Current All-Ceramic Systems

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Current All-Ceramic Systems

JAN 2011

CDR Scott Kooistra, DC, USN

________________________________________________________

In-Office Systems Page

CEREC-3 5-9

E4D Dentist 9

Lab-Based Systems

Feldspathic 2

IPS Empress Esthetic 3 IPS e.max Press 4

IPS e.max CAD 6

IPS e.max ZirCAD 14 IPS e.max ZirPress 4

CEREC inLab 10-11

InVizion 12

In-Ceram for CEREC inLab 12

CERCON 15 Lava / Lava DVS 16 BruxZir 17 Procera 18 Glass-Infiltrated Systems 19 In-Ceram Classic 19 Wol-Ceram 20

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FELDSPATHIC SINTERED [powder – liquid]__

Products:

IPS d.SIGN veneering ceramic

Ivoclar

VITA VM-7 overlay for ceramic frameworks

VITA

VITA VM-9 overlay for zirconium oxide

VITA

VITA VM-13 overlay for metal frameworks

VITA

VITA VM-15 overlay for metal frameworks

VITA

Synspar/Softspar

JenericPentron

Ceramco 3 overlay for metal

Dentsply Ceramco

Finesse overlay for pressed ceramics

Denstply Ceramco

**

HUNDREDS OF DIFFERENT PRODUCTS **

Characteristics: Traditional powder-liquid slurry "stacked" onto metal or ceramic

Excellent esthetics and translucency

LOW flexural strength (<100 Mpa)

MUST be etched and resin-bonded to tooth (veneers)

Manufacturer-specific to a particular system

(i.e. Ivoclar IPS d.Sign porcelain overlaid on Ivoclar metals, etc)

Indications: Porcelain veneers (certain products)

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PRESSABLE CERAMICS - leucite reinforced__

Products:

IPS Empress Esthetic

Ivoclar

Finesse Pressable

Dentsply Ceramco

OPC

Jeneric Pentron

Cerpress SL

Dillon

Fortress

Mirage CDP

Authentic

Jensen

Cergo Kiss

Degudent

[ other products available]

Characteristics: Leucite particle reinforced (2-4 micron particles evenly dispersed)

Lost-wax technique; heat pressed

Excellent esthetics and translucency

Moderate flexural strength (120-160 Mpa)

Can be surface stained or cut back/layered with feldspathic porcelain

MUST be etched and resin-bonded to tooth structure for strength

Indications: Pressed porcelain veneers Inlays & onlays

Anterior all-ceramic crowns

Posterior crowns through first molar (if bondable to tooth)

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PRESSABLE CERAMICS - lithium disilicate___

Products:

IPS e.max Press

Ivoclar

IPS Empress 2

[Production Discontinued]

Ivoclar

OPC 3G

Jeneric Pentron

Characteristics: Lithium disilicate crystal reinforced framework / coping

Lost-wax technique for frameworks / copings

ALL copings and frameworks overlaid with feldspathic porcelain Very good esthetics and translucency

Excellent marginal fit

Moderate flexural strength (360-400 Mpa)

Moderate masking of underlying tooth/restorative structure

Recommend bonding to tooth BUT, conventional cementation possible

Indications: Anterior 3-unit FPDs (through 2d premolar as abutment) Anterior crowns

Posterior crowns

Veneers? Possible, but thicker since coping with overlay porcelains

PRESSABLE CERAMICS - other_____________

Products:

IPS e.max Zirpress

Ivoclar

CERCON Press

Dentsply

Authentic

Jensen

[other products available]

Characteristics: Stronger than feldspathic "layering" porcelains; possibly better margins

Indications: Pressed ceramic over metal copings and FPD frameworks

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CAD-CAM - in office_______________________

Product:

CEREC 3

Sirona www.cereconline.com

** 25 year track record – over 15 million restorations placed ** Characteristics: Intra-operatory scanning of prepared tooth

Intra-office milling of restoration

Numerous ceramic/composite material “blocks” available Very Good esthetics depending on material utilized

