ceramics

REALITY’S CHOICESCeramics

©2005 REALITY Publishing Co. Vol. 19 The Ratings 113

1a. HeraCeram Heraeus Kulzer

1b. IPS Empress Ivoclar Vivadent

1c. Lava 3M ESPE

2a. Authentic Microstar

2b. IPS D.Sign Ivoclar Vivadent

2c. Omega 900 Vita/Vident

3a. Cerabien Noritake

3b. CreationJensen

3c. EX-3 Noritake

3d. Vita VM7/VM9 Vita/Vident

4a. Ceramco 3 Dentsply Prosthetics

4b. OPC Pentron

4c. Procera Nobel Biocare

5a. Duceram LFC Dentsply Prosthetics

5b. Vitadur Alpha Vita/Vident

6a. Finesse Dentsply Prostheticss

6b. IPS Eris Ivoclar Vivadent

7a. Ceramco II Dentsply Prosthetics

7b. Finesse All-Ceramic Dentsply Prosthetics

8a. Duceragold Dentsply Prosthetics

8b. Duceram Plus Dentsply Prosthetics

8c. In-Ceram Spinell Vita/Vident

Product Type Clinical Indications Cement Options Fluorescence

Feldspathic

Pressedlow fusing

Feldspathic overCAD/CAM zirconia

Feldspathic low fusing

Pressed

PFM crowns & bridgesAnterior crowns on

pressed core veneers,inlays, onlays

Crowns & bridgespressed over metal

veneers, inlays, onlayspressed over ceramic

Crowns & bridges w/Lavacoping veneers, inlays,

onlays w/o coping

PFM crowns & bridgesVeneers, inlays, onlays

w/o metal

Veneers, inlays, onlays,anterior crowns

Any cement for PFMResin cement for metal-free

Any cement when supported with metal

Resin cement when all-ceramicNot available for testing

Any cement w/Lava copingResin cement w/o coping


Resin cement

HeraCeram Heraeus Kulzer

Authentic Microstar

Lava 3M ESPE

Omega 900Vita/Vident

IPS Empress Ivoclar Vivadent

FeldspathicPFM crowns & bridgesVeneers, inlays, onlays

w/o metal


IPS D.SignIvoclar Vivadent

Synthetic

Synthetic

Synthetic Feldspathic

Feldspathic

Veneering alumina copings

Veneering alumina & zirconia copings


w/o metal


w/o metal

Any cement w/alumina coping

Any cement w/coping



Cerabien Noritake

Vita VM7/VM9 Vita/Vident

EX-3 Noritake

Creation Jensen


w/o metal


Ceramco 3 Dentsply Prosthetics

Ceramics

©2005 REALITY Publishing Co. Vol. 19114 The Ratings

Product Type Clinical Indications Cement Options Fluorescence

PressedAnterior crowns, inlays,

onlays, veneersResin cement Not available for testing

Not available for testing

OPC Pentron

CAD/CAM aluminacoping

Crowns Any cement w/alumina copingProcera Nobel Biocare

Hydrothermal fluorine glass low

fusing

Final layer over any conventional ceramic

Depends on restoration substructure

Not available for testingDuceram LFC Dentsply Prosthetics

Feldspathic w/ 10% alumina

Veneering, alumina copings, veneers, inlays,

onlays w/o coping

Any cement w/alumina copingResin cement when unsupported

Not available for testingVitadur Alpha Vita/Vident

Low fusing w/ leucite

PFM crowns & bridgesCrowns, inlays, veneers

all-ceramic


Finesse Dentsply Prosthetics

Fluorapatite glassover lithium

disilicate

Crowns and anteriorbridges

Any cement, but resin is preferred

IPS Eris Ivoclar Vivadent


w/o metal


Not available for testingCeramco II Dentsply Prosthetics

PressedVeneers, inlays, onlays

anterior crownsResin cement Not available for testingFinesse All-Ceramic

Dentsply Prosthetics

Hydrothermal low fusing

PFM crowns & bridgesVeneers, inlays, crowns

over pressed cores


Not available for testingDuceragold Dentsply Prosthetics


w/o metal


Duceram Plus Dentsply Prosthetics

Magnesium oxideand alumina

Anterior crowns Resin cementIn-Ceram SpinellVita/Vident

Ceramics


Description Feldspathic porcelain based on a newly developed synthetic, puri-fied quartz glass product called PyroSYG, which is presumably anessential part of the system to enhance transparency, brightness,chroma, fluorescence, and opalescence. Also contains synthetic

leucite. Can be multi-fired and reported to still maintain its coef-ficient of thermal expansion and fracture resistance. Due to asimple firing procedure, it is possible to shorten the firing cyclesto speed up fabrication. It supposedly has a lower abrasive indexdue to reduced surface roughness.

Among the different kits, there are 2 opaque sets. The powderset is used for the spraying technique, while the paste set is usedfor fast manual application. The Matrix Set is indicated for indi-vidual characterization. Also available is a Dentin Incisal Set, aShoulder Margin Set and Stains-Set. Available in 16 Vita shades.

Clinical IndicationsVeneer over metal Crowns and bridges.Veneer over pressed ceramic cores Anterior crowns.Unsupported Veneers, inlays, onlays, and

anterior crowns.

Ceramics


(4.2)HeraCeramHeraeus Kulzer1a

NEW

Can be applied to a variety of substructures orused unsupportedFluoresces close to tooth structure

How about a more creative name?Short track record

Despite the continued emergence of indirect resin materials, thevast majority of laboratory-fabricated esthetic restorations remainceramic in nature. And there is a dizzying number of ceramics thathave been developed to more closely match natural tooth structureand eliminate the need for metal substructures.

While the materials have, no doubt, gotten much better, therole of the laboratory technician has also expanded. Dentists nowrely more heavily on the expertise of the technician who worksdaily with these materials, but the final responsibility for therestoration remains with the clinician.

