polishing for glass ceramics: which protocol?

JPOR-228; No. of Pages 11

Review

Polishing for glass ceramics: Which protocol?

Ta nia Mara da Silva DDS, MD studenta,*,Ana Carolina Rodrigues Danzi Salvia DDS, MDa,Rodrigo Furtado de Carvalho DDS, MDb,Clovis Pagani DDS, MD, PhDa,Daniel Maranha da Rocha DDS, MD, PhDc,Eduardo Galera da Silva DDS, MD, PhDa

aDepartment of Restorative Dentistry, Sao Jose dos Campos School of Dentistry, UNESP – Univ Estadual Paulista,

Sao Paulo, BrazilbDepartment of Restorative Dentistry, Dental Prosthesis Area, Sao Jose dos Campos School of Dentistry,

UNESP – Univ Estadual Paulista, Sao Paulo, BrazilcDepartment of Restorative Dentistry, Universidade Federal de Sergipe, Brazil

j o u r n a l o f p r o s t h o d o n t i c r e s e a r c h x x x ( 2 0 1 4 ) x x x – x x x

a r t i c l e i n f o

Article history:

Received 20 November 2012

Received in revised form

11 February 2014

Accepted 26 February 2014

Available online xxx

Keywords:

Dental ceramics

Polishing methods

Superficial roughness

a b s t r a c t

Purpose: The execution of adjustments on ceramic restorations is sometimes necessary for

either correction of occlusion and/or inadequate contours or esthetical improvements.

Clinically, the surfaces undergo weariness through fine grinding diamond burs which

remove the superficial glazing layer. Several materials for ceramic polishing have been

used in an attempt to reach a satisfactory surface smoothness. The aim of this study was to

perform a literature review on different polishing protocols of several dental ceramics.

Study selection: This is a literature review performed through scientific articles published

between 2004 and 2012, indexed in MEDLINE, PubMed and Scielo databases. The study

selected and analyzed a total of 20 relevant articles that evaluated different types of

ceramics, polishing treatment and surface roughness.

Results: After an extensive literature review, this study observed: 1 – after the rupture of the

glazing layer due to the adjustments of the restorations, the best choice for the polishing of the

surface will depend on the type of ceramics used; 2 – glazing procedure provide excellent

results regarding to the superficial smoothness; however, if reglazing is impossible, either

abrasive rubber cups/points or sandpaper discs followed by the use of diamond polishing

pastes results in a satisfactory superficial smoothness; 3 – clinical studies that take into

account the behavior of the protocols polishing are scarce and should be encouraged; 4 – the

large number of variables influence the final outcome of polishing should be considered.

Conclusions: The necessity in standardization of methodologies to enable a comparison

among researches.

# 2014 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

* Corresponding author at: Avenida Engenheiro Francisco Jose Longo, 777, Jardim Sao Dimas, Sao Jose dos Campos, SP CEP: 12245-000,Brazil. Tel.: +55 12 8101 0308; fax: +55 12 3947 9010.

E-mail addresses: [email protected] (T.M. da Silva), [email protected] (A.C.R.D. Salvia), [email protected](R.F. de Carvalho), [email protected] (C. Pagani), [email protected] (D.M. da Rocha), [email protected] (E.G. da Silva).

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/jpor

Please cite this article in press as: da Silva TM, et al. Polishing for glass ceramics: Which protocol?. J Prosthodont Res (2014), http://dx.doi.org/10.1016/j.jpor.2014.02.001

http://dx.doi.org/10.1016/j.jpor.2014.02.0011883-1958/# 2014 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

http://dx.doi.org/10.1016/j.jpor.2014.02.001

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Contents

1. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

2. Materials and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

3.1. Classification of dental ceramics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

3.2. Grinding and polishing protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 000

j o u r n a l o f p r o s t h o d o n t i c r e s e a r c h x x x ( 2 0 1 4 ) x x x – x x x2

1. Introduction

By working with ceramic restorations, the dentist often needs

to perform clinical adjustments through wear by diamond

burs, consequently removing the superficial glazing layer.

These adjustments are needed when the restoration exhibits

premature occlusal contacts and/or inadequate contours [1–3].

The rupture of the glazing layer increases the superficial

roughness, leading to clinical problems: weariness of the

antagonist tooth [4]; retention of microbial biofilm [5] and

inflammation of the periodontal tissues; staining [6]; unsatis-

factory esthetics [7] and smaller resistance to cracks propaga-

tion [2,8–11]. Because of these aforementioned reasons, the

researchers have stated the use of a reglazing process [12] or

polishing of the ceramic restorations [13] as alternatives which

result in a greater superficial smoothness.

The reglazing may be performed prior to the luting

procedure and involves reheating the ceramics. However,

not even is possible to execute such procedure, especially

when adhesive ceramic restorations are being used, which

demands that the occlusal adjustment be made after

cementation [14]. In these cases, the polishing procedure is

an important alternative [14–16].

The efficacy of the ceramic polishing systems is a

controversial issue in literature. Several studies reported that

the final surfaces obtained with the polishing procedure are

not comparable with the final reglazing surfaces [17–20]. On

the other hand, other authors have reported that the polishing

systems did not exhibit the capacity of reaching surfaces

similarly to those obtained after the glazing procedure [21].

Different alternative polishing techniques have been

described for ceramic restorations [11,22,23]. Several polishing

kits are available into dental market. These are composed by a

great variety of materials, including: diamond burs, abrasive

rubbers cups, felt wheels and diamond polishing pastes. The

effect on the superficial roughness generated by the different

adjustment [10] protocols followed by the polishing of ceramic

restorations is of great interest for the dentist and the

superficial roughness have been studied by several research-

ers [2,3,9–11,19,20,22,24].

