silica is too high for use in veneering aesthetic layers bonded to metal substrates. @t such temperatures the alloys would melt. In addition, the thermal contraction coefficient of crystalline silica is too low for these alloys. Bonds between the silica terahedra can be broken by the addition of &

alkali metal ions such as sodium, potassium, and calcium. ,hese ions are associated with the oxygen atoms at the corners of the tetrachedra and interrupt the oxygen silicon bonds. @s a result, the three-dimensional silica network contains many linear chains of silica tetrahedral that are able to move more easily at lower temperatures than the atoms that are locked into the three-dimensional structures of silica tetrahedral. ,his ease of movement is responsible for the increased fluidity $decreased viscosity', lower softening temperature, and increased thermal expansion conferred by glass modifiers. ,oo high a modifier concentration, however, reduces the chemical durability $resistance to attack by water, acids, and alkalis' of the glass. In addition, if too many tetrahedral are disrupted, the glass may crystalli-er $devitrify' during porcelain firing operations. 8ence, a balance between a suitable melting range and good chemical durability must be maintained. Manufactures employs glass modifiers to produce dental porcelains with different firing temperatures. <ental porcelains are classified according to their firing temperatures. @ typical classification is as follows: 8igh fusing Medium fusing (ow fusing 7ltra low fusing 1A+++ 9 $!A4!+=' 11+1+ - 1A+++ 9 $ !+1A+ - !+4!+ =' ) ++ - 11+++ 9 $ 1 *!+ - !+1!+ =' I ) ++ 9 $1 *!+='

,he medium fusing and high fusing types are used for the production of denture teeth. ,he low fusing ultraslow fusing porcelains are used for crown and bridge construction. 1ome of the ultraslow fusing porcelains are used for titanium and titanium alloys because of their low contraction coefficients that closely match those of these metals and because the low firing temperatures reduce the risk for growth of the metal oxide. 8owever, some of these ultraslow fusing porcelains conation enough leucite to raise porcelains. ,he potential advantage of ultraslowfusing veneering ceramics are the reduction in sintering times, decrease in sag deformation of =5< frameworks, less thermal degradation of ceramic firing ovens, and less wear of opposing enamel surfaces. Because commercial dental laboratories do not fabricate denture teeth for complete denture or removable partial dentures, it has become more common to classify crown and bridge porcelains as high fusing $) + - 11+++9' and low fusing $F ) ++ 9'. 8owever, this change in classification has not been universally adopted ,hus, to avoid confusion, the sintering temperature range should be identified $at least initial' in discussions between dentists and dental technicians so that the less abrasive benefit claimed for ultraslow fusing porcelains that were used exclusively between the 1&*+s and 1&&+s. Because it ensures ade6uate chemical durability, self gla-ing of porcelain is preferred to an add on gla-e. @ thin external layer of glassy material is formed during a self glass phase and settling of crystalline particles within the surface for an applied gla-e procedure contains more glass modifiers and thus has a lower firing

1+

temperature. 8owever, a higher proportion of glass modifiers tends to reduce the resistance of the applied gla-es to leaching by oral fluids. @nother important glass modifier is water, although it is not an intentional addition to dental porcelain. ,he hydronium ion, 8AEJ, can replace sodium or other metal i)o+ns in a ceramic that contains glass modifiers. ,his fact accounts for the phenomenon of Kslow crack growthL of ceramics that are exposed to tensile stresses and moist environments. It also may account for the occasional long-term failure of porcelain restorations after several years of service. =eldspathic 5orcelains 5otassium and sodium feldspar are naturally occurring minerals composed primarily of potash $/!E' and soda $;a!E', respectively. ,he also contain alumina $@l!EA' , and silica $1iE !' components. =eldspars are used in the preparation of man dental porcelains designed for metal-ceramic crowns and many other dental glasses and ceramics. ?hen potassium feldspar is mixed with various metal oxides and fired to high temperatures, lit can form leucite and a glass phase that will soften and flow slightly. ,he softening of this glass phase during porcelain firing allows the porcelain powder particles coalesce is called li6uid-phase sintering, a process controlled by diffusion between particles at a temperature sufficiently high to form a dense solid. ,he driving force for sintering is the decrease in energy caused by a reduction in surface area. @s explained in the key terms section, section, three dental products $In-ceram @lumina, spinell, and Mirconia' are slightly sintered to produce interconnected pore channels that are necessary for subse6uent glass infiltration. @nother important property of feldspar is its tendency to form the crystalline mineral leucite when melted. (eucite is a potassium-aluminum-silicate mineral with a large coefficient of thermal expansion $!+to! ppmG o9' compared with feldspar glasses $which have coefficients of thermal expansion less than 1+ppmG o9'. ?hen feldspar is heated at temperatures between 11 + o 9 and 1 A+ it undergoes incongruent melting to form crystals of leucite in a li6uid glass. Incongruent melting is the process by which one material melts to form a li6uid plus a different crystalline material. ,his tendency of feldspar to form leucite during incongruent melting is used to advantage in the manufacture of porcelains for metal bonding. =urther information is provided in the sintering of porcelain section. Man dental glasses do not contain leucite as a raw material. 1ince feldspar is not essential as a precursor to the formation of leucite, as described earlier, these glasses are modified with additions of leucite to control their thermal contraction coefficients. =eldspathic porcelains contain a variety of oxide components, including 1iE! $ !-*! wt" ' , @lEE $11-1* wt"',k!E$&-11 wt"', ;a! E $ -4 wt"', and certain additives, including (i! E and B!EA. ,hese ceramics are called porcelains because they contain a glass matrix and one more crystal phases. ,hey cannot be classified as glass ceramics because crystal formation does not occur through controlled nucleation and crystal formation and growth. there are four types of veneering ceramics. ,hese include $1' low-fusing ceramics $feldspar based porcelain and nepheline senate- based porcelain'. $!' ultra low-fusing ceramics $porcelains and 11

glasses'. $A' stains. and $0' gla-es $ self gla-e and add on gla-e'. ,he particle type and si-e of crystal particles, if present, will greatly influence the potential abrasives of the ceramic prosthesis. ,he thermal expansion coefficients of some ultraslow fusing ceramics $sintering temperatures be below ) ++ 9' and low-fusing ceramics are listed. ,hese ultra low-fusing ceramics represent an exciting new fail of ceramic core and veneering materials because of their microstructural features. ,he ontain either a well-distributed dispersion of small crystal particles or few or no crystals, depending on the whether the ceramic is to be used as a veneer or gla-e. Initial results of wear studies are promising in several cases relative to reduced enamel wear caused these ceramics. ,hese results are summari-ed in a later section of this chapter $see wear of %namel by ceramic 5roducts and Ether Hestorative Materials'. O!,er A##i!i:es: Ether metallic oxides can be introduced, as indicated in ,able !1-1. Boric oxide $B!EA' behaves as a glass modifier, that is, it decreases viscosity, lowers the softening temperature and forms its own glass network. Because boric oxide forms a separate lattice interspersed with the silica lattice, it still interrupts the more rigid silica network and lowers the softening point of the glass. @lumina is not considered a true glass former by itself because of the dimensions of the ion and the oxygenGaluminum ratio. ;evertheless, it can take part in the glass network to alter the softening point and viscosity. 78 5igmenting oxides are added to obtain the various shades needed to simulate natural teeth. ,hese coloring pigments are produced by fusing metallic oxides together with fine glass and feldspar and then regrinding to a powder. ,hese powders are blended with the unpigmented powdered frit to provide the proper hue and chrome. %xamples of metallic oxides and their respective color contributions to oxide $yellowish brown' manganese oxide $lavender', and oxide $green' titanium oxide $yellowish brown', manganese oxide $lavender', and cobalt oxide $blue'. Epacity may be achieved by the addition of cerium oxide, -irconium oxide, titanium oxide, or tin oxide. 98 Composi!ion: <ental porcelains are essentially mixture of fine particles of =eldspar and 6uart-. 8owever the general trend towards the use of less kaolin $clay' with an increase in the feldspar content in order to improve translucency suggests that dental porcelain should be more correctly described as glasses. ,he feldspar melts first to provide a glossy matrix for the 6uart-. ,he 6uart- thus act as a filler to provide strength. ,he 6uart- may be replaced by alumina $@l!EA' such a material is referred to as alumonous porcelain Lo' 0usin+ #en!al porcelain: O<i#e 1iE! B!EA 1!

=ei+,! > *&.A* 4. A

9aE /!E ;a!E @l!EA

1.) ).AA 0.)1 ).11

1A

Me#ium 0usin+ #en!al porcelain: O<i#e 1iE! B!EA /!E ;a!E @l!EA 9i!E MgE 5!E

=ei+,! > *0.!+ !.)+ ).!+ 1.&+ 1&.++ !.1 +. +.4

10

Composi!ion o0 #en!al ceramics 0or 0usin+ !o ,i+, !empera!ure allo-s: /io#en! Ceramco VM2 /io#en! Ceramco Compoun# opa?ue opa?ue ;@ opa?ue #en!in /D #en!in T ;C /G 9 (>* (>* 7A7 (>* 9B (>* (>* 1iE! !.+ .+ !.0 *.& *!.! @l!EA 1A. 11.* 1 .1 11.)+ 1A.0+ 9aE +.*1 +.&) /!E 11.+ &.* &.& 1+.+ 11.A ;a!E .!) 0.4 *. ) .0! .A4 ,iE! A.+1 !. & +.*1 MrE! A.!! +.1* .1* 1.0* +.A0 1nE! *.0 1 .+ 0.& +. + Hb!E +.+& +.+0 +.+) +.1+ +.+* BaE 1.+& A. ! MnE +.!* 7EA B!EA, 9E! 0.A1 A. 0 A.!0 &. ) .) and 8!E

PROPERTIES GENERAL PROPERTIES O. CERAMICS 78 PHDSICAL PROPERTIES O. PORCELAIN S!ren+!,: 5orcelain is a material having good strength. 8owever it is brittle and tends to fracture. ,he strength of dental porcelain is usually measured by terms of this flexure strength or modulus of rupture. .le<ure s!ren+!,: It is a combination of compressive, tensile, as well as shear strength. 2round 11,+++ 51I $4 .)M5a' 2la-ed !+,0* 51I $101.1 M5a' 1' 9ompressive strength of porcelain is 0)+++ psi $A!1 M5a' tensile strength N +++ psi $A M5a'O. ,ensile strength is low because of the unavoidable surface defects like porosities and microscopic cracks. S,ear s!ren+!,: It is low and is due to the lack of ductility caused by the complex structure of dental porcelain N*+++ 51I $11+ M5a'O Inade6uate firing weakens porcelain, the firing also decrease strength as more of the core gets dissolved in the flexure. !' 1urface 8ardness: 5orcelain is much harder than natural teeth. /8; 0*+ $enamel A0A'. A' ?ear resistance: 5orcelain is more resistant to wear than natural teeth. 0' ,hermal properties: 5orcelain has low thermal conductivity, co-efficient of thermal expansion is close to that of natural teeth *.0 to 4.) x 1+-*GE9 ' 1pecific gravity: ,he specific gravity of fired porcelain is usually less, because of the presence of air voids. It varies from !.! to !.A *' <imensional stability: 5orcelain is dimensionally stable after firing. 4' 9hemical stability: It is insoluble and impermeable to oral fluids. @lso it is resistant to most solvents. 8owever contact with hydrofluoric acid causes etching of the porcelain surface. @ source of this is @5= $acidulated phosphate fluoride' and stannous fluoride. which are used as topical fluorides. )' %sthetic properties: ,he esthetic 6ualities of porcelain are excellent. It is to match ad#acent tooth structure in translucency, color and intensity. In addition, attempts have also been made to match the fluorescent property of natural teeth when placed under ultraviolet light. &' Biocompatibility: It is compatible with the oral tissues. ,he margins of finishing line can be even extended to the gingival sulcus 1+' Modulous of elasticity: 5orcelain has a high modulous of elasticity N1+ x 1+ * 51I $*& 25a'O 11' Eptical properties: ,he colors of commercial premixed dental porcelains are in the yellow to yellow red range. 7sually supplied in blue, yellow, pink, orange, brown and grey. ,he modifiers are added to the opa6ue and body porcelain during building of the crown.

1*

1urface staining: <isadvantages of surface staining are a lowered durability as a result of high solubility and reduction of translucency. Epa6ue porcelains have very low translucency values to mask metal substructure surfaces. Body porcelain translucency values range between !+" and A ". Incisal porcelains have the highest values of translucency and range between 0 " and +". 1ince dental enamel is fluorescent under ultraviolet light, uranium oxide have been added to produce fluorescence with porcelain. 8owever because of the low but detectable radioactivity of uranium, newer formulations contain rare earth oxides such as cerium oxide which produce fluorescence.

98 /IOLOGICAL PROPERTIES : ,hey have excellent biocompatibility. A8 CHEMICAL PROPERTIES : It resist attack by chemicals. ,hey have to be roughened by etching with hydrofluoric acid or sand blasting to improve the retention of a cement to the internal surface of the restoration E8 MECHANICAL PROPERTIES: (ow tensile strength %xhibits little plastic deformation 8ave good compressive strength a' 9ompressive strength : ++++psi b' tensile strength : +++psi c' 1hear strength:1*+++psi d' %lastic modulus : 1+ P 1+* psi e' /noop hardness : 0*+ f' 9 , % :1! P 1+ -*psi g' H.I : 1. ! 1. 0 F8 THERMAL PROPERTIES: ,hey have insulating capacity.

;8 OPTICAL PROPERTIES: ,hey have good optical properties ,hey are translucent because of absence of free electrons. S!ren+!, o0 porcelains: S!ren+!, o0 porcelain is #ecrease# "-$ 1. By the presence of stress concentration areas !. 5orosity, roughness , machine damage A. 1harp line and point angles

14

0. Interface between bonded structures where elastic modulus of ! components are different. More brittle material should have less elastic modulus. 1o it can transfer stress to one with high modulus of elasticity. . Interface between bonded structure where large difference in thermal coefficient. Material should have lower coefficient of thermal expansion, so the other has protective compressive stress. *. @reas of sharp point contacts on brittle material. Hounding of opposing cusp is done, so that occlusal contacts are large areas. Me!,o#s o0 s!ren+!,enin+ porcelain: 1. Method of strengthening brittle materials !. Method of designing components to minimi-e the stress concentration and tensile stress. 78 Me!,o# o0 s!ren+!,enin+ "ri!!le ma!erials: <one in ! ways 1. <evelopment of residual compressive stresses within the surface of the material 98 Ion e<c,an+e mec,anism : ,his techni6ues is called chemical tempering. in this procedure, a sodium containing glass is placed in a bath of molten potassium nitrate , potassium ions in the bath exchanges place with some of the sodium ions in the surface of the glass article. ,he potassium ions being around A " larger than the sodium ions, s6uee-es in to the place formerly occupied by the sodium ions this creates large compressive stresses in the surface of the glass these residual stresses produce a strengthening effect. A8 T,ermal !emperin+: ,his is the most common form of strengthening. ,his creates residual surface compressive stresses by rapidly cooling the surface of the ob#ect while it is hot and in the softened state. ,his rapid cooling produces a skin of rigid glass surrounding a soft molten core.as the molten core solidifies, it tends to shrink, but the outer skin remains rigid. ,he pull of the molten solidifying core as it shrinks, creates residual tensile stresses in the core and residual compressive stresses within the outer surface. E8 Disrup!ion o0 crac& propa+a!ion: by A ways 1. 9rack tip interactions !. 9rack tip shielding A. 9rack bridging 1. Crack tip interactions: these occur when obstacles in the microstructure act to impede the crack motion. ,hese obstacles are second phase particles and act to deflect the crack out of the crack plane. ,he re orientation of the crack plane leads to a reduction of the force being exerted on the crack in the area of deflection. ?hen the crack is deflected out of plane, the crack is no longer sub#ected to pure tensile stresses and will involve some shear displacement thus increasing the difficulty of crack propogation. 1)

2. Crack tip shielding : By ! ways a' ,ransformation toughening b' Microcrack toughening

a* Trans0orma!ion !ou+,enin+: ,his is most commonly associated with the presence of -irconia. 7nder unrestrained conditions, -irconia undergoes a high to low temperature phase transformation which involves A- " volume increase. In toughened ceramic, the high temperature phase of -irconia is constrained at room temperature. @pplied tensile stresses were to advance the crack plane. In the area directly behind the crack tip, the matrix constrains on -irconia are released, allowing low temperature transformation to take place. ,he transformed phase occupies a greater volume in the bulk material resulting in compressive forces that tend to counteract any advancing crack tip stresses. "* Micro crac& !ou+,enin+ : ,he high coefficient of thermal contraction and volume reduction associated with the high to low temperature phase transformation of leucite crystals create a condition which causes the leucite crystals to contract significantly more than the glass matrix. 9ompressive forces are created in the glass matrix surrounding the particles leading to micro cracking in the leucite phase. ,he residual compressive stresses in the glass phase around the particles can counteract the tensile stresses which drive the crack forward. 3. Crack tip bridging: It occurs when a second phase act as a ligament to make it more difficult for the crack faces to open. ,his is better understood by bonded fiber composites. ,he fibers act as ligaments which makes it more difficult to open the crack at an applied stress. Methods of designing components to minimi-e stress concentrations and tensile stress: 1. Minimizing tensile stresses: In a full coverage metal restoration with porcelain, the metal being of higher thermal expansion will contract faster than the porcelain as a result the metal is placed in tension and the porcelain in compression. =or partial metal coverage restorations, the #unction between the metal and the porcelain is a potential site for high stress as, the area with only metal will have no balancing compressive forces.so ideally full coverage restorations are preferred. 5orcelain unsupported by metal is more sub#ective to fracture. Reducing stress raisers: 1tress raisers are discontinuities in ceramic structures and in brittle materials that cause stress concentration. ,he design of ceramic restorations should avoid stress raisers. @brupt changes in shapeG thickness in the ceramic contour can act as stress raisers and make the restoration more prone to failure. ;otches caused the porcelain 1&

due to the folds of the underlying platinum foil substrate also is a stress raiser. 1harp line angles, large changes in the thickness of porcelain are factors leading to stress concentration. 7sually contact points should be avoided and contact areas should be preferred to avoid locali-ed stress areas. I8 Rein0orcemen! o0 inner sur0ace "- a ,i+,er s!ren+!, ceramic: %x. @luminous core porcelain 9erestore Heinforced high alumina crown II8 Rein0orcemen! o0 inner sur0ace "- me!al "on#in+: %x. 5latinum foil 2old foil swaged gold coping of +.&+-+.10mm thickness $renaissance system' ,itanium $procera' e.g. ,itanium coping III8 Porcelain 0usi# !o me!al res!ora!ions %x. ;oble metal alloys 2old containing alloys 2old free alloys Base metal alloys ;ickel chromium alloys 9obalt chromium alloys $rarely used in ceramic bonding' IV8 Desi+nin+ o0 res!ora!ions: ,he design should be such that it should not be sub#ected to tensile stress. ,o avoid stress concentration in porcelain, sharp angles should be avoided and the porcelain should be of uniform thickness. ,ensile stresses can be avoided by having a favorable occlusion in porcelain #acket crown. In porcelain fused to metal restoration, the metal should be strong and ductile not allowing flexing. 9ontact of opposing tooth or teeth should be either on porcelain or on metal, but not at the #unction. .luorescence an# Opalescence: =or clinicians who practice esthetic restorative dentistry, particularly in the field of ceramics, fluorescence is an important physical property. ;atural teeth are fluorescent. In other words, they emit visible light when exposed to ultraviolet light. =luorescence adds to the vitality of a restoration and minimi-es the metameric effect between teeth and restorative materials. ,he components of porcelain consist of agents that cause them to fluoresce. thus, they also will emit visible light when exposed to ultraviolet light. It is important that all the basic components of the porcelain, including the dentins, enamels, stains and even the gla-ing agents, are fluorescent. Epalescence is the ability of a translucent material to appear blue in reflected light and orange-yellow in transmitted light. Epalescence also contributes to the vitality of a restoration. MODE O. SUPPLD <ental porcelains are available as fine powders to be used with li6uid I $or distilled water'. ,he powders and li6uid are mixed to form a plastic mass which is shaped or moulded into a desired shape, it is then fired $or sintered' at a high temperature in order to fuse the particles together to form a ceramic body which is esthetically like a natural crown. !+

