Ceramics in dentistry: historical roots and current perspectives

The effect of surface roughness on the flexure strength of an alumina reinforced all-ceramic crown material

OBJECTIVES

The aim of the current study was to assess the contribution of surface defects to early failures. Specific surface flaw distributions were introduced to a series of nominally identical standard disc shaped specimens to assess the contribution of surface flaws to early failures rather than depending on average fracture strengths that cannot be used reliably as a design parameter for brittle all-ceramic crown materials.

METHODS

Sets of 30 Vitadur-Alpha core porcelain discs (15mm diameter, 1.7mm thickness) were ground on silicon carbide abrasive paper to induce specific surface flaw distributions to a series of nominally identical standard disc shaped specimens. Mean flexure strengths, standard deviations and associated Weibull moduli (m) were determined using bi-axial flexure (ball-on-ring).

RESULTS

A significant increase in mean bi-axial flexure strength and associated Weibull modulus was identified for the "fine" compared with the "coarser" ground nominally identical disc shaped specimens. A reduction in the degree of coarseness of the fit surface of specimens led to an increase in the mean bi-axial flexure strength compared with a control group of samples and therefore an associated increase in the survival probability at low strength levels.

CONCLUSIONS

The use of a relevant testing method (bi-axial flexure) combined with the Weibull analysis as a method of predicting survival rates from the strength data could aid in identifying the failure mechanisms involved in crown fracture. This would result in an improved validation of the strength data rather than depending on the average fracture strength that cannot be used reliably as a design parameter for brittle all-ceramic crown materials.

Factors affecting enamel and ceramic wear: a literature review

Enamel wear by ceramics may adversely affect maintenance of the vertical dimension of occlusion and can increase the potential for thermal sensitivity. In this article, factors related to the abrasion of enamel by dental ceramics are critically reviewed. Concepts of physical, microstructural, chemical, and surface characteristics of dental ceramics on wear are presented based on research published since 1950. A PubMed search for key words (wear of enamel and ceramic) was supplemented with a hand search to identify relevant peer-reviewed articles published in English. Based on the literature, it can be concluded that material factors, their proper handling, and control of the patient's intrinsic risk factors related to wear are critically important to the reduction of enamel wear by dental ceramics.

Clinical evaluation of all-ceramic crowns

STATEMENT OF PROBLEM

There are few in vivo studies on the clinical performance of all-ceramic crowns.

PURPOSE

The aim of this study was to evaluate the clinical performance of IPS Empress crowns.

MATERIAL AND METHODS

Thirty-seven all-ceramic IPS Empress crowns were placed in 20 patients. Twenty crowns were luted with Variolink II low-viscosity resin cement in combination with Syntac Classic dentin adhesive; the remaining 17 were luted with Variolink II in combination with Syntac Single Component. All procedural steps were performed by the same prosthodontist. Using the California Dental Association's (CDA) quality evaluation system, 2 calibrated evaluators examined the crowns for margin integrity, anatomic form, surface, and color for a period of 12 to 41 months, with a mean of 24.56 months after insertion. Kaplan-Meier statistical analysis was used to calculate the survival rate of the crowns. Values obtained for plaque and gingival conditions were compared to control teeth with use of the Wilcoxon signed ranks test (P<.05).

RESULTS

Based on the CDA criteria, 94.6% of the crowns were rated satisfactory. Fracture was registered in only 1 crown. One endodontically treated tooth failed due to the dislodgement of the prefabricated dowel. No significant difference was observed in the gingival health status of crowns that had margins placed above or at the level of the gingival margin. However, in crowns that had subgingival margin finish lines, the percentage of bleeding on probing was significantly higher than that of the contralateral control teeth.

CONCLUSION

In this in vivo study, IPS Empress crowns luted with both dentin bonding agents functioned satisfactorily with a relatively low fracture rate over a mean evaluation period of 24.56 months.

