Current All-Ceramic Systems

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1 Current All-Ceramic Systems JAN 2011 CDR Scott Kooistra, DC, USN In-Office Systems Page CEREC E4D Dentist 9 Lab-Based Systems Feldspathic 2 IPS Empress Esthetic 3 IPS e.max Press 4 IPS e.max CAD 6 IPS e.max ZirCAD 14 IPS e.max ZirPress 4 CEREC inlab InVizion 12 In-Ceram for CEREC inlab 12 CERCON 15 Lava / Lava DVS 16 BruxZir 17 Procera 18 Glass-Infiltrated Systems 19 In-Ceram Classic 19 Wol-Ceram 20 1

2 FELDSPATHIC SINTERED [powder liquid] Products: IPS d.sign veneering ceramic Ivoclar VITA VM-7 overlay for ceramic frameworks VITA VM-9 overlay for zirconium oxide VITA VM-13 overlay for metal frameworks VITA VM-15 overlay for metal frameworks Synspar/Softspar Ceramco 3 overlay for metal Finesse overlay for pressed ceramics VITA VITA VITA VITA Jeneric Pentron Dentsply Ceramco Denstply Ceramco ** HUNDREDS OF DIFFERENT PRODUCTS ** Traditional powder-liquid slurry "stacked" onto metal or ceramic Excellent esthetics and translucency LOW flexural strength (<100 Mpa) MUST be etched and resin-bonded to tooth (veneers) Manufacturer-specific to a particular system (i.e. Ivoclar IPS d.sign porcelain overlaid on Ivoclar metals, etc) Porcelain veneers (certain products) Overlay porcelain on ceramic and metal copings and frameworks 2

3 PRESSABLE CERAMICS - leucite reinforced Products: IPS Empress Esthetic Ivoclar Finesse Pressable OPC Cerpress SL Fortress Authentic Cergo Kiss Dentsply Ceramco Jeneric Pentron Dillon Mirage CDP Jensen Degudent [ other products available] Leucite particle reinforced (2-4 micron particles evenly dispersed) Lost-wax technique; heat pressed Excellent esthetics and translucency Moderate flexural strength ( Mpa) Can be surface stained or cut back/layered with feldspathic porcelain MUST be etched and resin-bonded to tooth structure for strength Pressed porcelain veneers Inlays & onlays Anterior all-ceramic crowns through first molar (if bondable to tooth) * NOT indicated for 2d molars, bruxers, or when bonding not possible 3

4 PRESSABLE CERAMICS - lithium disilicate Products: IPS e.max Press Ivoclar IPS Empress 2 [Production Discontinued] OPC 3G Ivoclar Jeneric Pentron Lithium disilicate crystal reinforced framework / coping Lost-wax technique for frameworks / copings ALL copings and frameworks overlaid with feldspathic porcelain Very good esthetics and translucency Excellent marginal fit Moderate flexural strength ( Mpa) Moderate masking of underlying tooth/restorative structure Recommend bonding to tooth BUT, conventional cementation possible Anterior 3-unit FPDs (through 2d premolar as abutment) Anterior crowns Veneers? Possible, but thicker since coping with overlay porcelains PRESSABLE CERAMICS - other Products: IPS e.max Zirpress Ivoclar CERCON Press Authentic Dentsply Jensen [other products available] Stronger than feldspathic "layering" porcelains; possibly better margins Pressed ceramic over metal copings and FPD frameworks Pressed ceramic over zirconium oxide crown copings and FPD frameworks 4

