-1-

INTRODUCTION

- The word ceramic is derived from the Greek word keramos which literally

means burnt stuff which has come to mean more specifically a material

produced by burning or firing2.

- The term ceramic refers to any product made essentially from a non-

metallic inorganic material usually processed by firing at a higher

temperature to achieve desirable properties. This material is opaque,

relatively weak and porous and would be unsuitable for dental applications.

It consisted mainly of kaolin8.

- Blending of ceramic with other minerals such as silica and feldspar produced

the translucency and extra strength required for dental restorations and were

called porcelain. Thus porcelain refers to a specific compositional range of

ceramic materials made by mixing kaolin, quartz, and feldspar and firing at

high temperature8.

- The main advantages of porcelain, responsible for its wide acceptance, are

its excellent esthetic properties, durability, and biocompatibility.

 -2-

HISTORY OF CERAMICS2,4

- Ceramics were probably the first materials to be artificially made by humans

and porcelain was among the first materials to be subjected to early
laboratory research by scientists.
- The first ceramics fabricated by man were earthenware pots used for
domestic purpose which were made some 6000 to 7000 years ago.

Historically, three basic types of ceramic materials were developed.

1. Earthenware: it is fired at low temperatures and is relatively porous.

2. Stoneware, which appeared in china in about 100 B.C., is fired at a

higher temperature than earthenware, which results in both higher
strength and also renders the material impervious to water.

3. Porcelain, was developed in China in about 1000 A.D that obtained by

fluxing white china clay with Chine stone to produce a white
translucent stoneware. This porcelain material was much stronger that
the earthenware and stoneware.

- In 1708 method of fluxing white clay was fortuitously discovered by

laboratory experiments in Meissen in Germany.

- In 1717 A Jesuit father named dEntrecolles learnt the secret of Chinese

porcelain.
 -3-

- 1728 : Fauchard first to suggest use of porcelain in dentistry. The first

porcelain to be used in dentistry in early 18 th century was based on triaxial

porcelain composition .

- 1774 : Duchateau first to make a porcelain denture. He collaborated

with Nicholas Dubois de Chemant to improve the method of fabrication.

- Amber Tess improved the design of the dental core porcelain oven in 1880.

- In 1806 Fonzi fuses porcelain to metal to produce terrometallic teeth

- Elias Wildman in 1838 formulated a translucent porcelain with shades much

closer to natural teeth.

- 1845: White produced first commercial porcelain denture teeth on

industrial scale using Stockton formula.

- 1900 : Introduction of medium fusing porcelain

- 1903: The first All- Ceramic crowns introduced by Land

- 1968 : Mac culloh first described glass ceramic

CLASSIFICATION OF CERAMICS
1. Based on Fusion Temperature8
- high-fusing ceramics 1315O to 1370O C;

- medium-fusing ceramics 1090O to 1260O C

 -4-

- low-fusing ceramics 870O to 1065O C.

ultra low fusing ceramics has been introduced with fusion temperature lower than
870O C.

2. According to firing technique:

- Air fired (at atmospheric pressure)
- Vaccum fired (at reduced pressure)

3. Fabrication Technique8
- Sintered porcelain
- Castable porcelain
- Machined porcelain
- Infiltrated porcelain
- Pressed porcelain

4. Based on indication9
- Ceramic for artificial teeth
- Jacket crown, inlay and onlay ceramic
- Metal ceramic
- Anterior ceramic

5. Based on translucency9
- opaque
- translucent
- transparent
 -5-

6. Based on type:
- Feldspathic porcelain
- Aluminous porcelain
- Glass ceramic
- Glass infiltrated aluminous
- Glass infiltrated spinell

7. According to the Sub-Structure

- Cast metal ceramic
- Swaged metal ceramic
- Sintered metal
- Glass ceramic

NATURE OF CERAMICS5

- Ceramics are compounds of one or more metals with a

nonmetallic element, usually oxygen. The larger oxygen atoms
serve as a matrix, with the smaller metal atoms tucked into the spaces
between the oxygen.
- Silica (SiO2) forms the basis of many ceramics and can exist in many
different forms. Silica occurs as a crystalline material in the forms of quartz,
crystobalite and trydamite.
- The atomic bonds in a ceramic crystal have both a covalent and ionic
character. These strong bonds are responsible for the great stability of
ceramics and impart very useful properties, such as hardness, high modulus
of elasticity and resistance to heat and chemical attack. On the other hand,
 -6-

the nature of this bonding creates difficulties for the dental ceramist since all
the ceramic materials are brittle

Three basic types of ceramic materials are7

- Earthen ware
- Stone ware
- White ware

CERAMICS

Earthen Ware Stone Ware White Ware

Porcelain Other White Wares

Domestic Decorative Dental 1. Tile

Porcelain Porcelain Porcelain 2. Electrical insulators
3. Sanitary Ware

- All these are composed of essentially the same materials ; the principal
difference is in the proportion of the primary ingredients ( such as feldspar,
silica , and kaolin / clay) and firing procedures ( temperature , methods etc ).
Other compounds such as potash, soda, or lime are often added to give
special properties.
 -7-

Earthen ware (porous pottery ):

- Consists mainly of kaolin and was fired at low temperature. It is relatively
weak and porous.

Stone ware (Impervious pottery ) :

- Use of high temperature during sintering process, resulted in stronger and
more impervious pottery known as stone ware.

White ware:
Composed of blends of three naturally occurring minerals:
1. Pure white clay (Kaolin)
2. Quartz
3. Feldspar

- When these three ingredients are pulverized, blended, formed into shapes
and baked, they compose what is known as white ware.

- These ceramics are called porcelains because they contain a glass matrix
and one or more crystal phases. Porcelain is a type of white ware that has
relatively high strength and translucency.

