Luting agents and cementation procedures (PDF)

C E M E N TAT I O N CHAPTER Cement: a material that on hardening will fill a space or bind adjacent objects 31...

C E M E N TAT I O N CHAPTER Cement: a material that on hardening will fill a space or bind adjacent objects 31 LUTING AGENTS AND Luting Agents and Cementation: the process of attaching parts C E M E N TAT I O N P R O C E D U R E S Cementation by means of cement D R. A D H A M N I YA Z I procedures Luting agent: any material used to attach or Pages 909-927 cement indirect restorations to prepared teeth OUTLINE OUTLINE IDEAL PROPERTIES Ideal properties Ideal properties Adhesion to restorative material Adequate strength to resist functional forces Classifications Classifications Lack of solubility in oral fluids Low film thickness Types of cement Types of cement Biocompatible Comparisons of luting agents Comparisons of luting agents Possession of anicariogenic properties Radio-opaque Procedure techniques Procedure techniques Ease of manipulation Esthetic and color stable  C L A S S I F I C AT I O N C L A S S I F I C AT I O N OUTLINE Ideal properties According to ingredients: According to function: Function Cement Classifications Water Based Oil Based Resin Based Zinc Phosphate, Zinc Polycarboxylate, Definitive Cement Composite Resin, Glass Ionomer -Glass Ionomer -Zinc Oxide -Composite Types of cement Cement Eugenol -Adhesive Temporary Cement Zinc Oxide Eugenol/Non-Eugenol -Resin Modified -Zinc Oxide Resins High Strength Zinc Phosphate, Zinc Polycarboxylate, Composite Resin, Glass Ionomer Comparisons of luting agents Glass Ionomer Non-Eugenol -Compomer -Zinc Low Strength Zinc Oxide, Calcium Hydroxide Polycarboxylate Temporary Filling Zinc Oxide, Zinc Polycarboxylate Procedure techniques -Zinc Liners Calcium Hydroxide Varnishes Resin In A Solvent C L A S S I F I C AT I O N C L A S S I F I C AT I O N OUTLINE According to matrix type: According to mechanism: Ideal properties Matrix Cement Mechanism Cement Classifications -Cement fills the restoration-tooth gap Phosphate Zinc Phosphate and holds by engaging in small Non-Adhesive irregularities Types of cement Zinc Oxide Eugenol -Example, zinc oxide, zinc phosphate Phenolate Calcium Hydroxide Zinc Polycarboxylate -Surface irregularities are inhanced by Comparisons of luting agents Polycarboxylate Glass Ionomer Micromechanical air abrasion or acid etch -Improves the frictional retention Bonding Resin Polymethyl Methacrylate Dimethyl Methacrylate -Example, resin cements Procedure techniques Adhesive -chemical bond formation between cement and tooth structure RMGI Hybrid Ionomer Molecular Bonding -example, zinc polycarboxylate, glass ionomer TYPES OF CEMENTS TYPES OF CEMENTS Z I N C P H O S P H AT E Zinc phosphate Zinc phosphate Reaction: Zinc polycarboxylate Zinc polycarboxylate Zinc oxide eugenol Zinc oxide eugenol Zinc oxide (powder) reacts with the phosphoric acid (liquid) ——> zinc Glass ionomer Glass ionomer aluminophosphate gel Resin modified glass ionomer Resin modified glass ionomer Exothermic reaction Resin Resin Z I N C P H O S P H AT E Z I N C P H O S P H AT E Z I N C P H O S P H AT E Mechanical (non-adhesive) Mixing Time 1.5 - 2 Min Advantages Disadvantages Indication Contraindication -Strength to maintain -Irritating effect on the restoration the pulp Working Time 5 Min -Cast Crowns -mixed early and set -lack of anticariogenic -Ceramic Inlays -Metal Ceramic sharply properties -Ceramic Veneers Setting Time 5 - 9 Min Crowns -lack of adhesion to -Resin Bonded FDP -Cast Posts the tooth Film Thickness 25 micrometer Z I N C P H O S P H AT E Z I N C P H O S P H AT E TYPES OF CEMENTS Frozen glass slab technique Modified zinc phosphate cements Zinc phosphate Copper and silver cements To prolong working time and shorten setting time Zinc polycarboxylate Higher solubility Glass slab cooled at 6oC - 10oC Zinc oxide eugenol Lower strength 50-70% more powder incorporation Glass ionomer Fluoride cements Working time is increased by 4-11 mins Resin modified glass ionomer Higher solubility Setting time shortened by 20-40% Stannous fluoride 1-3% Resin Z I N C P O LY C A R B O X Y L AT E Z I N C P O LY C A R B O X Y L AT E Z I N C P O LY C A R B O X Y L AT E Molecular bonding (2 MPa) Reaction: Advantages Disadvantages Zinc oxide (powder) reacts with the Indication Contraindication -Low irritation -Lower compressive -Chemical bond to strength polyacrylic acid (liquid) ——> polymer -Ceramic Inlays -Cast Crowns tooth structure -Difficult to clean chain of carbonyl groups and polyacid -Metal Ceramic -Ceramic Veneers -Easy