LES JOURNES DENTAIRES INTERNATIONALES DU QUBEC 2011

PRESENT

NAVIGATING THROUGH THE MAZE OF ALL CERAMIC RESTORATIONS

BY DR. RICHARD A. WILLIAMSON, DDS, MS, FACP

TUESDAY, MAY 31ST, 2011

8:30 a.m. to 11:00 a.m.

Navigating Through the Maze of All Ceramic Restorations Richard A. Williamson, D.D.S., M.S., F.A.C.P. University of Iowa College of Dentistry Department of Family Dentistry 1. 2. 3. 4. 5. Advantages of All Ceramics Disadvantages of all Ceramics Advantages of metal ceramics Disadvantages of metal ceramics Understanding All-Ceramics 5.1. Veneering porcelain 5.2. Core 5.3. Ceramic Composition 5.4. Strength / Esthetics 5.5. Type of Restoration 5.6. Categories of Ceramic Systems 6. Ceramic composition categories 6.1. Predominately Glass (Esthetic Ceramics) 6.1.1. High Aluminosilicate Glass content 6.1.1.1. Feldspathic or Synthetic

6.1.2. Small amount of fillers 6.1.2.1. 6.1.2.2. 7. Leucite (40-50%) High melting glasses

Particle-filled Glass (stronger) 7.1.1. 7.1.2. Lithium Disilicate (70%) Alumina (70%)

7.1.3. 8. Polycrystalline Ceramics (strongest) 8.1. 8.2. 9. Procera IPS e.max ZirCAD , Cercon Zr, Lava Zr, InCeram YZ

Strength vs Esthetics 9.1. Translucent Ceramic (high glass content) 9.2. High Strength Cores + Layering ceramic

10.

Translucent Ceramics 10.1. 10.2. 10.3. Sintered Feldspathic Pressable Ceramics CAD/CAM

11.

High Strength Cores 11.1. Opaque High Strength Cores Lithium Disilicate Alumina Zirconia

11.1.1. 11.1.2. 11.1.3. 11.2. 11.3.

Esthetic Layering generally required Does not require bonding

12. Type of Restoration 12.1. 12.2. 12.3. Porcelain Laminate Veneers Partial Coverage Restorations Conventional Crowns Covering metal (Cast Post and Core) Covering acceptable colored dentin Covering discolored dentin/metal posts

12.3.1. 12.3.2. 12.3.3.

13.

Categories of Ceramic systems 13.1. 13.2. 13.3. Glass-based Ceramics Alumina-based Ceramics Zirconia-based Ceramics

14. Glass-Based ceramics 14.1. 14.2. 14.3. Feldspathic Leucite reinforced Lithium Disilicate Lithium Disilicate

14.3.1.

14.3.1.1. IPS Empress 2 14.3.1.2. IPS e.max Press 14.3.1.3. IPS e.max CAD (CEREC inLab system) 15. Alumina-based ceramics 15.1. 15.2. 15.3. 15.4. 16. In-Ceram Alumina In-Ceram Spinell In-Ceram Zirconia Procera

Zirconia based ceramics 16.1. 16.2. Lava IPS e.max ZirCad

17. Zirconia 17.1. A polymorphic material in 3 forms Cubic Tetragonal Monoclinic

17.1.1. 17.1.2. 17.1.3. 18.

Zirconia based ceramics 18.1.1. 18.1.2. 18.1.3. 18.1.4. CAD-CAM Technology Design 20-25% enlarged coping/framework Milled from homogeneous green state zirconia After milling sintering 20-25% shrinkage

19.

Zirconia based ceramics 19.1. Lava Veneering porcelains 20.1. Consist of a glass + crystalline phase over a core 20.1.1.1. Crystalline phase 20.1.1.1.1. 20.1.1.1.2. 20.1.1.1.3. Fluorapatite Aluminum oxide Leucite

20.

20.1.1.2. Core under veneering porcelains 20.1.1.2.1. 20.1.1.2.2. 20.1.1.2.3. 21. Lithium - disilicate Core Aluminum-oxide Core Zirconium-oxide Core

Success of all-ceramic restorations

22.

Failure of all-ceramics 22.1. Primary cause of Failures for all-ceramic Fixed Partial Dentures (FPDs) 22.2. Primary cause of Failures for metal-ceramic FPDs

23.

Evidence Based Literature 23.1. 23.2. IPS Empress Veneers Feldspathic Porcelain Veneers

24. Ceramic Inlays/Onlays 24.1. 24.2. CEREC CAD/CAM Inlays/onlays IPS Empress inlays/onlays

25. Extensively Studied All-Ceramic Systems 25.1. Leucite-reinforced glass-ceramic 25.1.1.1. IPS Empress 25.2. Glass-infiltrated ceramics 25.2.1.1. In-Ceram Alumina 25.2.1.2. In-Ceram Spinell 25.3. Polycrystalline Alumina 25.3.1.1. Procera Alumina 26. IPS Empress Single crowns 27. IPS Empress 2 single crowns 28. IPS Empress 2 Crowns/FPDs 29. In-Ceram single crowns 29.1. In-Ceram Alumina and Spinell Crowns

30. Procera AllCeram single crowns

31. Zirconia-modified alumina ceramic 31.1. In-Ceram Zirconia core

32. All Ceramic Fixed Partial Denture (FPD ) 32.1. 32.2. Zirconia Fixed Partial Denture frameworks Lithium-Disilicate Fixed Partial Denture (FPD ) frameworks

33. All ceramic Resin Bonded FPDs 34. Choosing an all ceramic system 35. Ivoclar Porcelain Options 35.1. 35.2. 35.3. 35.4. 35.5. IPS Empress Esthetic- Leucite reinforced IPS Empress CAD- Leucite reinforced IPS e-max Lithium Disilicate IPS e-max Zirconium IPS e-max Ceram veneering porcelain

36. Lithium Disilicate 36.1. Full Contour or Substructures 36.1.1.1. IPS e.max CAD 36.1.1.2. IPS e.max Press 36.1.1.2.1. Layering with IPS e.max Ceram Nanofluorapatite

36.1.1.2.1.1. 37. Zirconium 37.1. Substructures

37.1.1.1. IPS e.max ZirCad 37.2. 37.3. Zirliner necessary for bond and fluoresence Full Contour

37.3.1.1. IPS e.max Ceram 37.3.1.2. IPS e.max ZirPress 38. Leucite reinforced 38.1. Fabrication options 38.1.1.1.1.1. 38.1.1.1.1.2. Press CAD/CAM

39. Lithium Disilicate Indications for Anterior and Posterior substructures 39.1. 39.2. 3-unit FPD substructures up to 2nd premolar (molar if not layered: pressed) Cementation 39.2.1.1. Adhesive bonding 39.2.1.2. Conventional 40. Zirconium Fabrication Options 40.1. CAD/CAM

41. Zirconium Luting 41.1. 41.2. Conventional Adhesive bonding (DO NOT Etch)

42. Summary 42.1. Ceramic based systems Composition Strength vs Esthetics How to Choose

42.1.1. 42.1.2. 42.1.3.