This study proposes to show methods of polishing showing

better performance. The proper polishing allows a lower

retention of bacterial plaque and inflammation of the

periodontal tissues, wear of antagonists teeth, more resis-

tance to cracks propagation and better esthetic for the

restorations. Considering the above information, the aim of

this study was to perform a literature review on the different

polishing protocols for the several dental glass ceramics.

Please cite this article in press as: da Silva TM, et al. Polishing for glass c10.1016/j.jpor.2014.02.001

2. Materials and methods

This is a literature review performed through scientific articles

published between 2004 and 2012, indexed in MEDLINE,

PubMed and Scielo databases. The search of databases was

performed using the keywords: ceramics, polishing methods

and surface roughness. Allowing the use of such keywords in

English, Portuguese and Spanish.

The inclusion criteria were studies related to methods for

polishing the surface in several ceramics, the effect of the type

of ceramic in the surface roughness and the effect of polishing

in ceramic surface. We excluded studies that addressed other

factors that were not related to the descriptors above. Also, we

excluded the use of abstracts, by not providing full analysis of

the studies presented.

The present study found 45 articles with at least one of the

criteria discussed. Thus, in this study selected and analyzed a

total of 20 relevant articles that evaluated different types of

ceramics, polishing treatment and surface roughness in the

same research.

3. Results

3.1. Classification of dental ceramics

The structure and the mechanical properties of dental

ceramics are the factors which are closely related to the

polishing efficacy [26,27]. Dental ceramics can be classified

into three main categories: glass, particle-reinforced glass,

and polycrystalline ceramics [25–27].

Glass ceramics are those which best minimize the optical

properties of enamel and dentin. Glass is composed of an

atomic network that does not show a normal pattern for

spacing (distance and angle) among them, and it has an

amorphous structure. The glass contained in dental ceramics

derivates mainly from the mineral group so-called feldspar

and is based on silica (silicon oxide) and alumina (aluminum

oxide) [27]. Therefore, the feldspathic ceramics belong to a

family so-called aluminosilicate glasses [27]. Feldspar-base

glasses are resistant to crystallization during firing presenting

a long firing range and being biocompatible.

In reinforced glass ceramic, filling particles are added to the

glass composition to improve the mechanical properties and

control the optical effects, such as: color, opalescence, and

opacity [30]. These filling agents are generally crystalline, but

they may also be glass particles with higher melting point. The

compositions are based on two or more different materials

eramics: Which protocol?. J Prosthodont Res (2014), http://dx.doi.org/



j o u r n a l o f p r o s t h o d o n t i c r e s e a r c h x x x ( 2 0 1 4 ) x x x – x x x 3


(phases) and are formally known as ‘‘composites’’ [2,37]. The

first filling materials used in dental ceramics were the particles

of the crystalline material so-called leucite [26,27]. These

particles were added to create ceramics which could be

successful when used on metallic infrastructure [28,29].

The particles for crystalline filling can be mechanically

added to the glass, by mixing glass crystals and powder prior to

the firing. In a recent approach, the filling particles are created

within the glass object, after the piece formation. Next, a

special thermal treatment is executed in the glass piece

resulting in the precipitation and growth of the crystals from

inside the glass [27]. Since these filling particles are chemically

derived from glass atoms themselves, the composition of the

remnant glass is altered. This aforementioned process is

called ‘‘ceramization’’ [26]. Such ceramics, composed by these

particles, are known as glass ceramics. The first glass ceramics

commercialized, Dicor (Dentsply, York, USA), exhibited filling

particles of crystal material so-called mica (55% volume) [30].

More recently, a glass ceramics containing 70% volume of

lithium disilicate filling crystal was developed for dental uses

(IPS Empress 2, now IPS e.max Press and IPS e.max CAD,

Ivoclar Vivadent, Schaan, Liechtenstein).

Polycrystalline ceramics do not have glass components. All

their atoms are densely grouped in crystalline matrixes, which

results in a material difficult to crack when compared to the

less dense and more irregular atom network found in the glass

ceramics. Thus, polycrystalline ceramics are generally more

resistant than glass ceramics [27]. However, the former tend to

be more opaque than glass ceramics and they are used as

infrastructure materials, on which glass ceramics are applied,

resulting in an improved esthetics [27].

According to the study developed by Sasahara et al. [9] the

microstructure has great influence on the performance of the

ceramics. Some ceramics are more easily glazed (that is, they

reach a smoother surface after glazing). This is likely related to

the composition of its glass matrix and its behavior under the

heat generated in the glazing cycle. The leucite content may

play an important role in the easiest polishing of these

materials.

3.2. Grinding and polishing protocols

The glazing and polishing are two options for the surface

finishing of esthetic ceramics. Both techniques have drawn

attention from numerous studies comparing the superficial

aspects through using visual, microscopic, and profilometric

analysis. The studies agreed that the glazing procedure can

produce a polished ceramic surface. On the other hand, the

polishing procedure may provide a surface showing char-

acteristics more similar to the natural tooth. There are some

authors who prefer the polishing procedures because their

higher level of control during the finishing of the final surface;

however, there is not a literature consensus on the ideal

polishing protocol [31].

The mean roughness value (Ra) was the parameter mostly

used by the authors evaluating the effect of the different

protocols of ceramic polishing [2,3,9–11,19,20,22,24]. This

parameter describes the texture of a surface and it can be

define as the mean arithmetical value of all the absolute

distances of the profile inside of the measuring length [2,32].