Preparation and analysis of macroporous TiO2 films on Ti surfaces for bone-tissue implants

This article describes the preparation and analysis of macroporous TiO2 films on Ti surfaces, for application in bone tissue-Ti implant interfaces. These TiO2 bioceramic films have a macroporous structure consisting of monodisperse, three-dimensional, spherical, interconnected pores adjustable in the micron size range. Micron-sized polystyrene (PS) bead templates are used to precisely define the pore size, creating macroporous TiO2 films with 0.50, 16, and 50 microm diameter pores, as shown by scanning electron microscopy. X-ray photoelectron spectroscopy shows the films to be predominantly composed of TiO2, with approximately 10% carbon. X-ray diffraction reveal rutile as the main phase when fired to the optimal temperature of 950 degrees C. Preliminary experiments find that the in vitro proliferation of human bone-derived cells (HBDC) is similar on all three pore sizes. However, higher [3H]thymidine incorporation by the HBDC is observed when they are grown on 0.50- and 16-microm pores compared to the 50-microm pores, suggesting an enhanced cell proliferation for the smaller pores.

Influence of core buildup material on the fatigue strength of an all-ceramic crown

STATEMENT OF PROBLEM

Clinically relevant variables and testing methods have not been used to investigate the effects of core buildup materials on the strength of all-ceramic restorations.

PURPOSE

The aim of this study was to evaluate the compressive strength of Optimal Pressable Ceramic (OPC) all-ceramic crowns supported by 1 of 3 different core materials and subjected to static or cyclic loading in air or water.

MATERIAL AND METHODS

A total of 135 human extracted third molar teeth were divided into 3 equal groups, and cores of amalgam, composite, and dentin (control) were fabricated. Complete crown preparations with a circumferential 90 degrees shoulder margin 1 mm deep were prepared to support complete crown restorations. Testing in compression was performed at a loading rate of 2.0 mm/min. Sixty teeth (20 with each type of core) were subjected to static loading, with equal numbers tested in air and water. The remaining 75 teeth (25 with each type of core) were subjected to cyclic loading in water. The compressive and diametral tensile strengths of 6 x 12-mm OPC cylinders also were tested in both air and water. The data were analyzed with 1-way analysis of variance followed by the Tukey multiple means comparison test (P<.05).

RESULTS

Analysis of the static fracture stress of OPC crowns indicated no significant differences among the core materials (values from testing in air and water, respectively: dentin core 22.7 +/- 4.5 MPa and 19.7 +/- 4.7 MPa; amalgam core 25.2 +/- 5.2 MPa and 21.6 +/- 6.3 MPa; and composite core 20.9 +/- 4.1 MPa and 18.7 +/- 4.9 MPa). Under wet conditions, static versus cyclic loading produced significantly different results for each of the core materials (dentin core 19.7 +/- 4.7 MPa vs. 9.5 +/- 1.5 MPa; amalgam core 21.6 +/- 6.3 MPa vs. 10.3 +/- 1.6 MPa; composite core 18.7 +/- 4.9 MPa vs. 13.3 +/- 3.2 MPa). A significant difference was observed for the solid compressive cylinders tested in water (793.8 +/- 280.1 MPa) versus in air (1473.6 +/- 527.4 MPa).

CONCLUSION

Within the limitations of this study, the mean compressive strength of OPC crowns tested in water was significantly different under cyclic versus static loading. No significant difference among the 3 core materials was found with respect to crown compressive strength.

Mechanical properties of glass-only porcelains prepared by the use of two feldspathic frits with different thermal properties

