1

CONTENTS

INTRODUCTION
STRUCTURE
4
HISTORY
TERMINOLOGIES
CLASSIFICATION
COMPOSITION
PROPERTIES
36
STRENGTHENING OF DENTAL PORCELAIN
CONDENSATION OF DENTAL PORCELAIN
45
FIRING PROCEDURE
STAGES OF MATURITY
ALL CERAMICS
CLASSIFICATION
53
CONVENTIONAL POWDER SLURRY CERAMIC
HICERAM ALUMINA REINFORCED PORCELAIN
54
OPTEC HSP LEUCITE REINFORCED PORCELAIN
56
DUCERAM LFC - HYDROTHERMAL LOW FUSING
CERAMIC 60
PRESSABLE CERAMIC
IPS EMPRESS
61
OPTEC PRESSABLE CERAMIC
INFILTRATED CERAMIC
INCERAM
CASTABLE CERAMIC
DICOR
CERA PEARL
MECHINABLE CERAMIC
CEREC VITBLOCS MARK I AND II
CELAY BLOCKS

REFERENCES

136

4
14
24
26

38

47
52
53

66
73
79
83
132

INTRODUCTION
Man has been obsessed with duplicating, restoring and replacing various lost
body parts like the limbs, ear, nose and eyes with artificial prosthesis and teeth being
no exception. Restoration of teeth is not recent but ancient, dating back to 1 st century
Roman B.C. Many materials have been used to restore and replace a lost teeth or a
part of it, of these ivory was popular but not without its disadvantages.The quest for
an artificial prosthesis similar to the nature tooth, both in function and esthetics, in the
oral environment still remains as a foremost concern to the dentist, which has led to
the use of CERAMICS in dentistry.
CERAMICS
Ceramics are defined as man-made solid objects formed by nonmetallic and inorganic
raw materials that are baked at high temperatures. Stoneware and pottery are still
made from impure clays, sand and feldspar minerals, and are baked in kiln,s First
pulvering the raw materials into a fine powder and then adding water to obtain a
working consistency for shaping and molding makes these objects. The unbaked
objects dried and placed in a kiln and heating to sufficiently high temperatures to
make the individual particles coalesce into a solid mass.
Ceramics are nonmetallic, inorganic materials that contain metal oxides whose
structure is crystalline, displaying a regular periodic arrangement of the component
atoms and may exhibit ionic or covalent bonding. Also a low-fusing glass matrix
filled with high-fusing filler. It is heated above the fusing temperature of the lowfusing glass but well below the temperature needed to fuse the high-fusing filler. The
filler, as in composite resins, improves strength and esthetics.
Glasses are described as supercooled liquids, not structureless or truly amorphous like
a gas. In liquids, structural units or arrangements of atoms exist as they do in
crystalline solids, but these units are not arranged in a regular manner. Glasses and
liquids differ in one respect in a glass, each atom has permanent neighbours at a
farily definite distance while in a liquid the neighbours about any atom are continually
changing. Glass is an inorganic product of fusion, which has cooled to a rigid
condition without crystallization. Common glass is made of silica sand, sodium oxide
and potassium oxide, and by adding aluminium oxide a plate glass is made. If silica is
heated to 1000oC and then gradually increased in temperature to 1500oC over the
course of hours it changes into cristobalite. Tridymatie is an impurity of cristobalite
and is formed when the quartz is heated between 870-1470 oC. Enamels are closely
connected to the glass industry as they may be compared to fusible glass made opaque
by adding opacifiers.
Porcelain is a type of ceramic. All porcelains are ceramics but all ceramic are not
porcelains. The traditional porcelain is composed of three naturally occurring
minerals: pure white clay (kaolin), silica (quartz), and feldspar. After baking it is
known as whiteware because of its color from the clay. The basic components of

3
dental porcelain are silica and feldspar. Additional components are aluminium oxide
as well as pigments and opacifying agents, depending on the application.Ceramics,
industrial porcelains and dental porcelains are fabricated from the same compounds, it
is merely the concentrations of the various components that differentiate them.
STRUCTURE

0
0

0 Si 0 Si 0

0
0

HISTORY OF CERAMIC
Aesthetics and durability of material in the oral environment has always been a
foremost concern to the dentist and is still a foremost concern to the dentist.The desire
for a durable and aesthetic material is ancient although dental technology existed in
Etrutia as early as 700 B.C. and during the Roman 1st Century BC. Little progress
took place in dental art from the beginning of the Christian era to about 1500 AD.
This was described as the dark ages of physical activities, a probably there was much
activity, creative though and invention, but records were either not kept or later
destroyed.
Artificial teeth were made from
1. Animal products such as ivory teeth or bone
These were unsatisfactory because they tend to deteriorate and disintegrate in
the mouth and absorb stains and odour.
AMBROISE PARE (1562) is credited for having prepared artificial teeth from bone
and ivory.
JACQUES GUILLENMEAU was a pupil of PARE, who prepared a substance by
fusing certain waxes, gums, ground mastic, powdered pearl and white coral. This
may have been the forerunner, in principle of esthetic fused porcelains, which
appeared many years later.
2. Teeth taken from the mouth of dead persons
The disadvantage were,
Expensive
Scared people
Developed a natural repugnance to put a corpses teeth into their mouth.
Repeated failures
Risk of transmitting diseases like syphilis
3. Bamboo
The disadvantages of bamboo are esthetically poor and functionally not
durable in the oral environment.

4
4. Mineral tooth or Porcelain tooth CERAMICS originally referred to the art of
fabricating of pottery.
The term ceramic is derived from the Greek term KERAMOS, which means A
POTTER OR POTTERY.
It is believed that this word is realized to a Sanksrit term meaning BURNED
EARTH, since the basic components were clays from the earth, which were heated
to form pottery (FRIEDMANN 1991).
Ceramic is a non-metallic, inorganic material. The term CERAMIC applies to a
wide variety of materials, including metal oxides, borides, carbides, nitrides and
complex mixture of these materials.
Ceramic objects have been constructed for thousands of years. The earliest
techniques used were crude. It consisted of shaping the item in clay/soil and then
baking it to fuse the particles together, which resulted in coarse and porous products
such as goblets and other forms of potter.
21,000 BC; earliest man-made ceramic artifacts were dated.
5000 BC: clay pots were discovered.
Later development led to detailed stoneware items
100 BC: colored, glazed vessel made (Han Dynasty)
600 BC: translucent porcelain made (Tang Dynasty)
Egyptian faieces are the first to enamel a substructure with a ceramic venner. Their
typical blue green hues resulted form metal oxides created during the firing process.
More recently the Chinese ceramist developed porcelain. Vitrification, translucency,
hardness and impermeability characterized it.
In the 17th century, the Europeans attempted to develop porcelain of similar quality
that of the Chines. By 1720s the Europeans mastered the art of manufacturing fine
translucent porcelain. This lead to the promulgation of information regarding the
fundamental components of porcelain: KAOLIN and FELDSPAR.
In 1723, enameling of metal denture bases was described by PIERRE FAUCHARD,
which initiated research in porcelain that imitates color of the teethand gingival tissue.
By 1774, a Parisian apothecary ALEXIS DUCHATEAU with the assistance of a
Parisian dentist NICHOLAS DUBOIS de CHEMENT made the first successful
porcelain dentures at the GUERCHAND PORCELAIN FACTORY, replacing the
stained and malodours ivory processes.
NICHOLAS DUBOIS worked diligently at perfecting the invention (a very difficult
achievement because the one-piece denture had to resist distortion during firing).
In course of his experiments, DUBOIS continuously improved his porcelain
formulation and was awarded both French and English patent.
He termed them UNCORRUPTIBLE TEETH that gained wide currency and for
many years was synonymous with porcelain teeth.
In 1817, a French immigrant dentist, ANTOINE PLANTON introduced individual
porcelain teeth in America.
In 1837, CLAUDIUS ASH produced fine porcelain teeth and later went on to
introduce TUBE TEETH which could be inserted over a post on a denture. It
became widely accepted for use in bridges as well as in full dentures.

In 1851, JOHN ALLEN of Cincinnati patented CONTINUOUS GUM TEETH

prosthesis consisting of two to three porcelain teeth fused to a small block of
porcelain colored like gingiva.
The search for suitable tooth colored filling material continued and was led by the
prominent artist-dentist ADELBERT.J.VOLCK who brought about somewhat
unsatisfactory products as early as 1857.
The modern synthetic porcelain or silicate cements-porcelain inlays fashioned to fit
prepared cavities precisely were marketed first in 1880.
In 1882, glass inlays (not porcelain) was introduced by HERLRST.
In 1885 LOGAN fused porcelain to platinum post thus resolving the retention
problem. He termed them as RICHMOND CROWN. These crowns represent the
first innovative use of metal ceramic system.
The first ceramic crowns and inlays were made by C.H.LAND in 1886. He fused
feldspathic porcelain to burnished platinum foil (used as a substructure) with high
controlled heat of a gas furnace.
Improvement in translucency and color of dental porcelains were realized through
developments that ranged from the formulation of ELIAS WILDMENA in 1838 to
introduction of vacuum firing in 1949.
The popularity of ceramic restoration declined with the introduction of acrylic resin
into dentistry till 1940s after which its popularity increased as the disadvantage of
acrylic resin were realized.
Vacuum firing of ceramics resulted in denser and more translucent restorations than
the air fired restorations.
In 1950s and early 1960s dental porcelains were developed with high coefficient of
thermal expansion, which allowed compatibility with dental casting alloys. This
enabled the fabrication of porcelain fused to metal restorations.
Refinements in the mental ceramics systems dominated dental ceramic research
during the past 35 years that resulted in improved alloys, porcelain metal bonding and
porcelains.
All porcelain crown systems, despite its aesthetic advantage failed to gain widespread
popularity because the chief disadvantage of early restorations was their low strength.
This resulted in the usage of ceramic restorations in low stress situations such as
anterior teeth. But still fractures of restorations were very common, which resulted in
the development of higher strength materials.
The development of high strength ceramics followed 2 paths. The first approach was
to use 2 ceramic materials to fabricate the restoration. A high strength but nonaesthetic core material is veneered with a lower strength aesthetic material. This
approach is similar to the metal ceramic system, but its advantage over the metal
ceramic system is that the ceramic core can be more easily masked than the metal
substructure. The second approach is to develop a ceramic that combines good
aesthetic with high strength. This technique has the additional advantage of not
needing the additional thickness of material to make a high strength core. However at
present the strongest ceramics are non-aesthetic ceramics. The popularity of all

6
ceramic systems increased after the introduction of alumina reinforced dental
porcelain. Mc.LEAN and HUGHES in 1965 were the first to introduce high strength
porcelain into dentistry.
They advocated the introduction of glass-alumina
composites.
McLEAN used a relatively opaque inner core of high alumina content for maximum
strength. This was surrounded by combination of body and enamel powder with
respectively 15% and 5% alumina resulting in restoration that were 40% stronger than
traditional feldspathic porcelain.
The technique was further developed by improving the fabrication technique of
alumina core. Here the porous alumina was fused with a specially formulated glass
by a process called slip casting. This material was called INCERAM (1988) whose
strength is about 3 to 4 times greater than earlier alumina core material. Thus these
materials have been used in high stress FPDs. Different oxides have been used to
strengthen ceramics like magnesium and zirconium. The ceramics, which used MgO,
were called INCERAM SPINELL, whose strength is less than INCERAM but its
translucency is better. So used for anterior crowns. Zirconium oxides were the latest
to be used to strengthen ceramics, which can be used in the case of posterior bridges.
High strength aesthetic ceramics have been developed again using glass-ceramic
composite microstructure for improving strength. In one system molten porcelain is
cast into a refractory mold formed by traditional loss wax technique. These are
Castable ceramics and are called DICOR porcelain. These are transparent after
casting and must be subjected to a carefully controlled 11 hours firing sequence to
promote the mica crystal growth that gives the restoration its strength. This was
introduced in 1972.
Shrink free all ceramic crown systems were introduced in 1980s Eg.CERESTORE
(1983: Cerestore injection-molded core by Sozio and Riley).
Manufacturers have introduced high strength ceramics using leucite [potassium
aluminum silicate] crystals dispersed in glassy matrix. Leucite is precipitated from
feldspar is incorporated in metal-ceramic porcelain formulation to increase the
coefficient of thermal expansion of ceramics to match that of the metal substructure
E.g. OPTEC HSP, CERIMATE and IPS EMPRESS.
In 1989 Alceram a replacement for Cerestore was introduced. CAD/CAM
[COMUTER AIDED DESIGNING / COMPUTER AIDED MANUFACTURING]
has been introduced into dentistry as early as 1970 which has now revolutionized the
designing and processing of all ceramic crowns and bridges by cutting down the time
for impression making and processing of the ceramic crowns and bridges. E.g.
CEREC 2, CEREC 3, CELAY, PROCERA (1993).
TERMINOLOGY
ALUMINA :
The oxide of aluminum (A1O3)
ALUMINA CORE : A ceramic containing sufficient crystalline alumina to achieve
adequate strength and opacity when used for the production of a core for ceramic
jacket crowns.

7
ALUMINOUS PORCELAIN : Glass strengthened by the addition of alumina.
AMORPHOUS : Without definite form or shape; formless; without real or apparent
crystalline form; uncrystallized.
CAD-CAM: Computer-aided design combined with computer-aided machining. In
dentistry, laser mapping of a cavity preparation can be fed to a computer-controlled
milling machine.
CERAMIC : Any of various heat resistant and corrosion resistant materials made by
shaping then firing a nonmetallic metal, such as clay, at a high temperature; a
compound of metallic and nonmetallic elements.
CERAMIC, DENTAL: A compound of metals (aluminum, calcium, lithium,
magnesium, potassium, sodium, tin, titanium and zirconium) and nonmetals (silicon,
boron, fluorine and oxygen) that may be used as a single structural component as one
of the several layers that are used in the fabrication of a ceramic-based restoration.
CERAMIC JACKET CROWN : An all-ceramic crown without a supporting metal
substrate that is made a ceramic with a substantial crystal content (>50 vol%) from
which its higher strength and / or toughness is derived; distinguished from porcelain
jacket crowns which are made with a lower strength core material, usually aluminous
porcelain or feldspathic porcelain.
CLAY :A native hydrated aluminum silicate, produced by the decomposition of rocks
due to weathered (A1203, SiO2. H2O); insoluble in water and organic solvents but
absorbs water to form a plastic, moldable mass, water serving as a lubricant between
the colloidal particles; a widely distributed colloidal lusterless earthy substance,
plastic when moist but permanently hard when fired, that is composed primarily of
decomposed igneous and metamorphic rocks rich in the mineral feldspar in the form
of crystalline grains <0.002mm in diameter, whose essential constituents are kaolinite
and other hydrous aluminous minerals.
DISPERSION STRENGTHENING : A mechanism by which a crystalline phase of
high strength and high modulus of elasticity is dispersed in an amorphous glassy
matrix to produce a high strength composition.
FELDSPAR : Any of a group of abundant rock-forming minerals occuring
principally in igneous, plutonic and some metamorphic rocks and consisting of
silicates of aluminum with potassium, sodium, calcium and rarely barium; X 20,
A12O3.SiO2 where X is either Na or K.
FELDSPATHIC PORCELAIN :A ceramic composed of a glass matrix phase and
one or more crystalline phase one of which is leucite (K 20,A12O3, 4SiO2) which is used
to create high-expansion porcelain that is thermally compatible with metal allow core
substructures; a more technically correct name for this is leucite porcelain because
feldspar is not present in the final processed porcelain nor is it necessary as a raw
material to produce leucite crystals.
FLUX : (Latin fluere to flow) a substance used to promote fusion especially of
metals or minerals; a substance (as rosin or borax) applied to surface to be joined by
soldering, brazing or welding just prior to or during the operation to clean and free
them from oxide and promote their union; a substance (as borax) added in
glassmaking for promoting vitrification.