5orcelain is supplied as a kit containing: 1. =ine ceramic powders in different shades: %namel <entin 9ore !. 1pecial li6uidGdistilled water A. 1tains of colour pigments 0. 2la-e CERAMIC PROCESSING METHODS ,he single unit crown may be a metal ceramic crown $also called a porcelain fused-to-metal crown', a traditional aluminous porcelain crown based on a core of aluminous porcelain, or the newer ceramic crowns based on a core of leucite reinforced porcelain, in#ection or pressure molded leucite based ceramic, glass ceramic, sintered aluminous porcelain, sintered aluminum oxide, or glass-ceramic processed from cast glass. ,he types of restoration, with their variations, are discussed in detail in succeeding sections. ,he processing stages of the ceramic core for production of ceramic prostheses are summari-ed in ,able. ,hese seven different processes represent the main procedures that were available in !++A. the 6uality of the final ceramic prosthesis is dependent on each stage of the fabrication process. Machining or grinding of the core structure is of particular importance since flaws or minute cracks can be introduced that can possibly be propagated to the point of fracture during subse6uent intraoral stressing cycles. ,he use of computer aided manufacture $9@M' bprocesses are most likely to induce such damage, although the ceramics with higher fracture toughness are less likely to exhibit such damage. It is possible that subse6uent sintering or veneering procedures can reduce the potential for propagation of cracks in the prostheses while in service. 8owever, insufficient data are available from clinical studies of ceramics. ,he processing procedures for these ceramics are as follows. ,he feldspathic porcelain of traditional 5=M restorations, some aluminous porcelains $Ditadur-;, 8i9eram', and pure alumina ceramic $5rocera @ll9eram' are condensed by vibration or dry-pressed $5rocera' and sintered at high temperature. 5ressable ceramics $e.g., I51 %mpress, I51 %mpress !, =inesse @ll-9eramic, E59, and E59-A2', when heated and sub#ected to hydrostatic pressure, flow into a mold and after removal and divesting are then veneered. 9ast and cerammed crowns, such as the obsolete product <icor, are made using the lost-wax techni6ue. ,he molten glass is cast into a mold, heat-treated to form a glass-ceramic, and colored with shading porcelain and surface stains. =or slip cast ceramics $I-9eram, In-9eram 1pinell, and In-9eram Mirconia', a slurry of li6uid and particles of alumina, magnesia-alumina silicate $spinel', or -irconia is placed on a dry refractory die that draws out the water from the slurry. ,he slip-cast deposit is sintered on this die, and then it is coated with a slurry of a glass phase layer. <uring firing, the glass melts and infiltrates the porous ceramic core. ,ranslucent porcelain veneers are then fired onto the core to provide the final contour and color. !1

=or 9@<-9@M processes, the ceramic block materials $<icor M29, Dita 9erec Mk I, and Dita 9erec Mk II' are shaped into inlays or crowns using a 9@<9@M system $9erec'. 9@M refers to computer-aided milling or machining. ,his process is sometimes referred to as a 9@<-9@M process, where 9IM refers to computer-integrated machining or milling. ,hese blocks can also be used in copy milling devices $9elay' that mill or machine blocks into core shapes in a manner similar to that for cutting a key from a key blank, that is, by tracing over a master die of the shape to be produced out of the ceramic. SINTERED PORCELAINS Leuci!e rein0orce# 0el#spa!,ic porcelain Eptec 815 material $lenericG5entron, Inc.' is a feldspathic porcelain containing up to 0 vol" tetragonal leucite $1chmid et al, 1&&!. 5iche et al, 1&&0. <enry and Hosenstiel, 1&& '. ,he greater leucite content of Eptec 815 porcelain compared with conventional feldspathic porcelain for metal-ceramics leads to a higher modulus of rupture and compressive strength $Daidyanathan et al, 1&)&'. ,he large amount of leucite in the material contributes to a high thermal contraction coefficient $/at-, 1&)&'. In addition, the large thermal contraction mismatch between leucite $!! to ! x 1+3*GQ9' and the glassy matrix $) x 1+R*GQ9' results in the development of tangential compressive stresses in the glass around the leucite crystals when cooled. ,hese stresses can act as crack deflectors and contribute to increase the resistance of the weaker glassy phase to crack propagation. @fter heat treatment of Eptec 815 for one hour at temperatures ranging from 4+ to &)+Q9, a second metastable phase identified as sanidine $/@l1iAE)' forms at the expense of the glassy matrix $Daidyanathan et al, 1&)&'. ,he crystalli-ation of sanidine is associated with a modification of the optical properties of the material from translucent to opa6ue. 8owever, sanidine does not appear when the porcelain is heated to &)+Q9, since sanidine is metastable in the temperature range ++-&! Q9. ,he recipitation of sanidine has been reported as well upon isothermal heat treatment of conventional feldspathic porcelain for metal-ceramics $Mackert et al, 1&)*b. Mackert, 1&)). Barreiro et al, 1&)&'. @n isothermal timetemperature- transformation diagram that makes it possible to predict the amount of leucite and sanidine in samples sub#ected to different thermal histories has been established $Barreiro and Dicente, 1&&A'. Alumina "ase# porcelain @luminous core porcelain is a typical example of strengthening by dispersion of a crystalline phase $Mc(ean and /edge, 1&)4'. @lumina has a high modulus of elasticity $A + 25a' and high fracture toughness $A. to 0 M5a.m+ '. Its dispersion in a glassy matrix of similar thermal expansion coefficient leads to significant strengthening of the core. ,he first aluminous core porcelains contained 0+ to +" alumina by weight $Mc(ean and 8ughes, 1&* '. ,he core was baked on a platinum foil and later veneered with matched-expansion porcelain. 8i-9eram $Dident, Baldwin 5ark, 9@' is a more recent development of this techni6ue. @luminous core porcelain is now baked directly onto a refractory die $Mc(ean et al , 1&&0'. !!

Ma+nesia "ase# core porcelain Magnesia core ceramic was developed as an experimental material in 1&) $ESBrien, 1&) '. Its high thermal expansion coefficient $10. x 1+S*GQ9' closely matches that of body and incisal porcelains designed for bonding to metal $1A. x 1+3*GQ9'. ,he flexural strength of ungla-ed magnesia core ceramic is twice as high $1A1 M5a' as that of conventional feldspathic porcelain $* M5a'. ,he core material is made by reacting magnesia with a silica glass within the 11++-11 +Q9 temperature range. ,his treatment leads to the formation of forsterite $Mg!1i+0' in various amounts, depending on the holding time. ,he proposed strengthening mechanism is the precipitation of fine forsterite crystals $ESBrien et al, 1&&A'. ,he magnesia core material can be significantly strengthened by gla-ing, thereby placing the surface under residual compressive stresses that have to be overcome before fracture can occur $?agner et al, 1&&!'. 6irconia "ase# porcelain Mirage II $Myron International, /ansas 9ity, /1' is a conventional feldspathic porcelain in which tetragonal -irconia fibers have been included. Mirconia undergoes a crystallographic transformation from monoclinic to tetragonal at 114AQ9. 5artial stabili-ation can be obtained by using various oxides such as 9aE, MgE, T!EA, and 9eE, which allows the high-temperature tetragonal phase to be retained at room temperature. ,he transformation of partially stabili-ed tetragonal -irconia into the stable monoclinic form can also occur under stress and is associated with a slight particle volume increase. ,he result of this transformation is that compressive stresses are established on the crack surface, thereby arresting its growth. ,his mechanism is called transformation toughening. ,he addition of yttria-stabili-ed -irconia to a conventional feldspathic porcelain has been shown to produce substantial improvements in fracture toughness, strength, and thermal shock resistance $Morena et al 1&)*a. /on et al, 1&&+'. 8owever, other properties, such as translucency and fusion temperature, can be adversely affected. ,he modulus of rupture of commercially available -irconia-reinforced feldspathic dental porcelain $Mirage II' is not significantly different from that of conventional feldspathic porcelain $1eghi et al, 1&&+b'. GLASS CERAMICS Mica "ase# @s described earlier, glass-ceramics are obtained by controlled devitrification of glasses with a suitable composition including nucleating agents. <epending on the composition of the glass, various crystalline phases can 4$!':1A0-10A $1&&*' "rit #ev $ral %iol &ed 1A4 nucleate and grow within the glass. ,he advantage of this process is that the dental restorations can be cast by means of the lost-wax techni6ue, thus increasing the homogeneity of the final product compared with conventional sintered feldspathic porcelains.<icor $<entsply Inc., Tork, 5@' is a mica-based machinable glass-ceramic. ,he machinability of <icor glass-ceramic is made possible by the !A

presence of a tetrasilicic fluormica $/Mg! 1i0E1+=!' as the ma#or crystalline phase $2rossman and >ohnson, 1&)4'. Micas are classified as layer-type silicates. 9leavage planes are situated along the layers, and this specific crystal structure dictates the mechanical properties of the mineral itself. 9rack propagation is not likely to occur across the mica crystals and is more probable along the cleavage planes of these layered silicates $<aniels and Moore, 1&4 '. In the glass-ceramic material, the mica crystals are usually highly interlocked within the glassy matrix, achieving a 3house of cards3 microstructure $2rossman, 1&4!'. ,he interlocking of the crystals is a key factor in the fracture resistance of the glass-ceramic, and their random orientation makes fracture propagation e6ually difficult in all directions. @fter being cast, the <icor glass is converted into a glass-ceramic by means of a single-step heat treatment with a six-hour dwell at 1+4+Q9. ,his treatment facilitates controlled nucleation and growth of the mica crystals.8owever, it is critical to re-invest the cast glass restoration prior to the crystalli-ation heat treatment, to prevent sagging or rounding of the edges at high temperature. ,he match in the thermal expansion coefficients of the glass and the investment is achieved by use of a leucite based gypsum-bonded investment. ,he interaction of the glass-ceramic and the investment during the crystalli-ation heat treatment leads to the formation of calcium magnesium silicate at the surface of the glass-ceramic $<enry and Hosenstiel, 1&&A'. ,his crystalline phase could be formed by decomposition of the mica into magnesium silicate that later reacts with the gypsum-bonded investment. ,his surface layer, called the3ceram layer3, has been reported to decrease the strength of glass ceramic crowns significantly $9ampbell and /elly, 1&)&. /elly et al, 1&)&'. ,he effects of alumina and -irconia additions on the bending strength of <icor glass-ceramic have been investigated. It was found that alumina additions successfully increase the bending strength of <icor glass-ceramic, whereas -irconia additions had no effect ' (engetal, 1&&A'. H-#ro<-apa!i!e "ase# 9erapearl $/yocera, 1an <iego, 9@' is a castable glass ceramic in which the main crystalline phase is oxyapatite, transformable into hydroxyapatite when exposed to moisture $8obo and Iwata, 1&) '. Li!,ia "ase#: 2lass-ceramics can be obtained from a wide variety of compositions, leading to a wide range of mechanical and optical properties, depending on the nature of the crystalline phase nucleating and growing within the glass. %xperimental glassceramics in the system (i!E-@l!EA- 9aE-1iE! are currently the ob#ect of extensive research work. ,he choice of ade6uate additives is critical in the development of tougher and higher-strength glassceramics $@nusavice et al. 1&&0b'. <ifferential thermal analysis can be efficiently used to determine the heat treatment leading to the maximum lithium disilicate crystal population in the shortest amount of time, thereby optimi-ing the nucleation and crystalli-ation heat treatment of this type of glassceramic $5arsell and @nusavice, 1&&0'. Mac,ina"le ceramics

!0

Cerec system:,he evolution of 9@<-9@M systems for the production of machined inlays, onlays, and crowns led to the development of a new generation of machinable porcelains.,here are two popular systems available for machining all-ceramic restorations. ,he best-known is the 9erec system $1iemens, Bensheim, 2ermany'. It has been marketed for several years, and two materials can be used with this system: Dita Mark II $Dident, Baldwin 5ark, 9@' and <icor M29 $<entsply International, Inc., Tork, 5@'. Dita Mark II contains sanidine $/@l1iAE)' as a ma#or crystalline phase within a glassy matrix. @s explained earlier, the presence of sanidine could explain the lack of translucency of this material. <icor M29 is a machinable glassceramic similar to <icor, with the exception that the material is cast and cerammed by the manufacturer. 9olorants have been added to match tooth color. ,he glass-ceramic contains 4+ vol" of the crystalline phase $2rossman, 1&&1'. ManufacturerSs control over the processing of this material and the higher volume percent of the crystalline phase could explain the improved mechanical properties of <icor M29 compared with conventional <icor glass-ceramic. ,he use of adhesive resinbased cements has been shown to improve the fracture resistance of all-ceramic crowns $%den and /acic-, 1&)4. 2rossman and ;elson, 1&)4'. Ether studies have shown that the overall fracture resistance of <icor M29 was independent of cement film thickness $1cherrer et al., 1&&0'. 5resently, the main identified weakness of the 9erec system is the marginal fit of the restorations $@nusavice, 1&&A'. Celay system: ,he 9elay system $Mikrona ,echnologie, 1preitenbach, 1wit-erland' uses a copy-milling techni6ue to manufacture ceramic inlays or onlays from resin analogs. ,he 9elay system is a mechanical device based on pantographic tracing of a resin inlay or onlay fabricated directly onto the prepared tooth or onto the master die $%idenben-e7G., 1&&0'. @s with the 9erec system, the starting material is a ceramic blank available in different shades. Ene ceramic material currently available for use with the 9elay system is Dita-9elay $Dident, Baldwin 5ark, 9@'. ,his material contains sanidine as the ma#or crystalline phase within a glassy matrix. Hecently, ln9eram pre-sintered slip-cast alumina blocks $Dident, Baldwin 5ark, 9@' have been machined with the 9elay copy-milling system used to generate copings for crowns and fixed partial dentures $Mc(aren and 1orensen, 1&& '. ,he alumina copings were further infiltrated with glass following the conventional ln-9eram techni6ue, resulting in a final marginal accuracy within + urn. SLIP CAST CERAMICS Alumina "ase# (Gn Ceram* ln-9eram $Dident, Baldwin 5ark, 9@' is a slip-cast aluminous porcelain. ,he alumina-based slip is applied to a gypsum refractory die designed to shrink during firing.,he alumina content of the slip is more than &+", with a particle si-e between +. and A. micrometers. @fter being fired for four hours at 11++Q9, the porous alumina coping is shaped and infiltrated with a lanthanum-containing glass during a second firing at 11 +Q9 for four hours. @fter removal of the excess glass, the restoration is veneered with matched expansion veneer porcelain $5robster and <iehl, 1&&!'. ,his processing techni6ue is uni6ue in dentistry and leads to a high-strength !

material due to the presence of densely packed alumina particles and the reduction of porosity. ,wo modified porcelain compositions for the In 9eram techni6ue have been recently introduced. In-9eram 1pinell contains a magnesium spinel $Mg@l!E0' as the ma#or crystalline phase with traces of alpha-alumina, which seems to improve the translucency of the final restoration. ,he second material contains tetragonal -irconia and alumina. @ variety of alumina-glass dental composites can be prepared by the glass-infiltration process. 8owever, research has shown that the fracture toughness of the composites is relatively insensitive to the volume fraction of alumina in the range investigated $?olfrtfll., 1&&A'. Ho! presse#$ in%ec!ion mol#e# ceramics Leucite based I51 %mpress $Ivoclar 71@, @mherst, ;T' is a leucite-containing porcelain. 9eramic ingots are pressed at 11 +Q9 $under a pressure of +.A to +.0 M5a' into the refractory mold made by the lost-wax techni6ue. ,his temperature is held for !+ minutes in a specially designed automatic press furnace $<ong et al, 1&&!'. ,he ceramic ingots are available in different shades. ,hey are produced by sintering at 1!++Q9 and contain leucite crystals obtained by surface crystalli-ation $8oland et al. , 1&& '. ,he leucite crystals are further dispersed by the hot-pressing step. ,he final microstructure of I51 %mpress exhibits 0+" by volume of tetragonal leucite. ,he leucite crystals measure 1- um and are dispersed in a glassy matrix. ,wo finishing techni6ues can be used with I51 %mpress: a staining techni6ue or a layering techni6ue involving the application of veneering porcelain. ,he two techni6ues lead to comparable mean flexure strength values for the resulting porcelain composite $(uthy et al, 1&&A'. ,he thermal expansion coefficient of the I51 %mpress material for the veneering techni6ue $10.& x 1+3*GQ9' is lower than that of the material for the staining techni6ue $1) x 1+R*GQ9' to be compatible with the thermal expansion coefficient of the veneering porcelain. ,he flexural strength of I51 %mpress material was significantly improved after additional firings $<ong et al, 1&&!'. ,he strength increase is attributed to a good dispersion of the fine leucite crystals as well as the tangential compressive stresses arising from the thermal contraction mismatch between the leucite crystals and the glassy matrix. !pinel based @lceram $Innotek <ental 9orp, (akewood, 9E' is a material for in#ectionmolded technology and contains a magnesium spinel $Mg@l!E0' as the ma#or crystalline phase $Mc(ean and /edge, 1&)4'. ,his system was initially introduced as the 3shrink-free3 9erestore system, which relied on the conversion of alumina and magnesium oxide to a magnesium aluminate spinel. Ene of the recogni-ed advantages of this system was the excellent marginal fit of the restorations $?ohlwend et al, 1&)&'. CONDENSATION (COMPACTION* ,he process of packing the powder particles together and removing excess water is known as condensation. 5roper condensation gives dense packing and reduce the shrinkage of porcelain and minimi-e porosity in the fired porcelain.9ondensation procedure is followed in application of core, dentin and enamel porcelain either in !*

porcelain #acket crown or porcelain fused to metal.,he porcelain powder is mixed with distilled water or special li6uid supplied by the manufacturer to form a thick paste. 1mall portions of the paste are then applied to the platinum matrix in #acket crown preparation over the die until the desired shape of the crown has been attained. %xcess water is removed by blotting with a linen cloth or similar absorbent material.,he remaining water serves as a binder for the powder so that the crown may be properly shaped before firing. 5owder consisting of a mixture of particle si-es compact more easily than those with particles of one si-e only. ,his reduces the si-e of the spaces between the particles and thus reduces firing shrinkage.@ well compacted crown not only reduces firing shrinkage but also shows a regular contraction over its entire surface. Me!,o#s o0 con#ensa!ion: 1" #ibration: Mild vibration are used to densely pack the wet powder upon the underlying matrix. ,he excess water comes to the surface and its is blotted with a tissue paper. 2" !patulation: @ small spatula is used to apply and smoothen the wet porcelain. ,his action brings excess water to the surface. 3" $et brush techni%ue: ,he mix should be creamy and capable of being transferred in small increments to the platinum matrix with hair brush. &" 'ltrasonic: @ ceramosonic condenser can induce supersonic vibration in porcelain creates intimate inter relation between metal and opa6ue porcelain. (" )ra*itational: +" $hipping: @ny method may be used for condensation but care is taken not to allow the porcelain to dry out completely as the porcelain powder is held together due to surface tension of water. <ry the wet structure in a warm atmosphere before placing into the hot furnace. @fter condensation the compacted mass supported by the matrix or metal coping should be placed on a fire tray and inserted into the muffle of the ceramic furnace. Porcelain Con#ensa!ion 5orcelains for ceramic and metal - ceramic prostheses, as well as for other applications, is supplied as a fine powder that is designed to be mixed with water or anther vehicle and condensed into the desired form $see =ig !1-!'. ,he powder particles are of a particular si-e distribution to produce the most densely packed porcelain when they are properly condensed. If the produce the densely packed porcelain when they are properly condensed. If the particles are of the same si-e, the density of packing would not be nearly as high. ,horough condensation is also crucial in obtaining dense packing would not be nearly as high. ,horough condensation is also crucial in obtaining deus packing of the powder particles. <ense packing of the powder particles. <ense packing of the powder particles dense packing of the powder particles. <ense packing of the powder particles provides two benefits: lower firing shrinkage and porosity in the fires porcelain. ,his packing, or condensation, may be achieved by various methods, including vibration, spatulation, and brush techni6ues.