manipulation -Surface must be -Resin Bonded FDP groups Crowns -Adequate strength clean for adhesion -Cast Post -Low solubility -Short working time -Anticariogenic Z I N C P O LY C A R B O X Y L AT E Z I N C P O LY C A R B O X Y L AT E TYPES OF CEMENTS Polyacrylic acid react with the tooth surface Zinc phosphate Mixing Time 30-40 Sec calcium and chelates (bonding) Zinc polycarboxylate Zinc polycarboxylate have different flow Zinc oxide eugenol Working Time 2.5 Min properties than zinc phosphate, exhibiting Glass ionomer thinning with increased shear rate Setting Time 6 - 9 Min Resin modified glass ionomer Weak bond with gold and porcelain but good bond with non-precious alloys Resin Film Thickness 25 micrometer ZINC OXIDE EUGENOL ZINC OXIDE EUGENOL ZINC OXIDE EUGENOL Reaction Mechanical (non-adhesive) Advantages Disadvantages Zinc oxide (powder) reacts with acid Indication Contraindication -Sedative effect on -Low strength eugenol (liquid) ——> Zinc eugenolate pulpal tissue -Disintegration in oral If resin cements are to -Good sealing ability fluids ZnO + H2O ———> Zn(OH)2 Used as a temporary be used with the final -Resistance to -Less anticariogeNic cement agent cementation marginal penetration -Highest solubility Zn(OH)2 + 2HE ———> ZnE2n + 2H2O Good thermal insulation ZINC OXIDE EUGENOL ZINC OXIDE EUGENOL ZINC OXIDE EUGENOL Classification according to ADA specification no. 30 Powder : Liquid: 4:1, 6:1 (by weight) Mixing Time Until Homogeneous Type I: temporary cement Two paste: same amount Affected By Temp. & Type II: definitive cement Working Time Affected by moisture and temp. Moisture Type III: temporary restoration and thermal Setting Time 4 - 10 Min insulating base Sets faster in oral cavity Type IV: cavity liner Reversible reaction Film Thickness 25 micrometer TYPES OF CEMENTS GLASS IONOMER GLASS IONOMER Zinc phosphate Reaction Molecular bonding (3-5 MPa) Zinc polycarboxylate Zinc oxide eugenol Silicate glass (powder) reacts with Indication Contraindication polyacrylic acid (liquid) ——> glass Glass ionomer -Cast Crowns ionomer -Metal Ceramic -Ceramic Restorations Resin modified glass ionomer Crowns -Resin Bonded FDP -Cast Post Resin GLASS IONOMER GLASS IONOMER GLASS IONOMER Mixing Time Depend On Type Powder : liquid (follow instruction) Advantages Disadvantages -Bonding Property -Low Flexural Capsule type (like amalgam) -Anticariogenic Effect Strength Working Time 3 - 5 Min -Easy To Use -High Modulus Of Two paste system (mix homogeneous) (Capsule) Elasticity Setting Time 5 - 9 Min -Different Shades -Absorbs Water -Biocompatible During Setting Phase -Good Marginal Seal -Less Esthetic Film Thickness 25 micrometer GLASS IONOMER TYPES OF CEMENTS RESIN MODIFIED GLASS IONOMER Sensitive to water and air Zinc phosphate Reaction When exposed to ambient air it will craze and crack Zinc polycarboxylate Radio-opaque fluroaluminosilicate glass and ——> cohesive failure from micro crack formation micro encapsulated potassium sulfate (powder) Zinc oxide eugenol reacts with polycarboxylate acid modified with Smith D.C. Glass ionomer methacrylate groups, 2 HEMA and tartaric acid The cause of post cement sensitivity —> bacterial (liquid) ——> acid/base glass ionomer reaction Resin modified glass ionomer invasion, hydraulic pressure and acidity in the early with a self cured or light cured polymerization setting stage and wash of thin mix. Resin of the methacrylate group RESIN MODIFIED GLASS IONOMER RESIN MODIFIED GLASS IONOMER RESIN MODIFIED GLASS IONOMER Molecular bonding >10 MPa Advantages Disadvantages Mixing Time 8 - 10 Sec -Set On Demand -Lower Flexural Indication Contraindication -Immediate Finishing Strength Working Time 2.5 Min -Better Esthetics -High Modulus Of -Cast Crowns -Higher Tensile Elasticity -Metal Ceramic Strength -Absorbs Water Setting Time 5 - 9 Min Crowns -Ceramic Restorations -Anticariogenic During Setting Phase -Cast Post -Resin Bonded FDP Bond To Resin But Less Than GI -The Material Of Composite -Less Esthetic Film Thickness 25 micrometer Choice For Casted Restorations RESIN MODIFIED GLASS IONOMER TYPES OF CEMENTS RESIN Zinc phosphate Chemical bond Zinc polycarboxylate Reaction The moisture sensitivity remains an issue Zinc oxide eugenol Polymerization reaction, combination The polyalkenoic acid plays a role starting Glass ionomer of dimethacrylate with other monomers the adhesion “diffusion based adhesion” containing various amounts of ceramic Resin modified glass ionomer fillers Difficulty of removal after set Resin RESIN RESIN RESIN Micromechanical bonding Advantages Disadvantages 18-20nMPa