Achieving Superior Results with "New" Ceramic Materials
Davide Bertazzo CDT
Active Member of the Italian Academy of Esthetic Dentistry
Dental technicians around the globe consistently choose and rely on the IPs e.max® family of materials for their restorative cases. Whether pressing or milling, layering or simply polishing, IPS e.max is unquestionably the material of choice to meet the expectations of today’s dentists and patients for offering the strength, function and esthetics they demand. With more than 150 million lithium disilicate restorations placed over the past 15+ years, IPS e.max is one of the most extensively studied and tested materials on the dental market and has withstood the scrutiny of clinical researchers to verify its long-term viability and 10+-year survival rate.
All-ceramic materials along with CAD/CAM technology have dramatically improved the success rate of indirect restorative cases. Find out why Davide Bertazzo, CDT, member of the Italian Academy of Esthetic Dentistry, is passionate about all-ceramic materials and Making It E.max!
Whether pressed or milled, today’s all-ceramic materials, used in conjunction with CAD/CAM technologies, have not only widened our restorative options but also our color choices, which has positively impacted the restorative results that can be achieved.
We can now achieve highly esthetic results in challenging cases as well as highly specific multidisciplinary treatment modalities. The positive impact of all-ceramic materials is borne out in the literature, with a multitude of case studies that highly recommend these materials for esthetic results in anterior teeth. (1-3)
Further considerations for the use of all-ceramic materials are their biocompatibility and clinical success rate. The optimum biocompatibility of all-ceramic materials within the oral cavity places them in the category of biologically stable, (4) while their high percentage of clinical success over time, has been shown to be approximately 93% at 10 years and from 91% to 94% at 12 years. (5,6)
The advent of CAD/CAM technology and its attendant all-ceramic materials significantly solved many problems of the past where the success or failure of an indirect restorative case depended largely on choosing and properly handling the correct metal for the understructure.
Careful alloy selection, substructure design and thickness, along with proper oxidation to achieve high bond strengths, were the critical considerations that shielded us from possible failures. Yet, failures often happened due to the countless variables involved in the fabrication process.
Cracking, crevices, and debonding were very common problems, often caused by internal tensions between the ceramic and metal or by the lack of purity and gas-free surfaces of the metals used. The opaque applied to the metal was also critical to the bonding process. It had to provide the right amount of coverage to support the dentin ceramic. However, in most cases this was not enough to ensure the right bond between metal and ceramic.
Brightness and how dental technicians worked on dentin was crucial to the final esthetic result. Dentin had to have the right mix of translucency, saturation and brightness. Controlling the dentin ceramic also determined the shade, chroma and value of the final layered ceramic restorations.
We must try to preserve the knowledge and acquired experiences of the past by readapting these older concepts in an improved manner, giving life to new techniques and thus taking advantage of the present.
Ceramics reinforced with lithium disilicate, with an average distribution of 70% lithium disilicate crystals in the glass material, are even more resistant to fracture owing to higher flexural resistance values. (7,8)
Glass-ceramic cores can be obtained with several degrees of translucency and opacity, allowing control of the value of the veneers from the core itself. Any defects in shape or enamel discoloration can be corrected as well.9
The computer-aided revolution (CAD/CAM) has set a standard in production processes, with many benefits such as fewer internal flaws in milled materials.10, 11 It is possible to mill ceramic blocks with matte or translucent core materials, applying ceramic layers until the desired color and shape are achieved.
Today, taking advantage of characteristics from translucent materials to be intruded by light as well as the color of the underlying tooth, it is possible to guide the light itself into the dental substance and gingiva, obtaining an excellent result in terms of integration.
We should always seek to control translucency through the materials that we use, paying attention in particular to the value of our restorations. The perfect mix between the color of the substrate, the translucency of the core, the layering technique we use on the core as well as cementation by the clinician with the correct luting agent, all will determine the success or failure of our restoration. The stratification technique must resemble as much as possible the one provided by Mother Nature and, in doing so, imitate dental structures in relation to the age of the tooth to be replicated.
Exploiting the versatility of IPS e.max ceramic on both lithium disilicate and IPS e.max ZirCAD restorations simplifies the fabrication phases of the dental technician and offers the guarantee of stability with minimum of shrinkage between the various firings. Personally, I find that the IPS e.max Ceram powder dentin achieves the right balance between translucency, saturation and brightness, with the added possibility to control the value and chroma from the dentin core.
Every restoration we fabricate is a challenge, especially since our goal is to replicate nature.12 Restorations with ceramic veneers represent one of the most demanding challenges toward achieving that goal but also one of the most satisfying. The clinical result is influenced by several factors that must be taken into consideration while working as a team to guarantee the success of the end result as well the health and satisfaction of every patient. The choice of material is key to esthetic and functional success.
That is why IPS e.max is my choice for recreating the beauty of nature.
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REFERENCESDella Bona A, Kelly JR. The clinical success of all-ceramics restorations. J Am Dent Assoc 2008;39(Suppl):8S–13S.
Friedman MJ. A 15-year review of porcelain veneer failure—A clinician’s observations. Compend Contin Educ Dent 1998;19:625–632.
Peumans M, De Munck J, Fieuws S, Lambrechts P, Vanherie G, Van Meerbeek B. A prospective ten-year clinical trial of porcelain veneers. J Adhes Dent 2004;6:65–76.
Ludwig K. Lexikon Der Zahnmedizinischen Werkstoffkunde 2005, Quintessenz Verlag.
Layton D, Walton T. Up to 16-year prospective study of 304 porcelain veneers. Int J Prosthodont 2007;20:389–396.
Fradeani M, Redemagni M, Corrado M. Porcelain laminate veneers: 6- to 12-year clinical evaluation—A retrospective study. Int J Periodontics Restorative Dent 2005;25:9–17.
Giordano R, McLaren EA. Ceramics overview: Classification by micro- structure and processing methods. Compend Contin Educ Dent 2010;31:682–684.
Kelly JR, Benetti P. Ceramic materials in dentistry: Historical evolution and current practice. Aust Dent J 2011;56 (Suppl 1):84–96.
Bertazzo D, Conti A. Esthetic veneers for an orthodontic restoration case. Quintessence Dent Technol 2019;42:146–163.
Davidowitz G, Kotick PG. The use of CAD/CAM in dentistry. Dent Clin North Am 2011;55:559–570.
Wiedhahn K, Kerschbaum T, Fasbinder DF. Clinical long-term results with 617 Cerec veneers: A nine-year report. Int J Computer Dent 2005;8:233–246.
Bertazzo D. Esthetic restoration with ceramic veneers in a case of altered passive eruption: The appropriate choice of materials is key. Quintessence Dent Technol 2018;41:243–256.
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