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Cermaic Restorations

All-ceramic restorations are highly aesthetic dental solutions that have seen significant advancements in materials and bonding techniques. Various types of dental ceramics, including aluminous core ceramics, heat pressed ceramics, and zirconia ceramics, offer different benefits such as strength and appearance. The increasing use of all-ceramic restorations highlights the need for further clinical studies to establish their long-term efficacy compared to traditional metal ceramic restorations.

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8 views41 pages

Cermaic Restorations

All-ceramic restorations are highly aesthetic dental solutions that have seen significant advancements in materials and bonding techniques. Various types of dental ceramics, including aluminous core ceramics, heat pressed ceramics, and zirconia ceramics, offer different benefits such as strength and appearance. The increasing use of all-ceramic restorations highlights the need for further clinical studies to establish their long-term efficacy compared to traditional metal ceramic restorations.

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ALL CERAMIC

RESTORATION
S
By Dr. Aarushi Jain
Introduction :

All-ceramic restorations are some of the most aesthetically pleasing restorations


currently available. Well-made all-ceramic restorations be virtually
indistinguishable from unrestored natural teeth.
• In the last few decades, there have been tremendous advances in the mechanical
properties and methods of fabrication of ceramic materials.
• Advances in bonding techniques have increased the range and scope for use of
ceramics in dentistry.
Dental ceramics :

CERAMICS- compounds of one or more metals with a non-metallic element,


usually oxygen; they are formed of chemical and biochemically stable substances
that are strong, hard, brittle, and inert non-conductors of thermal and electrical
energy (GPT 10)
• DENTAL CERAMICS- An inorganic compound with non-metallic properties
typically consisting of oxygen and one or more metallic or semi metallic,
elements (e.g.. Aluminium, calcium, lithium, magnesium, potassium, silicon,
sodium, tin, titanium, and zirconium )that is formulated to produce the whole or
part of a ceramic based dental prosthesis.
ALL CERAMIC SYSTEMS
ACCORDING TO DIFFERENT FABRICATION TECHNIQUES :
ACCORDING TO COMPOSITION :
ACCORDING TO ROSENSTEIL :
Aluminous core ceramics
Heat pressed ceramics
Machinable ceramics
• Metal reinforced ceramics
ALUMINOUS CORE CERAMICS

McLean and Hughes in 1965.


• COMPOSITION - Aluminum oxide (alumina)
crystals dispersed in a glassy matrix
HEAT PRESSED CERAMIC :
INDICATIONS :
MACHINABLE CERAMICS :
• CEREC System ( Sirona dental systems, LLC)
Ceramics used in CEREC Systems :

VITA Mark II (VITA North America)

IPS Empress CAD (Ivoclar Vivadent)

IPS e.max CAD (Ivoclar Vivadent)

CEREC Blocs C (Cerec 3D, Sirona Dental Systems, Inc.),


• In-Ceram Alumina and Spinell (Dentsply Prosthetics).
METAL REINFORCED SYSTEM :

CAPTEK SYSTEM
ZIRCONIA CERAMICS :
Zirconium crowns are definitely more robust than porcelain crowns.

They last longer too, compared to porcelain that chip and break.

Porcelain crowns also need to be fused to a metal base and the metal is that black
unsightly line above the gums of people with porcelain crowns.
• Since Zirconium crowns are milled from a chunk of crystal, they are guaranteed
to be at least 5 times stronger than porcelain and it metal fuse. Zirconium crowns
also provide strength without that bulky appearance that porcelain is so known
for.
SELECTION OF ALL CERAMIC
RESTORATIONS
ALL CERAMIC RESTORATIONS :
TOOTH PREPARATION :

ARMAMENTARIUM :
Handpiece
Coarse-grit flat-end tapered diamond (6847-016)
Coarse-grit football-shaped diamond (6379-023)
Fine-grit flat-end tapered diamond (8847KR-016)
CP-11/12 binangle chisel
Procedure :

