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CERAMICS

REALITY’S CHOICES

All-Purpose
1a. Ceramco 3
Dentsply/Ceramco

1b. Omega 900


Vident

2. Ceramco II
Dentsply/Ceramco

3a. Creation
Jensen

3b. IPS d.Sign


Ivoclar Vivadent

Bonded
1. IPS Empress
Ivoclar Vivadent

2. IPS Eris
Ivoclar Vivadent

3. OPC
Pentron

4. Finesse All-Ceramic
Dentsply/Ceramco

Miscellaneous
1a. Duceram LFC
Dentsply/Ceramco

1b. Procera AllCeram


Nobel BioCare

2. Finesse
Dentsply/Ceramco

3a. In-Ceram Alumina


Vident

3b. In-Ceram Spinell


Vident

©2003 REALITY Publishing Co. Vol. 17 ©2002 REALITY Publishing Co. Vol. 16 The
The Ratings
Ratings 99
99
Ceramics

Ceramic materials are still the mainstays of esthetic den- Cements


tistry. With the rapid advance of ceramic technology, While we tested one compomer-like cement with 10 differ-
manufacturers are now making materials with much greater ent ceramic and resin materials and did not find any
potential of mimicking nature than was previously possible. tendency for this cement to expand and fracture the experi-
However, the success or failure of a ceramic restoration is mental crowns, we still believe it is risky to cement an
still largely controlled by the expertise of the dentist/techni- all-ceramic restoration with a resin ionomer cement. We
cian team. strongly recommend a resin cement for any metal-free
restoration.
Ceramic Materials Categories
• All-Purpose Includes ceramics primarily marketed Repairs
for use in ceramometal restorations. Many of these RRL tested a simulated clinical protocol if you were repair-
porcelains vary only in color and translucency. ing a restoration in the mouth using a hydrophilic dental
However, it is also possible to use ceramometal porce- adhesive. This assumes you are repairing a restoration with
lain to fabricate inlays, onlays, veneers, and metal-free exposed enamel and dentin, in addition to the fractured sur-
crowns. face of the restoration. Since hydrophilic adhesives require a
• Bonded Consists of ceramic materials used exclusive- dentin substrate with various levels of moisture, we tested
ly for all-ceramic restorations. These materials are repairs using our moist protocol. The results showed all
typically reinforced porcelains, designed to withstand ceramics had higher repair strengths when the ceramic was
forces of occlusion without the support of a metal sub- dried. This means it is prudent to use an adhesive that can
structure, assuming they are bonded to the teeth. also bond to dry tooth structure.
• Miscellaneous Materials that do not fit into the first
two categories. Fluorescence
Veneers supplied by the manufacturers were fabricated out
Tests of our CHOICES and photographed in vivo to determine
Bond Strength how close to natural teeth the material fluoresces under
Two selected materials, provided by the manufacturers, were black light.
treated in a variety of methods, followed by bond strength
tests. Sandblasting followed by a one-minute application of
hydrofluoric acid produced the highest bond strengths.
However, high strength alumina cores were not tested.

All-Purpose Ceramics

Ceramco 3 is more opacious than Ceramco II. It has bet-


ter infinite optical properties, which makes it more suitable
Ceramco 3 for metal-ceramic restorations at a minimal thickness. Being
1A Dentsply/Ceramco
(4.2) less translucent than Ceramco II, it is less suitable for
veneering non-discolored teeth. However, it provides a
polychromatic appearance for veneering lightly discolored
teeth. Ceramco 3 is more suitable for masking dentin than
Third generation feldspathic porcelain designed to be used Ceramco II.
for ceramometal restorations. The entire system, from the It also has better handling, better polishing, and better
opaques, through the dentins, natural enamels and opal firing than Ceramco II. Ceramco 3 has more esthetic qual-
enamels reportedly impart the fluorescence of natural denti- ities built into it. The lab tech can impart the requested
tion. It offers 24 highly esthetic shades, including 8 new shades more easily. The improved strength is important,
“Illumine” bleach white shades. Shade-coordinated with with no reported fractures or other failures.
Finesse All-Ceramic so combined cases (PFM & all-ceram-
ic) will presumably be difficult to detect. Indications include Fluorescence
all single and multiple unit porcelain-fused-to-metal Manufacturer did not supply requested restoration.
restorations using conventional high-fusing ceramic alloys
with or without silver. It can also be used for veneers and
other metal-free restorations.

