Ceramics overview: classification by microstructure and processing methods.

The plethora of ceramic systems available today for all types of indirect restorations can be confusing--and overwhelming--for the clinician. Having a better understanding of them is key. The authors use classification systems based on the microstructural components of ceramics and the processing techniques to help illustrate the various properties and uses.

Qualitative and quantitative fracture analyses of high-strength ceramics.

The aims of this study were to assess the applicability and repeatability of qualitative and quantitative analyses of the fracture patterns of four different high-strength ceramics. Ten bar-shaped specimens of four high-strength ceramics with different material composition and fabrication methods had been fractured by three-point bending in water (n = 40). Commonly used fractographic patterns for brittle materials, such as mirror and mist, were used to characterize and quantify the fractured surfaces of these specimens. The analyses were performed twice, on separate occasions, by the same operator. Assessment of the association between fractographic patterns and fracture stress was carried out, and repeatability assessments of the measurements were performed. The fracture initiator site and the common fractographic markers surrounding this site were found in all specimens. Statistically significant correlations were found between certain fracture patterns and stress at fracture. The repeatability of the measurements of the different fractographic patterns varied among the materials. Fracture analyses seem applicable as a tool to determine the fracture initiation site and to estimate the force vectors involved in the fracture of dental high-strength ceramics.

Comparison of the load at fracture of Turkom-Cera to Procera AllCeram and In-Ceram all-ceramic restorations.

PURPOSE: This study investigated the occlusal fracture resistance of Turkom-Cerafused alumina compared to Procera AllCeram and In-Ceram all-ceramic restorations. MATERIALS AND METHODS: Sixmaster dies were duplicated from the prepared maxillary first premolar tooth using nonprecious metal alloy (Wiron 99). Ten copings of 0.6 mm thickness were fabricated from each type of ceramic, for a total of thirty copings. Two master dies were used for each group, and each of them was used to lute five copings. All groups were cemented with resin luting cement Panavia F according to manufacturer's instructions and received a static load of 5 kg during cementation. After 24 hours of distilled water storage at 37 degrees C, the copings were vertically compressed using a universal testing machine at a crosshead speed of 1 mm/min. RESULTS: The results of the present study showed the following mean loads at fracture: Turkom-Cera (2184 +/- 164 N), In-Ceram (2042 +/- 200 N), and Procera AllCeram (1954 +/- 211 N). ANOVA and Scheffe's post hoc test showed that the mean load at fracture of Turkom-Cera was significantly different from Procera AllCeram (p < 0.05). Scheffe's post hoc test showed no significant difference between the mean load at fracture of Turkom-Cera and In-Ceram or between the mean load at fracture of In-Ceram and Procera AllCeram. CONCLUSION: Because Turkom-Cera demonstrated equal to or higher loads at fracture than currently accepted all-ceramic materials, it would seem to be acceptable for fabrication of anterior and posterior ceramic crowns.

Confocal examination of subsurface cracking in ceramic materials.

PURPOSE: The original ceramic surface finish and its microstructure may have an effect on crack propagation. The purpose of this study was to investigate the relation between crack propagation and ceramic microstructure following cyclic fatigue loading, and to qualitatively evaluate and quantitatively measure the surface and subsurface crack depths of three types of ceramic restorations with different microstructures using a Confocal Laser Scanning Microscope (CLSM) and Scanning Electron Microscope (SEM). MATERIALS AND METHODS: Twenty (8 x 4 x 2 mm(3)) blocks of AllCeram (AC), experimental ceramic (EC, IPS e.max Press), and Sensation SL (SSL) were prepared, ten glazed and ten polished of each material. Sixty antagonist enamel specimens were made from the labial surfaces of permanent incisors. The ceramic abraders were attached to a wear machine, so that each enamel specimen presented at 45 degrees to the vertical movement of the abraders, and immersed in artificial saliva. Wear was induced for 80K cycles at 60 cycles/min with a load of 40 N and 2-mm horizontal deflection. The specimens were examined for cracks at baseline, 5K, 10K, 20K, 40K, and 80K cycles. RESULTS: Twenty- to 30-microm deep subsurface cracking appeared in SSL, with 8 to 10 microm in AC, and 7 microm close to the margin of the wear facets in glazed EC after 5K cycles. The EC showed no cracks with increasing wear cycles. Seventy-microm deep subsurface cracks were detected in SSL and 45 microm in AC after 80K cycles. Statistically, there was significant difference among the three materials (p < 0.05). Bonferroni multiple comparison of means test confirmed the ANOVA test and showed that there was no statistical difference (p > 0.05) in crack depth within the same ceramic material with different surface finishes. CONCLUSIONS: The ceramic materials with different microstructures showed different patterns of subsurface cracking.