Low- and non-leucite-containing commercial porcelains with low firing temperatures have become popular. However, improving the strength of glass porcelains is difficult. The purpose of this study was to determine if dispersed glass particles could be used as a reinforcing agent for an all-glass porcelain. We produced 3 feldspathic glasses (high-fusing, medium-fusing, low-fusing) by melting powders consisting of potassium-feldspar and 0, 5, or 20 mass% Na2O, respectively. For high-fusing, medium-fusing, and low-fusing feldspathic glasses, the deformation temperatures were 945 degrees C, 647 degrees C, and 518 degrees C, and the thermal expansion coefficient values were 8.6 x 10(-6)/degrees C, 10.3 x 10(-6)/degrees C, and 13.4 x 10(-6)/degrees C between 25 degrees C and the glass-transition temperature, respectively. The high-fusing-glass (or medium-fusing-glass) powders were mixed with low-fusing-glass powders before being fired into test specimens. The mean flexural strength and fracture toughness (K1C) of 3 single-glass porcelains ranged from 57 to 63 MPa and from 0.68 to 0.73 MPa m(1/2), respectively, presenting no significant differences in one-way ANOVA. However, the flexural strength of 50% high-fusing-glass + 50% low-fusing-glass porcelain was 114 MPa (p < 0.05) and K1C was 1.2 MPa m(1/2) (p < 0.05). Microcracks were observed with a back-scattered scanning electron microscope and were associated with the high- (or medium-) fusing glass particles, suggesting residual stress in the low-fusing-glass matrix due to a coefficient of thermal expansion mismatch between the dispersed glass particles and the matrix glass. The dispersing glass particles appeared to act as a reinforcing agent for strengthening a glassy porcelain.

Retrospective assessment of 546 all-ceramic anterior and posterior crowns in a general practice

STATEMENT OF PROBLEM

There is need to determine whether following a consistent procedural protocol in a private dental practice will result in high success rates for all-ceramic anterior and posterior crowns fabricated from aluminous porcelain veneered to high-alumina content-supporting cores. Aluminous porcelain is known to have poor tensile strength and fracture resistance when subjected to shear forces.

PURPOSE

This study examined the long-term survivability of alumina core, all-ceramic crowns in both anterior and posterior locations.

MATERIAL AND METHODS

Following a consistent protocol over 6 years, 546 all-ceramic, In-Ceram crowns (32.4% anterior [n = 177] and 67.6% posterior [n = 369]) were consecutively luted with glass ionomer resin hybrid cement and periodically observed by the same dentist who prepared and cemented them.

RESULTS

The overall success rate was 99.1% (n = 541) with a 0.9% (n = 5) failure rate. The success-to-failure ratio for anterior all-ceramic crowns was 98.9% to 1.1% (n = 175:2); the posterior crown ratio was 99.2% to 0.8% (n = 366:3).

CONCLUSION

Following a consistent protocol of careful tooth preparation and crown cementation resulted in high success rates for anterior and posterior all-ceramic crowns. Glass ionomer resin hybrid cement appeared to be a reliable luting agent. All-ceramic alumina core crowns are durable and provide optimum esthetic choices for anterior and posterior locations.

Flexural strength of Cerec 2 machined and jointed InCeram-Alumina and InCeram-Zirconia bars

OBJECTIVE

The flexural strength of Cerec 2 InCeram-Alumina and InCeram-Zirconia bars is evaluated. The focus of the in vitro study is to identify a jointing procedure for InCeram which may be used for producing full-ceramic fixed-partial-denture frameworks.

METHODS

Six groups (n=15) of machined and jointed InCeram-Alumina (T1-T5) and InCeram-Zirconia (T6) bars (3x4x13mm(3)), respectively, were examined using a 3-point-bending test. InCeram-Alumina joint-free controls were: machined (C1), slip cast (C2, C3) and cut from the block (C4) bars. Machined joint-free InCeram-Zirconia bars were used as controls (C5). InCeram-Alumina slip was used for jointing T1-T5 and InCeram-Zirconia slip for bars T6. Bars were jointed in groups T1 and T2 using butt joint (S1), in T3 and T4 oblique (S2, S3) and in T5 and T6 rounded (S4) joint shapes.

RESULTS

Two-way analysis of variance showed significant differences between materials (p<0.001) and jointing shapes (p<0.001). The rounded (S4) shape showed the highest flexural strength of 434 (65) MPa of InCeram-Alumina (T5) and 475 (54) MPa of InCeram-Zirconia (T6) bars, respectively but machined/joint-free InCeram-Alumina (511 (59) MPa, C1) and machined/joint-free InCeram-Zirconia (624 (58) MPa, C5) were significantly (p<0.01/p<0.001) stronger. No significant differences (p>0.05) were found between machined/jointed InCeram-Zirconia (475 (54) MPa, T6), joint-free InCeram-Alumina slip cast (498 (125) MPa, C2) and joint-free InCeram-Alumina machined bars (511 (59) MPa, C1).