8
FRIT : Materials of which glass is made after having been calcified or partly fused in
a furnace but before vitrification; glass variously compounded that is quenched and
ground as a basis for glazes or enamels; powdered glass; ceramic melt in which a
glass is formed.
GLASS :Any of a large class of materials with highly variable mechanical and optical
properties that solidify from the molten state without crystallization, that are typically
based on silicon dioxide, boric dioxide, aluminum oxide or phosphorous pent oxide,
that are generally transparent or translucent and that are regarded physically as supercooled liquids rather than true solids. An amorphous inorganic usually transparent or
translucent substance consisting typically of a mixture of silicates or borates or
phosphates formed by fusion of sand or some other form of silica or by fusion of
oxides of boron or phosphorous with a flux (soda, potash) and a stabilizer (lime,
alumina) and sometimes metallic oxides for coloring; a non-crystalline brittle solid.
GLASS-CERAMIC : A solid consisting of a glassy matrix and one or more crystal
phases produced by the controlled nucleation and growth of crystals in the glass.
GLASS-INFILTRATED DENTAL CERAMIC : A minimally sintered A1203 or
MgA12O4 core with a void network that has been sealed by the capillary flow of
molten glass; In-CERAM (A12O3) and IN-CERAM Spinell (MgA12O4) core.
INJECTION MOLDED CERAMIC : A glass or other ceramic material that is used
to form the ceramic core by heating and compressing a heating ceramic into a mold
under pressure; IPS Empress.
KAOLIN : Fine clay used in ceramics and refractories and as a filter or coating for
paper and textiles.
KAOLINITE :A mineral, the principle constituent of kaolin, A12O3, 2SiO2.2H2O.
LEUCITE : White or gray mineral, KA1Si2O6, consisting of potassium aluminum
silicate occuring in igneous rocks with a glassy fracture.
MICA : Any of a group of chemically and physically related mineral silicate,
common in igneous and metamorphic rock each containing hydroxyl, alkali and
aluminum silicate groups.
OPACIFIER : A white or pale cream-colored oxide, which is used to decrease
translucency and act as a masking agent, often, tin oxide or titanium dioxide.
PORCELAIN :A hard, white, translucent ceramic made by firing a pure clay and
then glazing with variously colored fusible materials; china; a white, ceramiccontaining glass with a glazed surface; ceramic containing minerals held together with
glass.
PORCELAIN JACKET CROWN : One of the first all-ceramic crowns, made from a
low strength aluminous core material and veneering porcelain usually utilizes a thin
platinum foil substructure.
POTASH : K2CO3 [potassium carbonate]; K2 (OH) [potassium hydroxide]; any of
several compounds containing potassium, especially soluble compounds, such as K 20
[potassium oxide], KC1 [potassium chloride] and various potassium sulfates.
POTASH FELDSPAR : Orthoclase.
QUARTZ : A mineral, SiO2 consisting of a silicon dioxide that next to feldspar is the
commonest mineral.

REFRACTORY : Capable of enduring or resisting high temperatures.

SAND : Consisting mostly of quartz commonly used for making mortar and glass.
SILICA : Chemically resistant dioxide, SiO2, of silicon that occurs naturally in the 3
crystalline modifications of quartz, tridymite and cristobalite, in amorphous and
hydrated forms (as opal) and in less pure forms (sand, diatomite, tripoli) and
combined in silicates that can be prepared artificially as a fine powder water glass or
other soluble silicates and also in colloidal form, and that is used primarily in making
glass, ceramics and refractories, in producing elemental silicon, its alloys and
compounds.
SILICATE : Any of numerous insoluble often complex metal salts containing silicon
and oxygen in the anion, that constitute the largest group of minerals and with quartz
make up the greater part of the earths crust.
SINTER : To cause to become a coherent mass by heating without melting: although
there is not a fusion of the porcelain powder particles, they join together by flow on
contact as a result of surface energy; densification by partial fusion.
SLIP-CAST SLURRY : A fine particle ceramic dispersed in an aqueous liquid
medium is poured into a porous mould, which rapidly extracts the liquid causing the
formation of a close-packed but weak ceramic particle structure.
SODA : Any of various forms of sodium carbonate; chemically combined sodium.
SPINEL : Any of several hard, white, orange, red, green, blue, or black minerals with
composition MgA12O4.
SWAGE : Shape to the form of a model, cast or die by compressive strength
(porcelain teeth soldered to gold plates swaged to fit the mouth).
VITRIFICATION : (Latin vitrum glass) to change into glass or a glassy substance
by heat and fusion.
CLASSIFICATION
ACCORDING TO TYPE
1. Feldspathic porcelain
2. Aluminous porcelain
3. Glass infiltrated aluminous
4. Glass infiltrated spinell
5. Glass ceramics
ACCORDING TO USE
1. Ceramic for artificial teeth
2. Jacket crown, inlay and onlay ceramic
3. Metal ceramic
4. Anterior bridge ceramic
ACCORDING TO PROCESSING TECHNIQUE
1. Sintered porcelain
2. Castable porcelain
3. Machined porcelain
4. Infiltrated porcelain
5. Pressed porcelain

10
6. ACCORDING TO FIRING TECHNIQUE
1. Air fired (at atmospheric pressure)
2. Vacuum fired (at reduced pressure)
3. Diffusible gas firing
ACCORDING TO FIRING TEMPERATURE
1. High fusing
- >1300 C
2. Medium fusing
- 1101 t0 1300C
3. Low fusing
- 850-1101C
4. Ultra low fusing
- <850C
ACCORDING TO SUBSTRATE MATERIAL
1. Cast metal
2. Sintered metal
3. Swaged metal
4. Glass ionomer
5. CAD/CAM.
COMPOSITION Dental porcelains, to a large extent, are glassy materials. Glasses
are super-cooled liquids / non-crystalline solids with only a short-range order in their
atomic arrangement. During cooling, molten glass solidifies with a liquid structure
instead of a crystalline structure. Such a structure is called vitreous and the process of
forming it is known as vitrification. The principal anion present in all glasses is O2
ion, which forms very stable bonds with small multivalent cations such as silicon,
boron, phosphorous etc. (e.g.,. in silicon glasses, SiO4 tetrahedra are formed which
are responsible for the random network of glass). These ions are termed as glass
formers. For dental applications, only two glass forming oxides silicon oxide and
boron oxide are used to develop the principal network. Additional properties like low
fusion temperature, high viscosity, color and resistance to devitrification is obtained
by the addition of other oxides like potassium, sodium, calcium, boron or aluminum
oxides to the glass forming lattice, SiO4.
HIGH FUSING PORCELAINS
FELDSPAR
Traditionally, the basic ingredients of these types of porcelains are feldspar
kaolin (clay) and quartz. Feldspar is the primary constituent, and all porcelains based
on feldspar are referred to as feldspathic porcelains. Natural feldspars can be either
sodium feldspar (albite) or potassium feldspar (orthoclase / microline) which are
minerals composed of potash (K2O), Soda (Na2O) Alumina (Al2O3) and silica (SiO2).
For dental purposes, light potassium based feldspar is generally selected because of its
increased resistance to pryoplastic flow and an increased viscosity. The pyroplastic
flow of dental porcelain should be low in order to prevent rounding of margins, loss
of tooth from and obliteration of surface markings. Feldspars are present in
concentrations of 75 to 85% and undergo incongruent melting at temperatures
between 1150C and 1530C. Incongruent melting is the process by which one
material melts to form a liquid plus a different crystalline material. Hence a glassy
phase is formed and suspended inside it are crystalline potassium alumino silicate
crystals known as leucite.

11

KAOLIN / CLAY Kaolin / clay (Al2O3, 2SiO2, 2H2O) serves as a binder. When mixed
with water, it forms a sticky mass, which allows the unfired porcelain to be
easily worked and molded. On heating, it reacts limitedly with feldspar (known
as pyrochemical reaction) and thereby provides rigidly. It also adheres to the
framework of quartz particles and shrinks considerably during firing.
Unfortunately, pure kaolin is white in color and reduces the translucency of
porcelain. Consequently, it is included only in small concentrations of 4 to 5%.
PURE QUARTZ Pure quartz is used porcelain as a strengthener. The main function
of quartz (silica) is to impart more strength and firmness, and a greater
translucency. Silica remains uncharged at the usual firing temperatures
and hence contributes stability to the mass during heating by providing a
framework for other constituents. It is present in concentrations of 13 to
14%. Traces of iron may be present as impurities in the quartz and must
be removed to prevent discoloration of porcelain.
MEDIUM, LOW AN ULTRA LOW FUSING PORCELAINS
The low and medium fusing porcelain powders are glass which have been
ground from blocks of matured porcelain. For this, the raw ingredients are mixed and
fused, and the fused mass is the quenched in water. The rapid cooling induces
stresses in the glass to the extent that considerable cracks and fractures occur. This
process is referred to as fritting and the product so obtained is called a frit. The brittle
material is then ground to a fine powder of almost colloidal dimensions. During
subsequent firing, little or no pyrochemical reaction occurs, but the glass phase
softens and flows slightly. This softening allows the powder particles to coalesce
together (sintering) and form a dense solid. However, the temperature must be
controlled to minimize the pyroplastic flow.
The raw ingredients for the low and medium fusing porcelains are basically the same
as for the high fusing porcelain powders but in addition contain balancing oxides /
fluxes. These additions tend to modify the properties by interrupting the glass
network and hence are also known as glass modifiers.
GLASS MODIFIERS
These acts as fluxes and help in reducing the softening temperature of glass by
decreasing the amount of cross-linking between the oxygen and the glass forming
elements like silica i.e., they disrupt the continuity of the SiO 4 network. E.g., if Na2O
is added, the sodium ions break the bridging Si-O-Si bond leaving behind two nonbridging oxygens. The modifier concentration should not be too high, because if too
many tetrahedra are disrupted, there may occur crystallization during the porcelain
firing operations. The most commonly used glass modifiers are potassium, sodium
and calcium oxides. These are introduced as carbonates that revert to oxides on
heating. Other oxides added may be lithium oxide, magnesium oxide, phosphorous
pentoxide etc.

0
0

12

0 Si 0 Si 0 + Na2O

0
0

0
0

0 Si Si 0 + 2Na+

0
0

Diagram showing interruption of silica tetrahedral by sodium oxide.

INTERMEDIATE OXIDES
The addition of glass modifiers not only lowers the softening temperature but
also reduces the viscosity of the glass. A less viscous porcelain would have a lower
resistance to slump or pyroplastic flow and it is therefore necessary to produce glasses
with low firing temperatures and a high viscosity. This can be achieved by using
intermediate oxides lie aluminum oxide (Al 2O3), which cannot actually form a glass
but can take part in the glass network.
BORIC OXIDE
Boric oxide (B2O3) serves as a glass modifier as well as a glass former. The
amorphous matrix of B2O3 is formed by the three dimensional arrangement of BO 3
triangles. Because the bonds extend in only three directions compared to four in SiO 4
the stability of boric oxide is weaker i.e., glass formed of boric oxide has a
comparatively lower melting point, less viscosity and a higher expansion. When B 2O3
is added to silica glass, the amorphous network consists of a continuous arrangement
of SiO4 tetrahedra and BO3 triangles. Inspite of the continuous lattice arrangement,
the softening point of glass is lowered because of the interruption of the more rigid
and stable SiO4 network by the BO3 lattice.
A typical low fusing porcelain can be shown to have the following composition.
Composition of typical low fusing porcelain
Weight
Low fusing porcelain
Oxide
percent
Glass
SiO2
69.36
Formers
B2O3
7.53
Glass
CaO
1.85
Modifiers
K2O
8.33
NaO
4.81
Intermediate oxides
Al2O3
8.11

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OPACIFYING AND COLORING DENTAL PORCELAIN

The translucency of dental porcelain depends on whether a single-phase glass
or mixture of glasses is used. If a single-phase glass frit is employed in which all of
the constituents are completely taken into solution, the resultant product is highly
transparent. In case of fluxed feldspathic porcelains, the degree of fusion and pyrochemical reactions are limited to an extent such that some crystalline feldspar remains
un-dissolved in the glassy matrix. This difference in refractory indices of the crystal
and glass produces porcelain with opalescent or grayish blue translucency. Another
method of developing translucent gray or opalescent characteristics in porcelain is the
use of a mixture of two or more single phase glass frits of slightly different refractive
indices.The translucency of porcelain can be further decreased by using an opacifying
agent. An opacifying agent is generally a metal oxide-ground to a very fine particle
size of <5m. Zircomium oxide is the most common opacifier employed and is
usually incorporated into the concentrated color frit to be later added to the unfired
porcelain. The difference between the refractive indices of the glass and the opacifier
is the basic mechanism behind opalescence. Different wavelength of visible light are
scattered differently by the opacifying particles. This effect depends upon the size as
well as the volume distribution of the particles. Particles in the size range 0.4 to 0.8
m generate a blue tinge in reflecting light and turn yellowish red in transmitted light.
Preferably, the size of the particle should be nearly the same as the wavelength of
visible light. Dentin porcelains are more opaque compared to enamel porcelains.
COLOURING AGENTS
Pigmenting or coloring oxides are added to obtain various shades needed to
simulate natural teeth. These pigments, generally metal oxides, are added to the glass
used for porcelain manufacture and then subjected to the fritting process. The frit so
obtained is highly color concentrated. These colored glasses are then finely ground
and blended with the un-pigmented porcelain powder to obtain the proper hue and
chroma. The different colouring pigments used in dental porcelain are given in the
table below.
Different coloring pigments used in dental porcelain
Ferric oxide (black), platinum gray
Gray
Chromium oxide, Copper oxide
Green
Cobalt Salts
Blue
Ferrous oxide, Nickel oxide
Brown
Titanium oxide
Yellowish brown
Manganese oxide
Lavender
Chromium-tin, Chromium-alumina
Pink
Indium
Yellow / Ivory
STAINS AND COLOR MODIFIERS
Stains are generally low fusing colored porcelains used to imitate markings
like enamel check lines, calcification spots, fluoresced areas etc. Stains in finely
powdered form are mixed with water or glycerine and water or any other special
liquid. The wet mix is applied with a brush either on to the surface of porcelain

14
before glazing, or built into the porcelain (internal staining). Internal staining is
preferable as it gives more life like results and also prevents direct damage to the
stains by the surrounding chemical environment. Color modifiers on the other hand
are less concentrated than stains and are used to obtain gingival effects or highlight
body colours, and are best used at the same temperature as the dental porcelain.
GLAZES AND ADD-ON PORCELAIN
Glazing is done so as to produce enamel like luster after occlusal and
morphologic corrections have been made in a porcelain restoration. It also seals pores
on the surface of a fired porcelain. The removal or reduction in the size and number
of these surface flaws after glazing markedly increases the strength of porcelain by
preventing crack propagation. It has been seen that if the glaze is removed by
grinding, transverse strength may be only half that of glazed porcelain.
Glazing can be of two types: self glazing (autoglazing) and add-on glazing. In the
self-glazing procedure, an external glaze layer is not applied but the completed
restoration itself is subjected to glazing. Whereas in the add-on glazing, an external
glaze layer is applied on the surface. Add-on glazes are uncolored glasses whose
fusing temperature have been lowered by the addition of glass modifiers. The thermal
expansion of an add-on glaze is also fractionally lower than the ceramic body to
which it is applied. This places the glazed layer under compression and hence crazing
or peeling of the surface is avoided. Disadvantages of add-on glazes are its low
chemical durability, difficult to apply evenly and almost impossible to attain a
detailed surface characterization.
Too high temperatures or prolonged glazing could result in increased pyroplastic flow
of the material and hence roundening off of the line angles and loss of surface
characteristics. Also, an over glazed surface appears glassy and takes on the greenish
hue of a natural glass thereby defying the natural enamel look. Add-on porcelains are
generally similar to glaze porcelains except for the addition of opacifiers and color
pigments. Add-on porcelains should exclusively be used for simple corrections of
tooth contour or contact points.
PROPERTIES
Compressive strength
50,000 psi
Tensile strength
5,000 psi
Shear strength
16,000 psi
Elastic modulus
10X106 psi
Linear coefficient of thermal expansion
12X10-6 / C
Specific gravity
2.2 to 2.3
Liner shrinkage
High fusing 11.5%
Low fusing 14.0%
Refractive index
1.52 to 1.54
The compressive strength is quite high compare to tensile or shear strength.
1. The tensile strength is low because of the unavoidable surface defects.
2. The shear strength is low because of lack of ductility in the material.
3. Voids and blebs greatly reduce the strength of porcelain.
4. Blebs are internal voids tend to reduce the specific gravity of porcelain.