The polishing procedures involve some fundamental

principles which allowed us to understand better their

application in dentistry. The efficacy of the polishing devices

is determined by several factors: the structure and mechanical

properties of the substrate; hardness difference between the

device and the substrate; the hardness, size and shape of the

abrasive particles used with the device; the physical properties

of the vehicle material used to apply the abrasive material

(hardness, elasticity, flexibility, thickness, porosity); the

velocity and pressure which the abrasive material is applied

onto the substrate; the lubrication and the use of lubricants

during the application of the abrasive material (water,

glycerin, grease, vaseline) [33]. Nevertheless, in the several

studies reviewed, it was possible to note the lack of detailed

information regarding to the protocol used. Table 1 shows a

sample of the studies used in this literature review.

Asai et al. [34] compared four machined ceramic material

submitted to either polishing or overglazing procedure. The

specimens of glass, particle-reinforced and polycrystalline

ceramics were polished with medium, fine and extra-fine

abrasive rubber cups (Ceramdia, Morita, Tokyo, Japan), at a

rotational speed of 4000 rpm for 3 min. The surfaces of

overglazed specimens were homogenously smooth as op-

posed to the striated surfaces of the polished specimens, with

no significant differences in the compressive fracture strength

between the groups ( p > 0.05). Nevertheless, surface pores,

which could act as starting points of crack growth, were

observed even on the glazed specimens. As glazing was carried

out on as-ground surfaces, it was likely that the coarse surface

was not uniformly coated with the glazing material, thereby

resulting in incomplete removal of surface defects. Similarly,

Karayazgan et al. [35] observed a greatest superficial smooth-

ness in the groups overglazing ( p = 0.16) and dual ion-

exchange ( p = 0.39), without statistically significant differ-

ences between them, when it was evaluated the adhesion of

Candida albicans strains on glass ceramics, whereas the worst

results were promoted by polishing ( p = 0.04) with diamond

wheels (ECOMET 3, Buehler Ltd., IL, USA). Perhaps, the

polishing method has not been successful due to the

granulations of the diamond wheels (50 and 35 mm), or even

the pressure (66.72 N) of 15 seconds and the rotational speed

(350 rpm) applied over the specimen. On the other hand,

Dalkiz et al. [23] reached unfavorable outcomes when over-

glazing procedure was employed on the ultra low-fusing and

low-fusing feldspathic ceramic material (3.2; 3.7 mm). This fact

may be related to both the deepness of the risks and the

irregular superficial pattern. Probably, the second glazing cycle

would have more difficult in removing the risks created by the

diamond burs as efficiently as the first cycle. However, when it

was applied the polishing method (Sof-Lex, 3M ESPE, St. Paul,

MN, USA) followed by self-glaze, it was obtained a smoothest

ceramic surface in both ceramic materials (0.9 and 0.6 mm).

Probably, the four sequential polishing discs employed at a

rotational speed of 15,000 rpm for 10 s, diminished the grooves

over the specimens, facilitating the activity of self-glaze.

Scientific papers also report acceptable superficial smooth-

ness when the system Sof-Lex was employed [2,11,16,22,

28,36,44]. However, this system presents some difficult in the

polishing of irregular surfaces (e.g. occlusal surfaces), conse-

quently limiting its indication. Similar results to those




Table 1 – Studies used in this literature review.

Articles Dental ceramics Grinding Polishing protocols Conclusions

Jung et al. [45] IPS Empress (Ivoclar Vivadent,

Schaan, Liechtenstein)

Tungsten carbide bur 1. Diafix-oral (Kerr, Peterborough, UK);

2. MPS gel;

3. Diamond polisher;

4. Ceramiste silicon polisher;

No differences were detectable between the

methods applied to ceramic restorations with

respect to roundness of contours and surface

roughness

Albakry et al. [41] IPS Empress (Ivoclar Vivadent,

Schaan, Liechtenstein)

Empress 2 (Ivoclar Vivadent, Schaan,

Liechtenstein)

Diamond wheel (Isomet,

Buehler Ltd, Lake Bluff, IL, USA)

1. Untreated (control group);

2. Silicon carbide paper (220, 320, 500, 800,

1200) + diamond paste;

3. Overglazed;

4. Silicon carbide paper (180, 220) + diamond

discs (Grinder-Polisher, Buehler, UK Ltd,

Coventry, UK);

5. Aluminum oxide sandblasted.

The polished and untreated groups showed

higher roughness values, and the lower

roughness values showed ground and

sandblasted groups

Glavina et al. [44] Vita Mark 2I (Vita Zahnfabrik, Bad

Sackingen, Germany)

– 1. Sof-Lex discs (3M, St. Paul, MN, USA);

2. Hawe brushes (Hawe Neos Dental,

Bioggio, Switzerland);

3. Hawe brushes and diamond paste Diabrill

(Oralia Dental GmbH, Kostanz, Germany);

4. Politip-P rubber cups (Vivadent, Schaan,

Liechtenstein).