Mixing Time Depends On Type -Excellent Mechanical -Polymerization Indication Contraindication Properties Shrinkage -High Bond Strength -Microleakage Working Time Depends On Type -Light Cured Cements -High Esthetics -Technique Sensitive -All Ceramic Are Contraindicated -Cleaning After Restorations With Metal Or Thick Setting Time 3 - 7 Min Cementation Takes Zirconia Restorations Time Film Thickness 20 - 60 micrometer RESIN RESIN OUTLINE Classification according to mechanism of Classification based on bonding procedure Ideal properties matrix formation Total etch (etch + bond + resin) Classifications Light cured One step (etch & bond + resin) Types of cement Self cured Self adhesive (etch + bond & resin) Comparisons of luting agents Dual cured Self etch, self adhesive (etch, bond & resin) Procedure techniques  OUTLINE Ideal properties Classifications POWDER : LIQUID Types of cement Comparisons of luting agents Procedure techniques RESIN FDP C E M E N TAT I O N  Reference All-Ceramic Restoration Prepared By Dr. Yasser Mahfooz Presented by Dr. Adham Niyazi Objectives of this lecture All-Ceramic Restoration All-Ceramic Restoration All ceramic restorations were introduced in dentistry in What is the difference between metal Understanding the strengthening methods of the dental ceramic and all ceramic tooth preparation? order to overcome some of the problems of the metal- ceramic. ceramic restorations: Understanding the different between All-ceramic systems. What are the types of all-ceramic Poor esthetics (metal line, decrease light transmission) Identify the criteria for selection of all-ceramic systems. restoration? Decreased biocompatibility due to the allergy (Ni). Identify the ceramic used for all-ceramic partial fixed dental prostheses. What is the difference between porcelain and ceramic?  All-Ceramic Restoration All-Ceramic Restoration All-Ceramic Restoration All-ceramic can provide some of the most esthetically Basically porcelain is a type of glass - Feldspathic porcelain pleasing restorations currently available that have: three dimensional network of silica 1-Feldspars are mixtures of (K2o. Al2o3.6SiO2 ) and (Na2o. Higher strength ceramics (silica tetrahedral). It is brittle. Al2o3.6SiO2 ), fuses when melts forming a glass matrix. Adhesives for bonding the ceramic restoration to tooth 2-Quartz (SiO2 ) fine crystalline dispersion through the glassy structure. phase. 3-Fluxes used to decrease sintering temperature. 4-Kaolin act as a binder. 5-Metal oxides: provide wide variety of colors. All-Ceramic Restoration All-Ceramic Restoration High-strength ceramics 1. High-strength ceramics. Using high strength ceramic core materials. Advantages of all-ceramic restorations: 2. Strengthening mechanisms of dental ceramics. Optimum restoration design. 1. Esthaetics. 3. All-ceramic systems. 2. Biocompatibility. 4. Selection of all-ceramic systems. 3. Chemically stable. 5. All-ceramic partial fixed dental prostheses 4. Allow for supra-gingival finish line.  High-strength ceramics High-strength ceramics High-strength ceramics Using high strength ceramic core materials: Using high strength ceramic core materials: Using high strength ceramic core materials: High strength ceramic core such as In-ceram alumina, In-ceram Low strength of the all ceramic zirconia and yttrium zirconia. used as internal substructure restorations surrounded by feldspathic ceramic produce an esthetic and strong In-ceram Alumina framework Veneering with a feldspathic ceramic restoration Two layers limited for low stress high strength core (non esthetic) veneered with a lower strength Porcelain Situations (anterior teeth) (similar to the metal ceramic technique). yttrium stabilized zirconia Veneering the frame work framework with a feldspathic ceramic High-strength ceramics All-Ceramic Restoration Strengthening mechanisms of dental ceramics Optimum restoration design: 1. High-strength ceramics. Feldspathic ceramics are brittle materials. They are Using a proper framework, selection of the abutment susceptible to fracture at the time of placement or during 2. Strengthening mechanisms of dental ceramics. function. They contain defects from which fracture initiates and coping design, such as proper thickness, no sharp line 3. All-ceramic systems. related to the following: angles or point angles and proper dimension of the connectors. 