How Do You Choose the Ceramic That Best MeetsYour Patient’s Needs?With the proliferation in ceramic materials, choosing the oneproduct to meet your patient’s needs seems to be an insurmount-able task. This is especially true if you consider that most dentistsare just the end users and not the fabricators of the restorations.Nevertheless, dialogues with patients can quickly eliminate somematerials from consideration, while elevating others. For example,if a patient’s highest need is the ultimate esthetic restoration froman appearance standpoint and is willing to compromise onstrength, then a metal-free restoration assumes a higher positionon the decision tree.

On the other hand, if strength and track record are moreimportant to the patient, then selecting a proven ceramic that canbe applied reliably over a metal coping would be a prudentapproach.

Clinical IndicationsThese are the uses that we found could be used with the materialand may not always match the recommendations of the manufac-

turer. For this section, the term “Anterior Crown” applies to allteeth except molars. In some instances, the same indication mayappear twice. For example, “Anterior Crown” may be an indica-tion when the material is supported by a coping or when thematerial is unsupported. This apparent contradiction merelymeans that in some instances, the material should have substruc-ture support (on a premolar), while in other situations, no supportis necessary (mandibular incisor).

What Do You Need to Know About the Terminology?From a dentist’s point of view, the plethora of new terms can be aconfusing maze. From pressed ceramic to slip cast, the only men-tion of these terms in this section will be in relationship todescribing specifics of preparation design and other clinically rele-vant items such as cement selection.

Fluorescence This test shows how the material appears as a veneer in vivo

under black light. Materials exhibiting fluorescence that does notmatch that of natural teeth would not be a good choice in themouth of patients such as models, actors, etc. While most of themanufacturers of ceramic materials chose not to participate in ourfluorescence testing by providing us with veneers of their materi-als, we were able to procure veneers of some of the materials dueto the kind assistance of several commercial laboratories.

Product ListingWhile there are many different uses to these products, we havechosen to list them solely according to their rating by the EditorialTeam.

Description Leucite-reinforced, pressed ceramic. Restorations are waxed andinvested in a special flask system. Different types of ceramic ingotscan be used in either the layered or shaded technique by pressingthe softened ceramic in a special furnace to fill the burned outinvested mold. The new Esthetic version presumably allowsenhanced esthetics with 11 new ingots, including two specificallyfor bleached teeth, coordinated cut-back technique for more con-trolled layering, and a better investment material.

Clinical IndicationsVeneers, inlays, onlays, and anterior crowns.

Cement OptionsResin cement mandatory.

Ceramics


IPS EmpressIvoclar Vivadent

www.ivoclarvivadent.us.com (4.2) 1b

The Standard for pressablesEven average technician can get great fits

Fracture propensityCan encourage overpreparation

HeraCeram is a new ceramic that seems to be livingup to its billing of being able to be applied over a vari-ety of metals due to its favorable thermal expansioncharacteristics. Despite its quartz composition, it reallyhandles and behaves like a conventional feldspathicporcelain. Since it can be used to veneer both metal

and pressed ceramic cores as well as by itself forveneers, it is an excellent choice for combination cases,although using it for metal-free bridges is still risky.The esthetics of this material is very good, especiallythe clear and opalescent enamels. And it fluorescesvery close to tooth structure (slightly brighter).

REALITY

Cement OptionsDepends on its substructure. When used over metal, virtually anycement will suffice. When used unsupported, a resin cement isnecessary.

Fluorescence

HeraCeram

http://www.ivoclarvivadent.us.com

Ceramics


IPS Empress, popularly known as just Empress, is quitepossibly the best known ceramic brand name in theworld and is still the standard against which all otherpressed ceramics are compared. It would be difficult tofind a dentist who at least had not heard about or usedEmpress. Being the first pressed ceramic, it began a rev-olution in esthetics that continues to grow and prosper.

Being on the market for over 15 years, it has stoodthe test of time and still has many devoted advocates. Itis also quite possibly the most researched ceramic mate-rial, with numerous studies completed over the years.The overall results from these studies have helped in let-ting us know the limitations to this material (as well asmost other non-alumina, non-zirconia ceramics), prima-rily that it should not be used for molar crowns orbridges. In addition, it has been found that Empress isrelatively kind to the opposing dentition when it comesto wear.

Another significant finding is that the original stain-ing technique was adequate for mid-level esthetics, butcutting back the pressed coping and conventionally lay-ering colors is definitely necessary if exemplary estheticsis the goal. This modification in the technique was doneintuitively by the better ceramists and was the impetusbehind the Esthetic Line. When it is layered properly,extremely esthetic restorations can be produced. Ofcourse, it requires more artistic skills to create these lay-ered masterpieces compared to the easily achievedstaining technique.

The whole concept of waxing and pressing a ceramicrestoration seems to be easily mastered by most

ceramists. This ease of fabrication is probably the reasonthat excellent fits can be achieved routinely with thismaterial.

There are, however, some chinks in the armor. The firstone relates more to the genre of ceramics for whichEmpress was the originator, namely pressed. Due to thespace it requires and dentists desire to use it whereverpossible, there had been an unfortunate trend of prepar-ing teeth for veneers with excessive reduction. In essence,Empress was causing teeth to be prepared to meet theneeds of the material, instead of choosing a material tomeet the needs of the teeth and patient. Overpreparingteeth lead to a backlash and a return to stacked porcelainwhen less tooth reduction was indicated.

On the other hand, one evaluator reports successwith the new ingots for veneers as thin as 0.5mm. Thesenew ingots allow this thinness due to their improvedshading and translucency. And, depending on the shadeand the type of ingot, it fluoresces at a level eitherslightly brighter or just brighter and with a yellowishcast compared to tooth structure.

Another problem has been fractures, even when it isused anterior to the molars. This is to be expected whenthe sheer number of Empress restorations are taken intoaccount, but virtually every evaluator mentioned thisfrailty. However, two evaluators report having done atotal of about 20 anterior, 3-unit bridges over a 10-yeartime span with only one failure.