SIGNIFICANCE

Compared to conventional slip cast InCeram-Alumina the flexural strength of machined/jointed InCeram-Zirconia appears to be adequate for fixed-partial-denture frameworks.

Structural reliability of alumina-, feldspar-, leucite-, mica- and zirconia-based ceramics

OBJECTIVES

The objective of this study was to test the hypothesis that industrially manufactured ceramic materials, such as Cerec Mark II and Zirconia-TZP, have a smaller range of fracture strength variation and therefore greater structural reliability than laboratory-processed dental ceramic materials.

METHODS

Thirty bar specimens per material were prepared and tested. The four-point bend test was used to determine the flexure strength of all ceramic materials. The fracture stress values were analyzed by Weibull analysis to determine the Weibull modulus values (m) and the 1 and 5% probabilities of failure.

RESULTS

The mean strength and standard deviation values for these ceramics are as follows: (MPa+/-SD) were: Cerec Mark II, 86.3+/-4.3; Dicor, 70.3+/-12.2; In-Ceram Alumina, 429. 3+/-87.2; IPS Empress, 83.9+/-11.3; Vitadur Alpha Core, 131.0+/-9.5; Vitadur Alpha Dentin, 60.7+/-6.8; Vita VMK 68, 82.7+/-10.0; and Zirconia-TZP, 913.0+/-50.2. There was no statistically significant difference among the flexure strength of Cerec Mark II, Dicor, IPS Empress, Vitadur Alpha Dentin, and Vita VMK 68 ceramics (p>0.05). The highest Weibull moduli were associated with Cerec Mark II and Zirconia-TZP ceramics (23.6 and 18.4). Dicor glass-ceramic and In-Ceram Alumina had the lowest m values (5.5 and 5.7), whereas intermediate values were observed for IPS-Empress, Vita VMK 68, Vitadur Alpha Dentin and Vitadur Alpha Core ceramics (8.6, 8.9, 10.0 and 13.0, respectively).

CONCLUSIONS

Except for In-Ceram Alumina, Vitadur Alpha and Zirconia-TZP core ceramics, most of the investigated ceramic materials fabricated under the condition of a dental laboratory were not stronger or more structurally reliable than Vita VMK 68 veneering porcelain. Only Cerec Mark II and Zirconia-TZP specimens, which were prepared from an industrially optimized ceramic material, exhibited m values greater than 18. Hence, we conclude that industrially prepared ceramics are more structurally reliable materials for dental applications although CAD-CAM procedures may induce surface and subsurface flaws that may adversely affect this property.

Survival of In-Ceram crowns in a private practice: a prospective clinical trial

STATEMENT OF PROBLEM

Prior reports on some all-ceramic crown systems have indicated high failure rates through fracture.

PURPOSE

This study prospectively evaluated the survival of infiltrated alumina crowns (In-Ceram) in a private practice.

MATERIAL AND METHODS

All the In-Ceram crowns placed in a prosthodontic practice since its introduction in 1990 were serially included. Patients were recalled at 6 monthly intervals. Those who did not attend in the previous 6 months were contacted by telephone and a series of answers to standardized questions recorded. The few patients who were lost to follow-up or who died were removed from the study from the time of last contact.

RESULTS

A total of 408 crowns in 107 patients were followed for periods from 1 to 86 months. As the 3-year data combined a meaningful period of service with a large sample size, these data were focused on. The 3-year survival rate was 96% for a sample size of 223. Three-year data indicated that core fracture and porcelain fracture occurred at rates of approximately 0.6% and 0.3% per year, respectively. Otherwise sound restorations were removed at a rate of approximately 0.3% per year for esthetic, endodontic, or prosthetic reasons. Anterior crowns tended to have a slightly higher 3-year survival rate (98%) than premolars or molars (94%).

