Heinrich Kappert

High-strength CAD/CAM-fabricated veneering material sintered to zirconia copings — A new fabrication mode for all-ceramic restorations

OBJECTIVES With this in vitro study the fracture strength of zirconia-based crown copings being veneered with a CAD/CAM generated high-strength ceramic cap by sintering is compared with anatomically identical zirconia-based crowns, which were either overpressed or veneered by the layering technique for completion. METHODS A 1.2mm, 360 degrees chamfer preparation was performed on a second maxillary molar and was dublicated 15 times in a cobalt-chromium-alloy. A sample of 45 zirconia copings was produced and divided into three groups. In the first group (VT) zirconia copings received conventional veneering in layering technique, in the second group the veneering porcelain was pressed over the zirconia coping (PT), and for the third group (ST) a CAD/CAM-fabricated high-strength anatomically shaped veneering cap was sintered onto the zirconia coping. All crowns were cemented conventionally onto their dies and tested in the universal testing machine until clinical failure. The fracture load data were compared by a one-way analysis of variance and a multiple comparison posthoc test (alpha<0.05). RESULTS Specimens from group VT showed a mean (S.D.) fracture load of 3700.39 (1238.72) N, group OT 3523.73 (1181.11) N and group ST 6262.67 (2257.42) N. The difference between groups VT/OT and ST were statistically significant (P<0.001). SIGNIFICANCE The new CAD/CAM-fabricated bilayered restorations (ST) were superior to the present techniques (VT and OT) in terms of fracture load and offer the possibility to produce cost-effective crowns and fixed partial dentures with a potential lower risk of chippings.

Ceramics as biomaterials for dental restoration

Sintered ceramics and glass–ceramics are widely used as biomaterials for dental restoration, especially as dental inlays, onlays, veneers, crowns or bridges. Biomaterials were developed either to veneer metal frameworks or to produce metal-free dental restorations. Different types of glass–ceramics and ceramics are available and necessary today to fulfill customers’ needs (patients, dentists and dental technicians) regarding the properties of the biomaterials and the processing of the products. All of these different types of biomaterials already cover the entire range of indications of dental restorations. Today, patients are increasingly interested in metal-free restoration. Glass–ceramics are particularly suitable for fabricating inlays, crowns and small bridges, as these materials achieve very strong, esthetic results. High-strength ceramics are preferred in situations where the material is exposed to high masticatory forces.

Fracture load of different crown systems on zirconia implant abutments.

OBJECTIVES The purpose of this study was to evaluate the fracture load of single zirconia abutment restorations using different veneering techniques and materials. MATERIALS AND METHODS The abutment restorations were divided into 6 groups with 20 samples each: test abutments (control group A), lithium disilicate ceramic crowns bonded on incisor abutments (group B), leucite ceramic crowns bonded on incisor abutments (group C), premolar abutments directly veneered with a fluor apatite ceramic (group D (layered) and group E (pressed)) and premolar abutments bonded with lithium disilicate ceramic crowns (group F). The fracture load of the restorations was evaluated using a universal testing machine. Half of each group was artificially aged (chewing simulation and thermocycling) before evaluating the fracture load with the exception of the test abutments. RESULTS The fracture load of the test abutments was 705 ± 43N. Incisor abutments bonded with lithium disilicate or leucite ceramic crowns (groups B and C) showed fracture loads of about 580N. Premolar restorations directly veneered with fluor apatite ceramic (groups D and E) showed fracture loads of about 850N. Premolar restorations bonded with lithium disilicate ceramic crowns (group F) showed fracture loads of about 1850N. The artificial ageing showed no significant influence on the strength of the examined restorations. SIGNIFICANCE All ceramic crowns made of lithium disilicate glass-ceramic, adhesively bonded to premolar abutments showed the highest fracture loads in this study. However, all tested groups can withstand physiological bite forces.

Bioceramics and their application for dental restoration

Abstract This review article covers the historical development of ceramics, from the beginnings to the present. Feldspar based ceramic biomaterials for veneering metal frameworks, which are based on the jacket porcelain crown, have firmly established themselves in restorative dentistry since the 1970s. Currently, the development of restorative dental materials that can be used to replace metal represents a major challenge. As a result, this review will focus on the latest materials in this field. These materials include glass ceramics as well as high performance sintered ceramics. Glass ceramics exhibit more favourable optical properties, such as translucency and colour, compared with high performance ceramics, while the latter demonstrate high flexural strength and toughness. Both groups of materials have specialised applications in restorative dentistry and are capable of covering all the indications of dental restorations. The two types of materials, that is, glass ceramics and ceramics, have to be processed in accordance with their properties. As a result, the processing techniques, such as moulding, sintering and machining, will be discussed in detail in addition to the properties of the materials. Additional development possibilities for the materials will be presented on the basis of customer/patient needs and the successful long term use of glass ceramics and ceramics. In this context, it is clear that high performance ceramics and layered composites (consisting of high performance ceramics veneered with glass ceramics) offer the best possible solution for indications in the posterior region of the mouth. In contrast, glass ceramics are used to fabricate inlays and onlays for all parts of the jaw. In addition, glass ceramics can be used to fabricate crowns and small bridges to replace anterior dentition.

Microstructure analysis of dental castings used in fixed dental prostheses—a simple method for quality control

The aim of this study was to evaluate the microstructural quality of noble alloy castings from commercial dental laboratories using the wiping–etching method as a simple method for quality control. In total, 240 castings from two noble alloys (AuAgCuPt and AuPtZn) were taken from a days production of five different dental laboratories. The casting quality was evaluated by determining the grain size and by assessing the number and size of shrinkage cavities after acidic etching of the alloy surfaces. The AuAgCuPt alloy castings showed an acceptable quality in the microstructural analysis. The results of AuPtZn castings, however, were not satisfactory because 50.8% of the samples showed a remarkably poorer quality compared to the specifications made by the manufacturer. The proportion of the employed reclaimed alloy had no influence on the casting quality when AuAgCuPt alloy was used, but was influential when casting restorations with AuPtZn alloy. When determining the quantity and size of shrinkage cavities, none of the evaluated castings was of such a poor quality that a replacement of the castings had to be considered. The differences in grain size and quantity of shrinkage cavities were reflecting the individual laboratory process rather than the admixture of new/reclaimed alloy. The presented analysis can be used as a simple method for quality control of dental castings.