!4

,he first method uses mild vibration to pack the wet powder densely on the underlying framework. ,he excess water is blotted or wiped away with a clean tissue or fine brush, and condensation occurs toward the blotted or bushed area, in the second method a small spatula is used to apply and smooth the it is removed. ,he second method a small spatula is used to apply and smooth the wet porcelain. ,he smoothing action brings the excess water to the surface, where it is removed. ,he third method employs the addition of dry porcelain powder to the surface to absurd the water. @ brcelain powder to the surface to accord the water places the dry powder. @ brush to the side opposite from an increment of wet porcelain places the dry powder. @s the water is drawn toward the dry powder, the wet particles are pulled together. ?hichever method is used, it is important to remember that the surface tension of the water is the driving force for condensation, and the porcelain must never be allowed to dry out until condensation is complete. 9ondensed mass is gradually heated by first placing it in front of the muffle of a preheated furnace and later inserting into the furnace. 7* Lo' "is?ue s!a+e: ,he flux begins to melt and flow in between the porcelain particles. ,he mass attains some rigidity but very little cohesion. @t this stage the material is porous and undergoes minimum of shrinkage. ,he porcelain do not have translucency and gla-e. 9* Me#ium "is?ue s!a+e: 8ere the flux flows freely in between the particles the material is still porous, but there is complete cohesion between the particles and most of the shrinkage is complete. In this stage also there is lack of translucencey and gla-e. A* Hi+, "is?ue s!a+e: 8ere with shrinkage is completed. ,here is very little porosity, the mass has attained complete rigidity and smoothness, the body does not appear to be gla-ed. Most of the addition and alterations are carried out after the porcelain has attained medium bis6ue stage. (ess the number of firing, higher is the strength and better the esthetics. ,oo many firings give a life less, over translucent porcelain. PORCELAIN .URNACE ,he ordinary air fire porcelain furnace consists of a muffle, a pyrometer, a thermocouple and in its most simple form a rheostat or variable transformer for control of firing temperature and sophisticated automatic and programmable time and temperature controller for the most modern furnaces. ,he muffle is the heating unit providing necessary high temperature for baking of porcelain. ,he heating element is a coiled wire of platinum and is embedded into the refractory material of the muffle. ,he muffle is provided with a door for easy access and to prevent fluctuation of temperature due to heat loss. ,he pyrometer is a millivoltmeter calibrated to read in degree of temperature. ,he thermocouple consists of platinum wire #oined at one end with another wire made of &+" platinum and 1+" rhodium. ,he #oint is placed inside the muffle, this is known as hot #unction of the thermocouple. ,he free ends of the thermocouple are attached to the pyrometer outside the muffle. ?hen heat is generated inside the muffle, the dissimilar metals of the thermocouple at the hot #unction generates and !)

electromotive force which deflects the needle of the pyrometer indicating the calibrated temperature. @s the electromotive force varies with variation in temperature inside the muffle, such variations can be measured as temperature on the pyrometer. ,he temperature controller regulates the current fed to the heating element inside the muffle thereby inducing increase or decrease in muffle temperature. ,he main problem in air fired furnace is the opacity of the porcelain due to porosity. Coolin+: ,he cooling of dental porcelain is complex matter, particularly when the porcelain is fused to metal a metallic substrates. Multiple firings of metal ceramic restorations can cause the co-efficient of thermal contraction the porcelain to increase and can actually make it more likely to cra-e or cra-e because of tensile stress development. 9ooling must be carried out slowly and uniformly. If shrinkage is not uniform it causes cracking and loss of strength. <uring cooling, subsurface submicroscopic surface cracks occur. Because of the low thermal conductivity of porcelain, the differential between the thermal dimensional change of the outside and inside can introduce stresses which embrittle the porcelain. <ifferent methods and porcelain firings are: !' @ir firing A' 5ressure firing 0' 2as firing ' Dacuum firing 7* Air 0irin+: @ir inside a furnace is modulated to the same atmospheric pressure during this procedure. ,here is more chances of air entrapment in porcelain. ?e will get more porous, less translucent porcelain. 9* Pressure 0irin+: ,he air inside the furnace is sub#ected to a pressure e6ual to 1+ atmosphere as the porcelain reaches its maturation temperatures. ,his compresses the air inside the porcelain mass and reduces the si-e of the air bubble. A* Gas 0irin+: ,he air in the furnace is replaced by a diffusible inert gas like argon or hydrogen which diffuses out through the maturing porcelain. E* Vacuum 0irin+: 5artial vacuum firing reduces air voids, so porosity is reduced, so better translucent effect. ,he air from the furnace is evacuated and this eliminating air from porous spaces which collapses on itself. ,his is the best and widely used method.

!&

LA/ORATORD MANU.ACTURING PROCEDURE In the production of porcelain tooth, the powder ingredients are weighted and mixed with water containing starch, gum tragacanth, or other organic materials to form a putty like mass that can be handled conveniently. ,he molding techni6ue varies with different manufacturers. 2enerally, the split molds are made of bron-e and may be separated so that one portion contains the negative pattern for the lingual surface of 1! teeth and the other contains the negative pattern for the labial surface or face of the teeth. ?hen the two piece molds are used, a thin layer of the enamel mix is placed in the labial mold to provide the enamel color, and the body mix, which forms the bulk of the tooth, is placed over this. ,hen a thin veneer of enamel mix is placed in the incisal portion of the lingual mold and is also covered with body mix. ?hen combined, the two halves with the porcelain mixes form a tooth with contours and coloration similar to natural teeth. ,he techni6ue employs a third portion, which also fits against the labial surface for the purpose of accurately forming the enamel colored porcelain separately before the body portion is added. ,he techni6ue for the three piece molds involves placing the dough like enamel mix in the labial half first, pressing the third or blender mold into it and heating the molds until the mix stiffness. ,hey are then opened, the excess mix is trimmed away and the body mix is added to all the second and larger lingual half of the mold. 1mall noble metal rings are embedded in the porcelain to provide a base for the gold plated nickel pins used for the retention of the teeth in the denture base. ,hese rings are made of a metal or alloy with a high melting point and usually are split to allow for the shrinkage of the surrounding porcelain during fusion. Before the moulds are filled, the rings are placed over the tips of tapered points that extend into the tooth from the lingual half of the mould. @fter the moulds are filled by either method, they are placed in a press and heated until the porcelain mix develops sufficient hardness to allow handling. %ach anterior tooth at this stage is approximately one fifth over si-e to allow for shrinkage. @fter A stage of firing, the teeth have been cooled slowly to prevent cra-ing, all that remains and the attachment of the pins. =or this operation small bits of solder are stamped to the ends of the gold clad pins and they are inserted, solder downward, to contact the metal ringes at the base of the tapered openings in the lingual body of the teeth. ?hen heated, either in a furnace or electrically, the solder melts and #oins the pin firmly to the embedded rings. CERAMIC PROSTHESES: Aluminous Porcelain Cro'ns: @nother method of bonding porcelain to metal makes use of tin oxide coatings on platinum foil. ,he ob#ective of this techni6ue is to improve the aesthetics by a replacement of the thicker metal coping with a thin platinum foil, thus allowing more room for porcelain. ,he method consists of bonding aluminous porcelain to platinum A+

foil copings. @ttachment of the porcelain is secured by electroplating the platinum foil with a thin layer of tin and then oxidi-ing it in a furnance to provide a continuous film of tin oxide for porcelain bonding. ,he rationale is that the bonded foil will act as an inner skin on the fit surface to reduce subsurface porosity and formation of microcracks in the porcelain, thereby increasing the fracture resistance of crowns and bridges. ,he clinical performance of these crowns has been excellent for anterior teeth, but approximately 1 " of these crowns fractured within 4 years after they were cemented to molar teeth with a glass ionomer cement. Based on a 1&&0 survey, metal-ceramic crowns and bridges were used for approximately &+" of all fixed restorations. 8owever, recent developments in ceramic products with improved fracture resistance and excellent aesthetic capability have led to a significant increase in the use of all-ceramic products. 9eramic crowns and bridges have been in widespread use since the beginning of the twentieth century. ,he ceramics employed in the conventional ceramic crown were high fusing feldspathic porcelains. ,he relatively low strength of this type of porcelain prompted Mc(ean and 8ughes $1&* ' to develop an alumina-reinforced porcelain core material for the fabrication of ceramic crowns. ,he alumina-reinforced crowns are generally regarded as providing slightly better aesthetics for anterior teeth than are the metal-ceramic crowns that employ a metal coping. 8owever, the strength of the core porcelain used for aluminareinforced crowns is inade6uate to warrant the use of these prostheses for posterior teeth. In fact Mc(ean reported a fracture rate of molar aluminous porcelain crowns of approximately 1 " after years. Cas!a"le an# mac,ina"le Glass Ceramics (Dicor an# Dicor MGC* ?hen used for posterior crowns, ceramic crowns are most susceptible to fracture. 1hown in =igure !1-* $see also the color plate' is the stress distribution computed by finite element analysis in a +. mm-thick molar <icor crown loaded on the occlusal surface, #ust within the marginal ridge area. ,he maximum tensile stress is located within the internal surface directly below the point of applied force and #ust above the + m-thick layer of resin cement $see the arrow in fig. !1.*'. this site represents the critical flaw responsible for crack initiation under an applied intraoral force. ,he location of initial crack formation was consistent with the location of maximum tensile stress predicted by the finite element calculations as shown in figure !1.*. an 1%M image of a fractured clinical crown of <icor glass-ceramic is shown in fig !1.). because of the smaller forces exerted on anterior crowns, the risk for fracture of anterior crowns is significantly less than that for posterior crowns. ,he first commercially available castable ceramic material for dental use, <icor, was developed by 9orning 2lass works and marketed by <entsply international. <icro is a castable glass that is formed into an inlay, facial veneer, or full-crown restoration by a lost-was casting process similar to that employed for metals. @fter the glass casting core or coping is recovered, the glass is sandblasted to remove resideual casting investment and the sprues are gently cut away. ,he glass is then covered by a protective 3embedment3 material and sub#ected to a heat treatment that causes microscopic platelike crystals of crystalline material $mica' to grow within A1

the glass matrix. ,his crystal nucleation and crystal growth process is called ceramming. Ence the glass has been cerammed, it is fit on the prepared dies, ground as necessary, and then coated with veneering porcelain $as shown in fig. !1.)' to match the shape and appearance of ad#acent teeth. <icor glass-ceramic is capable of producing surprisingly good aesthetics, perhaps because of the 3chameleon3 effect, where part of the color of the restoration is picked up from the ad#acent teeth as well as from the tinted cements used for luting the restorations. <icor glass-ceramic contains about vol" of tetrasilicic fluormica crystals. ,he ceramming process results in increased strength and toughness, increased resistance to abrasion, thermal shock resistance, chemical durability, and decreased transluency. <icor M29 is a higher 6uality product that is crystalli-ed by the manufacturer and provided as 9@<-9@M blanks or ingots. ,he 9@<-9@M ceramic <icor M29 contains 4+ vol" of tetrasilicic fluormica platelets, which are approximately !m in diameter. ,he mechanical properties of <icor M29 are similar to those of <icor glass-ceramaic, although it has less translucency $contrast ratio of +.01 -+.00 versus +. *, respectively'. <icor has recently been discontinued presumably because of low tensile strength and the need to color the prosthesis on the exterior region rather that within the core region, which would more closely resemble a natural tooth. @lthough <icor is no longer sold, the principles for selection are useful when products of similar mechanical and physical properties are being considered. ,he advantages of <icor glass-ceramic were ease of fabrication, improved aesthetics, minimal processing shrinkage, good marginal fit, moderately high flexural strength, low thermal expansion e6ual to that of tooth structure, and minimal abrasiveness to tooth enamel. ,he disadvantages of <icor glass-ceramic were its limited use in low-stress areas and its inability to be colored internally. @s designed, it was colored with a thin outer layer of shading porcelain and surface stain to ieve acceptable aesthetics. 8owever, <icor M29 ingots have been supplied in light and dark shades, making it possible for technicians to build depth of color into the fabrication process. @lthough both of the <icor products were based on a glass-ceramic core that was minimally abrasive to opposing tooth enamel, the re6uired shaduing or veneering porcelains were more abrasive. @esthetically, <icor crowns were more lifelike than metal-ceramic crowns, which often exhibit a metal collar, a gray shadow subginigivally, or poor translucency. ,he life expectancy of <icor crowns in highstress areas is not as good as that of 5%M crowns. ,wo veneering materials were used to improve the color of <icor crowns: <icor 5lus, which consisted a pigmented feldspathic porcelain veneer, and ?illiSs 2lass, a veneer of Ditadur ; aluminous porcelain. ,ooth preparation for glass-ceramic of this type is the same as that re6uired for metal-ceramic prostheses except that, for first and second molars a reduction of !mm is recommended. Ecclusal surfaces and incisal edges must be reduced a minimum of 1. mm. @xial surfaces should be reduced a minimum of 1.+mm. ,he preparation should be either a shoulder with a rounded gingivoaxial line angle or a heavy chamfer. A!

Pressa"le Glass Ceramics: @ glass-ceramic is a material that is formed into the desired shape as a glass, then sub#ected to a heat treatment to induce partial devitrification $i.e., loss of glassy structure by crystalli-ation of the glass'. ,he crystalline particles, needles, or plates formed during this ceramming process serve to interrupt the propagation of cracks in the material when an intraoral force is applied, thereby causing increased strength and toughness. ,he use of glass-ceramics in dentistry was first proposed by Mac9ulloch in 1&*). 8e used a continuous glass-molding process to produce denture teeth. 8e also suggested that it should be possible to fabricate crowns and inlays by centrifugal casting of molten glass. 5ressure molding is used to make small, intricate ob#ects. ,his method uses a piston to force a heated ceramic ingot through a heated tube into a molk, where the ceramic form cools and hardens to the shape of the mold. ?hen the ob#ect has solidified, the refractory mold $investment' is broken apart and the ceramic piece is removed. It is then debrided and either stained and gla-ed $certain inlays' or veneered with one or more layers of a thermally compatible ceramic. I51 %mpress is a glass-ceramic provided as core ingots that are heated and pressed until the ingot flows into a mold. It contains a higher concentration of leucite crystals that increase the resistance to crack propagation $fracture'. ,he hot-pressing process occurs over a 0 min period at a high temperature to produce the ceramic substructure. ,his crown form can be either stained and gla-ed or build up using a conventional layering techni6ue. ,he advantages of this ceramic are its lack of metal, a translucent ceramic core, a moderately high flexural strength $similar to that of Eptimal 5ressable ceramic', excellent fit, and excellent aesthetics. ,he disadvantages are its potential to fracture in posterior areas and the need to use a resin cement to bond the crown micromechanically to tooth structure. I51 %mpress and I51 %mpress! are typical products representative of several other leucite-reinforced and lithia disilicate-reinforced glass-ceramics, respectively. 1ome properties of I51 %mpress and I51 %mpress! glass-ceramic core materials are listed in table. !1.*. I51 %mpress is a leucite-containing glass-ceramic that contains about A vol" of leucite $/@I1I!E*' crystals, which increases the resistance to crack propagation $fracture'. ,he veneering ceramic also contains leucite crystals in a glass matrix. @fter hot pressing, divesting, and separation of the ceramic units the sprue segments, they are veneered with porcelain containing leucite crystals in a glass matrix. @ cross-sectional illustration of an I51 %mpress crown is illustrated in fig. !1.&. ,he I51 %mpress! is similar except that the core consists of lithia disilicate crystals in a glass matrix and the veneering ceramic contains apatite crystals. ,he very small apatite crystals cause light scattering in a way that resemble by the structure and components of tooth enamel. ,he coefficient of expansion of the apatite glass-ceramic veneering ceramic is &.4 ppmG + 9, which is similar to that of I51 %mpress! core ceramic $1+.* ppmG + 9'. Ebviously, this veneering ceramic should not

AA

be used with the I51 %mpress core ceramic that has a much higher expansion coefficient $1 + ppmG+ 9'. ,he core microstructure of I51 %mpress! glass ceramic is 6uite different from that of I51 %mpress, as evidenced by the 4+ vol" of elongated lithia disilicate crystals in I51 %mpress!. ,he primary crystal particles in I51 %mpress! are +. to 0m in length. @ smaller concentration of lithium orthophosphate crystals $(i ! 1i! E ' approximately +.1 to +.Am in diameter has also been reported $8oland et al., !+++'. ,he microstructural difference between I51 %mpress and I51 empress! results in a slight decrease in translucency for I51 9mpress! $+. ' $8olland et al., !+++'. @s is the case for most pressable glass-ceramics, the advantages of I51 empress and I51 %mpress! glass-ceramic core materials are their potential for accurate fit, excellent transluency and overall aesthetics, and a metal-free structure. <isadvantages are their low to moderately high flexural strength and fracture toughness. ,hese properties limit their use to conservative designs in low to moderate stress environments. 1hown in fig. !1-1+, !1-11 and !1-1! are three-unit glass-ceramic =5<s made from a lithiadisilicate-based core material. ,he =5< shown in fig. !1-1! was made without a veneering ceramic to enhance the fracture resistnce. @ summary of important properties is presented in ,able !1-4 for a variety of dental ceramics. @ list of pressable ceramics and their veneering ceramics is summari-ed. E59 and E59 A2 are two pressable ceramics that are similar in nature to I51 %mpress and I51 %mpress!, respectively. E59 is a leucite-containing ceramic and E59 A2 contains lithia disilicate crystals. ,he ultralow-fusing temperature of the veneering porcelain suggests a low level of wear of opposing enamel. 8owever, insufficient clinical data are available to support this hypothesis. In-9eram @lumina, In-9eram 1pinell, and In-9eram Mirconia In-9eram is supplied as one of three core ceramics: $1' In-9eram spinell $!' in-9eram @lumina, and $A' in-9eram Mirconia. @ slurry of one of these materials is slip-cast on a porous refractory die and heated in a furnace to produce a partially sintered coping or framework. ,he partially sintered core is infiltrated with glass at 11+++ 9 for 0 hr to eliminate porosity and to strengthen the slip-cast core. ,he initial sintering process for the alumina core produces a minimal shrinkage because the temperature and time are sufficient only to cause bonding between particles and to produce a desired level of sintering. ,hus the marginal adaptation and fit of this core material should be ade6uate because little shrinkage occurs. ,he flexural strength $modulus or rupture' values of the glass-infiltrated core materials are approximately A + Mpa for in-9eram spinell $I91', ++ Mpa for In-9eram @lumina $I9@'and 4++ Mpa for In-9eram Mirconia $I9M' compared with strengths of 1++ to 0++ Mpa for <icor, Eptec 5ressable 9eramic, I51 %mpress and I51 %mpress!. <espite the relatively high strength of these materials, failures can still occur in single crowns as well as =5<s. Because of the variation in strength, the primary indications for these core ceramics vary as shown in ,able !1-&. =or example, I91 is indicated for use as anterior single-unit inlays, onlays, crowns, and veneers, I9@ is indicated for anterior and posterior crowns and anterior three-unit =5<s. Because of its high level of A0

opacity, I9M is not recommended for anterior prostheses. 8owever, because of its extremely high strength and fracture toughness, it can be used for posterior crowns and posterior =5<s. @s suggested in chapter 0, it is essential that the gingival embrasure areas of ceramic =5< connectors be designed with a large radius of curvature to minimi-e the stress-raiser effect in areas of moderate to high tensile stress. ,he connectors also should be sufficiently thick to minimi-e stresses during loading. =or %mpress and %mpress! ceramics used in molar areas, the connector height should be at least 0mm. A tables: 5age ;o. *)4 to *)& 7ntil in-9eram was introduced, aluminous porcelain had not been used successfully to produce =5<s because of low flexural strength and high sintering shrinkage. ,hus the principal indications for aluminous porcelain crowns were the restoration of maxillary anterior crowns when aesthetics was important and their use in patients with allergies to metals. Its advantages and disadvantages are summeri-ed in the following. @ schematic drawing of an In-9eram crown is shown in =ig !1.1A ,he same diagram can be used to illustrate crowns made with In-9eram 1pinell $I91' and In9eram Mirconia $I9M', which will be discussed below. ,he three In-9eram ceramics are glass-infiltrated core materials used for single anterior crowns $all three products', posterior crowns $In-9eram @lumina and in-9eram Mirconia', anterior three-unit =5<s $In-9eram @lumina', and three-unit posteriro bridges $In-9eram Mirconia'. ,he most translucent of the three ceramics- In-9eramics, In-9eram 1pinell, was introduced as an alternative to in-9eram @lumina. ,his ceramic has a lower flexural strength, but its increased translucency provides improved aesthetics in clinical situations in which the ad#acent teeth or restorations are 6uite translucent. ,he core of I91 is Mg@l 1E0 and that for I9M is a mixture of @l !EA and MrE!. ,hese core ceramics are also infiltrated with glass, and they are fabricated in a manner similar to that for I9@, although the firing temperatures and times may be different. ,he final I9@ core consists pf 4+ wt" alumina infiltrated with A+ wt" sodium lanthanum glass. ,he final I91 core consists of glass-infiltrated magnesium spindl $Mg@l!E0'. I9M contains approximately A+wt" -irconia and 4+ wt" alumina. ,he power-li6uid slurry is slip cast onto a porous die that absorbs water from the slurry, thereby densifying the agglomeration of particles onto the die. 1teps for fabricating in-9eram prostheses are as follows: $1' prepare teeth with an occlusal reduction of 1. to !.+mm and a heavy circumferential chamfer $1.!mm', $!' make an impression and pour two dies, $A' apply @l!EA on a porous duplicate die, $0' heat at 1!++ 9 for ! hours to dry @l!EA , $ ' sinter the coping for 1+ hours at 11!++ 9, $*' apply a sodium lanthanum glass slurry mixture on the coping, $4' fire for 0 hours at 11!++ 9 to allow infiltration of glass, $)' trim excess glass from the coping with diamond burs, $&' build up the core with dentin and enamel porcelain, $1+' fire in the oven, grind in the anatomy and occlusion, finish, and gla-e. ,he advantages of I9@ include a moderately high flexural strength and fracture toughness, a metal-free structure, and an ability to be used successfully with conventional luting agents $,ype 1 cements'. ,he collective advantages of the three A