CONCLUSION

Clinical failure rate of In-Ceram crowns was low. Crowns were lost because of core fracture, porcelain fracture, and removal without failure. Failure tended to be more common for molar and premolar crowns than for anterior crowns.

Three-body wear associated with three ceramics and enamel

STATEMENT OF PROBLEM

Wear of human enamel is a clinical concern whenever opposing teeth need to be restored using ceramic restorations.

PURPOSE

This in vitro study investigated wear of human enamel and 3 dental ceramics: a conventional porcelain (Vitadur Alpha), a low-fusing hydrothermal ceramic (Duceram-LFC), and a machinable ceramic (Vita Mark II) in a 3-body wear test.

MATERIAL AND METHODS

Thirty pairs of tooth-ceramic specimens were tested in a dental wear machine, under a standard load (40 N), rate (80 cycles/minute), and for 25,000 cycles in a simulated food slurry medium. Amount of wear was determined by measuring the height loss of the tooth and depth of wear track of the ceramic materials. Analysis of variance (ANOVA) was used to analyze the data, followed by Bonferroni multiple comparisons method to produce sets of simultaneous 95% confidence intervals.

RESULTS

ANOVA revealed significant differences between the groups for both enamel wear (P =. 002) and ceramic wear (P <.001). Further comparisons (95% CI significance level) revealed that the difference in enamel wear produced by Alpha porcelain and Duceram-LFC ceramic material was not statistically significant, whereas that produced by Vita Mark II ceramic was significantly less. Vita Mark II ceramic was significantly more resistant to wear than Alpha porcelain and Duceram-LFC ceramic. Furthermore, Alpha porcelain was significantly more resistant to wear than Duceram-LFC ceramic.

CONCLUSION

The abrasiveness of Alpha porcelain and Duceram-LFC ceramic was similar, yet both were significantly more abrasive than Vita Mark II ceramic. In addition, Vita Mark II was the most wear-resistant ceramic and Duceram-LFC ceramic the least resistant.

The clinical performance of ceramic inlays: a review

The availability of improved ceramic materials, bonding techniques, new technology and issues of amalgam safety have led to a revival of interest in ceramic inlays in dentistry over the past ten years. Clinical studies have been carried out during this time using various evaluation techniques to assess the clinical performance of these restorations. In this paper, recent clinical studies are examined and a review of the current state of knowledge regarding the clinical performance and survival statistics of ceramic inlays is presented. The major problems associated with ceramic inlay therapy appear to be fracture, hypersensitivity, degree of fit, maintenance of marginal integrity, microleakage, bond failures and cement wear. Other areas which also affect the clinical performance of ceramic inlays are ceramic wear, opposing tooth wear, plaque accumulation, gingivitis, secondary caries, colour stability, anatomic form and radiopacity. Recommendations based on the findings of clinical studies are also presented and whilst no specific material or technique has been shown to be clearly superior, certain principles which predispose to success can be identified. When compared with other forms of aesthetic intracoronal restorations, ceramic inlays perform well. However, their high cost and extreme technique sensitivity would appear to restrict their use to certain limited clinical situations.

IPS Empress inlays and onlays after four years--a clinical study

OBJECTIVE

Ceramic inlays are used as esthetic alternatives to amalgam and other metallic materials for the restoration of badly damaged teeth. However, only limited clinical data are available regarding adhesive inlays and onlays with proximal margins located in dentine. In a prospective, controlled clinical study, the performance of IPS Empress inlays and onlays with cuspal replacements and margins below the amelocemental junction was examined.

MATERIALS AND METHODS

Ninety-six IPS Empress fillings were placed in 34 patients by six clinicians. The restorations were luted with four different composite systems. The dentin bonding system Syntac Classic was used in addition to the acid-etch-technique. At baseline and after 6 months, one, two and four years after placement the restorations were assessed by two calibrated investigators using modified USPHS codes and criteria. A representative sample of the restorations was investigated by scanning electron microscopy to evaluate wear.