COMPOSITION OF PORCELAIN8:

feldspar 75 to 85 %
quartz 12 to 22 %
kaolin up to 4%
 -8-

- Porcelain are reinforced with crystalline inclusions such as alumina and

leucite into the glass matrix to form glass composites as part of
strengthening the material and improving the fracture resistance ( dispersion
strengthening) .

- It also contains oxides which function as fluxes. They acts by interfering

with the oxygen bonding

Typical Oxide composition of a dental porcelain

Material Wt%
Silica 63
Alumina 16
Boric oxide 7
Potash (K2O) 7
Soda (Na2O) 4
Other oxides 2

Feldspar3:

- It is a mixtures of potassium aluminium silicate (K 2O.Al2O3.6SiO2) ,also

known as orthoclase or microcline and sodium aluminium silicate, also
known as Albite (Na2O.Al2O3.6SiO2).
- Potash feldspar adds translucent qualities to the fired porcelain. When
melted between 2280 2730OC potash fuses with kaolin and quarts to form
the glassy phase. Potash feldspar increase the viscosity and decrease the
pyroplastic flow (slumping) during firing and helps to maintain the form of
porcelain build up while being heated.
 -9-

- Sodium feldspar lowers the fusion temperature of the porcelain and make it
more susceptible to pyroplastic flow.

Kaolin3
- It is a hydrated aluminium silicate (Al 2O.2 SiO2.2H2O) and acts as a binder,
increasing the mouldability of the unfired porcelain. It is opaque.

Its functions are

1. It increases the mouldability of porcelain.
2. Acts as a binder and helps in maintaining the shape of the unfired
porcelain during firing.
3. At high temperature , it fuses and reacts with other ingredients to form
the glassy matrix.

Quartz3
- It has a high fusion temperature and serves as the framework around which
the other ingredients flow. Thus helps to maintain the form and shape of a
free standing object during firing .
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Feldspar

Dental Porcelain

Domestic
porcelain

Stoneware

Kaolin Quartz
Earthenware
 - 11 -

Irregularity of glass structure due to the presence of large alkali cations7.

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MANUFACTURE AND PROCESSING OF CERAMICS8

- Many dental porcelains manufacturers buy feldspar as powder already

screened and cleaned from impurities to their specifications. Other raw
materials used in the manufacture of dental porcelains are various types of
SiO2 in the form of fine powder, alumina and hydrated alumina, as well as
alkali and alkaline earth carbonates as fluxes.

- During the manufacturing process, the ground ingredients are carefully

mixed together and heated to about 1200O C in large crucibles. Feldspar
melts incongruently at about 1150O C to form glassy phase with an
amorphous structure, and crystalline (mineral) phase consisting of leucite
(KAlSi2O6 or K2O.Al2O3.4SiO2). The crystalline structure of leucite is
tetragonal

Functions of leucite:
- To raise the co efficient of thermal expansion of porcelain and bring it closer
to the metal substrate; consequently increasing the hardness and fusion
temperature.
- strengthening of porcelain in high strength ceramics.eg Optec HSP, IPS
Empress.
- For dental porcelains, the process by which the particles coalesce is called
liquid-phase sintering, a process controlled by diffusion between particles at
a temperature sufficiently high to form a dense solid.
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Three-dimensional structure of leucite7.

 - 14 -

- The mix of leucite and glassy phase is then cooled very rapidly (quenched)
in water which cause the mass to shatter fragments. The product obtained,
called a frit, is ball-milled to achieve proper particle size distribution.

- The degree of fusion and pyrochemical reaction in the frit is limited to the
extent that a proportion of the feldspar remains undissolved in the glass flux.
Because of the difference in the refractive indices the final glass frit may
appear opalescent or assume a grey blue translucency similar to natural
incisal enamel.

- Coloring pigments in small quantities are added at this stage, to obtain the
delicate shades necessary to mimic natural teeth.

colour pigments9:

- Pink: chromium-tin or chrome-alumina produce pink colour. These pigments

are stable up to a firing temperature oh 1350oc. They are particularly useful
in eliminating the greenish hue in the glass.
- Yellow- brown : titanium oxide
- Blue: cobalt salts are used to produce these colours and are particularly
useful for producing some of the enamel shades.
- Green: chromium oxide is the main pigment for producing a greenish color
- Grey: iron oxide or platinum grey: are useful pigments for producing
enamels or for addition to the greyer section of the dentine colors.
 - 15 -

opacifying agents:

- The addition of opacifying agents is a delicate procedure and it consists of a

metal oxide ground to a very fine particle size (<5micron) to prevent
speckled appearance in porcelain. Common oxides used are
cerium oxide
titanium oxide
zirconium oxide

Stains and color modifiers:

- A stain is more concentrated than a color modifier. The later is used to obtain
gingival effects or to highlight body colors whereas the stain former are
more generally used as surface colorants or to provide enamel check lines,
decalcification spots etc.

Flourescense:

- It is usually produced by the addition of the uranium salt, sodium di uranate.

This salt produces a strong greenish yellow color and when small additions
of cerium oxide are made, a bluish white fluorescence can be achieved
similar to human tooth.

After the manufacturing process is completed, feldspathic dental porcelain

consists of two phases. One is the vitreous (or glass) phase, and the other is the
crystalline (or mineral) phase.
 - 16 -

PROCESSING8:
Porcelain Application and Condensation for metal ceramic:
- Wax framework is fabricated over the die and is cut back by 1 mm in the
esthetic areas to ensure enough space for porcelain application. The
framework is cast by the lost-wax technique.
- Then the powder is mixed with modeling liquid (mainly distilled water) to a
creamy consistency and is applied on the opaque layer, with allowances
made for shrinkage. To produce minimum shrinkage and dense, strong
porcelain, it is important to achieve a thorough condensation of the particles
at this stage. Various means of condensation may be employed.

