Dental Porcelain (2) Dental Material II Lecture # 14

Today we will continue with different system of Porcelain and different ways for adding porcelain to make restorations ,we talked about Alumina about reinforcing porcelain to make it stronger , to make its compressive strength better . Now another system which is very famous as well and commonly use nowadays by laboratory and by dentist its the :

Empress system:
Now basically this system means that they make the restoration in a wax pattern, inserting the wax ,melt it away and Inject porcelain inside the mould , just like the Lost Wax technique, similar method ,better adaptation of the restoration , so you shaping your restoration or you making the crown with wax or the bridge and then you pour the investment material around it in a mould you place it in the oven and then porcelain injected inside under pressure , it will flow inside and fill the space which was left by the wax , to produce the crown or the bridge .

This system has developed, It starts with a system called Cell stone(not sure) it basically the method is similar But the material became different a little bit, they improve the material they make it stronger so that the resulting Crown or Bridge would have good flexural strength ,compressive strength and it will handle the stress well inside the oral cavity. They produce the crown or the bridge by injecting the porcelain material into the mould for better adaptation, when the material cools

down it might shrink a little bit, so they incorporated magnesium oxide (not sure) to minimize shrinkage a little bit. Empress system -Empress I -Empress II The difference is the type of material, the type of porcelain. In porcelain the more glass crystals you got the more strength you have ,but it will be slightly more opaque, so it will not be as aesthetic as a material with less amount of crystals in. In porcelain we have: silicate, glass particles Note: If you get more crystalline structure you get better strength, but less translucency, the aesthetic will be slightly inferior compared to a material have less crystals. The difference of the structure will affect the way the material will appear and the strength of the material (the properties). In Empress I : they use a material called Leucite-reinforced feldspar glass ceramics, which means its reinforced by crystals, again the technique is similar to the lost wax technique.

Empress II: slightly different material and minerals. -lithium Disilicate -Apatite Glass Ceramics The strength is up to 400 MPa. It can be use for Crown in the anterior and premolar regions. In the posterior part of the mouth it is not strong as the Conia(not sure) (>700 Mpa) if you remember it .

So its suitable for three unit bridge to replace ant. or premolar Missing teeth . Pic24. Show 3 Unit Bridge replace ant. Teeth, made by lost wax technique. It can be used in making core for example, on top of this core layers of enamel of porcelain can be added, to give esthetic appearance of crown or bridge.

Cast glass and polycrystalline ceramics : Slightly different material but the same method (lost wax technique) Reinforced by making them more crystalline, it has fluoride, magnesium, potassium the compositions might be slightly different but this material does not have as many crystals as Empress I,II . when its injected, the crown at first appear more transparent, and for making it opaque they reheat it ,and they add layer of porcelain and glaze to make it looks more aesthetic.

So :

-Lost wax technique. -slightly different material. -More glassy, less crystalline. -appear transparent at first. - reheat it to make it more Opaque. -change the composition and crystalline structure a little

bit. - add layer of dentin and enamel porcelain to make it look good, more natural.

Used for single crowns not a bridges, cause its not strong as reinforced material, they need a metal underneath them to use in the posterior part of the mouth.

Now an example of New technique is the: Computer aided design/computer aided manufacture (CAD/CAM) porcelain restorations : Traditionally In clinic we prepared the tooth, take an impression, send it to the lab, the technician start to make the restorations for the clinic. But here a machine is doing the work. so as a dentist u do your preparation and you have the machine connected to the computer which connected to a camera and you take a picture for your preparation, this picture will be transferred to the computer, the machine will start to carve (milling) the restoration from porcelain to make the crown for you, the restoration might be ready for 20 min, the machine will depend on the picture u took for the preparation in your patient mouth.

The design will be done 10-25 min. The cementation will be by several cements resin cement, GIC cement. Pic slide 29: this is the machine and the intraoral camera ,take the picture for the preparation . Pic slide 30: here the machine will start to carve/drill the porcelain block to make the crown /inlay/onlay/veneer.. Any type of porcelain can be used It doesnt matter. So the Idea this machine: - save time and effort.

But it has disadvantages : - its not accurate as the lab work (technician),the crown will not fit accurately as the work which made at the lab by the technician ,means that the margin of the crown which done by machine will not fit and will be space between the cavity and the tooth that will lead to micro leakage. This is the major problem in this system. Clinical consideration: - The preparation should be smooth at possible no irregularity. - The surface of the preparation is coated with a reflective material, so when you take the picture it will be very clear.

Material that can be used include: -conventional feldspathic precelain. -Glass ceramics. -Inceram like porcelain.

Just a few words about Porcelain fused to metal(PFM) restoration: We said that Metal provide strength, support. Porcelain provide the esthetic appearance. The thickness of the metal can be up to 0.3-0.5 mm, the rest of the space or the thickness is for porcelain, so that its strong enough ,because it will be weak in thin sections (we talked about this last lecture).when restoration is made the color of the metal will mask or cover by layers of opaque porcelain to cover the black/dark color of the metal and then add the other layers of porcelain to make it look natural . The porcelain that used need to be:

- strong enough and reinforced with crystals, which add strength and they also affect the CTE of porcelain.

Porcelain its very different from metal (Porcelain have low CTE) , metal has a high CTE its a metallic material ,Now these two material because they are connected with each other they need to have similar CTE so they contract and expand at similar range ,no stress or fracture ,so we reinforced porcelain with crystals will have higher CTE close at possible to metal. So they will have similar properties, so they will respond to temperature changes in similar ways it will minimize stress.

