Alternative technique to conventional casting for construction of metal substructure in metal ceramic restorations

PRESENTED BY TAREK AL-MORADI

MASTER OF CROWN AND BRIDGE

SOHA MONEIR
MASTER OF ENDODONTICS

Success in fabricating metal ceramic crowns and fixed partial dentures depends to a large extent on obtaining high quality castings that are properly designed and well fitting. There are many methods of casting exist:

1- Conventional casting technique. 2- Alternative casting techniques.

1- Conventional casting technique: The conventional lost wax technique has been used since ancient times to convert wax pattern to cast metal. The process consists of surrounding the wax pattern with a mold made of heat-resistant investment material, eliminating the wax by heating, and then introducing molten metal into the mold through a channel called the sprue.

The technique have 3 important topics to mention: 1- Construction of wax pattern. 2- Converting the wax into metal. a- Spruing. b- Investing. c- Wax elimination. d- Casting process. e- Evaluation & finishing. 3- Metal preparation to receive a ceramic material. a- Investment removal. b- Surface grinding. c- Bonding of metal coping and ceramic material through:

 Mechanical retention. 1- Sandblasting 2- Abrasion Compression fit. Chemical bond. 1- Oxidation 2- Precoating 3- Electrodeposition 4- Surface etching 5- Sputtering Vander wall's force.

Casting Defects:
1-Roughness:
The surface of a casting should be smooth, although finishing and polishing are still required. Lines or grooves in the casting were usually present but overlooked in the wax pattern. They may necessitate a remake, particularly if they were positioned near the margin or the fitting surface. Generalized casting roughness may indicate a breakdown of the investment from excessive burnout temperature.

2-Nodules:
Bubbles of gas trapped between the wax pattern and the investment produce nodules on the casting surface. Even minute nodules can limit the seating of the casting to a considerable degree. When they are large or situated on a margin they usually necessitate remaking of the restoration.When small, they can often be removed with a no.1/4 or 1/2 round bur .A binocular micro-scope is extremely helpful to detect and remove nodules.

Remove a slight excess of metal to ensure the nodule does not interfere with complete seating. The key to avoiding nodules is a careful investing technique, a surfactant, vacuum spatulation, and careful coating of the wax pattern with investment. Castings made with phosphate-bonded investment are especially prone to such imperfections, and experience and care are required to produce castings that are routinely free of nodules.

 Rough casting Large nodules

Multiple nodules Nodules on occlusal surface

3- Fins:
Fins are caused by cracks in the investment that have been filled with molten metal. These cracks can result from a weak mix of investment (high water-powder ratio), excessive casting force, steam generated from too-rapid heating, reheating an invested pattern, an improperly situated pattern (too close to the periphery of the casting ring), or even premature or rough handling of the ring after investing.

4- Incomplete casting:
If an area of wax is too thin (less than 0.3 mm), which occurs occasionally on the veneering surface of a metal-ceramic restoration, an incomplete casting may result. Thickening of the wax in these areas is recommended. Incomplete casting of normal-thickness wax patterns may result from inadequate heating of the metal, incomplete wax elimination, excessive cooling ("freezing") of the mold, insufficient casting force, no enough metal.

5-Voids or Porosity:
# Voids in the casting (particularly in the margin area) may be caused by debris trapped in the mold (usually a particle of the investment undetected before wax elimination). A well-waxed smooth sprue helps prevent this. # Porosity resulting from solidification shrinkage ("suck back") occurs if the metal in the sprue solidifies before the metal in the mold, as may happen when a sprue is too narrow, too long, or incorrectly located or when a large casting is made in the absence of a chill vent.

# Gases may dissolve in the molten alloy during melting and leave porosity defects. # Back pressure porosity may be caused by air pressure in the mold as the molten metal enters. Its occurrence is reduced by using a more porous investment, locating the pattern near the end of the ring (6 to 8 mm), and casting with a vacuum technique.