1. The best surface smoothness was achieved

with Sof-Lex discs polishing system

2. All other methods are clinically acceptable

Ahmad et al. [42] Vitadur Alpha Enamel (Vita

Zahnfabrik, Bad Sackingen, Germany)

Diamond abrasive wheel

(70 mm)

1. Alumina polishing system (AXIS Dental

Corp, Irving, Tex);

2. Silicon carbide polishing system

(Universal Ceramic Polisher, Brasseler, USA,

Savannah, Ga);

3. Diamond polishing system (Dialite,

Brasseler, USA);

4. Self-glaze;

5. Overglazed.

1. Polishing with diamond abrasive wheel

alone significantly reduced flexural strength

2. Overglazing did not change the flexural

strength of aluminous ceramics

3. Self-glaze did not result in significant

improvement in flexural strength

Camacho et al. [37] Ceramco 2 (Ceramco Inc., Burlington,

NJ, USA)

Sandpapers of decreasing

abrasiveness (280, 400, 600 grift)

1. Self-glaze;

2. Crystar Paste (Kota Ind. e Com. Ltda., Sao

Paulo, SP, Brazil);

3. Diamond Excel (FGM Products

Odontologicos, Joinville, SC, Brazil).

The polishing pastes were used with four

different vehicles:

a. Dental rubber cup (Webbed Latch;

DentAmerica Ind., Bedford Circle, CA, USA);

b. Robinson bristle brush (One Gross;

DentAmerica Ind.);

c. Felt wheel (Mini Felt Wheel; Kota Ind. e

Com. Ltda.);

d. Buff discs (SuperSnap Buff Discs; Shofu

Inc., Quioto, Japan).

1. Robinson bristle brush, felt wheel and buff

disc were efficient vehicles to be used in

association with a diamond polishing paste

2. Both pastes provided similar and efficient

polishing

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Table 1 (Continued )


Al-Wahadni et al. [43] 1. IPS Empress 2 (Ivoclar Vivadent,

Schaan, Liechtenstein), 2. In-Ceram/

Vitadur Alpha (Vita Zahnfabrik, Bad

Sackingen, Germany)

– 1. Unglazed;

2. Adjustment kit Shofu Dental (Shofu

Dental GmbH, Ratingen, Germany);

3. Overglazed.

1. Significant differences in surface roughness

were observed between the ceramics and

among the finishing techniques

2. Unglazed IPS Empress 2 is rougher than

unglazed In-Ceram/Vitadur Alpha

Kou et al. [16] 1. Vita In-Ceram Alumina (Vita

Zahnfabrik, Bad Sackingen, Germany);

2. Vita In-Ceram Zirconia (Vita

Zahnfabrik, Bad Sackingen, Germany);

3. IPS Empress 2 (Ivoclar Vivadent,

Schaan, Liechtenstein);

4. Procera AllCeram (Nobel Biocare AB,

Goteborg, Sweden);

5. Denzir (Cad.esthetics AB, Skelleftea,

Sweden);

6. Vita Mark II (Vita Zahnfabrik, Bad

Sackingen, Germany).

Diamond rotary cutting

instrument (medium 107–

126 mm; fine 76 mm; extra-fine

46 mm) (Z & B, Berlin, Germany)

Sof-Lex discs (100, 29, 14 and 5 mm) (3 M,

Dental Products, St Paul, MN, USA)

1. Polishing of Denzir, IPS Empress 2 and In-

Ceram Zirconia made the surface smoother

compared with the state after grinding

2. To polish flat and convex surface of the

materials, the Sof-Lex system is applicable

Sasahara et al. [9] 1. IPS d.Sign (Ivoclar Vivadent,

Schann, Liechtenstein);

2. Finesse (Dentsply, Ceramco,

Burlington, NJ, USA);

3. Super Porcelain EX 3 (Noritake Co

Ltd, Nagoya, Japan);

4. Symbio (Degussa Dental, GmgH &

Co, KG, Rosbach, Germany).

Sandpapers of decreasing

abrasiveness (180, 320, 600 grift)

1. Self-glaze;

2. rubber + glaze–polishing with gray and

pink rubber wheels (Komet, Gebr Brasseler,

Germany) before self-glaze;

3. Second glaze – glaze, ground with fine

(3098F-KG Sorensen, Brazil) and extra-fine

(3098FF-KG Sorensen, Brazil) diamond burs,

white stone (Shofu Dental Corporation,

USA) and a second glaze cycle;

4. Rubber wheels – after the glaze layer was

broken as described in 3, polished with

rubber wheels gray, pink and ‘‘glaze’’

(Komet, Gebr Brasseler GmbH & Co KG,

Germany), using a moderate pressure;

5. Rubber wheels + diamond paste – the

procedures described in 4, using moderate

pressure and diamond paste (KG Sorensen,

Germany) applied with a felt wheel (Komet,

Gebr Brasseler, Germany);

6. Sandpaper discs – after the glaze layer

was broken as described in 3, polishing with

Sol-Lex medium, fine and extra-fine

sandpaper discs (3 M ESPE, St Paul, USA)

using light pressure;

7. Sandpaper discs + diamond paste – after

the procedures described in 6, polishing

with a felt wheel using moderate pressure

and the same diamond paste as group 5.