*Reinforcing porcelain with crystals or using crystalline porcelain will increase the CTE of porcelain and it will be close to the metal that will minimize the chance of stress formation between the material at the bonding interface which will minimize crack formation and fracture of porcelain.

We need certain requirements for the metal too in the restoration: -be able to withstand the temperature during firing of the porcelain. -should be rigid enough to support porcelain, so thickness of metal below 0.3 its not good enough, it will be too weak. -should be able to bond with porcelain otherwise it will be separate and the porcelain will fracture. -CTE similar to that of porcelain. So we have certain requirement for porcelain and for metal, so they will act as one Unite, handle the stress inside the oral cavity.

Types of alloys that can be used : Any type of alloys can be used to make porcelain fused to metallic restorations.. -High gold alloys -low gold alloys -Based metal alloys. High gold alloys: Contain palladium and platinum It decreases the CTE of metal to be closer to porcelain. _ it could also raise the melting temperature of the metal (to prevent melting during firing).

They add Tin and Indium to promote bonding metal with porcelain. These will form oxide on the surface of the metal this oxide will make the connection between porcelain and metal. The disadvantage of high gold alloy: - melting range is still low, the metal may become weak under high temperature and start to change its shape . -they are not stiff or rigid enough, the Modulus of elasticity is low . Since it got high gold quantity its slightly softer than you want it to be, so that way they not commonly used.

Low gold alloys:

Have better option: content.

- Not expensive since they have low gold - Better stiffness. - melting range is higher.

Silver-palladium alloys: Similar advantages to Low gold alloys but got silver in them.

Nickel-chromium alloys: -Rigid enough -high melting range, so they will not affected by high temperature during firing of porcelain. Disadvantage: - it might be voids in casting of the metal.

-high casting shrinkage .which means the size of your restoration might change. -its bond strength to porcelain Low compared to other alloys.

Pic slide 43: metal core is made and then they start to add opaque layer of porcelain and then gingival ceramic incisal ceramic or enamel or dentine layer just to give the shade and the appearance in a good way.

Pic slide 44: this is an example of ceramic oven ,where firing occur ,so they place the restoration inside this oven so that the layer of porcelain become solid ,take it out and then add another layer and then in out ..in at least 3 times .

Porcelain failures: -Mostly the failure happen at the bonding between porcelain and metal, if the oxide layer its too thick its not good for bonding its needs to be thin, and if the oxide layer is inadequate not completely covering the surface of the metal, it will be a site of stress formation a site of weakness and it might lead to fracture of porcelain in top of it .

-Incompatibility of CTE between metal and porcelain, it leads to stress formation and fracture. usually porcelain have slightly less CTE compared to the metal because when its shrinks as it cools down compressive stress forms and porcelain is strong at the compression. Porcelain repair: Can be done if the fracture is small, no need for repeating the whole crown.

All ceramic restorations: Or porcelain jackets crowns, they all made of porcelain no metal in it . More aesthetic, but not strong. Especially made for the ant. Teeth . Now what type of porcelain can be used? Reinforced porcelain, because no metal to support the ceramic material ,so we need it to be strong enough even its in the ant. Teeth .

Pic slide 45: Its a comparison between two crowns ,one of them made of metal and the other made of porcelain alone .

All ceramic crowns: we need core ceramic (alumina), and on the top of it we add dentin or enamel porcelain or porcelain similar to the cervical enamel area maybe slightly more yellowish ( in gingival margin is slightly yellowish than the rest of the tooth, why? because the enamel is thin in that area ), so they got self porcelain that has similar shade so that can be replicate similar shade of the natural tooth. Why did these restorations appear more natural? Because the way they reflect and absorbed light is similar to natural teeth.

So: -They resemble the translucently of enamel the bluish translucently of enamel is replicated. -They resemble the way dentine absorbed light and reflect it yellowish color of dentin is replicated. Inceram , Empress system ,reinforced ceramic porcelain can be used . Table slide 47: this table shows you different product available in the market, you will be more familiar with them in your clinic in the future.

Porcelain veneers: If you have malformation in your tooth like peg lateral or diastema and you want to correct it, we said that we can correct it by composite, but we have here better option which is porcelain why? Stronger. - More biocompatible.

Better shade better esthetics.

Pic slide 49 :in this case we adjust the appearance ,we close the diastema . Again any type of porcelain can be used for this, and we use resin cement to bond them and these cement also have shades so our shade even will be better .Both veneer and cement will have good shade whish make your restoration esthetically better. Again: - Better esthetics. - Biocompatibility. - Better surface finish. - Abrasion resistance is higher. Comparison to composite veneer. Capillary technology: They use a strip of wax, this strip contain metal, particles of palladium . they adapt it on the model (die),place it on the oven ,the wax will melted away ,a net of palladium will be left ,this network has spaces inside it ,they add another layer of wax which contain gold ,and place it again in the oven ,Now any space of the network will be filled with gold ,so will have solid surface core made of palladium and gold, on this core we add layers of porcelain to get a natural appearance. So this different way to make this crowns Capillary technology. Because of the network, the surface of the core will be irregular, and the bonding between this metal and porcelain will be mechanical.

Bonded platinum foil: Here the restoration will not be very strong, they use platinum foil, they add two layers of platinum foil on the model, and on top they add layers of porcelain to produce the restorations. One of these layers will be removed, why? Because we want space for the cement and only one will remain to support the ceramic. -its not strong as the traditional porcelain fused to metal restoration. Its not commonly used, but its a technique.

Forgive me for any mistake; its my first time in scripting .

I would like to thank my colleague Muhammad F Khatib for helping me out .^_^ .Thanx for everything . Done by me : Ahlam Gmal Abo kaf .

Good luck for everyone.