 Incomplete casting Incomplete casting with shiny rounded edges Suck-back porosity Gas inclusion porosity

6- Marginal Discrepancies: Inaccuracies of fit at the margin can be caused by distortion during removal of the wax pattern from the die. They may also result from increased setting expansion following uneven expansion of the mold.

7- Dimensional Inaccuracies: The casting can be either too small or too large. Attention to detail is essential for an accurately expanded mold. A standardized procedure is needed in regards to liquid- powder ratio, spatulation, the ring liner, the amount of liquid added, and mold heating.

 Marginal discrepancy

Under or oversized restoration

Casting defects:

Possible causes:

Incomplete casting

Wax pattern too thin Cool mold Insufficient molten metal

Incomplete wax elimination Debris trapped in the mold usually a particle of the investment Metal in the sprue solidifies before the metal in the mold, as may happen when the sprue is too narrow , too long, or incorrectly located Entrapment of gases in the molten alloys

Incomplete casting with shiny rounded edges Suck-back porosity

Gas inclusion porosity

Marginal discrepancy
Under or Oversized restoration

Wax pattern distortion Uneven expansion

Inadequate or excessive investment expansion

Back pressure porosity

Inability of air to escape through investment pores due to : No venting Long investment bridge Improper finishing of wax pattern Improper W/P ratio Excessive burnout temperature Air trapped during investing procedure Inadequate vacuum during investing Lack of surfactant Excessive vibration Increased W/P ratio Pattern too near edge of investment Premature heating( mold still wet) Too rapid heating Dropped mold

Rough casting

Large nodule Multiple nodules Nodules on occlusal surface Fins

2- Alternative casting techniques.

Electroforming bonded platinum foil coping Metal foil technology sintered powder technology Captek system CAD/CAM SYSTEM Procera allTitan Titan system Cicero system

Swaged gold alloy foil coping

All Ceramic Restorations

THE COMET SYSTEM

I) Electroforming (galvanioforming) technology

its the technique by which a thin layer of pure gold is deposited on polyurethane dies that are coated with a silver spacer using computer controlled platting equipment to control thickness.

The coping is plated with a noble paste primer before porcelain application. This technique has been developed to produce bioesthetic metal-ceramic restoration. Different types of alloys can be used to form coping by this technique as gold alloys, palladium alloys and nonprecious alloys.

Advantages:
Thin substructure. Economic and simplified procedure. Coping strength is greater than other foils.

Disadvantages
Uncertain bond quality or porcelain to metal Technique sensitive Coping strength lower than conventional casting

Marginal adaptation of 15-20 um

No porosity. No opportunity for shrinkage or expansion of the coping

Unknown problems with creep

Helieform HF600 system:

This system uses an electroforming technology to produce a thin pure gold coping. 1. The gold is deposited on polyurethane die that is coated with silver spacer using computer controlled led plating equipment to control thickness.

1. Duplicate the working die with the polyurethane material. 2. Drill the polyurethane and glue the electrode into the die. 3. Apply an even coat of the silver spacer to the preparation and allow it to dry. 4. Insert the dies into the plating equipment. A magnetic stirrer ensures circulation of the cyanide-free gold sulfite solution. 5. Turn on the electric current, and gold will be deposited on the die at an approximate rate of 0.02 mm per hour.

6. After plating, the die is removed by heating and the silver spacer is removed with nitric acid or air abrasion. 7. The surface of the coping is air abraded, then coated with a noble metal paste primer before porcelain application. This system has been adapted for fixed partial dentures.

II) metal foil technology:

A.bonded platinum foil coping:

1- twin foil restorations. 2- bonded single foil restorations

B.Swaged gold alloy foil coping

1- renaissance.
2- sunrise.