4. Selection of all-ceramic systems. Fabrication Defects 5. All-ceramic partial fixed dental prostheses Surface Cracks  Strengthening mechanisms of dental ceramics Strengthening mechanisms of dental ceramics Strengthening mechanisms of dental ceramics Fabrication Defects Surface Cracks Methods used to improve the strength and clinical Porosity in the glass-ceramic restorations has been shown to Air abrasion performance of dental ceramics include the following: constitute a fracture initiation site (by micro cracks Milling or grinding during Crack 1. Crystalline reinforcement. development) laboratory or clinical adjustment 2. Chemical strengthening. 3. Glazing. Strengthening mechanisms of dental ceramics Strengthening mechanisms of dental ceramics Strengthening mechanisms of dental ceramics 1-Crystalline Reinforcement: 1-Crystalline Reinforcement: 1-Crystalline Reinforcement -Absorb energy -Transformation Toughening (Zirconia ) Crystalline Improve the resistance of crack propagation. Introduction of a high proportion of crystalline phase Increase the Zirconia presents in three crystallographic shapes at different temperatures: The ways of the crystalline reinforcement: resistance of crack propagation (interruption of crack propagation). 1- Cubic (from 2680 ◦C, to 2370 ◦C). Absorb energy 2- Tetragonal (from 2370 ◦C to 1170 ◦C). Transformation Toughening 3- Monoclinic (from1170 ◦C to room temperature). When zirconia is alloyed with Yttria (Y2O3), the zirconia crystals retain their tetragonal shape at room temperature (Yttrium Partially Stabilized tetragonal Zirconia).  Strengthening mechanisms of dental ceramics Strengthening mechanisms of dental ceramics 1-Crystalline Reinforcement 2-Chemical Strengthening (feldspathic ) -Transformation Toughening (Zirconia ) Crack occurs in the Yttria Zirconia Replacement of small ions (Na) with larger ions (K) by diffusion from a Changes from the tetragonal to the monoclinic phase molten salt bath during immersing ceramic. The potassium ion is 35% larger than the sodium ion. increase in the size of the crystals This diffusion lead to residual compressive stresses and closing the crack. Na Compressive stresses leading to closing of the crack This is the reason of increasing strength of the Yttria Zirconia to the (900-1400 MPa). Increase the flexural strength of feldspathic dental porcelain up to 80% K Strengthening mechanisms of dental ceramics 3-Glazing (protective coating): Surface porcelain Addition of a surface glaze then fired at high temperature strengthened by replacement of the Low-expansion in the surface layer Small Na ions by the Large K ions Cooling Compression and reduces the Na Na depth and width of surface flaws. K K  All-ceramic systems All-Ceramic Restoration 1. High-strength ceramics. Inverse Proportion 2. Strengthening mechanisms of dental ceramics. 3. All-ceramic systems. Esthetic 4. Selection of all-ceramic systems. 5. All-ceramic partial fixed dental prostheses Strength All-ceramic systems All-ceramic systems All-ceramic systems 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: Classified according to the technique of construction: 1. Platinum foil matrix technique. This technique can be performed by: The first all-ceramic crown was developed by Land in 1886 and was known as the porcelain Jacket crown (PJC). 2. Slip cast ceramic. A. Feldspathic Porcelain (flexural strength 60 Mpa) The PJC was made from high-fusing porcelain utilizing platinum 3. Heat-pressed Ceramics B. Aluminous Core Ceramics (flexural strength 120-160 Mpa) foil for support during firing. 4. Machined ceramic. 5. Metal reinforced systems.  All-ceramic systems All-ceramic systems All-ceramic systems 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: A. Feldspathic Porcelain: A. Feldspathic Porcelain: A. Feldspathic Porcelain: Technique: Technique: Technique: 1- After impression, master cast and removable die preparation are made. 4- Introduce porcelain in the furnace (firing cycles) using the 6- Removing platinum foil. 2- Platinum foil matrix is adapted on the die (including the margin platinum foil as a tray to support the porcelain in the furnace. area). 7- The final restoration obtained is then tried in the 3- The porcelain mix (porcelain powder+ distilled water or water- patient’s mouth. based glycerin) is directly applied to the platinum foil matrix 5- Characterization, finishing, staining, and glazing are done. (conventional condensation technique). All-ceramic systems All-ceramic systems All-ceramic systems 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: B. Aluminous Core Ceramics : B. Aluminous Core Ceramics: A. Feldspathic Porcelain: Core Porcelain: Highest strength opaque Indications: porcelain 50% by weight fused alumina crystals. 1. Laminate Veneer. 