The past 3 years of research on materials for all-ceramic veneers, inlays, onlays, single-unit crowns, and multi-unit restorations are reviewed in this article. The primary changes in the field were the proliferation of zirconia-based frameworks and computer-aided fabrication of prostheses, and a trend toward more clinically relevant in vitro test methods. This article includes an overview of ceramic fabrication methods, suggestions for critical assessment of material property data, and a summary of clinical longevity for prostheses constructed of various materials.
Ceramic materials are best able to mimic the appearance of natural teeth; however, two obstacles have limited the use of ceramics in the fabrication of dental prostheses: (1) brittleness leading to a lack of mechanical reliability, and (2) greater effort and time required for processing in comparison with metal alloys and dental composites. Recent advances in ceramic processing methods have simplified the work of the dental technician and have allowed greater quality control for ceramic materials, which has increased their mechanical reliability. As a result, the proportion of restorative treatments using all-ceramic prostheses is rapidly growing.
Several authors previously reviewed progress in the field of dental ceramics . This article reviews the research literature and commercial changes over the past 3 years since the last review in this field. The recent developments in dental ceramic technology can be categorized into three primary trends:
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There has been a rapid diversification of equipment and materials available for computer-aided design/computer-aided manufacturing (CAD-CAM) of ceramic prostheses.
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The availability of CAD-CAM processing permitted the use of polycrystalline zirconia coping and framework materials. The relatively high stiffness and good mechanical reliability of partially stabilized zirconia allows thinner core layers, longer bridge spans, and the use of all-ceramic fixed partial dentures (FPDs) in posterior locations.
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Basic science researchers are increasingly using clinically relevant specimen geometry, surface finish, and mechanical loading in their in vitro studies. This implies that in vitro results will more accurately predict clinical performance of ceramic prostheses; however, clinicians still need to be cautious in extrapolating from the laboratory to the clinical case.
Methods of ceramic fabrication
A recent review of the literature included a taxonomy of dental ceramics, in which materials were categorized according to their composition and indications . The following sections are categorized by method of fabrication. This complements the previous review and reflects the recent diversification of CAD-CAM systems ( Table 1 ). Ceramics having similar composition may be fabricated by different laboratory techniques, and each method of forming results in a different distribution of flaws, opportunity for depth of translucency, and accuracy of fit. These differences should be important to the clinician because they persist beyond the walls of the dental laboratory and affect clinical performance.
| Fabrication method | Commercial examples | Composition |
|---|---|---|
| Powder condensation | Duceram LFC (Dentsply) a | Glass |
| Finesse Low Fusing (Dentsply) a | Leucite-glass | |
| IPS e.max Ceram (Ivoclar-Vivadent) b | Fluoroapatite-glass | |
| IPS Eris (Ivoclar-Vivadent) b | Fluoroapatite-glass | |
| LAVA Ceram (3M ESPE) c | Leucite-glass | |
| Vita D (Vita Zahnfabrik) d | Leucite-glass | |
| Vitadur Alpha (Vita Zahnfabrik) d | Leucite-glass | |
| Vitadur N (Vita Zahnfabrik) d | Alumina-glass | |
| Slip casting | In-Ceram Alumina (Vita Zahnfabrik) d | Glass-alumina |
| In-Ceram Spinell (Vita Zahnfabrik) d | Glass-alumina-spinel | |
| In-Ceram Zirconia (Vita Zahnfabrik) d | Glass-alumina-PS zirconia | |
| Hot pressing | Finesse All-Ceramic (Dentsply) a | Leucite-glass |
| Fortress Pressable (Mirage Dental Systems) e | Leucite-glass | |
| IPS Empress (Ivoclar-Vivadent) b | Lleucite-glass | |
| IPS Empress 2 (Ivoclar-Vivadent) b | Lithium disilicate-glass | |
| IPS e.max Press (Ivoclar-Vivadent) b | Lithium disilicate-glass | |
| IPS e.max ZirPress (Ivoclar-Vivadent) b | Fluoroapatite-glass | |
| OPC (Pentron Clinical Technologies) f | Leucite-glass | |
| CAD-CAM | ||
| Presintered | Cercon (Dentsply) a | Partially stabilized zirconia |
| DC-Zirkon (DCS) g | Partially stabilized zirconia | |
| Everest ZS-Blanks (Kavo) h | Partially stabilized zirconia | |
| IPS e.max ZirCAD (Ivoclar-Vivadent) b | Partially stabilized zirconia | |
| LAVA Frame (3M ESPE) c | Partially stabilized zirconia | |
| Procera AllCeram (Nobel Biocare) i | Alumina | |
| Procera AllZirkon (Nobel Biocare) i | Partially stabilized zirconia | |
| Vita YZ (Vita Zahnfabrik) d | Partially stabilized zirconia | |
| Densely sintered | Denzir (Cad.esthetics) j | Partially stabilized zirconia |
| Digiceram L (Digident) k | Leucite-glass | |
| Digizon (Digident) k | Partially stabilized zirconia | |
| Everest G-Blanks (Kavo) h | Leucite-glass | |
| Everest ZH-Blanks (Kavo) h | Partially stabilized zirconia | |
| IPS e.max CAD (Ivoclar-Vivadent) b | Lithium disilicate-glass | |
| ProCAD (Ivoclar-Vivadent) b | Leucite-glass | |
| Vitablocs Mark II (Vita Zahnfabrik) d | Leucite-glass | |
| Vitablocs TriLuxe (Vita Zahnfabrik) d | Leucite-glass | |
| ZirKon (Cynovad) l | Partially stabilized zirconia | |
| Glass infiltrated | In-Ceram Alumina (Vita Zahnfabrik) d | Glass-alumina |
| In-Ceram Spinell (Vita Zahnfabrik) d | Glass-alumina-spinel | |
| In-Ceram Zirconia (Vita Zahnfabrik) d | Glass-alumina-PS zirconia | |
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