A wide range of ceramics is available for clinicians to select for each clinical scenario. Each type of ceramic has its own advantages, disadvantages, and clinical considerations. This article summarizes the different types of ceramics available for the fabrication of ceramic restorations and recent advances in these materials in terms of composition and fabrication methods. Recent systematic reviews and clinical evidence are also discussed.
Key points
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A wide range of ceramic materials is available, and the classification of these materials will facilitate the selection of the appropriate one for each clinical scenario.
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The development of color-gradient, composition-gradient, and translucency-gradient materials has improved the esthetics of monolithic ceramic restorations.
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The introduction of additive manufacturing in the fabrication of ceramic restorations has the potential to enhance the esthetics of monolithic restorations and improve the manufacturing process.
Introduction
Technological developments in the field of dental manufacturing have revolutionized the production of metal-free dental restorations. Ceramic restorations have gained popularity over the last 2 decades among clinicians because of their favorable optical (improved correspondence to tooth structures), mechanical (resistance to material loss through fracture or wear), biological properties (biocompatibility and inertness), chemical stability (resistance to changes in pH and temperature, and exposure to stains), and thermal characteristics (good thermal insulation). In addition, they offer a lower cost of production and more efficient manufacturing techniques, which have led to the replacement of conventional metal-ceramic restorations with all-ceramic restorations in recent years, according to a nationwide survey.
The aim of the present article is to provide an overview of the different types of dental ceramics, recent advances in terms of composition, manufacturing methods, and clinical indication and evidence realted to each category of cearmic.
Ceramics
A wide range of ceramics is available in the market for the fabrication of indirect restorations, and they can be classified based on their composition/microstructure or manufacturing method. Considering the composition, ceramics can be classified into glass-matrix based, polycrystalline, and resin-matrix based. , This classification helps clinicians understand the advantages and disadvantages of each specific material in the oral cavity. In addition, it would enable the clinicians to recognize the optimal surface treatment for the delivery of indirect restorative materials when using resin cements. Considering the manufacturing techniques, ceramics can be fabricated through layering, slip-casting, heat-pressing, subtractive computer-aided design/computer-aided manufacturing ([CAD/CAM], also called milling), and additive CAD/CAM (also called 3D printing) processes. Table 1 presents samples of each category of ceramics, manufacturer’s recommended surface treatment for bonding clinical indications, and minimum thickness of restoration based on the indication.
| Category | Type | Product Name | Flexural Strength (MPa) a | Surface Treatment b | Clinical Indications b | Minimum Thickness per Indication (mm) b |
|---|---|---|---|---|---|---|
| Glass-matrix | Feldspar-reinforced | VITA Mark II VITA TriLuxe VITA TriLuxe forte VITA RealLife (VITA North America, Yorba Linda, CA) |
154 | Etch with 5% HF for 60 s | Inlays, Onlays, Veneers, Crowns, Veneer structure for FPDs |
|
| Leucite-reinforced | IPS Empress CAD (Ivoclar, Schaan, Liechtenstein) | 160 | Etch with 5% HF for 60 s | Inlays, Onlays, Veneers, Crowns |
|
|
| Lithium Disilicate | IPS e.max CAD (Ivoclar) | 530 | Etch with 5% HF for 20 s | Inlays, Onlays, Veneers, Crowns, 3-unit FPDs on teeth up to 2nd Premolar, Implant Crowns |
|
|
| Amber Mill (HASSBIO, Kangneung, Korea) | 450 | Etch with 5% HF for 30 s | Inlays, Onlays, Veneers, Crowns, 3-unit FPDs on teeth up to 2nd premolar |
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| Rosetta SM (HASSBIO) | 400 | Etch with 5% HF for 20 s | Inlays, Onlays, Veneers, Crowns, 3-unit anterior FPDs |
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| n!ce (Straumann, Freiburg, Germany) | 350 | Etch with 5% HF for 20 s | Inlays, Onlays, Veneers, Crowns, Implant Crowns |
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| CEREC Tessera (Dentsply Sirona, York, PA, USA) | 700 | Etch with 5% HF for 30 s | Inlays, Onlays, Veneers, Crowns |
