CosmoPost /

IPS Empress® Cosmo Ingot

Scientific Documentation
Scientific Documentation CosmoPost / IPS Empress® Cosmo Ingot Page 2 of 24

Table of Contents

1. Introduction 3
1.1 Origins of post anchors 3
1.2 Purpose of the root canal post 3

2. Various post systems and materials 4

2.1 Conventional post systems 4
2.2 Possibilities of tooth-coloured stabilization and build-up 4
2.3 All-ceramic post build-up systems 5
2.4 Summary of the advantages and disadvantages of different post systems 6

3. Technical Data Sheets 7

4. CosmoPost and IPS Empress Cosmo Ingot 9

4.1 Material 9
4.2 Procedure 9
4.3 Physical properties of the CosmoPost 9
4.4 Bonding systems and the CosmoPost 10

5. Material investigations 12
5.1 Flexural strength of various root canal posts 12
5.2 Influence of the surface texture on the bond strength between the post and core build-up 13
5.3 Increasing the strength of the bond between the post and core build-up material 14
5.4 Examinations of different types of bond between post and core build-up 15
5.5 Cyclical loading of several root canal post systems 15
5.6 Comparison of several post build-up systems 16
5.7 Mechanical strength of zirconium oxide root canal posts 17

6. Clinical investigations 19
6.1 Studies conducted on the CosmoPost and IPS Empress Cosmo ingot 19
6.2 Studies conducted on ZrO2-TZP-posts 21

7. Biocompatibility 22
7.1 Biocompatibility of zirconium-TZP-ceramics (CosmoPost) 22
7.2 Radioactivity of CosmoPost and IPS Empress Post ingot 22

8. Literature 23
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1. Introduction

1.1 Origins of post anchors

The first post anchors in the root canal were fabricated at the beginning of the 20th century. They
were called pivot teeth. Since it was discovered that the post exerts pressure on the root canal walls,
the root stump was stabilized with a gold ring to prevent the root from fracturing. In newer root canal
post systems, the pressure is absorbed by the core build-up, thus reducing the risk of fractures.

1.2 Purpose of the root canal post

A root canal post is used if teeth are severely damaged and devitalized. It has to provide adequate
retention for the build-up.
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2. Various post systems and materials

2.1 Conventional post systems

Materials
As a result of certain aspects of materials science and fabrication, metal-based posts and build-up-
materials were (and sometimes still are) preferred. The materials used range from cobalt-chromium
to nickel-chromium, and to precious metal alloys, such as gold-platinum or silver-palladium. Today,
however, titanium and platinum are the most commonly used materials (Meyenberg et al., 1995).

Procedures
Individual or semi-finished posts or screws are available. For both procedures, the build-ups may be
fabricated either directly with mouldable materials in the oral cavity of the patients or indirectly in the
dental laboratory by means of the casting technique after having taken an impression of the prepared
tooth structure (Simon and Paffrath, 1995).
Cementation may be carried out adhesively or conventionally. Adhesive cementation increases the
strength of the system comprising the post, build-up, and dentin (Mendoza and Eakle, 1994).

Assessment
Questions with regard to biocompatibility and aesthetics have led to critical assessments of metal-
based post systems. With all-ceramic crowns in particular, the use of metal posts is aesthetically
unsatisfactory, since the metal core often shines through the translucent, all-ceramic crown. This dark
bluish tinge is caused when the light penetrates through the translucent gingiva and the tooth structure
or crown and is reflected by the opaque post and/or core build-up material (Simon and Paffrath,
1995). The corrosion of the post and the build-up represents the main problem of such restorations,
particularly if non-precious metals are used (Wirz and Christ 1982; Koutayas and Kern, 1999).
Corrosion results in the accumulation of decomposition products in the dental and periodontal
tissues, thus resulting in discolouration and inflammation of the gingiva. In this respect, it must be
noted that different types of metal alloys also demonstrate different corrosion behaviour (e.g.
corrosion resistance of titanium).

2.2 Possibilities of tooth-coloured stabilization and build-up

The demand for highly aesthetic and biocompatible products led to the development of tooth-
coloured, metal-free post build-up systems.