1. Platinum foil is adapted Body porcelain: 15% crystal alumina. 2. Single anterior crown. Enamel porcelain: 5% crystal alumina. 2. Aluminous core Porcelain mix then The resulting restorations were approximately 40% stronger than those applied and fired. using traditional feldspathic porcelain.  All-ceramic systems All-ceramic systems All-ceramic systems 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: B. Aluminous Core Ceramics: B. Aluminous Core Ceramics: B. Aluminous Core Ceramics: 3. After firing, Body dentin porcelain is built up then 5. Finishing. 7. Removal of platinum foil. Cut back of body dentin. 4. Then enamel (incisal) 6. Staining and glazing. 8. Completed restoration. porcelain is built up and fired. All-ceramic systems All-ceramic systems All-ceramic systems 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: 1. Platinum Foil Matrix Technique: B. Aluminous Core Ceramics: B. Aluminous Core Ceramics: Disadvantages Poor marginal adaptation if the platinum foil is not precisely Advantages: Indications: adapted to the surface of the die. Simple fabrication. Single anterior crown. High cost of foil. Improved strength compared to Presence of Voids (improper condensation technique). conventional feldspathic porcelain (95% Poor strength (can not be used for posterior teeth, FPDs, success rate on maxillary anterior teeth) bruxism). Voids under SEM  All-ceramic systems All-ceramic systems All-ceramic systems 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics Classified according to the technique of construction: High-strength core frameworks for all-ceramic restorations, can be Technique: 1. Platinum foil matrix technique. produced with a slip-casting procedure such as the In-Ceram. 1- Duplicate the working die with an elastomeric 2. Slip cast ceramic. impression material, and pour it with the special 3. Heat-pressed Ceramics refractory die material. 4. Machined ceramic. 2- Slip is an aqueous suspension of the alumina particles 5. Metal reinforced systems. in water with dispersing agents. All-ceramic systems All-ceramic systems All-ceramic systems 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics Technique: Technique: Technique: 3- The slip is applied onto a porous refractory die which 5- After firing, the refractory die shrinks more than the 6- The fired porous core is later glass-infiltrated, a absorbs the water from the slip and leads to the condensed slip, which allows easy separation of the core unique process in which molten glass (aluminosilicate condensation of the slip on the die. from the refractory die. glass) is drawn into the pores by the capillary action at high temperature. 4- Then firing at high temperature (1150℃ ).  All-ceramic systems All-ceramic systems All-ceramic systems 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics 8- Excess glass is removed with Technique: diamond wheels or burs. 10- Veneering the VITA In-Ceram framework with fine-structure ceramic 7- After firing, excess glass is removed and the glass using the layering technique. infiltrated core is veneered with compatible porcelain with matching thermal expansion. 9- The surfaces are sandblasted with Al2O3 11- Finishing with rotary diamond instruments powder to remove any residual glass. All-ceramic systems All-ceramic systems All-ceramic systems 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics Two modified In-Ceram technique have been introduced: A. In-ceram Alumina: Crystalline phase is Alumina 12- Characterization of the shade of the veneer (Al2O3), flexural strength (500 MPa). 1. In-Ceram Spinell: Contains a magnesium spinel (MgAl2O4) provide the translucency of the final restoration. B. In-ceram Spinell: Crystalline phase is Magnesium 2. In-Ceram Zirconia: Contains zirconium oxide (ZrO2) provide Spinell (MgAl2O4), flexural strength (350 MPa). 13- Completed VITA In-Ceram the highest strength. C. In-ceram Zirconia: Crystalline phase is Zirconium ALUMINA crown. Oxide (ZrO2), flexural strength (600 MPa).  All-ceramic systems All-ceramic systems All-ceramic systems 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics 2.Slip-Cast Ceramics Indications: Indications: Indications: VITA In-Ceram ZIRCONIA: VITA In-Ceram ALUMINA VITA In-Ceram SPINELL 1. Anterior crown (only with severely 1. Anterior and posterior crowns. 1- Anterior Crowns discoloured abutment) 2. Only 3-unit Anterior bridge. (abutment with no discoloration) 2. Posterior crown. 