Method of Condensation9
a. Brush application.
b. Gravitation.
c. Spatulation.
d. Whipping.
e. Vibration.
- All these methods aim in bringing the water to the surface so that it can be
removed easily. The first layer of aluminous core or magnesia core paste is
made in thick bulk to get more strength. The mixed paste is applied with a
small brush on to the platinum foil on the surface of the die. Then to remove
water from the wet paste, some dry porcelain powder is sprinkled on the wet
surface with a brush
 - 17 -

- Brush Application Method. The dry powder is applied with the brush to a
small area of wet porcelain mass. As the water is withdraw toward the dry
area the wet particles are pulled closely together.

- In Gravitation method, gravity will bring the water of the paste to the
surface, which is then removed by a blotting paper or by a linen cloth.
- In Spatulation Method, the surface of the wet paste on the die is smoothened
with a small spatula, which will cause the water to come to the surface and
then it is removed with a blotting paper.
- In Whipping method, the surface of the wet paste is tapped lightly with a
spatula few times, and this will cause the water to come to the surface,
which is then removed by blotting paper.
- In vibration Method, mild vibration during packing the paste will cause the
water to come to the surface, which is then removed by blotting paper.

Drying
- After the porcelain mix has been applied and condensed, the restoration is
placed in an open preheated porcelain furnace to be dried. This drying stage,
which lasts between 5 and 8 minutes, is a very important step; it ensures that
any remaining excess water is removed from the porcelain mix.

Firing / Sintering
- Porcelain restorations may be fired either by temperature control alone or by
controlled temperature and a specified time. In the first method the furnace
temperature is raised at a constant rate until a specified temperature is
reached. In the second method the temperature is raised at a given rate until
certain levels are reached, after which the temperature is maintained for a
 - 18 -

measured period until the desired reactions are completed. Either method
gives satisfactory results, but the time and temperature method is generally
preferred because it is more likely to produce a uniform product.
CLASSIFICATION OF STAGES IN MATURITY7
Low bisque:
- The surface of the porcelain is very porous and will easily absorb a water
soluble die. At this stage the grains of porcelain will have started to soften at
their contact points. shrinkage will be minimal and the fired body is
extremely weak and friable
Medium bisque:
- The surface of the porcelain is slightly porous but the flow of the glass
grains will have increased and any trapped furnace atmosphere that has not
escaped via the grain boundaries will be trapped and become sphere-shaped. A
definite shrinkage will have taken place.

High bisque:
- The surface of the porcelain should be completely sealed and presents with a
much soother surface with a slight shine. Shrinkage should be complete and
the porcelain should have reached a high strength, allowing any
corrections by grinding to be made prior to glazing.

Glazing
- After the porcelain is cleaned and any necessary stains are applied, it is
returned to the furnace for the final glaze firing.
- Dental glazes consist of uncolored glass powders which can be applied to
the surface of the fired crown to produce a glossy surface. A glaze should
normally mature at a temperature below that of the restoration and the
 - 19 -

thermal expansion of the glaze should be fractionally lower than the ceramic
body to which it is applied. In this way the glaze surface is placed under
compression, and crazing or peeling of the surface is avoided.

Biscuit stage of vitreous sintering, involving flow of glass to form bridges between
particles7
 - 20 -

Cooling
- It is commonly accepted that the cooling stage is a critical one in the
fabrication of ceramic-metal restorations and that extreme (too fast or too
slow) cooling rates should be avoided.
- Too-rapid cooling of the outer layers may result in surface crazing or
cracking; this is also called thermal shock. Very slow cooling (i.e. in a
furnace) as well as multiple firings , might induce the formation of
additional leucite and increase the overall coefficient of thermal expansion
of the ceramic, and may also result in surface cracking and crazing. Slow
cooling is preferred, and is accomplished by gradual opening of the
porcelain furnace.

Castable glass ceramics5:

- Indication for use is in single anterior and posterior crowns.

- Castable ceramic systems are used to cast crowns by the lost wax process.
The wax pattern of the crown is invested in a phosphate-bonded investment.
An ingot of the ceramic material is placed in a special crucible and melted
and cast with a motor-driven centrifugal casting machine at 1,380C
(2,500F).

- The cast crown is a clear glass that must be heat treated to form a crystalline
ceramic, which is essentially a fluorine mica silicate. The crystallization
procedure takes several hours in a heat-treating or "ceramming" furnace,
with a final temperature of 1,075C (1,967F).
 - 21 -

Injection-Molded High-Leucite Porcelain:

- In this process high-leucite porcelain ingot cylinders are heated to 115C to
produce a plastic state. Then, the ingots are pressure-injected into investment
molds formed by the lost wax process for crowns, inlays, onlays, and
veneers.
Alumina Slip Casting11
- The alumina cores is formed by painting slurry of fine alumina particles on
plaster dies, which absorb the water to form a green state core. The alumina
is then sintered at 1,120C to form a dense mass. Glass is then applied and
fused at 1,100C for 4 hours to allow glass infiltration. The rest of the crown
is then formed by firing a body porcelain over the cores by traditional firing.
- This process for forming alumina cores gives very high strength values
(around 500 MPa).