... on a composite basis

Although composite-based root canal post build-up systems demonstrate improved aesthetics
compared with metal-based ones, they also have some disadvantages. Simon and Paffrath (1995),
for example, pointed out the reduced radiopacity and the difficulty of bubble-free application of the
composite in the canal lumen.
Sidoli et al. (1997) showed that the bonding strength of carbon-fibre systems (e.g. Composipost) is
lower than that exhibited by gold posts with gold build-ups or special steel posts with composite
build-ups.
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... on an all-ceramic basis

The main advantages of all-ceramic systems are their excellent aesthetics as well as their widely
acknowledged biocompatibility. With the use of ceramic post and build-up materials, the
transparency of all-ceramic crowns is maintained, since the translucency and shade of the ceramic
post are similar to that of natural dentin (see Fig. 1). Therefore, the undesired shining through of the
posts no longer occurs. Furthermore, the accumulation of corrosion products in the gingiva and the
resulting discolouration are no longer evident.

Ceramic post Metal post

The translucent ceramic post allows the The metal post reflects most of the
light to penetrate and scatters it also in penetrating light
the direction of the gingiva
Fig. 1 Comparison of the light reflection of a ceramic and a metal root canal post (in accordance with Meyenberg,
1994)

2.3 All-ceramic post build-up systems

Glass-ceramic systems
An impression is taken of the canal dimensions. After that the post build-up is fabricated of castable
glass-ceramics (e.g. Dicor) using the indirect method. However, the low strength of Dicor
considerably limits the range of indication (Paul and Schärer, 1996).

Aluminium oxide-reinforced ceramics

The adequate strength justifies the fabrication of the post and build-up of an aluminium oxide-
reinforced hard core ceramic material (e.g. In Ceram) (Kern and Knode, 1991). However, the
fabrication procedure is very time-consuming and technically exacting, which is a considerable
disadvantage (Paul and Schärer, 1996).
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Zirconium root canal posts

Given the increased strength compared with other ceramic materials, zirconium oxide is particularly
suitable as a material for root canal posts (Lüthy et al., 1993). The material exhibits high strength
values. Therefore, the same post dimensions are possible as with high-gold alloys or titanium (Simon
and Paffrath, 1995). Paul and Schärer (1996) recommend using adhesively cemented, translucent
zirconium oxide posts in the aesthetically demanding maxillary anterior region including the upper first
premolars (e.g. CosmoPost, Cerapost, Biopost).

2.4 Summary of the advantages and disadvantages of different post systems

Material of the root canal Advantages Disadvantages

post
metal posts with cast build-up
Titanium alloy post with
adhesively cemented composite
build-up
Composite-based posts
(e.g. Composipost)
All-ceramic-based posts (in
general)
Glass-ceramics (e.g. Dicor)
glass-infiltrated aluminium
ceramics (e.g. In-Ceram)
Zirconium oxide posts in general • see general comments on all-
CosmoPost
Seitner and Gläser (1997), supplemented
• good mechanical properties • unsatisfactory optical results:
(shining through of the metal;
discolouration of the gingiva)
• occurrence of corrosion and
accumulation of decomposition
products in the surrounding soft
tissues
• good mechanical properties • unsatisfactory optical results
• good biocompatibility (shining through of the titanium
post
• good aes thetics • low strength of the post build-up
system
• good optical properties • relatively brittle material
• good biocompatiblity
• no signs of galvanic corrosion
• see general comments on all- • low strength
ceramics
• see general comments on all- • time-consuming procedure
ceramics
ceramics
• improved strength
• see general comments on • difficult to remove
zirconium oxide posts
• the heat-curing technique
further increases the bonding
strength between post and
build-up material
• the cylindro-conical shape
facilitates cementation
• easy handling
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3. Technical Data Sheets

Product: COSMOP OST

Type of material: ZrO2-TZP BIO-HIP® Bio ceramic

Standard – Composition: (in weight %)

ZrO2 + HfO 2 + Y2O3 > 99

Y2O3 4.5 - 5.4
HfO 2 <5
Al2O3 < 0.5

Physical properties:

Tested in accordance with:

ISO/DIS 13356.2 Implants for surgery - Ceramic materials based on yttria-stabilized
tetrogonal zirconia (Y-TZP)