1. The best choice for surface treatment

depends on the porcelain used

2. Porcelains with lower leucite content

presented lower roughness compared to those

with higher leucite content, after polishing

with rubber or discs followed by diamond

pastes

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Sarac et al. [18] Vitadur Alpha (Vita Zahnfabrik, Bad

Sackingen, Germany)

Medium-grift diamond bur

(Diatech Dental AG, Heerbrugg,

Switzerland)

1. Overglaze;

2. Adjustment kit Shofu Dental (Shofu

Dental GmbH, Ratingen, Germany);

3. Polishing wheel Cera Master (Shofu

Dental GmbH);

4. Polishing stick Diamond Stick (Shofu

Dental GmbH);

5. Polishing paste Ultra II (Shofu Dental

GmbH);

6. Combination 2 and 4;



9. Combination 3 and 5.

The use of an adjustment kit alone or

preceding polishing paste application created

surfaces as smooth as overglazed samples

Tholt et al. [39] 1. AllCeram (Degussa, Dental, GmgH &

Co, KG, Rosbach, Germany);



Vitadur Alpha (Vita Zahnfabrik GmbH,

Germany)


(90 mm, 38 mm, 25 mm)

1. Self-glaze;

2. Diamond bur: 3195, 3195F e 3195 FF (KG

Sorensen) + Eve system (RA 105 Diamond,

Eve, Ernst Vetter, GmbH, Germany);

3. Diamond bur + Identoflex polishing

system (Identoflex, Buchs SG, Switzerland);

4. Identoflex polishing system;

5. Diamond bur + Ceramiste system (Shofu

Inc, Kyoto, Japan).

The 3 brands of ceramic materials tested

reacted differently when submitted to the

same polishing procedure

Al-Shammery et al. [38] Vitablocs Vita Mark 2 (Vita

Zahnfabrik, Bad Sackingen, Germany)

– 1. Sof-Lex discs: coarse, medium, fine and

super-fine (3 M ESPE, St Paul, USA);

2. Silicon carbide impregnated rubber

polishing wheel (Ruwa cream-pol,

Associated Dental Products Ltd., Swindon,

UK);

3. Wheel shape diamond impregnated

polishing bur (Shofu Ceramiste Points,

Shofu Dental Corporation, San Marcos,

USA);

Diamond impregnated polishing wheel

(Diafix-oral, Kerr UK Ltd., Peterborough,

UK).

1. Sof-Lex discs provided the better means of

reducing surface roughness

2. Wheel polishing was ineffective in reducing

surface roughness of the material

Karan et al. [22] 1. IPS d.sign (Ivoclar Vivadent, Schaan,

Liechtenstein);

2. IPS Empress (Ivoclar Vivadent,



Schaan, Liechtenstein).

A spiral 12-fluted tungsten

carbide bur (Dentsply, Surrey,

UK)

1. Polishing wheel Cera Master (Shofu

Dental, Menlo Park, CA) and polishing paste

(Ultra II, Shofu Dental, Menlo Park, CA),

using a rubber cup;

2. Sof-Lex discs: coarse, medium, fine and

extra-fine (3M ESPE, Seefeld, Germany)

Use of polishing discs (Sof-Lex) was more

effective for smoothing the porcelain surfaces

compared with use of a polishing wheel and

polishing paste

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Lohbauer et al. [40] IPS e.max1 Press (Ivoclar,

Liechtenstein)

Silicon carbide paper (4000,

1000, 800, 500, 320, 120 grit)

1. Polishing paste;

2. Bur

Dependency of fracture strength on surface

roughness is neither determined by crystallite

size of the glass ceramic material nor by filler

sizes of the resin composite

Werneck et al. [20] IPS Classic (Ivoclar Vivadent,

Liechtenstein)

Diamond bur 4138 FF (KG

Sorensen, SP, Brazil)

1. Overglazed;

2. Edenta polishing system (EXA-Cerapol

352/362, Cerapol Super 372, Edenta,

Switzerland);

3. Tri Hawk system (Tri Hawk, Canada).

Both of finishing and polishing procedures

promoted a smooth surface similar to glazed

surface

Dalkiz et al. [23] 1. Vita Omega 900 (Vita Zahnfabrik,

Bad Sackingen, Germany);

2. Finesse (Dentsply, Ceramco, York,

PA)

Medium-grift diamond bur (836–

11, Brasseler, Savannah, GA,

USA)

1. Self-glaze;

2. Overglaze;

3. Sof-Lex discs (3M ESPE, Seefeld, Germany)

1982C, 1982M, 1982 F and 1982 SF grift;

4. Fine diamond disc grinding (835-11,

Brasseler, USA) + Polishing + Self glaze;

5. Coarse diamond disc grinding (837-11,

Brasseler, USA) + polishing + self glaze;

6. Sof-Lex discs + Self glaze.

The smoothest surfaces were obtained with

polishing prior to self-glaze, for both ceramic

types

Asai et al. [34] 1. Vita Mark 2 (Vita Zahnfabrik, Bad

Sackingen, Germany);

2. ProCAD (Ivoclar Vivadent, Schaan,

Liechtenstein);

3. IPS Empress CAD (Ivoclar Vivadent,


4. IPS e.max CAD (Ivoclar Vivadent,

Schaan, Liechtenstein).

Diamond burs (Meister Point,

Noritake, Aichi, Japan)

1. Diamond rubber polishing points

Ceramida (8M, 8 F e 8 SF; Morita, Tokyo,

Japan);

Overglaze

Overglaze surfaces appeared smoother than

polished surfaces

Aykent et al. [36] Vitablocs Mark 2 (VITA Zahnfabrik,

Bad Sackingen, Germany)

Abrasive sandpaper 600 – grift

(3 M ESPE, St. Paul, MN, USA)

1. Diamond burs (46 mm, 25 mm – GEBR

Brasseler GmbH, Lemgo, Germany);

2. Sof-Lex dics: coarse, medium, fine (3M

ESPE, St. Paul, USA);

3. Silicon carbide impregnated rubber

polishing wheel (Ceramiste Standard:

Shofu, Inc);

4. Felt wheels (Super Snap Buff; Shofu,

Inc.) + diamond paste (Diamond Stick;

Shofu, Inc).