Finally, masking dark preparations and/or metal coresis not a strength of Empress.

REALITY

IPS Empress E01 (Ingot only)

IPS Empress EstheticIPS Empress TC1 (Ingot only)

IPS Empress B1 (Enamel)

Fluorescence

Description CAD/CAM system utilizing pre-sintered zirconia blanks for theframework and matched feldspathic veneering ceramic. Zirconia ischaracterized by its outstanding stability and biocompatibility, aswell as strength levels significantly higher than other all-ceramicmaterials.

The master model is scanned using white-light triangulationvia a non-touch optical scanner. The scanned data is then used todesign the coping or framework "on-screen". Lava Scanner con-sists of a non-contact optical scan system, a PC with a monitor,and the Lava CAD Windows-based software, which displays themodel as a three-dimensional object. The data are sent to themilling machine where chalk-like, pre-sintered zirconia oxide ismilled, after which the pattern goes through a specialized coloringprocess where the framework is dyed one of seven shades or thereis an option of leaving it unaltered, which gives you a bright whitecoping. The pattern is subsequently sintered through a preciseeight-hour heating and cooling cycle where it is reduced to its finalshape and size.

However, the frameworks cannot be etched or conventionallysilanated. Rocatec or CoJet treatment is recommended.

Lava Ceram is available in seven shoulder shades, 19 frame-work modifiers, 19 dentin porcelains, and four enamels. There arealso two enamel effect porcelains, four transparent opal porcelains,10 Magic shades, and 10 stains.

Clinical IndicationsVeneer over Lava Crowns and bridges.Lava Ceram (Unsupported) Veneers, inlays, onlays, and

anterior crowns.

Cement OptionsWhen supported by a Lava framework, any cement can beused. For unsupported Lava Ceram restorations, resin cementis mandatory.

Fluorescence

Ceramics


Lava3M ESPE

www.3mespe.com(4.2) 1c

NEW

Probably the strongest all-ceramicFit and esthetics are unmatched

Preparations must be ideal or your case will besent backFractures still reported

Lava Ceram Veneer

Lava Ceram over Lava Coping Lava Coping

http://www.3mespe.com

Description Second generation, low fusing, leucite-reinforced pressable ceram-ic that can be stained, layered, or the combination of the two. Itcan be pressed over ceramic ingots or metal. The assortment includes regular and opaque dentins, incisals,transparents and modifiers. The ingots are available in all of the

most commonly used Vita Shades and in four opacity levels rang-ing from 20% to 70%.

Clinical IndicationsPressed to metal Crowns and bridges. Pressed over ceramic ingots Veneers, inlays, onlays, and

anterior crowns.

Cement OptionsDepends on its substructure. When pressed over metal, virtuallyany cement will suffice. When pressed over ceramic, a resincement is necessary.

FluorescenceNot available for testing.

Ceramics


(4.1)AuthenticMicrostar2a

NEW

Can be pressed over ceramic or metal56 different ingots to choose from

Still can’t use for thin veneersStill need metal for bridges

Lava seems like a tremendous breakthrough in all-ceramic restorations. Not only is it extremely strong,but it also fits very well and looks great. Since LavaCeram can also be used unsupported, it can be usedvery successfully for combination cases. The excellentesthetics is partially due to the fact that the frameworkis shaded, which gives it a significant advantage overthe more typical white opaque copings of other sys-tems. There is also a good selection of bleachedshades. It fluoresces at a level higher than and with ayellow cast compared to tooth structure, especiallyLava Ceram without the backing of Lava, which has no

fluorescence at all. In other words, when Lava Ceram isapplied to Lava, the brightness of the former is toneddown by the latter.

However, evaluators have reported on a few frac-tures, mainly with the veneering material. There is stilla limitation on double abutment bridges and the num-ber of milling labs due to the steep capital investment.And your preparations need to be exemplary—cham-fers and rounded shoulders only. At least two of ourevaluators had cases rejected due to preparations thatwere not ideal.

REALITY

Description High fusing synthetic feldspathic porcelain created by Dr. RobertWinter and Don Cornell. Features a unique combination of fluo-rapatite and leucite crystals to imitate the optical properties ofnatural teeth. The fluorapatite crystals have similar size and shapeto the hydroapatite crystals found in natural tooth structure andaffect light in a similar way. The leucite crystals presumablyincrease the coefficient of thermal expansion making the ceramiccompatible with the underlying metal substructure. A recent studyfound that it caused the least amount of wear of opposing enam-el compared to six other ceramics.

The Kit is available in the 10 most popular Chromascop shadesor the 8 most popular A-D shades and can be used individually.The technician can presumably achieve bright colors and hightranslucency without adding opacifying agents. Has six matchedalloys for ceramometal use. Deep Dentin is used to intensify thechroma in limited thickness areas, Impulse is ready-mixed modi-fiers, Stains are in paste form, Essence stains are in powder form,Gingiva is to simulate soft tissue, and Bleach is obviously for teethwhich have been whitened. There is also a special refractory dieprocess to be utilized with a direct build up technique.

Clinical IndicationsVeneer over metal Crowns and bridges.Unsupported Veneers, inlays, onlays, and anterior

crowns.


Fluorescence

Ceramics


Excellent translucency for veneersLow enamel wear

Fluoresces brighter than tooth structureTechnique sensitive for ceramist

IPS d.Sign Ivoclar Vivadent(4.1) 2b

If there is such a thing as a “do it all” pressable,Authentic would be that material. It can be a stainedveneer, layered veneer, inlay, onlay, full crown,pressed over metal crown or bridge, the latter beingfull coverage, winged, inlay-retained, or encapsulat-ed/embedded. In other words, it can be used in almostany situation except when veneers need to be very

thin. Because of the versatility, it would be a goodchoice for combination cases. With a wide selection ofincisals and ingot opacities, it’s a well-designed esthet-ic system. From a ceramist’s perspective, firingtemperatures need to be increased about 10°C fromrecommendations, but the material itself is very for-giving.

