Recent

Advancements
In
Dental
Presented by Head of the
Dr. Athira Sasikumar Department:
Dr. B. Muthukumar
Guided by MDS(Professor and

Ceramics HOD)
 Introductio
n
Treatment options have
improved over a period of
time and in many cases which
require crown, we have
various options. Starting with
metal crowns, metal ceramic,
and even all ceramic crowns.
This all happened because we
needed a material that is
aesthetically superior without
compromising the strength.
 GPT-9- ceramics
Compounds of one or more metals with a nonmetallic element,
usually oxygen; they are formed of chemical and
biochemically stable substances that are strong, hard, brittle,
and inert nonconductors of thermal and electrical energy
 history
• Stone chips were shaped into tools by a process called flaking.
Sto • Chert, flint, ignimbrite, shale, lava, quartz, silicified limestone
ne
age

• Etruscans made teeth of ivory and bone

700
BC

• The first porcelain tooth material was patented in 1789 by de Chemant, a

French dentist in collaboration with Duchateau, a French pharmacist
178
9

W. Patrick Naylor,Introduction to Metal – Ceramic Technology – Second edition

 • Fonzi, an Italian dentist, invented a “terrometallic” teeth.
18 Individual porcelain teeth posterior porcelain blocks
08

• Planteau, a French dentist, introduced porcelain teeth to

18 the United States.
17
• Charles Land introduced one of the first ceramic crowns
19 to dentistry.
03

W. Patrick Naylor,Introduction to Metal – Ceramic Technology – Second edition

 • Controlled crystallization of a glass (Dicor) was demonstrated by Adair and
19 Grossman
84

19 • CAD/CAM technique were developed

85
• IPS Empress , In Ceram Zirconia, IPS Empress2 were used for ceramic
19 prostheses.
90

19 • Duceram LFC was introduced

92

W. Patrick Naylor,Introduction to Metal – Ceramic Technology – Second edition

 CLASSIFICATION OF DENTAL
CERAMICS
Uses or indications Firing temperature
a) Anterior and posterior crown a) Ultralow fusing - <850
B) Veneer b) Low fusing 850-1100
c) Medium fusing 1101-1300
C) Post and core d) High fusing >1300
D) Fixed dental prosthesis
E) Ceramic stain Medium- and high-fusing porcelains are used
F) Glaze for the production of denture teeth.

The low-fusing and ultra low-fusing types are

used as veneering ceramics for crown and
bridge construction.

W. Patrick Naylor,Introduction to Metal – Ceramic Technology – Second edition

 Processing method Principal crystal phase
i. Casting
a) Feldspathic porcelain
ii. Sintering
b) Leucite-based glass ceramic
iii. Partial sintering and glass
infiltration c) Lithia-based glass-ceramic
iv. Slip casting and sintering d) Aluminous porcelain
v. Heat press e) Alumina
vi. CAD-CAM milling f) Glass-infused alumina,
vii. Copy-milling g) Glass-infused spinel
h) Glass-infused zirconia,
i) Glass ceramic
W. Patrick Naylor,Introduction to Metal – Ceramic Technology – Second edition
 Based on microstructure Translucency
i. Amorphous glass i. Opaque
ii. Crystalline ii. Translucent
iii. Transparent
iii. Polycrystalline

W. Patrick Naylor,Introduction to Metal – Ceramic Technology – Second edition

Composition Fracture resistance
• Pure alumina  Low
• Pure zirconia
 Medium
• Silica glass
 High
• Leucite based glass
• Lithia based glass

W. Patrick Naylor,Introduction to Metal – Ceramic Technology – Second edition

Ingredient
COMPOSITION Functions
Feldspar (naturally occurring minerals composed of It is the lowest fusing component, which melts first and
potash [K2O], soda [Na2O], alumina and silica). flows during firing, initiating these components into a
solid mass.
silica
Silica (Quartz) Strengthens the fired porcelain restoration.
• Remains unchanged at the temperature normally
used in firing porcelain and thus contribute stability to
the mass during heating by providing framework for
the other ingredients

Kaolin (Al2O3.2 SiO2. 2H2O - Hydrated Used as a binder. • Increases moldability of the unfired
aluminosilicates) porcelain. • Imparts opacity to the finished porcelain
product.