5 CAD-CAM - in office Product: CEREC 3 Sirona ** 25 year track record over 15 million restorations placed ** Intra-operatory scanning of prepared tooth Intra-office milling of restoration Numerous ceramic/composite material blocks available Very Good esthetics depending on material utilized Restorations can be polished or surface stained and glazed Can be cut back and layered with feldspathic porcelain to increase esthetics CEREC 3 - MATERIALS Sirona has partnered with VITA, Ivoclar and 3M ESPE to establish a large group of diverse materials available for milling with the CEREC 3 system. Currently, the most commonly used materials for use with the CEREC 3 system include: Product: CEREC Blocs Sirona / VITA High-quality feldspar ceramic 12 monochromatic and 3 polychromatic blocks 140 MPa Utilizes CEREC color-choosing system MUST be etched/silanated and resin-bonded to tooth structure Indication: Inlays & onlays Veneers Anterior crowns 5

6 Product: IPS Empress CAD Ivoclar Leucite-reinforced ceramic; identical to pressed Empress material 160 MPa 3 types of blocks available: High translucency (HT) - monochromatic Low translucency (LT) - monochromatic Multiblocks varying chroma from cervical to incisal Can be cut back and layered with IPS Empress Veneer porcelain to optimize esthetics MUST be etched/silanated and resin-bonded to tooth structure * Use with either CEREC 3 or CEREC inlab systems Inlays & Onlays Anterior Crowns Posterior Crowns Veneers Product: IPS e.max CAD Ivoclar Lithium disilicate glass-ceramic Partially-sintered "Blue Block" 360 MPa Once milled and adjusted in the mouth, must be fully sintered in vacuum oven Can be bonded OR conventionally cemented! Capable of blocking underlying discolored tooth structure or core material Inlays & Onlays Veneers Anterior Crowns Posterior Crowns - when extra strength required or bonding not possible 6

7 Product: Paradigm MZ100 3M ESPE Composite material (84% ceramic filler) Monochromatic blocks No firing or glazing necessary 145 MPa Highly polishable with excellent esthetics MUST be etched/silanated and resin-bonded to tooth structure Inlays & onlays Veneers Anterior crowns Product: Paradigm C 3M ESPE Leucite-reinforced glass ceramic Easy to polish Can be stained and glazed to provide characterization 150 MPa MUST be etched/silanated and resin-bonded to tooth structure Inlays & onlays Anterior crowns Veneers Product: Mark II Vitablocs VITA Fine particle feldspar porcelain 140 MPa Monochromatic blocks, can be stained/glazed Excellent wear similar to enamel 7

8 High degree of translucency Easy to polish and glaze MUST be etched/silanated and resin-bonded to tooth structure Inlays & Onlays Anterior Crowns Posterior Crowns Veneers Product: VITABLOCS TriLuxe VITA Polychromatic blocks Inlays & Onlays Veneers Anterior Crowns Posterior Crowns 3 different chroma in one block, corresponding to cervical, body, incisal Manufactured of Mark II fine particle feldspar ceramic Product: VITABLOCS TriLuxe forte VITA Polychromatic blocks Inlays & Onlays Veneers Anterior Crowns Posterior Crowns Slight variations in shade transition as compared to VITABLOCS TriLuxe Product: VITABLOCKS RealLife VITA Unique Polychromatic blocks - 3-dimensional block structure with dentin core and enamel coat Imitates curved shade transitions naturally seen between dentin and incisal edge Veneers, Anterior Crowns, Posterior Crowns 8

9 Product: E4D Dentist D4D Technologies Company founded in 2003 ** VERY SIMILAR TO CEREC 3 ** Intra-operatory scanning of prepared tooth Intra-oral digitizer can record images without contrast medium (i.e. powder spray) DentaLogic software creates virtual model Intra-office milling of restoration with wireless connection to E4D mill Multiple ceramic material blocks available Good esthetics depending on material utilized Restorations can be polished or surface stained and glazed Can be cut back and layered with feldspathic porcelain to increase esthetics Inlays, Onlays, Crowns, Veneers E4D - MATERIALS D4D Technologies has partnered with Ivoclar and 3M ESPE to establish a group of diverse materials available for milling with the E4D system. The blocks of materials are the same as those utilized by CEREC 3. Currently, the most commonly used materials for use with the E4D system include: Product: IPS Empress CAD Ivoclar Product: Paradigm C 3M ESPE Product: Paradigm MZ100 3M ESPE Product: IPS e.max CAD Ivoclar [Characteristics and indications described in the "CEREC 3 - MATERIALS" section of this handout] 9