glass-infiltrated core materials are their lack of metal, relatively high flexural strength and toughness, and ability to be successfully cemented using any cement. In spite of this high flexural strength $0!& Mpa', the ?eibull modulus of I91 is 6uite low $ .4', which is indicative of a large scatter in the distribution of strength values relative to the probability of fracture. $,inschert et al., !+++'. Its marginal adaptation may not be as good as that achieved with other ceramic products. In one study the mean marginal discrepancies were )A m for 5rocera @ll 9eram, *A m for I51 %mpress, and 1*1m for In-9eram @lumina. Ether drawbacks of I9@ include its relatively high degree of opacity, inability to be etched, techni6ue sensitivity, and the relatively great amount of skilled labor re6uired. ,hese disadvantages apply also to In-9eram Mirconia. 9ompared with I9M, the opacities of I9@ and I9M core ceramics are much greater. @lthough these newer core ceramics have excellent fracture resistance inproper design of the connector area of a =5< can significantly reduce the fracture resistance and clinical survivability of the prosthesis. 1hown in fig. !1-10 is the stress distribution in a three-unit =5<, which shows relatively high principal tensile stress $red area' at the tissue side of the interproximal connector when an occlusal load of ! + ; is applied to the occlusal surface of the pontic. In summary, In-9eram 1pinell $I91' is a glass-infiltrated core ceramic that offers greater translucency for crowns than either the I9@ or I9M core ceramics. 8owever, I9@ has lower strength and toughness compared with I9@ and I9M. ,hus the use of I91 is limited to anterior inlays, onlyas, veneers, and anterior crowns. @lthough I9M is the strongest and toughest of the three core ceramics, its use is limited to posterior crowns and =5<s because of its high level of core opacity. I9M is a much stronger and tougher material and has greater opacity than I9@. GProcera AllCeram: ,he 5rocera @ll9eram crown is composed of densely sintered, high-purity aluminum oxide core combined with a compatible all9eram veneering porcelain. ,his ceramic material contains &&.&" alumina, and its hardness is one of the highest among the ceramics used in dentistry. 5rocera @ll9eram can be used for anterior and posterior crowns, veneers, onlays, and inlyas. @ uni6ue feature of the 5rocera system is the ability of the 5rocera 1canner to scan the surface of the prepared tooth and transmit the data to the milling unit to produce an enlarged die through a 9@<-9@M process. ,he core ceramic form is dry pressed onto the die, and the core ceramic is then sintered and veneered. ,hus the usual 1 "-!+" shrinkage of the core ceramic during sintering will be compensated by constructing an oversi-ed ceramic pattern, which will shrink during sintering to the desired si-e to accurately fit the prepared tooth. CAD CAM Ceramics: @s shown in the ceramic classification chart in all-ceramic cores can be produced by processes of condensation and sintering, casting and ceramming, hotpressing and sintering, sintering and glass infiltration, and 9@<-9@M processing for the 9erec <@B-9@M system the internal surface of inlays, onlays, or crowns is ground with diamond disks or other instruments to the dimensions obtained from a A*

scanned inage of the preparation. for some systems, the external surface must be ground manually, although some recent 9@<-9@M systems are capable of forming the external surface as well. @ milling operation within a 9erec 9@<-9@M unit $1iemens @ktiengesellschaft, Bensheim, 2ermany '. ,he ceramic lock is being ground by a diamond-coated disk whose translational movements are guided by computercontrolled input. @ cerec 9@<-9@M ceramic block is shown in =igure !1-1* before milling, at an intermediate milling stage, and after completion of the milling operation for an inlay. ,hese ceramics are supplied as small blocks that can be gound into inlays and veneers in a computer-driven 9@;-9@M system. Ditablocs M/ II are feldspathic procelains that are used in the same way as is <icor 829 $machinable glass-ceramic'. ,he disadvantages of 9@<-9@M restorations include the need for costly e6uipment, the lack of computer-controlled processing support for occlusal ad#ustment, and the techni6ue-sensitive nature of surface imaging re6uired for the prepared teeth. @dvantages include negligible porosity levels in the 9@<-9@M core ceramics, the freedom from making an impression, reduced assistant time associated with impression procedures, the need for only a single patient appointment $with the 9erec system', and good patient acceptance. @ list of 9@<-9@M and copy-milled ceramics is given in ,able !1-1+. @n advantage of 9@<-9@M ceramics is that one can select a core ceramic either for strength and fracture resistance, for low abrasiveness, or for translucency. for example, the extensive wear of opposing enamel that occurs when it is opposed by a feldspathic porcelain surface in the absence of posterior occlusion can be minimi-ed by selscting a core ceramic that is minimally abrasive to enamel. Cercon an# La:a 6irconia Core Ceramics: ,he cercon Mirconia system $<estsply 9eramco, Burlington, ;>' consists of the following procedures for production of -irconia-based prostheses. @fter preparing the teeth $!.+mm incisal or occlusal reduction and 1. mm axial reduction', an impression is made and sent tot he laboratory, where it is poured with a model material. @ wax pattern approximately +.) mm in thickness is made for each coping on the holding appliance on the left side of the scanning and milling unit $9ercon Brain'. @ presintered Mirconia blank is attached to the right side of the Brain unit. $9ercon Brain'. @ presintered -irconia blank is attached to the right side of the Brain unit. ,he blank has an attached barcode, which contains the enlargement factor and other milling parameters for computer control or the milling procedure @fter the unit is activated, parameters for computer control of the milling procedure @fter the unit is activated, the pattern in scanned and the blank is rough-milled and fine-milled on occlusal.

A4

Ceramic /loc& 9er@dapt 9ercon Base

Ceramic !-pe 8ighly sintered @l!EA 5resintered postsintered milling (eucite-base

Ceramic :eneer @ll cream

In#ica!ions Implant superstructure 9rowns =5<s 9rowns

Manu0ac!urer ;obel Biocare

MrE!. 9oercion after 9ream 1 ,riceram

and <entsply 9eramco <91 <ental @2G%sprident and <91 <ental @2GDitaG%spride nt and <ecim, Ivoclar

<9- /risten <9- Mirkon

5resintered MrE! hot Ditadur < 9rowns isostatic ,riceram =5<s postcompaction 5resintered MrE!. hot %mpress! isostatic postcompaction MrE!. presintered and (@D@ postsntered 9eram (eucite-based Malthechnik 9rowns =5<s 9rowns =5<s

<en-ir

(@D@ =rame 5ro9ad

and AM %15%

Deneers, inlays, Ivoclar onlays, and crowns 9rowns =5<s 9rowns and ;obel Biocare %lephant

5rocera @ll9eram 1ynthoceram

@l!EA. presintered and @ll9eram postsintered @l!EA. reinforced. 1intagon pressed and postsintered

DitaBlocs Mark =eldspathic porcelain Maltechnik II block DitaBlocks @lumina DitaBlocs 1pinell 1intered @l!EA. Ditadur followed by glass @lpha infiltration 1intered Ditadur MgE-@l!EA spinel @lpha followed by glass infiltration 1intered @l!EAGMrE! Ditadur followed by glass @lpha infiltration

Deneers, inlays, Dident onlays, and crowns 9rowns =5<s 9rowns and 9rowns and =5<s Dident Dident

DitaBlocs Mirconia

9rowns =5<s

and Dident

A)

Mircogon

MrE!. presintered and Mircogon postsintered

9rowns

%lephant

@nd gingival aspects in an enlarged si-e to compensate for the !+" shrinkage that will occur during subse6uent sintering at 1A*+ + 9. the processing times for milling are approximately A for a crown and )+ min for a four unit fixed =5<. ,he milled are approximately A min for a crown and )+ min for a four- unit fixed =5<. ,he milled prosthesis is removed from the and the remaining extraneous extension are removed. ,he -ircon coping or framework is then placed in the 9ercon furnace and fired at 1A ++ 9 for approximately * hours to fully sinter the yttria-stabili-ed -irconia core coping or framework. ,he sintering shrinkage is achieved uniformly and linearly in three dimensional space by the in targeted process of scanning, enlarging the pattern design, controlled milling and sintering. @fter any subse6uent trimming with a water cooled, hinge- speed diamond bur the finished ceramic core framework is then veneered with a veneering ceramic $9ercon 9eram 1' and stain ceramic @ll-ceramic prostheses represent the most aesthetically pleasing, but also the most fracture-prone prostheses. 8owever, with ade6uate tooth reduction, an excellent 6uality impression, a skilled technician, and a ceramic with reasonably high flexure strength $! + M5a' and fracture toughness $ !. Mpa.m1G!', reasonably high success rates can be achieved. ,he material that has the greatest potential fracture toughness $& M5a.mU' and flexural strength that has the greatest potential fracture toughness $& M5a.mU' and flexural strength $F&++ M5a' is pure tetragonal stabili-ed -irconia $MrE!'. ,inschert et al $!++lb' reported that the fracture resistance of three-unit ceramic =5<s $1!4) ;' made of 9ercon -irconia core ceramic $<entspy 9eramco' was more than twice as great as the values reported for In-9eram @lumina $ 10 ;' and %mpress! $*!1 ;'. 1hown in =igure is a comparison of the force re6uired to fracture three-unit =5<s cemented to dies with -inc phosphate cement. ,he -irconia product $9ercon' would be expected to exhibit less fracture resistance in this case, but clinical data are needed to confirm this hypotehsis. ,o ensure maximum survival times, ade6uate occlusal tooth reduction is essential for posterior teeth. Eptimal clinical performance of some ceramic products re6uire a minimal occlusal reduction of ! mm for molar tooth preparations. If the ceramic will be supported by a material with high elastic modulus such as a ceramic or metal post or an amalgam build-up, less occlusal reduction $1. mm' may be possible without compromising the survivability of the crowns. =or patients exhibiting extreme brusism, either metal or metal-ceramic prostheses should be used. METHODS O. STRENGTHENING CERAMICS: Minimi5e !,e e00ec! o0 s!ress Raisers ?hy do dental ceramic prostheses fail to exhibit the strengths that we would expect from the high bond forces between atomsV ,he answer is that numerous minute scratches and other defects are present on the surfaces of these materials. ,hese surface flaws behave as sharp notches whose tips may be as narrow as the spacing between several atoms in the material. ,hese stress concentration areas at the

A&

tip of each surface flaw can increase the locali-ed stress to the theoretical strength of the material even though a relatively low average stress exists throughout the bulk of the structure. ?hen the induced mechanical stress exceeds the actual strength of the material, the bonds at the notch tip break, forming a crack. ,his stress concentration phenomenon explains how materials fail at stresses far below their theoretical strength. 1tress raisers are discontinuities the ceramic and metal-ceramic structures and in other brittle materials that cause a stress concentration in these areas. ,he design of ceramic dental restorations should also avoid stress raisers in the ceramic. @brupt changes in shape or thickness in the ceramic contour can act as stress raisers and make the restoration more prone to failure. ,hus the incisal line angles on an anterior tooth prepared for a ceramic crown should be well rounded. In ceramic crowns, several conditions can cause stress concentration. 9reases or folds of the platinum foil or gold foil substrate that become embedded in the porcelain leave notches that act as stress raisers. 1harp line angles in the preparation also create areas of stress concentration in the restoration. (arge changes in porcelain thickness, a factor also determined by the tooth preparation, can create areas of stress concentration. @ small particle of porcelain along the internal porcelain margin of a crown also induces locally high tensile stresses. @ stray particle that is fused within the inner surface of a shoulder porcelain margin of a metal-ceramic crown can cause locali-ed tensile stress concentrations in porcelain when an occlusal force is applied to the crown. %ven though a metal-ceramic restoration is generally stronger than most ceramic crowns of the same si-e and shape, care must be taken to avoid sub#ecting the porcelain in a 5=M to loading the produces large locali-ed stresses. If the occlusion is not ad#usted properly on a porcelain surface, contact points rather than contact areas will greatly increase the locali-ed stresses in the porcelain surface as well as within the internal surface of the crown. =racture mechanics is a science that allows scientists to analy-e the influence of flawGstress interactions on the probability of crack propagation through an elastic brittle solid. ,he principles of linear elastic fracture mechanics were developed in the 1& +s by Irwin $1& 4'. ,his pioneering research on fracture phenomena was based on earlier investigations by 2riffth $1&!1' and Erowan $1&00, 1&0&, 1& '. Irwin found that when a brittle material was sub#ected to tensile stresses, specific crack shapes in certain locations were associated with greatly increased stress levels. 8e also recogni-ed the importance of determining the fracture toughness of these materials as a measure of their ability to resist fracture. ,he fracture toughness $/ I9' of a material represents the resistance of a material to rapid crack propagation. In contrast, the strength of a material depends primarily on the si-e of the initiating crack that is present. ,he strength of dental ceramics and other restorative materials is controlled by the si-e of the cracks or defects that are introduced during processing, production and handling. In this chapter a description is given of the processing

0+

methods used to produce ceramic prostheses and the potential of these methods to introduce flaws or cracks that may limit their clinical survival. ,he brittle fracture behavior of ceramics and their low tensile strengths compared with those predicted from bonds between atoms can be understood by considering stress concentrations around surface flaws. @s ceramics tends to have no mechanism for plastically deforming without fracture as do metals, cracks may propagate through a ceramic material at low average stress levels. @s a result, ceramics and glasses have tensile strengths that are much lower than their compressive strengths in the oral environment, tensile stresses are usually created by bending forces, and the maximum tensile stress created by the bending forces occurs at the surface of a prosthesis. It is for this reason that surface flaws are of particular importance in determining the strength of ceramics. @s the crack propagates through the material, the stress concentration is maintained at the crack, a pore, or a crystalline particle, which reduces the locali-ed stress. ,he removal of surface flaws or the reduction of their si-e and number can produce a very large increase in strength. Heducing the depth of surface flaws in the surface of a ceramic is one of the reasons that polishing and gla-ing of dental porcelain is so important. ,he fracture resistance of ceramic prostheses can be increased through one or more of the following six options: $1' select stronger and tougher ceramics. $!' develop residual compressive stresses within the surface of the material by thermal tempering, $A' develop residual compressive stress within interfacial regions of weaker, less tough ceramic layers by properly matching thermal expansion coefficients, $0' reduce the tensile stress in the ceramic by appropriate selection of stiffer supporting materials, $ ' minimi-e the number of porcelain firing cycles, $*' design the ceramic =5< prosthesis with greater bulk and broader radii of curvature to minimi-e the magnitude of tensile stresses and stress concentrations of curvature to minimi-e the magnitude of tensile stresses and stress concentrations during function, and $4' adhesively bond ceramic crowns to tooth structure. De:elop Resi#ual Compressi:e S!resses: Ene method of strengthening glasses and ceramics is the introduction of residual compressive stresses within the veneering ceramic. 9onsider three layers of porcelain: the outer two of the same composition and thermal contraction co-efficient and the middle layer of a different composition and a higher thermal contraction coefficient. 1uppose that the layers are bonded together and the bonded structure is allowed to cool to room temperature. ,he inner layer has a higher coefficient of thermal contraction and thus contracts more as it cools. 8ence, on cooling to room temperature, the inner layer produces compressive stresses in the outer layers as previously described for thermal tempering. ,his three-layer laminate techni6ue is used by 9orning 2lass works to manufacture dinnerware. @ similar condition can develop in a veneering porcelain bonding to an alloy coping used for metal-ceramic crowns and =5<s and ad#acent ceramic layers in allceramic prostheses. ,he metal and porcelain should be selected with a slight mismatch in their thermal contraction coefficients $the metal thermal contraction 01

coefficients $the metal thermal contraction coefficient being slightly larger' so that the metal contracts slightly more than the porcelain on cooling from the firing temperature to room temperature. ,his mismatch leaves the porcelain in residual compression and provides additional strength for the prosthesis. %xamples of how residual tensile stresses can weaken a metal-ceramic crown or =5< and how residual compressive stresses can weaken a metal-ceramic crown or =5< and how residual compressive stresses can increase fracture resistance are shown in =igure. ,he same principle applies to ceramic prostheses in which the thermal contraction coefficient of the core ceramic is slightly greater than that of the veneering ceramic $such as opaceous dentin or bodyGgingival porcelain'. ,he fabrication of metal-ceramic and all-ceramic prostheses usually involves processing at high temperature, and the process of cooling to room temperature affords the opportunity to take advantage of mismatches in coefficients of thermal contraction of ad#acent materials in the ceramic structure. Ideally, the porcelain should sustain slight compression in the final restoration. ,his ob#ective is accomplished by selecting an alloy that contracts slightly more than the porcelain on cooling to room temperature. @ further, yet fundamentally different, method of strengthening glasses and ceramics is to reinforce them with a dispersed phase of a different material that is capable of hindering a crack from propagating through the material. ,here are two different types of dispersions used to interrupt crack propagation. Ene type relies on the toughness of the particle to absorb energy from the crack and deplete its driving force for propagation. ,he other relies on a crystal structural change under stress to absorb energy from the crack. ,hese methods of strengthening are described below. Minimi5e !,e Num"er o0 0irin+ c-cles: ,he purpose of porcelain firing procedures is to densely sinter the particles of powder together and to produce a relatively smooth, glassy layer $gla-e' on the surface. In some cases, a stain layer is applied for shade ad#ustment or for characteri-ation such as stain lines or fine cracks. 1everal chemical reactions occur over time at porcelain firing temperatures and of particular importance are increases in the concentration of crystalline leucite in the porcelain designed for fabrication of metal-ceramic restorations. (eucite, /!E-@l!EA01iE!, is a highe-expansion crystal phase, which can greatly affect the thermal contraction coefficient of the porcelain. 9hanges in the leucite content caused by multiple firings can alter the thermal contraction coefficient of the porcelain. 1ome porcelains undergo an increase in leucite crystals after multiple firings that will increase their thermal expansion coefficients. If the expansion coefficient increases above the value for the metal, the expansion mismatch between the porcelain and the metal can produce stresses during cooling that are sufficient to cause immediate or delayed crack formation in the porcelain. Minimi5e Tensile S!ress T,rou+, Op!imal Desi+n o0 Ceramic Pros!,eses:

0!

,ougher and stronger ceramics can sustain higher tensile stresses before cracks develops in areas of tensile stress. 9onventional feldspathic porcelains should not be used as the core of ceramic crowns, especially in posterior areas, because occlusal forces can easily sub#ect them to tensile stresses that exceed the tensile strength of the core ceramic. Ef ma#or concern are tensile stresses that are concentrated within the inner surface of posterior ceramic crowns. 1harp line angles in the preparation also will create areas of stress concentration in the restoration, primarily where a tensile component of bending stress develops. @ small particle of ceramic along the internal porcelain margin of a crown will also induce locally high tensile stresses. ,hus the ceramic surface that will be cemented to the prepared tooth or foundation material should be examined carefully when it is delivered from the laboratory. =urthermore, when grinding of this surface is re6uired for ad#ustment of fit, one should use the finest grit abrasive that will accomplish the task. Because the forces on anterior teeth are relatively small, the low to moderate tensile stresses produced can be supported by ceramic crowns more safely. 8owever, if there is a great amount of vertical overlap $overbite' with only a moderate amount of hori-ontal overlap $over#et', high tensile stresses can be produced. Metal-ceramic crowns use a metal coping as the foundation of the restoration to which the porcelain is fused. ,he stiff, metal coping minimi-es flexure of the porcelain structure of the crown that is associated with tensile stresses. Most dental restorations containing ceramics should be designed in such a way as to overcome their weaknesses, that is their relatively low tensile strength, their brittleness, and their susceptibility to flaws in the presence of surface flaws. ,he design should avoid exposure of the ceramic to high tensile stresses. It should also avoid stress concentration at sharp angles or marked changes in thickness. Ene way to reduce tensile stresses on the cemented surface in the occlusal region of ceramic inlays or crowns is to use the maximum occlusal thickness possible. 8owever, within practical limits of tooth reduction, this thickness is typically !.+ mm. @luminous porcelain crowns are contraindicated for restoring posterior teeth because occlusal forces can induce tensile stresses, which are often concentrated near the internal surface of the crown. Metal-ceramic crowns use a metal coping as the foundation of the restoration to which the porcelain is fused. In an attempt to overcome these stresses, the strong, stiff, yet ductile metal coping minimi-es flexure of the porcelain structure of the crown that is associated with tensile stresses. Both the bonded platinum foil aluminous porcelain corwn techni6ue and the swaged gold alloy foil techni6ue are also based on this same concept. ,he tensile stresses in a ceramic =5< can be reduced by using a greater connector height and by broadening the radius of curvature of the gingival embrasure portion of the interproximal connector. 8owever, a connector height greater than 0 mm makes the anatomic form in the buccal area of a posterior =5< too bulky and unaesthetic. Ion E<c,an+e: 0A