Restorations can be polished or surface stained and glazed

Can be “cut back” and layered with feldspathic porcelain to increase esthetics

CEREC 3 - MATERIALS

Sirona has partnered with VITA, Ivoclar and 3M ESPE to establish a large group

of diverse materials available for milling with the CEREC 3 system. Currently,

the most commonly used materials for use with the CEREC 3 system include:

Product:

CEREC Blocs

Sirona / VITA www.cereconline.com

Characteristics: High-quality feldspar ceramic

12 monochromatic and 3 polychromatic blocks

140 MPa

Utilizes CEREC color-choosing system

MUST be etched/silanated and resin-bonded to tooth structure

Indication: Inlays & onlays Veneers

Anterior crowns Posterior crowns

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Product:

IPS Empress CAD

Ivoclar www.getempress.com

Characteristics: Leucite-reinforced ceramic; identical to pressed Empress material

160 MPa

3 types of blocks available:

High translucency (HT) - monochromatic Low translucency (LT) - monochromatic

Multiblocks – varying chroma from cervical to incisal

Can be “cut back” and layered with IPS Empress Veneer porcelain to optimize esthetics

* Use with either CEREC 3 or CEREC inLab systems

Indications: Inlays & Onlays Anterior Crowns Posterior Crowns Veneers

__________________

Product:

IPS e.max CAD

Ivoclar www.ivoclarvivadent.us

Characteristics: Lithium disilicate glass-ceramic

Partially-sintered "Blue Block"

360 MPa

Once milled and adjusted in the mouth, must be fully sintered in vacuum oven

Can be bonded OR conventionally cemented !

Capable of blocking underlying discolored tooth structure or core material

Indications: Inlays & Onlays Veneers

Anterior Crowns

Posterior Crowns - when extra strength required or bonding not possible

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Product:

Paradigm MZ100

3M ESPE www.3m.com

Characteristics: Composite material (84% ceramic filler)

Monochromatic blocks

No firing or glazing necessary

145 MPa

Highly polishable with excellent esthetics

Indications: Inlays & onlays Veneers

__________________

Product:

Paradigm C

Characteristics: Leucite-reinforced glass ceramic

Easy to polish

Can be stained and glazed to provide characterization

150 MPa

Indications: Inlays & onlays Posterior crowns Anterior crowns Veneers

__________________

Product:

Mark II Vitablocs

VITA www.vident.com

Characteristics: Fine particle feldspar porcelain

140 MPa

Monochromatic blocks, can be stained/glazed

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High degree of translucency

Easy to polish and glaze

Indications: Inlays & Onlays Anterior Crowns Posterior Crowns Veneers

__________________

Product:

VITABLOCS TriLuxe

VITA www.vita-zahnfabrik.com

Characteristics: Polychromatic blocks

3 different chroma in one block, corresponding to cervical, body, incisal

Manufactured of Mark II fine particle feldspar ceramic

Anterior Crowns Posterior Crowns __________________

Product:

VITABLOCS TriLuxe forte

Characteristics: Polychromatic blocks

Slight variations in shade transition as compared to VITABLOCS TriLuxe

Anterior Crowns Posterior Crowns __________________

Product:

VITABLOCKS RealLife

Characteristics: Unique Polychromatic blocks - 3-dimensional block structure with dentin core and enamel coat

Imitates curved shade transitions naturally seen between dentin and incisal edge

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Product:

E4D Dentist

D4D Technologies www.e4dsky.com

Company founded in 2003

Characteristics: ** VERY SIMILAR TO CEREC 3 **

Intra-operatory scanning of prepared tooth

Intra-oral digitizer can record images without contrast medium (i.e. powder spray)

DentaLogic software creates virtual model

Intra-office milling of restoration with wireless connection to E4D mill

Multiple ceramic material “blocks” available Good esthetics depending on material utilized

Restorations can be polished or surface stained and glazed

Can be “cut back” and layered with feldspathic porcelain to increase esthetics Indications: Inlays, Onlays, Crowns, Veneers

E4D - MATERIALS

D4D Technologies has partnered with Ivoclar and 3M ESPE to establish a group

of diverse materials available for milling with the E4D system. The blocks of

materials are the same as those utilized by CEREC 3. Currently, the most

commonly used materials for use with the E4D system include:

Product:

IPS Empress CAD

Ivoclar www.getempress.com

Product:

Paradigm C

Product:

Paradigm MZ100

Product:

IPS e.max CAD

Ivoclar www.ivoclarvivadent.us

[Characteristics and indications described in the

"CEREC 3 - MATERIALS" section of this handout]

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CAD-CAM – (LAB)________________________

Product:

CEREC inLab

Sirona www.cereconline.com www.inlab.com

Characteristics: Intro 2002

Lab-based system

Scanning of dies / milling of full contour restorations (inlays, onlays, crowns)

Scanning of dies / milling of copings and frameworks that must be overlaid

Mills materials from Sirona, 3M ESPE, Ivoclar, and Vident

** VERY POPULAR SYSTEM - EVER EXPANDING RANGE OF MATERIALS AND PRODUCTS IT CAN MILL **

** NEW inLab MC XL milling unit introduced 2008 with following characteristics: - Greater productivity than original MC L milling unit

- 60,000 RPM tandem burs

- 6 minutes full-contour crown

- 40-60 units per day

+/- 25 micron precision

** inEos scanner and infiniDent remote lab program allow small labs that do not have CEREC inLab to scan dies models and send data to CEREC inLab facility. Zirconium oxide and aluminum oxide copings and frameworks can be milled and then sent back for completion of the restoration (placing the overlay porcelain)

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CEREC inLab - MATERIALS

Manufacturer Description

Sirona

Sirona CEREC Blocs Full contour inlays, onlays, crowns, veneers ( same as CEREC 3)

Sirona inCoris ZI Zirconium Oxide crown copings and FPD frameworks [need porc overlay]

Sirona inCoris AL Aluminum Oxide crown copings [need porc overlay]

Sirona inCoris NP Non-precious metal copings and FPD frameworks [need porc overlay]

Sirona inCorix WAX Burn-out acrylic for investing copings and frameworks for casting

VITA

VITA TriLuxe forte Full contour inlays, onlays, crowns, veneers (same as CEREC 3) VITA TriLuxe Full contour inlays, onlays, crowns, veneers (same as CEREC 3) VITA Mark II Full contour inlays, onlays, crowns, veneers (same as CEREC 3) VITA RealLife Full contour inlays, onlays, crowns, veneers (same as CEREC 3)

VITA In-Ceram YZ Zirconium Oxide crown copings and FPD frameworks [need porc overlay]

VITA In-Ceram Classic In-Ceram copings [must be glass-infiltrated and overlaid]

VITA CAD-Waxx Burn-out acrylic for investing copings and frameworks for casting

VITA CAD-Temp Strong acrylic material for long-term temporary crowns and FPDs

Ivoclar Vivadent

IPS e.max CAD Lithium disilicate blocks for full-contour restorations or copings (CEREC 3) IPS e.max ZIRCAD Zirconium Oxide crown copings and FPD frameworks[need porc overlay]

IPS Empress CAD Full contour inlays, onlays, crowns, veneers (same as CEREC 3) Teilio CAD Strong acrylic material for long-term temporary crowns and FPDs

3M ESPE

3M Paradigm MZ100 Full contour inlays, onlays, crowns, veneers (same as CEREC 3) 3M Paradigm C Full contour inlays, onlays, crowns, veneers (same as CEREC 3)

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Product:

VITA In-Ceram for CEREC inLab

VITA www.vident.com

Characteristics: NOT the older In-ceram "slipcast" system

NOT very popular system, but still utilized

Similar materials to conventional In-Ceram, but copings and frameworks are milled from solid blocks of material, NOT slipcast

Magnesia, Alumina, or Zirconia copings/frameworks available

Frameworks infiltrated with InCeram glasses then overlaid with porcelain VERY Strong

3 “block” materials available Magnesia (350 Mpa) Alumina (500 Mpa) Zirconia (700 Mpa)

Can NOT etch Alumina or Zirconia

Conventional cementation acceptable; resin cementation recommended

Indications: Dependant on material milled

Magnesia - Anterior & posterior crowns

Alumina - Anterior & posterior crowns, FPDs (3-unit max) Zirconia - Posterior crowns, posterior FPDs (3-unit max)

Product:

inVizion for CEREC inLab

Vident www.vident.com

Partially sintered, Yttria-stabilized zirconium oxide blanks milled to copings and frameworks

Mills InCeram YZ blocks

Scanning of dies in CEREC inLab machine

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Frameworks sintered HIGH temps long time in ZRcomat oven

Overlaid with feldspathic porcelain (VM 9)

VERY strong (>900 Mpa)

Can NOT etch

Conventional cementation possible; resin cement recommended (Panavia 21, Panavia F)

* 10-year limited warranty on framework fracture !!