15
5. Porcelains extremely hard materials and because of this property offer
considerable resistance to abrasion. This could be a disadvantage in that it
causes excessive wear of the opposing natural tooth structure or the restorative
material.
6. The brittleness 0.1% deformation is sufficient to fracture porcelain before
fracture.
7. Uranium oxide / cerium oxide is added to match the fluorescence of porcelain
to that of the natural tooth.
8. Porcelain:
a. Relatively inert.
b. Chemically stable.
c. Corrosion resistant.
d. Highly biocompatible.
e. Conducive to gingival health as it prevents plaque addition.
f. Solubility is less.
TWO FACTORS AFFECTING THE PROPERTIES
1. Manner and degree of condensation / compaction of power.
2. Degree of firing and procedure followed to fuse mass.
STRENGTHENING DENTAL PORCELAIN
METHODS
1. Development of residual compressive stresses
2. Interruption of crack propagation
DEVELOPMENT OF RESIDUAL COMPRESSIVE STRESSES:
The propagation of cracks from surface flaws is responsible for the poor
mechanical behaviour of ceramics in tention, although it is also possible that flaws
within the interior of the material can also cause fracture initiation under certain
conditions. One widely used method of strengthening glasses and ceramics is the
introduction of residual compressive stresses within the surface of the object.
Strengthening is gained by virtue of the face that these residual stresses must first be
negated by developing tensile stresses before any net tensile stress develops. For
example, if the net compressive stress within a surface of ceramic is 60 Mpa, it would
take a total induced tensile stress of + 100 Mpa in this region to cause a fracture of
the material. Consider two strips of ceramic A, one that was subjected to a treatment
that introduced a residual compressive stress of 100 Mpa into its surface and the
other that was not treated. As the two strips are flexed equal amounts, the untreated
strip develops tensile in its convex surface, whereas the treated strip merely
experiences a decrease in the residual compressive stress. When the tensile stress in
the untreated strip reaches + 60 Mpa, for example, the untreated strip fracture but the
treated strip has a residual compressive stress of 49 Mpa remaining within its
surface. If the untreated strip breaks at 60 Mpa, the treated strip subjected to the same
force will still have 40 Mpa of residual compressive stress remaining. It would take
an additional applied tensile stress of + 10 Mpa to bring the surface tensile of the

16
treated strip to +60 Mpa. This increase in applied tensile stress from 60 to 160 Mpa
represents a 200% increase in strength over the untreated strip. There are several
techniques for introducing these residuals compressive stresses into the surfaces of
ceramic articles. Three of these methods are discussed below.
Ion Exchange:
The technique of ion exchange sometimes called chemical temperaturing, is
one of the more sophisticated and effective methods of introducing residual
compressive stresses into the surfaces of ceramics. This process involves the
exchange of larger potassium ions for the smaller sodium ions, a common constituent
of a variety of glasses. If a sodium-containing glass article is placed in a bath of
molten potassium nitrate, potassium ions in the bath exchange places with some of the
sodium ions in the surface of the glass article. The potassium ion is about 35% larger
than the sodium ion. The squeezing of the potassium ion into the place formerly
occupied by the sodium ion creates large residual compressive stresses (roughly 700
Mpa 100,000 psi) in the surfaces of glasses subjected to this treatment. These residual
compressive stresses produce a pronounced strengthening effect. However, this
process is best used on the internal surface of a crown, veneer, or inlay because this
surface is protected from grinding and exposure to acids. One study has shown that
grinding of only 100 m from an external surface reduces the strength of the treated
structure to its original value. Furthermore, contact with acidulated phosphate
fluoride over a cumulative time of 3 hours removes most of the ion-exchanged layer
as well. Not all ceramics are amenable to ion exchange. For example, alumina core
materials, DICOR glass-ceramic core material, and some conventional feldspathic
porcelains that are highly enriched with potash feldspar (K 2O, Al2O3.6SiO2) cannot be
sufficiently ion exchanged with potassium to warrant this treatment.
Thermal Tempering:
Perhaps the most common method for strengthening glass is by thermal
tempering. Thermal tempering creates residual surface compressive stress by rapidly
cooling (quenching) the surface of the object while it is hot and in the softened
(molten) state. This rapid cooling produces a skin of rigid glass surrounding a soft
(molten) core. 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 residual
tensile stresses in the core and residual compressive stresses within the outer surface.
For dental applications, it is more effective to quench hot glass-phase ceramics in
silicone oil or other special liquids rather than using air jets that may not uniformly
cool the surface.
Thermal Compatibility :
Most metals expand linearly with temperature up to the melting range. Thus,
a metal expands approximately the same amount when heated from 50 oC to 60oC as it
does from 200oC to 210oC. Dental porcelains behave differently; they have different
values in different temperatures ranges, and, as a result, the thermal expansion or
contraction of the porcelain cannot be precisely matched to that of the allow. Instead,
the thermal behaviour of the metal and porcelain must be adjusted by the
manufacturer in such a way that during the cool-down and properly directed so that

17
the porcelain is not subject to immediate or delayed failure. Ideally, the porcelain
should be under slight compression in the final restoration. This objective is
accomplished by selecting an alloy that contracts slightly more than the porcelain on
cooling to room temperature.Consider three layers of porcelain: the outer two of the
same composition and thermal contraction coefficient and the middle layer of a
different composition and a higher thermal contraction coefficient. Suppose that the
layers are bonded together and the bonded structure is allowed to cool to room
temperature. The inner layer has a higher coefficient of thermal contraction and thus
contracts more as it cools. Hence, an cooling to room temperature, the inner layer
produces compressive stresses in the outer layers as previously described for thermal
tempering. This three-layer laminate technique is used by Corning Glass Works to
manufacture their dinnerware.A similar rationale applies to porcelains and alloys for
metal-ceramic restorations. The metal and porcelain should be selected with a slight
mismatch in their thermal contraction coefficients (the metal thermal contraction
coefficient is slightly larger), so that the metal contracts slightly more than the
porcelain on cooling from the firing temperature to room temperature. This mismatch
leaves the porcelain in residual compression and provides additional strength for the
restoration.
Disruption of Crack Propagation :
A further, yet fundamentally different, method of strengthening glasses and
ceramics is to reinforce them with a dispersed phase of a different material that is
capable to hindering a crack from propagating through the material. There are two
different types of dispersions used to interrupt crack propagation. One type relies on
the toughness of the particle to absorb energy from the crack and deplete its driving
force for propagation. The other relies on a crystal structural change under stress to
absorb energy from the crack. These methods of strengthening are described later.
Dispersion of a Crystalline Phase :
When a tough, crystalline material such as alumina (Al 2O3) in particulate form
is added to a glass, the glass is toughened and strengthened because the crack cannot
penetrate the alumina particles as easily as it can the glass. The technique has found
application in dentistry in the development of aluminous porcelains (A12O3 particles
in a glassy porcelain matrix) for PJCs. Another ceramic dental material that uses
reinforcement of a glass by a dispersed crystalline substance is Dicor glass-ceramic.
The cast glass crown is subjected to a heat treatment that causes micron-sized mica
crystals to grow in the glass. When glass-ceramic restorations are subjected to high
tensile stresses, these microscopic crystals will disrupt crack propagation, thereby
strengthening the crown. In most instances, the use of a dispersed crystalline phase to
disrupt crack propagation requires a close match between the thermal contraction
coefficients of the crystalline material and the surrounding glass matrix.
Transformation Toughening :
A new technique for strengthening glasses involves the incorporation of a
crystalline material that is capable of undergoing a change in crystal structure when
placed under stress. The crystalline material usually used is termed partially
stabilized zirconia (PSZ). The energy required for the transformation of PSZ is taken

18
from the energy that allows the crack to propagate. Experimental work has shown
that transformation toughening may be a viable method for strengthening dental
porcelains. One drawback of PSZ is that its index of refraction is much higher than
that of surrounding glass matrix. As a result, the particles of PSZ scatter light as it
passes through the bulk of the porcelain, and this scattering produces an opacifying
effect that may not be aesthetic in most dental restorations.
CONDENSATION OF DENTAL PORCELAIN
Porcelain powder is mixed with a liquid binder so that the particles are held together,
and the thick creamy paste can be worked and built to the desired shape. The process
of bringing the particles closer and of removing the liquid binder is known as
condensation. Distilled water is the liquid binder used most commonly. However,
glycerine, propylene glycol or alcohol has also been tried. The liquid because of its
surface tension property serves as the binder. During subsequent firing it is
eliminated, and the porcelain particles fill the space formerly occupied by the binder
thereby resulting in shrinkage.
The aim of consideration is to pack the particles as close as possible in order to reduce
the amount of porosity and shrinkage during firing. Two important factors, which
determine the effectiveness of condensation, are the size and shape of the powder
particles. If only one-size particles are used, even the greatest condensation is
expected to leave a void space of 45 percent between the particles. With two sized
particles, the void space is reduced to2 5 percent, and with three or more sized
particles, the void space comes down to 22 percent. System that uses three sizes of
powder is known as the gap grading system. In addition, the shape of the powder
particles also governs the packing density. Round particles produce better packing
compared with angular particles. The most important factor in condensation is the
effect of surface tension. As the liquid is withdrawn, surface tension causes the
powder particles to pack closely together. However, sufficient amount of liquid
should be present so as to wet all the powder particles.
Several methods of condensation are employed (1) in the vibration method; the paste
is applied on to the platinum matrix and vibrated slowly. This brings the excess water
on to the surface, which is then drawn away with a linen or clean tissue. Excessive
vibration should be avoided as it can cause slumping of the mass (2). In the
spatulation method, a small spatula is used to apply and smooth the wet porcelain.
The smoothening action disturbs the particles bringing them closer and also the water
rises to the surface, which is removed as described earlier (3) Dry brush technique
involves placement of dry powder onto the wet surface. The excess water moves
from mixture to the dry powder by capillary action and the wet particles are pulled
together (4) In the whipping method, a large soft brush is moved in a light dusting
action over the wet porcelain. This brings excess water to the surface, and the same
brush can be used to remove any course surface particles along with the excess water.
A combination of the vibration and the whipping methods can also be used. The mix
is first vibrated and then whipped with a brush.

19

FIRING PROCEDURE
Most of the thermochemical reactions in porcelain are completed during the
manufacturing process. The role of firing is simply to sinter the particles of porcelain
powder together to form a dense restoration. Some chemical reaction may however
occur during prolonged firing or multiple firings, like the formation of leucite crystals
in porcelain. During firing, the following changes are seen in the porcelain. The first
change involves the loss of water, which was added to the powder to form a workable
mass. The excess water is partially removed by slightly warming the mix before it is
placed in the preheated furnace. This prevents the sudden production of steam that
could result in voids or fractures. After the mass is placed in a furnace, both free and
combined water are lost of until a temperature or 480oC is reached. The second
change occurs with a further rise in temperature when the particles fuse together by
sintering. As a continuous mass is formed, there occurs a decrease in volume referred
to as firing shrinkage (32-37% for low fusing and 28.34% for high fusing). The third
change seen is glazing which occurs at temperatures of 955-1065oC. Glazing results
in the formation of a glossy surface. After the mass has been fired, it is cooled very
slowly because rapid cooled might result in surface cracking and crazing.
Porcelain restorations may be fired either by the temperature method or the
temperature-time method. In the former, the furnace temperature is raised at a
constant rate until a specific temperature is reached. In the latter, the temperature is
raised at a given rate until certain levels are reached, after which the temperature is
maintained for a measured period of time until the desired reactions are completed.
Different media can be employed for firing like:
a) Air
b) Vacuum
c) Diffusible gas
AIR FIRING PROCEDURE:
All porcelain powder mixes have a certain amount of porosity present in them.
When these porcelains are placed in the air furnace, the furnace atmosphere occupies
these void spaces. Once the softening of glass begins, the grains of porcelain start
lensing at their contact points. Surface tension causes some of the porosity to be
swept out via the grain boundaries, but some of it gets entrapped by the flowing
ceramic around the air voids. With the increase in temperature, the void spaces
containing air assume a spherical appearance under the influence of surface tension.
Still further rise in temperature increases the pressure of the entrapped air and the
bubbles enlarge. Cooling decreases the pressure and hence the size of the bubble.
The surface of air-fired porcelain is generally devoid of bubbles because intestinal air
near the surface can escape easily. Whenever air-firing methods are employed, a very
slow maturation period is preferred to allow for the maximum amount of entrapped
air to escape. The porcelain should not be exposed to its full maturing temperature
and it is advisable to stay 30oC to 50oC below the maximum firing temperature.

20
POROSITY
Bubbles or voids in the fired porcelain are caused by inclusion of air during
firing or in some cases as a byproduct of vitrification of feldspar. Porosity reduces
both translucency and strength of dental porcelain. Translucency depends on the
number and size of the entrapped air bubbles. Large sized particles have fewer but
larger air voids between them compared to small sized particles. Fewer bubbles, even
of large size, give improved translucency. On the other hand, fine sized particles have
multiple small air bubbles present in between them, which makes them highly opaque.
It is, therefore, clear that porcelain powders fired in air must be of necessarily coarse
nature.
VACUUM FIRING
This technique is used to reduce porosity in dental porcelains. It works on the
basis of removing air or atmosphere from the interstitial spaces before surface sealing
occurs. Although the vacuum (760 torr) removes most of the air from interstitial
spaces, some of it is left behind. With the increase in temperature and because of
surface tension, the remaining air spaces assume a spherical appearance. When air at
normal atmospheric pressure is allowed to enter the furnace, it exerts a compressive
effect on the surface skin, which further compresses the internal voids to one tenth of
their original size. This results in a very dense porcelain with very few remaining
bubbles and that too of extremely small size.
Factors to be kept in mind while firing porcelain in vacuum are :
1. Porcelain powders must be dried slowly to eliminate the water vapour, and
vacuum should be applied before the placement of porcelain in the hot zone of
furnace. The interstitial spaces are hence reduced before the surface skin seals
off the interior too rapidly.
2. Vacuum should not be applied after the surface skin has sealed and the
porcelain has matured. Prolonged application can force the residual air
bubbles to rise to the surface and cause surface blistering. Additionally, high
temperatures can cause swelling of these blisters.
3. The vacuum should be broken while the work is still in the hot zone of the
furnace. This permits the dense skin to hydraulically compress the lowpressure internal voids.
4. Vacuum firing cannot reduce the large sized bubbles to any significant degree.
Hence, it is necessary to avoid porcelains with large interstitial spaces i.e.,
porcelain powders with small sized particles are preferred.
DIFFUSIBLE GAS FIRING
In this technique, a diffusible gas like helium, hydrogen or steam is
substituted for the ordinary furnace temperature. Air is driven out of the porcelain
powder bed and replaced by the diffusible gas. With these gases, the interstitial
spaces do not enlarge under the influence of increasing temperature, but decrease in
size or disappear. This occurs because these gases diffuse outward through the
porcelain or actually dissolve in porcelain.

