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Full ceramic crowns
Over the past 50 years, the rapid development of dental materials has led to significant changes in the field of dental esthetics. Improvements in dental composites, bonding systems, and the development of new materials, combined with computerized supporting systems, have introduced a new range of options for selecting the ideal dental and esthetic solution for your teeth.
To overcome named imperfections, the development of new materials with improved characteristics was necessary. Therefore, full ceramic crowns appeared as an ideal solution to overcome esthetic and biological flaws of metal-ceramics. In general, the advantages of full-ceramic crowns are related to better esthetics and biocompatibility. Since the entire prosthodontic restoration is made of ceramic or a combination of zirconia and ceramic, better translucency can be achieved, followed by a more natural and lifelike look of the crown. The marginal gingiva creates better and more intimate contact with the ceramics compared to the metal alloy, which makes full-ceramic crowns more suitable, especially in the esthetic zone. On the other hand, a problem with full-ceramic crowns was addressed to their mechanical characteristics: their brittleness, flexural strength, and fracture toughness. Ceramic is a rigid material, but its brittleness often leads to the failure of these crowns in the beginning due to cracks and consequential fractures. The introduction of zirconia among dental materials has revolutionized esthetic dentistry.
For many years, metal-ceramic crowns were considered the gold standard in dentistry. However, these prosthodontic solutions showed a lack of aesthetic appearance. When we analyze the consistency of the full thickness of these crowns, significant portions belong to the metal core, and the other portion is made of ceramics. It means that the skinny part of the entire crown is made of ceramics, which leads to the lack of translucency of metal-ceramic crowns. That is why the difference between the crown and the natural tooth was so noticeable. The next problem was related to the soft tissue around the crown, i.e., gums or marginal gingiva. Over time, the metal of the crown usually appears and becomes visible under the gums as a “metal shadow,” giving the unnatural look to the entire restoration. Besides this, during the tooth preparation for the crown, thanks to the minor lacerations of the gums, gum staining may occur as a result of the diffusion of metallic ions to the gums. This phenomenon is not related only to the lack of esthetics with these restorations but also to the biocompatibility of the material, and in this case, incompatibility. Biocompatibility is considered a significant characteristic when choosing the optimal material.
Ceramics used in dentistry
can be categorized into four groups:
1. Glass-based (silica) ceramics also known as feldspar ceramics. Well-known are VITABLOCKS Mark II and VITABLOCKS TriLuxe from Vita Zahnfabrik, Germany.
VITABLOCS Mark II and TriLuxe are both new-generation feldspar ceramics. Mark II has supreme aesthetic properties and can be used for inlays, onlays, and crowns. VITA’s ceramic system has been used for over 25 years with excellent clinical success and is one of the best companies on the market. TriLuxe blocks are known for their specific multichromatic structure, which means that the tooth shade gradient is already integrated into the block, and that way, the natural tooth’s play of color is already reproduced. In other words, a natural transition of shade and color from the neck to the incisal edge of the tooth is already matched.
The downside of this material is the relatively low flexural strength of around 150MPa; nevertheless, this can be balanced by performing a high-quality bonding technique.
2. Glass-based with fillers (crystalline or lithium-disilicate).
There are three subtypes inside this group, and each subtype represents an improved version of glass-ceramics. To improve the physical and aesthetic properties of silica ceramics, fillers have been added.
Mainly leucite fillers to improve translucency.
Further technological development leads to the usage of aluminosilicate and lithium oxide as a filler.
Emax is a lithium disilicate glass-ceramic that has been on the market for more than 20 years and has proven its quality to this day. This material is ideal for veneers, even non-prep veneers, since it can be fabricated and successfully indicated for a thickness of 0.3 mm. It is also indicated for minimally invasive crowns (with 1 mm thickness) and for various restorations, including inlays, onlays, and overlays, providing the best possible alternative to conventional composite dental fillings. Based on its physical properties, this material can be used in the frontal region for 3-unit bridges, but when it comes to the molar region, IPS e.max is not the material of choice in this area. A completely natural look of the tooth is possible to achieve with this material, even in the cases of a non-vital tooth that has changed color.
VITA Suprinity is a specially designed glass ceramic material reinforced with 10% zirconia dioxide, which enhances its load capacity and precision compared to conventional lithium disilicate ceramics. This results in improved edge stability and better dimensional stability. With all these improvements in physical properties, aesthetic requirements have not been disrupted. This material has a wide range of indications. It can be used for veneers, inlays, onlays, and overlays, but also for full ceramic crowns in frontal and lateral regions regardless of the chewing forces.
3. Crystalline-based with glass (alumina) fillers.
These materials have already been phased out due to their lower strength compared to zirconia oxide.
4. Polycrystalline solids, monophase ceramics, known as zirconia-oxide.
With the expansion of ceramic products on the market over the last 20 years, few companies have improved their technologies and increased the area of indications of their products. That is why different ceramic systems have developed. Since there is no such material that can satisfy all esthetical and mechanical needs for crowns in other areas of the jaw (due to different chewing forces), with the proper knowledge and advice from your dentist, you can have the perfect veneers, inlays, crowns, or bridges that can answer to all mechanical and esthetical requirements.
Considering all advantages and disadvantages of the available materials on the market, in our dental office, full-ceramic crowns are made of zirconia core (DDCubeX2, DDCubeONE, DDBioZX2, and DDBioZ from DentalDirekt, Germany) with ceramics fused to zirconia. The exceptional aesthetic, biological, and physical properties of zirconia have made it competitive with metal alloys, previously used for the crown’s core. Its translucency allows a better aesthetic appearance. Besides this, we produce full ceramic crowns with IPS e.max, VITA Suprinity, VITABLOCKS Mark II, and TriLuxe.
One of the most incredible aspects of each named material is its compatibility with various CAD/CAM systems, enabling the most effective production process with the highest precision and the best aesthetic outcome, considering the shape and size of the future crown. Besides this, CAD/CAM systems allow one-visit procedures, so that you can have your tooth prepared and leave the dental office with a cemented crown just in one visit, since the complete method is performed in a dental office without dental laboratory assistance. This way, all requirements can be satisfied to achieve the best possible outcome in terms of aesthetics, biocompatibility, and physical requirements.