,he techni6ue of ion exchange is one of the more sophisticated and effective methods of introducing residual compressive stresses into the surface of a ceramic. ,he ion-exchange process is sometimes called chemical tempering $@nusavice et al, 1&&!' and can involve the sodium ion since sodium is a common constituent of a variety of glasses and has a relatively small ionic diameter. If a sodium-containing glass article is placed in a bath of molten potassium nitrate, potassium ions in the bath exchange places with some of the sodium ions in the surface of the glass article and remain in place after cooling. 1ince the potassium ion is about A " larger than the sodium ion, the s6uee-ing of the potasium ion into the place formerly occupied by the sodium ion creates very large residual compressive stresses. ,he product 29 ,uf-9oat $29 9orp., ,okyo, >apan' was a potassium-rich slurry that could be easily applied to a ceramic surface and, when heated to 0 + + 9 for A+ min $in any standard porcelain furnace' caused a sufficient. Increases of 1++" or more in flexural strength have been achieved with several porcelain products that contained a significant concentration of small sodium ions. 8owever, the depth of the compression -one is less than 1++ m $anusavic et al. 1&&0'. ,herefore this strengthening effect could be lost if the porcelain or glass - ceramic surface is ground, worn, or eroded by long - term exposure to certain inorganic acids. T,ermal Temperin+: 5erhaps the most common method for strengthening glass is by thermal tempering thermal tempering creates residual surface compressive stresses. By rapidly cooling $ 6uenching' the surface of the ob#ect while it is hot and in the softened $molten' state. ,his rapid cooling produces a skin of rigid glass surrounding a soft $molten' core @s the molten core solidifies, it tends to shrink, but the outer skin remains rigid. ,he pull of the solidifying molten core, as it shrinks, creates residual tensile stresses in the core and residual compressive stresses within the outer surface. ,hermal tempering is used to strengthen glass for uses such as automobile windows and windshields, sliding glass doors, and diving masks. Eften, #ets of air directed at the molten glass surface accomplish the rapid cooling of the outer skin. If one observes the rear window of an automobile through polari-ed sunglasses, it is usually possible to discern a regular pattern of spots over the entire window. ,his pattern of spots corresponds to the arrangement of the air #ets employed by the manufacturer in the tempering process. =or dental applications, it is more effective to 6uench hot glass phase ceramics in silicone oil or other special li6uids rather than using air #est that may not uniformly cool the surface. ,his thermal tempering treatment induces a protective region of compressive stress within the surface $ <e8off and anusavic,1&&!' Dispersion S!ren+!,enin+

00

@ further, yet fundamentally different, method of strengthening glasses and ceramics is to reinforce them with a dispersed phase of a different material that is capable of hindering a crack from propagating through the material. ,his process is referred to as dispersion strengthening. @lmost all of the newer higher- strength ceramics derive there improved fracture resistance from the crack- blocking ability of the crystalline particles. Increasing the crystal containing primarily can strengthen dental ceramics containing primarily a glass phase can be strengthened by increasing the crystal content of leucite $/ !E.@l!EA.01iE!' lithia dislocate $(i!E.!1iE!', alumina $ @l!EA' magnesia - alumina spinel $MgE. @l!EA', -irconia $MrE!', and other types of crystals. 1ome crystal phase additions are not as effective as others in toughening the ceramics. ,oughening depends on the crystal type, its si-e, its volume fraction, the interpartics. ,oughening, and its relative thermal expansion coefficient relative to the glass matrix. =or example, the fracture toughness $/I9' of soda lime silica glass is +.4 Mpa . m1G! If one disperses 4+ vol " of terasilicic flourmill crystals in the glass.$<icor M29 glass - ceramic', the toughness increases only to 1. Mpa. m 1G!. 8owever, by dispersing 4+ vol" if lithia dislocate crystals in the glass matrix $ I51 %mpress!', / I9 increased to A.A Mpa. M 1G! $ 8oland and Beall, !++!'. ?hen a tough, crystalline material such as alumina $ @l !EA' is added to a glass the is toughened and strengthened because the crack cannot pass through the alumina Nparticles as easily as it can pass through the glass matrix. ,his techni6ue has found application in dentistry in the development of alimonies porcelains $ @l!EA particles in a glassy porcelain matrix' for porcelain #acket crowns. Most dental ceramics that heave a glassy matrix utili-e reinforcement of the glass by a disposed crystalline substance. ,inschert et al $!++lb' evaluated the mean strength and standard deviation values for several ceramics. ,his mean strength values were as follows. $Mpa W 1<' were 9erec Mark II, )*.AW1!.!. In 9eram @lumina, 0!&.A W )4.!. I51 %mpress. )A.& W 11.A. Ditadur @lpha 9ore, 1A1.+ W &. . Ditadur @lpha <entin, *+.4 W *.). Dita DM/ *), )!.4W 1+.+: and Mirconia-,M5, &1A.+ W +.!. ,here was no statistically significant difference among the flexure strength of 9erec Mark II, <icro, I51 %mpress, Ditadur @lpha <entin, and Dita DM/ *) ceramics $5F+.+ '. ,he highest ?eibull moduli were associated with 9erec Mark II and Mirconia-,M5 ceramics $!A.* and 1).0'. <icor glass-ceramic and In-9eram @lumina had the lowest values of ?eibull modules $m' $ . and .4', whereas intermediate values were observed for I51 %mpress, Dita DM/ *), Ditadur @lpha <entin, and Ditadur @lpha 9ore ceramics $).*, ).&, 1+.+ and 1A.+ respectively'. %xcept for In-9eram @lumina, Ditadur @lpha, and Mirconia-,M5 core ceramics, the investigated ceramic materials fabricated under the condition of a dental laboratory were not stronger or more structurally reliable than Dita DM/ *) veneering porcelain. Enly 9erec Mark II and Mirconia-,M5 specimens, which were prepared from an industrially optimi-ed ceramic material, exhibited m values greater than 1). 8ence, we conclude that industrially prepared ceramics are more

structurally reliable materials for dental applications, although 9@<-9@M procedures may induce surface and subsurface flaws that may offset this benefit. Trans0orma!ion Tou+,enin+: ?hen small, tough crystals are homogeneously distributed in a glass, the ceramic structure is toughened and strengthened because cracks cannot penetrate the fine particles as easily as they can penetrate the glass. <ental ceramics are strengthened and toughened by a variety of dispersed crystalline phases including alumina $Ditadur @lpha, 5rocera @ll9eram, In-9eram alumina', leucite $Eptec 815, I51 %mpress, E59', tetrasilicic fluormica $<icor, <icor M29', lithia disilicate $E59 A2, I51 %mpress!', and magnesia-alumina spinel $In-9eram spinell'. In contrast, dental ceramics based primarily on -irconia crystals $9ercon and (ava' undergo transformation toughening that involves a transformation of MrE! from a tetragonal crystal phase to a monoclinic phase at the tips of cracks that are in regions of tensile stress. ,he unit cells for tetragonal and monoclinic lattices are shown. ?hen pure MrE! is heated to a temperature between 104++ and !+1++ 9 and it is cooled, its crystal structure begins to change from a tetragonal to a monoclinic phase at approximately 11 ++ 9. <uring cooling to room temperature, a volume increase of several percentage points occurs when it transforms from the tetragonal to monoclinic crystal structure. ,his polymorphic transformation can be prevented with certain additives such as A mol" yttrium oxide $yttria or T !EA'. ,his material is designated as MrE!. ,M5 $tetragonal -irconia polycrystals'. ,he volume increase in this case is constrained if the -irconia crystals are sufficiently small and the microstructure is strong enough to resist the resulting stresses. ,his material is extremely strong $flexural strength of approximately &++ M5a' and tough $fracture tougheness, /I9, of approximately & M5a' and tough $fracture tougheness, /I9, of approximately & Mpam1G!'. ,he toughening mechanism of crack shielding results from the controlled transformation of the metastable tetragonal phase to the stable monoclinic phase. 1everal types of crack shielding processes are possible, including microcracking, ductile -one formation, and transformation -one formation. By controlling the composition, particle si-e, and the temperature versus time cycle, -irconia can be densified by sintering at a high temperature and the tetragonal structure can be maintained as individual grains or precipitates as it is cooled to room temperature. ,he tetragonal phase is not stable at room temperature, and it can transform to the monoclinic phase with a corresponding volume increase under certain conditions. ?hen sufficient stress develops in the tetragonal structure and a crack in the area begins to propagate, the metastable tetragonal crystals $grains' or precipitates next to the crack tip can transform to the stable monoclinic form. In this process a A vol " expansion of the MrE! crystals or precipitates occurs that place the crack under a state of compressive stress and crack progression is arrested. =or this crack to advance further, additional tensile stress would be re6uired. Because of this

0*

strengthening and toughening mechanism, the yttria-stablili-ed -irconia ceramic is sometimes referred to as ceramic steel. A"rasi:eness o0 Den!al Ceramics: @ review of the factors and material characteristics that cause excessive wear of enamel by ceramic prostheses is extremely important to optimi-e the performance of ceramic-based prostheses. 9eramics are generally considered the most biocompatible, durable, and aesthetic materials available for rehabilitation of teeth, occlusal function, and facial appearance. 9urrently available products exhibit variable mechanical properties $hardeness, flexure strength, fracture toughness, and elastic modulus', physical properties $index of refraction, color parameters, translucency, chemical durability, and thermally compatible expansion coefficients for the substrates. In spite of their overall excellence in meeting the ideal re6uirements of a prosthetic material, dental ceramics have one ma#or drawback. ,hese materials can cause catastrophic wear of opposing tooth structure under certain conditions. ,he most extreme damage occurs when a roughened surface contacts tooth enamel or dentin under high occlusal forces, which may occur because of bruxing, premaguided disclusion is ensured, the wear of opposing enamel and dentin will be greatly reduced. In addition, if the occluding ceramic surface area is periodically refinished after occlusal ad#ustment or fre6uent exposure to carbonated beverages andGor acidulated phosphate fluoride, the abrasive wear of opposing tooth structure is further reduced. @brasive wear mechanisms for dental restorative materials and tooth enamel include $1' adhesion $metal and composites', in which locali-ed bonding of two surfaces occurs, resulting in pullout and transfer of matter from one surface to the other, and $!' microfracture $ceramics and enamel', which results from gouging, asperties, impact, and contact stresses that cause cracks or locali-ed fracture. =or ceramic and enamel, two-phase brittle strucutres are involved. ,he ceramic onsists of a glass matrix that contains variable levels and si-es of crystals. ,ooth enamel consists of a small volume fraction of organic phase matrix and a high volume fraction of hydroxyapatite crystals. ,he wear of either material depends on the ease with which cracks can propagate through the structure. If microscopic cracks are forced to pass around the crystal particles rather than through them, the material will usually be more fracture and cracks through the glass phase, the particles are less fracture resistant than the glass matrix, or excessive voids or other defects exist along the pathway. ,he relative strengthening effect is dependent on several factors, including the strength of the glass and crystal phases, the si-e and spacing of crystalline paricles, the inferfacial bond strength of the crystal-glass interphase region, and the type and magnitude of residual stresses in the structure. ,hese factors are beyond the control of the dentist, although the dentist and laboratory technician can select ceramics that are highly fracture-resistant. ,he microfracture mechanism is the dominant mechanism responsible for surface breakdown of ceramics and the subse6uent damage that a roughened ceramic surface can cause to tooth enamel surfaces. e;amel is also susceptible to 04

this kind of microfracture through four specific mechanisms: $1' asperities extending from the ceramic surface that produce high locali-ed stresses and microfracture. $!' gouging that results from high stresses and large hardness differences between two surfaces or particles extending from these surfaces. $A' impact or erosion that occurs through the action of abrasive particles carried in a following li6uid such as saliva. and $0' contact stress microfracture that increases locali-ed tensile stress and also enhances the damage caused by asperties, gouging, and impact or erosion. Because of microfracture mechanisms, it may be necessary to polish the ceramic surface periodically to reduce the height of asperities and to minimi-e enamel wear rates. Ef ma#or concern is the potential catastrophic damage that can be incurred by enamel in contact with polycrystalline asperities having high fracture toughness $/I9' values such as alumina $A. -0.+ Mpa.m1G!' or cerium-stabili-ed -irconia $1+-1* Mpam 1G!', yttrium-stabili-ed -irconia $*-&Mpa.m1G!', or cerium--stabili-ed -irconia $1+-* Mpa.m 1G!'. In contrast glass has a fracture toughness of only +.4 Mpa.m1G! and should cause less gouging, contact stress, and impact damage within contacting enamel surfaces. ,he abrasiveness of ceramics against enamel is affected by numerous factors and properties of the crystal phase particle and the glass matrix $if present'. ,hese include hardness, tensile strength, fracture toughness, fatigue resistance, particle glass bonding, particle-glass interface integrity, chemical durability, exposure fre6uency to corrosive chemical agents $acidulated phosphate fluoride, carbonated beverages', abrasiveness of foods, residual stress, subsurface 6uality $voids or other imperfections', magnitude and orientation of applied forces, chewing and bruxing fre6uency, contacting area, lubrication by saliva, and wear fre6uency. ,hus it is understandable why the hardness of the ceramic is not a good predictor of the potential wear of enamel surfaces by a ceramic. 8owever, the larger the hardness difference between two sliding surfaces, the greater is the degree of gouging. =ear o0 ceramics Compare# 'i!, o!,er Ma!erials ,o minimi-e enamel abrasion by a contacting ceramic structure, we should use a ceramic that exhibits uniform surface microfracture at the same rate as tooth enamel under the same conditions of loading, antagonist structure, food substance abrasiveness, applied forces, and degree of lubrication. ,he breakdown of the ceramic surface should be uniform so that asperities such as large crystalline inclusions do not pro#ect out from the surface. ,hese asperities produce high stress concentration areas within the opposing enamel surface that lead to gouging, troughing, and greater locali-ed microfracture of the enamel structure. If such nonumiform surface wear of ceramics occurs duraing oral function, the only solutions available to reduce enamel wear are to reduce the occlusal load by occlusal ad#ustement or to polish the ceramic surface periodically to reduce stress concentrations and the height of these asperities. 1ome of the new ultralow-fusing ceramics have a wide range of thermal expansion coefficients as listed. ,hese are approximate values estimated for 0)

several low-fusing ceramic products produced by the <ucera company: <uceragold $4)++ 9' and <uceram (=9 $<entsply 9eramco' were introduced between 1&&1 and 1&&!. <uceram (=9 is classified as a hydrothermal ceramic that was claimed to develop a hydrothermal layer approximately 1m thick vitro. In theory, this property allows a protective layer to seal microscopic surface cracks. Its veneer is a low-fusing ceramic that minimi-es shrinkage of the core ceramic during subse6uent firings. <uceram (=9 and <uceragold do not contain large leucite crystals and therby retain a stable thermal expansion coefficient over several firings. ,he opalescence the fluorescence are also easier to achieve than for conventional low-fusing fieldspathic porcelains because of the ability to maintain very small crystal particles $0++- ++nm'. Because of its high expansion coefficient, <uceragold is intended as a veneer for high-expansion, low-fusing porcelains, were subse6uently developed as veneering ceramics for titanium metals and 5rocera @ll9eram $;obel Biocare, 2oteborg, 1ewden' core ceramics, respectively. ,i9eram is another ultralow-fusing ceramic and has a firing temperature of approximately 40++9. ,he initial veneering porcelain for 5rocera @ll9eram was Ditadur ; $Dita Mahnfabrik, Bad 1ackingen, 2ermany', a largeparticle aluminous porcelain. 9urrently, @ll9eram porcelain $<egussa <ental' is used. =inesse, an ultralow-fusing ceramic $R4*+ +9' that contains larger leucite crystals, was introduced by <entsply 9eramco, Inc. $%. ?indsor, ;>'. Dita Emega &++ $Dita Mahnfabrik' is another ultralow-fusing ceramic. =or 9@<-9@M processing, dicor M29 glass-ceramic $9aulkG<entsply, Milford, <%', Dita M/ I ceramic $Dita Mahnfabrik', and Dita M/ II ceramic $Dita Mahnfabrik' blocks are available, which also offer a small-particle distribution of crystals that may reduce wear of opposing enamel surfaces. It is not known what effect, if any, thermal mismatch differences will produce on the surface 6uality of these ceramics. Microcracking can lead to surface flaws, loss of surface material, and increased wear of enamel. 8owever, this effect should only occur when a gross mismatch occurs between a core ceramic and its veneering ceramic. Based on a study of abrasion by a ++-g slurry of glass $<erand and Dereby, 1&&&', 1++g alumina $1++ m', and 1!+g water, the mean wear depths $in microns' after a specified time period for several ceramics and tooth enamel were as follows: enamel $!0.A', =inesse $!+.A', Ditadur @lpha $1*.A', 5rocera $1 .)', <entsply 9eramco II $1A.*', Dita Emega $1A.1', ,i-9eram $1!.1', I51 %mpress $11.)', <uceragold $11. ', and 9reation $1+.)'. ,he enamel wear was significantly greater than that of all ceramics tested. ,he wear depth of Ditadur @lpha was significantly than that of all ceramics tested. ,he wear depth of Ditadur @plha was significantly greater than that for I51 %mpress, <uceragodl, and 9reation ceramics. It is clear that the relative wear rate of enamel by a highly abrasive medium is greater than that of most porcelains. =ear o0 Enamel "- Ceramic Pro#uc!s an# o!,er res!ora!i:e ma!erials

0&

@nother factor that can increase wear of ceramics against enamel is the nonuniform distribution or clustering of crystals. I51 %mpress after hot-pressing at 1)++ 9 exhibits clusters of relatively large $ -1+ m' leucite crystals $/@I1i!E*' with cracks between the crystal agglomerates. ,his non-interlocking arrangement of elucite crystals also occurs in the veneering ceramic after it is sintered at &1+ +9. in contrast, I51 %mpress! core ceramic exhibits a uniform dispersion of smaller lithia disilicate $(i1i!E0' crystals after hot pressing at &!+ + 9 and veneering at )+++ 9. Ene should expect greater wear of enamel by I51 %mpress compared with I51 %mpress!. I51 %mpress ceramic contains A vol" of leucite crystals that are formed in a noninterlocking particle cluster pattern $8oland et al, !+++'. ,he core microstructrue of I51 %mpress! is 6uite different from that of I51 %mpress, evidenced by elongated lithia disilicate crystals +. to 0 m in length and a smaller concentration of lithium orthophosphate crystals $(i !1i!E ' approximately +.1 to +.A m in diameter $8oland et al, !+++'. 1tudies of ultralow-fusing ceramics have generally revealed significantly lower enamel wear rates than those produced by conventional low-fusing porcelains. 8owever, the results of a recent study suggest that one of these ceramics, <uceram (=9, caused significantly more enamel wear $+.1&4 mm A', presumably because of the higher void volume within the surface layer of <uceram $Magne et al, 1&&&'. In this study, the combined enamelGceramic wear rates were significantly greater for <uceram (=9 $+.A*A mmA'. Deneering ceramics contain either large crystalline filler particles or a glass structure with no crystals or very small crystals. 1imilarly, the results from another in vitro study $@l-8iyasat et al, 1&&&' of enamel wear $after ! ,+++ simulated chewing cycles' by ceramics using a corn meal slurry $three-body condition' revealed greater relative wear depth in enamel by <uceram (=9 $+.40mm' and Ditadur @lpha $+.)+ mm' compared with Dita 9erec Mk II $+.0) mm'. ,he explanation given for the higher wear rate of enamel by <uceram (=9 was the presence of porosities within the surface of the ceramic. ,his result for <uceram (=9 is in contrast with two-body wear data $al-8iyasat et al, 1&&)a' that indicated significantly less enamel wear by <uceram (=9 also Dita Mk II $+.* mm' and a gold alloy $+.+& mm' and Dita Emega porcelain $+.&* mm'. ,he wear Ditadur @lpha porcelain $+.&A mm' and in distilled water without an abrasive food medium $+. 0 mm after ! ,+++ simulated chewing cycles' compared with Ditadur @lpha porcelain $+.&A mm' and Dita Emega porcelain $+.&* mm'. ,he wear rate of enamel by gold alloy was significantly less than by the four ceramics. Ene would expect the latter types of ceramics to cause minimal wear of enamel. Met-ler et al $1&&&' reported that the relative enamel loss was less for two lower fusing ceramics, =inesse $+. *' and Dita Emega &++ $+.*+', compared with <entsply 9eramco II porcelain $+.) ', large-particle leucite-based porcelain.