REALITY

IPS d.Sign

IPS d.Sign to metal

Ceramics


Omega 900 is a good low fusing porcelain and one ofthe first introduced after Duceram LFC. It has a homo-geneous distribution of glass and crystal phase in thestructure, has good abrasion properties, causes lowwear of opposing dentition, and is easy to polish chair-

side after making adjustments. It has a good trackrecord, with no reported problems with fractures,delaminations, or cracks. Also matches Vita’s 3D shadesystem, but it fluoresces at a much higher level thantooth structure.

REALITY

Description Low fusing feldspathic porcelain that is presumably compatiblewith a wide variety of metals. Due to its smaller particle size (3microns), it supposedly has a denser structure and lower wear onthe opposing dentition and is inherently stronger due to uniformleucite distribution. At least one study has found it is kinder toopposing enamel compared to Ceramco II, but exhibits behaviorin this regard similar to Finesse. Its yellow-orange glass is stated toproduce warm tones and high translucency.

It is packaged in standard sets with paste or powder opaque.Also offered in a professional set which includes Translucents,Opal Translucents, Cervicals, Luminaries, Gingival, and Nuancepowders.

Clinical IndicationsVeneer over metal Crowns and bridges.Unsupported Veneers, inlays, onlays, and anterior

crowns.


Fluorescence

Low wear on opposing teethEasily polished chairside

Not meant for veneering ceramic coresFluoresces at a higher level than teeth

(4.1)Omega 900 Vita/Vident2c

IPS d.Sign is a versatile system that is capable of pro-ducing very esthetic restorations. One evaluatorroutinely uses it over Captek and describes the resultsas incredible, although it also excels over most othermetals too. It offers great translucency, which makesveneers very life-like. Ceramist can build in a lot ofcolor in thin layers and the fit is laudatory—this makes

it a good choice for very conservative veneers.However, it tends to be technique sensitive and the col-ors are unique to this system. In addition, one evaluatorhas noticed a small number of fractured veneers. It alsofluoresces at a higher level than tooth structure, exceptwhen it is applied over metal, its brightness is toneddown to a close match with tooth structure.

REALITY

Omega 900

Ceramics


Description Specifically developed for veneering alumina substructures, espe-cially Procera. It features a full shade selection including 18 base,17 margin, 19 opacious body, 18 body, 4 cervical, and 3 enamelshades.

Clinical IndicationsOnly indicated for veneering alumina frameworks—not designedto be used as a stand-alone product.

Cement OptionsWith an alumina framework, virtually any cement can be used.

Fluorescence

Will please the most discriminating dentistsand patientsCan match even in-between shades

Only applicable for alumina and zirconiaframeworksCannot be used for combination cases

NEW

CerabienNoritake(4.0) 3a

Cerabien

Cerabien can produce very esthetic restora-tions. There is even a version made for zirconiacopings that applied over Lava framework willimpress even the most discerning eyes.However, it does require a ceramist who canhandle its intricacies. The internal and externalshading modifiers are excellent and the porce-lains allow easy internal characterization. Theuse of shades NP1.5 and NP2.5 to allow shadesbetween A1 and A2 and A2 and A3 respectivelyare nice options for precise shade matching.The disadvantage is that it is not formulated foruse on refractory material or platinum foil forveneers. This means that it is not the material ofchoice for combination cases. And its fluores-cence is slightly brighter than tooth structure.

REALITY

Ceramics


Creation has long been considered the ultimateesthetic porcelain, with the kit giving the ceramist allthe tools to create life-like restorations, especiallywhen it comes to veneers and single anterior crowns,although it is not considered a production porcelain—it is more a boutique porcelain because of the complexlayering performed by some ceramists. However, itsstrength has been questioned, bringing to the fore-front that classic decision between appearance andfunction. With its high hardness, it is also probably not

the material to use in patients who brux. One evalua-tor only uses it for shoulders on PFM crowns due to itshigh chroma. In addition, the dentin powders arekeyed only to the classic Vita Lumin shade guide—con-version computations are required for matchingprescriptions written using Vita 3D. And, probably dueto its high hardness, it is not as highly polishable com-pared to others in this category. On the other hand, itfluoresces at a level very close to tooth structure.

REALITY

Description Conventional feldspathic porcelain created by Willi Geller. Arecent study found it had the most resistance to wear and was thehardest compared to eight other porcelains. Designed to be usedin a multi-layered buildup technique. Dentin shades tend to havea higher chroma than some other brands of porcelain and are lesstranslucent than other systems in order to maintain the value. Thispresumably gives the technician freedom to use more translucentmaterials over the body, which provides vitality and depth.

Moreover, because of the higher chroma and greater opacity ofDentin powders, thinner layers can be used. The kit comes withfour standard enamels: S-57, S-58, S-59, and S-60. Each has a dif-ferent value ranging from white to gray. They can be used invarious concentrations to achieve different effects. For example,

S-57 (highest value) can be used on the ridges or cusp tips of arestoration to brighten the area. Another would be to use S-60(lowest value) on a light shade like A-2, which would create a grayincisal effect. Powders are said to handle well, offer exact shadematching, and simulate many of the same optical properties foundin teeth.

Clinical IndicationsVeneer over metal Crowns and bridges.Unsupported Veneers, inlays, onlays, and anterior crowns.


Fluorescence

The ultimate esthetic ceramicHigh chroma allows thinner layers wherespace is limited

Very hard—not indicated for bruxersNo shades matched to 3D shade guide

(4.0)Creation Jensen3b

Creation

Ceramics


Description High-fusing, synthetic leucite-reinforced feldspathic porcelainwith a very fine particle size. Its coefficient of thermal expansionpresumably remains stable during repeated firings. It is supposed-ly compatible with precious, semi-precious, non-precious andsilver-free alloys. It is also stated to produce less wear to opposingteeth.

