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

Statement of problem. One common test of single-unit restorations involves applying loads to clinically realistic specimens through spherical indenters, or equivalently, loading curved incisal edges against flat compression platens. As knowledge has become available regarding clinical failure mechanisms and the behavior of in vitro tests, it is possible to constructively question the clinical validity of such failure testing and to move toward developing more relevant test methods. Purpose. This article reviewed characteristics of the traditional load-to-failure test, contrasted these with characteristics of clinical failure for all-ceramic restorations, and sought to explain the discrepancies. Literature regarding intraoral conditions was reviewed to develop an understanding of how laboratory testing could be revised. Variables considered to be important in simulating clinical conditions were described, along with their recent laboratory evaluation. Conclusions. Traditional fracture tests of single unit all-ceramic prostheses are inappropriate, because they do not create failure mechanisms seen in retrieved clinical specimens. Validated tests are needed to elucidate the role(s) that cement systems, bonding, occlusion, and even metal copings play in the success of fixed prostheses and to make meaningful comparisons possible among novel ceramic and metal substructures. Research over the past 6 years has shown that crack systems mimicking clinical failure can be produced in all-ceramic restorations under appropriate conditions. (J Prosthet Dent 1999;81:652-61.)

Clinically relevant approach to failure testing of all-ceramic restorations.

Statement of Problem. The conservation of sound tooth structure helps preserve tooth vitality and reduce postoperative sensitivity. Innovative preparation designs, like those for porcelain laminate veneers, are much less invasive than conventional complete-coverage crown preparations. However, no study has quantified the amount of tooth structure removed during these preparations. Purpose. The purpose of this study was to quantify and compare the amount of tooth structure removed when various innovative and conventional tooth preparation designs were completed on different teeth. Material and Methods. A new comprehensive tooth preparation design classification system was introduced. Typodont resin teeth representing the maxillary left central incisor, maxillary left canine, and mandibular left central incisor were prepared with the following designs: partial (V1), traditional (V2), extended (V3), and complete (V4) porcelain laminate veneer preparations; resin-bonded retainer preparation with grooves (A1) and with wing/grooves (A2); all-ceramic crown preparation with 0.8 mm axial reduction and tapering chamfer finish line (F1), all-ceramic crown preparation with 1.0 mm axial reduction and rounded shoulder finish line (F2), and metal-ceramic crown with 1.4 mm axial reduction and facial shoulder finish line (F3). After tooth preparations (10 per group), the crown was separated from the root at the CEJ. The removed coronal tooth structure was measured with gravimetric analysis. Means and standard deviations for tooth structure removal with different preparation designs were calculated and analyzed with analysis of variance at a significance level of P Results. Significant differences in the amount of tooth structure removal were noted between preparation designs. Ceramic veneers and resin-bonded prosthesis retainers were the least invasive preparation designs, removing approximately 3% to 30% of the coronal tooth structure by weight. Approximately 63% to 72% of the coronal tooth structure was removed when teeth were prepared for all-ceramic and metal-ceramic crowns. For a single crown restoration, the tooth structure removal required for an F3 preparation (metal-ceramic crown) was 4.3 times greater than for a V2 preparation (porcelain laminate veneer, facial surface only) and 2.4 times greater than for a V4 preparation (more extensive porcelain laminate veneer). Conclusion. Within the limitations of this study, tooth preparations for porcelain laminate veneers and resin-bonded prostheses required approximately one-quarter to one-half the amount of tooth reduction of conventional complete-coverage crowns. (J Prosthet Dent 2002;87:503-9.)

Tooth structure removal associated with various preparation designs for anterior teeth

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

Ceramic-based crowns, particularly molar crowns, can fail prematurely from accumulation of fracture and other damage in continual occlusal contact. Damage modes depend on ceramic types (especially microstructures), flaw states, loading conditions, and geometric factors. These damage modes can be simulated and characterized in the laboratory with the use of Hertzian contact testing on monolayer, bilayer, and trilayer structures to represent important aspects of crown response in oral function. This article reviews the current dental materials knowledge base of clinically relevant contact-induced damage in ceramic-based layer structures in the context of all-ceramic crown lifetimes. It is proposed that simple contact testing protocols that make use of sphere indenters on model flat, ceramic-based layer structures—ceramic/polymer bilayers (simulating monolithic ceramic crowns on dentin) and ceramic/ceramic/polymer trilayers (simulating veneer/core all-ceramic crowns on dentin)—can provide useful relations for predicting critical occlusal loads to induce lifetime-threatening fracture. It is demonstrated that radial cracking from the lower core layer surface is the dominant failure mode for ceramic layer thicknesses much below 1 mm. Such an approach may be used to establish a scientific, materials-based foundation for designing next-generation crown layer structures. (J Prosthet Dent 2001;86:495-510.)

Use of contact testing in the characterization and design of all-ceramic crownlike layer structures: A review

This in vitro study evaluated the fracture resistance of all-ceramic crowns as a function of the elastic modulus of the supporting die. All-ceramic crowns were made for dies with three different elastic moduli and two different crown lengths. The occlusal surface was loaded in compression with a 12.7-mm steel ball. The fracture load increased markedly with the increase in elastic modulus. The largest increase was seen when only the occlusal surface of the crown was covered. The characteristic fracture load of the complete-crown restorations was more than double that of the occlusal-cover restorations in the dies with the lowest modulus of elasticity, while for the dies with the highest modulus of elasticity the difference in the characteristic fracture load for the two configurations was not significant.

The fracture resistance of all-ceramic crowns on supporting structures with different elastic moduli.

This in vitro study measured the changes in the fracture resistance of posterior crowns as a function of crown length. The crowns, 10 for each group, were made of a feldspathic porcelain (Ceramco), a glass-ceramic material (Dicor), and an alumina-reinforced glass (In-Ceram). Three different crown lengths were tested on acrylic resin dies. The restorations were fractured in a testing machine using a steel ball, 12.7 mm in diameter, that contacted the occlusal surface at three distinct points. Statistical analysis was performed using the Weibull distribution. The fracture resistance increased significantly with increasing crown length for all crown materials.

S S Scherrer

Papers

The fracture resistance of all-ceramic crowns on supporting structures with different elastic moduli.

The effect of crown length on the fracture resistance of posterior porcelain and glass-ceramic crowns.