Density > 6.0 g/cm3

Porosity (open) 0 %
Flexural strength (4-point) > 800 N/mm²
Coefficient of thermal expansion (100°-500°) 10.0 ± 1.0 µm/(mŸK)

R+D / Scientific Service Visa: P. Oehri

Date of issue / Reference: June 1997 – oep/mam

Replaces version of: ---
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Product: IPS EMPRESS COSMO INGOT

Type of material: Pressable ceramic

Standard - Composition: (in weight %)

SiO 2 54 - 59
ZrO2 15 - 19
Al2O3 3-7
P2O5 4-7
Li2O 7 - 10
Na2O 2-5
K2O 3-7
F 0.5 - 2
+ Pigments 0-2

Physical properties:

Tested in accordance with:

ISO 6872 Dental ceramic

Type II ceramic
Flexural strength > 100 N/mm²
Chemical solubility < 2000 µg/cm2
Coefficient of thermal expansion (100°-500°) 9.5 ± 0.5 µm/(mŸK)
Transformation temperature 545 ± 10 °C

R+D / Scientific Service Visa P. Oehri

Date of issue / Reference: June 1997 – oep/mam

Replaces version of: ---
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4. CosmoPost and IPS Empress Cosmo Ingot

4.1 Material

CosmoPost
The prefabricated, cylindro-conical CosmoPosts are made of Zirconium oxide ceramic (ZrO 2-TZP1-
ceramic), which has been successfully used for medical appliances (hip replacements) for
approximately 10 years. The good compatibility, corrosion resistance, and excellent mechanical
strength (high flexural strength and fracture toughness) of the ZrO2-TZP-ceramic is particularly
valued (Luthardt and Musil, 1997). The high temperatures during production result in a high-quality
ceramic material, which is free of porosity.
IPS Empress Cosmo Ingot
A glass-ceramic containing zirconium oxide is used as the base material. Its expansion coefficient is
slightly lower than that of the ZrO2-TZP-ceramic. This adjustment of the expansion coefficient and
the high ZrO2 content of the IPS Empress Como Ingot ceramic [15-19 wt. %] permits an optimum
bond to the ZrO 2-TZP-ceramic of the CosmoPost (Schweiger et al., 1998a + b).

4.2 Procedure

The core build-up made of the IPS Empress Cosmo ingot is pressed onto the zirconium oxide root
canal post according to the familiar IPS Empress heat-pressing technique (Wohlwend and Schärer,
1990). If at least one-third of the natural tooth crown is still present, the core build-up may also be
fabricated of composite materials (e.g. Tetric Ceram). This approach offers the advantage of the root
canal post and core build-up being inserted during one single appointment.

4.3 Physical properties of the CosmoPost

ZrO2-TZP-ceramic of the CosmoPost

Mean grain size ∼ 0.4 µm

Pressure resistance 2000 MPa
Vickers hardness 1200 HV
Modulus of elasticity 210 GPa
Fracture toughness (K1C) 7 MPa m½
Abrasion behaviour < 0.002 mm³/h
Corrosion resistance < 0.1 mg/m² * 24h
Data from Metoxit AG, Thayngen (CH)
(see item 3 for further details)

1
Above 1170° C the monoclinic zirconium dioxide forms a tetragonal modification. The addition of Y2O3 permits
stabilizing the tetragonal modification until room temperature is reached. The result is a stabilized zirconium
dioxide with a grain size below 0.4 µm. It is called zirconia-TZP (Tetragonal Zirconia Polycrystals)-ceramic
(Luthardt and Musil, 1997).
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4.4 Bonding systems and the CosmoPost

Bond between canal wall and post

For an optimum bond, an adhesive bond between the root canal dentin and the zirconium oxide has
to be achieved. Therefore, the CosmoPost is adhesively cemented with a self-curing or dual-curing
luting composite2 in combination with a modern dentin bonding agent.

Bond between post and build-up material

The bond between the CosmoPost and the IPS Empress Cosmo ingot is a ceramic-ceramic bond,
which can be achieved with the familiar IPS Empress heat-pressing technique. The push out test of
Kakehashi et al. (1997) showed that a high-strength bond is achieved in this way.
The root canal post - build-up system is further reinforced by the root canal post, which extends to
the upper end of the build-up.
If the core build-up is fabricated of a composite material (e.g. Tetric Ceram), the bond is
mechanically achieved by roughening the surface of the zirconium oxide post.