21

VARIOUS STAGES OF MATURITY

Several stages of dental porcelain have been identified when it is sintered or fired.
The common terminology used for describing the surface appearance of an unglazed
porcelain is bisque.
Low bisque :
The surface of porcelain is quite porous. The grains of porcelain begin to
soften and lense at their contact points. Shrinkage is minimal and the fired body is
extremely weak or friable.
Medium bisque :
Pores still exist on the surface of porcelain, but the flow of glass grains is
increased. As a result, any entrapped furnace atmosphere that could not escape via
the grain boundaries becomes trapped and sphere shaped. A definite shrinkage is
evident.
High bisque:
The flow of glass grains is further increased, thereby completely sealing the
surface and presenting smoothness to the porcelain. In the case of non-feldspathic
porcelains, a slight shine appears at this stage. The fired body is strong and any
corrections by grinding can be made prior to final glazing at this stage.
ALL CERAMIC SYSTEMS
CLASSIFICATION
1. Conventional powder slurry ceramic
Hi Ceram Alumina reinforced porcelain
Optec HSP Leucite reinforced porcelain
Duceram LFC Hydrothermal low fusing ceramic
2. Pressable ceramic
IPS Empress
Optec Pressable ceramic
3. Infiltrated ceramic
In-Ceram
4. Castable ceramic
DICOR
Cera Pearl
5. Mechinable ceramic
Cerec Vitablocs Mark I and II
Celay Blocks
DICOR MGC
ALUMINA REINFORCED CERAMIC / ALUMINIOUS CERAMICS
It was introduced by McLEAN and HUGES in 1965. They advocated the use
of glass alumina composite. McLean used a relatively opaque of high alumina
content for maximum strength surrounded by a combination of body and enamel

22
powder 15% and 5% respectively, of alumina resulting in a restoration that has 40%
more strength than traditional restoration.
Gradually high alumina ceramics developed which consisted of minimum 95%
alumina. When alumina powder was fired first a welding of contact points occur
followed by normal sintering which, resulted in a unique fusing effect of partial
fusion. Further there is a expansion of crystal lattice by migration of atoms which
lead to movement of grain boundaries and reduction of porosity. The strength of the
crown increased to about 800 Mpa.
Indications
1. There is a shoulder thickness of only 0.5 mm possible on the labial surface.
2. There is an occlusal clearance of more than 0.5 mm in lateral excursions.
HI CERAM
Hi-Ceram was developed in 1985 borrowing a technique from industrial
manufacturing.It is a system similar to aluminous core ceramic crown, using an epoxy
die, a swaged resin coping and a conventionally applied ceramic.
Indications :
1. Anterior crowns
2. Posterior crowns where occlusal conditions are favourable.
3. Patients who do not want a metal core.
4. Patients who are allergic to metals.
5. Patients who require light reflection from tooth through the core of the crown
for esthetic purpose.
Contraindication
1. For posterior crowns where occlusal stress is high.
OPTEC HSP (HIGH STRENTTH PORCELAIN)/OPTEC VP (VENEER
PORCELAIN)
Many porcelain systems cause wear to the opposing dentition during function, which
usually necessitates nightguard use. New low-wear ceramics may remove the need
for a nightguard in the future. With the advent of low-fusing, low-wear ceramics built
over a pressable ceramic (Optimal Pressable Ceramic [OPC], Jeneric / Pentron, Inc.),
has excellent esthetics, translucent margins and many of the new colors are designed
to match bleached teeth. The Optimal System is the newest generation of ceramic
powder, stemming from Jeneric / Pantrons eight years of research, development and
clinical success with high-strength leucite based ceramic products.
Lifelike anterior metal ceramic restorations are very difficult to fabricate; even the
most talent ceramist has difficulty producing natural color and translucency because
of the metal core. The elimination of the metal framework or coping immediately
increases the chance for esthetic success. Ceramic cores are either opaque or
translucent; the opaque cores exhibit better fracture toughness. Translucency is better
controlled with semi-opaque cores or when the porcelain matches the color and light
transmission of the natural dentin as in the leucite-reinforced ceramics (Optec, Jeneric
/ Pentron, Inc.; IPS Empress, Ivoclar Williams). The strength needed for anterior
crowns does not always call for a metal or ceramic opaque core. According to
Anusavice, All-ceramic crowns should be reserved for anterior and premolar teeth.

23
It is a lucite reinforced All ceramic material (leucite is 45-50%). IPS Empress and
OPC basically are the same ; however, OPCs leucite crystal (filler) is smaller,
resulting in higher compressive strength (187 to 320 psi) and a flexural strength of
over 23,000 psi. The process of heat pressing the ceramic rather than stacking the
material differentiates OPC form IPS Empress.
It has 50% leucite in a glass matrix therefore stronger than conventional feldspathic
porcelain. These leucite crystals are dispersed in a glassy matrix by controlling their
nucleation during production. No core is required like Dicor. VP is higher in chroma
than HSP.
Indications
Anterior Single Units.
Posterior Single Units.
Veneers.
Contraindications
Clenching and bruxism.
Short clinical crowns
Large or immature pulp chambers.
Abnormal occlusal relationships
Existing periodontal disease.
OPC is the second-generation product of IPS EMPRESS. OPC is 15% stronger.
OPC has a clinical history of 8 years. OPC has 58 shades of porcelain powders
compared to the 19 of IPS EMPRESS, which aids in achieving the highest level of
esthetics. OPC is matched to the universally used Vita shade guide system. No need
to purchase a new chromoscope shade guide. It is fabricated using injection-molding
technique.
PHYSICAL PROPERTIES
Flexural Strength
It is approximately 167Mpa. With OPC, Jeneric Pentron has increased
strength and reliability by reducing the size of the leucite crystal and improving its
distribution without reducing the total crystalline content. This gives it a compressive
strength of 187 to 320psi and flexural strength of over 23,000psi. Unlike a few other
All-ceramic systems, Optimal is a bondable material, giving the entire tooth an
additional measure of strength.
Translucency
Its translucency is 3.
Marginal Fit
Optimal provides an extremely high degree of fit to tooth. This results in
increased load bearing capacity.
Low Fusing Ceramics
Low fusing ceramics have been developed primarily for the use with titanium
frameworks. Titanium is now being used for metal ceramics because of its
biocompatibility and corrosion resistance.\Low fusion porcelains are required to

24
adequately match the coefficient of thermal expansion of titanium to reduce residual
stress, which may result in failure of the overlying ceramic.
The fusion temperature of these materials ranges from 650 oC to 850oC. Lower fusing
temperatures may also preserve the microstructure of the ceramics, in contrast to the
high fusing material, which may suffer from dissolution of crystalline components.
PHYSICAL PROPERTIES
Flexural Strength
Flexural strength of low fusing ceramics is comparable to feldspathic
ceramics.
Indications :
Used directly to fabricate all ceramic inlays, onlays and veneers.
For repair and correction of metal ceramic margins.
DUCERAM LFC
It is a low fusing ceramic. It is composed of an amorphous fluorine glass
containing hydroxyl ions and the base layer composed of Duceram Metal Ceramic
leucite containing porcelain.
Duceram LFC is then layered on base layer as a powder-slurry. It is then
strengthened by ion exchange mechanism involving hydroxyl ions thus decreases the
surface micro flaws and increase fracture resistance. It has a firing temperature of
702oC.
IPS EMPRESS
IPS EMPRESS is a heat-pressed glass-ceramic that has superior mechanical
properties for several reasons. The high shrinkage of leucite crystals creates
compressive stress in the vitreous phase, when prevents the development of surface
cracks. The randomly oriented leucite crystals are tightly packed in the vitreous phase
and stop the propagation of micro cracks. The combination of heat pressing, initial
firing, and stain and glaze of the veneers creates an additional 50% in strength. The
higher cohesive strength and fracture toughness allow for thicker areas of porcelain
with a lesser risk of fracture.
IPS EMPRESS glass-ceramic has been successfully used as metal free dental
restorative in clinical situations for the past 6 years. Numerous studies confirm that
this material fulfills the high standards of esthetics demanded form restorations such
as inlays onlays and veneers.
IPS EMPRESS systems are characterized as follows:
1. It is an All-ceramic system.
2. It is a glass-ceramic system.
3. It is leucite reinforced.
4. It is based of principles of surface crystallization.
5. Features increased strength due to dispersion strengthening.
6. It is processed using a heat processing technique.

25
CHEMICAL COMPOSITION ON IPS EMPRESS
The chemical composition of IPS EMPRESS glass-ceramic is given in weight
%.
SiO2 59.0 to 63.0
AI2O3 19. to 23.5
H2O 10.0 to 14.0
Na2O 3.5 to 6.5
CeO2 - 0 to 1.0
CaO 0.05 to 3.0
BaO 0 to 1.5
TiO2 0 to 0.5
Manufacturing of IPS empress glass-ceramic
Initially a base glass whose composition is of particular importance is chosen
this is important for controlled crystallization (at a later stage) is melted subsequently.
It is heat treated to initiate nucleation and primary crystallization, and then it is
grounded.The powder to which the stabilizer, additives, fluorescent agent and
pigments have been added is then pressed to form ingot. Once the ingot has been
sintered to about 1200oC it is ready for sale on the market for processing in EP500
press furnace.
Fabrication of IPS Empress restoration :
The fabrication of a dental crown according to layering technique, for example
is characterized by wax up of a reduced model that is invested in a special investing
material, after a muffle has been preheated the wax is burnt-out, it is placed in a
EP500 press furnace (Ivoclar Company Limited, Schaan, Liechtenstein).
Subsequently, a glass-ceramic ingot for layering technique is pressed into the mould
of the reduced crown at 1180oC according to the viscous flow process. The crown
framework is exposed to this temperature for 35 minutes. It is then cooled, divested
and finished. Then the ceramic incisal materials for layering technique for short
layering ceramic and glaze are applied. These materials are sintered at about 910 to
870oC respectively. Glass-ceramic ingots for sintering technique is preferred for
fabrication of the various restorations like inlay, onlays, and veneers etc.
The ingot is pressed at 1050oC for staining technique. This provides IPS EMPRESS
glass-ceramic with its ultimate strength and esthetic properties.
PHYSICAL PROPERTIES
Flexural Strentth
The basis strength of EMPRESS glass-ceramic has been shown to measure
approximately 120 to 140 Mpa. The basic strength accounts to the EMPRESS glassceramic, which has been divided from the muffle but not exposed to further heat
treatment of layering.
Heat processing the material significantly improves is flexural strength whereas heattreating the material alone dose not. Additional firing after heat pressing further
increases the material strength to about 140 to 220 Mpa. The flexural strength of the
IPS EMPRESS glass-ceramic is the result of microscopic areas of compressive strain

26
on the surface of the crown, inlays etc, produced by internal stress by heat.
Significant increase in the flexural strength can be achieved by glazing the ceramic
materials for the staining and the layering techniques.
Fracture Resistance
IPS EMPRESS crowns have a good fracture resistance when compared with
all other All-ceramic crowns. The fracture resistance of DICOR is not much higher
than that of VITADUR. The fracture resistance of IPS EMPRESS is about 0.5 to 1
Kn. The fracture resistance of IPS EMPRESS greatly depends on the cementation
method. Sandblasting, etching with HF and subsequently silanizing greatly increasing
the fracture resistance. The fracture resistance is higher when the IPS EMPRESS is
fixed with adhesive cements than conventional cements.
Fracture Toughness
Dental ceramic can fail through growth of microscopic surface flaws that form during
processing or from surface impact during service. New dental ceramics have been
developed to improve resistance to crack propagation, which induced furomica,
leucite, alumina and zirconia reinforced glass. The leucite reinforced All-ceramic
system, IPS EMPRESS demonstrated significantly higher fracture toughness than
alumina or fluromica reinforced materials DICOR and DICOR MGC.
INCERAM
SADOUN developed INCERAM in 1985. It makes use of aluminous core that is
infiltrated with a glass to achieve high strength substratures that can support crowns
and bridges. It belongs to a class of material known as interpenetration phase
composites. These materials have at least two phases that are interveined and extend
continuously from the internal to external surfaces. These material posses improved
mechanical and physical properties when compared to the individual components.
They have improved fracture resistance and strength due to the fact that a crack must
pass through alternative layer of components no matter what direction the crack
propagates.
Composition of Inceram
Al2O3 90.8%
SiO2 3.6%
K2O 1.0%
CaO 0.04%
Fabrication Procedure
An All-Ceramic restoration system INCERAM is based on the slip casting of
an alumina core with its subsequent glass infusion. After the impression is taken the
die is poured with special gypsum supplied with INCERAM, then the INCERAM
ALUMINA is applied onto the die.The alumina powder is mixed with deionized
water supplied in pre-measured container. Dispensing agent is added to create a
homogenous mix of alumina in water. This mixture is sonicated in VITASONIC thus
initiating the dispersion process. Then vacuum is applied to remove the air
bubbles.This solution of alumina is referred to as slip which is then painted onto the
gypsum die with a brush. The alumina is built up to form a core for the ceramic tooth.

27
The water is removed by the capillary action of the porous gypsum, which packs the
particles into a rigid network.
The aluminous core is then placed in the IN-CERAMET furnace and sintered.
The cycle involves a slow heating of approximately 2oC/min to 1120oC for 2 hours to
produce approximation of the particles with minimal compaction and minimal
shrinkage of alumina. Sintering is only about 0.2% thus an interconnected porous
network is created connecting pores on the outer surface with those on the inner
surface.Low viscosity lanthanum aluminosilicate glass is used to fill the pores in the
alumina. The glass is mixed with water and placed on a platinum gold alloy sheet.
The external surface of the core is placed on the glass, which is heated in the INCERMET to 1100oC for 4-6 hours. The glass becomes molten and flows into the
pores by capillary diffusion. The excess glass is removed by sandblasting with
alumina particles.The last step is fabrication of INCERAM restoration involves
application of aluminous porcelain to the core to produce the final form of restoration.
The low viscosity lanthanum glass is used to infiltrate the alumina core in INCERAM.
This should be in air environment as recommended by the manufacture. The
INCERAM aluminous glass ceramic produced by lanthanum glass infiltration is about
50% translucent as dentin. In clinical situations where there is a discolored
preparation or a cast post and core this increased opacity over the dentin is
advantageous were as when maximum translucency is necessary INCERAM
ALUMINA is problematic.
PHYSICAL PROPERTIES
Flexural Strength
The flexural strength of INCERAM ALUMINA varies from 300 Mpa to 600 Mpa. It
is four times greater than other classes of dental ceramics. It is theorized that this
high strength results from the primarily crystalline nature of this material and its
minimal glassy phase. A flaw would have to propagate through its high modulus
alumina to cause ultimate failure.INCERAM material is not used as core alone ; they
are also veneered with a low strength material to achieve the final esthetic result. The
effect on strength of veneering cost a minimal drop in the strength of INCERAM
ALUMINA material if the core remained at least 1mm thick. If the core material is
thinned to about 0.5mm and then veneered with 1 mm thickness of porcelain, then the
flexural strength drops to 255 Mpa. This should be adequate for incisors and
bicuspids but not for molars.
Fracture Resistance
The fracture strength of INCERAM ALUMINA is higher when compared to
other all-ceramic systems. It is about 1060 (341 N).
Fracture Toughness
Dental ceramics can fail through growth of microscopic surface flaws that
form during processing or from surface impact during service. In Inceram alumina
the resistance to crack propagation is improved by reinforcement with alumina.
Fracture toughness is about 4.49 Mpa.m1/2 or 4.7 Mpa M-2.