2- Premolars or Molars crown (not preferred) 3. Anterior and posterior bridge. All-ceramic systems All-ceramic systems All-ceramic systems 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics Classified according to the technique of construction: These restorations are also based on the lost wax technique, 1. Platinum foil matrix technique. where the restorations are waxed, invested and pressed at high 2. Slip cast ceramic. temperature. 3. Heat-pressed Ceramics a. Leucite-based Pressed b. Lithium Disilicate-based Pressed More marginal adaptation than high-strength alumina core Ceramic ( IPS Empress I ) Ceramic ( IPS Empress II, IPS 4. Machined ceramic. materials. e.max ) 5. Metal reinforced systems. Used to fabricate frameworks, cores or full contoured crowns.  All-ceramic systems All-ceramic systems All-ceramic systems 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics Technique: a. Leucite based pressed ceramic ( IPS Empress I ) : b. Lithium silicate based pressed ceramic ( IPS Empress II, IPS It contains leucite as a major crystalline phase, dispersed in a glassy matrix. e.max ): 1- Wax the restoration to final contour, sprue, and invest as Flexural strength is about 160 MPA. The major crystalline phase of the core material is lithium conventional metal casting. disilicate (approximately 70%). 2- If the veneering technique is used, only the body porcelain The material is pressed at 1150˚C. shape is waxed. It has mean flexural strength of about 400 MPa. 3- Heat the investment to 800˚C to burn out the wax pattern. The material is pressed at 920℃. All-ceramic systems All-ceramic systems All-ceramic systems 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics Technique: Technique: Technique: 4- Insert a ceramic ingot of the appropriate shade and alumina 5- After heating to 1150˚C for IPS Empress I or 920 ˚C for IPS 7- Remove the ceramic from the contact surfaces using Al2O3 air plunger in the space produced by sprue burnout and place the Empress II, the softened ceramic is slowly pressed into the mold abrasion. refractory investment in the special pressing furnace. under vacuum. 8- Remove the sprue, and refit it to the die. 6- Remove the reaction layer using ultrasonic bath.  All-ceramic systems All-ceramic systems All-ceramic systems 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics e.g. IPS EmpressI, IPS Empress II or IPS e.max. 3.Heat-Pressed Ceramics Technique: Indications: Advantages: 9- Esthetics can be enhanced by applying an enamel layer of a. IPS Empress I: matching porcelain or by adding surface characterization then 1. High esthetics. Single anterior crown glazing. 2. Better margin. Laminate veneer 3. High strength. Inlays and onlays All-ceramic systems All-ceramic systems All-ceramic systems 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics 3.Heat-Pressed Ceramics e.g. IPS EmpressI, IPS Empress II or IPS e.max. Indications: Indications: IPS Empress I IPS Empress II, IPS e.max b. IPS Empress II or IPS e. max: b. IPS Empress II or IPS e. max: Crystalline phase Leucite Lithium disilicate Fracture strength 160 MPa 400 MPa 1- Posterior crown. 4- Inlays or Onlays. Indications 1. Single anterior crowns. 1. Anterior three unit FPD with the second premolar as the 2- Anterior crown. 5- Laminate Veneers. 2. Laminate veneers. most posterior abutment. 3- Anterior bridges and 1st premolar replacement 6- Occlusal Veneers. 3. Inlays and onlays 2. Single anterior and posterior crowns. upto second premolar as the last abutment. 3. Inlays and onlays. 4. Occlusal veneer. 5. Laminate veneers.  All-ceramic systems All-ceramic systems All-ceramic systems Classified according to the technique of construction: 4. Machined Ceramics 4. Machined Ceramics A. MAD/MAM (Copy Milling) 1. Platinum foil matrix technique. We have 2 types of machined ceramic systems: 2. Slip cast ceramic. A. MAD/MAM Systems 3. Heat-pressed Ceramics (Manually Aided Designing, Manually Aided Milling) 4. Machined ceramic. (Copy Milling) 5. Metal reinforced systems. B. CAD/CAM Systems (Computer Aided Designing/ Computer Aided Milling) a. Zirkonzhan system b. Celay system All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics A. MAD/MAM B. CAD/CAM: 3 B. CAD/CAM: - Resin mock-up coping is constructed then fixed to a resin template. 