Sof-Lex and Shofu polishing systems produce

smoother surfaces

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Karayazgan et al. [35] VMK 95 (Vita Zahnfabrik, Bad

Sackingen, Germany)


(70 mm)

1. Natural glaze (Vita Zahnfabrik, Bad


2. Overglaze (Vita Zahnfabrik, Bad


3. Dual ion exchange – slurries ranging from

10 mol% lithium chloride (LiCl) to 90 mol%

sodium chloride (NaCl) in distilled water,

heat-treated at 750 8C for 30 min and 450 8Cfor 30 min;

4. Polishing – 50 mm diamond wheel

(ECOMET 3, Buehler Ltd., Lake Bluff, IL,

USA); 35 mm diamond wheel and 15 mm

diamond paste (Cosmedent Inc., Chicago, IL,

USA) applied on a cloth wheel (ECOMET 3,

Buehler Ltd., Lake Bluff, IL, USA).

Polished and natural-glaze specimens showed

rougher surface characteristics than

overglazed and dual-ion-exchanged specimens

Scota et al. [24] 1. Super Porcelain EX-3 (Noritake,

Nagoya, Japan);

2. Ceramco 3 (Dentsply, Burlington,

NJ, USA);

3. Duceram Plus (Ducera Dental,

Rosbach, Germany);

4. Heraceram (Heraeus Kulzer,

Wehrhein, Germany).

Diamond burs (4138, 4138F e

4138FF (KG Sorensen, Barueri,

SP, Brazil)

1. Self-glaze;

2. Edenta polishing system (Edenta, St.

Gallen, Switzerland);

3. Komet polishing system (Komet, Lemgo,

Germany).

1. The polished surfaces with Edenta and

Komet systems did not reproduce the smooth

surface of the glazed surfaces

Edenta system provided less roughness surface

Sarikaya et al. [2] 1. VMK 95 (Vita Zahnfabrik, Germany);

2. Ceramco 3 (Degudent GmbH, USA);

3. Matchmaker MC (Schottlander, RU);

4. VITABLOCS Mark II (Vita

Zahnfabrik, Germany).

Abrasive sandpaper (600 grift)

during 10 s on a 300 rpm

1. Control–no surface treatment;

2. Self-glaze;

3. Sof-Lex discs (3M ESPE, St. Paul, MN,

USA);

4. NTI CeraGlaze polishing kit (NTI-Kahla

GmbH, Germany);

5. Dialite II polishing kit, (Brasseler, USA);

6. Sparkle diamond polishing paste

(Pulpdent, USA);

7. Zircate zirconium silicate cleaning-

prophy paste (Dentsply Int. Inc., USA);

8. Prisma Gloss aluminum oxide polishing

paste (Dentsply, Int. Inc., USA);

9. Sof-Lex + Sparkle;

10. Sof-Lex + Zircate;

11. Sof-Lex + Prisma Gloss.

Polishing kits (Dialite and NTI CeraGlaze) and

discs (Sof-Lex) were effective in surface

smoothness

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obtained with the system Sof-Lex has been observed with the

system Jota (Jota AG Rotary Instruments, Ruthi, Switzerland),

when it was applied on the ceramics Vitablocs Mark 2 (Vita

Zahnfabrik, Bad Sackingen, Germany) and IPS Empress CAD

(Ivoclar Vivadent, Schaan, Liechtenstein) (0.37; 0.33 mm) [39].

Specimens of an experimental fluormica based glass

ceramic polished with the system Sof-Lex were statistically

significantly less rough (2.76 mm) than the as-machined

(4.84 mm) or the group Diafix-oral (Kerr, Peterborough, UK)

(4.00 mm), without statistically significant differences between

the last two groups [38]. For Vita Mark 2, in its as-machined

state (4.45 mm), after polishing with Sof-Lex (2.42 mm) or using

polishing wheels (Diafix-oral) (1.50 mm), there were highly

statistically significant differences among them [38]. Also,

according to Jung et al. [45], the system Diafix-oral promoted

low surface roughness on the ceramic IPS Empress (Ivoclar

Vivadent, Schaan, Liechtenstein) (smooth surfaces in 64.5–

77.3% of the specimens).

Surfaces as smooth as glazed specimens (<2 mm) were

achieved when an adjustment kit was applied alone (�1.7 mm)

or preceding a polishing paste (�1.5 mm) or a polishing stick

(�1.5 mm) (all systems of Shofu) [18]. The abrasive particles of

the white stone in the adjustment kit are hard enough to

remove the irregularities from the ceramic surfaces and the

polishing paste could provide a slight improvement when it

was applied after the adjustment kit. However, the polishing

alone cannot remove the irregularities [18]. Also, positive

outcomes were promoted by the Shofu system (Shofu Dental,

Ratingen, Germany), when it was employed on the ceramics

IPS Empress 2 (Ivoclar Vivadent, Schaan, Liechtenstein) and

Vitadur Alpha (Vita Zahnfabrik, Bad Sackingen, Germany) [43].

In another study, the systems that produced smoothest

surfaces were CeraMaster (Shofu, Shofu Dental, GmbH,

Ratingen, Germany) associated with a diamond paste (Ultra

2, Shofu) (0.20 mm) and the reglazing (0.19 mm), recommended

for the ceramic Imagine Reflex (Wieland Dental, Technok

GmbH & Co. KG, Pforzheim, Germany) [3]. Nevertheless, the

system Sof-Lex (0.48 mm) was less effective compared to the

other treatments [3]. It is important to emphasize that such

porcelain, which contains nanoleucite crystals thinner than

the traditional porcelain, was polished after the removal of the

glaze layer with a coarse grained diamond drill to simulate the

occlusal clinical setting.

