all-ceramic restorations
Making An Informed Decision When Prescribing All-Ceramic Restorations

Written by Andrew Sedlerh

Written by Andrew Sedler

Written by Andrew Sedler

Making An Informed Decision When Prescribing All-Ceramic Restorations
The Most Commonly Placed Restorations in America

All-Ceramic Restorations

All-ceramic restorations are the most commonly placed restorations in America. But there is still a large amount of confusion as to the options and features of the various materials and styles of crown fabrication. The purpose of this article will be to lay out the basic options available in materials and restoration styles, and I will also touch on some of the best applications for the various restoration categories within all-ceramic restorations.

The goal of any dental restoration is so well stated by Dr. Newton Fahl - “The primary goal of either monolithic or layered restorations is to reintegrate form, function, and esthetics with minimal damage and maximum longevity to the remaining natural dentition. Today’s state-of-the-art technology available in both realms is capable of yielding from above average to excellent esthetic results. The clinical choice between one or the other can depend on several factors that include strength and esthetics and whether restoring the anterior or posterior segments.”

Compendium, February 2014. Volume 35, Issue 2.

IPS e.max Lithium Disilicate

e.max has become a staple restoration at Burbank Dental Lab. The versatility and durability are matched with outstanding esthetics in both monolithic and layered options. Within the e.max system, there are a variety of opacities and shades. These restorations can be either pressed or CAD Milled restorations.

Special Note

e.max is Ivoclar’s brand name for their “whole” all-ceramic system, including e.max ZirPress (fluorapatite glass-ceramic), e.max ZirCAD (Zirconium ZrO2), e.max Ceram layering porcelain (fluorapatite glass-ceramic), and the most recognized e.max LS2 (Lithium disilicate glass ceramic - LS2). The latter is what most clinicians refer to as e.max.

Opacities

Opacities - Figure 1

HT is supplied in 16 A–D and 4 Bleach BL shades. Due to their high translucency – similar to that of natural enamel – these ingots are suitable for producing small restorations (e.g. inlays). Their lifelike "chameleon effect" allows these restorations to adapt seamlessly to the natural tooth structure. The restorations are efficiently customized with the staining technique. 

e max press third - fig. 2

MT is provided in the following shades: A1, A2, A3, B1, BL2, BL3, and BL4. These medium-translucency ingots are used in cases where a brighter material than HT and a more translucent material than LT is needed. Restorations made of the MT ingots are ideal for the staining and cut-back techniques.

(The opacity has been the most often used for over a decade)

LT is available in 16 A–D and 4 Bleach BL shades. Their low translucency – similar to that of natural dentin – renders these ingots suitable for creating large restorations (e.g. posterior crowns). The material exhibits true-to-nature brightness and chroma, which prevents greying of the restorations. The aesthetic appearance of the restorations is maximized by the cut-back technique.

MO is available in five group shades (MO 0, MO 1, MO 2, MO 3, MO 4). Given their opacity, these ingots are intended for the fabrication of substructures that are placed on vital or slightly discolored prepared teeth. They form an excellent base for natural-looking restorations completed with the layering technique.

HO is supplied in three group shades (HO 0, HO 1, HO 2). Due to their opacity, these ingots are used to create frameworks on severely discolored teeth and on titanium abutments. They successfully mask dark backgrounds to achieve highly esthetic results. The anatomical shape of the restorations is customized with IPS e.max Ceram.

The Impulse ingots are available in two different levels of brightness (Opal 1, Opal 2). The restorations produced with these ingots have exceptionally opalescent properties. 
This material is ideal for producing (thin) veneers for light teeth, which require an opalescent effect.

emax veneer - Figure 3

e.max layered is especially versatile because it can be fabricated with a range of layering strategies, ranging from a fully layered coping to Mostly Monolithic - Micro-Layered restorations, and of course the full Monolithic option. 

Burbank Dental Lab
Burbank Dental Lab Laminated Success Guide

REQUEST YOUR FREE IMPLANT SUCCESS GUIDE BELOW

Success Guides

Styles of Layered e.max

  • A coping much like pfm copings for full coverage porcelain pfms
  • Best used in high esthetic demands, with minimal parafunction or occlusal issues like bruxing.

Layered coping - Figure 4 and 8

Facial Incisal Cutback - Figure 5

  • Similar to a metal lingual pfm design.
  • Best used in esthetic situations with limited lingual space, and in patients that have some functional issues like bruxing.

Micro layering e.max - Figure 6

  • Essentially Monolithic but with strategic minimal “cut-back” in non-functioning areas.
  • Best in heavier bruxers especially if they function on the anterior incisal edges.

Full Monolithic - Fig. 7

  • Full contour 100% Lithium Disilicate, either pressed or CAD Milled.
  • Best in posterior zones, and in the anterior area for heavy bruxer patients using translucent zirconias.

Zirconia Restorations

Zirconia restorations have swept in throughout all categories of restorations. This includes gold crown replacements that are very strong but not extremely cosmetic as well as both monolithic and layered options that are quite esthetic.

Opacities & Strengths

Opacities can range from very opaque with almost equivalent block out capacity as metal, to very translucent in the range of medium translucency e.max. Be aware that the strength will generally decrease as translucency increases.

  • Katana Supra Translucent (STML)  Most Translucent - Similar to e.max MT Medium Translucency  • 750 MPa
  • Zir-MAX.M e Slightly more opaque than Katana STML     1000 MPa
  • Katana ML  Medium Translucency Similar to Burbank's  Zir-MAX M  e     1100 MPa
  • Zir-MAX.M  Medium Translucency  Similar to e.max  MO Medium Opacity 100 MPa

 

Zirconia Layered Options

Layered coping - Figure 8

  • A coping much like pfm copings for full coverage porcelain pfms
  • Best used in high esthetic demands, with minimal parafunction or occlusal issues like bruxing.

Facial Incisal Cutback - Figure 9

  • This layering strategy layers the facial, interproximal and wraps the incisal edge, but has monolithic zirconia occlusion in centric and most of the excursive function.
  • Good for moderate bruxers that do not brux extensively on the incisal edges.

Facial layerign with incisal "Scoop" - ledge - Fig. 10

  • This strategy has all functional areas including the incisal edge made of monolithic zirconia, only the facial and interproximal areas are in layered porcelain.
  • On the facial just under the incisal edge, the monolithic zirconia is designed with a scooped out area.
  • Best used for more extensive bruxers that tend to brux on the incisal edges, but where an elevated esthetics dimension is the desire and is accomplished by facial layering. (The incisal edge can be slightly compromised esthetically compared to an actual layered incisal edge.)

Full Monolithic - Fig. 7

  • Full contour 100% Zirconium.
  • Best in posterior zones, and in the anterior area for heavy bruxer patients using translucent zirconias.

When in doubt on what is the best material and layering strategy for your case, Burbank Dental Lab has experienced technical advisors ready to assist you.

Additionally, you can order a FREE All-Ceramic Material Selection Guide below.

Did you like this article?

Let us know by giving us a clap!

1+

Top 10 Most Clapped Articles

Resource Center

Products

Slide 1

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.