28
Inceram Spinell
A second-generation material, inceram spinell, is based on the inceram
technique, has recently been introduced. The technique of fabrication is essentially
the same as the original system.The primary difference is a change in composition to
produce a more translucent core. The porous core is fabricated from a magnesium
alumina powder to form the porous core after sintering instead of alumina powder as
in INCERAM ALUMINA. This type of material has a specific crystalline structure
referred to as SPINELL.The porous spinell is secondarily infiltrated with a low
viscosity, lanthanum aluminosilicate glass, which produces a more translucent
substructure upon which Vitadur Alpha is veneered to form the final restoration. The
glass infiltration of INCERAM SPINELL should be done in a vacuum environment.
INCERAM SPINELL is twice as translucent as INCERAM ALUMINA
because the refractive index of its crystalline phase is closer to that of glass and the
vaccum infiltration leaves less porosity. The translucency of INCERAM SPINELL
closely matches that of dentin.
Indications:
Anterior crowns
In clinical situations where maximum translucency is needed.
Contraindications :
Posterior restorations.
Anterior and posterior FPDs
In discolored preparations and cast posts as the level of translucency is
excessive and leads to an overly glassy low value appearance.
PHYSICAL PROPERTIES
Flexual Strength
The flexural strength of INCERAM SPINELL is 15% to 40% that of
INCERAM ALUMINA thus being indicated for anterior crowns only. About 350
Mpa.
Fracture Toughness
The fracture toughness of INCERAM SPINELL is about 2.7 Mpa M-2.
Inceram Zirconia
INCERAM ZIRCONIA is also a second-generation material based on
INCERAM fabrication technique. The difference is being a change in composition to
produce a material that has improved flexural strength and fracture toughness.
The porous core fabricated with INCERAM ZIRCONIA has a tetragonal form of
crystal. The porous core is secondarily infiltrated with a low viscosity, lanthanum
alumino-silicate glass, which produces a stronger substructure.
Zirconia has a physical property called transformation toughening (strengthening)
when an external source is applied to the material is goes through a phase
transformation to a monoclinic form of zirconia. The monoclinic form of crystal is
3% to 5% larger, thus in places of micro cracks this process can seal the cracks.

29
PHYSICAL PROPERTIES
Flexural Strength
Flexural strength of INCERAM ZIRCONIA is twice as that of alumina. The
highest strength at 800 Mpa.
Fracture toughness
Also tough that of aluimina. It is about 6.8 Mpa M-2.
Indication
3 unit FPDs for posteriors.
CASTABLE GLASS CERAMIC
DICOR
A glass ceramic is a material that is formed into the desired shape as a glass
and subsequently heat-treated under controlled conditions to induce partial
devitrification ir crystallization. This conversion process, which involves crystal
nucleation and growth is referred to as ceramming and is accompanied by a small
and controlled volume change. The crystalline particles, needles or plates formed
during the ceramming process constitute an interlocking network, which increases the
strength of the material by interrupting crack propagation. The first description of
DICOR castable ceramic was given by Adair and Grossman in 1984.
The glasses ceramic material is composed of SiO2, K2O, MgO, MgF2, minor amounts
of Al2O3, and ZrO2 incorporated for durability, and a fluorescing agent for esthetics.
The fluoride acts as a nucleating agent, and improves the fluidity of the molten glass.
After ceramming, the material is approximately 55% crystalline an contains
tetrasilicic fluoride crystals (K2 Mg5 Si8O20Fl), which closely resemble mica. The
refractive index of these crystals is close to that of the surrounding glass matrix,
helping to maintain translucency in the devitrified body. Mica crystals are achromatic
and the desired shade in final restoration is developed by adding external colorants.
The disadvantage behind the use of these colorant stains is that they may be lost
during occlusal adjustment, during routine prophylaxis or through the use of
acidulated fluoride gels.
The fabrication method for DICOR restorations uses the lost wax and centrifugal
casting techniques similar to those used for fabricating alloy castings. A wax pattern
similar to the final restoration is made and invested in a phosphate bonded refractory
material. Molten glass is then cast into the heated mould after dewaxing. The cast
restoration is freed from the investment, covered by a protective embedment
material and subjected to ceramming. Addition of 2.5% lithium fluoride to the
embedment material may promote crystallization of mica and increase the fracture
toughness of glass ceramic. The completed restoration is acid etched on its fit surface
to enhance bonding to the underlying tooth. Surface stains and colored luting cements
are employed to improve upon the esthetics.
Properties
The physical properties of DICOR are given in the table.
FELDSPATHIC
PROPERTY
DICOR
ENAMEL
PORCELAIN
3
Density, g.cm
2.7
3.0
2.4

30
Translucency
0.56
0.48
0.27
Modulus of rupture psi
22000
1500
11000
Compressive strength, psi
120000
58000
25000
Modulus of Elasticity, psix106
10.2
12.2
12.0
Microhardness
362
343
450
Esthetic Qualities
DICOR restorations are highly esthetic because of their translucency, which
closely matches that of natural tooth enamel. The numerous small mica crystals that
constitute castable ceramic closely match in their index of refraction to the
surrounding glass phase. In addition, the castable ceramic permits a one-piece
restoration made entirely of the same material, and no opaque substructure exists to
impede light scattering. A chameleon effect is seen with DICOR restorations in
which the restoration acquires a part of the colour from adjacent teeth and fillings as
well as the underlying cement lute. Application of an external colouring system
allows independent control over hue, chroma and value. However, as mentioned
before, there are chances of losing this external layer thereby defeating the best of
esthetics.
Precision Of Fit
It has been found to withstand 20 years of simulated toothbrush abrasion without
any changes. The resistance of DICOR to chemicals and staining agents also
compares favorably with conventional feldspathic porcelains. Little wear of the cast
ceramic or the opposing dentition occurs when using DICOR restorations. Two
reasons for this property are:
a. Closely matching hardness between the cast ceramic material and natural
enamel.
b. The DICOR shading porcelains contain minimal abrasive opacifying agents.
Tissue Acceptance
DICOR is chemically inert and has shown to pass all the biocompatibility tests.
The periodontal tissue reaction to DICOR is considered quite favourable because
1. There is no need for opaquer porcelains to mask the metal substructure.
These coarse grained opaque porcelains generally promote the adherence of
plaque.
2. The absence of an opaque layer allows the technician to obtain natural
contouring often found in metal ceramic restorations.
Little discomfort occurs on contact with hot or cold foods because of its
extremely low thermal conductivity and a coefficient of thermal expansion, which
closely matches that of natural enamel.
Radiographic Qualities
The radiographic density of DICOR is similar to that of enamel allowing
proper evaluation of the underlying structures and the margins.
Advantages
1. Excellent marginal fit
2. Relatively high strength

31
3. Surface hardness and occlusal wear is similar to enamel
4. Can reproduce wax patterns precisely by using the lost wax technique
5. Simple uncomplicated fabrication from waxup to casting, ceramming and
colouring
6. Ease of adjustment
7. Excellent esthetics resulting from natural translucency
8. Inherent resistance to plaque accumulation (seven times less than on the natual
tooth surfaces).
Disadvantages
1. Chances of losing low fusing feldspathic shading porcelains, which have been
applied for good colour matching.
Uses
Inlays, onlays, complete crowns and possibly partial tooth coverage
restorations. It is not indicated for fixed partial denture or removable partial denture
abutments with deep rests or internal attachments.
CERA PEARL
Castable apatite ceramic was first developed by Hobo and Bioceram Group as
CaO-P2O5-MgO-SiO2 glass ceramic. This material can be cast similar to the dental
metal alloys. Its casting once obtained has an amorphous structure but when
subjected to ceramming, crystalline oxylapatite, Ca10(PO4)6O results. This apatite is
chemically unstable but becomes stable when exposed to moisture by forming
crystalline hydroxylapatite. Compared to normal enamel, the crystals of Cera Pearl
show a somewhat irregular arrangement and this different arrangement probably
accounts for its superior mechanical properties.
Cera Pearl is composed of CaO, P2O5, MgO, SiO2 and traces of other elements.
CaO(45%) and P2O5 (15%) are the main ingredients in glass formation. They are
essential for formation of hydroxylapatite crystals as well. MgO (5%) helps in the
formation of hydroxyapatite and along with CaO decreases the viscosity of the
compound when melted. SiO2(34%) in combination with P2O5 forms the matrix.
Further SiO2 regulates the thermal properties.
Because the crystalline constituent is similar to natural enamel, Cera Pearl is also
expected to be quite biocompatible. The Youngs modulus, tensile strength and
compressive strength of Cera Pearl are appreciably higher than conventional
porcelains and most restorative materials where as hardness compares favourably with
the natural enamel. The values for these mechanical properties are given in the table
below. Cera Pearl is indicated for both crowns and inlays. However, Cera Pearl is
still currently in a research phase and is not yet commercially available. It is included
in the text because it is a castable glass ceramic and has properties that are
comparable to other ceramic materials.

Thermal
Conductivity (Cal
cm/cm2secC)

Coefficient of
Thermal Expansion
(10-6 / C)

Knoop Hardness
Number (KHN)

Compressive
Strength
(MPa)

Tensile
(MPa) Strength

Youngs Modulus
(GPA)

Material

32

Cera Pearl
103
150
590
350
11.0
.0023
Gold Alloy
95
140
220-240
14.4
Enamel
80
14
390
390
11.4
.0022
Dentin
20
70
280
70
7.0
.0014
Porcelain
70
80
170
590
12.0
.0024
Amalgam
58
70
360
120
25.0
.0540
Composite
18
18
185
39.0
.0026
resin
SHRINK FREE CERAMIC
CERESTORE
It is a shrink-free alumina crown developed by the Coors Biomedical Co. and
later sold to Johnson & Johnson. It is fabricated using lost wax technique and then
injection molding to produce a coping. MgAl 2O4 spinell and an alpha-alumina oxide
make the core replaced by Alceram. The use of a shrink-free ceramic coping formed
on an epoxy die by a transfer molding process overcomes the limits and firing
shrinkage of conventionally produced aluminous porcelain jacket crowns. The
Cerestore coping is veneered with conventional aesthetic porcelain.
Flexural strength:
It is approximately 150 Mpa.
CERAMIC MACHINING SYSTEMS
CAD-CAM (Computer Assisted Design-Computer Aided Manufacturing) system has
been introduced to the dental profession recently. Development of CAD-CAM
system for the dental profession began in 1970s with DURET in France,
ALTSCHULER in US & BRANDESTINI in Switzerland.
Optical scanning and computer generation of restoration were attempted as early as
1971 (ALTSCHULER 1971/1973). With the continued improvement in the
technology, a number of systems are currently being investigated. The teams most
actively pursuing this technology of CAD/CAM systems in dentistry are:
1. French group headed by Dr. FRANCOIS DURET.
2. Denti CAD units by Dr. DIANNE RCHOW.
3. CEREC system by MORMANN and BRANDESTINI.
The introduction of CAD/CAM system to restorative dentistry represents a major
technological breakthrough. It is now possible to design and fabricate ceramic
restoration at a single appointment, as opposed to the traditional method of making
impression, fabricating a provisional prosthesis and using a laboratory for
development of a restoration. Certain errors, which were inherent to the indirect
method, have been eliminated in these systems. Additionally CAD/CAM generated

33
save the dentist and patient time, provides an esthetic restoration and have the
potential for extended wear resistance.
All CAD-CAM system are technically complex & involves three distinct and complex
steps:
1. Collection of information
2. Designing of restoration and
3. Fabrication of the restoration
The popular CAD-CAM systems used in dentistry are:
CELAY system
CEREC system
DCS Precident system
PROCERA system
CEREC
CEREC is a dental CAD/CAM machine. CAD/CAM stands for computer
assisted design, computer aided manufacturing. Mormanns work led to the
development of Siemens CEREC CAD-CAM system. It was developed in Zurich
Switzerland. It is used to fabricate inlays, onlays, crowns, 7/8 crowns and veneers.
This system enables the direct chair side placement of ceramic restoration without
auxiliary laboratory support.
CEREC CAD/CAM machine is used to produce full ceramic restorations in one
patient visit. It has been used clinically since 1986. CEREC 2 was introduced in
1996; CEREC 3 and Scan were introduced by Sirona Dental Systems (Germany) in
2000.
The CEREC technique consist of:
1. Three-dimensional scanning of the cavity or taking an optical impression.
2. Immediate data transformation and
3. Axial milling, which is integrated into a mobile unit.
Occlusal surfaces can now be machined on the Cerec 2 unit smaller pixel size/higher
accuracy in depth measuring = increased resolution of the optical impression.
There are 3 different programs for design, Extrapolation, Correlation, and linear. (1)
Anatomically adapted (extrapolation) (2) Correlated to functionally generated path
(correlation (3) Bucco-linearly flat (inner).
The Cerec system is the only method in dentistry to permit the exact machining of
ceramic veneers. The precision of Cerec 2 grinding unit improvements form the
Cerec 1 system, in an SEM examination marginal widths of Cerce 2 were
considerably smaller than Cerec1.
THE CEREC FAMILY:
CEREC CAD/CAM was developed in ZURICH SWITZERLAND. It has been in
clinical use since 1985.86. Since the introduction of CEREC CAD/CAM in 1985
there has been major advancement CAD/CAM systems, which has resulted in the
development of CEREC 2 AND CEREC 3 systems.