2
If purely light-curing resins are used, there is a risk of inadequate polymerization in the depth of the root canal.
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Bond between build-up material and residual dentin

An excellent bond between the build-up material and residual dentin is a decisive factor for success
of the therapy. Paul et al. (1996) showed that the best adhesion values can be achieved with the
combination of a dentin adhesive and a self-curing hybrid composite.

Fig. 2a: optimum bond between the glass- Fig. 2b: optimum bond between the glass
ceramic (core build-up) and the ZrO2-ceramic ceramic (core build-up) and the ZrO2-ceramic
(CosmoPost); polished surface at 2000-fold (CosmoPost); fracture surface at 5000-fold
magnification magnification
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5. Material investigations

5.1 Flexural strength of various root canal posts

1200

1000
Flexural strength [MPa]

800

600

400

200

0
Dicor In-Ceram unalloyed steel Cerapost Cosmopost hard metal

Comparison of the flexural strength of various root canal post system; all data from Simon and Paffrath (1995)
except the flexural strength of CosmoPost: internal results Ivoclar AG, Schaan
Cerapost (Brasseler) is also made of ZrO2-TZP-ceramic

Conclusion: The flexural strength of the CosmoPost is very high and is between that of unalloyed
steel and tungsten carbide.

These results for the flexural strength of zirconium oxide root canal posts are confirmed by
investigations of McLaren and Sorensen (1997) who measured a 3-point flexural strength of 1110
MPa for zirconium oxide ceramic.
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5.2 Influence of the surface texture on the bond strength between the post and core
build-up

The purpose of this study was to evaluate the effect of surface conditioning (the CosmoPosts were
either untreated or demonstrated a roughened surface) and thermocycling on the retention of the core
build-up material (IPS Empress Cosmo ingot) heat-pressed onto the CosmoPost. The bond strength
was measured in a push-out test in the Schenk testing machine.

350

300

250
Bond strength [N]

200

150

100

50

0
untreated rough surface after TC rough surface after TC

Kakehashi et al. (1997)

Rough surface: The surface roughness [Ra] is at least 0.4 - 0.8 µm

TC: 10,000 thermo-cycles in water (5 / 55° C) during 333 h
Conclusion: The posts with the rough surfaces produce a higher strength of the bond to the build-
up material than do the untreated posts. The thermo-cycles did not significantly affect
the bond strength between the ceramic posts and the core build-up material.
For that reason, the posts are supplied with an adequately roughened
surface. Therefore, they do not have to be pre-treated in the laboratory.
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5.3 Increasing the strength of the bond between the post and core build-up material
with the IPS Empress heat-pressing procedure
The bonding strength between the CosmoPost and the IPS Empress Cosmo ingot ceramic was
tested. In the selected test procedure (Schenk testing machine), the posts were forced out of the
ceramic core build-up material at an advance rate of 5 mm/min. The first crack was recorded. A so-
called prototype, i.e. a zirconium oxide post adhesively bonded to the core build-up, was used as the
control group.

250

200
Bond strength [N]

150

100

50

0
Cosmopost Prototype Cosmopost, rough Prototype, rough
surface surface

Kakehashi et al. (1997)

CosmoPost: CosmoPost and Empress Cosmo ingot, bonded using the heat-pressing
technique.
Prototype: Post of the same material as the CosmoPost (cylindrical shape), adhesively
bonded with the ceramic core build-up material
Rough surface: The surface roughness [Ra] is 0.4 - 0.8 µm
Conclusion: The zirconium oxide posts bonded with the core build-up by means of the heat-
pressing technique demonstrated higher bonding strength than those bonded with an
adhesive. This increased bonding strength is particularly notable with untreated
zirconium oxide posts.
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5.4 Examinations of different types of bond between post and core build-up

Various types of bond between the post and core build-up were examined. Pressing, adhesive
cementation, and milling of the entire structure. The breaking load and the deflection at fracture were
measured and compared. The load was exerted perpendicular to the post axis.
load [N] resp. deflection [µm/N]

30.0
25.0

20.0
15.0
10.0
5.0
0.0
pressing adhesive milling
(Cosmopost/Empress) (Cosmopost/Empress) (one piece In-ceram zirc)

deflection [µm/N] load [N]

Jeong et al (2001)

Conclusion: The investigation shows that the adhesive cementation of the ceramic build-up onto
the ceramic post may be a true alternative to the conventional pressing technique.
The elastic bond between the rigid materials provides an additional advantage.