Among the different kits available, there are 16 body shades.There is a NP shade kit which contains two Noritake originalshades (NP1.5 & NP2.5), with the 1.5 between A1 and A2, whilethe 2.5 is between A2 and A3. Both have slightly reddish hues.The system also comes in two bleach shades NW 0 and NW 0.5.Note that the full kit does not contain Paste Opaque porcelain.



Fluorescence

Can make ceramometal look like all-ceramicVery smooth surface texture

Learning curveNot for the novice

EX-3 appears to be a rising product that may be hardto beat for veneers and PFM restorations. Has a verysmooth surface texture and matches Noritake’s otherporcelains used for alumina and zirconia, which makescombination cases easier. It also has a comprehensivecoloring system, including a nice intrinsic staining con-cept. However, this material is not for the noviceceramist, since there is a substantial learning curve to

understanding the shading system and capabilities,especially to be able to create 3D effects as opposed tostacking ceramic masses. Nevertheless, when thisobstacle is conquered, the ceramometal results can vir-tually duplicate those of all-ceramic. On the otherhand, it fluoresces at a level much higher than toothstructure.

REALITY

NEW

EX-3Noritake(4.0) 3c

EX-3

Ceramics


Description Veneering porcelains for alumina (VM7) and zirconia (VM9)frameworks. Reported to be very kind to opposing teeth. Thebasic layering technique consists of two porcelains – Base Dentineand Enamel. The Base Dentines presumably enhance the chromaand opacity, so the material can be used in thinner areas wherechroma is needed, but where there is not enough room for thedentin layer. There are several effects that can be achieved with theuse of Effect Liners, Effect Chromas, Effect Enamels, Mamelons,Effect Pearl and Effect Opal porcelains.

Clinical IndicationsOnly indicated for veneering alumina or zirconia frameworks—not designed to be used as a stand-alone product.

Cement OptionsWith an alumina or zirconia framework, virtually any cement canbe used.

Fluorescence

Low wear on opposing teethExceptional esthetics

Needs supporting substructureNot for combination cases

VM7 and VM9 are basically the same products with aslight tweaking for the two different types of copings.It is capable of producing very esthetic restorations.

One evaluator, however, felt it could present sometechnical challenges to the ceramist. And it fluorescesat a level higher than tooth structure.

REALITY

(4.0)Vita VM7/VM9Vita/Vident3d

NEW

Vita VM9

Ceramics


Description Third generation natural feldspathic porcelain system. It offers 24esthetic shades, including eight “Illumine” bleach white shades.Shade-coordinated with Finesse All-Ceramic so combined cases(PFM & all-ceramic) will presumably be difficult to detect.

Ceramco 3 is more opacious than Ceramco II. It has betterinfinite optical properties, which makes it more suitable for metal-ceramic restorations at a minimal thickness. Being less translucentthan Ceramco II, it is less suitable for veneering non-discoloredteeth. However, it provides a polychromatic appearance forveneering lightly discolored teeth. Ceramco 3 is more suitable formasking dentin than Ceramco II.

It also has better handling, better polishing, and better firingthan Ceramco II. Ceramco 3 has more esthetic qualities built into

it. The lab tech can impart the requested shades more easily. Theimproved strength is important, with no reported fractures orother failures.



Fluorescence

PredictableGood bleach shades

Fluoresces darker and more yellow than toothstructureNo dedicated veneer powders

Ceramco 3 carries on a legacy that is about as close toa brand identification as it gets in this category. Theprimary advantage of this version over its siblingsseems to be an extension of the shade range withrefined colors, which are quite accurate. Especiallyappreciated are the white bleached shades. From theceramist’s view, the powders are colored, making it fareasier to see boundaries between different layers (e.g.body, opacious dentin, incisal, mamelon characteriza-tion, etc.) prior to firing. This could be a big advantagefor novices.

Its powders are also keyed to the Vita 3D Mastershade guide, an attractive feature for clinicians whohave adopted this shade matching system. And its veryfine grain size makes it highly polishable. This is agood, reliable, predictable middle-of-the-road productthat won’t disappoint you, but probably won’t terriblyimpress you either. On the other hand, it does not havea set of powders specifically designed for porcelainveneers, as does its immediate older sibling, whichwould be a better choice in a case involving a combi-nation of veneers and crowns. And it fluoresces darkerand with a yellowish cast compared to tooth structure.

REALITY

Ceramco 3 Dentsply Prosthetics(3.9) 4a

Ceramco 3

Ceramics


Description Pressed ceramic with a reduced size of leucite crystals, whichimproves the crystalline component, thereby increasing strength.It addresses the esthetic considerations of all-ceramic restorationswith a shaded translucent pressed core and layering porcelains.The core and powders are made from similar ceramic materialsand are color coordinated to compliment each other.

Clinical IndicationsAnterior crowns, inlays, onlays, and veneers.

Cement OptionsResin cement is mandatory.


Good track recordLabs like it

Hard to grow up in the shadow of EmpressNo snob appeal

OPC (Optimal Pressable Ceramic) followed Empressin the pressable arena and has always been tryingever since to get some respect. And, by all accounts,it’s a pretty good material, with esthetic results thatcan be compared to Empress. Its track record as faras strength is concerned is equal if not better thanthat of Empress. Indeed, one study found OPC wasstronger than Empress. And the shaded translucentcores fit as well if not better than those of Empress.There is also a low wear veneering porcelain, whichpresumably is kinder to the opposing dentition.Since it can be used for a variety of restorations, it’sa good choice for combination cases. From a labperspective, it seems to be an easy system to learn.

REALITY

Description CAD/CAM all-ceramic coping system consisting of a pressed anddensely sintered, high purity (99.5%) aluminum oxide. It is thenveneered with various porcelains such as Cerabien, Creation AV,or Vitadur Alpha, although NobelRondo has recently been intro-duced to be the matched ceramic. Preparations should have

chamfer or rounded shoulder margins and be deep enough for thecoping, which can now be produced in 0.4mm and 0.6mm thick-nesses plus the veneering porcelain (1.0mm). Recommendedposterior occlusal reduction is 2.0mm. Without adequate reduc-tion, esthetics will suffer. Your impression is sent to a lab with aspecial scanner, which then transmits the information to the pro-duction lab via modem. It is there that the coping is milled. It isthen sent back to the original lab for conventional buildup of theveneering porcelain. If your lab is not skilled in this area, estheticswill be mediocre.