Smoothness similar to glazing was obtained by polishing

with rubber wheels (Komet, Gebr Brasseler, Germany) fol-

lowed by glazing on the ceramics IPS D.Sign (Ivoclar Vivadent,

Schaan, Liechtenstein) (0.19 mm), Finesse (Dentsply, Burling-

ton, NJ, USA) (0.21 mm) and Symbio (Degussa Dental, Rosbach,

Germany) (0.13 mm.) [9]. Also, good results were obtained with

rubber wheels followed by a diamond paste (KG Sorensen,

Germany) when it was applied with a felt wheel (Komet) on the

ceramic IPS D.Sign (0.21 mm) and the rubber wheels employed

alone on the ceramic Finesse (0.23 mm) [9]. For the ceramic

Super Porcelain EX 3 (Noritake Co Ltd, Nagoya, Japan), all

protocols differed from glazing, however, the rubber wheels

and glazing, as well as Sof-Lex and diamond paste applied

with a felt wheel did not differ among them (0.20 mm) [9].

According to Scota et al. [24], the polishing systems

Komet and Edenta (Edenta, St. Gallen, Switzerland), applied

on the feldspathic ceramics Super Porcelain EX 3, Ceramco


3 (Dentsply, Burlington, NJ, USA), Duceram Plus (Ducera

Dental, Rosbach, Germany) and Heraceram (Heraus Kulzer,

Wehrhein, Germany), after roughening with the diamond burs

4138, 4138F and 4138FF (KG Sorensen, SP, Brazil), did not

reproduce the smoothness of the glazed surfaces (0.18; 0.24;

0.09; 0.08 mm) [24]. However, Edenta provided surfaces less

roughened (0.42; 0.33; 0.40; 0.45 mm) than that obtained with

Komet (0.47; 0.57; 0.71; 0.72 mm) [24]. On the contrary, the

polishing systems Edenta (EXA Cerapol 352/362, Cerapol Super

372, Switzerland) (0.23 mm) or Tri Hawk silicon tip (Tri Hawk

Inc., Ontario, Canada) (Universal phase 1 and 2) (0.21 mm)

promoted roughness similar to glazing (0.21; 0.20 mm), when

they were applied on the feldspathic ceramic IPS Classic

(Ivoclar Vivadent, Schaan, Liechtenstein) [20]. It is interesting

to highlight that Scota et al. [24] performed the polishing

during 1 min at each point, whereas Werneck et al. [20] applied

the tips during 5 s at each point, nevertheless, the result

achieved was similar to glaze. Perhaps, the lack of control in

the pressure and speed while performing the polishing has

caused such difference.

A particle-reinforced glass ceramic (Vitablocs Mark 2)

presented smaller roughness values when it was polished

with the systems Sof-Lex (0.63 mm) or Ceramiste (Shofu)

(0.68 mm) than in the surfaces polished with a diamond paste

applied with a felt wheel (0.95 mm) or with a diamond rotary

cutting instrument (1.2 mm) [36]. Although there was no

statistical difference among groups, the highest bacterial

adhesion was observed on the group diamond rotary cutting

instrument (GEBR Brasseler GmbH, Lemgo, Germany) [36]. In

the group Sof-Lex, the specimens were polished with 3

sequential sandpaper discs (100, 29, 14 mm) for 60 s each; in

the group Ceramiste (Shofu), the surface was smoothed with a

white stone and a sequence of 3 silicone-carbide rubber points

(Ceramiste Standard, Shofu) for 60 s; in the group diamond

paste, it was employed a felt wheel (Shofu) with a diamond

paste (Shofu) for 60 s each, whereas in the group diamond

rotary cutting instrument, two points (46 mm and 25 mm) were

applied for 30 s each. Thereby, according to the protocols for

use of the materials evaluated, perhaps the group diamond

rotary cutting instrument was less favorable due to the

granulation of the instruments and the time duration, which

differs from the other groups.

Moreover, another study reported good results with the

Shofu system and others [39]. For AllCeram (Degussa Dental,

GmgH & Co, KG, Rosbach, Germany), lowest roughness values

were obtained with the Eve systems (Eve, Ernst Vetter, GmbH,

Germany) (0.4 mm), Identoflex (0.5 mm) and Ceramiste (Shofu)

(0.5 mm). For IPS Empress 2, the best systems were Identoflex

(Identoflex, Buchs SG, Switzerland) (0.6 mm) and Ceramiste

(Shofu) (0.5 mm). And, for Vitadur Alpha, it was the system Eve

(0.4 mm) [39]. According to Ahmad et al. [42], for the same

ceramic, SEM images showed that the polishing systems that

promoted lowest surface roughness and did not damage the

flexural strength were the alumina polishing system (AXIS

Dental Corp, USA), silicon carbide polishing system (Universal

Ceramic Polishers, Brasseler, USA) and diamond polishing

system (Dialite, Brasseler, USA), all applied at low speed

(10,000 rpm). Also, for IPS Empress and IPS Empress 2, the

polishing performed with silicon carbide sandpapers promot-

ed significantly lower surface roughness [41].




j o u r n a l o f p r o s t h o d o n t i c r e s e a r c h x x x ( 2 0 1 4 ) x x x – x x x10


What has been reported so far can be confirmed by Sarikaya

& Guler [2]. They related that each type of ceramic (glass or

particle-reinforced glass ceramics) shows a best result with a

certain type of polishing method. The surfaces obtained with

polishing and/or cleaning-prophy paste materials were rougher

when applied alone compared with the surfaces polished

through using Sof-Lex, Dialite, or NTI polishing kit (NTI-Kahla

GmbH, Germany) ( p < 0.05), resulting in improved surface

smoothness [2]. The group machinable feldspathic porcelain

block (Vitablocs Mark 2) demonstrated lower Ra values than the

other porcelain materials, although without significant differ-

ences among the various polishing techniques [2]. It is thought

to be due to the extreme hardness of Mark 2 feldspathic blocs.