/re#ci et al $1&&0' reported significantly lower estimated -year enamel wear rates for amalgam $ + m' and a new 9erec 9@<-9@M ceramic $& m', Dita 9erec Mk II D4/, compared with the original Dita 9erec Mk I ceramic $!! m'. In comparison, the wear of enamel by enamel was 1+4 m. 8acker et al $1&&*' found considerably lower enamel wear rates for a gold-palladium alloy $& m' compared with @ll9eram veneer ceramic $*+ m' and <entsply 9eramco porcelain $!A+ m'. >agger et al $1&& ' reported the following wear depths of dentin after exposure to wear by restorative materials: amalgam $+ m', microfilled composite $4 m', gold alloy $1*.4 m', conventional composite $A1.4 m', and Ditadur ; aluminous porcelain $1++ m'. these results indicate that direct filling materials are less abrasive to dentin than aluminous porcelain. ,his result is not surprising. ?hat is of importance of importance is the significant potential benefit of amalgam and microfilled composite as the least abrasive restorative materials fr situations in which dentin is exposed. @l-8iyasat et al $1&&)b' investigated the effect of a carbonated beverage $9oca 9ola' on the wear of human enamel and three dental ceramics: Ditadur @lpha $feldspathic porcelain', <uceram (=9 $ultralow-fusing porcelain', and Dita Mark II, a machinable ceramic. ,ooth and ceramic specimens were tested in a wear machine under a load of 0+ ;, at )+ cycles per minute, for a total of ! ,+++ cycles. ,he test was performed in distilled water or with intermittent exposure to a carbonated beverage $9oca 9ola'. ?hen tested in water @lpha porcelain caused significantly more enamel wear and also exhibited greater wear than <uceram (=9 and Dita Mark II. 8owever, after exposure to the carbonated beverage, the enamel wear produced by <uceram (=9 did not differ significantly from that produced by @lpha porcelain. Dita Mark II produced the least amount of enamel wear. %xposure to the carbonated beverage significantly increased the enamel wear. ,he wear of <uceram (=9 and vita Mark II increased with exposure to the carbonated beverage. It was produced by <uceram (=9 and Dita Mark II ceramics. Everall, Dita Mark II was the most resistant to wear and also significantly less abrasive than Ditadur @lpha porcelain. Re#ucin+ A"rasi:eness o0 Ceramics "- Polis,in+ an# Gla5in+: In theory, the smoothest surface should cause the least wear damage to opposing surfaces. <epending on the initial surface roughness of the ceramic surface, gla-ing the surface may not ade6uately decrease the surface roughness since the glassy layer may be of insufficient thickness to fill in scratches and grooves within the ground surface. ,hus, under certain conditions, polishing or polishing followed by gla-ing may be re6uired. >agger and 8arrison $1&&0' reported that the amount of enamel wear produced by both gla-ed $!).) m' and ungla-ed Ditadur ; aluminous porcelain $!& m' was similar. however. the wear produced by polished porcelain $1! m'

was substantially less. 5olished or gla-ed porcelain caused significantly less wear than ungla-ed porcelain. 5olishing was accomplished with AM 1oflex disks and 1hofurubber points. @fter ! ,+++ cycles of abrasion testing of various porcelain surface on human enamel in vitro, @l-8iyasat et al $1&&4' reported no significant difference between the enamel wear of gla-ed and polished groups, but wear produced by the ungla-ed groups was significantly higher $5I+.+ '. 1ixty pairs of tooth-porcelain specimens were tested under load in distilled water with and without intermittent exposure to a carbonated beverage. ?ear of enamel and Ditadur @lpha porcelain specimens was determined after ,+++, +,+++ and ! ,+++ cycles. %xposure to carbonated 9oca 9oal and schweppes beverages significantly increased the amount of enamel wear produced by all porcelain surfaces $5 I+.++1'. ,he finish of the porcelain surface did not influence its wear resistance under these conditions. Gui#elines 0or Minimi5in+ E<cessi:e =ear o0 Enamel "- Den!al ceramics: ,o minimi-e the wear of enamel by dental ceramics, the following steps should be taken: $1' ensure cuspid-guided disclusion: $!' eliminate occlusal prematurities: $A' use metal in functional bruxing areas. $0' if occlusion in ceramic, use ultralow-fusing ceramics $ ' polish functional ceramic surfaces. $*' repolish ceramic surfaces periodically. and $4' read#ust occlusion periodically if needed. 1ome ultralow-fusing ceramics are less abrasive than traditional low-fusing ceramics, but few clinical studies have been reported on any of these materials to validate the in virto findings. 9aution should be exercised in selecting these new ceramics for use since they exhibit widely variable expansion co-efficients and may not be thermally compatible with certain ceramic core materials or metal substrates. Malocclusion is likely the ma#or wear-causing factor that must be avoided to achieve acceptable wear performance with any ceramic product. 5olishing is preferred over gla-ing as a procedure to reduce abrasion damage of enamel. 9eramic surfaces should be refinished periodically after acid exposure especially acidulated phosphate fluoride. ,he 1hofu porcelain polishing kit followed with diamond paste or 1of(ex discs $AM' without a diamond paste follow up are useful as effective finishing products. 9eramic and opposing surfaces should be examined periodically for evidence of excessive wear. Ecclusal ad#ustment and polishing of the ceramic surfaces should be performed to reduce the risk for further surface degradation. ;oble metal surfaces are especially indicated for individuals who exhibit evidence of severe bruxing since the wear rates of gold alloys are very low compared with the wear damage caused by either traditional ceramics or recent lower-fusing ceramics. @ rough ceramic surface that is in hyperocclusion with opposing enamel is very likely to cause great abrasive wear of tooth surfaces. to minimi-e the risk of such wear damage to tooth enamel or other surfaces, the smoothest possible ceramic surface should be produced. ,his can be accomplished by $1' polishing only, $!' polishing followed by gla-ing, or $A' gla-ing only. ,he second choice is !

preferred. 2la-ing is recommended whenever possible before cementation of a prosthesis. if this is not possible, polishing along is acceptable. 8owever, gla-ing of a very rough ceramic surface may not sufficiently reduce the surface roughness to minimi-e wear damage. It is clear that a gla-ed rough, nongla-ed surface because the more-abrasive crystalline particles tend to be covered by the lessabrasive glass phase. it is not always possible to polish a ceramic surface in the clinic. Because of the heat generated during the polishing of ceramic-based prostheses that re6uire extensive polishing, the temperature increase of pulpal tissue may lead to irreversible pulpitis. ,his is especially true when the tooth has been greatly reduced in si-e and the pulp chamber is within +. mm of the external surface of the prepared tooth. ,here are several clear indications for polished ceramic surfaces. 5olishing of ceramic prostheses should be performed when they cannot be autogla-ed. 5olishing of ceramic restorations that have functional occlusal pathways or subgingival extensions will ensure optimal smoothness. @ll 9@<-9@M inlays or other ceramic prostheses that will not receive veneering ceramic should also be polished. Intraoral instrumentation can produce a smoother surface than an autogla-ing procedure. 8ighly polished porcelain may also be naturally gla-ed or overgla-ed without significantly increasing the surface roughness. Increased time or cycles of gla-ing with decrease surface roughness. 5olishing instruments should be selected according to type of ceramic, type of restoration, and level of smoothness desired. If the crown was ground with a 1++ m grit diamond, the first polishing abrasive should be 4 m or less. If the abrasive is too fine, more time will be needed to polish the surface. 8ulterstrom and Bergman $1&&A' found that two of the best polishing systems are 1of-(ex disks $AM <ental' and 1hofu 5orcelain (aminate 5olishing /it followed by diamond paste. =or the 1of-(ex disks, one should start with a disk that is the most effective at removing the initial grinding patterns. If the abrasive grit si-e on the disk is too small, it will take too long to decrease the roughness. If the grit si-e on the disk is too small, it will take too long to decrease the roughness. If the grit si-e is too large $e.g., extra-coarse or coarse', the surface will become rougher. @lso, if the polishing procedure is performed in the mouth, care should be taken to avoid heat build-up. 1of-(ex 1of-(ex disk are made to be used in a wet environment, so water coolant should be used whenever possible. LUTING AGENTS ,he development of new materials such as all-ceramic restorations has brought about a substantially different attitude concerning luting agents.?hile -inc phosphate cement has been the standard for nearly a century, its overall properties are insufficient for certain types of restorative systems. =or example, this traditional cement, which has been 6uite successful for metal-based restorations, falls far short for porcelain restorations. ?hen -inc phosphate cement is used to lute all-ceramic A

restorations, bulk fractures can be expected. 1pecifically, during mastication energy is transmit. @ series of cores fabricated by means of a pressing process. @ low-fusing porcelain $=inesse, <entsply 9eramco' fused to a gold metal substrate Xa typical example of this materialCs potential. In the case of -inc phosphate cement, the energy is distributed in locali-ed regions at the restoration-preparation interface. ,he application of high levels of stress in locali-ed -ones then predisposes the restoration to fracture. ,he fractures associated with the early all-ceramic crowns could be attributed to this phenomenon. ,he ability to bond not only to the surface of the tooth but also to the internal surface of the ceramic restoration reduces this potential appreciably. ?hen all contact surfaces are bonded as a single structure, the masticatory energies are distributed more uniformly. 9onse6uently, fractures within the ceramic restoration are reduced significantly. It is important, therefore, to select a luting agent that exhibits the appropriate properties. 1uch a cement should not only bond to the surfaces of the preparation through the hybridi-ing process but also to the internal surfaces of the ceramic restoration by means of silanation and acid etching. =inally, the cement should exhibit sufficient flexural strength, flexural modulus and fracture toughness. Ether desirable properties include color stability and sufficient release of fluoride to offer protection against secondary caries. ,his luting agent should possess dual-cure potential as well as multiple viscosities for use with different types of restorations. ;ewer composite-based resins such as 9alabra $<entsply 9aulk' show promise in fulfilling these re6uirements. PORCELAIN INLADS3ONLADS 5orcelain is indicated primarily for restoring gingival cavities in the buccal or labial surfaces of the teeth, where the restoration is free from direct force applications. 9avities are prepared with uniform thickness to the inlay, with the outer walls tapered outward only slightly. 9avities on the proximal surfaces of the anterior teeth are occasionallyl restored by means of porcelain inlays. =or access for impression and placement of inlay labial and lingual walls and the cavity should be removed. %tching the finished inlay with hydrofluoric acid and undercutting the cavity slightly after the impression is taken aid in developing a cement bond for ade6uate inlay retention. Incisal angles and edges of the anterior teeth may also be restored with porcelain inlays. 7sually a step is prepared in the remaining portion of the tooth and plantium pins are cemented in the dentin to provide ade6uate retention. 5orcelain is rarely indicated for either occlusal or two surface inlays in the posterior teeth because of its tendency to fracture under direct force application. =or inlay fabrication, the procedure that permits the fusion of the porcelain directly on the ceramic investment die material. ,hree types of investment materials have been developed for this purpose, including a silicate, a phosphate, and a calcium sulfate bonded type, having differential physical properties. @lthough the process eliminates the platinum matrix, it is time consuming and does not effectively shorten procedure. Hesults on one study did not yield on inlay

with significantly improved margin accuracy over that obtained with the conventional platinum matrix techni6ue. ,he conventional techni6ue for porcelain inlays, with the platinum matrix, has been modified to what has recently been described as the Krapid inlay techni6ueL. ,he use of this modification has increased in popularity. %ssential to the procedure in the proper cavity design and the formation of the accurate impression on good dies, as well as careful adaptation of the platinum matrix. In this techni6ue, time is varied in the three firing operation by insertion of the porcelain to be fused directly into the furnace at 1!+ +9 on a special 6uick heating tray after it has been dried briefly by being placed in front of the furnace door. ,he firing time at this temperature is about ! seconds, after which it is air cooled to room temperature. ,he second and third applications of porcelain are made with comparable firing time for each. ,his method has significantly shortened the inlay firing operation. ,he cementing medium in an important factor in the final appearance of the restoration, since shrinkage tends to make porcelain inlays undersi-e and a fine cement line may become visible at the margins. ,he more translucent silico phosphate rather than the opa6ue -inc cements is sometimes selected as a cementing medium for porcelain restorations. PORCELAIN VENEERS In#ica!ions: 1. <iscoloration ,etracycline, revitali-ation, fluorosis and even teeth darken with age. !. %namel defects like hypoplasia and malformations A. <iastemata 0. Malposition and malocclusion . 5oor restorations *. @ging 4. ?ear pattern ). @genesis of lateral incisor Con!rain#ica!ions: 1. ;on-availability of enamel !. Eral habits like bruxism, tooth to foreign body ob#ect habits. A#:an!a+es: 1. 9olor and esthetics !. Bond strength A. 5eriodontal health 0. Hesistance to abrasion . Inherent porcelain strength *. Hesistance to fluid absorption Disa#:an!a+es: 1. ,ime involved !. <ifficulty in repair A. ,echni6ue sensitive 0. ,ooth preparation

=ragility of material *. 9ost Too!, re#uc!ion: 1. (abial reduction +.A to +. mm !. Incisal or lingual finishing line should be modified chamfer A. 1ulcular marginal placement exactly at gingival margin with rounded shoulder preparation. Me!,o#s o0 0a"rica!ion: 1. Hefractory investing techni6ue !. 5latinum foil techni6ue A. 9ost ceramic laminate techni6ue a. 9astable ceramic $<icor' b. 9astable appetite $cerapearl' E!c,in+ o0 enamel: 1. ;eighbouring teeth are protected by mylar strips or a dead soft metal matrix band 2. %tched with A+-A4" phosphoric acid solution for 1 seconds. 3. ?ashed with copious amount of water for A+ seconds. E!c,in+ o0 porcelain :eneer: 1. %tch the inner surface using a etching gel 4. " hydrofluoric acid constantly brushed upwards to the periphery of the laminate and allow to stand for 4-1+ minutes. !. 9ompletely submerge the veneer in a 1+" solution of baking soda and water until the acid is neutrali-ed Bonding and porcelain veneers forms the following layers $from tooth surface outside' 1. %tched enamel !. 9ombined %-< bonding agent $(ight activated' A. 9omposite resin luting agent layer 0. 7nfilled resin layer . 1ilane coupling agent to enhance adhesive properly of resin *. %tched porcelain veneer
.

E<pan#e# use o0 porcelains: 1. 9onventional lingual etched porcelain retainers !. =or posteriors buccal etched porcelain retainers A. 9ombination of buccal and lingual etched retainers 0. Interproximal retainers . %tched porcelain pieces.

PORCELAIN )AC2ET CRO=N AND PLATINUM REIN.ORCED CRO=NS ,he original porcelain #acket crown, made of feldspathic porcelain, possessed excellent esthetic but was very prone to fracture. ?ith the development of aluminous reinforcement, the restoration again generated interest amongst dentists. It is still an inherently weak restoration, however its use should be restricted to incisors, where a maximum cosmetic result is necessary. More than any other restoration, the porcelain #acket crown depends on tooth support which is more critical for the fracture resistance of the restoration than the bulk of porcelain. ,he K9rescent moon fractureL often seen in this type of restoration is a direct result of inade6uate preparation length. ,he recommended incisal reduction range from 1 to 1.0 to !mm. ,o produce ade6uate esthetic result, it is best to reduce the incisal edge by !mm. @ny greater reduction will increase the stress in the facial surface which can result in the facial half moon fracture. @xial reduction if facial and lingual surfaces should about 1mm. Hecommendations for reduction of the lingual surface range from +. to 1mm. @ll the line angles to be round off. @ shoulder 1mm wide is generally preferring shoulders narrower than 1mm should be reserved for those teeth too small to safely permit more than minimal destruction of tooth structure. =inally sufficient dentin must remain to provide a strong core. Maximum accuracy re6uires dies that is hard enough to with stand the pressures of fabrication, an acrylic resin backed, silver plated die should always be used. 7ndercuts below the shoulder must be blocked out by acrylic resin prior to foil adaptation. If undercut is not blocked it makes difficult to remove and causes distortion on removal. ,he finished #acket preparation therefore should have the appearance of a miniature tooth, with no undercuts and shoulder about +. to 1mm wide placed slightly beneath the gingival tissues around the entire tooth. ,he separating medium is applied to all parts of the die that will be contacted by block out material. ,he block out material and excess foil will be removed later for final finishing and evaluation. .oil a#ap!a!ion: ,o fabricate the porcelain #acket crown a piece of +.+! mm or +.++1 inch platinum foil of correct shape and si-e is selected. ,he foil is annealed in a Bunsen burner flame, 6uenched and carefully wrapped around the die to give the basic matrix form. ,he shoulder area can be formed with the thumbnail. @ pair of fine scissors are used to remove excess foil. @ tinnerCs #oint approximately 1. mm wide is formed on the mesial or distal aspect and along the incisal edge. ,he uppermost piece of foil is reduced by half, and a wedge shaped section axio-incisal corner. @ wedge may also be removed at the axiiogingival corner. ,he longer edge of the foil is folded over the shorter one and the tinnerCs #oint closed.

,he foil is burnished gently but firmly with a beaver foil burnisher. Burnish from the incisal edge to the shoulder, beginning at the #oint and then around the preparation from the #oint. once the basic shape is established, the foil is removed from the die and excess foil removed from the skirt leaving a 1-!mm extension. ,he skirt adds strength and stability to the matrix. Heannel the foil, replace it on the die and complete the burnishing. If a wedge shaped section was not removed from the tinnerCs #oint at the axiogingival corner of the shoulder, then four thickness of foil will remain. If so, the area can be carefully reduced with a rubber wheel with care not to perforate the foil. Hemove and reanneal the foil to burn of any remaining debris. ,he procedure of annealing is to remove gaseous impurities from the platinum. ,he matrix is degassed in an oven at !1+++9 = for * minutes under vacuum and replace the matrix on the die. Pla!inum rein0orce# cro'ns: =or the fabrication of a platinum reinforced crown either a twin foil techni6ue. 1ingle foil techni6ue maybe used @ twin foil techni6ue re6uires the fabrication of the second foil with the ,innerCs #oint on the opposite side from the first to be adapted on the die. ,he skirt of the second foil is removed. ,he first foil replaced on the die, and a second foil pushed into place over it. 1ince it is the second foil that will later remain in the crown. It is removed, abraded tin-plated, oxidi-ed and replaced. In the single foil techni6ue, atleast one day prior to foil fabrication, the die, except for the shoulder portion is spaced with die relief material e6ual to one thickness of foil. @fter the foil is adapted, the should skirt portions are protected prior to tin plating by covering them with either inlay wax or cyanocrylate gel. ,his burns of during oxidation, leaving an area of clean foil to which the porcelain will not bond. @fter the finished crown has been gla-ed, this area of foil is removed with a sharp scalpel and the die spacer removed from the die to produce an accurate fit. Aluminous Core Porcelain /uil# Up: @lthough the core material is different, the techni6ue for core fabrication is the same for both the standard porcelain #acket crown and the platinum reinforced crown. 5latinum reinforced core material is slightly more opa6ue to mask out the gray colour of the oxidi-ed foil. ,he core material is mixed to a stiff consistency with the recommended li6uid, blotted to remove excess li6uid applied to the foil. @n even thickness of +. mm should cover all of the foil with the exception of the skirt. ,he core material should be well condensed and excess moisture removed by blotting. @fter the basic core buildup. ,he die is replaced on the cast and the occlusion ad#usted as necessary. More porcelain may be added to reinforce high stress areas, such as the cingulum of maxillary anteriors or the marginal ridge area of premolars. ,he lingual area should also be thickened, as with a metal coping, for extra strength.

In core design, the high stress cervical areas should be taken into consideration. If these are areas of excess tooth reduction, the core thickness is increased to compensate and allow even and optimum veneer porcelain thickness of approximately 1mm. @fter completing the core build up, excess material is removed from the skirt and the porcelain slightly ditched with the tip of the brush. @ ditch is made in the porcelain all around the shoulder to prevent contraction of the shoulder portion of the matrix during firing. ,he porcelain is condensed well by vibrating and blotting to avoid porosity. ,he core is then fired. @luminous core porcelain is fired under vacuum to 11!++= with the first firing. In other method of firing system, the porcelain is fired from 1 ++ += to 1&+++= for six minutes. ,he vacuum is broken and the porcelain is raised to !+++ += and held for 1 minutes. ?ith the first firing, there will be some shrinkage away from the shoulder and perhaps some fissuring. ,he surface of the porcelain should be ground with a clean diamond stone and any fissures opened slightly. ,he foil is checked to ensure adaptation and reburnished if necessary, it is then placed in an ultrasonic cleaner. @ more fluid porcelain mixture is used for the second core bake to allow the material to flow into any small discrepancies and ditched area. ,he porcelain is condensed and fired. ,he second core firing is better done in air because subse6uent core firings in vacuum may cause YbloatingC or bubbling of the porcelain. ,he core porcelain is allowed to mature in air at 11!++9 for 1 minutes to obtain higher density and therefore higher strength. .irin+ re?uiremen!s o0 core porcelain: 1. Haise firing temperature slowly 1 ++9 per minute, rapid drying and firing increase the risk of fissuring in the core. !. Break vacuum immediately on reaching maximum maturing temperature. 9ontinues firing in vacuum will cause hone comb porosity. A. @ir fire for at least 1 minutes at maximum maturing temperature or even higher for extra strength. @lumina crystals improves density and bonding of crystals to the porcelain matrix and strength can be greatly increased. 0. @fter cooling check degree of fusion by immersing in ink surface in dense with no honey comb porosity, the dye wash off clearly. Den!in porcelain: Mix dentin porcelain with distilled water on a glass slab to a creamy consistency. Moisten the core porcelain with distilled water and apply the weak porcelain in small increments to the gingival area using the moist brush, smooth the porcelain towards the incisal area so that it is chamfered to a fine edge about 1GArd the distance from the cervical margin. Make certain that the porcelain has a gradual chamfer since a sharp angle can create demarcation lines. 9ondense the porcelain by vibrating and drying with a paper tissue.