Choice of ceramic for use in treatments with porcelain laminate veneers.

Porcelain laminate veneers (PLVs) have been used for over two decades to treat esthetic and/or functional problems, particularly in the anterior sector. A range of dental ceramic materials are presently available on the market for these treatments, though with very different characteristics in terms of the composition, optic properties and manufacturing processes involved. As a result, selection of the material best suited for the management of each individual patient may prove complicated. The present study proposes a simple system for selecting the most appropriate ceramic material, based on the two variables that most influence the esthetic outcome: the intrinsic characteristics of the substrate tooth, and the characteristics of the ceramic material in terms of resistance and optic properties.

Investigation of human enamel wear against four dental ceramics and gold.

OBJECTIVES: This in vitro study compared the wear of enamel against aluminous porcelin, bonded porcelain, low fusing hydrothermal ceramic, feldspathic machinable ceramic, and cast gold. METHODS: Fifty pairs of tooth-material specimens were tested in a dental wear machine, under a standard load (40 N), rate (80 cycles min-1) and for 25,000 cycles in distilled water. The amount of wear was determined by measuring the height loss of the tooth, and the depth of wear track of the restorative materials. RESULTS: There was a significant difference in wear among the groups for both enamel and materials (p < 0.001). Follow-up comparisons (95% CI significance level) showed that gold caused significantly less enamel wear than all ceramics tested. The amount of enamel wear in the aluminous and bonded porcelain groups was significantly higher than with the hydrothermal and machinable ceramic groups. There was no significant difference between the amount of enamel wear produced by the aluminous and bonded porcelains nor between that produced by the hydrothermal and machinable ceramics. Furthermore, the wear of the aluminous and bonded porcelains was significantly greater than that of the hydrothermal ceramic, the machinable ceramics and gold. No significant difference in wear was found between aluminous and bonded porcelains, hydrothermal and machinable ceramics, or between machinable ceramic and gold. However, the hydrothermal ceramic had significantly greater wear than gold. CONCLUSIONS: It was concluded that the hydrothermal and the machinable ceramics were significantly less abrasive and more resistant to wear than the conventional aluminous and bonded porcelains. Gold was the least abrasive material and most resistant to wear, although the difference in wear between the machinable ceramic and gold was not statistically significant.

A review of all-ceramic restorations.

To select the most appropriate type of all-ceramic system for clinical use, the clinician must be familiar with the differences between systems. This article discusses five categories of all-ceramic restorative systems relative to their processing techniques, strength and wear characteristics. The authors present and compare results of published in vitro studies and short-term clinical studies.

Long-term clinical success of all-ceramic posterior restorations.

Modern all-ceramic systems offer a highly esthetic, biocompatible, and functional alternative to traditional restorative materials. Such systems allow for a wide range of indications, from inlays to multiple-unit fixed partial dentures, and are increasingly used in posterior regions of the mouth. Many of these systems have been introduced to the market only recently. However, new materials and techniques should be followed up and their clinical performance proven for at least 5 years before they become routine modalities of treatment. This article reviews the current literature and scientific data on the long-term success of all-ceramic restorations in the posterior region and compares and discusses alternative treatment options.

History, development and clinical success of porcelain inlays.

The drive for alternative to amalgam as a restorative material is led by concerns about the safety of mercury within amalgam and also by aesthetic demands from patients. Early attempts to address these issues produced disappointing results in terms of performance from directly-placed resin composites in posterior teeth. While directly-placed posterior restorative materials have improved in recent years the indirect constructed inlay may more readily meet the functional requirements of premolar/molar teeth. This article seeks to review the history, development and clinical success of porcelain when used as an inlay material. A case is included to demonstrate the clinical application of this aesthetic technique and the author's personal recommendations.

A systematic review and meta-analysis of the survival of non-feldspathic porcelain veneers over 5 and 10 years.