10 CAD-CAM (LAB) Product: CEREC inlab Sirona Intro 2002 Lab-based system Scanning of dies / milling of full contour restorations (inlays, onlays, crowns) Scanning of dies / milling of copings and frameworks that must be overlaid Mills materials from Sirona, 3M ESPE, Ivoclar, and Vident ** VERY POPULAR SYSTEM - EVER EXPANDING RANGE OF MATERIALS AND PRODUCTS IT CAN MILL ** ** NEW inlab MC XL milling unit introduced 2008 with following characteristics: - Greater productivity than original MC L milling unit - 60,000 RPM tandem burs - 6 minutes full-contour crown units per day +/- 25 micron precision ** ineos scanner and infinident remote lab program allow small labs that do not have CEREC inlab to scan dies models and send data to CEREC inlab facility. Zirconium oxide and aluminum oxide copings and frameworks can be milled and then sent back for completion of the restoration (placing the overlay porcelain) 10

11 CEREC inlab - MATERIALS Manufacturer Description Sirona Sirona CEREC Blocs Full contour inlays, onlays, crowns, veneers ( same as CEREC 3) Sirona incoris ZI Sirona incoris AL Sirona incoris NP Sirona incorix WAX Zirconium Oxide crown copings and FPD frameworks [need porc overlay] Aluminum Oxide crown copings [need porc overlay] Non-precious metal copings and FPD frameworks [need porc overlay] Burn-out acrylic for investing copings and frameworks for casting VITA VITA TriLuxe forte Full contour inlays, onlays, crowns, veneers (same as CEREC 3) VITA TriLuxe Full contour inlays, onlays, crowns, veneers (same as CEREC 3) VITA Mark II Full contour inlays, onlays, crowns, veneers (same as CEREC 3) VITA RealLife Full contour inlays, onlays, crowns, veneers (same as CEREC 3) VITA In-Ceram YZ VITA In-Ceram VITA CAD-Waxx VITA CAD-Temp Zirconium Oxide crown copings and FPD frameworks [need porc overlay] Classic In-Ceram copings [must be glass-infiltrated and overlaid] Burn-out acrylic for investing copings and frameworks for casting Strong acrylic material for long-term temporary crowns and FPDs Ivoclar Vivadent IPS e.max CAD Lithium disilicate blocks for full-contour restorations or copings (CEREC 3) IPS e.max ZIRCAD Zirconium Oxide crown copings and FPD frameworks [need porc overlay] IPS Empress CAD Full contour inlays, onlays, crowns, veneers (same as CEREC 3) Teilio CAD Strong acrylic material for long-term temporary crowns and FPDs 3M ESPE 3M Paradigm MZ100 Full contour inlays, onlays, crowns, veneers (same as CEREC 3) 3M Paradigm C Full contour inlays, onlays, crowns, veneers (same as CEREC 3) 11

12 Product: VITA In-Ceram for CEREC inlab VITA NOT the older In-ceram "slipcast" system NOT very popular system, but still utilized Similar materials to conventional In-Ceram, but copings and frameworks are milled from solid blocks of material, NOT slipcast Magnesia, Alumina, or Zirconia copings/frameworks available Frameworks infiltrated with InCeram glasses then overlaid with porcelain VERY Strong 3 block materials available Magnesia Alumina Zirconia (350 Mpa) (500 Mpa) (700 Mpa) Can NOT etch Alumina or Zirconia Conventional cementation acceptable; resin cementation recommended Dependant on material milled Magnesia - Alumina - Zirconia - Anterior & posterior crowns Anterior & posterior crowns, FPDs (3-unit max), posterior FPDs (3-unit max) Product: invizion for CEREC inlab Vident Intro 2005 Partially sintered, Yttria-stabilized zirconium oxide blanks milled to copings and frameworks Mills InCeram YZ blocks Scanning of dies in CEREC inlab machine Frameworks stained with coloring liquid 12

