Statement of problem Developments in ceramic core materials such as lithium disilicate, aluminum oxide, and zirconium oxide have allowed more widespread application of all-ceramic restorations over the past 10 years. With a plethora of ceramic materials and systems currently available for use, an overview of the scientific literature on the efficacy of this treatment therapy is indicated. Purpose This article reviews the current literature covering all-ceramic materials and systems, with respect to survival, material properties, marginal and internal fit, cementation and bonding, and color and esthetics, and provides clinical recommendations for their use. Material and methods A comprehensive review of the literature was completed seeking evidence for the treatment of teeth with all-ceramic restorations. A search of English language peer-reviewed literature was undertaken using MEDLINE and PubMed with a focus on evidence-based research articles published between 1996 and 2006. A hand search of relevant dental journals was also completed. Randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were reviewed. The last search was conducted on June 12, 2007. Data supporting the clinical application of all-ceramic materials and systems was sought. Results The literature demonstrates that multiple all-ceramic materials and systems are currently available for clinical use, and there is not a single universal material or system for all clinical situations. The successful application is dependent upon the clinician to match the materials, manufacturing techniques, and cementation or bonding procedures, with the individual clinical situation. Conclusions Within the scope of this systematic review, there is no evidence to support the universal application of a single ceramic material and system for all clinical situations. Additional longitudinal clinical studies are required to advance the development of ceramic materials and systems.

Current ceramic materials and systems with clinical recommendations: A systematic review

This article presents a brief history of dental ceramics and offers perspectives on recent research aimed at the further development of ceramics for clinical use, at their evaluation and selection, and very importantly, their clinical performance. Innovative ceramic materials and ceramics processing strategies that were introduced to restorative dentistry since the early 1980s are discussed. Notable research is highlighted regarding (1) wear of ceramics and opposing enamel, (2) polishability of porcelains, (3) influence of firing history on the thermal expansion of porcelains for metal ceramics, (4) machining and CAD/CAM as fabrication methods for clinical restorations, (5) fit of ceramic restorations, (6) clinical failure mechanisms of all-ceramic prostheses, (7) chemical and thermal strengthening of dental ceramics, (8) intraoral porcelain repair, and (9) criteria for selection of the various ceramics available. It is found that strong scientific and collaborative foundations exist for the continued understanding and improvement of dental ceramic systems.

Ceramics in dentistry: historical roots and current perspectives

In this study, the hypothesis was tested that the marginal and internal fit of CAD/CAM fabricated all-ceramic three-unit fixed partial dentures (FPDs) can be as good as in metal-ceramic FPDs. Twenty-four all-ceramic FPDs were fabricated and randomly subdivided into three equally sized groups. Eight frameworks were fabricated using the Digident CAD/CAM system (DIGI), another eight frameworks using the Cerec Inlab system (INLA). Vita Inceram Zirkonia blanks were used for both groups. In a third group frameworks were milled from yttrium-stabilized Zirconium blanks using the Lava system (LAVA). All frameworks were layered with ceramic veneering material. In addition, six three-unit metal-ceramic FPDs served as control group. All FPDs were evaluated using a replica technique with a light body silicone stabilized with a heavy body material. The replica samples were examined under microscope. The medians of marginal gaps were 75 microm for DIGI, 65 microm for LAVA and INLA and 54 microm for the conventional FPDs. Only the DIGI data differed significantly from those of the conventional FPDs. Within the limits of this study, the results suggest that the accuracy of CAD/CAM generated three-unit FPDs is satisfactory for clinical use.

Clinical fit of all-ceramic three-unit fixed partial dentures, generated with three different CAD/CAM systems

Clinical evaluation of all-ceramic crowns fabricated from intraoral digital impressions based on the principle of active wavefront sampling

Statement of problem After the development of a variety of ceramic restorative systems over the past 20 years, the fabrication of fixed dental prostheses has undergone considerable change. Esthetics and resistance to fracture are two of the main determinants of the success of a restoration; the third is marginal adaptation. Therefore, a systematic review of the literature dedicated to the marginal accuracy of ceramic systems is indicated. Purpose This study reviewed the current scientific literature that pertains to the marginal fit of ceramic crowns fabricated with different systems and investigated the factors that influence marginal adaptation. Material and methods An electronic search was completed by using the PubMed and Scopus databases with the following combination of key words: (discrepancy or fit or gaps or adaptation) and (disilicate or ceramic) and (copings or crowns). The search was limited to English-language peer-reviewed articles published before April 15, 2012. Titles and abstracts were read to identify articles that fulfilled the inclusion criteria designed for this review. Results Of 469 studies identified, 54 satisfied the selection criteria and were included in this review. All were published between 1994 and 2012. A total of 17 ceramic systems were tested in 48 in vitro and 6 in vivo studies. Of all the marginal gaps measured, 94.9% were in the range of clinical acceptability. Study heterogeneity made it impossible to conduct a proper meta-analysis of research findings and to compare and rank the various systems in terms of marginal fit. Four parameters were found to influence marginal adaptation: finish line configuration, value of the predefined cementing space, veneering process, and cementation. Conclusions The systems evaluated in the selected articles generally provide a clinically acceptable marginal fit. The current state of research does not allow for a proper comparison of the various systems in terms of marginal fit. The use of computer x-ray microtomography is recommended for further research on marginal adaptation.

Marginal adaptation of ceramic crowns: A systematic review

The terminology describing "fit" and the techniques used for measuring fit vary considerably in the literature. Although fit can be most easily defined in terms of "misfit," there are many different locations between a tooth and a restoration where the measurements can be made. In this work, the measurements of misfit at different locations are geometrically related to each other and defined as internal gap, marginal gap, vertical marginal discrepancy, horizontal marginal discrepancy, overextended margin, underextended margin, absolute marginal discrepancy, and seating discrepancy. The significance and difference in magnitude of different locations are presented. The best alternative is perhaps the absolute marginal discrepancy, which would always be the largest measurement of error at the margin and would reflect the total misfit at that point.

Considerations in measurement of marginal fit

The objective of this study was to measure marginal fit of castable ceramic versus gold crowns. Full veneer gold and ceramic crowns were made on Ivorine dies. Crowns were cemented, embedded, sectioned faciolingually and mesiodistally, and photographed for measurement of absolute marginal discrepancies (cavosurface angle to casting margin) to evaluate fit. Results revealed no statistically significant differences in fit among four locations around the margins of either ceramic or gold crowns. There was no statistically significant difference in the combined absolute marginal discrepancy (fit) between ceramic and gold crowns. The variance of the combined absolute marginal discrepancy (fit) of the ceramic crowns was significantly different than that of the gold crowns (p = 0.01 level). The standard deviation (variability) of the gold crowns was more than twice that of the ceramic crowns. Randomized block ANOVA demonstrated statistically significant differences among individual gold crown specimens, but none among individual ceramic crown specimens.

J. Robert Holmes

Papers

Considerations in measurement of marginal fit

Marginal fit of castable ceramic crowns.

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