Clinical IndicationsCrowns. While veneers and bridges (using the new zirconia mate-rial) are now being recommended, it is not being promoted forinlays and onlays.

The original CAD/CAM lab systemCan fit very well when scanned properly

Esthetics not as good as othersAccuracy of scanning is not automatic

(3.9)OPC Pentron4b

(3.9)Procera Nobel Biocare4c

Ceramics


Cement OptionsDue to its high strength, you presumably can use any cement youchoose, although acceptable bond strength with Panavia 21 hasbeen reported.


Procera is the original, lab-based, CAD/CAM system.As such, there was plenty of enthusiasm for it when itwas introduced, but “the buzz” has largely shiftedover to Lava. Nevertheless, Procera has the trackrecord, which overall, has been good. Most studieshave given it high marks on strength, even on molars,and shown that the marginal fit of the coping to beclinically acceptable. The fit, however, is dependent onthe skill of the technician who scans the case—this isnot automatic and consistent result. Gap width hasbeen measured to be 60µ.

Our experience shows Procera can be reasonablyesthetic, with the core able to block out dark teeth andmetal implant abutments. The 0.4mm coping definite-ly is better from an esthetic point of view, but the

0.6mm should still be used for molar crowns for theadded strength. Margins need to be slightly subgingi-val—this is not a material that can readily adapt to thesupragingival “contact lens” effect. More translucentcrowns such as IPS Empress will probably be moreesthetic when the tooth substrate is not very dark. Andthis system is not known for its bleach shades.

Despite its strength, however, at least three evalua-tors have reported fractured crowns. One evaluatorreported that the crowns always seem to fit too loose.Another evaluator finds it works well on implants.Radiographically, the crowns can look odd due to thedifferences in radiopacities between the coping andveneering material.

REALITY

Description Low fusing ceramic with a unique fluorine glass with an extreme-ly low firing temperature (670°C). It gets harder in the mouthinstead of weakening supposedly due to an ion exchange that

occurs between the porcelain and the oral fluids. And it is notaffected by multiple firings.

Clinical IndicationsFinal external layer of porcelain over any conventional ceramic.

Cement OptionsDepends on the type of restoration on which it is being appliedsince it is not designed to be used as a stand-alone product.


The original low fusing porcelainVery smooth surface

Can it really heal itself?Not etchable

Duceram LFCDentsply Prosthetics(3.8) 5a

Ceramics


Duceram LFC is the original low fusing ceramic that isnot only supposed to be kinder to opposing teeth, butwith the added claim of being able to heal itself in themouth. However, at least one study has found the lowfusing does not automatically mean low wear, whileanother study found LFC caused less wear on an oppos-ing enamel specimen in a wear machine compared tothree other ceramics, but was still not as wear-friendlyas gold. One evaluator reported LFC itself had ratherhigh wear in the occlusal contact area.

Regardless of these studies, when a rotary instru-ment is applied to LFC, it actually melts the surface andthen, in a way, it reglazes automatically. In addition, itssurface is very smooth due to its extremely small parti-

cle size, similar to a microfill composite. But whether itreally can heal flaws itself through ion exchange is stilldebatable.

Unfortunately, not all is good with LFC. It presum-ably does not etch well and, therefore, cannot be usedby itself for bonded restorations. For this application, athin coping of conventional porcelain must first befired, over which the LFC is applied. With ceramomet-al, body porcelain still is baked over the metal coping,while the LFC is again applied on the surface in a thinlayer.

From a clinical perspective, it can produce goodesthetics.

REALITY

Description Conventional feldspathic porcelain with 10% aluminous oxidecontent for extra strength. Matches the Vita Classic and 3Dshade guides. Includes Translucent, Intensive, Cervical, DentineModifier, and window porcelains. It has a wide range of inten-sive porcelains for color effects, particularly in the enamel andincisal areas.

Clinical IndicationsVeneer over alumina-based copings Crowns and bridges.Unsupported Veneers, inlays, onlays,

and anterior crowns.

Cement OptionsAny cement when used as a veneering porcelain over a high strengthcoping. When used unsupported, resin cement is mandatory.


Rates high in estheticsVersatile—can be used in combination cases

Not kindest to opposing teethMay not be best for refractory veneers

(3.8)Vitadur AlphaVita/Vident5b

NEW

Ceramics


Vitadur Alpha is still one of the most esthetic porce-lains, with a wide range of dentin colors, goodopacious dentins, and a natural high value incisal halo.It has very nice optical properties, especially withrespect to incisal edge characterization, and is quitepolishable. Works particularly well when trying to cre-ate or match teeth with pronounced opalescent

characteristics in the enamel. Because it can be usedover alumina or metal substructures or unsupported, itwould be a good choice for combination cases.However, one evaluator was not enthusiastic aboutusing it for refractory-type veneers while another rou-tinely used it in this application. In addition, its wear ofopposing teeth is higher than others in this category.

REALITY

Description Low fusing porcelain containing 8%–10% leucite. Designed withless leucite and finer crystal structure compared to conventionalporcelain. Can be used on metal (including titanium) and onFinesse All-Ceramic. The lower fusing temperature presumablyallows for increased opalescence in the enamel porcelains.Opaquers, opaceous dentins, dentins and margins are available in18 shades. There is a full range of 16 Vita shades plus the A0/i1and B0/i2 shades, with the latter two mainly for bleached teeth.Dentins and opaceous dentins are also available in the new whiter,brighter shades A01/i3 and B01/i4. The opal enamels are alsoavailable in four bleach shades.