CAD/CAM5:

- First, a powder is applied to the patient's prepared tooth to provide contrast

for the optical scanner. Next, the prepared tooth is scanned with an optical
probe, and the image is stored in a computer.
- The restoration is designed on a monitor screen with computer assistance.
After the restoration is designed, a bloc of a machinable glass-ceramic is
selected by shade. With information from the computer, the restoration is
milled in a few minutes in a compartment of the chairside unit.
- The restoration is then acid etched, and a silane agent is applied in
preparation for bonding to the tooth preparation. After cementing with a
resin cement, the main surfaces are contoured with a diamond contour
instrument and polished.
 - 22 -

PROPERTIES OF CERAMICS3

Strength:

Porcelain has good strength. However, it is brittle and tends to fracture. The
strength of porcelain is usually measured in terms of flexure strength (or modulus
of rupture)

(a) Flexure Strength:

- It is a combination of compressive, tensile, as well as shear strength.
- Glazed porcelain is stronger than ground porcelain.
Ground - 75.8 MPa (11,000 psi)
Glazed - 141.1 MPa (20,465 psi)

b) Compressive Strength: 331MPa (48,000psi)

(c) Tensile Strength:

- Tensile strength is low because of the unavoidable surface defects like
porosities and microscopic cracks. When porcelain is placed under tension,
stress concentrates around these imperfections can result in brittle fractures -
34 MPa (5,000 psi).

(d) Shear Strength:

- It is low and is due to the lack of ductility caused by the complex structure
of porcelain. - 110 MPa (16,000psi)3,4
 - 23 -

Modulus of elasticity:
Porcelain has high stiffness (69Gpa) / l0x 106Psi

Surface hardness:

- Porcelain much harder (460 KHN) than natural teeth. It can wear natural
teeth. Thus, it should be very carefully placed opposite natural teeth.

Thermal properties:

1. Thermal conductivity - Porcelain has low thermal conductivity -

0.00500C/cm
2. Co efficient of thermal expansion - It is close to that natural teeth - 12-

14xl0-6/0C

Specific Gravity:

- The true specific gravity of porcelain is 2.242. The specific gravity of fired
porcelain is usually less (2.2 to 2.3), because of the presence of air voids.

Linear Shinkage:

- The linear firing shrinkage of feldspathic porcelains has been reported to be

14.0% for low fusing porcelain ( ceramic-metals) and 11.5%. for high fusing
porcelain(denture teeth).
- Medium fusing porcelains has shrinkage between high and low fusing types.
 - 24 -

Refractive Index:
- The refractive index of dental porcelain is in the range of 1.52 - 1.54.
- Dental porcelain is optically heterogeneous. The greatest light scattering
effect of porcelain is obtained with an increase in difference in refractory
index between the particles (opacifiers) and the main bulk of the porcelain
phase.

Chemical Stability:
- It is insoluble and impermeable to oral fluids. Also it is resistant to most
solvents. However, hydro fluoric acid causes etching of the porcelain
surface. Etching improves the bonding of the resin cement. Chemical
dissolution occurs as a result of solubilization created by hydrogen bonding
effects of water and locally high acidity
- Dental ceramics may be dissolved by very high acidic fluoride solutions
(APF) used for protecting outer layers of enamel against caries.

Esthetic Properties:

a) Opalescence
- It is an optical property of a material in which there is a scattering of the
short wavelengths of the visible spectrum of light giving the material a
bluish appearance under reflected light and an orange brown appearance
under transmitted light.
- Opalescence in dental porcelains is a light scattering effect achieved with the
addition of minute concentrations of oxides with high refractive index in the
range near the wavelength of visible light.
 - 25 -

b) Fluorescence

- It is the absorption of radiation of a particular wavelength and its reemission

as a radiation of longer wavelength. The energy that the tooth absorbs is
converted into light with longer wavelengths in which case the tooth actually
becomes a light source.
- Fluorescence can be achieved in dental porcelain by the addition of uranium
salts, cerium oxides, samarium spinels and lanthanide earth.

c) Luminary properties:
- This is nothing but the optical shade lightening wherein the intensification of
light is achieved by luminosity. The porcelains with this property is called
as luminary porcelains

Bio Compatibility:
- Excellent compatibility with oral tissues. Most ceramic implant materials
have very low toxic effects on tissues , because they are in an oxidized state
and are corrosion resistant .They are minimally toxic, non immunogenic,
and non carcinogenic . However , they are brittle and lack impact and shear
strength.

Bonding to porcelain:
- The bonding of porcelain and resins introduced new techniques and aroused
considerable interest but this bonding requires some modifications in the
porcelain surface. Silane primer is the coupling agent normally used.
 - 26 -

METHODS OF STRENGTHENING

1) According to JOHN W. MCCLEAN6

Strengthening can be increased by
- Enameling of metals wherein porcelain is directly fused to a metal coping.
- Dispersion strengthening of glasses -- which is done by dispersing ceramic
crystals of high strength to the glass matrix e.g. aluminous porcelain, slip
casting alumina (in ceram ), non shrink ceramics.
- Controlled crystallization of glasses with crystal seed or nuclei present.
- Chemical toughening which is nothing but ion exchange process that
involves replacement of small monovalent ions (sodium) at the surface with
large ions generating large compressive stresses which would decrease the
tendency to crack propagation.
- Bonding to foils which can function as a metal substructure / matrix for the
porcelain.

2) According to K. J. ANUSAVICE strengthening can increased by two ways

i) Minimize the effect of stress raisers

1. Reduce fabrication defects e.g. void.

2. Avoid hand condensation before sintering as this may cause porosity.

3. Development of microcracks should be controlled by matching thermal

contraction of crystals and glass matrix.

4. Line angles should be rounded.

5. Surface flaws should be minimized.

ii) Develop residual compressive stresses:

 - 27 -

- One widely used method of strengthening glasses and ceramics is the

introduction of residual compressive stresses within the surface of an object.

Strengthening is gained by virtue of the fact that these residual stresses must

first be negated by developing tensile stresses before any net ensile stress

develops. This can be done using a core porcelain which has a high co-

efficient of thermal contraction than the enamel or veneering porcelain and

hence this produces a compressive stress upon cooling, Which can improve

the strength of the ceramic material.

iii) Minimize the Number of firing cycle:

- Leucite which is a high expansion phase used in metal ceramic systems can

expand drastically and cause fracture between porcelain and metal on

repeated firings and hence firing cycles should be minimized.

iv) Minimize tensile stress through optimal design of ceramic prosthesis.