** Similar to CERCON, LAVA, e.maxZirCAD systems Indications: Posterior crowns

Posterior FPDs (max. span 38 mm) Anterior crowns – not as translucent

Anterior FPDs – not as translucent (max. span 38 mm) __________________

Product:

IPS e.max ZirCAD

Ivoclar www.ivoclar.com

Part of IPS e.max system by Ivoclar

Partially sintered Yttrium-stabilized milled zirconium oxide copings/frameworks

Frameworks stained with coloring liquid Frameworks fully sintered at HIGH temps

Overlaid with layered feldspathic porcelain (e.max IPS Ceram)

or

pressed ceramic material (e.max IPS ZirPress)

Can NOT etch

Conventional cementation acceptable; Resin bonding recommended (Panavia 21, Panavia F)

** Similar to inVizion, CERCON, LAVA systems

Indications: Posterior crowns

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__________________

Product:

Sirona inCoris ZI for CEREC inLab

Sirona www.inlab.com

Charateristics: Intro 2008

Presintered Yttrium-stabilized milled zirconium oxide copings/frameworks

5 different framework shades

Overlaid with feldspathic porcelain

Can NOT etch

Conventional cementation acceptable; resin cement recommended (i.e. Panavia 21, Panavia F)

** Similar to inVizion, CERCON, LAVA, IPS e.max ZirCAD systems

Anterior FPDs – not as translucent (max. span 38 mm) __________________

Product:

Sirona inCoris AL for CEREC inLab

Sirona www.inlab.com

Charateristics: Intro 2008

Presintered 100% Al2O3 copings/frameworks

Ivory shaded framework

Overlaid with feldspathic porcelain (Vitadur Alpha or VM7)

Strong (>500 Mpa)

Can NOT etch

Conventional cementation possible; Resin bonding recommended (Panavia 21, Panavia F)

Anterior crowns – more translucent than Zirconium Oxide Anterior 3-unit FPDs – (max. span 38 mm)

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Product:

CERCON

Dentsply Ceramco www.dentsply.com www.ceramco.com Characteristics: Intro 2002

Zirconium oxide copings and frameworks overlaid with porcelain

Ceramco PFZ overlay porcelain can be layered or pressed to full contour

VERY strong (>1300 MPa)

"Stand alone" system with scanner, design software, mill, and furnace

> 225 labs using in U.S. - over 3 million units placed worldwide

Partially sintered Yttria-stabilized zirconium oxide blanks

Scanning of dies and models

Maximum span of 47 mm

Framework guaranteed 7 years against breakage

Resin cement recommended (Panavia 21, Panavia F)

** Similar to LAVA, inVizion, e.max ZirCAD systems Indications: Posterior crowns

Posterior FPDs Anterior crowns Anterior FPDs

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Product:

LAVA

3M ESPE www.3m.com Characteristics: Intro 2001

Zironium oxide copings & frameworks overlaid with feldspathic porcelain

Stand alone system with scanner, design software, mill, and furnace

Presintered milling of zirconium oxide copings & frameworks

Frameworks shaded with 1 of 8 different tints prior to sintering

Frameworks fully sintered at HIGH heat for long period time

Overlaid with LAVA Ceram layering porcelain

“Authorized Lava Milling Centers” – approx. 60 in U.S. 5-year warranty against fracture of ZrO2 frameworks

** Similar to inVizion, CERCON, e.max ZirCAD systems Indications: Posterior crowns

Posterior 3-, 4-unit FPDs (max span 55 mm) Anterior crowns – not as translucent

Anterior 3-, 4-, 5-unit FPDs (max span 55 mm)

Product:

LAVA DVS

3M ESPE www.3m.com Characteristics: Intro 2010

Unique fully-digital, 3 layer fabrication technique

Scanning of die with design and milling of zirconium oxide coping

Ceramic veneer designed and milled to fit over zirconium oxide coping

Veneer fused to zirconium oxide coping with special "fusion ceramic"

Indications: Posterior single crowns Anterior single crowns

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Product:

BRUXZIR

Glidewell Laboratories www.bruxzir.com Characteristics: Intro 2009

MONOLITHIC, full-contoured solid zirconium oxide crowns and FPDs

No overlay porcelain placed

No chipping or delamination of overlay porcelain

Surface glazed, stained and polished to final shine

VERY strong (>1,400 Mpa)

Presintered milling of zirconium oxide onlays, crowns, FPDs

Milled restorations fully sintered at 1,400C for 6.5 hours

Fair esthetics; better than metal, less than layered ceramics

Minimum occlusal thickness of 0.5 mm

Reduction requirements less than other zirconium oxide products

Conventionally cemented; resin bonding recommended for short or non-retentive preparations (i.e. Panavia F, Panavia 21)

Indications: Onlays

Posterior crowns Posterior FPDs

“Bruxers who desire tooth-colored restorations” “Minimal inter-occlusal space available”

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Product:

PROCERA

Nobel Biocare www.nobelbiocare.com Characteristics: PROCERA Alumina

Very dense aluminum oxide coping/framework

Very good esthetics; moderate masking of underlying tooth/restorative structure

HIGH flexural strength (700 Mpa)

0.6 mm thick for crown copings 0.25 mm thick for veneer copings

Can NOT be etched

Conventional cementation possible

Recommend air abrasion of internal surface/resin cement (i.e. Panavia 21)

5-year warranty on copings and frameworks

Indications: Veneers

Anterior FPDs (2-4 units)

Characteristics: PROCERA Zirconia

Good esthetics – coping more opaque HIGH flexural strength (800+ Mpa)

0.7 mm thickness; 4 shades

Can NOT be etched

Conventional cementation possible

Recommend air abrasion of internal surface/resin cement (i.e. Panavia 21)

5-year warranty

Very few labs using this product – especially for FPDs Indications: Posterior crowns

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Glass-Infiltrated Systems__________________

Product:

In-Ceram Classic

Vident www.vident.com

Characteristics: Long, successful track record over 20 years – started 1989 Europe

“Slip – cast” technique to fabricate coping/framework 3 different materials (powders)

Powder-liquid slurry painted on dies, dried, baked, infiltrated, overlaid

InCeram Spinell = Magnesium Oxide coping

InCeram Alumina = Aluminum Oxide coping/framework InCeram Zirconia = Zirconium Oxide coping/framework

Infiltration of copings and frameworks with lanthanum glass in high-temp oven imparts ultimate strength

**A variation of this technique is used with CEREC InLab materials**

VERY Strong

Spinell (350 Mpa) Excellent esthetics

Alumina (500 Mpa) Good – Excellent esthetics Zirconia (700 Mpa) Good esthetics

Alumina and Zirconia can NOT be etched

Conventional cementation acceptable, BUT sandblasting of copings & resin cementation recommended (i.e. Panavia)

Indications: Spinell Anterior & premolar crowns

Alumina Anterior & posterior crowns, anterior 3-unit FPDs Zirconia Anterior & posterior crowns, posterior 3-unit FPDs

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Product:

Wol-Ceram

Wolz Dental Technik

Characteristics: Modification / variation of In-Ceram system

Copings Produced via unique method: Aluminum oxide and zirconium oxide copings produced via electrophoretic deposition of particles when dipped in a liquid slurry. Technique same as InCeram after coping production.

Glass infiltration of copings / frameworks

Overlaid with feldspathic porcelain

Moderate to High strength

Can NOT etch

Conventional cementation possible; air abrasion and resin cement recommended (i.e. Panavia)

Indications: Anterior crowns Posterior crowns

4-unit anterior FPDs (max. span 25 mm – connectors 3mm X 3mm) 3-unit posterior FPDs (max. span 25 mm – connectors 3mm X 3mm)