Clinical IndicationsVeneer over metal Crowns and bridges. Veneer over Finesse All-Ceramic Anterior crowns, veneers,

inlays, and onlays.

Cement OptionsWith a metal substructure, virtually any cement can be used. Witha Finesse All-Ceramic substructure, resin cement is mandatory.

Fluorescence

Kind to opposing teethEasy to use as an add-on material

Too translucent for someTechnically demanding for lab

FinesseDentsply Prosthetics(3.7) 6a

Finesse

Ceramics


Finesse followed Duceram LFC in the low fusing, kind-to-opposing-teeth market. But unlike LFC, it is not justdesigned as the final layer but as the total veneeringporcelain either over metal or Finesse All-Ceramic sub-structure. While some of the evaluators have hadreasonably good success with it esthetically, othershave found it to be too translucent, which can makerestorations appear too grey, and the bleach shadesare also very white and stark. On the other hand, itssofter surface is definitely appealing and allows it to

be adjusted and polished with comparative ease, butone evaluator now uses it exclusively as an add-onmaterial due to its low fusing temperature. In thisrespect, it is easy to use. However, for full-blownrestorations, it is a technique sensitive material fromthe laboratory standpoint, requiring meticulous atten-tion to mixing, oven temperature calibration andmaintenance, etc. And it fluoresces with a bright yel-low cast.

REALITY

Description Lithium disilicate substructure, which is veneered with a fluorap-atite glass-ceramic. Characteristics of the low-fusing, highly stablematerial include reduced firing temperatures as well as homoge-nous composition for easy polishing and finishing. Available in afull range of Chromascop and Vita 3-D shades. It offers a fullrange of occlusal dentin, mamelon and opal effect materials formore individualized characterizations and four ultra-light bleachshades. In addition, Dentin, Incisal, Impulse, and Transparentmaterials enable fabrication of restorations that reportedly blendwell with surrounding dentin.

Clinical IndicationsAnterior and posterior crowns and three-unit bridges that haveone pontic and do not extend beyond the second premolar.

Cement OptionsAlthough it can be conventionally cemented, bonding with a resincement is preferred.

Fluorescence

Strength appears to be goodWide variety of shades

Not as strong as zirconia-based materialsGreek goddess of strife and discord?

(3.7)IPS ErisIvoclar Vivadent6b

IPS Eris

Ceramics


Description Conventional feldspathic porcelain system that is compatible witha wide range of metals. The Ultra-Pake pre-mixed opaque systempresumably gives complete, uniform coverage of the metal in avery thin layer. The effects of the opaque modifiers can be seen asthey are brushed on wet so there are no unexpected surprises afterthe opaque is baked. Ultra-Escent crystals sprinkled over thin lay-ers of opaque create a light refractive opaque surface to mimicnatural teeth.

Body and opal incisals supposedly give accurate shades andlook very natural when used over properly modified opaque.Opaceous dentin and color modifiers are incorporated to controlcolor in thin areas and provide special effects. The transparentporcelain is very clear and provides a nice, natural look. The Edgeshoulder porcelain combines the convenience of pre-mixed pastesin syringes with a quick-drying, quick-hardening carrier to deliv-er clean lift-off with sharp, accurate margins. For labs using highsilver alloys, Ceramco II silver porcelain is recommended to avoiddiscoloration.




The standard for PFMs over the yearsForgiving for both dentist and ceramist

Not the tops in esthetics anymoreMore abrasive to enamel

As the replacement for the ill-fated IPS Empress2, IPSEris (which is the name for the Greek goddess of dis-cord and strife—could they not have found a morepositive name?) has tried to make us forget its prede-cessor. In this regard, it’s done a pretty good job, sinceEris has performed well clinically and at least one studyconfirms its clinical success with very few reported fail-ures. However, the same study found that it lost itsgloss within two years. When it comes to bridges, oneevaluator reports four failures out of 30 over fiveyears.

While one evaluator considers that it could be oneof esthetic dentistry’s best kept secrets, one evaluatordoes not believe it matches up well against Lava oreven Cercon (which did not make our list). In other

words, with alumina, zirconia, and pressed to metaltechnique, where does lithium disilicate fit?

It is especially good with combination veneer,crown, and bridge cases, although when it comes toveneers, you would just use the veneering porcelain. Itdoes, however, require a full shoulder preparation,which may be too aggressive in some situations. Oneevaluator also thought Eris was somewhat too opaque.

The majority opinion is that esthetics is acceptable,especially if a patient wanted a posterior crown with-out metal and the tooth already has a pre-existingcrown with an aggressive preparation. For anterioruse, the patient would have to compromise on esthet-ics in favor of strength. And it fluoresces at a levelslighter higher than tooth structure.

REALITY

Ceramco II Dentsply Prosthetics(3.6) 7a

Ceramics


Ceramco II has performed admirably for many yearsas the standard ceramic for routine PFMs. It is consid-ered a production-type porcelain due to its forgivingnature, it does not require exception shade matching,and it is less expensive than most others in this catego-ry. Although more opaque than other ceramics, it hasstill been a successful and durable veneer material,although if the veneer is thin, you have to be very care-

ful when seating or it has a tendency to fracture. Inaddition, it is very forgiving in terms of its compatibili-ty with a wide variety of alloys for substructures. Themain disadvantage is that it does not seem to allow thefinest of detail in internal shading and fabrication ofthe ultimate porcelain restoration. It also has beenshown to be more abrasive against enamel comparedto a low fusing porcelain such as Finesse.

REALITY

Description Leucite-reinforced, pressed ceramic core material engineered witha coefficient of thermal expansion matched to Finesse low-fusingporcelain using a layering technique. This should create an idealbond between the porcelain and core without the need to create awash layer, saving time and enhancing the integrity of the restora-tion. It is available in 18 Vita shades (including A0 and B0). Forbleached teeth, there are new shades in porcelain and ingots:A0/i1, B0/i2, A01/i3 and B01/i4 shades.