Glass modifiers, e.g. K, Na, or Ca oxides or basic oxides They interrupt the integrity of silica network and acts
as flux.
Color pigments or frits, e.g. Fe/Ni oxide, Cu oxide, MgO, To provide appropriate shade to the restoration
TiO2, and Co oxide.
Zr/Ce/Sn oxides, and Uranium oxide To develop the appropriate opacity.
Phillips science of dental materials –11th edition
METAL-CERAMIC SYSTEM
• Consist of cast metallic framework (core) on which at least two layers
of ceramics are baked

Phillips science of dental materials –11th edition

CLASSIFICATION
1. Cast metal ceramic restorations
Cast noble metal alloys (feldspathic porcelain)
Cast base metal alloys (feldspathic porcelain)
Cast titanium (ultra low fusing porcelain)
2. Swaged metal ceramic restorations
Gold alloy foil coping (Renaissance, Captek)
Bonded platinum foil coping

Kelly JR. Nishimura I. Campbell SD. Ceramics in dentistry: Historical roots and current perspectives. J prosthet dent 1996:75 18-32.
 DISADVANTAGES OF METAL CERAMIC
SYSTEM
1. Potential for metal allergy
2. Poor esthetics(can not be used when a relatively high degree of translucency is
desired.)
3. Abrasive damage to opposing dentition
4. Potential for fracture
5. Metal framework sometimes shows through gingiva resulting in dark margins

Phillips science of dental materials –11th edition

 ALL CERAMIC SYSTEM
Classified into
1. Conventional ceramics
2. Castable glass ceramics
3. Injection moulded glass ceramics
4. Glass infiltrated core ceramics
5. Machinable ceramics
ALUMINIOUS CORE CERAMICS

• The high-strength ceramic core was first introduced to dentistry by

McLean and Hughes in 1965.
• It is composed of aluminum oxide crystals (40-50%) dispersed in a
glassy matrix.
• Platinium foil adapted to die, Platinium foil functions as matrix.
• Examples :
– Hi-Ceram (Vident)
– Vitadur
– N core (Vident)
Kelly JR. Nishimura I. Campbell SD. Ceramics in dentistry: Historical roots and current perspectives. J prosthet dent 1996:75 18-32.
LEUCITE REINFORCED PORCELAIN
• Feldspathic porcelain with a higher leucite crystal content (leucite
reinforced).
• Leucite increases flexural strength, compressive strength and
coefficient of thermal expansion.
• Its manipulation, condensation and firing is quite similar to the
alumina reinforced porcelain jacket crowns (using platinum foil matrix).
• Increase resistance to glassy phase to crack propagation
• eg. Optec HSP

Kelly JR. Nishimura I. Campbell SD. Ceramics in dentistry: Historical roots and current perspectives. J prosthet dent 1996:75 18-32.
MAGNESIA BASED CORE PORCELAIN
• Used high-expansion magnesia-based core material compatible
with porcelain

• Similar to leucite reinforced

Phillips science of dental materials –11th edition

 2. CASTABLE GLASS CERAMICS
Glass-ceramics are polycrystalline materials developed for application
by casting procedures using the lost wax technique, hence referred to
as “castable ceramic”.
Castable glass
ceramics

Apatite glass Other glass

Fluormicas
ceramics ceramics

Lithia calcium
Dicor Cera pearl
phosphate
Phillips science of dental materials –11th edition
DICOR
• The first commercially available castable glass-
ceramic.
• Developed by ‘The Corning Glass Works (Corning
N.Y.) and marketed by Dentsply International
(Yord, PA, U.S.A).
• Cast glass ceramic is composed of:
a. Tetrasilicic flouromica crystal (crystalline) - 55%
by volume.
b. Glass matrix (non-crystalline) - 45% by volume.