5.5 Cyclical loading of several root canal post systems

Metal and ceramic posts, as well as fibre-reinforced resin posts, were embedded in acrylic resin
blocks. After storage in H2O at 37° for 48 hours, the posts were subject to cyclical loading at a 45°
angle. The load was continuously increased by 25N until failure of the test sample.
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1600 140

1400 120

1200
100

equivalent load [N]

loading cycles (n)

1000
80
800
60
600
40
400

200 20

0 0
Titanium post Cosmopost Aesthetiplus Exp.Fiber Exp. Fiber
1.5 1.7 1.4 1.5 2.0

Rathke et al. (2001)

Points: Number of loading cycles

Bars: Size of the equivalent load, i.e. standardized to the number of cycles that reach maximum load.

Conclusion: The ceramic posts withstood a higher load than the commercial fibre-reinforced resin
posts.
CosmoPost (1.7 mm) does not significantly differ from the 2 mm thick experimental
Fibre Post.

5.6 Comparison of several post build-up systems

Various combinations of root canal post and core build-up materials (upper incisors) were subject to
thermocycling (1.2 m. cycles, 5°/55°C). The survival rates and the fracture loads were determined.
Examined combinations: titanium/composite, zirconium oxide (Cerapost)/composite, zirconium oxide
(Cerapost)/ceramic (Empress Cosmo), gold/gold.
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100 450
400

fracture strength [N]

80
survival rate [%]
350
300
60 survival rate [%]
250
200 frac.strength [N]
40
150
20 100
50
0 0
tit/comp zirc/comp zirc/cer cast/cast

Butz et al (2001)

Conclusion: The survival rate and fracture load values were comparable, except those for the
zirconium oxide/composite combination.
The zirconium oxide/ceramic combination showed a survival rate of 100 % in the
thermocycling test. These findings were also confirmed by the investigations of Strub
et.al (2000) and Heydecke et al (2002).

5.7 Mechanical strength of zirconium oxide root canal posts

Differently conditioned CosmoPosts of both sizes were examined with the help of a 3-point bending
test. The influence of the following treatments were determined: a) Influence of silicatization on the
surface (Rocatec procedure) and b) Influence of heat exposure during the application of the pressed
ceramic.

2500 20
Weibull strength [MPa]

18
Weibul modulus m

2000 16
14
1500 12 Weibull strength
10
1000 8 Weibull modulus
6
500 4
2
0 0
1.7 silicat.

1.4 silicat.
untreated

untreated

heat treat.

heat treat.
1.7

1.4

1.7

1.4

Fischer et al. (1998)

The flexural strength values for ZrO2 found in the literature are lower. The 40 % higher values of the
present investigation may be attributed to the ‘size effect’ typical for ceramic materials. The strength
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increase resulting from the silicatization (Rocatec procedure) is caused by the increase of the inherent
compressive strain in the surface layer of the posts, which may partially compensate the tensile strain
relevant for a failure.
Conclusion: The heat exposure during pressing does not influence the strength of the posts.
The silicatization increases the Weibull strength σ63.21%. However, it also increased
the scattering of the values.
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6. Clinical investigations

6.1 Studies conducted on the CosmoPost and IPS Empress Cosmo ingot

Head of study: Prof. Dr. P. Schärer / Prof. Dr. H. Lüthy

Klinik für Kronen- und Brücken-Prothetik, Teilprothetik und zahnärtzliche
Materialkunde, Zentrum für Zahn-, Mund- und Kieferheilkunde der
Universität Zürich (Switzerland)
Objective: Clinical evaluation of CosmoPost and IPS Empress Cosmo ingot
Experimental: Between 1995-1998, a total of 51 CosmoPosts were directly or indirectly
seated in anterior and posterior teeth. 21 posts were luted with Panavia
21TC (self-curing) and 30 posts were luted with Variolink II (dual-curing).
Results: Up to the date of this publication, no clinical failures were noted. Thirty-six
posts were examined after a mean wearing period of 14.2 and 33.1
months. The only fracture in the laboratory was cause by a processing
error.
Cement Controlled Posts Mean Wearing Min./Max.
(n) Period
Panavia 21TC 11 33.1 months 22.5 months / 43 months
Variolink II 25 14.2 months 12 months / 21 months