&

2ingival or cervical dentin porcelain and body porcelain are different in colour bleeding. @pply the body dentin porcelain to the remaining core porcelain using the incremental brush techni6ue work the porcelain from the incisal edge first and carry it down the labial surface towards the gingival porcelain. In this way the body porcelain will blend easily with the slightly moist gingival porcelain. 9ontinue to build around the approximal areas but do not fill in approximal space of the gingival. @lways maintain the correct contour. %xtend the porcelain incisally to a length of 1mm to allow for shrinkage. =inally build up the lingual portion of porcelain by dentine porcelain to the correct occlusal relationship. 5orcelain will always shrink towards its greatest bulk and these areas are to be found at the incisal, the proximal and at the supra-bulge, line and point angles. Enamel porcelain: Before mixing the enamel and translucent porcelains make sure that the dentin build up is kept moist. 9heck that atleast +. mm of dentin porcelain is covering the core at the incisal with a periodontal probe. Hemove the other half of the incisal dentin and smooth the surface using brush. @pply enamel porcelain to the surface, making sure that each increment is positioned very gently. 1mooth the enamel porcelain towards the dentin blend line and extend it proximally, do not alter the original contour of the tooth. ,he finished enamel should be extended by 1 to 1. mm beyond the ad#oining central incisor. ,hicker enamel reduce value and increase translucency. ,he restoration is dried and then placed in the oven to 1 +++9= to 1& ++= under total vacuum. It is held at that temperature for one minute and then removed. ,he restoration is ad#usted, tried in the mouth and final morphological features are added, it is gla-ed by placing it in the muffle at 1& + += is held at that temperature for two to four minutes without vacuum before removal from the furnace. ,he matrix is then removed by prying it away from the shoulder with a sharp instrument. ,he loose edge is grasped firmly with cotton pliers and the platinum is twisted out. Aes!,e!ic Po!en!ial o0 Me!al Ceramic cro'ns Versus All Ceramic Cro'ns: @lthough metal -ceramic prostheses account for about 4+ " of all fixed restorations a metal - ceramic $M9' crown is not the best aesthetic choice for restoring a single maxillary anterior tooth. @ ceramic crown offers a greater potential for success in matching the appearance of the ad#acent natural tooth, but ceramic crowns are more susceptible to fracture, especially in posterior sites. @ dark line at the facial margin of a M9 crown occasionally associated with a metal collar or minimi-ed margin is of great concern when gingival recession occurs. ,his effect can be minimi-ed by using a ceramic margin or by using a very thin knife - edge margin of Mattel coated with opa6ue shoulder porcelain. ,he technician should polish and gla-e this margin to or with very thin knife - edge metal margins on the facial surface are successful procedures for improving the aesthetics.

*+

Sin!erin+ o0 porcelain ,he thermocemical reactions between the porcelain powers components are virtually completed during the original manufacturing process. ,herefore the purpose of firing is simply to sinter the particles of powder together properly to form the prosthesis. 1ome chemical reactions occur during prolonged firing times or multiple firings. Ef particular importance are the observed changes in the (ucite content of the porcelains designed for fabrication of metal - ceramic restorations. (ocution is a high - expansion $ and hinge- contraction' crystal phase whose volume fraction in the glass matrix can greatly affect the thimble contraction coefficient of the porcelain. 9hanges in the (ucite content can cause the development and the metal, which can produce tensile stresses during cooling that are sufficient to cause crack formation in the porcelain. ,he condensed porcelain mass is placed in front of or below the muffle of a preheated furnace at approximately * ++ 9 $1!+++ =' for low- fusing porcelain. ,his preheating procedure permits the remaining water vapor water vapor to dissipate. 5lacement of the conduced mass directly into even a moderately warm furnace results in a rapid production of steam, there by introducing voids fracturing large sections of the veneer. @fter preheating for approximately min, the porcelain is placed into the furnace, and the firing cycle is initiated. ,he si-e of the powder particles influences not only the degree of condensation of the porcelain but also the soundness +r apparent density of the final product. @t the initial firing temperature, the voids are occupied by the atmosphere of the furnace. @s sintering ..of .the particles begins, the porcelain particles bond at their points of contact. @s the temperature is raised, the sintered glass gradually flows to fill up the air spaces. 8owever, air becomes trapped in the form of voids because the fused mass is too viscous to allow all the air to escape. @n aid in the reduction of porosity in dental porcelain is vacuum firing. Dacuum firing reduces porosity in the following way. ?hen the porcelain is plac0d in the furnace, the power particles are packed together with air channels around them. @s the air pressure inside the furnace muffle is reduced to about onetenth of atmospheric pressure by the vacuum pump, the air around the particles is also reduced to this pressure. @s the temperature rises, the particles sinter together, and closed voids are formed within the porcelain mass. ,he air inside these closed voids is isolated from the furnace atmosphere. @t a temperature about o 9 $&&o=' below the upper firing temperature, the vacuum is released and the pressure inside the furnace increases by a factor of 1+, from +.1 to 1 atm. Because the pressure is increased by a factor of 1+, the voids are compressed to one-tenth of their original si-e, and the total volume of porosity is accordingly reduced. ;ot all the air can be evacuated from the furnace. ,herefore a few bubbles are present in vacuum-sintered porcelains, but they are markedly smaller thank the ones obtained by air-firing. @ finished metal-ceramic multiple unit bridge. O:er+la5in+ an# s,a#in+ ceramics @s shown in ,able !1-!, natural gla-ed $autogla-ed or self-gla-ed',medium-fusing feldspathic porcelain is much stronger than ground, rough, nongla-ed porcelain.If the gla-e is removed by grinding, the transverse *1

strength may be 0+ to 0*" less than that of the porcelain with the gla-e layer intact. ,he gla-e is effective in reducing crack propagaion within the outer surface because the surface flaws may bebridged and the surface will be under a state of compressive stressive stress. 8owever, the results from one study indicate that porcelains with highly polished surfaces $1-umabrasive paste' have comparable strength to that of specimens that were polished and gla-ed $=airhurst et al, 1&&!'. ,his observation is of clinical importance because after the porcelain prosthesis is cemented kin the mouth, it is common practice for the dentist to ad#ust the occlusion by grinding the surface of the porcelain with a diamond bur, unfortunately, this procedure weakens the porcelain markedly if the gla-e is removed and the surface is left in a rough condition. If the porcelain surface is rough, a natural gla-e treatment is recommended since the fracture resistance of the surface is greater than that of ungla-ed porcelains. 5orcelains for metal-ceramic and ceramic prostheses, porcelain veneers, or denture teeth may be characteri-ed with stains and gla-es to provide a more lifelike appearance. ,he fusing temperatures of gla-es are reduced by the addition of glass modifiers that lower the chemical durability of gla-es somewhat. 1tains are simply gla-es and are sub#ect to the same chemical durability problem 8owever, most of the currently available gla-es have ade6uate durability if they are as thick as + um or more.Ene method for ensuring that the applied characteri-ing stains will be permanent is to use them internally. Internal staining and characteri-ation can produce a lifelike result, particularly when simulated enamel cra-e lines and other features are built into the porcelain rather than merely applied to the surface. ,he disadvantage of internal staining and characteri-ation is unsuitable. It is logical to assume that fine polishing of a roughened surface followed by gla-ing produces smoother surface than polishing alone, sandblasting followed by gla-ing, or diamond grinding followed by gla-ing. @ highly polished and gla-ed surface is smoother than the surfaces of gla-ed specimens that have been sandblasted or roughened with a diamond followed by gla-ing8 Coolin+ o0 Me!al Ceramic Pros!,eses ,he proper cooling of a porcelain prosthesis from its firing temperature to room temperature is the sub#ect of considerable controversy. ,he catastrophic fracture of glass that has been sub#ected to sudden changes in temperature is a familiare experience. ,he cooling of dental porcelain is a complex matter, particularly when the porcelain is fused to a metallic substrate. Multiple firings of a metal-ceramic restoration can cause the coefficient of thermal contraction of the porcelain to increase and can actually make it more likely to crack because of tensile stress development. ,he chief limitation to the use of an all-porcelain crown in fixed prosthodontics is its lack of tensile strength. @ method for minimi-ing this disadvantage is to fuse the porcelain directly to a metal coping that fits the prepared tooth. 1uch a metal-ceramic prosthesis is shown schematically in figure !1-1. ,he metal on the facial side is approximately +.A to +. mm thick. It is veneered with opa6ue porcelain approximately +.Amm in thickness. ,he body porcelain is about 1mm thick. *!

If a stronger material is used as an inner core of a ceramic crown, cracks can develop only when the stronger material is deformed or broken, assuming that the veneering porcelain is firmly bonded to the stronger substrate. ?ith proper design and physical properties of the porcelainand metal, the porcelain is rein-forced so that brittle fracture can be abided or at least minimi-ed when these crowns are restricted to anterior teeth. @lthough most metal-ceramic prostheses involve cast melt copings, several novel noncast approaches $sintering, machining, swaging, and burnishing' to coping fabrication have been developed in recent years Creep or Sa+ Resis!ance 7nfortunately, high-temperature creep or sag of some high noble and noble alloys occurs when the temperature approaches &)++ 9$1)+++ ='. ,he creep can be reduced if the metal has the proper composition so that a dispersion strengthening effect occurs at the high temperature. ?hen such gold alloy is heated to &)+ + 9 or higher, a second phase is precipitated that can harden or strengthen the alloy such creep has been reduced in some of the commercial alloys, but it apparently cannot be eliminated. ,he solidus temperature $the lower end of the melting range' of base metall alloys, such as nickel-chromium, is higher than that ofgold alloys. hence, base metal alloys are les susceptible to sag than are gold-based alloys. 8owever, the newer ultralow-fusing veneering ceramics that were introduced in the early 1&&+s are fired at lower temperatures$sintering temperatures below ) ++9' than traditional low-fusing porcelains. =or alloys with solidus temperatures of 1++++9 or higher, creep $sag' deformation should be negligible. Copin+s 0or Me!al Ceramic Pros!,eses: =our types of process for producing a metal coping for metal-ceramic prostheses are available: $1' electrodeposition of gold or other metal on a duplicate die, $!' burnishing and heat-treating metal foils on a die, $A' 9@<-9@M processing of a metal ingot, and $0' casting of a pure metal $95 ,i' or an alloy $high noble, noble, or predominantly base metal' through the lost-wax process. ,his discussion focuses primarily on the third option since it is the most widely used process. ,he traditional development of the metal-ceramic prosthesis was the result of advances in the formulation of both alloys and porcelains. ,o bond a ceramic veneer to cast alloy copings, a ceramic must have a fusion temperature well above its sintering temperature and, it also must have a co-efficient of thermal contraction that is closely matched to that of the alloys. @ metal oxide is necessary to promote chemical bonding of the ceramic veneer to the metal substrate. =oil copings may or may not re6uire a metal oxide or a bonding agent to ensure retention of the veneering ceramic. ,he use of one type of foil coping is discussed in the following section. ,he gold alloys developed for porcelain bonding have higher melting ranges than typical gold alloys for cast metal prostheses. the higher melting ranges are necessary to prevent sag, creep, or melting of the coping during porcelain firing. ,hese gold alloys contain small amounts $about 1"' of base metals such as iron, indium, and tin, as discussed in 9hapter 1&. ,he base metals form a surface oxide layer during the so-called 3degassing3 treatment, and this surface oxide is responsible *A

for development of a bond with porcelain. ,his porcelain-metal bond is primarily chemical in nature and is capable of forming even when the metal surface is smooth and little opportunity exists for mechanical interlocking. ,he alloys and porcelains used for the construction of such restorations have a number of rather stringent re6uirements. =or example, if undesirable residual tensile stresses in the porcelain are to be avoided, both the metal and the ceramic must have thermal contraction profiles on cooling that are closely matched or with the metal exhibiting a slightly higher contraction. If the contraction differences are large, stresses may occur that weaken both the porcelain and the bond. =or example a difference in the coefficients of thermal contraction of 1.4 ppmG + 9 can produce a shear stress of !)+ m5a $A&,)++psi' in porcelain next to the gold-porcelain interface when the porcelain is cooled from & 0+9 $14 ++ =' to room temperature. Because the shear resistance to failure is far less than !)+ m5a, these thermal stresses could cause spontaneous bond failure. 8igh tensile stresses are known to develop in porcelain veneers from a contraction coefficient mismatch between alloy and porcelain. ,he tensile stresses induced within the porcelain by occlusal forces would, of course, be added to residual thermal tensile stresses. 8owever, when the metal and its porcelain veneer exhkibit similar contraction curves and an average contraction coefficient difference of +. ppmG+9 or less $between the porcelain3s glass transition temperature and room temperature', fracture is unlikely to occur except in cases of extreme stress concentration or extremely high intraoral forces. ,hese metal-ceramic combinations are know as thermally compatible systems. Many prostheses made from metal and porcelain materials having contraction coefficient differences between +. and 1.+ppmG+9 are known to survive for many years. ,hese results are explainable by survival probability analyses that assume that the maximukm biting forcxes on anterior crowns rarely exceeds !!!0 ; $ ++lb'. In fact, the 2uinness book of records $1&&A' cites the maximum clenching force ever recorded for posterior teeth as 0AA4 ; $&4 lb' between molar teeth and much lower forces between premolars and between anterior teeth. ,hus a rather small number of patients have bite force capabilities that are likely to cause fracture of metal ceramic crowns or bridges even when residual thermal incompatibility stresses are present. @s general rule , lower forces are generated by younger children versus older children, female patients versus male patients, a more closed bite versus a raised bite table, occlusion between natural teeth and denture teeth compared with the force generated between natural teeth against natural teeth. @nother e6ually important property of metal-ceramic systems is that the alloy should have a high proportional limit and, particularly, a high modulus of elasticity. @lloys with a high modulus of elasticity also share a greater proprtion of stress compared with the ad#acent porcelain. ,he metal framework must not melt during porcelain firing and also must resist high -temperature3sag3 deformation sag or flexural creep can occur only at high temperatures. It does not occur at oral temperatures.

*0

,he metal-ceramic prosthesis is generally fabricated by a dental technician. ,he casting procedures are similar to those described for the casting of inlays and crowns. Because of the high melting temperature of the alloys, a phosphate-bonded investment must be used. ,he casting should be carefully cleaned to ensure a strong bond to the porcelain. =or example, an alloy such as Elympia $heraeus /ul-er', a gold-palladium, silver-free alloy, is heated in the porcelain furnace to a temperature of 1+A)+9 $1&+++ =' to burn off any remaining impurities and to form a thin oxide layer. In many alloy systems, this so-called degassing treatment does not actuallyk degas the interior structure of the alloy, but it does produce an oxide layer on the alloy surface that is essential for the formation of the porcelain-metal bond. ,he need for a clean metal surface cannot be overemphasi-ed. ,he surface may be cleansed ade6uately by finishing with clean ceramic-bonded stones or sintered diamonds, which are used exclusively for finishing. =inal sandblasting with high purity alumina abrasive ensures that the porcelain is bonded to a clean and mechanically retentive surface. Epa6ue porcelain is condensed with a thickness of approximately +.Amm and is then fired to its maturing temperature. ,ranslucent porcelain is then applied, and the tooth form is built. 5orcelain powder is applied by the condensation methods previously described. ,he unit is again fired. 1everal cycles of porcelain application and firing may be necessary to complete the prosthesis. @ final gla-e is then obtained. Me!al Ceramic Cro'ns /ase# on /urnis,e# .oil Copin+s: 9aptek $5recious 9hemicals 9ompany Inc.' is a technology that is based on the principle of capillary attraction to produce a gold composite metal. ,he 9aptek 5 and 2 metals can produce thin metal copings for single crowns or frameworks for metalceramic fixed partial dentures $=5<s' with a maximum span length of 1)mm $that allows space for up to two pontics'. 9aptek is an acronym for 3capillary casting technology3. ,he finished metal coping may be described as a composite material consisting of a gold matric reinforced with small particles of a 5t-5d-@u alloy. ,he inner and outer surfaces contain approximately &4" @u. ,he grain si-e of the foil is 1 to !+ m. Malleable 9aptek metal strips are burnished on a refractory die to fabricate the metal coping of a metal-ceramic crown without the use of a melting and casting process. %xamples of 9aptek metal-ceramic crowns are shown in =igure. ,he procedural steps are described below. 1tarting with a master model of the prepared tooth or teeth, a 9aptek refractory die is produced. ,he 9apsil relief li6uid is sprayed onto the stone die$s' to reduce surface tension, allowing 9apsil impression material or 9apvest refractory die material to flow freely and to reduce bubbles and imperfections. @fter die spacer is applied to the master die, undercuts are blocked out. ,he master die is placed in the proper si-e-duplication flask, and 9apsil silicone material is poured into the flask around the master die$s'. ,he master die is removed from the hardened silicone, and an accurate high-temperature refractory is puoured into the new silicone mold. *

,he refractory die is heat-treated, the margins are marked with a red pencil, and an adhesive $9aptek @dhesive' is applied to the die. ,he adhesive aids the adhesion of 9aptek material to the die and also enhances capillary attraction. ,he next step re6uires the application of 9aptek p, a highly malleable gold, platinum, and palladium alloy. ,his internal reinforcing skeleton provides a three dimensional network of capillaries that will be eventually filled by 9aptek 2 material forming a composite high gold metal alloy. ,his layer is burnished on the die, and after the margins are trimmed, it is sintered in a porcelain furnace on the recommended 9aptek thermal processing cycle. ,his capillary structure is next infused with molten gold that is supplied by the 9aptek 5 material. ,he 9aptek 5 is pressed in place using uniform firm pressure so it conforms to the shape of die. %xcessive pressure or pulling of the material will cause it to tear or break. @fter trimming away any excess material, any voids are filled with trimmings of 9aptek 5 segments. ,he crown andGor bridge units are now ready for firing. ,he pieces are heated at a rate of + to )++ 9Gminute to the recommended firing temperature. ;ext, 9aptek 2 strips are applied. ,he 9aptek 2 metal strip contains &4. wt" gold and !. wt" silver. ,he copings andGor bridge components are fired again in the furnace according to the recommended 9aptek firing cycle. @fter processing, 9aptek 2 forms a high gold metal alloy composite through capillary attraction. ,he capillary action is used as the #oining method of the hard particles and the resilient particles of metal present n the final coping. ,he gold melts, yet the 9aptek 5 structure remains stable. ,he 9aptek composite metal coping is now complete and ready for refractory die removal. ,he coping is now complete and ready for refractory die removal. ,he coping is divested, and the margins are finished. =or the production of =5<s $bridges', 9aptek pontics are used. ,hese are specially designed pontics that are precast using a metalceramic alloy and plated with pure gold. ,he copings andGor pontics are coated with a mixture of a powder and li6uid $9apbond', which will provide a thin covering of gold material to enhance areas of 9aptek 5 that have been ground during ad#ustment. ,he 9apbond will also provide a gold color that is identical to that of areas that have not been ground. 9apcon li6uid and powder are applied to areas between pontics and abutments, as well as pontic surface areas. ,he powder contains an alloy of gold, platinum, and palladium to provide the same base material structure as 9aptek 5. 9arcon absorbs, through capillary attraction, the 9apfil material in the same way that 9aptek 2 is absorbed into 9aptek p, producing a gold connecting area that enhances the color of the pontic surface. 9apcon is also used to enhance the buccal or labial pontic areas of 9aptek preformed pontics. ,he units are veneered with tow thin layers of opa6ue porcelain and other veneering porcelain layers. Before the opa6ue layer is applied, the finished 9aptek coping has a thickness of approximately +.! mm. ,hus this techni6ue provides a much thinner coping thickness than traditional cast metals $+. mm' and will provide additional space for veneering porcelain. ,he marginal adaptation is dependent on the skill of the technician in trimming the burnished materials. 7nlike traditional cast **

metals that provide atomic bonding to opa6ue porcelain through an external oxide layer, 9aptek metal achieves bonding to opa6ue porcelain through as external oxide layer, 9aptek metal achieves bonding through a combination of surface interlocking and residual stresses produced by slight differences in thermal expansion coefficients. @lthough 9aptek metal is indicated for crowns and =5<s, no long-term clinical data are available to determine the survivability of 9aptek ceramic prostheses. /on#in+ Porcelain !o Me!al: ,he primary re6uirements for the success of a metal-ceramic prosthesis is the development of a durable bond between the porcelain and the alloy. Ence such a bond is achieved, there is an opportunity to introduce stresses in the prosthesis during the porcelain firing procedures. @n unfavorable stress distribution during the cooling process can result in cracking of the porcelain, and delayed fracture can also occur. ,hus, for a successful metal-ceramic prosthesis to be reali-ed, both a strong interface bond and thermal compatibility are re6uired. ,heories of metal-ceramic bonding have historically fallen into two groups: $1' mechanical interlocking between porcelain and metal and $!' chemical bonding across the metal-porcelain interface. @lthough chemical bonding is generally regarded to be responsible for metal-porcelain adherence, evidence exists that, for a few systems, mechanical interlocking may provide the principal bond. ,he oxidation behavior of these alloys largely determines their potential for bonding with porcelain. Hesearch into the nature of metal-porcelain adherence has indicated that those alloys that form adherent oxides during the degassing cycle also form a good bond to porcelain, whereas those alloys form no external oxide at all but rather oxidi-e internally. It is for these alloys that mechanical bonding is needed. @ variety of tests have been advocated for measuring the bond strength. ;one can be regarded as an exact measure of the adhesion of porcelain to metal except in cases in which the metal-porcelain couple is matched thermally so that porcelain ad#acent to the interface is essentially stress-free. ,his is a situation virtually impossible to attain because the metal exhibits a linear contraction behavior as a function of temperature and the porcelain exhibits a nonlinear contraction plot. 9linical fractures of metal-ceramic restorations, although rare, still occur, especially when a new alloy or porcelain is being used or when a new coping technology has been adopted. @s is generally true for all dental materials, there is a learning curve associated with the initial use of new products. ?hen fractures occur, it is a good idea to make a vinyl polysiloxane impression of the fracture site for future fractographic analysis. @ll information on the crown or bridge should be recorded. Including the visual appearance of the fracture site. @lthough there are in infinite number of fracture paths that may occur, three types are of particular importance in diagnosis the cause of fracture. 1hown in figure are fracture paths that have occurred primarily at three sites: $1' along the interfacial region between opa6ue porcelain $5' and the interaction -one $1' between opa6ue porcelain and the metal substrate $top'. $!' within the interaction -one $center'. and $A' along the interfacial region between the metal and the interaction -one $bottom'. =or conventional metal-ceramic crowns *4