Kelly JR. Nishimura I. Campbell SD. Ceramics in dentistry: Historical roots and current perspectives. J prosthet dent 1996:75 18-32.
 Chameleon effect
• Dicor glass-ceramic was capable of producing
remarkably good esthetics because of the
“chameleon” effect- part of the color of the
restoration was picked up from the adjacent teeth as
well as from the tinted cements used for luting the
restorations.
• Transparent crystals scatter the incoming light as
if light is bouncing off a large number of small
mirrors that reflect the light and spread it over the
entire surface of ceramic. Thus dicor glass change
color according to their surroundings.
Craig’s Restorative dental materials –13th edition.
FABRICATION
CASTABLE APATITE GLASS CERAMIC
• Sumiya Hobo & Iwata developed a castable apatite glass-ceramic
which was commercially available as Cera Pearl (Kyocera Bioceram,
Japan).
• CERA PEARL (Kyocera San Diego, CA): contains a glass powder
distributed in a vitreous or non-crystalline state

Phillips science of dental materials –11th edition

 Desirable characteristics of Apatite
Ceramics
• Cerapearl is similar to natural enamel in composition, density, refractive index, thermal
conductivity, coefficient of thermal expansion and hardness.
• Bonding to tooth structure : Cerapearl surface is activated by air abrading (to provide
mechanical interlocking effect) or treatment with activator solution (etching of with HCI
preferentially removes the glassy phase from the surface, thus exposing the apatite
phase).
• The glass ionomer can then bond to this apatite phase both chemically (ion-exchange)
and mechanically (interlocking effect).

Phillips science of dental materials –11th edition

 3. PRESSABLE CERAMICS
• Can be heated to a specific temperature and forced under pressure to
fill a cavity in a refractory mold.

pressable
glass ceramics

Shrink free Leuicite Lithia

ceramics reinforced reinforced

Cerecstone IPS Empress IPS Empress 2

Al-ceram Optec OPC 3G
Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
SHRINK FREE CERAMICS
• The development of non-shrinking ceramics such as the Cerestore
system was directed towards providing an alternate treatment.
• Hullah & Williams described the formulation of shrink-free ceramics
• Injection molded/heat pressed
• Shrink-free ceramics were marketed as two generations of materials
under the commercial names :
i. Cerestore (Johnson & Johnson. NJ, USA)
ii. Al-Ceram (Innotek Dental Corp, USA)

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 LEUCITE REINFORCED PORCELAINS
• Leucite-reinforced porcelains can be broadly
divided into:
i. IPS empress (ivoclar williams)
Ii. Optec pressable ceramic / OPC
(jeneric/pentron)
IPS EMPRESS (ivoclar williams)
• pre-cerammed, pre-coloured leucite-
reinforced glass-ceramic formed from the leucite
system by controlled surface crystallization
• it is a type of feldspathic porcelain containing a
higher concentration of leucite crystals, which
increases the resistance to crack propagation.
• 30%-35% leucite content
Dental ceramics: a review of new materials and processing methods-
LITHIA REINFORCED PORCELAINS

• IPS Empress 2 (Ivoclar Vivadent)

and Optec OPC 3G contain more
than 70% by volume of lithia
disilicate as the principal crystal
phase.
• IPS Empress 2 is a recently
introduced hot-pressed ceramic

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 4. GLASS INFILTRATED
CERAMICS/SLIP CAST CERAMICS
• Specialized ceramics reinforced by an unique glass infiltration process
• Involves condensation of an aqeuous slip on a refractory die

Inceram

In-ceram Inceram Inceram

alumina core spinell core zirconia core

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
IN-CERAM ALUMINA
• Developed by a French scientist and dentist Dr. Michael Sadoun
(1980)
Composition: In-Ceram ceramic consists of two 3- D interpenetrating
phases :
1. Alumina crystalline- 99.56 wt%
2. An Infiltration glass lanthanum aluminosilicate with small amounts
of sodium and calcium.

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
IN-CERAM SPINELL
• The porous core is fabricated from a magnesium alumina powder
after sintering. This type of material has a specific crystalline structure
referred to as spinell.
• The primary difference is a change in composition to produce a more
translucent core

Kelly J. Dental ceramics: current thinking and trends. Dent Clin N Am 2004(48):513-530.
IN-CERAM ZIRCONIA
• A second-generation material based on In ceram fabrication
technique.
• Core is 30% glass and 70% zirconia
• High degree of opacity but has good modulus of elasticity and
fracture toughness

Kelly J. Dental ceramics: current thinking and trends. Dent Clin N Am 2004(48):513-530.
 5. MACHINABLE CERAMICS
• From 1998, machined ceramics came into being. There are two major
systems for the fabrication of this technique.
1. Digital systems
• CAD CAM technology
2. Analogous systems
• Copy milling/grinding technique
• Erosive techniques

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 MULTILAYERED DENTAL
PROSTHESES
• Metal/ceramic bilayers are still considered the gold standard for fpds
• Development of a series of ceramic materials with high crystalline content are
able to withstand the mechanical stresses :
i. Alumina-based zirconia-reinforced glass infiltrated ceramic
Ii. Polycrystalline alumina
Iii. Y-tzp
• chipping fractures of the veneering ceramic were frequently reported
• multilayered restorations made from cad-cam blocks showed significantly higher
fracture strength values.