13 Frameworks sintered HIGH temps long time in ZRcomat oven Overlaid with feldspathic porcelain (VM 9) VERY strong (>900 Mpa) Can NOT etch Conventional cementation possible; resin cement recommended (Panavia 21, Panavia F) * 10-year limited warranty on framework fracture!! ** Similar to CERCON, LAVA, e.maxzircad systems Posterior FPDs (max. span 38 mm) Anterior crowns not as translucent Anterior FPDs not as translucent (max. span 38 mm) Product: IPS e.max ZirCAD Ivoclar Intro 2006 Part of IPS e.max system by Ivoclar Partially sintered Yttrium-stabilized milled zirconium oxide copings/frameworks Frameworks stained with coloring liquid Frameworks fully sintered at HIGH temps Overlaid with layered feldspathic porcelain (e.max IPS Ceram) or pressed ceramic material (e.max IPS ZirPress) VERY strong (>900 Mpa) Can NOT etch Conventional cementation acceptable; Resin bonding recommended (Panavia 21, Panavia F) ** Similar to invizion, CERCON, LAVA systems Posterior FPDs (max. span 38 mm) Anterior crowns not as translucent Anterior FPDs not as translucent (max. span 38 mm) 13

14 Product: Sirona incoris ZI for CEREC inlab Sirona Charateristics: Intro 2008 Presintered Yttrium-stabilized milled zirconium oxide copings/frameworks 5 different framework shades Overlaid with feldspathic porcelain VERY strong (>900 Mpa) Can NOT etch Conventional cementation acceptable; resin cement recommended (i.e. Panavia 21, Panavia F) ** Similar to invizion, CERCON, LAVA, IPS e.max ZirCAD systems Posterior FPDs (max. span 38 mm) Anterior crowns not as translucent Anterior FPDs not as translucent (max. span 38 mm) Product: Sirona incoris AL for CEREC inlab Sirona Charateristics: Intro 2008 Presintered 100% Al 2 O 3 copings/frameworks Ivory shaded framework Overlaid with feldspathic porcelain (Vitadur Alpha or VM7) Strong (>500 Mpa) Can NOT etch Conventional cementation possible; Resin bonding recommended (Panavia 21, Panavia F) Anterior crowns more translucent than Zirconium Oxide Anterior 3-unit FPDs (max. span 38 mm) 14

15 Product: CERCON Dentsply Ceramco Intro 2002 Zirconium oxide copings and frameworks overlaid with porcelain Ceramco PFZ overlay porcelain can be layered or pressed to full contour VERY strong (>1300 MPa) "Stand alone" system with scanner, design software, mill, and furnace > 225 labs using in U.S. - over 3 million units placed worldwide Partially sintered Yttria-stabilized zirconium oxide blanks Scanning of dies and models Maximum span of 47 mm Framework guaranteed 7 years against breakage Resin cement recommended (Panavia 21, Panavia F) ** Similar to LAVA, invizion, e.max ZirCAD systems Posterior FPDs Anterior crowns Anterior FPDs 15

16 Product: LAVA 3M ESPE Intro 2001 Zironium oxide copings & frameworks overlaid with feldspathic porcelain Stand alone system with scanner, design software, mill, and furnace Presintered milling of zirconium oxide copings & frameworks Frameworks shaded with 1 of 8 different tints prior to sintering Frameworks fully sintered at HIGH heat for long period time VERY strong (>900 Mpa) Overlaid with LAVA Ceram layering porcelain Authorized Lava Milling Centers approx. 60 in U.S. 5-year warranty against fracture of ZrO2 frameworks ** Similar to invizion, CERCON, e.max ZirCAD systems Posterior 3-, 4-unit FPDs (max span 55 mm) Anterior crowns not as translucent Anterior 3-, 4-, 5-unit FPDs (max span 55 mm) Product: LAVA DVS 3M ESPE Intro 2010 Unique fully-digital, 3 layer fabrication technique Scanning of die with design and milling of zirconium oxide coping Ceramic veneer designed and milled to fit over zirconium oxide coping Veneer fused to zirconium oxide coping with special "fusion ceramic" Posterior single crowns Anterior single crowns 16