34
CEREC 3 is the latest version. CEREC 3 has many advantages over CEREC 2
system. Those having CEREC 2 systems by incorporating new software called
CEREC L ink can exploit these advantages. The following section gives a brief
introduction to the CEREC family.
CEREC:
The CEREC was first introduced in 1986. it consisted of a mobile unite containing a
small camera, a computer with scan and 3-axis-of rotation milling machine. This old
milling machine was water-pressure driven hydro version.
CEREC2:
It is a tried-and-tested, compact CAD/CAM (Computer Aided Design-Computer
Integrated Machining) system for chairside applications. It is the CAD/CIM system
with the largest number of users worldwide, several million successful restorations
and clinical experience since 1986. it consists of a mobile unit containing a small
camera, a computer with scan and 3-axis-of-rotation milling machine. The milling
machine has an electric motor called E version to provide a better and smoother
cutting of ceramic resulting in better fitting restorations.
The occlusal surfaces can now be machined on the Cerec 2 unit. It has smaller pixel
size/higher accuracy in depth measuring which increases the resolution of the optical
impression. There are 3 different programs for designing: Extrapolation, Correlation,
and linear. (1) Anatomically adapted (extrapolation) (2) Correlated to functionally
generated path (correlation) (3) Bucco-linearly flat (linear).
The precision of Cerec 2 grinding unit has been found to be 2.4 times higher than
Cerec.
CEREC3:It is the modular CAD/CAM system that adapts flexibly to practice
requirements. It provides virtually unlimited scope for incorporating the CEREC 3
modules into the practice layout. It gives flexible integration into the practice
workflow (direct or indirect working; labside or chairside; one or more treatment
sessions the choice being yours). It provides rapid imaging, design, handling
hygiene through the integration of the SIDEXIS intraoral X-ray system and the
SIROCAM 2 intraoral camera.
CEREC 3 is flexible and offers the most advanced solution for every practice concept.
The new highlight in the CEREC product range is the modular CEREC 3, which
offers virtually unlimited scope to optimize practice workflow. Consisting of a
separate imaging unit and milling unit, the CEREC 3 adapts to a wide variety of
different practice layouts. The systems are designed for multiple as well as single
restorations and enable to use the imaging unit for other tasks during the milling
process.
The imaging and milling units can be located in one room or in separate locations.
They communicate with each other either via cable or via radio signals.
The CEREC 3 milling unit can be installed in a wide variety of different locations like
in the treatment room itself (essay access), in a cupboard (reduced noise), in an
unused corner or niche (saves space), in the practice lab or as a fascinating eyecatcher in the waiting room.

35
The multiple functions of the CEREC3 imaging unit are creating optical impressions,
designing the ceramic restoration, and chairside patient communication.
Advantages of CEREC 3:
1. The CEREC 3 imaging unit incorporates a mobile PC, which has been
specially approved for medical applications. Milling chamber is separate form
the imaging / designing unit.
2. The system is now Windows based.
3. Cerec 3 can be used in conjunction with a Cerec 2 by using the Link
software.
4. Two burs (one is tapered) do the cutting instead of one bur and one diamond
wheel.
5. No adjust process (time savings)
6. Faster milling times (5 minute savings)
7. Greater occlusal anatomy
8. All design windows can be open at once
9. Help screen runs automatically and guides through the process.
MILLING CHAMBER:
The new CEREC 3 software is Windows based allowing greater compatibility
and sharing possibilities.
CEREC EQUIPMENT
The intuitive user interface has been optimized for dental applications and
does not require any specialist computer knowledge.
Equipment:
Flat panel monitor.
High-precision measuring camera.
Microprocessor-controlled image capture card, which processes the images
from the 3-D measuring camera in real time.
Windows-based CEREC 3-Software.
The CEREC 3 imaging unit with SIDEXIS and SIROCAM 2 is designed for mobile
applications as well as for integration into a networked practice system.
CEREC SCAN:
It is an entry-level model for indirect working. Low capital outlay is ideal for
new practice start-ups. All processing steps can be delegated to the assistant.
Upgrade option:
It can be turned into a fully-fledged CEREC system via the addition of an
imaging unit.
Based on the CEREC 3 milling unit, the CEREC Scan has been optimized for the
indirect working mode, i.e. the creation of ceramic restoration from dental models.
The resultant cost reductions make the CEREC Scan an attractive option for dentists
who are setting up in practice for the fist time and whose financial resources are
limited.
By adding the imaging unit at a later date the CEREC Scan can be converted into to a
fully-fledged CEREC 3 system.

36
FABRICANTING PROCEDURE:
Following the preparation phase the assistant takes a conventional insitu
impression and then produces a partial model made of quick-setting silicone This
model is then clamped into the holder of the milling unit, where it is scanned by the
built-in laser (duration: approx.5 minutes).
The design process is performed on a separate a PC in the dental practice. The actual
production of the ceramic restoration takes place in the milling unit.
Although the CEREC Scan restorations are produced indirectly they can still be
completed in a single treatment session, due not least to the speed of the laser
scanning operation. The patient can watch the fascinating scanning and milling
process live. The CERECE Scan is geared to the same broad range of clinical
indications as the CEREC 3. The production process can be delegated to an assistant
or dental technician in the practice laboratory. This cuts costs and helps to integrate
the CEREC concept into the existing treatment procedure.
In LAB from SIRONA:
Introduced at the 2002 Chicago Mid-Winter meeting, the inLab system is
designed specifically for Laboratory applications. The idea is to use CERECs fast
manufacturing processes for producing crown copings and bridge frameworks.
These substructures are to be milled from VITA INCERAM SPINELL, ALUMINA
and ZIRCONIA blocks. The flexural strength of these materials is as follows:
INCERAM SPINELL: 350Mpa.
INCERAM ALUMINA: 550Mpa.
INCERAM ZIROCONIA: 750Mpa.
Ideally, the clinician and the technician can apply the appropriate strength
material for varying clinical applications. Once the substructure has been milled, the
technician glass infiltrates the pre-sintered framework and then builds up the final
restoration with a traditional porcelain stacking procedure with VITADUR ALPA
porcelain.
The process of building the substructure (coping or bridge framework) is as follows:
1) Scanning of the model
8-12 minutes
2) Designing the substructure (on a PC)
5 minutes
3) Milling the substructure
12-30 minutes
4) Glass infiltration
5-10 minutes
A crown coping will take about 30 minutes to the finish. A bridge takes
slightly longer at 57 minutes. Note however, the technician can be performing other
functions during much of this process, namely the scanning and milling. Actual
technician hands-on time is mere 5-15 minutes depending on the size of the
restoration. This compares with a very long time to accomplish the same takes with
regular INCERAM techniques, which is one of the main reasons INCERAM is not as
widespread as it should be, but it should be because INCREAM has one of the best
track records of ALL-CERAMIC materials.

37
Another bonus to this system over, says Procera is the choice of color
matching. When the substructure is infiltrated with glass there is a choice of four
colors. No opaqueing is required. This alone makes the inLab system more desirable
but the laser scanning system is more accurate than mechanical systems. In fact the
marginal accuracy of the inLabs is excellent.
CEREC SOFTWARE
The original software of CEREC system is the Cos 1.0. This was replaced
with updated versions like Cos 2.0 and Cos 2.1, which are used for CEREC 2
systems.
Crown 1.30 and 1.31:
There have been many software upgrades since CEREC 2 came onto the
market. Most of these upgrades have been offered to users free of charge.
CROWN 1.30 is the latest release. It replaces Crown 1.21 and allows to use
the CEREC 2 with Link software version R600. Compared to working with R425,
the PC constructs the milling data instead of the CEREC 2. This makes things much
faster.
Other features include:
Continue milling after instrument change
Perfect adaptation of the restoration to the used block-size by automatic
Block-rotation prior or the milling, which leads to smaller blocks and longer
lifetime of disk and bur.
CEREC 3 Software:
The first software used for CEREC 3 systems was the R425. The CEREC 3
system now used the following software R600, R601, R800, R850 and the recently
updated versions R900.
R425:
It is the older version, which does not allow transfer of data from PC back to
CEREC 2.
R600:
It allows all designs, including the Correlation & linear. It helps to save files
(Restoration/Export) anywhere on your computer, or to send the file to any one of the
drives (floppy, zip, CD, etc) or might have on your computer itself. You can open
files (Restoration/import) from anywhere on your computer or your drives. When
designing in Link, you can now choose which type of bur you want to mill with. This
allows you to use your computer to generate the milling data for your CEREC 2 (your
computer generates milling data faster than your CEREC2).
The CEREC 3 software is easy to use and produces optimum results. The CEREC 3
software like the corresponding hardware is based on a modular concept. We can
choose the basic software for the creation of inlays and onlays or opt for the CEREC 3
Crown and/or CEREC 3 Veneer software packages. Whatever choice is made it

38
produces high-quality ceramic restorations simply, quickly and with the utmost
reliability.
More than three quarters of all CEREC users deploy crown construction software.
Compared with the previous versions, the new CEREC 3 Crown is even quicker and
easier to use. An example to illustrate how simple it is to create high-quality ceramic
restorations will be given in the clinical procedure for CEREC system.
CEREC LINK:
It is a software package, which allows CEREC 2 users to exploit all the
functions of CEREC 3 (including parallel design and milling). It helps in export of
CEREC 2 images to a PC, access to PC functions during the design process and
parallel milling and design.
OPTICAL IMPRESSION:
After tooth preparation the impression of the prepared tooth should be taken.
In the CEREC CAD-CAM system instead of a conventional.
Impression with elastomeric impression material an optical impression with a CEREC
camera is taken. Before taking an optical impression the prepared tooth surfaces are
powdered with a special powder, which has the ability to reflect the infrared light
emitted from the camera.
BACKGROUND INFORMATION ON POWDERING:
To take an optical impression it is necessary to powder (or opaque) the tooth
surface to be imaged because of two reasons: The surface of the tooth must be
covered with a non-reflective coating to make it easier for the infrared camera to see
detail. Without the non-reflective coating the effect on the camera is similar to our
looking into a very bright light. Because of the high translucency of enamel, without
an opaque surface applied to the tooth, the infrared beam would be projected back to
the camera from totally different depths within the tooth.
METHODS OF POWDERING:
Powdering of the prepared tooth surface can be done using either:
1. BUTANE-PROPELLED POWDERIGN SYSTEM
2. PAINT ON SYSTEM or SCAN WHITE
3. POWDER MEISTER SYSTEM
BUTANE PROPELLED POWDERING SYSTEM:
The butane-propelled powdering systems has been the most widely used
powdering system with CEREC, as it was the first introduced system of powdering
but it has many disadvantages, which are as follows: it frequently clogs; even when a
concerted attempt is made to hold the butane can upright. The powdering tubs are
flimsy and easily deflected by the cheek or tongue. In order to change the direction of
the powdering tube, a second hand is required, necessitating the clinician to let go of
mirror or cheek.
PAINT-ON OR SCANEWHITE SYSTEM:
The above difficulties with the butane powdering system have forced many
users to use a paint-on system. This paint-on system called Scan White has its own
disadvantages.
In the January 1999 issue of the International Journal of

39
Computerized Dentistry, the German clinician Andreas Lenzen listed these
disadvantages:
The editing of the marginal line is usually unavoidable.
It is not always opaque in the case of dark backgrounds.
A relatively long time is required to remove it form dentin.
THE POWDER MEISTER:
The powder Meister makes powdering easy. With the ergonomically designed
powdering tube, there is no longer a difficult area of the mouth to place imaging
powder. With only a slight twist of thumb and index finger, the direction of powder
flow can be changed with no interruption of the powdering process. The rigid
stainless steel powdering tube can act as a cheek retractor and apply powder at the
same time. In addition it is clog-proof and eliminates the need to constantly replace
costly butane cans. The real advantage of the Powder Meister is its ability to place
precise amounts of powder in very difficult access areas.Notice the extremely even
powder placement that is shown in this second molar area. The distal proximal box of
the second molar as well as the mesial contact area of the third molar is well
powdered. Being able to easily rotate the direction of the powdering tube with the
same hand that holds the powdering device allows the clinician to easily place powder
in any desired area with no difficulty.
This well powdered second molar preparation assures the clinician a well fitting
restoration with a minimum of intraoral adjustment.
INSTALLATION:
The powder Meister attaches to the air supply of the handpiece delivery
system with a male quick disconnects. The corresponding female connection is
installed in the handpiece delivery system and controlled by the foot control. For
clinicians not having an existing foot-controlled air supply going to a female quick
disconnect, can easily and inexpensively be accomplished. The Powder Meister
comes with a male quick disconnect with a convenient built-in/off switch which
allows the clinician to easily activate the air supply to the Powder Meister.
POWDER MEISTER ADVANTAGES:
Clog-free operation
Even powder flow
Ergonomic design
Autoclavable tip
Durable construction
One-handed operation
An end to the need for expensive butane cans
CHARACTERISTICS OF THE THREE IMAGING POWDERS:
VITA POWDER:
Vita powder is titanium dioxide and zirconium oxide. Of the three powders,
Vita is most likely to have larger flames of powder visible on the surface being
powdered. However, Dr. Dennis Fasbinder, at the University of Michigan, found that

40
there was no difference in the resulting marginal gap between restorations made on
test dies powdered with Vita powder or Dicor powder, which has a smoother
appearance.
DICOR POWDER:
Caulks, Dicor powder is an excellent powder comprised of titanium dioxide,
zirconium oxide, and talc. Dicor powder provides a wonderfully smooth powder flow
absent of the larger flakes that are noticeable with the Vita powder. Dicor powders
only disadvantage is the necessity of buying a new powdering tip with each bottle,
which dramatically increases the cost.
PROCAD POWDER:
Of the three powders, ProCad powders has the greatest flow properties. The
highly dispersed silica and titanium dioxide mixture is so flow-able that it pours out of
its bottle almost like you can imagine sand would pour. The advantage of ProCad
powder is this flow-able nature which makes snowdrifting: and large flakes of
powder the least likely to happen. The disadvantage of the ProCad powder is the
tendency to be slightly messier in the mouth. The high flow properties allow the
powder to escape beyond the area where the powdering tip is pointed. ProCad
powder is also the most difficult to wash out of the mouth.
HINTS ON POWDERING:
IMAGING LIQUID:
The imaging liquid is absolutely essential for excellent powdering. There are
those who attempt to merely dampen the tooth with water to help the powder to stick
which does not help as the same airflow that takes the powder to the tooth also
evaporates the moisture that was intended to help adhere the powder. The imaging
liquid is a glycerin and water combination that makes the surface of the tooth slightly
sticky, causing the powder to adhere very well. The imaging liquid is applied
generously to the area to be powdered and dry thoroughly before powdering.
ADJUSTING THE POWDER MEISTERS POWDER FLOW:
To begin powdering with the Powder Meister it is important to adjust the
amount of air pressure going to the powder bottle. With the foot on the air supply
foot control, open the air restrictor valve until powder just starts being expelled into
the suction tube. Opening the air restrictor valve only a little bit more will provide
ideal powdering. Using a minimum amount of airflow reduces the possibility of
snowballs or snowdrifts.
NOTE:
Until getting used to powdering with the Powder Meister, it is suggested that
smaller amounts of powder be placed in the bottle. Some clinicians report that
placing rice or silica gel crystals in the powder bottle help remove excess humidity
form the powder. In climates with high humidity in the air, the powder will collect
too much moisture for good powdering. (The powder bottle can also be microwaved
periodically to expel excess moisture.)