DEPTH ORIENATION GROOVES


BUR USED-Coarse-grit flat-end tapered
diamond
• GROOVES PLACEMENT-1.2 to 1.4 mm deep on
the labial and 2.0 mm deep on the incisal
INCISAL REDUCTION
BUR USED-coarse-grit flat-end tapered
diamond.
• Approximately 1.5 to 2.0 mm of tooth
structure is removed.
LABIAL REDUCTION
The tooth structure still remaining between the
depth orientation grooves on the incisal portion of
the labial surface is planed away.
The gingival portion of the labial surface is reduced
with the coarse-grit flat-end tapered diamond to a
depth of 1.2 to 1.4 mm. This reduction extends
around the labioproximal line angles and fades out
on the lingual aspects of the proximal surfaces
• The end of the coarse-grit flat-end tapered
diamond bur will form the shoulder finish line,
while the axial reduction is done with the sides of
the diamond.
LINGUAL REDUCTION
Lingual reduction incisal to
the cingulum is done with the
coarse-grit football-shaped
diamond, with care taken not
to over reduce the junction
between the cingulum and
the lingual wall (apical to the
cingulum)
AXIAL REDUCTION
Reduction of the lingual axial surface is
done with the coarse-grit flat-end tapered
diamond.
The wall should form a minimum taper with
the gingival portion of the labial wall.
The radial shoulder is at least 1.0 mm wide
and should be a smooth continuation of the
labial and proximal radial shoulders.
• All of the axial walls should be smoothed
with a fine-grit flat-end tapered diamond,
accentuating the shoulder at the same
time
Posterior teeth :

Occlusal reduction Functional cusp bevel Axial


reduction
Inlays and onlays :
Impression procedure :
TEMPORIZATION :
TRY – IN :

Patient is asked to moisten the ceramic and adjacent teeth with saliva.

The shade is evaluated under incandescent, fluorescent, and natural light.


• The patient should be allowed to look at the completed restoration in a wall
mirror and approve it before cementation
A thin coating of a pressure indicator such as Occlude (Pascal) can be applied to
these materials before seating to reveal the exact location of the contact.

Broad, relatively flat surfaces –a large, smooth-cutting Busch Silent Stone (Pfingst)

Reshaping of grooves and ridges-smaller pointed diamond stones and green stones
• Roughened ceramic surfaces are smoothed with clean white stones and polished
with rubber wheels of progressively finer grit such as those found in the
Ceramisté porcelain adjustment kit (Shofu) or diamond-impregnated wheels and
points (Dialite, Brasseler
CEMENTATION PROCEDURE :
The crown is rinsed and then dried with compressed air.

The tooth preparation is cleaned with a rubber cup and flour of pumice, washed, and
dried.

A thin layer of cement is applied to the internal surfaces of the crown. The crown is
seated, and excess cement is removed from the marginal areas with an explorer and a
clean brush.

A slight excess is left to avoid ditching the cement at the margin. The curing light is
aimed at marginal areas from facial, lingual, and occlusal directions for 40 seconds.

When light activation is not used, 6 minutes be allowed for autopolymerization.


Bulky margins or premature occlusal contacts are adjusted with a fine diamond stone.
Conclusion :

The use of all-ceramic restorations is increasing, and this trend will continue.

Higher-strength ceramic materials have expanded the indications for all-ceramic


restorations; however, at this time, their efficacy is not similar to that of metal
ceramic restorations.
• There fore, long term clinical studies and experience is still need to use all-
ceramic restoration as an viable alternative treatment option for patients
especially in esthetically demanding cases.
References :
Contemporary Fixed Denture Prosthodontics – Rossensteil; 5th edn

Fundamentals of fixed prosthodontics- Shillingburg; 4th edn.

Fundamentals of Tooth Preparation- Shillingburg; 2th edn.

Phillips’ science of dental materials- Anusavice KJ, Shen C, Rawls HR; 11th edition

Dental Materials Science-Ramakrishna alla; 1st edition

Art and Science of Operative Dentistry-Sturdevant 4th edition

Warreth A, Elkareimi Y. All-ceramic restorations: a review of literature. Saudi Dent. J.. 2020.

Rosenblum MA, Schulman A. A review of all-ceramic restorations. J Am Dent Assoc”.. 1997 Mar 1:128(3):297-307.

Peampring C. Sanohkan S. All-ceramic systems in esthetic dentistry: A review. M

Dent J 2014; 34: 82-90.


• Vargas MA, Bergeron C. Diaz-Arnold A. Cementing all-ceramic restorations: recommendations for success. J Am Dent Assoc. 2011 Apr
1;142:20S-4S

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