Clinical IndicationsVeneers, inlays, onlays, and anterior crowns.

Cement OptionsResin cement mandatory.


Finesse All-Ceramic is an Empress wannabe, withprobably the only advantage being the presumptionthat the Finesse low-fusing porcelain that is applied onthe pressed copings is softer and kinder to the oppos-ing dentition. Esthetics has the potential to be very

good, but two evaluators reported a fairly high inci-dence of fractures. There is also a recent 3-year studythat found a fracture rate of 7%, although the samestudy reported 98% of the restorations had an excel-lent esthetic result.

REALITY

(3.6)Finesse All CeramicDentsply Prosthetics7b

Less abrasive when veneered with FinesseMatched system with Finesse low-fusing

Empress wannabeHigh fracture rate

Description Second generation, conventional feldspathic porcelain. It has alow glass point, which makes it compatible with most refractorydie materials for the production of crowns, inlays, and veneers.The relatively lower firing temperature presumably creates a morefavorable surface texture. The assortment of porcelains comes in amodular arrangement, which includes fluorescing powder andpaste opaquers, standard as well as opal enamels, standard as wellas fluorescing dentins, and a full array of color modifiers. Each setof porcelains can be purchased separately or as a whole system.

Ceramics


Description Low-fusing hydrothermal ceramic with a relatively high firingtemperature (800oC). Presumably reacts with saliva to form a sili-ca-hydroxyl layer on the ceramic that is softer, less abrasive, andgentler to the opposing dentition. It also supposedly continuous-ly heals surface flaws, thereby strengthening the restoration.Compatible with Type IV gold alloys plus Cergo pressable ceram-ic. Shades are keyed to the Vita.

Clinical IndicationsVeneer over metal Crowns and bridges.Veneer over Cergo Veneers, inlays, onlays, and anterior crowns.

Cement OptionsDepends on its substructure. When used over metal, virtually anycement will suffice. When used with Cergo, a resin cement is nec-essary.


Duceragold is the porcelain developed and designedto be coupled with Degunorm alloy to form the“Golden Gate” system of combining gold with porce-lain. As such, it does have attributes such as having asmooth surface texture, adequate esthetics, and a rela-

tively low firing temperature. Now, there are morealloys that match this porcelain, along with Cergopressable ceramic. While using a hydrothermal ceramicseems to make sense, clinical evidence of superiorityover other low-wear porcelains still needs to be shown.

REALITY

Duceram PlusDentsply Prosthetics(3.5) 8b

NEW

DuceragoldDentsply Prosthetics(3.5) 8a

Track recordTranslucency makes it a good choice forveneers

Surface texture not as good as newer generationFluoresces much higher than tooth structure

Can be used with metal or ceramic coresMakes you feel better using it

Hydrothermal superiority unproven clinicallyUniqueness of Golden Gate has passed

Ceramics




Fluorescence

Duceram Plus has been an extremely lifelike and nat-ural-appearing porcelain, especially when used forveneers, where its translucency really shines. It hasstood the test of time and is still performing well. Itwill not disappoint even clinicians who are more dis-cerning. For the ceramist, it is very production friendly

yet esthetic. Matches same family of porcelains for alu-mina and zirconia, which makes combination caseseasier. Has a comprehensive coloring system. However,surface texture isn’t as a good as the newer generationof finer grain porcelains. And it fluoresces at a levelmuch higher than tooth structure.

REALITY

Description A sibling of the original In-Ceram Alumina, it utilizes a translu-cent magnesium oxide and alumina core. It is still reportedlystronger than other, translucent-core all-ceramic materials.

Clinical IndicationsAnterior crowns and veneers when more aggressive tooth reduc-tion is necessary, although anterior 3-unit bridges may also bepossible. However, it also cannot be reliably etched, leaving itsbond strength dependent on aggressive sandblasting. Rocatec canalso be used to enhance bondability.

Cement OptionsResin cement is mandatory.

Fluorescence

Translucent = estheticGood track records

Only moderately stronger than pressablesNot etchable

(3.5)In-Ceram SpinellVita/Vident8c

Duceram Plus

In-Ceram Spinell

Ceramics


In-Ceram Spinell gives the option of using a reason-ably high strength substructure (stronger than most ifnot all pressables) that it is nicely translucent. It is cer-tainly not as strong as alumina or zirconia-basedcopings, but you would use it when esthetic demandstake precedence over ultimate strength. This includesanterior 3-unit bridges. It also fits quite well. It wouldtypically be veneered with Vitadur Alpha. While it may

remind you of the Dicor debacle, our clinical resultshave failed to show a high fracture rate. As a matter offact, its track record has been quite exemplary.However, it does require adequate reduction, whichrestricts its use for veneers. Nevertheless, one evaluatorreported good success with veneers bonded usingPanavia F (do not use silane). It fluoresces at a levelhigher than tooth structure.

REALITY

CerconDentsply Prosthetics

CerinateDen-Mat

CergogoldDentsply Prosthetics

ColorlogicDentsply Prosthetics

Fortress Mirage

In-Ceram AluminaVita/Vident

In-Ceram Zirconia Vita/Vident

Mirage Mirage

Mirage II Mirage

StylePressMetalor

OTHER PRODUCTS IN THIS CATEGORY

WE GREATLY APPRECIATE THE FOLLOWING LABS FOR PROVIDING SOME OF THE VENEERS FOR FLUORESCENCE TESTING:

ProWest Dental LaboratoryDale Mercer, General Manager#500, 816 – 7th Ave S.W.Calgary, Alberta T2P 1A1Canada1-866-466-5277www.prowestdentallab.com

Rego Dental LaboratoryNelson Rego8233 Firestone Blvd Downey, CA 90241562-861-0846

http://www.prowestdentallab.com

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ceramics

Documents

pfmresin cement

anteriorbridgesany cement

veneersresin cement

metalresin cement

metalfreeany cement

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anterior crownsany cement

dentsply prosthetics4b