The aesthetic results have been evaluated as excellent, especially when

compared to conventional metal post.
Publication: Kakehashi Y, Lüthy H, Naef R, Wohlwend A, Schärer P., A new all-
ceramic post and core system: clinical, technical and in-vitro results,
Internationl Journal of Periodontics & Restorative Dentistry 18 (1998),
587-593
Fehér A, Egger B, Lüthy H, Schumacher M, Loeffel O, Schärer P., ISO-
Zementevaluation und klinische Untersuchung von Zirkonoxidstiftaufbauten,
Acta Med Dent Helv 4: 201-209 (1999)

Head of study: Dr. D. Edelhoff

Klinikum für Zahnärztliche Prothetik, Universitätsklinikum der RWTH
Aachen (Germany)
Objective: Clinical evaluation of CosmoPost and IPS Empress Cosmo ingot
Experimental: From May 1997 to December 1999, 39 CosmoPost root canal posts were
seated in the anterior region and 37 CosmoPosts in the posterior region
according to the indirect (41) and the direct method (35).
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Results: Seventy-one posts were clinically examined after an average wearing

period of almost 40 months. No absolute failures (root, core build-up or
post fractures) were noted. Four relative failures occurred among the
restorations seated according to the indirect method (2 retention losses of
permanently cemented posts and 2 ceramic delaminations from the core
build-up).
Publication: Edelhoff D, Wurzelstifte und individuelle Stumpfaufbauten aus Keramik –
erste klinische Erfahrungen mit dem CosmoPost-System, Quintessenz 49
(1998) 257-265.
Edelhoff D, Spiekermann H, Yildirim M; Klinische Erfahrungen mit
konfektionierten Wurzelstiften und individuellen Stumpfaufbauten aus
Keramik, Dtsch Zahnärztl Z 55 (2000) 11, 746-750
Edelhoff D, Spiekermann H, Junge LM, Sorensen JA, Yildirim M; Clinical
results of an All-ceramic post and core system, J Dent Res 79
(2000),#3185
Edelhoff D, Junge LM, Spiekermann H, Yildirim M; Three-year clinical
results of two all-ceramic post systems, J Dent Res 81(Spec
IssA)(2002),#2586

Head of study Prof. P. Pospiech / Hr. F. Nothdurft

Ludwig-Maximilians-Universität, Munich (Germany)

Experimental: The first post build-ups were seated in July 1998. The posts were
conventionally cemented (ProTec Cem, Ketac Cem). Until the end of
1999, 20 CosmoPosts were examined.
Results: After a mean observation period of 9.7 months (2-16 months) no failures in
the form of a post or tooth fracture were noted.
Smaller, clinically irrelevant delamination of the build-up material were
observed during removal of the temporary.
Publication: Nothdurft Frank Philipp: Werkstoffkundliche und klinische Untersuchungen
zu vollkeramischen Stiftaufbauten; internal report to Ivoclar Vivadent AG

Head of study: Dr.med.dent.Peter Jöhren / Jesko Gärtner

Fakultät für Zahn-, Mund- und Kieferheilkunde der Universität Witten /

Herdecke (Germany)

Experimental: Forty anterior teeth with root canal fillings were restored with CosmoPosts
and Tetric Ceram build-ups. The crowns were fabricated of IPS Empress 2
and Allceram.
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Results: The last recall examinations were completed at the end of 2002/beginning
of 2003. Up until now, the results are outstanding. No fractures, irritation of
the gingiva, etc. The aesthetic results are considered excellent for all cases.
Publication: Gerhards U, Gärtner J, Jöhren HP, Gängler P; Der Einfluss eines
keramischen Stiftsystems (CosmoPost) auf das kosmetische Ergebnis von
vollkeramischen Frontzahnkronen am Beispiel des Empress 2- und des All-
Ceram Systems; internal report to Ivoclar Vivadent AG