A) bonded platinum foil coping

twin foil restorations:

Porcelain can be bonded to platinum foil in such way that the die is covered with a double layer of platinum. The inner layer is adapted on the die while the second layer is placed overall the die surfaces except the shoulder This layer is bonded to the porcelain after tin plating and it will prevent crack formation. The inner platinum foil is removed prior to crown cementation.

bonded single foil restorations:

the single restoration utilizes only one matrix, which is bonded to the core porcelain. Steps: 1. the matrix is adapted till the cervical apron. 2. Piece of rubber dam is punched and stretched over adapted matrix so that it covers the shoulder and the matrix apron but not the axial walls.

3. The matrix is then air abraded with aluminous oxides, where the abrasive particles will not affect the shoulder or the apron because of the rubber covering. 4. The abraded matrix is tin plated and oxidized. 5. Then opaque porcelain is applied, followed by dentine and enamel. 6. A scalpel is used to cut the single foil at the point where plating stops.

Advantages: improved internal adaptation and slightly greater strength when compared with twin foil tech.

B) Swaged gold alloy foil coping:

renaissance:
Renaissance system is a laminated gold alloy foil that is delivered to the user in fluted shape. The foil is placed over an epoxy die adapted and burnished. The final adaptation is achieved by swaging. The adapted, matrix is flame sintered to form a coping. An interfacial alloy powder is applied and fired and the coping is then veneered with porcelain.

Advantage: Adequate strength Good marginal adaptation Ease of use

Disadvantage Indicated for single anterior tooth only

sunrise:
The sunrise system is another gold foil supported ceramic system that uses ceramco II porcelain.

Advantages: a yellow background to porcelain ease of use low cost good esthetic

Disadvantage: Can use to single restoration in which occlusal stress is minimal.

III) Captek system (capillary technology):

Fabrication
1. Once the refractory dies are prepared, the "P Material" is applied.

(Au-Pt-Pd layer)

2. The "P Material" is next pressed in the P-Press and smoothed with an an instrument. 3. The "P Material" is then fired in the oven. This photo shows the particles.

4. After the "P Material" is fired, the "G Material" is applied and fired.

(97%gold)

5. Through capillary action, the "G Material penetrates the "P Material" so you end up with gold on the inside and outside 6. Finished metal.

Advantages
Excellent esthetics Excellent marginal adaptation

Capek unlike other Dental Mental is NOT an alloy but a Composite. This gives the metal a very high melting temperature and a capillary effect when applying porcelain. As shown in the cross section below.

IV) sintered powder technology:

Degusint system:
It is an innovative method for manufacture of fixed dental prosthesis. This method involves direct modeling and sintering of precious metal alloy powder (gold) to form a restoration.

The powder is first compacted then sintered during sintering process which is carried out below the liquidus temperature of alloy. The powder particles form a compact material, resulting in sintering shrinkage which be kept to minimum in order to achieve a precise fit.

The degusint system achieves this by employing specific grain size, shape, and distribution. Degusint powder is spherical; the grain size is adjusted so that the gaps between larger grains are filled with smaller ones, resulting in high density.

This system is used for fully anatomical inlay. on lay. crowns. and metal substructure in metalceramic restorations.

V) CAD/CAM process

The process can be use to prepare metal inlays and crowns from alloys that difficult to cast, such as pure titanium and titanium alloys. There is no need for either an impression the prepared tooth or casting procedures.

There are many system used among which are: Minnesota system computer aidedprosthetic system(CAP) precident system micro-denta system titan system procera system Cicero system THE COMET SYSTEM

Procera system:
Procera allTitan

This is a combination of copy milling and spark erosion tech. in which, the external contour of the crown or coping can be shaped out of a solid piece of Ti or Ti-alloy by milling machine. While the internal contour is spark eroded with a carbon electrode.

1. A stone die or replica of the prepared natural tooth was scanned using the Procera Scanner

2. the data transferred to the computer were used in the design process to develop specific characteristics for the coping.