17 Product: BRUXZIR Glidewell Laboratories Intro 2009 MONOLITHIC, full-contoured solid zirconium oxide crowns and FPDs No overlay porcelain placed No chipping or delamination of overlay porcelain Surface glazed, stained and polished to final shine VERY strong (>1,400 Mpa) Presintered milling of zirconium oxide onlays, crowns, FPDs Milled restorations fully sintered at 1,400C for 6.5 hours Fair esthetics; better than metal, less than layered ceramics Minimum occlusal thickness of 0.5 mm Reduction requirements less than other zirconium oxide products Conventionally cemented; resin bonding recommended for short or non-retentive preparations (i.e. Panavia F, Panavia 21) Onlays Posterior FPDs Bruxers who desire tooth-colored restorations Minimal inter-occlusal space available 17

18 Product: PROCERA Nobel Biocare PROCERA Alumina Very dense aluminum oxide coping/framework Very good esthetics; moderate masking of underlying tooth/restorative structure HIGH flexural strength (700 Mpa) 0.6 mm thick for crown copings 0.25 mm thick for veneer copings Can NOT be etched Conventional cementation possible Recommend air abrasion of internal surface/resin cement (i.e. Panavia 21) 5-year warranty on copings and frameworks Veneers Anterior crowns Anterior FPDs (2-4 units) PROCERA Zirconia Good esthetics coping more opaque HIGH flexural strength (800+ Mpa) 0.7 mm thickness; 4 shades Can NOT be etched Conventional cementation possible Recommend air abrasion of internal surface/resin cement (i.e. Panavia 21) 5-year warranty Very few labs using this product especially for FPDs Posterior FPDs (2-14 units) 18

19 Glass-Infiltrated Systems Product: In-Ceram Classic Vident Long, successful track record over 20 years started 1989 Europe Slip cast technique to fabricate coping/framework 3 different materials (powders) Powder-liquid slurry painted on dies, dried, baked, infiltrated, overlaid InCeram Spinell = Magnesium Oxide coping InCeram Alumina = Aluminum Oxide coping/framework InCeram Zirconia = Zirconium Oxide coping/framework Infiltration of copings and frameworks with lanthanum glass in high-temp oven imparts ultimate strength **A variation of this technique is used with CEREC InLab materials** VERY Strong Spinell (350 Mpa) Excellent esthetics Alumina (500 Mpa) Good Excellent esthetics Zirconia (700 Mpa) Good esthetics Alumina and Zirconia can NOT be etched Conventional cementation acceptable, BUT sandblasting of copings & resin cementation recommended (i.e. Panavia) Spinell Anterior & premolar crowns Alumina Anterior & posterior crowns, anterior 3-unit FPDs Zirconia Anterior & posterior crowns, posterior 3-unit FPDs 19

20 Product: Wol-Ceram Wolz Dental Technik Modification / variation of In-Ceram system Copings Produced via unique method: Aluminum oxide and zirconium oxide copings produced via electrophoretic deposition of particles when dipped in a liquid slurry. Technique same as InCeram after coping production. Glass infiltration of copings / frameworks Overlaid with feldspathic porcelain Moderate to High strength Can NOT etch Conventional cementation possible; air abrasion and resin cement recommended (i.e. Panavia) Anterior crowns 4-unit anterior FPDs (max. span 25 mm connectors 3mm X 3mm) 3-unit posterior FPDs (max. span 25 mm connectors 3mm X 3mm) 20

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