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
MONOLITHIC ZIRCONIA
RESTORATIONS
• Among polycrystalline ceramics, yttria-stabilized tetragonal zirconia
polycrystal (Y-TZP) for monolithic restorations has been developed
more recently to overcome problems related to chipping of porcelain
layers applied over zirconia
• Y-TZP shows superior performance among dental ceramics due to the
high strength
• superior fracture toughness
• The better translucency of the new zirconia materials

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 NEW GLASS-CERAMICS
• New glass-ceramics were designed to contain lithium
silicate as the main crystalline phase in a vitreous matrix
reinforced with zirconium dioxide crystals (10%).
• Commercial examples of lithium silicate glass-ceramics
are:
A. Suprinity (vita zahnfabrik, bad sachingen, germany), a
material marketed in a partially crystallized state and
that requires an additional thermal cycle in a furnace

B. CELTRA duo (dentisply-sirona, bensheim, germany), a

material that is already in its final crystallization

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
ADVANTAGES
• Lithium silicate crystals are up to 6 times smaller than lithium
disilicate crystals present in lithium disilicate glass ceramic- due to the
presence of zirconia particles in the material
• these new zirconium-reinforced lithium silicate materials maintain
good optical properties
• attain good surface finishing as they have a high amount of glass
matrix
• have good mechanical properties
• faster to be milled in CAD-CAM machines than lithium disilicate
glass-ceramics and are already offered in their fully crystallized or
need a very short crystallization cycle
• superior polishability due to the smaller crystal sizes in the
microstructure.
Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 POLYMER INFILTRATED CERAMIC
NETWORKS (PICNS)
• Recently, a new material has been developed by Vita which is marketed as a
polymer infiltrated in a porous ceramic
• The material is considered a resin-ceramic composite material, composed of two
interconnected networks: a dominant ceramic and a polymer.
• final shrinkage of the polymer after infiltration is much greater than the shrinkage
experienced upon cooling of the infiltration glass.
• PICN is based on initial sintering of a porcelain powder followed by infiltration
with a monomer mixture.

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 Advantages:
• easier to mill and can be easily repaired by
composite resins.
• Lower elastic modulus and higher damage
tolerance.
• The fracture toughness value was similar to
that of the feldspathic ceramic.
• The stain resistance of picn was superior to
lava ultimate and inferior than that reported for
ips e.Max
INDICATIONS Disadvantage
• The shrinkage of the curing resin
• Based on the reduced elastic modulus of
Enamic, this material is especially indicated for results in interfacial stresses occurring
prosthetic treatments on stiff implants. between the ceramic framework and the
polymer resulting in debonding and a
• Due to the inferior optical properties, PICNs are
more suitable in the molar than in the anterior higher opacity because of the gaps
region developed at the interface.
MOST COMMON CAD CAM SYSTEMS

DIRECT CAD-CAM SYSTEM

• CEREC SYSTEM
• CEREC- Chair Side Economic Reconstruction of Esthetic Ceramic
• First demonstrated in 1986
INDIRECT CAD – CAM
• PROCERA ALL CERAM SYSTEM
• CICERO SYSTEM
• LAVA SYSTEM
COPY MILLING
Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
Cerec System consists of :
• A 3-D video camera (scan head)
• An electronic image processor (video processor) with
memory unit (contour memory)
• A digital processor (computer)
• A miniature milling machine

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
Materials used with CEREC
• Dicor MGC: mica based machinable glass ceramic containing 70% vol of
crystalline phase
• Vita Mark II (Vident):contain sanidine as a major crystalline phase within a
glassy matrix.
• ProCad (Ivoclar):Like Ivoclar's popular Empress™ material, ProCAD is
reinforced with tiny leucite particles, and has been referred to as: "Empress
on a stick".
• Vita IN-Ceram Blanks (Vita Zhanfabrik):
• IN-Ceram Spinell.
• IN-Ceram Alumina.
• IN-Ceram Zirconia

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 PRO-CAD
It is a new CEREC ceramic material based on leucite reinforced glass
ceramic with increased strength.