3 Steps Milling CAD/CAM systems according to the components - Milling procedure is then started from a zirconia ceramic blocks (a stylus 1. Digitizing/ Scanning CAD/CAM classification according to the used scans the mock-up and its movement is transferred to the copying tool which Types of CAD/CAM ceramics mills the ceramic block) 2. Designing à Software (CAD) 1 Scanning 3. A production technology (CAM) 2 (Milling) Designing  All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: CAD/CAM systems according to the components 1. Digitizing/ Scanning CAD/CAM systems according to the components 1. A digitalization tool/scanner: that transforms geometry into digital data that a. Intra-oral 2. Software (CAD): by which the restoration is designed producing a data set can be processed by the computer. b. Extra-oral for the product (coping, framework, crown, bridge, laminate, endocrown, inlay, This may be: Intra-oral scanning onlay, post and core) to be fabricated. Intra-oral (e.g.: scanning prepared teeth, opposing teeth, bite registration) Extra-oral (e.g.: scanning working casts and dies, wax up, impressions) 3. A production technology (CAM): that transforms the data set into the desired product by milling the ceramic block using a milling machine. Working cast Impression Wax pattern All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: 2. Designing the restoration à Software (CAD) 2. Designing the restoration à Software (CAD) 2. Designing the restoration à Software (CAD) Scanning (digital Prepared teeth on Check enough impression) the screen occlusal clearance Tracing The Margin Designing the crown or retainers and the connector for the FPD  All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: 3. A production technology (CAM) 3. A production technology (CAM) 2. Designing the restoration à Software (CAD) Milling Milling Check occlusion of the designed restoration by virtual articulation Ceramic Blocks for Milling Different Sizes and types of Blocks All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: 3. A production technology (CAM) CAD/CAM classification according to the used The size of the frameworks is precisely increased to allow for the shrinkage Different types of blocks 1. Chair-side production (in-office milling) that occurs during sintering. Once a framework has been sintered. it is e.g. Cerec, E4D veneered with layered esthetic porcelains in a manner similar to that for the 2. Lab production (extra-oral scanner) metal ceramic technique. e.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Kavo everest, Cercon-smart 3. Centralized fabrication in a production center (intra-oral scanner + lab milling) e.g. Cerec, E4D, I-Tero, Terios 3-shape  All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: 2. Lab production (extra-oral scanner) 1. Chair-side Production (in-office milling): 2. Lab production (extra-oral scanner): e.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Cercon-smart All components of the CAD/CAM system are A conventional final impression should be send it to the laboratory. Cerec located in the dental clinic. The remaining CAD/CAM production steps are carried out completely in No need for laboratory procedure. the laboratory with the assistance of an extra-oral scanner. Impression using intra-oral camera. E.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Kavo everest, This saves time and offers the patient indirectly Cercon-smart fabricated restorations at one appointment. E4D Cerec In Lab system E.g. Cerec , E4D All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: 2. Lab production (extra-oral scanner) 2. Lab production (extra-oral scanner) 2. Lab production (extra-oral scanner) e.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Cercon-smart e.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Cercon-smart e.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Cercon-smart Scanning Designing Milling Cleaning Sintering Procera Milling Scanner Zirkonzahn CAD/CAM system Cercon-smart  All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: 2. Lab production (extra-oral scanner) 2. Lab production (extra-oral scanner) e.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Cercon-smart e.g. Cerec In Lab (Ineos scanner), Procera, Zirkonzhan, Cercon-smart 3. Centralized fabrication in a production center (intra-oral scanner + lab milling): Scanning and software designing can be performed in the clinic, then the milling takes place in a production center. Eg. Cerec, E4D, Lava, I-Tero, Terios 3-shape. Scanning Contact scanner Shape on computer screen Milling machine Procera restorations Procera All-Ceramic System Procera All-Ceramic System All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: 3. Centralized fabrication in a production center (intra-oral scanner + Types of CAD/CAM ceramics Types of CAD/CAM ceramics lab milling) e.g. Cerec, E4D, Lava, I-Tero, Terios 3-shape 1. Feldspathic ceramics 4. Inceram Alumina blocks Galss infiltrated 2. Leucite-reinforced ceramics. after milling 5. Inceram Zirconia blocks 