1. Conventional feldspathic porcelain should be used in posterior regions.

2. Sharp line angles should be avoided

3. Adequate overjet /overbite is essential.

4. Slip metal coping in vital.

v) Ion exchange (or) chemical tempering.

 - 28 -

- If a sodium containing glass particle is place in a bath of molten potassium

nitrate, potassium ion in the bath exchange with some sodium ions in the
glass particle.
- This induces compressive stress onto the surface of the substance thereby
increasing the strength of the ceramic.

vi) Thermal tempering:

- This is the most common method of strengthening glass. Thermal tempering

creates residual surface compressive stresses by rapidly cooling (quenching)

the surface of the object while it is hot and in the softened (molten) state. As

the molten core solidifies, it tends to shrink, but the outer skin remains rigid.

The pull of the solidifying molten core as it shrinks creates tensile stresses in

the core and residual compressive stresses within the outer surface and

contributing to enhanced strength.

vii) Dispersion strengthening

- A dispersed phase is introduced to prevent crack propagation into the matrix
phase.
Example : Leucite, Magnesia alumina spinels, Zirconia

viii) Transformation toughening

- The transformation of one crystalline form to another can cause toughening
and prevents the development of cracks.
Eg. Tetragonal crystal to monoclinic crystal of zirconium
METAL CERAMIC SYSTEMS3
 - 29 -

Indications for use of the metal-ceramic crown:

1. In cases of parafunctional mandibular activity where an aesthetic
restoration is essential.
2. Where lingual clearance of less than 0.8mm is present after tooth
preparation (e.g. metal-backed crown).
3. Teeth requiring fixed splitting or being used as bridge abutments.
4. In all posterior teeth where full coverage is necessary for aesthetic
reasons.
5. Where deep chamfer preparations are desirable, e.g. lingual shoulder
areas or periodontally involved teeth.

Contra-indications for use of the metal-ceramic crown

1. Adolescent teeth where minimal tooth preparation is essential.

2. Adult teeth where enamel wear is high and there is sufficient bulk of
tooth structure to allow room for metal and porcelain, e.g. 1.5mm.

3. Anterior teeth where aesthetics is of prime importance, e.g. light

shades or very translucent teeth.8
- Porcelain fused to metal restorations involves a advantage of the good

mechanical properties of cast dental alloys with the excellent aesthetic

properties of porcelain.

- A major requirements of the materials used in PFM restorations is

compability of the metal and ceramic used. Feldspathic porcelains used for
 - 30 -

PFM work normally contain significant amounts of leucite. This increases

the coefficient of thermal expansion of the porcelain to a value which is

closer to that for the metal. This helps to prevent the development of thermal

stresses during the cooling from the firming temperature. The presence of

leucite also helps to strengthen requirement for PFM ceramics as specified

in ISO Standards is 50 MPs, which is equivalent to the requirement for

dentine / enamel porcelains used in all-ceramic restorations.

- The composition of the ceramic generally corresponds to that of the glasses,

except for increased alkali content. The addition of greater quantities of

soda, potash, and/or leucite is necessary to increase the thermal expansion to

a level compatible with coping. The opaque porcelains also contain

relatively large amounts of metallic oxide opacifiers to conceal the

underlying metal and to minimize the thickness of the opaque layer

- There are four types of alloy currently available for porcelain bonding.

These are (1) high-gold alloys, (2) low-gold-content alloys, (3) silver-

palladium alloys, and (4) nickel-chromium alloys.

TYPES OF METAL CERAMIC SYSTEM:

Bonded platinum foil coping

 - 31 -

A method of bonding porcelain to metal makes use of tin oxide coatings on

platinum foil

Objective

- To improve the esthetics by a replacement of the thicker metal coping with a

thin platinum foil , thus allowing more room for porcelain .

- Attachment of porcelain is secured by electroplating the platinum foil with a

thin layer of tin and then oxidizing it in a furnace to provide a continuous

film of tin oxide for porcelain bonding .

Metal ceramic crowns based on swaged foil copings

- Renaissance and captek are the products designed to fabricate the metal

coping of a metal ceramic crown without the use of a melting and casting

process. It is a laminated gold alloy foil that is delivered to the user in a

flutted shape reminessent of a miniature coffee filter. This pleated foil is

swaged with a swaging instrument, burnished with a hand instrument on the

die and then flame sintered to form a coping with moderate strength. An

inter facial alloy power is applied and fired, the coping is then veneered with

condensed porcelain , and the porcelain is then sintered at typical porcelain

firing temperature.

Advantages
 - 32 -

- High Strength
- Potential for fixed partial dentures
- Excellent fit
Disadvantages
- Appearance of metal margins
- Discoloration by metal
- Difficulty producing an appearance of translucency
- Bond failure with metals
- Possible disadvantages of alloy used

Metal-ceramic bond
- This bond is brought about by secondary atomic force like Vander walls
forces. This bond takes place by three means :
1. Mechanical.
2. Chemical
3. Compression
Mechanical

- Good wetting of the metal surface or metal oxide surface by the porcelain is

essential to achieve mechanical bond. Surface tension provides intimate

contact of porcelain with all the microsurface irregularities of the metal.

Before the application of porcelain, metal casting should be carefully

cleaned to insure a strong bond to the porcelain, with a carborundum

mounted point.

Chemical Bond
 - 33 -

- In principle, some components of alloy combine chemically with porcelain.