100 The Ratings ©2003 REALITY Publishing Co. Vol. 17


Ceramics

Fluorescence
Omega 900
1B Vident (4.2)

Fine particle metal ceramic made from yellow-orange glass to


give it warm tones and more translucency. Has a low firing
temperature of 900°C, but doesn’t sacrifice consistent shading.
Due to its more homogeneous structure, number of tension
cracks and abrasion of opposing teeth should be reduced and
polishing is improved. Can be used for crowns, bridges, and
veneers. Features three opal translucents, seven regular
translucents, three cervicals to increase illusion of depth, 10
Nuance shades to create specific effects, Luminaries, which
are used to alter the fluorescence, three corrective shades,
seven margin shades, and two soft tissue shades.

Ceramco II Body and opal incisals give accurate shades and look very
2 Dentsply/Ceramco (4.0) natural when used over properly modified opaque. Opaceous
dentin and color modifiers are incorporated to control color
in thin areas and provide special effects. The transparent
porcelain is very clear and provides a nice, natural look. The
Easy-to-use porcelain system that is compatible with a wide Edge shoulder porcelain combines the convenience of
range of metals. The Ultra-Pake pre-mixed opaque system pre-mixed pastes in syringes with a quick-drying, quick-
gives complete, uniform coverage of the metal in a very thin hardening carrier to deliver clean lift-off with sharp, accu-
layer. The effects of the opaque modifiers can be seen as they rate margins. For labs using high silver alloys, Ceramco II
are brushed on wet so there are no unexpected surprises after silver porcelain is recommended to avoid discoloration.
the opaque is baked. Ultra-Escent crystals sprinkled over
thin layers of opaque create a light refractive opaque surface Fluorescence
to mimic natural teeth. Manufacturer did not supply requested restoration.

Fluorescence
Creation
3A Jensen (3.8)

Created by Willi Geller. Designed to be used in a multi-lay-


ered buildup technique. Has fluorescence similar to natural
teeth. Includes the full Vita range in dentin shades and four
standard enamels. Other components include Illusion, which
is a modifier to lower value, In Nova, which are modifiers
with fluorescence, Make In to create mammelons, Make Up
for surface staining, Pearl Enamels when less translucency is
desired, Shoulder porcelain to help transmit light, and Tissue
Colored materials for matching soft tissue.

©2003 REALITY Publishing Co. Vol. 17 The Ratings 101


Ceramics

IPS d.Sign
3B Ivoclar Vivadent (3.8)
www.ivoclarvivadent.us.com

Created by Dr. Robert Winter and Don Cornell. Features a


unique combination of fluorapatite and leucite crystals to
imitate the optical properties and fluorescence of natural
teeth. Has six matched alloys for ceramometal use. Other
advantages include low wear of opposing enamel and low
firing temperatures (900°C). Includes the full Vita range in
dentin shades, 10 Chromascop dentins, three incisals, Deep
Dentin to intensify the chroma in limited thickness areas,
Impulse ready-mixed modifiers, Stains in paste form,
Essence stains in powder form, Gingiva to simulate soft tis-
sue, and Bleach to match teeth which have been whitened. Fluorescence
Clinical results, both with and without metal support, show
esthetics can be excellent.

Bonded Ceramics

IPS Empress
1 Ivoclar Vivadent (4.1)
www.ivoclarvivadent.us.com

Unique leucite-reinforced, pressed ceramic. Restorations are


waxed and invested in a special flask system. Different types
of ceramic ingots can be used in either the layered or shad-
ed technique by pressing these materials in a special furnace
to fill the invested mold. Our experience with IPS Empress
has been very positive, with a wide variety of restorations fit-
ting well and having very good to excellent esthetics. Various
studies have validated its strength. However, we have had
some fractures, especially with veneers.