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| GC Initial LiSi Block (GC, Tokyo, Japan) | 400 | Etch with 5%-9% HF for 20 s | Inlays, Onlays, Veneers, Crowns, Implant Crowns |
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| Lithium Silicate | Obsidian® (Glidewell Laboratories, Newport Beach, USA) | 385 | Etch with 5% HF for 10 s | Inlays, Onlays, Veneers, Crowns |
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| Zirconia-reinforced Lithium Silicate | CEREC Celtra® Duo (Dentsply Sirona) | 370 | Etch with 5%-9% HF for 30 s | Inlays, Onlays, Veneers, Crowns |
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| VITA SUPRINITY® PC (VITA North America) | 420 | Etch with 5% HF for 20 s | Inlays, Onlays, Veneers, Crowns, Implant Crowns |
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| Polycrystalline | 3Y | Katana HTML Plus (Kuraray Noritake Dental, Tokyo, Japan) | 1150 | Air-particle abrasion with 50 μm Alumina at 3 bar for 10 s | Inlay, Onlay, Veneer, Crowns, FPDs, Frameworks |
|
| IPS e.max ZirCAD LT (Ivoclar) | 1200 | Air-particle abrasion with 25–70 μm Alumina at 1 bar or 70–110 μm Alumina at 1.5 bar | Full or Partial Crowns, Copings, FPDs with max 2 Pontics, FDP frameworks with max 2 Pontics |
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| 4Y | Katana STML (Kuraray Noritake Dental) | 750 | Air-particle abrasion with 50 μm Alumina at 3 bar pressure for 10 s | Inlays, Onlays, Veneers, Crowns, monolithic FPDs (up to 3-unit), Frameworks (up to 3-unit) |
|
|
| IPS e.max ZirCAD MT (Ivoclar) | 850 | Air-particle abrasion with 25–70 μm Alumina at 1 bar or 70–110 μm Alumina at 1.5 bar | Crown, 3-unit FPDs |
|
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| 5Y | Katana UTML (Kuraray Noritake Dental) | 550 | Air-particle abrasion with 50 μm Alumina at 1 bar for 10 s | Inlays, Onlays, Veneers, Crowns, Anterior FPDs (up to 3-unit), Anterior Frameworks (up to 3-unit) |
|
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| Composition-gradient | Katana YML (Kuraray Noritake Dental) | 750–1100 | Air-particle abrasion with 50 μm Alumina at 3 bar for 10 s | Monolithic crowns, monolithic FPDs, cut-back frameworks |
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| IPS e.max ZirCAD Prime (Ivoclar) | 650–1200 | Air-particle abrasion with 25–70 μm Alumina at 1 bar or 70–110 μm Alumina at 1.5 bar | Crown and copings, FPDs with max 2 pontics, FPD frameworks with max. 2 pontics |
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| IPS e.max ZirCAD Prime Esthetic (Ivoclar) | 650–850 | Air-particle abrasion with 25–70 μm Alumina at 1 bar or 70–110 μm Alumina at 1.5 bar | Crowns and 3-unit FPDs |
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| IPS e.max ZirCAD MT Multi (Ivoclar) | 650–850 | Air-particle abrasion with 25–70 μm Alumina at 1 bar or 70–110 μm Alumina at 1.5 bar | Crowns and 3-unit FPDs |
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| Cercon® ht ML (Dentsply Sirona) | 750–1200 | Air-particle abrasion with 110–125 μm Alumina at 2–3 bar | Crowns, Telescopic Primary Crowns, FDPs with max 2 pontics |
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| Resin-matrix | Subtractively Manufactured (Milled) | Lava ultimate (3M, Saint Paul, USA) | 200 | Air-particle abrasion with 50 μm Alumina at 2 bar until surface becomes matte | Inlays, Onlays |
|
| VITA Enamic (VITA North America) | 150 | Etch with 5% HF for 60 s | Inlays, Onlays, Veneers, Crowns, Implant Supported Crown |
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| CERASMART® (GC) | 238 | Air-particle abrasion with 25–50 μm Alumina at 1.5 bar or Etch with 5% HF for 60 s | Inlays, Onlays, Veneers, Crowns, Implant Supported Crown |
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| AVENCIA ™ (Kuraray Noritake Dental) | 225 | Air-particle abrasion with 30–50 μm Alumina at 1–2 bar | Inlays, Onlays, Veneers, Crowns |
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| Additively Manufactured (Printed) | Ceramic Crown (SprintRay, Los Angeles, USA) | 150 | Air-particle abrasion with 50 μm Alumina at 1 bar | Inlays, Onlays, Veneers, Crowns |
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| VarseoSmile® TriniQ® (BEGO, Bremen, Germany) | 120 | Not indicated in IFU | Inlays, Onlays, Veneers, Crowns, Anterior FPDs (up to 7-units with no Pontic or 3-units with 1 Pontic) |
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| Flexcera Smile Ultra Plus (Desktop Health, Newport Beach, USA) | 112 | Not indicated in IFU | Inlays, Onlays, Veneers, Crowns, FDPs |
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| Rodin® Sculpture 2.0 (Pac-Dent, Brea, USA) | 200 | Not indicated in IFU | Inlays, Onlays, Veneers, Crowns, FDPs up to 5-units |
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