Heating to 10000 C in vacuum for 10 minutes degasses the metal first. Then

air cooled slowly. This will remove the gases from the surface of the metal

and induce some age hardening of the alloy. At the same time base metal

atoms will diffuse to the surface of the metal and form an oxide film

(indium, tin or zinc oxide). This oxide film will provide chemical bond when

porcelain is applied over it.

- Then opaque porcelain paste is applied to the surface in thin layer and

slowly oven dried. This will cause the porcelain to shrink on to the metal

surface. Then the metal is pushed into the real hot zone of the furnace. Now

the surface tension will play a part to cause good wetting of the surface of

the metal with porcelain and bring about mechanical interlocking. At the

same time chemical bond will take place between porcelain and metal oxide.

- Then, on further heating to the maturing temperature of porcelain (950 C),

shrinkage and pore elimination will occur.

Compressive Bond:
 - 34 -

- On cooling-metal will contract faster than porcelain and this itself will put

metal under tension and porcelain under compression. This will make the

porcelain to bond to the metal firmly.

- Thus once this first layer of porcelain is firmly bonded to the metal surface,

then other porcelain pastes like dentin and enamel pastes are added to build

up the whole crown in shape and size and fired as usual.

Peremuter and Montagnon have advised etching of ceramic with 7.5% to 10%

hydrofluoric acid for 2 to 10 minutes followed by application of silane coupling

agent. Etching is advised for the following reasons:

- To wash away the alkaline layer of he absorbed water on the porcelain

surface.
- To increase the surface tension and develop surface characteristics.
- To increase the micromechanical bonding between ceramic and resin.

Various commercially available etchants are:

1. Stritpit which contains Hydrofluoric acid and sulfuric acid.
2. Ceram etch which contains Hydrofluoric acid.
3. Super etch which contains nitric, hydrochloric and hydrofluoric acid.
4. Dicor Etching Gel contains ammonium bifluoride.
5. APF gel which contains sodium fluoride hydrofluoric and phosphoric acid.
Silanization: This refers to silane coating of an etched glass surface to increase its
surface affinity to polymers.
 - 35 -

Surface treatment for bonding with alloys:

There are two treatments for bonding with alloys they are
1. tin plating and
2. silica coating.

Porcelain repair:

The general method for repair is as follows:

1. Establish a dry field.

2. Remove the surface of adjacent remaining porcelain with an abrasive bur.

3. Treat the area to be repaired with etching gel, and clean off.

4. Silanize the ceramic surface with a silane component.

5. Apply metal bonding component over exposed metal surfaces.

6. Apply bonding resin to the entire area.

7. Repair the restoration with composite component and cure.

The shear bond strengths of repair systems usually range from 10 to 15 MPa after

storage in water for 1 day and thermocycling.

CERAMIC PROSTHESES 9

Aluminous porcelain
 - 36 -

- In 1965 Mc. Lean and Hughes developed aluminous Porcelain

- Alumina is added as filler in high percentages to strengthen the porcelain

and is used as a core. That is, as a first layer over the die while building a

crown. In the finished crown, this presence of alumina prevents propagation

of Crack.

- Presence of alumina in a porcelain may strengthen it, but it will affect the

translucency and there by the colour of porcelain. Therefore proper selection

of the particle size of alumina is important. The quantity of alumina in

porcelain powder is-

In Core Powder - 50 Percent

In Dentin Powder - 15-20 Percent

In Enamel Powder - 5 Percent

Machinable ceramics

- The ceramic ingots used in CAD-CAM restorations do not require

further high temperature processing. They are placed in a machining

apparatus to produce the desired contours. This is followed by occlusal

adjustment and then polishing, etching and bonding the restoration to the

prepared tooth.

CEREC
 - 37 -

- Ceramic Reconstruction System was the first commercially available

CAD/CAM system used in dentistry. An intra oral video camera images the

tooth preparation and the adjacent surfaces.

Cerec Vitablocs Mark I.

- In 1986 Cerec I was introduced by Swiss

- This is a feldspathic porcelain, which was the first composition used with

the Cerec system. It is similar in composition, strength and wear properties

to feldspathic porcelain used for porcelain-fused-to-metal restorations.

Cerec Vitablocs Mark II

- In 1994 Cerec II introduced by Siemens company

- This is a feldspathic porcelain of increased strength, and has a finer grain

size than the Mark I compositions; an in vitro evaluation shows that this

produces less abrasive wear of the opposing tooth structure.

Castable Glass-Ceramics (Dicor)

- Dicor is the first castable glass that is formed into an inlay, facial veneer, or

full-crown restoration by a lost-wax casting process similar to that employed

for metals. After the glass casting core or coping is recovered, the glass is

sandblasted to remove residual casting investment and the sprues are gently
 - 38 -

cut away. The glass is then covered by a protective "embedment" material

and subjected to a heat treatment that causes microscopic plate like crystals

of crystalline material (mica) to grow within the glass matrix. This crystal

nucleation and crystal growth process is called ceramming.

- Dicor glass-ceramic contains about 55 vol% of tetrasilicic fluormica

crystals. The ceramming process results in increased strength and toughness,

increased resistance to abrasion, thermal shock resistance, chemical

durability, and decreased translucency.

- The advantages of Dicor glass-ceramic were ease of fabrication, improved

aesthetics, minimal processing shrinkage, good marginal fit, moderately high

flexural strength, low thermal expansion equal to that of tooth structure, and

minimal abrasiveness to tooth enamel.The disadvantages of Dicor glass-

ceramic were its limited use in low-stress areas and its inability to be colored

internally.

- Two veneering materials were used to improve the color of Dicor crowns:

Dicor Plus, which consisted a pigmented feldspathic porcelain veneer, and

Willi's Glass, a veneer of Vitadur aluminous porcelain.