41

APPLYING POWDER TO THE PREPARATION:

Before applying powder to the preparation, it is helpful to spray the first bit of
powder on a non-critical area, such as an adjacent tooth. This frees the powder tube
of any large flakes of powder and allows a preview of the powder flow. Any time the
airflow through any powdering device (including the powder Meister) is stopped,
powder settles in the powdering tube and a few large flakes form. Each time the flow
is started again some of these large flakes can be seen as the powder is applied to the
tooth. Being aware of this tendency is helpful. The easily rotated powdering tube of
the powder Meister greatly minimizes the number of times it is necessary to stop and
start the airflow.
A common tendency is for clinicians to apply powder with too much air
pressure. Less accidental snow drifting will occur with less air pressure. It takes a
few more seconds to powder with less air pressure, but the consistency of results is
worth the time. There are those clinicians that apply powder with the rubber dam in
place. This might be essential with the conventional butane propelled powdering
system, but is not necessary with the Powder Meister. The stainless steel powdering
tube can easily be used to push a cotton roll away form the prepared tooth prior to
powdering or to retract the cheek while powdering. As long as the tip is not
completely immersed in saliva, it will not clog. For moisture control during
powdering upper molars, a Dry Tip distributed by Microcopy and available through
Patterson Dental, is much more effective than a cotton roll.
IMPROVING THE CHARACTERISICS OF THE POWDER:
With the removal of Dicor powder from the market, the clinician can choose
between the remaining two imaging powders, ProCad powder and Vita powder. Most
clinicians find that ProCad powder gives a very grainy optical image and are
frustrated by the large flakes and lumps that are found in the Vita powder. Vita
powder can be filtered, which results in an optical image of a very high quality,
almost equaling the results obtained with Dicor powder.
To filter the Vita powder, stretch nylon stocking over the Vita powder bottle
and fasten it in place with a rubber band. Touch the bottle to a plaster vibrator and
collect the filtered powder in a cup.
POWDERING SUBGINGIVAL MARGINS:
There is no reason why porcelain bonding needs to be limited to supragingival
preparations however; if the margins cannot be seen they cannot be powdered.
Exposing the margin of a subgingival restoration is quick, easy and predictable with
electrosurgery. If the tissue is inflamed, there may be some bleeding following the
use of electrosurgery. With the proper haemostatic technique bleeding can be easily
controlled. Avoid using retraction string in porcelain bonding, as there is no good
time to remove it. If it is removed prior to the bonding procedure, bleeding can be
induced at a time when a totally dry field is necessary. Attempting to remove the

42
string after the bonding procedure can be difficult since the string can be bonded to
the tooth.
After the powdering of the prepared tooth surface is completed a hand-held
camera is placed over the prepared powder-coated cavity to obtain a fixed image on
the computer screen. The camera used for capturing the optical impression is CEREC
camera. The camera is adjusted till a clear image and all aspects of the tooth so that
the computer can read all internal walls cavosurfaces equally. This procedure is made
easy by using the camera accessories like the C-STAT while taking the optical
impressions.
CAMERA ACCESSORIES
C-STAT is a camera accessory used to support SIROCAM 2 camera. The
following section describes about C-STAT and how to use it with SIROCAM 2
camera for realization of exact digitalized picture of perfect angulation.
Without the C-STAT in place, the clinician tends to rest the end of the camera
on the most posterior tooth in order to stabilize the camera. The result, over time, is
an accumulation of small scratches on the tip of the camera lens. With enough
accumulation these scratches can interfere with accurate z-values being read. Because
this lens must be able to withstand autoclaving, it is quite sophisticated and therefore
expensive ($900) to replace. The C-STAT not only protects this expensive lens, but
the stabilizing tip is a wonderful camera support. The kit comes with 6 individual,
autoclavable, C-STATs.
The inside of the support should not touch the camera prism while sliding the
support on the camera. Make sure that the inside of the support is free of white
impression powder, as it will avoid scratching the prism. In most cases the camera
can be laid with the sliding support on the CEREC machine.
But be cautious to lay down a support with a wax impression when using the
Function or Correlation programs. In this case it is recommended that the support be
removed before putting back the camera. Then the camera is secure and the wax
impression will not be damaged. When grinding the rests it is recommended to use a
plastic bur. Then polish with an abrasive rubber wheel. Do not work with too much
speed and too much pressure, and suction off the excess. To realize the best retention
of impression wax perforate the rest base with a rose burr (no.24). Press the warmed
wax on the perorated rest base and shape it with a wax knife or a scalpel. To prevent
the prism form being smudged with wax, cut away the excess on the inside of the
support. The white and the black supports are provided in the same shape. For
instance you can use white ones for the anterior regions (veneers and anterior crowns)
and the black ones for the premolar and molar regions.
ANTERIOR REGION:

43
To take pictures form crown preparation in the anterior region, cut both rests
to about 1.5-2 mm. The camera can be stabilized over the two rests on the incisal
edges or the premolar cusps and rotated to the desired position.
PREMOLAR AND MOLAR REGION:
For use in the premolar and molar regions, grind away the anterior rest. Taper
the posterior rest by grinding it to a point. In this way realize a stable support in an
interproximal space. To take the picture, slide the camera through the support, to find
the appropriate position. The distance between the camera lens and the occlusal
surface should be 4-5 mm. Angulate the camera slightly to the occlusal surface on the
posterior rest of the support.
FUNCTION AND CORRELATION: GREEN
For the Function and Correlation programs, which demand congruent digital
pictures, it is recommended, to make an impression. Shorten the anterior rest and
remove the posterior rest. Perforate the posterior rest base with a round burr (no-8) 67 times. With occlusal wax, such as Moyco Beauty Pink, make a small impression. It
is easy to take another congruent picture with this positioning support.

CHARACTERISTICS:
C-STAT consists of plastics and can be cleaned in the thermodisinfector.
Sterilization is possible till 135 Celsius. The rests can be modified with instrument
and materials form to adapt the support to the different functions.
Once the camera is adjusted with the help of the C-STAT and a clear image of
all the aspects of the cavity is obtained, the operator releases the foot pedal freeze
frame the preparation on the screen.
The focal length of the camera lens is 10 mm. Any depth greater than 10 mm
will not be focused properly and result in the generation of ill fitting restorations.
CONTROLLING THE TONGUE DURIGN THE OPTICAL IMAGE:
Some patients have tongues that can be almost unmanageable during the
taking of the optical image. This can be quite difficult because these unruly tongues
will invariably wipe away the powder form critical parts of the tooth preparation or
fight the camera position as it is being aligned. This problem can be overcome by
using Dry Tips by Microcopy. Dry Tips are water absorbant, and when placed
between the tongue and the preparation, are extremely effective at protecting the
preparation form intrusion by the tongue. When the camera is placed in the mouth,
the camera pushes on the Dry Tip, which in turn pushes the tongue out of the way.

44
The proper software should be selected for designing and milling the
restoration. These have been dealt with earlier in the section CEREC family under
CEREC software.
More than three quarters of all CEREC users deploy crown construction
software. Compared with the previous, the new CEREC 3 Crown is even quicker and
easier to use.
DESIGNING OF THE RESTORATION:
The restoration is designed from the images shown on the computer screen by
using series of icons or symbols. The operator can electronically design the
restoration by moving a cursor along the limits of the preparation thereby defining the
boundaries.
The internal limits are created, as are the walls and cavosurfaces margins.
Thus the gingival floor, axial walls, cavosurfaces margins, proximal contours
(contacts) and marginal ridges are established.
The procedure can be stopped at anytime and edited to override the computer
and allow the operator to correct the electronically generated features. Once the
restoration has been designed, the computer develops and onscreen, three-dimensional
model or image of the inlay or onlay or veneer.
The entire information generated can be stored automatically on a
programmed floppy disk. The design phase usually takes 2 to 8 minutes even when
designing multiple cusp replacement or veneers.
An example of designing of a restoration is given below:
The following examples illustrate how simple it is to create high-quality
ceramic restorations
Begin by selecting the type of restoration (inlay, onlay, partial crown, crown
or veneer), the design method (extrapolation, tooth database, correlation or
function), as well as the tooth in question.
The optical impression can be taken directly in the patients mouth or from a
model.
The outcome is a three-dimensional data model, which is
automatically stored.
Begin by encircling the equators of the neighbouring teeth. Following this
you trace the precise baseline. The integrated tooth database adapts the
selected restoration to the anatomical situation of the neighbouring teeth.
The orientation of the crown and the height of the proximal marginal ridges
are determined on the basis of the neighbouring fissures
The positions and height of the cuspal apices are calculated wit reference to
the neighbouring teeth and then displayed. All the other design lines are

45

calculated automatically. The restoration is then ready for immediate milling.

Alternatively, you can view each design step in turn and modify each line
individually.
If you decide not to mill the restoration immediately, you have the option of
viewing the equator and the relevant contact points with the neighbouring
teeth. Various viewing modes and cross sections allow you to cheek the
thickness and height of the contact points.
In this window you can view any cross-section of your choice through the
restoration. All the verticals can be individually edited. In addition, this
window allows you to determine the thickness of the ceramic material in the
occlusal region.

MILLING PROCEDURE:
After all the data have been supplied, the computer selects the size of the
ceramic block required. There are many types of preformed blocks present
commercially to be used with CEREC CAD/CAM system.
The blocks used in this system are as follows:
3M MZ100
VITA Mark II and Master
Ivoclar ProCAD
VITA Mark II Esthetic Line
VITA Alumina and Spinell
Other blocks
3M MZ 100:
3M Paradigm MZ100 Block for CEREC is made from 3M Z100 block
material contains 85 wt% ultrafine zirconia-silica ceramic particles that reinforce a
highly cross-linked polymeric matrix. The polymer matrix consists of bisGMA
(Bisphenol A diglycidyl ether dimethacrylate) and TEGDMA (tri[ethylene glycol]
dimethacrylate), and employs a patented ternary initiator system. The characteristics
of 3M MZ100 are as follows:
The Mark II Vitablocs
The Mark II Vitablocs, manufactured by Vita, represent the second generation
of CERECVitablocs. Manufactured from a new fine particle dental ceramic with
wear characteristics similar to natural tooth enamel. This means a CEREC restoration
made of Mark II blocks does not wear the opposing enamel cusps any more than
natural tooth enamel does.

46
Traditional dental ceramic restorations cause a noticeable higher rate of wear
in the opposing enamel cusp. On this subject a study was carried.
Out by Dr. I. Krejci et al. in the Dental Institute of Zurich. The results have
been published.
The microstructure of CEREC Vitablocs makes the material very easy t grind,
finish and polish. The homogenous microstructure also enables better, more even and
retentive results of acid etching. This is essential for achieving a secure bond between
restoration and natural tooth substance by means of the adhesive technique.
The flexural strength of the Mark II material has been considerably improved
and amounts to approximately 160 Mpa.
ProCAD BLOCKS:
ProCAD blocks have just recently been introduced to the market form Ivoclar.
Like Ivoclars popular Empress material, ProCAD is reinforced with tiny leucite
particles, and has been referred to as Empress on a stick.
Notes on usage:
1. ProCAD blocks are held in place by a new screw (Patterson item # 84050013).
2. Since ProCAD is a harder material a new lubricant must be used (75ml per
water tank) or you may double up on the current Dentatec lubricant (i.e. use
50ml instead of 25 ml).
3. Bur/wheel life will be shortened if you mill the two materials on the same
instruments.
4. Every ProCAD propellant comes with a new nozzle.
5. Shade cross-reference: 100 = A1, A2, B1, B2, C1 200 = A3, A3.5 300 = B3,
B4 400 = C2, D2, D3 500 = A4, C3, C4, D4
6. In order to stain and glaze the ProCAD material, its recommended to use the
ProCAD shading paste, but other stains have also worked.

ALUMINA AND SPINELL COMPING BLOCKS:

The Alumina and Spinell coping blocks are available for doing InCeram
crowns. The dentist or assistant makes an Alumina or Speinell coping (using the
Lab software which comes with CEREC II) and sends the coping to the lab. The
coping is then glass-infiltrated and the technician applies layers of InCeram Porcelain,
which is fused to the coping making a very strong and esthetic crown. Alumina
blocks are for posterior copings and the Spinell blocks are designed for anteriors.
Megadenta Bloxx is available only in Europe and have one, two or three
shades incorporated into each block.

47
Once the desired size block is selected then it is mounted on a metal stub,
which allows it to be inserted into the milling unit. After the block is inserted the
small window is closed and the milling device is activated. The milling is
accomplished by a three-axis-of-rotation cutting machine, which mills 25-m slices.
A diamond wheel is driven by electric motor, which generally takes 4 to 7
minutes to complete the procedure.
The milling allows for the occlusal contours of all cuspal inclines, marginal
ridges and proximal contours. It does not provide for internal and secondary occlusal
anatomy. The operator develops this Intraorally after the inlay has been cemented.
For milling of crown copings and bridge-frameworks with CEREC in Lab the
long-tapered-diamant and the cylinder-diamant with a diameter of 1.6 mm are used.
The usage of the 1.2mm cylinder-diamant, to mill outer shape of copings and bridge
frameworks, gives no benefits. The long-tapered-diamant has to be screwed to the
left side and the cyliner-diamant to the right side. Care should be taken, when
changing worn diamants.
The 1.6 mm (long) diamant is used for the vast majority of restorations. The
1.2 mm is used mainly for anterior restorations and crown with endodontic posts.
LONGEVITY OF THE CYLINDER
The number of millings that are possible wit a cylinder are a function of the
type and size of restoration, whether or not extended milling is used, and the kind of
material (Vita Mark II or ProCad) being milled. Extended milling increases not only
the milling time but also the amount of wear on the cylinder. It has been shown that
milling ProCad blocks slightly decreased the life of the milling instruments. Using
extra Dentantec solution and tooth preparations free of irregularities will prolong
instrument life.
The larger the restoration, the older the cutters and the use of extended milling
all make the estimated time longer.
DENTATEC SOLUTION AND EXTENDED MILLING:
While milling too much heat is generated. This heat generated is harmful to
the milling machine and the diamants used. So it should be dissipated using a coolant
like Dentatec solution. Cerec suggests a change of water at the start of every 6 th
milling.
The Dentatec solution also act as a lubricant in the milling process. In
addition to providing a lubricating function, which increases the life of the milling
instruments, the solution also contains an antimicrobial. Even with the antimicrobial,

48
if the CEREC 2 is not used for a period of time, an odor come form the milling
chamber. To eliminate this, change the water after prolonged period of unuse.
When the milling pictogram is clicked the CEREC 3 software tells what size
of ceramic blocks is required. Then insert the corresponding block into the milling
unit and initiate the milling process. The imaging and milling units communicate via
a wireless link (option).
Before the milling process begins the computer control system automatically
detects and compensates for tool wear. A cylindrical and a conical diamond burr
shape the restoration. The conical burr enables very fine details to be created on the
occlusal surface.
SPEED OF CEREC CAD/CAM SYSTEM:
The main advantage of using CEREC CAD/CAM system is its speed in
manufacturing a restoration in a very short period of time. The following table shows
the time taken to produce various restorations by using CEREC CAD/CAM system.
Process step
Coping
bridge framework
Scanning (automatic) approx. 10min.
approx. 20min.
Design
approx. 2min. approx. 6min.
Milling (automatic) approx. 15min.
approx. 50min.

