ALL CERAMIC RESTORATION

All ceramic restorations:-All ceramic inlays -all ceramic onlays -porcelain laminate veneers -all ceramic crowns Fabrication process: 1-sintered 2-heat pressed 3-cast 4-slip cast 5-computer generated 6-metal reinforced

1-Sintering steps: -mixing slurry powder +liquid -condensation -vacuum firing -staining and glazing. Examples I Aluminous porcelain jacket crowns -Either 1- Use platinum foil (0.5) -We choose platinum because it is a noble metal doesnt form oxide so no fusion will occur. -The foil will cover the stone -.N.B.porcelain can't be applied on stone die. -Then build the porcelain core (40-50% alumina) over the foil. -the final contour (restoration) either formed by: 1-porcelain layering technique. We add porcelain layers using feldespathic porcelain 2-surface characterization, build the core to its maximum contour from the beginning add colors to the surface. -In all-ceramic we dont need opaque coz the color is matched. 2-Refractory die (vitadur-N and Hi-ceramic) special material smoother than stone die to apply porcelain directly.

II optec HSP (High Strength Porcelain) -refractory die (with matching thermal expansion) -firing at 1038C

III foil crown >>1st system (vita) >>pt foil(0.09-0.159mm burnished on die) >>feldspathic porcelain IV Mirage

2-Heat-Pressed
Steps: -wax pattern -investment -burnout at 850C -pressed at 1150C Injection molding (ingots are softened not melted) -surface staining or layer technique. Examples:

I IPS empress 1(ivoclar porcelain system)

-leucite based -inlays,onlays,veneers,crowns

II IPS empress 2
-Lithium silicate based -crowns,FPDs

3-Slip-casting -Slip: suspension of fine particles in a liquid -Liquid=alumina powder, water, additive Steps: 1-duplicate the stone die after coating it with spacer. 2-use special die plaster as duplicating material this plaster -Porousso can absorb water. -Shrink upon heating. 3-after duplication coat the special die with the slip. 4-upn drying water will be absorbed by the porous plaster from slip (condensation), so layer of slip will be participated. 5-Sintering 10 hours at 1120C (shrinkage of the die)so it will be separated from the slip shell. 6-Mix of glass powder and water applied on coplings. 7-infiltration 4-6 hours at 1100C (glass infiltration)molten glass is drawn into the porous by capillary action to reinforce and strengthens the shell. 8-excess glass removed-finish with air abrasion.

Examples: I in-ceram spinell -Magnesium spinell (MgAl2O4) II in-ceram zirconia -Zirconide (ZrO2) More strong N.B.-empress and in Ceram are the most usable techniques -Shoulder finish line is used because it provides both marginal fit and resist breakage. -Shoulder with bevel finish line should be avoided because forces will be directed to the bevel causing fracture.

4-Cast Glass-ceramics
-Gass-ceramics Steps: 1-Wax pattern 2-Investment 3-Burnout 4-melt the porcelain then cast the glass ceramic with motor driven casting machine (like metal) 5-glass ceramics surface staining or layer technique *This technique not used any more. Examples:

I Dicor
-Tetra silicate fluomica

II Dicor plus
-Dicor core and aluminous porcelain

III Dicor MGC (Mica Glass Ceramic)

-Higher percent crystallinity -Cerec process

IV Procera All-Ceram system

-Industrial CAD/CAM process -Die scanning, contact scanner by touching the dieenlarge it a little so it will compensate for porcelain shrinkage later during firing. -Milling machine

5-Computer-generated systems
I CAD-CAM

II CEREC Process
-Laser imaging camera (optical impression) scanning the preparation after coating it with opaque powder. -Operator programs the design of inlays/onlays -Computer directs the milling machine -Dicor MGC, Vita MarkII

III celay process

-Direct resin pattern (tooth-die)fabricated on the prepared tooth or on master die. -Copy milling

6-METAL REINFORCED SYSTEMS

-Thin metal coping on which the ceramic is fired -It is metal ceramic as opposed to all-ceramic -provide best marginal accuracy.

I Captek System

Steps: 1-duplicate working die in the special refractory material. 2 -2 metal impregnated wax sheets adapted to a die and firedforming gold-platinum-palladium coping layer 3--Porcelain application in a manner similar to that for a conventional metal ceramic crown

II Electroformed
Steps: 1-the working die with the polyurethane material. 2-coat the die silver spacerdry 3-insert the die into the plating equipment. 4-Pure gold coping (controlled thickness) 5 -Noble metal paste primer 6-Porcelain application

Indications of all-ceramics
1-High esthetic requirements 2-Favorable distribution of occlusal load (due to the weakness of the restoration). 3-Considerable proximal caries 4-Incisal edge reasonable intact (no attrition) 5-used with endodontic teeth if used with cement mask the metallic color.

Contraindications
1-Conservative restoration can be used 2-High caries index 3-Insufficient tooth structure 4-thin teeth facial-lingual 5-Unfavorable distribution of occlusal load (patient with Para functional habit) 6-endodontic teeth with post and core because: Translucency of porcelain cannot mask out cast metal or prefabricated post system.

Advantages:
1-superior esthetic. 2-excellent transulecency(similar to that of natural tooth) 3-good tissue response.

Disadvantages
1-low strength 2-abrasive 3-marginal accuracy 4technique difficulties

Step by step procedure

1-Incisal (occlusal reduction) The completed reduction of the incisal edge should provide 1.5 to 2 mm of clearance. 2-Facial reduction orientation grooves placed :one in the middle of the facial wall ,one in the mesiofacial, and one in the distofacial line angles. 1-1.5mm reduction is performed with a cervical component parallel to the proposed path of withdrawal and an incisal component to the original contour of the tooth. 3-Lingual reduction 1-1.5mm clearance in all mandibular excursive movements has been obtained 4-Shoule finish line is on all surfacesshould be 1-1.2 mm wide. If the margins are subgingivally the finish line should be deep chamfer. 5-Finishing In-Ceram Impress amount of reduction Incisally 1.5mm 2mm
All around 1.2-1.5 1mm

*Hight of clinical crown for all ceramic crowns 5mm before tooth preparation.

For porcelain fused to metal 3.5 mm

**Problem with fixed bridge all ceramicweak at connectorthe connector should be at least 4 mmtoo bulkyimpinge on IDPtissue irritation (contraindication from periodontal view) ***FPD span length: Anterior to canine not more than 11mm Distal to canine not more than 9mm

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