Fluorescence

102 The Ratings ©2003 REALITY Publishing Co. Vol. 17


Ceramics

Fluorescence

IPS Eris
2 Ivoclar Vivadent
(4.0)

As the replacement for the ill-fated IPS Empress2, IPS Eris


uses lithium disilicate substructure, which is veneered with a
fluorapatite glass-ceramic. It is indicated for anterior and
posterior crowns and three-unit bridges that have one pon-
tic and do not extend beyond the second premolar.
Characteristics of the low-fusing, highly stable material
include reduced firing temperatures as well as homogenous
composition for easy polishing and finishing. In addition,
Dentin, Incisal, Impulse, and Transparent materials enable
fabrication of restorations that reportedly blend well with
surrounding dentin.

only two fractures. A recent study found OPC was stronger


OPC than IPS Empress. The shaded translucent cores fit as well
3 Pentron
(3.8)
if not better than those of IPS Empress. There is also a low
wear veneering porcelain, which presumably is kinder to the
opposing dentition. 3G version presumably has higher
strength.
Pressed ceramic with a reduced size of leucite crystals, which
improves the crystalline component, thereby increasing Fluorescence
strength. Out of 356 trackable restorations, we have had Manufacturer did not supply requested restoration.

of the Finesse low-fusing porcelain. The result is an


Finesse improved bond between the porcelain and the core material.
4 All-Ceramic (3.7) This should enhance the integrity of the restoration and
Dentsply/Ceramco erase the seam between the core and porcelain, an important
esthetic consideration. While the long term bond strength
to dentin and physical strength of the porcelain still remains
Designed to be veneered with low-fusing Finesse porcelain, to be seen, Finesse All-Ceramic seems to offer a great deal
this integrated system is indicated for anterior and premolar of what many of us have been waiting for in a porcelain —
full-coverage crowns, veneers, inlays, and onlays. The advan- a high strength porcelain that is less abrasive and scores high
tage of the all-ceramic core and low-fusing porcelain is the in esthetics. Clinical reports have been encouraging.
reduced wear to opposing dentition, chairside repair, and
polishability. The Finesse All-Ceramic core material is engi- Fluorescence
neered with a coefficient of thermal expansion to match that Manufacturer did not supply requested restoration.

©2003 REALITY Publishing Co. Vol. 17 The Ratings 103


Ceramics

Miscellaneous Ceramics

smooth due to its extremely small particle size, similar to a


Duceram LFC
1A Dentsply/Ceramco (4.0) microfill composite. One recent study found LFC caused
less wear on an opposing enamel specimen in a wear
machine compared to three other ceramics, but was still not
as wear-friendly as gold.
Low fusing ceramic with a unique fluorine glass with an Lastly, it has a natural opalescence which gives LFC an
extremely low firing temperature (670°C). It has several enamel-like character. Other porcelains have to add colored
advantages over conventional feldspathic or aluminous particles to achieve the opal effect.
porcelain. First, it reportedly gets harder in the mouth Unfortunately, not all is good with LFC. It presumably
instead of weakening. This increase in hardness, which does not etch well and, therefore, cannot be used by itself for
gives it the ability to heal its own microcracks, is supposed- bonded restorations. For this application, a thin coping of
ly due to an ion exchange that occurs between the porcelain conventional porcelain must first be fired, over which the
and oral fluids. LFC is applied. With ceramometal, body porcelain still is
Another advantage over conventional porcelains is that baked over the metal coping, while the LFC is again applied
it is very easy to polish. This is achieved due to its low fus- on the surface in a thin layer.
ing temperature. When a rotary instrument is applied to
LFC, it actually melts the surface and then, in a way, Fluorescence
reglazes automatically. In addition, its surface is very Manufacturer did not supply requested restoration.