STAINING AND GLAZING:

In certain circumstances it may be necessary and/or appropriate to naturalize
the CEREC restorations. This can be accomplished by adding stain to the restoration
and then firing (glazing) it in an oven.
The Ney Miniglaze oven is a simple, manual and inexpensive chairside oven
available for this process. To add porcelain a more expensive (and automatic)
vacuum furnace like the Labs use, such as the Vita Vacumat 30 is needed.
CEMENTATION OF RESTORATION:
The weakest part of the CEREC restorations the luting agent layer is exposed
margin. The long-term success of the restorations depends mainly on the success of
luting agent, which requires a low shrinkage rate, high wear resistance, bonding to
both tooth structure and the ceramic, polishability, and color stability. Previous result
have generally indicated that dual cure resin composites are preferred for the luting of
ceramic inlays, because of their ability to set completely and have greater resistance to
occlusal loading compared with GIC. The GIC is reliable chemical bond to tooth
structure and its fluoride release. The final smoothening is achieved using a polishing
paste applied with a rubber cup.
FINISHING & POLISHING:

49
The frequent frustration with a CEREC2 restoration is the time it takes to
finish the restoration after it has been bonded. This obstacle can easily be overcome.
The place to start, especially when using extrapolation, is before the tooth has been
prepared for the CEREC 2 restoration. Observe carefully the shape of the existing
occlusion, marginal ridge heights, and cusp.
Placement before any tooth reduction has begun. Form a mental image of
these anatomical landmarks for reproduction later. An intraoral picture, frozen on the
monitor, would be helpful. Later, when the restoration has been bonded, any areas of
gross excess can be quickly reduced.
When reducing excess porcelain, the appropriate diamond is essential. It is
possible to crack porcelain, even after the restoration has been bonded, with a
diamond that is too coarse. The wonderful characteristic of the Vita Mark II porcelain
that allows it to be nonabrasive to the opposite tooth also allows it to be easily carved
with a fine-grit diamond. The bur used for occlusal reduction is a 1923 F (F is for
fine) football shaped Neodiamond form Microcopy. The Neodiamond is an
inexpensive, one use diamond. This football-shaped diamond can be used more
than once, but should be discarded at the first sign of dullness. One of the most
common mistakes leading to frustration in finishing the restoration is using a diamond
past its useful life. Make the initial gross occlusal reduction and the finishing of the
interproximal areas with the rubber dam in place.
Note: Be sure to use water spray during gross reduction. A diamond used at
high speed against porcelain can cause heat buildup and porcelain cracking. It is also
possible to crack the porcelain restoration by having the patient close too hard on the
articulating paper in the adjustment process. This porcelain has excellent strength
characteristic. However, a sharp opposing cusp under premature excess pressure can
crack a bonded porcelain restoration.
The interproximal finishing is done with a round end taper 850012 F from
Axis. Because of the vertical nature of the proximal box walls, the infrared camera is
not able to process data as accurately as it can on the occlusal. As a result of this
situation there may be more discrepancy in the fit in this area, causing the need for
extra finishing at the vertical part of the proximal box wall. This is easily done with
the taper diamond or a Profin from Dentatus. If the bottom line has been accurately
drawn, there will be little need for finishing this area. However, the profin is
excellent for smoothing the occasional area of residual cement that has been left
behind.
Once the appropriate occlusion has been established, smooth any rough areas
with the same fine-grit football-shaped diamond as above but now at low speed and
without water spray. Caulk Enhance polishing cups used in a slow speed followed by

50
brown rubber points used in a high-speed handpiece at low RPM, gives a very
acceptable polish.
The following instruments help in the various steps in preparation of the
restorations, finishing and polishing the CEREC restorations.
Proper anatomical occlusal morphology and a smooth wet look shine on the
porcelain surface are requirements for achieving excellent CEREC restorations. This
can be achieved by LS-7257 Prep N Glaze Logic Set. This comprehensive set
provides the clinician with everything required to deliver CEREC restorations, from
start to finish.
The solution:
KaVo SONICflex prep Ceram (0571 0331) permits perfect finishing and
exactly defined cavities through precise transfer of the geometry of the tips directly to
the tooth substance. With tips specially developed for adhesive inlays and onlays
with optimum bevel angles:
Tips with defined edge angles: lateral (60) and cervical (75).
Tips diamond-coated on one side (mesial and distal).
Features:

Avoidance of undesired undercuts.

Optimized result: The result of the preparation in the difficult
approximal region is reproducible and is considerably improved.
Less treatment stress, especially in critical procedures.
Less treatment time: Considerable time saving compared with
conventional methods.
Quality improvement: Through cavity design, which protects substance
and adjacent teeth.
Wide range of applications: May be used for all All-ceramic and fine
hybrid composite and other inlay systems, such as CEREC IPS
EMPRESS and TARGIS VECTRIS (registered trade marks of Sirona
Dental Systems GmbH, Bensheim and Ivoclar AG, Schaan).

DCS PRICEDENT
The DCS Precident system (Digitizing Computer System) called the Dux or
titan system in USA was developed in 1988 and introduced to the market in 1990.
Since then about 150 units have been used in Germany and other countries.
Originally this system was designed for fabricating metal copings for
porcelain fused to metal crowns and FPDs.
The following features are available in this system:

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1. Acquisition of data form the prepared tooth is performed manually on the
digitizer. A touch probe is traced along the conventional stone cast. The 3
dimensional morphology of the prepared tooth can be easily obtained and
reconstructed from a limited amount of data.
2. Up to 7 units FPD on one side of the arc can be made with this system.
a. All ceramic coping can also be produced with the specially designed endmill and porcelain block.
b. It takes about 30 to 45 minutes form digitizing to milling process in the
fabrication of a single crown.
c. The marginal accuracy of milled coping has been proved clinically
acceptable.
This system consist of 3 main parts:
1. A desktop computer.
2. A digitizer and
3. A milling machine with 3 degree of freedom.
FABRICATION TECHNIQUE:
DIGITIZING:
Tooth preparation and impression making are performed in the conventional
manner. The trimmed working die of the prepared tooth is placed on the digitizer
table. The sensor tips 1.0 mm in diameter and 10.0mm in length is used to trace the
prepared tooth. On the display a 2-dimensioanl outline of the prepared tooth with a
marginal line and a 0.2*0.2mm grids will be indicated.
When each grid is touched with the sensor tip 3-dimensioanl outline of the
prepared surface area will be measured and transferred to the data bank. The areas for
which data are already stored will be changed to blue. Once the entire area has been
digitized the 3-dimensional reconstruction of the stored data about the prepared tooth
is displaced. The white line on the 3-dimensional reconstruction represents the
marginal line. If the line is not smooth, digitization should be done again.
COMPUTER-AIDED DESIGNIGN:
Data for fabricating a metal coping can be obtained by adding offset for the
desired thickness of metal on the top of the prepared tooth surface data. Thickness
can be varied according to the coping design. This coping data for complete or partial
porcelain coverage can be developed in this system.
Occlusal morphology cannot be designed by this system. The time required
for digitizing, designing and the data conversion to milling path data is about 15 to 20
minutes for a single crown and 20 to 30 minutes for a 3 unit FPD.
COMPUTER AIDED MILLING:

52
Metal copings are milled from titanium blocks. In accordance with CAD data,
the milling program selects the titanium block that will results in the minimum
remaining material.
End mill of 3 and 2 nm in diameter are used in the milling process.
The steps in the milling process are:
1. A titanium block is fixed in the milling machine with the jig.
2. The inside of the coping is milled with the CAD data.
3. The titanium block is removed, turned over and replaced when the milling of
the inside of the coping is finished, the milling machine will automatically
stop to allow the side of the titanium block to be changed.
4. The outer surface of the coping to which the porcelain or the resin material
will be attached later is milled.
5. To allow the removal of the coping from the block, the connecting part
between the coping and the remaining block is cut.
6. The time required for milling a single crown coping is about 30 to 45 minutes.
About 90 to 120 minutes are required for the 3 unit FPD coping.
7. The infrastructure for ceramic crown can also be milled using this system form
a block of high performance METROXIT ZIRCONIUM OXIDE TZP
BIOCERAMICR type TAP (tetragonal polycrystalline Zirconium oxide).
FINISHING AND POLISHING:
Finishing and polishing are performed in the conventional manner on the die.
Porcelain or composite resin can be used as a facing material and is applied with the
conventional method.

ACCURACY AT THE MARGINS:

The average gap between the coping and die at the margin is 30 to 50
micrometer. Although there is stillroom for improvement, it is fair to conclude that
this system is able to achieve clinically acceptable marginal accuracy comparable to
that of conventional complete cast crown (30 to 50 microns) and other CAD/CAM
system (50 to 100 microns).
PROCERA SYSTEM
This process for manufacturing crowns, process and implant superstructures
uses a combination of copy milling, spark erosion and laser welding.
PROCERA technology was first developed for processing titanium. The
application of PROCERA system for manufacturing individual crown made of
extremely dense sintered aluminium oxide ceramics resulted with the increasing
demand for improved aesthetics.
ALUMINIUM OXIDE CERAICS:

53
Crowns manufactured with PROCERA system shows strength values never
reached by an all-ceramic system. Flexural strength is 699 +/-70.8 Mpa according to
the manufacture. ANDERSSON and ODEN research at the UNIVERSITY of
MICHIGEN indicates a flexural strength approximately twice as high as that of INCERAM and more than three times of other ALL-CERAM systems.
THE PROCERA ALL-CERAMIC SYSTEM:
The three main parts of the PROCERA system are:
1. A scanner,
2. A personal computer,
3. A modern or disk for transmission of data to the workstation.
FABRICATING PROCEDURE:
The die of the prepared tooth is first mechanically scanned. The scanner has a
sapphire ball tip that reads the die shape by circular scanning, describing the tooth
using approximately 20000 measured values.
When scanning is completed the technician can design the coping on the
computer monitor. Various programs are offered to the operator such as design of the
crown, its desired shape and preparation margins.
15 to 25% shrinkage of the aluminum oxide ceramic material is expected
during sintering process. This is compensated by enlarging the design in the computer
files.
The data are collected and then transferred to a PROCERA workstation via
modem. This means that the master cast need no longer be sent out of the dentist
office. The process of manufacturing the coping could theoretically be initiated at any
point on the earth and at the workstation an enlarged die model is precision milled by
a computer-controlled milling machine.
High purity aluminium oxide powder with a defined grain size is then
pressed onto the die using very high pressure. This enormous pressure give the
material a high packing density, a main factor in the material strength. The outside of
the coping is milled before the sintering process. By sintering at a very high
temperature (1550C) the coping will shrink to the original dimension and will have
excellent marginal fit.
VENEERING THE PROCERA CROWN:
A special ceramic material with co-efficient of thermal expansion adjusted to
aluminium oxide (7*10-6 micro meter /ml) has been developed for the PROCERA
technique.

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THE BASE KIT:

It consist of
16 dentin shades
5 translucent shades
4 incisal shades.
THE MASTER KIT:
It has 12 modifiers accurately adjusted to each other and it also offers 8 basic
dentin shades.
This leads to a wide range of possibilities for customized design of the
restoration.
CELAY
The CELAY SYSTEM employs a copy milling machine and uses
manufactured porcelain blanks to mill out ceramic inlays, onlays, crowns and bridges
is the CELAY system (Siervo et al, 1994). This system is a precision copy- milling
machine.
The Celay system is unique in its milling capabilities. Its milling arms are
able to move in 8 axes of freedom, which allows the milling of complex, threedimensional shapes. Thus, it can mill the occlusal aspects of restorations in very fine
detail. The marginal fidelity of these milled restorations is excellent. According to
the manufacturer, marginal gap of only 50mm can be achieved. Marginal gaps of 60
mm were attained in an independent study. The Celay system provides the ability to
fabricate both direct and indirect ceramic restorations. Copy milling technology
requires the generation of a pattern of the desired restoration. This pattern can be
fabricated directly from the mouth or on a pattern of the desired restoration. This
pattern is then copy milled using the Celay machine to generate the final restoration.
The system uses an approach similar to the pantographic method of duplicating keys.
FABRICATION TECHNIQUE:
Preparation of porcelain inlays should allow for a porcelain thickness of 1.5
mm, and the ideal occlusal depth and the isthmus width of the porcelain inlays is
2mm. Preparation should be slightly conical with rounded internal line angles. Cavo
surface margins should be sharp and not beveled. Any undercut or deep areas are
filled in with light polymerized glass Ionomer cement. The dies are then sealed with
2 coats of thin cyanoacrylate and any undercuts are blocked out with wax. An ultra
thin die lubricant is placed as a separator. An appropriate amount of a special blue
composite resin is paled in the die and carved to shape, creating what is termed a
Pro-inlay. The occlusal aspect of the pro-inlay can be created with carving

55
instruments or burs after it had been light polymerized for a minimum of 2 minutes.
After this, the pro-inlay is then removed form the die and polymerized form the
bottom for another minute.
The pro-inlay is fixed in the Celay using the point method an then ready to
be copy milled. One or tow inlays are mounted with the rod method. This
procedure requires that a small hole be drilled in one of the central surfaces, after
which a special pin is cemented wit cyanoacrylate for positioning in the Celay. The
reference scanning disk is placed in the machine, and the appropriate size porcelain
blank is chosen. The reference disk acts as a scanning stylus that is moved across the
surface of pro-inlay.
MILLING INSTRUMENTS:
The following milling instruments and polishing instruments are used:
1. A coarse diamond disk with a grit size of 126 um (Diametal, Biel,
Switzerland) for efficient bulk reduction.
2. A finishing diamond disk with a grit size of 64um (Diametal) for precision
milling of the final contour.
3. Round tipped diamonds with a grit size of 64um (Diametal) for narrow
concavities that is secondary occlusal anatomy.
4. Sharp tipped diamond with a grit size of 64um (Diametal) for secondary
occlusal anatomy.
5. Polishing instruments loaded with diamond powder (Shofu).

56

Schematic representation of copy milling.

57

Schematic summary of CAD/CAM and copy milling

operations.

A block of porcelain has been placed into the machine

and is now being milled.
This 37 years-old women wanted to replace the defective and aging amalgam in her maxillary
right first molar with a more esthetic restoration

A 30 micron
The try-in shows a
After 7 minutes the
diamond quickly
slight
gapimaging
that will be
final is
porcelain
The tooth is sprayed
with
The tooth
isolated with rubber dam
curs
off
the
filled
with
resin
restoration
drops tois coated with
powder, a white powder to make
it
and
the preparation
porcelain
sprue.
cement.
the
because
of
the
photoreceptive
imaging liquid, a thin oily substance
tray.

The dentin bonding

A digitizing
camera is used
The preparation
is to record theThe tooth is
partially
dried
agent is applied in
dimensions
etched for instead
15 to 20of making a
The
CAD/CAM
(CEREC)
following the acid
multiple calculate
cores then air
traditional
seconds impression
dimensions before milling of the

polymerized.

58

59

60

The desk-top Celay (Vident) machine has its own selfcontained liquid cooling system.

The proper shade and size of pre-manufactured Vita

Celay porcelain ceramic blank is selected.

61

The pattern is traced manually and the machine

mills the ceramic blank to the exact shape and
size of the pattern

62

REFERENCES
1. David A Graber., Ronald E Goldstein. Porcelain and composite inlays and
onlays esthetics posterior restorations. Quintessence Publication.
2. Aschheim Dale. Esthetics dentistry second edition. A clinical approach to
techniques and materials. Mosby Publication. 137-180.
3. Baratieri., Luiz N. Esthetics direct adhesive restoration on fractured anterior
teeth. Quintessence Publication. 265-310.
4. Robert G. Craig. Restorative dental materials. Xth Edition. Mosby Publication.
Harcourt Brace and Company Pvt. Ltd. 467-496.
5. Ronald E. Goldstein. Esthetics in dentistry. IInd Edition. B.C. Decker Inc. 339390.
6. John W. McLean. Dental ceramics proceedings of the first international
symposium on ceramics. Quintessence Publication.
7. Jack L. Ferracane. Materials in dentistry principles and applications. II nd
Edition. Lippincott Williams and Wilkins. 158-165.
8. David A. Graber. Porcelain laminate-veneers. Quintessence Publication.
9. Philips. Science of dental materials. Kenneth J. Anusvice. X th Edition. W.B.
Saunders Company, Harcourt Asia Pvt. Ltd. 583-618.
10. A. Parameswaran, K.S. Karthikeyan. Materials in restorative dentistry.
Meenakshi Ammal Trust. 203-231.
11. Vimal K.Sikri. Textbook of operative dentistry. CBS Publishers. 439-481.
12. Theodore M. Robertson. Herald O. Heyman. Sturdevants art and science of
operative dentistry. IV Edition. Mosby Company. 133-226.

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