PURPOSE: This systematic review aimed to report and explore the survival of dental veneers constructed from non-feldspathic porcelain over 5 and 10 years. MATERIALS AND METHODS: A total of 4,294 articles were identified through a systematic search involving all databases in the Cochrane Library, MEDLINE (OVID), EMBASE, Web of Knowledge, specific journals (hand-search), conference proceedings, clinical trials registers, and collegiate contacts. Articles, abstracts, and gray literature were sought by two independent researchers. There were no language limitations. One hundred sixteen studies were identified for full-text assessment, with 10 included in the analysis (5 qualitative, 5 quantitative). Study characteristics and survival (Kaplan-Meier estimated cumulative survival and 95% confidence interval [CI]) were extracted or recalculated. A failed veneer was one which required an intervention that disrupted the original marginal integrity, had been partially or completely lost, or had lost retention more than twice. A meta-analysis and sensitivity analysis of Empress veneers was completed, with an assessment of statistical heterogeneity and publication bias. Clinical heterogeneity was explored for results of all veneering materials from included studies. RESULTS: Within the 10 studies, veneers were fabricated with IPS Empress, IPS Empress 2, Cerinate, and Cerec computer-aided design/computer-assisted manufacture (CAD/CAM) materials VITA Mark I, VITA Mark II, Ivoclar ProCad. The meta-analysis showed the pooled estimate for Empress veneers to be 92.4% (95% CI: 89.8% to 95.0%) for 5-year survival and 66% to 94% (95% CI: 55% to 99%) for 10 years. Data regarding other non-feldspathic porcelain materials were lacking, with only a single study each reporting outcomes for Empress 2, Cerinate, and various Cerec porcelains over 5 years. The sensitivity analysis showed data from one study had an influencing and stabilizing effect on the 5-year pooled estimate. CONCLUSION: The long-term outcome (> 5 years) of non-feldspathic porcelain veneers is sparsely reported in the literature. This systematic review indicates that the 5-year cumulative estimated survival for etchable non-feldspathic porcelain veneers is over 90%. Outcomes may prove clinically acceptable with time, but evidence remains lacking and the use of these materials for veneers remains experimental.

Tooth wear against ceramic crowns in posterior region: a systematic literature review.

The objective of this systematic review was to assess tooth wear against ceramic crowns in posterior region in vitro and in vivo. An electronic PubMed search was conducted to identify studies on tooth wear against ceramic crowns in posterior region. The selected studies were analyzed in regard to type of crowns, natural antagonist, measuring protocol and outcome. From a yield of 1 000 titles, 43 articles were selected for full-text analysis; finally, no in vitro and only five in vivo studies met the inclusion criteria. As there is heterogeneity in design, used measuring method, ceramics and analysis-form, a meta-analysis was not possible. Results of these studies are very controversial which makes a scientifically valid comparison impossible. This review indicated that some all-ceramic crowns are as wear friendly as metal-ceramic crowns. Up to now, it has been impossible to associate tooth wear with any specific causal agent. The role of ceramic surface treatment that might be responsible for the changing in rate of tooth wear seems undetermined as yet through clinical trials. The literature reveals that studies on this topic are subject to a substantial amount of bias. Therefore, additional clinical studies, properly designed to diminish bias, are warranted.

All-ceramic systems: laboratory and clinical performance.

Several all-ceramic systems have been developed in dentistry to meet the increased expectations of patients and dentists for highly aesthetic, biocompatible, and long-lasting restorations. However, early bulk fractures or chippings have led the research community to investigate the mechanical performance of the all-ceramic systems. This overview explores the current knowledge of monolithic and bilayer dental all-ceramic systems, addressing composition and processing mechanisms, laboratory and clinical performance, and possible future trends for all-ceramic materials.

Cementing all-ceramic restorations: recommendations for success.

BACKGROUND: Several all-ceramic restorative systems of various compositions, properties and indications are available to the dental practitioner. Because of the large number of systems, the dental team faces questions and decisions when choosing the appropriate system and the appropriate means of cementation. OVERVIEW: The authors present a brief overview of the cementation options for various types of all-ceramic restorations. In this article, they discuss the cementation of current all-ceramic restorations and make clinical recommendations tailored to each type of ceramic. CONCLUSION AND CLINICAL IMPLICATIONS: The clinician must have a good understanding of the ceramic type to determine whether a restoration should be cemented adhesively or nonadhesively. Other variables, such as isolation and preparation design, also influence the cementation choice. Various ceramic types demand different surface treatments before cementation. Choosing and applying the appropriate surface treatment and cementation procedure will contribute to long-lasting restorations. The literature is lacking in clinical trial results that validate current in vitro data regarding cementation of all-ceramic restorations.

Cements and adhesives for all-ceramic restorations.

Dental cements are designed to retain restorations, prefabricated or cast posts and cores, and appliances in a stable, and long-lasting position in the oral environment. Resin-based cements were developed to overcome drawbacks of nonresinous materials, including low strength, high solubility, and opacity. Successful cementation of esthetic restorations depends on appropriate treatment to the tooth substrate and intaglio surface of the restoration, which in turn, depends on the ceramic characteristics. A reliable resin cementation procedure can only be achieved if the operator is aware of the mechanisms involved to perform the cementation and material properties. This article addresses current knowledge of resin cementation concepts, exploring the bonding mechanisms that influence long-term clinical success of all-ceramic systems.

