Advances in All Ceramic Restorations. Alaa AlQutub Umm AlQura University, Faculty of Dentistry

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1 Advances in All Ceramic Restorations Alaa AlQutub Umm AlQura University, Faculty of Dentistry

2 Types of materials used in esthetic zone I. Metal ceramic restoration: Metal ceramic alloy features : Produce surface oxide Coefficient of thermal expansion is greater than that of porcelain veneer Melting range higher than the fusing temperature of dental porcelain. Not distort at firing T. of porcelain Ease of use Biocompatible

3 Classification of dental casting alloys: Based on function (type I,II,III, IV) Based on color or composition yellow golds White golds Low gold High palladium Silver palladium Palladium silver ADA classification : High noble (noble metal content >60 % and gold >40%) Noble (noble metal content >25% ) Predominantly base (noble metal content <25%).

4 Chemical components of dental porcelain: Alumina, Feldspar, Quartz, Kaolin Component of dental porcelain kit: 1. Opaque porcelain: Made by addition of insoluble metallic oxides----high refractive indices Thickness of this layer depends on: brand of porcelain and the shade ) Minimum thickness.2mm and the maximum is.5mm( Function: it establish the metal porcelain bond it masks the color of the metal

5 2. Dentine porcelain: It correspond in color to the dentin of natural teeth The bulk of the crown is made by it Major determinant for shade It may extend to the incisal one third or occlusal surfaces 3. Enamel porcelain: More translucent than the dentin porcelain Restricted range of shades Not restricted to one area of a tooth 4. Translucent porcelain: Don t allow for transmission of all light Applied to the entire surface of the crown Gives depth and natural enamel like translucency

6 5. Stains : Contain less silica or alumina more sodium and potassium oxides Mixed with lower fusion point porcelain 6. Glazes: Colorless low fusing porcelain Fills small surface porosities and irregularities Re creats the glassy appearance of natural tooth

7 Mechanism of bonding: Van der waal forces Mechanical retention Compression bonding Direct chemical bonding Requirements to bond to metal: High CTE It should have slightly lower CTE than that of the alloy

8 Oxidation: o Cleans the metal of organic debris and remove trapped gases o It allows specific oxides to form on the metal surface o Over oxidation responsible for bond failure Post oxidation treatment: For removing oxide layer : o Chemical method o Mechanical method

9 II. All ceramic materials Aluminous core ceramic:. Composed of aluminum oxide crystal in a glassy matrix.. an opaque inner core composed of(50%) alumina for high strength. this core was veneered with a combination of esthetic body and enamel porcaline.. 40% stronger than traditional porcalin. Slip cast ceramic(in- ceram):. Used in crowns and veneers. In ceram is about 3-4 times greater than earlier alumina. 2 modified porcalin (in ceram ) :in ceram S pinell(mgal 2o4) - in ceram zirconia(zro2). Adv:. high strength.high fracture toughness. Dis: fair marginal fit. High enamel abrsiveness

10 Hot pressed ceramic o Types : 1. Leucite based (leucite is the major crystalline phase) ex: Empress. Optimal. Cerpress. Finesse. Advantages: medium strength and fracture toughness and enamel abrasivness Disadvantages: fair marginal fit 2. Lithium silicate based (ex :empress 2 empress cosmo) Advantages: high to medium strength high fracture toughness low enmel brasivness Disadvantages: fair marginal fit

11 Machined ceramic (CAD/ CAMsystems) Cerec system: consist of computer integrated imaging and milling system at lest 3 materials can be used(vita mark dicor. MGC.procad) Disadvantages: poor marginal fit, lack of sophistication marginal adabtation of cerec 2 is improved and the occ anatomy can be shaped Celay system : uses a copy milling technique to manufature ceramic inlay and onlay Advantages: marginal ccuracy seem to be little better than the cerec 2 procera system: advantages: very high fracture togh medium strength Disadvantages: fair marginl fit

12 Metal reinforced : Types: Captec system and electroformed (produces a thin pure gold coping) Advantages: good marginal fit - excellent esthetic -medium enamel abrasion - medium fracture tough disadvantages : low strength

13 III. Fiber reinforced composites Indication : optimal esthetic need. decrease wear to opposing teeth. conservative abutment prep use of adhesive luting tech. metal free Contraindications : inability to maintaine fluid control. long span needed. pt with parafunctional habit. Unglazed opposing porcelain. Pt who abuse alcohol Advantage : Good flexure strength and other physical characteristics. FRC is translucent and require no opaque masking. FRC have been to make two phase all polymer prostheses (internal glass fiber reinforced composite covered by a particulate composite)

14 Available materials: Classified according to: 1. type of fiber ( glass,polyethylene and carbon) 2. fiber orientation ( unidirectional, braided and woven) 3. whether the fiber is impregenated by the dentist or lab: there are available non-impregnated materials (polyethylene preimpregnated material weaves and glass weaves). Or (Vectris, Fiberkor, splint-it ). 4. whether the material is formed by hand or with a machine.

15 Tooth Preparation For All Ceramic Restoration 1. Complete Ceramic Crowns: Advantages: Superior esthetics Good tissue response even for subgingival margin Slightly more conservative of facial wall than metal ceramic Disadvantages: Reduced strength compared to metal ceramic crown Proper preparation extremely critical Among least conservative preparation Brittle nature of material Can be used as single restoration only

16 Indications: High esthetic requirement The tooth should be relatively intact with suffient coronal structure to support the restoration Favorable distribution of the occlusal load Contraindications: When more conservative restoration can be used Rarely recommended for molar teeth

17 Preparation:

18 2. Ceramic Inlay & Onlay Indications: Demand for esthetics Low caries rate Intact buccal & lingual enamel Contraindications: High caries index Poor plaque control Bruxism Advantaged: Superior esthetics Conservative Durable Disadvantaged: Abrasive of opposing teeth Difficult to adjust occlusion Wear of luting agent Expensive Long term success rate unknown

19 Preparation steps:

20 3.Porcelain laminate veneers Indications: Discoloration or damaged anterior teeth Contraindications: High caries index Poor plaque control Bruxism Disadvantges: Increased tooth comtour Expensive

21 Preparation steps:

22 Difference between preparation of all-ceramic restorations and other types of preparation especially preparation of fiberreinforced composite restorations

23 Cast Restorations Intra-Coronal Extra-Coronal Intra-Radicular Inlays Onlays Post & Core Full Coverage Partial Coverage All Metal All Ceramic PFM ¾ Crown Modif. ¾ Crown Revere ¾ Crown 7/8 Crown Proximal ½ crown Pin modif ¾ crown

24 Metal Ceramic preparation (PMF)

25 Partial Coverage ¾ Crown: posterior

26

27 anterior

28 7/8 preparation:

29 proximal ½ crown:

30 Fiber-Reinforced composite FPD

31

32

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