made from cast copings, the interaction -one is usually synonymous with the metal oxide layer. =or coping made using atypical methods such as the technologies associated with the 9aptek system, and electroforming processes, bonding to porcelain is achieved either through a combination of mechanical interlocking and residual stresses that occur because of a metal-ceramic contraction mismatch or through the application of a bonding agent. ,o characteri-e the principal site of fracture, magnification of A to 1++ times is re6uired because a thin layer of retained porcelain may not be visible without magnification. %ach of the three principal fracture paths in figure may be caused by excessive stress development, a material deficiency, of a processing deficiency. /on#in+ o0 Porcelain !o Me!al Usin+ Elec!ro#eposi!e# Su"s!ra!es: 9eramic bonding to metals in certain cases re6uires the electrodeposition of metal coatings and heating to form suitable metal oxides. <eposition of a layer of pure gold onto the cast metal and a subse6uent short KflashingL deposition of tin have been shown to improve the wetting of porcelain interface. In addition, the electrodeposited layer acts as a barrier between the metal casting and the porcelain to inhibit diffusion of atoms from the metal into the porcelain, within the normal limits of porcelain firing cycles. @ light color of the oxide film enhances the vitality of the porcelain when compared with the dark oxides that re6uire heavy opa6ue layers to mask dark unaesthetic oxides. Because the activated surface can be controlled from golden reddish-brown to gray, an additional dimension is available for color control of the porcelain. @lloys and metals such as cobalt-chromium, stainless steel, palladium-silver, high-and low-gold-content alloys, and titanium all have been successful electroplated and tin-coated to achieve satisfactory ceramic bonding. Darious proprietar agents are also available that are intended for application to the metal surface before condensation of the opa6ue porcelain layer. ,hese are applied as a thin li6uid to the metal surface and are fired in a manner similar to that of opa6ue porcelain. ,he function of these agents is twofold: $1' they are intended to improve metal ceramic bonding by limiting the build-up of an oxide layer on the base metal surface during firing, and $!' they can improve aesthetics by helping to block the color of the dark metal oxide. /ene0i!s an# Dra'"ac&s o0 Me!al Ceramics: ,he properly made crown is stronger and more durable than the ordinary aluminous porcelain crown. 8owever, a long-span bridge of this type may be sub#ect to bending strains, and the porcelain ma crack or fracture because of its low ductility. ,hese difficulties can be partly overcome with proper prosthesis design, as discussed earlier. 5roper occlusal relationships are also particularl important for this type of prosthesis. ,he most outstanding advantages of metal-ceramic prostheses are the permantnt aesthetic 6uality of the properly designed reinforced ceramic unit and their resistance to fracture. 7nlike similar acrylic resin veneered structures, almost no wear *)

of the porcelain occurs by abrasion and there is no staining along the interface between the veneer and the metal. =urthermore, as shown in a clinical stud, the fracture rate of metal-ceramic crowns and bridges is as low as !.A" after 4. years $9oornaert et al, 1&)0'. @ slight advantage of metal-ceramic prostheses over ceramic prostheses is that less tooth structure needs to be removed to provide the proper bulk for the crown, especially if metal only is used on occlusal and lingual surfaces. @s previously noted, high rigidity of the structure is needed to prevent fracture of the porcelain. Der little flexibility can be sustained by dental porcelains because of their moderately high modulus of elasticity e.g., *& 2pa compared with values of &&.A 2pa for a ,ype ID gold alloy, !!.0 2pa for amalgam, and 1*.* 2pa for a resin-based composite' and their relatively low tensile strength. @s a result, only limited elastic deformation of the porcelain approximately $less than +.1" strain' can be tolerated before fracture occurs. It follows, therefore, that a sufficient bulk metal is necessary to provide the proper rigidity. ,he minimal metal coping thickness necessary in the occlusal region is approximately +.Amm. the shape of the crown cannot be conspicuously out of line with the anatomic form of ad#acent teeth. ,herefore the bulk of the natural tooth may need to be sacrificed to provide ade6uate space to ensure ade6uate fracture resistance and aesthetics. REVIE= O. MATERIALS 7* Op!e& HSP (Leuci!e Rein0orce# porcelain*: Eptek 815 $>eneric 5entron Inc. ?alingord 9,' is a high leucite porcelain designed to make an all ceramic crown without a core. @ very esthetic system, it can be built on foil or on a refractory die. @lthough the strength as improved over a normal feldspathic porcelain, it is not expected to be as strong as those built with a core. A#:an!a+es: Effers a very esthetic crown system. Disa#:an!a+e: @ slightly higher rate of fracture exposed. 9* T,e aluminous porcelain %ac&e! cro'n: 5orcelain #acket restoration has been in use since (and introduced it in 1&+A. =racture of the restoration was a problem and, in 1&* Mc(ean and 8ughes introduced the aluminous porcelain #acket crown. 5orcelain was strengthened by dispersion of alumina particles in a KcoreL porcelain which could be built over platinum foil to a thickness of +. to 1.+mm. ,raditional $feldspathic' porcelain could then be build over this core. ,he core contained 0+" to +" alumina, which strengthened the porcelain #acket crown by about +", while still allowing good light penetration and esthetics. ,he composition of aluminous porcelain is similar to that of conventional porcelain except for the increased alumina content $0+- +"'. ,he alumina particles are much stronger than 6uart- and have a higher modulus of elasticity. 1ince the fracture of porcelain is essentially caused by propagation of cracks through the structure, the alumina crystals tend to obstruct the path of the crack.

*&

@luminous porcelain is an opa6ue porcelain used to construct the core layer of the porcelain #acket crown as an initial layer to mask the color of the tooth dentin or the color of the metal. If it is metal ceramic restoration, the opa6ue agent is usually the -iroconium oxide. A#:an!a+e: ,he aluminous porcelain #acket crown offers excellent esthetics, improved strength. Disa#:an!a+es: ,his material is not indicated for posterior teeth, fixed partial dentures, or in cases of heavy bruxism. ,he core is sometimes bright at the neck. A* Hi Cream: ,he authors 1outhan and >orgensen found that a refractory die could get better marginal adaptation by wetting it directly than by using the platinum foil techni6ue. 1ubse6uently, 8i-9ream system was developed to make an aluminous porcelain #acket crown on a refractory die. A#:an!a+es: ,he crowns are designed to be built on a refractory die. Disa#:an!a+es: Material not indicated for posterior teeth. =5< and heavy bruxism. E* Al Cream (Ceres!ore$ Cas! core*: In 1&)A 1o-io and Hiley and 9oors Biomedical 9ompany $(akewood 9E' introduced the 9erestore system. It employs a heat stable epoxy die and an aluminous core porcelain which is in#ection moulded by controlling time and temperature of the firing cycle, it was believed that a shrink free ceramic system resulted. In%ec!ion moul#e# !ec,ni?ue: ,he coping wax pattern is fabricated on a heat stable epoxy resin die. ,he die and wax pattern are invested in a special flask by plaster, and the wax can be removed with boiling water and the flask is oven heated at 1)++9 for 0+ minutes. In this system aluminous magnesium core material containing about 4+" alumina with a thermosetting binder having a transition temperature of 1*++9 is used, which is heat softened and in#ection moulded under air pressure in to the preheated mould cavity, formed by the lost wax process on a specially formulated epoxy die material compatible with this techni6ue. ,his special epoxy die is heat stable at the moulding temperature and undergoes uncontrolled expansion during curing of the epoxy. En cooling the thermoset material sets and is disinvested from the mould. ,he green state ceramic core still on the epoxy die and is then ad#usted by core is then removed from the die and fired in a furnace under precise time and temperature control for several hours upto a maximum of 1A+++9. @fter firing the alumina magnesium core is then veneered, with a special veneer porcelain similar to aluminous porcelain following a conventional techni6ue. ,hus expanded epoxy die in combination with magnesium core, provide for compensation of firing shrinkage. Because the first layer of ceramic in this techni6ue is molded directly against a die of the preparation, an excellent marginal fit is 4+

possible. Its compressive strength does not differ significantly from that of conventional aluminous porcelain crowns. @t present time, this system is used for single unit restorations. A#:an!a+es: Effers improved strength, excellent esthetics and marginal adaptation, shrinkage compensation mechanism. Disa#:an!a+es: 9ost, time of manufacture, unavailable for purchase today. F* In cream: In cream composed of fine si-ed particles of aluminium oxide core with significantly improved strength, developed by <r. 1adoun in 5aris and recently tested by 1eghi et al. ,he core is fired for 1+ hours period in a special furnace on a refractory die. 9onventional veneer porcelain can then be build to contour. A#:an!a+es: 1ystem offer strength $0 times greater than regular' and excellent marginal adaptation. In#ica!ions: May be used for anterior esthetic areas, possible posterior use and =5<. ;* Dicor (Cas! Glass Ceramic3Cas! Ceramic Cro'n*: <icor $<entsply International, Tork, 5@' is a castable glass system composed of 1iE!, /!E, MgE, Mg=! which is manufactured by 9orning 2lass ?orks. 8ence the full contour of the crown is built with <icor. Tec,ni?ue o0 0a"rica!ion: 9rowns are formed by full contoured anatomic wax pattern which are invested in a phosphate bonded investment. Ence the wax has been eliminated in a burnout furnace, a castable glass ceramic material is heated to a molten state $@ special glass is cast at about 10+++9' and cast in the mold on a centrifigual casting machine. @fter cooling to room temperature, the casting of transparent amorphous glass is removed from the investment, cleaned and trimmed then sub#ected to heat treatment. =or the heat treatment reinvest in a refracgtory material and fire it in a special furnace. ,his converts transparent week restoration into a semicrystalline translucent restoration. ,he maximum temperature re6uired for this firing is 1+4 +9 for several hours. ,his increase the strength and promotes the development of a crystalline phase of tetrasilica $Mica' within a glass matrix. ?hen the colour is deep within the tooth, this method fall short. @n alternative techni6ue is to cast the glass as a core and bake veneer porcelain over it $<icor plus, ?illCs glass'. In other system the castable ceramic material developed in >apan, the ceramming process produce hydroxyapatite crystal in the glass matrix. A#:an!a+es: %ase of fabrication, chameleon effect, conservation of tooth structure $1.! to 1.Amm reduction is ade6uate', flexibility of fabrication, ade6uate strength for anterior teeth, good marginal adaptation, excellent biocompatibility, less pla6ue accumulation $4 times less according to 1evit et al'. B* Sunrise:

41

@nother gold foil supported ceramic system that uses ceramico II porcelain. If either sunrise or renaissance system could be used with a core porcelain, strength would be appreciably high, but no such research has been found in the literature. H* Procera (No"le P,arma$ C,ica+o$ USA IL*: 5romotes the use of commercially pure titanium coping which is fabricated through milling and spark erosion process. ,he process takes the stone die and through the use of a copy milling machine, makes three graphite copies and one plastic Z7reol' copy die. En the plastic die the contours of a routine metal coping are waxed. ,his die with the newly added external coping contour, is placed in the copy milling machine and a copy of the external contours is milled in &&.*" commercially pure titanium. @t this time, only the external contours have been duplicated, leaving the titanium copy still solid. ;ext, the solid titanium coping is inverted into low fusing metal which holds it in place for the spark erosion process. ,he graphite die is placed in the spark erosion unit and used as template for the internal contours of the coping. ,wo to four graphite dies are needed to ensure accurate replication of the contours of the preparation. ,his is because of the degradation of the die from the heat generated by the spark erosion process. ,he coping is now hand finished on the die and ,i9ream is applied as specified. @ low fusing porcelain ,i-cream is developed specially for this process applied in a conventional manner. ,he advantages proclaimed by the manufacturer are: !' 9onsistency none of the problems associated with casting of alloys. A' Biocompatibility of pure titanium 0' @ porcelain kinder to opposing natural dentition. ' @ccurate unit relationships through laser welding on the master cast Disa#:an!a+es: !' ;o esthetic advantage over other metal ceramic system A' (imited number of laboratories offers this system Indication: 5rocera might be used in metal sensitive patients. IPS empress (I:oclar USA$ Am,ers!$ ND*: @ new addition for metal free ceramic restoration, uses a wax up, lost wax techni6ue. ,he ceramic is leucite reinforced and comes in pre cerammed cylinders in various shades. ,he wax is invested in a special flask with a newly developed investment and placed into the base of the compress press-furnace. ,he correct shade cylinder is heated to 11+++9 at which the cylinder becomes plastici-ed. ,he cylinder is then heat pressed under a vacuum into the mould where it is hold under pressure to allow complete and accurate fill of the investment cavity. ,he system uses a special light cure die material and a new 9hromas 9op shade guide. A#:an!a+es: 8igh flexure strength, no shrinkage after pressing procedure, dimensionally stable after several firings. 7sed for inlays, onlays, crowns and veneers. Disa#:an!a+es: 1ystem is expensive.

4!

9han and ?eber studied pla6ue retention with different crown systems and found ceramic crowns exhibited little pla6ue retention, whereas ceramic metal crowns retained less pla6ue than natural teeth. =ear Ra!e: Monasky and ,aylor found that the rougher the porcelain surface, the faster the wear rate. 5orcelains should be highly polished before gla-ing to minimi-e wear of opposing tooth structure. RECENT ADVANCES IN PORCELAIN 78 Hea! presse# ceramics (IPS empress*: I51 empress ceramic system used to fabricate crowns, inlays, onlays and veneers. In this system a ceramic ingot using high temperature $11++ +9' pressing fabrication procedure is converted to a ceramic restoration. ,he techni6ue consists of slowly forcing a softened ceramic into a mould made by traditional lost wax process. %sthetics can be enhanced by applying an enamel layers of feldspathic porcelain or surface stains on the facial surface of anterior crowns and veneers. By heat pressing, thermal expansion of glass and ceramic are said to induce compressive stresses at the interface and strengthens the restoration. 8eat pressing significantly improves the flexure strength, whereas heat treatment alone does not affect the strength. Proce#ure: 1' ?ax the restoration to final contour, sprue and invest as with conventional gold castings. If the veneering techni6ue is used, only the body porcelain shape is waxed. !' 8eat the investment to )+++9 to burn out the wax pattern. A' Insert a ceramic ingot and alumina plunger in the sprue and place the refractory in the special pressing furnace. 0' @fter heating to 11 ++9 slowly press the softened ceramic into the mold under vacuum. ' @fter pressing recover the restoration from the investment by air-abrasion, remove the spure and refit it to the die. 98 Slip cos! alumina cro'ns an# .PDIs (Inceram*: ,he inceram system uses a fine grain alumina core material. ,echni%ue: 1' Inceram coping produced directly on special plaster die by brush techni6ue !' 8eat pressed coping prepared by in#ection moulded techni6ue. Moul#e# !ec,ni?ue: ,he inceram system is used in the slip cost alumina techni6ue. 8ere a fine grain alumina core prepared on the porous plaster die, duplicated from the working cost. ,he alumina slip is ultrasonically mixed and applied to the plaster die and subse6uently fired in a special porcelain furnace. ,he resultant porous coping is infused with a special glass to give a high strength core material. (ater this core is veneered with an esthetic feldspathic porcelain.

4A

Proce#ure: 1' <uplicate the working die with an elastomeric impression material and pour it with the special plaster. @ny undercuts must be blocked out first and two coats of die spacer applied. ?hen the plaster has fully set $! hours' remove the die, mark the margins, and apply the wetting agent. !' Mix the appropriate shade of alumina slip with ultrasonic agitation, place the mixture under a vacuum, brush apply it to the plaster die and shape with a blade, trimming back to the margins carefully. A' ,he slip is fired in a special furnace initially through a prolonged drying cycle to 1!++9 that dries the die material, which shrinks away from the core. ,hen the alumina is fired at 11!++9 $!+0)+='. ,he resulting core is porous and weak at this stage but can be carefully transferred to the master die after the die spacer is removed. ,he relatively low sintering shrinkage $about +.A"' is compensated for by an expansion of the special plaster. 0' 5aint a thick coat of the approapriate shade of glass mixture onto the surface of the core and fire at 11+++9 $!+1!+='. ' Hemove excess glass from the core by grinding and air abrasion. *' @pply body and incisal porcelain to the core in the same manner as described for traditional porcelain #acket crowns. CAD CAM res!ora!ions (Compu!er Assis!e# Desi+n3Compu!er Assis!e# Manu0ac!ure*: All ceramic res!ora!ions: 1ince 1&) , 0 ma#or 9@<-9@M systems for fabricating prosthesis have emerged. ,he <uret $=rench' system, the Minnesota system $<enticad', 9icero $<ritch' system are the only three capable of producing complete crowns and =5<Cs. ,he cerac system $1wiss' is limited to inlays. 9erac system is a 9@<9@M ceramic restoration with a laser imaging camera that constructs the tooth preparation in A dimensions. 8ere a special video camera is used to scan the prepared tooth data from the image is manipulated by the dentist to design a restoration that is machined from a ceramic block using computeri-ed milling machine. Eperator can also program by design of inlayGonlay in the same manner. 5resently layers of colors and thus esthetics cannot be built into the restoration. ,he surface colouration concept similar to <icorCs seems the best available esthetic choice today. <icor restorations are made of a castable glass ceramic having an advantage $1' low abrasion of opposing enamel, $!' (ow pla6ue accumulation. A#:an!a+es: 9@<-9@M eliminates the problems that arise from direct application techni6ues currently employed. Disa#:an!a+e: 8igh cost, inaccuracy of marginal adaptation, and inability to built layers of color and translucency. CADCAM (Ceramic 0use# !o me!al res!ora!ions*: ,he 9icero system for the production of ceramic fused to meal restoration used the optical scanning, nearly, net shaped metal and ceramic sintering and computer aided crown fabrication techni6ues. 40

,his system produces crowns, =5<Cs with different layers such as metal, dentin and incisal porcelain for proximal strength and esthetics . DE.ECTS IN CERAMICS =abrication defects are created during processing and consist of voids or inclusions generated during sintering. Microcracks develop upon cooling in feldspathic porcelains and are due to thermal contraction mismatch between either the crystals and the glassy matrix $Mackert et al, 1&&0' or between the porcelain and the metal substrate. 9ondensation of a ceramic slurry by hand prior to sintering may introduce porosity. 1intering under vacuum has been shown to reduce the amount of porosity in dental porcelains from .* to +. *" $lones and ?ilson, 1&4 '. 5orosity on the internal side of clinically failed <icor glass-ceramic restorations has been shown to constitute a fracture initiation site $/elly et al 1&&+'. 1urface cracks are induced by machining or grinding. ,he average natural flaw si-e varies from !+ to + micrometers $@nusavice et al, 1&&1'. 7sually, failure of the ceramic originates from the most severe flaw. ,he si-e and spatial distribution of the flaws #ustify the necessity of a statistical approach to failure analysis $?eibull, 1&A&'. 1urface crystalli-ation of leucite can be induced by seeding the surface of a feldspathic glass with leucite particles $8oland et al, 1&& '. 9eramic materials for all ceramic restorations are in contact with refractory die materials during firing or pressing at high temperatures. 1urface reactions have also been reported between glass-ceramics and the refractory embedment used during the crystalli-ation process, thereby modifying the mechanical properties of the final product $9ampbell and /elly, 1&)&. <enry and Hosenstiel, 1&&A'. <iffusion processes are temperature-dependent, and surface reactions are likely to occur between the porcelain and the refractory die material. De+ra#a"ili!- o0 Den!al Ceramics: ,he degradation of dental ceramics generally occurs because of mechanical forces or chemical attack. ,he possible physiological side-effects of ceramics are their tendency to abrade opposing dental structures, the emission of radiation from radioactive components, the roughening of their surfaces by chemical attack with a corresponding increase in pla6ue retention, and the release of potentially unsafe concentrations of elements as a result of abrasion and dissolution. ,he chemical durability of dental ceramics is excellent. ?ith the exception of the excessive exposure to acidulated fluoride, ammonium bifluoride, or hydrofluoric acid, there is little risk of surface degradation of virtually all current dental ceramics. %xtensive exposure to acidulated fluoride is a possible problem for individuals with head andGor neck cancer who have received large doses of radiation. 1uch fluoride treatment is necessary to minimi-e tooth deminerali-ation when saliva flow rates have been reduced because of radiation exposure to salivary glands. 5orcelain surface stains are also lost occasionally when abraded by prophylaxis pastes andGor acidulated fluoride. In each case, the solutes are usually not ingested. =urther research that uses standardi-ed testing procedures is needed on the chemical durability of dental 4

ceramics. @ccelerated durability tests are desirable to minimi-e the time re6uired for such measurements. ,he influence of chemical durability on surface roughness and the subse6uent effect of roughness on wear of the ceramic restorations as well as of opposing structures should also be explored on a standardi-ed basis

4*