Dicor MGC

- In 1968 "DICOR" was described by Grossman and Adair

 - 39 -

- This is a machinable glass ceramic composed of fluorosilicic mica crystals

in a glass matrix. It has greater flexural strength than the castable Dicor and

the Cerec compositions. This material is softer than conventional feldspathic

porcelain and produces less abrasive wear of the opposing tooth structure

than Cerec Mark I and more wear than Cerec II in an in vitro study

- Dicor MGC is a higher quality product that is crystallized by the

manufacturer and provided as CAD-CAM blanks or ingots. The CAD-CAM

ceramic Dicor MGG contains 70 vol % of tetrasilicic fluormica particals,

which are approximately 2 m in diameter. The mechanical properties of

Dicor MGC are similar to those of Dicor glass-ceramic, although it has less

translucency.

Celay.

- In 1991 Celay ( Mikrona ) were introduced

- This material can be used for CAD-CAM - produced restorations or used in

the copy-milling technique .It is a fine-grained feldspathic porcelain that is

said to reduce the wear of antagonist tooth structure. The physical and

clinical propertied of Celay are also identical to those of Cerec Vitablocs

Mark II.

Procera AIlCeram
 - 40 -

- In 1993 Procera all - ceramic system marketed, developed by Andersson and

Oden.

- The Procera AII Ceram crown is composed of densely sintered, high-purity

aluminum oxide core combined with a compatible All Ceram veneering

porcelain. This ceramic material contains 99.9% alumina, and its hardness is

one of the highest among the ceramics used in dentistry. Procera All Ceram

can be used for anterior and posterior crowns, veneers, onlays, and inlays.

- A unique feature of the Procera system is the ability of the Procera Scanner

to scan the surface of the prepared tooth and transmit the data to the milling

unit to produce an enlarged die through a CAD-CAM process. The-core

ceramic form is dry pressed onto the die, and the core ceramic is then

sintered and veneered. Thus the usual 15%-20% shrinkage of the core

ceramic during sintering will be compensated by constructing an oversized

ceramic pattern, which will shrink during sintering to the desired size to

accurately fit the prepared tooth.

Glass-Ceramics

- A glass-ceramic is a material that is formed into the desired shape as a glass,

then subjected to a heat treatment to induce partial devitrification (i.e., loss

of glassy structure by crystallization of the glass). The crystalline particles,

needles, or plates formed during this ceramming process serve to interrupt

 - 41 -

the propagation of cracks in the material when an intraoral force is applied,

thereby causing increased strength and toughness. The use of glass-ceramics

in dentistry was first proposed by MacCulloch in 1968. He used a

continuous glass-molding process to produce denture true teeth.

Presabble Glass-Ceramics

- This method uses a piston to force a heated ceramic ingot through a heated

tube into a mold, where the ceramic cools and hardens to the shape of the

mold. When the object has solidified, the refractory mold (investment) is

broken apart and the ceramic piece is removed. It is then debrided and either

stained and glazed (certain inlays) or veneered with one or more layers of a

thermally compatible ceramic.

- In 1991 IPS Empress ceramic marketed, which was developed by

Wohlwend IPS Empress is a glass-ceramic provided as core ingots that are

heated and pressed until the ingot flows into a mold.

- IPS Empress is a leucite-containing glass-ceramic that contains about 35 vol

% of leucite (KAlSi2O6)crystals, which increases the resistance to crack

propagation (fracture). The veneering ceramic also contains leucite crystals

in a glass matrix.

- The IPS Empress2 is similar except that the core consists of lithia disilicate

crystals in a glass matrix and the veneering ceramic contains apatite crystals.
 - 42 -

The very small apatite crystals cause light scattering in a way that resembles

the scattering by the structure and components of tooth enamel.

- The hot-pressing process occurs over a 45-min period at a high temperature

to produce the ceramic substructure.

- Advantages

lack of metal

translucent ceramic core

excellent fit and aesthetics.

- Disadvantages

potential to fracture in posterior areas

need to use a resin cement to bond the crown micromechanically to

tooth structure.

Optec pressable ceramic and Optec pressable ceramic 3G

- These are two pressable ceramics that are similar in nature to IPS Empress

and IPS Empress2, respectively . OPC is a leucite ceramic and OPC G3

contains lithia discilate crystals. The ultralow-fusing temperature of the

veneering porcelain suggests a low level of wear of opposing enamel.

Cerestore
 - 43 -

- Shrink free ceramic with crystallized magnesium alumina spinel , fabricated

by injection molded technique to form a dispersion strengthened core.

In-Ceram Alumina, In-CeramSpinell, and In-CeramZirconia

- In-Ceram is supplied as one of three core ceramics:

1. In-ceram Spinell,

2. In-Ceram Alumina

3 In-Ceram Zirconia

- The final In-Ceram Alumina core consists of 70 wt% alumina infiltrated

with 30 wt% sodium lanthanum glass. The final ln-Ceram Spinell core

consists of glass-infiltrated magnesium spinel (MgAl2O4). ln-Ceram Zirconia

contains approximately 30 wt% zirconia and 70 wt% alumina.

- A slurry of one of these materials is slip-cast on a porous refractory die and

heated in a furnace to produce a partially sintered coping or framework. The

partially sintered core is infiltrated with glass at 1100 O C for 4 hr to

eliminate porosity and to strengthen the slip-cast core.

- Indication:

In-ceram Spinell - anterior single-unit inlays, onlays, crowns,

and veneers.
In-Ceram Alumina - anterior and posterior crowns and anterior
three-unit FPDs.
In-Ceram Zirconia - posterior crowns and posterior FPDs.
 - 44 -

Because of its high level of opacity, is not recommended for anterior

prostheses.