6.2 Studies conducted on ZrO 2-TZP-posts

The ZrO2-TZP-post used in this study is a prototype of the CosmoPost and is made of the same
material as the CosmoPost, but it features a cylindrical shape (in contrast to the cylindro-conical
CosmoPost). Given this identical material composition, it can be assumed that the clinical results
achieved with the ZrO2-TZP-posts are also valid for the CosmoPost.
Head of study: Dr K.H. Meyenberg
Klinik für Kronen- und Brücken-Prothetik, Teilprothetik und zahnärztliche
Materialkunde, Zentrum für Zahn-, Mund- und Kieferheilkunde der
Universität Zürich (Switzerland)
Objective: Clinical evaluation of the ZrO2-TZP-posts
Experimental: Fifteen ZrO2-TZP-ceramic root canal posts were seated in 13 patients. Six
IPS Empress restorations, 6 In-Ceram restoration, 2 veneers, and 1 PFM
crown were fabricated. The core build-up was made of a hybrid composite
material.
Results: After an average of 11 months (6-27 months), the restorations were
checked for the first time. Up to this first recall, no failures were noted. All
restorations achieved and 'excellent' rating as far as aesthetics was
concerned.
Publication: Meyenberg KH, Lüthy H, Schärer R, Zirconia Posts: A New All-Ceramic
Concept for Nonvital Abutment Teeth, J Esthet Dent 7 (1995) 73-80
Scientific Documentation CosmoPost / IPS Empress® Cosmo Ingot Page 22 of 24

7. Biocompatibility

7.1 Biocompatibility of zirconium-TZP-ceramics (CosmoPost)

The following tests were conducted on the zirconium-TZP-ceramic material:

In vitro tests: Cytotoxicity (with cell cultures)

Chromosome damage (mutagenicity test, Ames Test)
Hemolysis
In vivo test: (with rabbits, mice, guinea pigs, and sheep)
Acute toxicity
Irritation
Sensitization
Long- and short-term implant investigations
None of these tests has shown any sign of a health risk potential of the CosmoPost. The implant
investigations have shown that zirconium-TZP-ceramics evidence the same biocompatibility as do
pure Al2O3-ceramics, the biocompatibility of which was proven at the beginning of the seventies
(Rieger, 1994).

7.2 Radioactivity of CosmoPost and IPS Empress Post ingot

The radioactivity of the ceramic powder in question was measured by means of γ-spectronomy. The
uranium and thorium activity was determined.

U-238 [Bq/g] TH-232 [Bq/g] Limiting value [Bq/g]

ISO-6872 /
ISO 13356.2

IPS Empress Cosmo Ingot 0.027 0.005 1.0 / 0.2

CosmoPost < 0.005 < 0.003 1.0 / 0.2
Results of an investigation conducted by Petri H, Forschungszentrum Jülich (G), Zentralabteilung für chemische
Analysen.