Determinação da tensão de falha de lascamento da porcelana de cobertura em prótese livre de metal utilizando análise de imagem / Determination of the failure stress of the porcelain chipping cover in metal free prosthesis using image analysis

A introdução da zircônia na Odontologia deu-se pela necessidade de melhores propriedades mecânicas dos materiais cerâmicos, pois com a crescente demanda estética, os cerâmicos tornaram-se materiais de largo uso, devido às suas propriedades estéticas e mecânicas. Em busca dessas propriedades, vários estudos analisaram a taxa de sobrevivência de restaurações zircônia-porcelana, relatando como uma das causas de falha a fratura precoce da porcelana de cobertura e o aumento significativo nos relatos clínicos de lascamento da porcelana de recobrimento aplicada sobre "coping" de zircônia. Diante desse problema, o objetivo deste trabalho foi determinar a tensão de falha no lascamento a partir de casos de clínicos e experimentais pertinentes a esse fenômeno em próteses fixas livres de metal .Foram coletados dados de artigos dos últimos 15 anos, por meio das bases de dados Pubmed e Google Schoolar, sendo selecionados para essa revisão os que obtiveram melhor abordagem do assunto, dando ênfase às possíveis causas de falhas nas restaurações cerâmicas dos casos clínicos e os ensaios realizados, visando um melhor entendimento desse fenômeno, via análise quantitativa e qualitativa, para melhor utilização e aproveitamento desse material na Odontologia. Para determinação da tensão de falha, foi empregada a mecânica da fratura linear elástica e determinado o fator de correção da trinca com base nas dimensões da trinca.Com a presente pesquisa, nota-se que amplitude de tensão influencia no processo de fratura, embora não tenha apontado exatamente para a causa da fratura. No entanto, pode-se inferir que uma baixa taxa de sobrevivência está relacionada a um grande defeito que, por sua vez, necessitou de uma sobrecarga para conduzir o processo de lascamento. Portanto, melhorias no processo de fabricação podem otimizar as características do material e sua aplicação final para suportar as tensões, a fim de aumentar a taxa de sobrevivência(AU)

The introduction of zirconia in dentistry was due to the need for better mechanical properties of ceramic materials, because of an increasing aesthetic demand. Ceramics became widely used materials due to their aesthetic and mechanical properties. Aiming at these properties, several studies have analyzed the survival rate of zirconia-porcelain restorations, reporting as one of the causes of failure. Early porcelain fracture coverage and a significant increase in clinical reports of veneering porcelain applied over "coping "of zirconia. In view of this problem, the objective of this work was to determine the failure causes of chipping from clinical and experimental cases associated to this phenomenon in fixed metal free prostheses. Data from articles of the last 15 years were collected through the Pubmed and Google Schoolar databases. Those who obtained the best approach to the subject were selected for this analysis, emphasizing the possible causes of failures in the ceramic restorations of the clinical cases and the tests performed. Aiming for a better understanding of this phenomenon, via quantitative and qualitative analysis, to better use this material in dentistry. To determine the failure causes, linear elastic fracture mechanics were used and the crack correction factor was determined based on the crack dimensions. With the present research, it is noticed that stress amplitude influences in the fracture process, although it has not pointed exactly the cause of the fracture. However, it can be inferred that a low survival rate is related to a large defect, this in turn needed an overload to conduct the chipping process. Therefore, the manufacturing process can improve the characteristics of the material and its final application to withstand the stresses in order to increase the survival rat(AU)

The metal-free approach to restorative treatment planning.

Considerable developments in the area of metal-free restorations--in response to increasing esthetic demands from patients--are offering the clinician and dental technician new therapeutic paths to follow when performing restorative treatments. Effective and reliable high-strength ceramic systems, suitable for anterior and posterior sites, may allow the achievement of predictable esthetics and function. Along with the evident indications for the treatment of anterior compromised elements, these types of restorations may be used in a wider variety of clinical cases, including complex prosthetic rehabilitations. Appropriate usage of different materials according to the specific clinical situation is mandatory for long-lasting, functional, and esthetic results. Therefore, a thorough application of metal-free restorations may be considered a "metal-free approach", which includes a specific formulation of treatment planning. In this article, the different materials, selection criteria, clinical indications, and benefits are evaluated, with a particular regard for treatment planning.