Procera
1B AllCeram (4.0)
Nobel Biocare
www.nobelbiocare.com

All-ceramic crown and bridge system consisting of a


pressed and densely sintered, high purity (99.5%) aluminum
oxide core, which is veneered with various porcelains such as
Noritake Cerabien, Creation AV, Vitadur Alpha, Ducera
AllCeram, etc). Preparations should have chamfer or rounded
shoulder margins and be deep enough for the coping (0.5mm)
plus the veneering porcelain (1.0mm). Recommended poste-
rior occlusal reduction is 2.0mm. Without adequate
reduction, esthetics will suffer. Your impression is sent to a lab ably can use any cement you choose, although acceptable
with a special scanner, which then transmits the information bond strength with Panavia 21 has been reported.
to the production lab in New Jersey or Sweden via modem. It Our experience shows Procera can be very esthetic, with
is there that the coping is milled using CAD/CAM technol- the core able to block out dark teeth and metal implant abut-
ogy. It is then sent back to the original lab for conventional ments. But margins need to be slightly subgingival — this is
buildup of the veneering porcelain. If your lab is not skilled in not a material that can readily adapt to the supragingival
this area, esthetics will be mediocre. “contact lens” effect. More translucent crowns such as IPS
The promoted advantage of the Procera system is that Empress will probably be more esthetic when the tooth sub-
the coping, although highly dense, still permits the passage strate is not very dark.
of light and has a translucency that is necessary when trying Its marginal fit could be the best of any of these types of
to recreate the optical properties of natural teeth. materials. Despite its strength, however, we have had two
Recent studies have shown the marginal fit of the coping fractured crowns. While veneers and bridges are now being
to be clinically acceptable and the strength to be nearly twice recommended, it is not being promoted for inlays and onlays.
as high as the In-Ceram Alumina core and five times that of
IPS Empress. However, another study found In-Ceram was Fluorescence
stronger than Procera. Due to its high strength, you presum- Manufacturer did not supply requested restoration.

104 The Ratings ©2003 REALITY Publishing Co. Vol. 17


Ceramics

perature allows for increased opalescence in the enamel


Finesse porcelains. And the high polishability of the material at
2 Dentsply/Ceramco (3.8)
chairside eliminates the need for reglazing after adjustments.
Finesse can be used with a wide range of casting alloys,
including many high-gold alloys such as Finesse Gold. It is
also available in four bleach shades.
Low fusing porcelain containing 8%–10% leucite. Designed
with less leucite and finer crystal structure compared to con- Fluorescence
ventional porcelain, Finesse has the advantage of being less Manufacturer did not supply requested restoration.
abrasive to the opposing dentition. The lower fusing tem-

In-Ceram Our experience with In-Ceram has been very positive. It


3A Alumina (3.5) offers excellent esthetics, fit, and soft tissue response. Due to
its high strength, In-Ceram can be cemented with many
Vident
types of cement, including provisional cements. Even
though the core cannot be etched, adhesion can be achieved
by treatment with Rocatec or CoJet combined with cemen-
High strength all-ceramic system due to its unique, glass- tation using Panavia 21.
infiltrated, alumina core material. It has about triple the
strength of other ceramic systems, not including Procera Fluorescence
AllCeram. Not quite as strong as ceramometal, it has suffi-
cient strength for single crowns and three-unit anterior
bridges. Even though its core is relatively dense, it still
allows light to pass through, enhancing the esthetics. The
Alpha veneering porcelain includes opaceous dentins, col-
ored translucents, colored body modifiers, opal translucents
and the Artist Line, which contains fluorescent luminary
powders which can be used as shoulder porcelains. In addi-
tion, there are gingival colored powders. One recent study on
bridges found a 33% failure rate when the pontic was a
molar, 11% failure when the pontic was a premolar, and no
failures with anterior pontics after five years. However, In-
Ceram Alumina has never been recommended for posterior
bridges. Another study found In-Ceram was stronger than
Procera AllCeram.

©2003 REALITY Publishing Co. Vol. 17 The Ratings 105


Ceramics

Fluorescence
In-Ceram Spinell (3.5)
3B Vident

Spinell, a sibling of the original In-Ceram Alumina, utilizes


a translucent magnesium oxide core. It is still reportedly
stronger than other, translucent-core all-ceramic materials.
Spinell is mainly indicated for inlays, onlays, and anterior
crowns, although anterior 3-unit bridges may also be possi-
ble. However, it also cannot be reliably etched, leaving its
bond strength dependent on aggressive sandblasting. But it
can be bonded with Panavia 21 after the sandblasting.

other products in this category


Authentic Ducera Gold Lava
Microstar Dentsply/Ceramco 3M ESPE
Cerabien Duceram Plus Mirage
Noritake Dentsply/Ceramco Mirage
Cercom EX3 Mirage II
Dentsply/Ceramco Noritake Mirage
Cerinate Fortress StylePress
Den-Mat Mirage Metalor
Cergogold HeraCeram Vitadur Alpha
Dentsply/Ceramco Heraeus Kulzer Vident
Colorlogic In-Ceram Zirconia
Dentsply/Ceramco Vident

106 The Ratings ©2003 REALITY Publishing Co. Vol. 17