The above values show that the radioactivity of CosmoPost and IPS Empress Cosmo ingot is far
below the maximum values stipulate by ISO- 6872:1995/Amd.1:1997(E) (Dental ceramic) and ISO
13356.2 (Implants for surgery - Ceramic materials based on yttria-stabilized tetragonal zirconia (Y-
TZP)).
Scientific Documentation CosmoPost / IPS Empress® Cosmo Ingot
8. Literature
Butz F, Lennon AM, Heydecke G, Strub JR
Survival rate and fracture strength of
endodontically treated maxillary incisors with
moderate defects restored with different post-and-
core systems: an in vitro study
Int J Prosthodont 2001;14:58-64
Fischer H, Edelhoff D, Marx R
Mechanische Beanspruchbarkeit von Zirkonoxid-
Wurzelstiften
Dtsch Zahnärztl Z 53 (1998)
Heydecke G, Butz F, Hussein A, Strub JR
Fracture strength after dynamic loading of
endodontically treated teeth restored with
different post-and-core systems
J Prosthet Dent 2002 Apr;87(4):438-45
Jeong SM, Jeong JH, Kang DW, Ludwig K, Kern M
Evaluation of the fracture resistance of zirconia
posts in all-ceramic post and core restorations
J Dent Res 80 (2001) 706
Kakehashi X, Lüthy H, Wohlwend A, Loeffel O,
Schärer P
Retention of ceramic cores pressed on zirconia
posts
IADR abstract (1997)
Kakehashi Y, Lüthy H, Naef R, Wohlwend A,
Schärer P
A new all-ceramic post and core system: clinical,
technical and in-vitro results
Int J Periodont Rest Dent 1998;18:587-593
Kern M, Knode H
Stifkernaufbauten aus In-Ceram - direkte und
indirekte Methode
Quintessenz Zahntech 17 (1991) 457
Kern M, Pleimes AW and Strub JR
Stability of Restorations with All-Porcelain or
Metal Post and Cores
J Dent Res 71 (1992) 122
Koutayas S, Kern M,
Vollkeramische Stiftkernaufbauten-Stand der
Technik
Quintessenz 50,7 (1991) 701-711
Luthardt RG, Musil R
Hochleistungskeramik und CAD/CAM-
Technologie in der Zahnmedizin: Zur Frage der
Page 23 of 24
dentaltechnologischen Bearbeitbarkeit von
Zirkondioxid-Keramik
Swiss Dent 18 (1997) 10-14
Lüthy H, Schärer P, Gauckler L
New materials in dentisty: Zirconia posts. Abstr.
IV-2, Monte Verità Conference on Biocompatible
Materials Systems (BMS)
11-14 Oktober 1993, Ascona, Schweiz
McLaren EA and Sorensen JA
Flexural Strength of Ceramic Materials With
Different Treatments
J Dent Res 76 (1997) 392
Mendoza DB, Eakle WS
Retention of posts cemented with various dentinal
bonding cements
J Prosthet Dent 72, (1994) 591
Meyenberg KH
Dental Esthetics: A European Perspective
J Esthet Dent 6 (1994) 274 - 281
Meyenberg H, Lüthy H, Schärer R
Zirconia Posts: A New All-Ceramic Concept for
Nonvital Abutement Teeth
J Esthet Dent 7 (1995) 73-80
Paul SJ, Schärer P
Plastische Aufbauten in der Kronen- und
Brückenprothetik
Quintessenz 47 (1996) 1519-1531
Rathke A, Heintze SD, Zappini G
Cyclic loading of incisors restored with different
post systems
J Dent Res 80 (IADR abstr. 2001) 705
Rieger W
Studies of Biocompatibility of ZrO2 and Al2O3
ceramics
Contribution, 6th Biomaterial Symposium Göttingen
(1994)
Schweiger M, Frank M, Cramer van Clausbruch S,
Höland W, Rheinberger V
Microstructure and Properties of a Pressed Glass-
Ceramic Core to a Zirconia Post
QDT (1998a) 73-79
Schweiger M, Frank M, Cramer von Clausbruch S,
Höland W, Rheinberger
Scientific Documentation CosmoPost / IPS Empress® Cosmo Ingot Page 24 of 24

Microstructure and Properties of a Composite Strub JR, Pontius O, Koutayas S

System for Dental Applications composed of Survival rate and fracture strength of incisors
Glass-Ceramics in the SiO2-Li2O-ZrO2-P2O2-System restored with different post and core systems after
and ZrO2-ceramic (TZP) exposure in the artificial mouth
Journal of Mat.Sci: Mat in Medicine; to be printed J Oral Rehabil 2001 Feb;28(2):120-4
(1998b)
Wirz U, Christ R
Seitner T und Gläser R Korrosionserscheinungen an Schrauben und
Vollkeramische Restaurationen bei stark Stiften bei Zahnaufbauten – eine in-vitro-Studie
zerstörten Seitenzähnen Schweiz. Monatsschr. Zahnheilk 92 (1982) 408
Quintessenz 48, (1997) 499-514
Wohlwend A, Schärer P
Sidoli GE, King PA, Setchell DJ Die IPS Empress-Technik - Ein neues Verfahren
An in vitro evaluation of a carbon fiber-based post zur Herstellung von vollkeramischen Kronen,
and core system Inlays und Facetten
J Prosthet Dent 78, (1997) 5-9 Quintessenz Zahntech 16 (1990) 966-978

Simon MHP, Paffrath J

Neue Perspektiven zur vollkeramischen
Stabilisierung und zum Aufbau devitaler Zähne
Quintessenz 46 (1995) 1085-1101

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Content: Magdalena Wey / Petra Bühler-Zemp
Edition: November 2002