3. The coping was produced in titanium using electric discharge machining and copy milling techniques to create the restoration substructure 4. a veneer material of low-fusing porcelain was added to the coping to create the anatomical and occlusal requirements in the restoration

This process is used to prepared attachments, crowns and inlays from metals and alloys (Ti, Ti alloys). Multiple Procera AllTitan copings have been used to fabricate the titanium substructure for a fixed bridge restoration. In this situation, the titanium units and a titanium pontic are laser welded together to form the multi-unit restoration.

Disadvantage:
The surface and color instability of low fusing porcelain.

Titan system :
Its CAD/CAM system that produce metal copings for porcelain fused to metal single and multiple restorations. This system uses stone dies fabricated from regular impression tech. however, it uses a computerized mechanical mill to fabricate coping on bases of data recorded directly from the die surface and dose not require Wax patterns.

Steps:
1) digitizing from the die surface. (From 3-8 min.) 2) Mathematical processing of data program (program the computerized mill). (From 8-12 min.) 3. Milling or processing of the copings from discs or blocks of titanium or other alloys. (From 20-25 min.)

The milling process consists 3 steps

1. rough milling the inside of the coping to remove the bulk of the material. 2. Fine milling to increase the accuracy. 3. Rough external milling.

The multiple unit restorations constructed in the same way of the single unit in addition to: Determination of the position of the pontics. determination of the shape and size of the connectors between units

Cicero system:
Its CAD/CAM system produce ceramic fused to metal restorations such as crowns, fixed partial dentures and inlays with different layers as metal dentin and incisal porcelain, for maximum strength and esthetics.

Cicero system makes use of a fast laser-stripe scanning method to measure the three dimensional geometry of preparation and its surrounding and opposing teeth.

Steps:
1. vedio camera is used to scan the preparation 2. a computer calculates the pinots by triangulation and information is digitized from master cast. 3. Design of the restoration is manipulated by dentist to choose the best design.

4. Cicero refractory block is fixed with high precision in the milling machine, and creating a refractory model. 5. Then sintering of a thin layer of alloy powder on the refractory model is done. The powder consists of aluminumoxidebased ceramic

6. The Cicero porcelain is then applied in the appropriate shade. A paste porcelain tablet is pressed on metal covered refractory die and fired under standardized conditions vacuum in porcelain funace. 7. The refractory block is then replaced in the milling machine to the interface of the porcelain and fired

8. The external surface of the crown is then milled for characterization of grooves, fossae and cusp lines. 9. Last step is individual staining and glazing of the external surface. 10. Finally, refractory die is removed by grinding and air abrasion.

THE COMET SYSTEM

The COMET system uses stone dies fabricated from impressions. Three steps are involved: (1) Digitizing data from the die surface or a wax pattern surface. (2) Mathematical processing of data to program the milling machined. (3)Milling of copings, crowns, multiunit restorations, and implant abutments.

1) An impression is obtained of the prepared abutments in the patient and the master cast poured in die stone. 2) The planned restoration is then waxed 3) wax pattern optoelectronically Scanned and digitized. 4) After removing the wax pattern from the die, the surfaces of the abutments in the cast are digitized as well.

5) The prepared abutment surface and contact and occlusal surfaces of the adjacent and opposing teeth on the master model are digitized. 6) A CAD program is used to generate the new crown surface; whereas, the crown interior is computed from the abutment surface data. 7) For the production of custom copings, it is sufficient to digitize the prepared abutment on the master cast. Exterior and interior surfaces of the copings are computed by the software.

 This system can be used to construct: Single crowns, inlays, onlays, and FPD frameworks can be made of various metals or metal alloys, ceramics, or resin materials.

All Ceramic Restorations

1) Aluminous core ceramic 2) Leucite reinforced porcelain 3) Glass ceramic:

A. Dicor. B. Cerapearl

4) Injection-molded glass-ceramics 5) In-Ceram 6) Machined ceramic:

A. Cerec B. Celay C. Procera All Ceram system