- The flexural strength (modulus of rupture):

In-Ceram Spinell (ICS) - 350 MPa

In-Ceram Alumina (ICA) - 500 MPa

In-Ceram Zirconia (ICZ) - 700 MPa

- The advantages,

moderately high flexural strength and fracture toughness,

metal-free structure,
ability to be used successfully with conventional luting agents
(Type I cements).
- Disadvantage:

marginal adaptation may not be as good as that achieved with other

ceramic products.
relatively high degree of opacity
inability to be etched
Cercon and Lava Zirconia Core Ceramics11

- It uses a scanning and milling unit. The wax pattern is anchored on the

holding appliance on the left side of the scanning and milling unit (Cercon

Brain). A presintered zirconia blank is attached to the right side of the Brain

unit
 - 45 -

- After the unit is activated, the pattern is scanned and the blank is rough-

milled and fine-milled on occlusal and gingival aspects in an enlarged size to

compensate for the 20% shrinkage that will occur during subsequent

sintering at 1350' C. The processing times for milling are approximately 35

- The milled prosthesis is removed from the unit and placed in the Cercon

furnace and fired at 1350OC for approximately 6 hours to fully sinter the

yttria-stabilized zirconia core coping or framework.

CEROMERS (Ceramic Optimized Polymers)

- They are more complex laboratory processed composites called as polymer

glasses, filled polymers or ceramic optimized resins. It is used in inlays,

onlays, single unit crowns, and also with fibre reinforcements for splints and

short span fixed partial dentures

CERAMICS IN IMPLANTS

- There are two basic types of ceramic implant materials. They can be

classified by the manner in which they interact with bone.

non reactive

bioactive

- Non reactive ceramics, such as aluminum oxide and sapphire, are well

tolerated by bone tissue, in much the same way as titanium. They have high
 - 46 -

strength, stiffness, and hardness. Their fracture resistance is poor, however,

especially when they are subjected to bending forces.

- Bioactive ceramics react directly with bone tissue and result in the formation

of hydroxyapatite or some other calcium phosphate compound on their

surface. This reaction produces a direct chemical bond between the implant

and the new bone.

- Since it is relatively weak in tension and bending it is not suitable for use

in high-stress situations. Therefore, it works best as a coating for a titanium

implant.

CERAMICS IN ORTHODONTIC BRACKETS

- Ceramic brackets are used as an alternative to plastic brackets.

Monocrystalline and poly crystalline ceramic materials used in

manufacturing these brackets provide excellent color fidelity and stain

resistance. Poly crystalline brackets are superior to monocrystalline type.

The first ceramic used was aluminium oxide or alumina , followed by

zirconia. Alumina brackets , 99.8% pure, are clear and translucent ; partly

stabilized zirconia can take shades between ivory and white.

 - 47 -

CRITERA FOR THE SELECTION AND USE OF DENTAL CERAMICS9

- The dentist should not use all the ceramic crowns for patients with evidence
of extreme bruxism, clenching or malocclusion. In this case, the metal
ceramic or all-metal prostheses should be used.
- The experience of the laboratory technician should be extensive to ensure a
success rate of at least 98% over a three year period. This is the success rate
for metal-ceramic crowns and bridges after 7.5 years.
- The dentist should judge whether the previous aesthetic success with metal-
ceramic prostheses combined with the aesthetic demands of the specific
patient would yield more predictable outcomes and longevity than an all
ceramic crown.
- Use all ceramic crowns when adjacent anterior teeth exhibit a high degree of
translucency. Because of their relatively translucent core materials, Optimal
Pressable Ceramic OPC35, IPS Empress, IPS Empress2, and Finesse All-
Ceramic systems are useful for matching adjacent tooth shades for young
patients and others who may exhibit a high degree of translucency. Use the
ceramic course materials in posterior areas when limited space or high stress
conditions exist.
- Patients must accept the described benefits, risk, and alternatives to the
proposed treatment, and they must give their consent for the treatment to be
performed
- The skill of the dentist is of paramount importance in producing perfect
impressions derived from smooth preparations free of undercuts with
continuous well defined margins and with adequate tooth reduction3.
 - 48 -

CONCLUSION

Existing ceramic materials and innovative ceramics processing strategies have

been introduced in restorative dentistry since the early 9080s. The notable recent
advancement include 1) the advent of predictable ceramic materials and technique
for esthetic complete crowns, partial coverage and laminate veneer restoration. 2)
improved metal ceramic esthetic with the advent of opalescent porcelain and
framework modification, 3) introduction of CAD CAM and machining as a route
to fabrication of restoration, 4) improved understanding of the clinical response of
all ceramic prostheses and of the materials factors that influence clinical longevity.
Strong scientific and collaborative foundation should exist between dentist
and ceramic engineering community for continued development and improvement
of ceramic system5.
 - 49 -

References :

1. Dental porcelain, Dent Clin N Am 15 (1971) 33-42

2. Development of dental ceramics- an historical prespective,
Dent clin N Am 29 (1985) 621-644
3. W. Patric Naylor, Introduction to metal ceramic technology,
quintessence publication; 1992
4. Ceramics in dentistry: historical roots and current perspective ,
J Prosthet Dent 75:18-32 1996
5. A review of all ceramic restorations, J Am Dent Asso 128:297-307 1997
6. Evolution of dental ceramics in the twentieth century,
J Prosthet Dent 85:61-66 2001
7. William J.Obrien. Dental materials and their selection; 3rd edition
quintessence publication; 2002
8. Craig RG, Powers JM. Dental materials properties and manipulations. 11th ed.
St. Louis : CV Mosby ; 2002; 391-416.
9. Anusavice K.J.: Phillips Science of dental material; 11th ed. St. Louis : Elsevier
;2004;255-280.
10.Dental ceramics: current thinking and trends,
Dent Clin N Am 48 (2004) 513530
11. Recent Advances in Materials for All-Ceramic Restorations,
Dent Clin N Am 51 (2007) 713727