3. Lithium disilicate reinforced ceramic. Lava C.O.S. system iTero system 3 Shape TRIOS  All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: Types of CAD/CAM ceramics Types of CAD/CAM ceramics Types of CAD/CAM ceramics 6. Yttrium-stabilized zirconium oxide block (900-1200 Mpa) for the 7. Monolithic Yttrium-stabilized zirconium oxide block : CAD/CAM technique Important Note: Flexural strength: (1200-1400 MPa). -Used for: Esthetic (high translucent). Anterior and posterior crowns High strength All ceramic restorations with high opacity are indicated in Need veneering layer Used for: Multi-unit (6 units anteriorly and 4 units posteriorly bridges) the anterior region only in case of severe tooth discoloration to get the benefit of 1. Single anterior and posterior crowns 2. Anterior (6 units) and posterior (4 units) multi-unit bridges masking the discoloration from its opacity. 3. Used as monolithic and can be milled as a full anatomic restoration so it can be used in patients with bruxism or in case of limited inter- occlusal distance.) Vita In-Ceram YZ (Vita Company) IPS e. max Zir CAD (Ivoclar vivadent company) All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: Types of CAD/CAM ceramics Types of CAD/CAM ceramics Types of CAD/CAM ceramics 7. Monolithic Yttrium-stabilized zirconium oxide block : 8. Hybrid ceramic (Vita Enamic): (ceramic+ polymer network (86% wt 8. Hybrid ceramic (Vita Enamic): (ceramic+ polymer network (86% wt E.g.: Prettau zirconia and High translucent ceramic). ceramic). Zirconia blanks, Bruxzir blocks. 1- lower brittleness than pure ceramic and better abrasion behavior than 3- Its dual network structure (ceramic+polymer) features a reliable crack stop composites. function. 2- Clearly higher elasticity than traditional dental ceramics since the acrylate 4- Ensures unique balance between strength and elasticity and provides high polymer network provides flexibility. absorption of masticatory forces (suited for implant-supported crown restorations). Prettau zirconia High translucent zirconia Milled monolithic restorations (Zirkonzahn) (Zirkonzahn) (full anatomic)  All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: Types of CAD/CAM Ceramics B. CAD/CAM: B. CAD/CAM: Types of CAD/CAM ceramics Types of CAD/CAM ceramics Advantages: 8. Hybrid ceramic (Vita Enamic): (ceramic+ polymer network (86% wt 9. Zirconia-reinforced lithium silicate ceramic (Vita Suprinity): ceramic). 1. Eliminate the uncomfortable experience of the conventional impression. (selecting Vita Suprinity trays, preparing and using materials, disinfecting impressions). In addition, digital Flexural strength: approx. 420 MPa impression avoids problems associated with the conventional impression e.g. : Hybrid ceramic (Vita Enamic) Flexural strength: approx. 130 -140 MPa bubbles, inadequate margin….etc. All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: Advantages: Advantages: Advantages: 4. When taking bite registration (centric occlusion) digitally, nothing is placed between 2. Excellent teaching tool because you can evaluate your preparation on a 19-inch 3. Insufficient clearance is detected immediately through a color-coded bite maxillary and mandibular teeth. This reduces the risk of an inadequate inter-occlusal monitor which also shows you if you have captured all the needed data before registration allowing corrections to be made directly, so reduce the times of relationship. sending it to the lab restoration remake  All-ceramic systems All-ceramic systems All-ceramic systems 4. Machined Ceramics 4. Machined Ceramics 4. Machined Ceramics B. CAD/CAM: B. CAD/CAM: B. CAD/CAM: Advantages: Advantages: Advantages: 5. No need to keep large amounts of impression materials and models in the 6. Sending the impression to the laboratory is a digital transfer by one of many methods 7. Prevent cross infection. office because digital scans can be stored on hard disks. such as e-mail or flash drive which saves time All-ceramic systems All-ceramic systems 4. Machined Ceramics Classified according to the technique of construction: B. CAD/CAM: Advantages: 1. Platinum foil matrix technique. 2. Slip cast ceramic. 3. Heat-pressed Ceramics 8. Due to the significant reduction in remakes (i.e. saving money) because all the details 4. Machined ceramic. (adequate occlusal reduction, and the accuracy of the models, the margin of preparation) can be seen before the impression is sent to the lab (which ensures good 5. Metal reinforced systems. product quality) and saving time, the CAD/CAM system is a valuable and cost effective technology.