Indications:
• Veneers
• Partial crowns
• Anterior and posterior crowns

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 PROCERA ALL CERAM SYSTEM

• First system which provides outsourced

fabrication using a network connection.
• Developed by dr. Matts anderson for nobel
biocare embraces the concept of CAD CAM.
• The procera all ceram crown involves a
densely sintered high-purity alumina core
combined with a low-fusing veneering porcelain
fabricated by the pressed powder technology.

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 CICERO SYSTEM
• computer integrated crown reconstruction
• was introduced by Denison et al
• It includes optical scanning, metal and Ceramic sintering,
and computer-assisted milling to obtain restoration.
• The CICERO method of crown fabrication consists of
i. optically digitizing gypsum die
ii. designing the crown layer buildup
iii. subsequently pressing, sintering
iv. milling consecutive layers of a shaded high-strength
alumina-based core material
v. Final finishing is performed in the dental laboratory

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 LAVA SYSTEM
• Introduced in 2002
• mainly used for fabricating zirconia framework for the
all ceramic restorations.
• Uses a laser optical system to transfer and digitize
information received from the preparation.
• The lava cad software suggests a pontic automatically
according to the margin

Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
 COPY MILLING
• Mechanical shaping of an industrially prefabricated material
• Wax pattern of restoration is scanned and the replica is milled out of
the ceramic blank
• Copy milling takes about 20-30 minutes

COPY
MILLING

CERCON CERAMILL
CELEY
SYSTEM SYSTEM
Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
New cerec tessera high-strength glass ceramic blocks impress with fast processing,
high esthetics and robust strength
• A new material for CAD/CAM-fabricated restorations for anterior and posterior
regions. The advanced lithium disilicate (ALD) ceramic is characterized primarily by
the fact that it can be fired exceptionally quickly. The glaze firing takes only four and a
half minutes, so the entire manufacturing process is accelerated.
• The fast firing time is mainly made possible by the special and new composition of the
ceramic made of lithium disilicate and virgilite, a lithium aluminum silicate. Tessera
blocks are composed of a new material containing virgilite.
 Additive Manufacturing Of
Zirconia
• Ceramic materials were only recently
considered in AM processing due to their
intrinsic properties. The high melting
points of ceramics make them difficult to
melt under normal heating methods.
Although it is possible to melt some
ceramics, this process can cause new
phase formation.
• Suspension (27 vol% of zirconia powder,
55% distilled water, boehmite sol,
dispersants, and 3 mol% yttria partially
stabilized zirconia powder) for fabricating
Dental Prostheses/Crown material by
extrusion/ jetting technique.

Galante, R., Figueiredo-Pina, C. G., & Serro, A. P. (2019). Additive manufacturing of ceramics for dental applications: A review. Dental Materials. doi:10.1016/j.dental.2019.02.026
10.1016/j.dental.2019.02.026
 CONCLUSION

It is apparent that ceramics as a material group would continue to play a

vital role in dentistry owing to their natural aesthetics and sovereign
biocompatibility with no known adverse reactions. However, there will
always remain a compromise between aesthetics and biomechanical
strength.
REFERENCES
1. Phillips science of dental materials –11th edition
2. Craig’s Restorative dental materials –13th edition.
3. Mannapallil – 3 rd edition
4. W. Patrick Naylor, Introduction to Metal – Ceramic Technology – Second edition
5. William J.O Brien, Dental materials and their selection- 3rd edition.
6. Kelly JR. Nishimura I. Campbell SD. Ceramics in dentistry: Historical roots and current perspectives. J prosthetic dent
1996:75 18-32.
7. Kelly J. Dental ceramics: current thinking and trends. Dent Clin N Am 2004(48):513-530.
8. Dental ceramics: a review of new materials and processing methods- SILVA L et al. Braz. Oral Res. 2017;31(suppl):e58
9. New CEREC Tessera High-Strength Glass Ceramic Blocks impress with fast processing, high esthetics, and robust strength
10. Hot Isostatic Pressing Technology for dental ceramics, Vol. 2 No. 3 (2023): Biomaterials Journal.
Thankyou!!