Also, significant difference was not observed between the VMK

95 (Vita Zahnfabrik, Germany) and Ceramco 3 porcelains, which

presented the highest Ra values [2]. Probably, the differences in

the results might be explained by the different characteristics

of the porcelain materials against the polishing protocols

employed. For the porcelain feldspathic materials (VMK 95 and

Ceramco 3), the lowest Ra values were obtained in the group

self-glaze (0.724; 0.609 mm), without significant difference in

comparison to the groups Sof-Lex, NTI CeraGlaze Polishing kit

(NTI-Kahla GmbH, Germany), Dialite 2 (Brasseler, USA), control

and Sof-Lex combined with Prisma Gloss (Dentsply, USA). For

the low-fusing porcelain material (Matchmaker MC, Schott-

lander, RU), the lowest Ra value was achieved with Dialite 2

(0.366 mm), without difference from the groups self-glaze, Sof-

Lex, NTI CeraGlaze Polishing kit and Sparkle (Pulpdent, USA) [2].

Finally, for Vitablocs Mark 2, the lowest Ra value was obtained in

the control group (0.314 mm), without differences in comparison

to self-glaze, Sof-Lex, Dialite 2, Sparkle, Zircate (Dentsply, USA)

and Prisma Gloss [2].

Also, Camacho et al. [37] related no statistically significant

differences between the two polishing pastes tested Crystar

Paste (Kota Ind. and Com. Ltda., Sao Paulo, SP, Brazil) and

diamond excel (FGM Produtos Odontologicos, Joinville, SC,

Brazil), however, the opposite occurred with the vehicle-paste

interaction ( p < 0.05). Summarizing, Robinson bristle brush

(One Gross, DentAmerica Ind., USA) (0.09 mm), felt wheel

(Kota) (0.11 mm) and buff disc (Shofu) (0.10 mm) were efficient

vehicles to be used in association with a diamond polishing

paste. On the other hand, the rubber cup (Webbed Latch, CA,

USA) (0.24 mm) showed poor efficiency for mechanical polish-

ing of the feldspathic ceramic (Ceramco 2, Ceramco Inc.,

Burlington, NJ, USA). These outcomes suggests that the use of

rubber cups for polishing ceramic restorations is not advis-

able, maybe because of the limited retention of the paste on its

surface during the procedure, as well as the increase of

temperature on the ceramic surface when the rubber cups

were employed, which can cause microfissures on the ceramic

surface and decrease the ceramic structural strength and

contribute to the failures. In addition, it can be occurred due to

some factor inherent to the trademark or the characteristics of

the ceramic material. The procedures were performed by a

single operator, which consisted in spreading the polishing

paste on the ceramic surface and then the operator performed

a cycle of 30 eight-shaped movements with each vehicle under

a constant light manual pressure and cooled with a continu-

ous air-jet blowing. Nevertheless, these results opposed those

obtained by Asai et al. [34], who employed the rubber points of


the brand Ceramdia (by SEM images). Moreover, the results

achieved with the felt wheel were different from those

obtained by Aykent et al. [36] (�1 mm), despite of the similarity

of the protocol use. Perhaps, this difference is due to the

different ceramic materials employed in both studies.

Despite the inefficiency of using polishing pastes alone, an

interesting account is highlighted in the study of Lohbauer

et al. [40], where the specimens polished with a polishing paste

(brand not mentioned) showed a decrease in the surface

roughness (0.214 mm), increasing the fracture resistance of the

ceramic IPS e.max1 Press (441.4 MPa).

From this review, it has been observed that the use of

diamond polishing pastes at the end of the polishing process

provide an improvement in the superficial smoothness [9,18].

However, the use of diamond polishing pastes alone is not

enough for providing an adequate polishing of different

ceramic materials [18]. Moreover, the physical sizes of the

grits and crystals play an important role in the final

topographic result [10]. In addition, due to the difficult in

reaching intraoral access, occlusal corrections may result in

insufficient polishing and the formed microcracks may be

susceptible to later catastrophic fractures. Thus, if occlusal

adjustment of a ceramic restoration has to be made after

cementation there is always need for a careful intraoral

polishing with polishing kits and discs [2].

4. Conclusions

According to this literature review, it can be concluded:

1. After the rupture of the glazing layer due to the adjustments

of the restorations, the best choice for the polishing of the

surface will depend on the type of ceramics used.

2. The glazing procedure provide excellent results regarding

to the superficial smoothness; however, if reglazing is

impossible, either abrasive rubber cups/points or sandpa-

paer discs followed by the use of diamond polishing pastes

results in a satisfactory superficial smoothness.

3. Clinical studies that take into account the behavior of the

protocols polishing are scarce and should be encouraged.

4. The large number of variables that influence the final

outcome of polishing should be considered. This study

demonstrated the need for greater standardization of

methodologies, enabling a comparison between researches.

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polishing for glass ceramics: which protocol?

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