RESULTS

Seven of the 96 restorations investigated had to be replaced (failure rate 7%; Kaplan-Meier). Four inlays had suffered cohesive bulk fractures and three teeth required endodontic treatment. After four years in clinical service, significant deterioration (Friedman 2-way Anova; p < 0.05) was found to have occurred in the marginal adaptation of the remaining restorations. Seventy-nine percent of the surviving restorations exhibited marginal deficiencies, independent of the luting composite. Neither the absence of enamel margins, nor cuspal replacement significantly affected the adhesion or marginal quality of the restorations.

CONCLUSION

After four years, extensive IPS Empress inlays and onlays bonded with the dentin bonding system Syntac Classic were found to have a 7% failure rate with 79% of the remaining restorations having marginal deficiencies.

In vitro investigation of the wear of human enamel by dental porcelain

STATEMENT OF PROBLEM

Metal ceramic systems are advocated when both esthetics and strength are required. A major drawback to many porcelains is their wear and destruction of opposing natural dentition.

PURPOSE

This study evaluated the wear of enamel opposing 1 traditional and 2 recently introduced low-fusing feldspathic dental porcelains.

MATERIAL AND METHODS

Six blocks of Ceramco II, Finesse, and Omega 900 feldspathic porcelain materials were fabricated and fired according to manufacturer recommendations. Porcelain blocks were polished through 0.25 microm diamond polishing paste. Thirty-six enamel specimens were obtained and milled to a 2 mm (+0.5 mm) diameter. Enamel specimens were attached to an offset cam motor operating at 60 Hz. Enamel specimens were in constant contact with the stationary porcelain blocks under a load of 600 g and traversed a distance of 8 mm. Diameter and height of enamel specimens were measured at times of 0, 6, 12, 24, and 48 hours and subsequent determination of enamel volume loss recorded. Profilometric surface roughness of the ceramic blocks was also measured for the corresponding times.

RESULTS

Statistical analysis revealed that both Finesse and Omega 900 feldspathic porcelains caused significantly less enamel volume loss when compared with Ceramco II porcelain at all time intervals. Surface roughness revealed no consistent significant differences among porcelains.

CONCLUSION

Both Finesse and Omega 900 porcelains were not as destructive to human tooth structure as Ceramco II porcelain. These results suggest an advantage of the new, lower-fusing porcelains in conditions where natural dentition wear is a concern.

Porcelain for veneers

An ideal porcelain veneer placed on a non-discolored tooth requires the least amount of tooth preparation and the use of a translucent porcelain that interferes minimally with the transmission of light. In contrast, veneering a discolored tooth requires additional tooth preparation and the use of a chromatic or opacious porcelain. This article discusses several criteria for the selection of porcelain for porcelain veneers, including some steps to enhance the esthetic properties of these restorations.

In vitro study of fracture incidence and compressive fracture load of all-ceramic crowns cemented with resin-modified glass ionomer and other luting agents

STATEMENT OF PROBLEM

Anecdotal reports based on clinical observation have recently linked resin-modified glass ionomer luting agents with postcementation fracture of all-ceramic crowns.

PURPOSE

This study evaluated the fracture incidence of In-Ceram and VitaDur Alpha porcelain jacket all-ceramic crowns cemented with 5 luting agents (Fuji I, Fuji Plus, Vitremer, Advance, and Panavia 21) during 2 months storage in 0.8% NaCl solution.

MATERIAL AND METHODS

Fifty human maxillary premolar teeth were prepared for each ceramic system and divided into 5 subgroups of 10 teeth to be cemented with 5 luting cements. Specimens were observed for fracture lines and crack initiation at storage times up to 2 months. Incidence of fracture was analyzed with Fisher's Exact test. Specimens that did not fracture during storage were loaded in compression to failure. Failure loads were analyzed by analysis of variance and multiple pairwise comparisons.

RESULTS

Only all-ceramic crowns cemented with Advance cement fractured during the 2-month observation period, and porcelain jacket crowns were found to fracture earlier and more frequently than In-Ceram crowns. Cracks initiated at the crown margin, and multiple crack lines were found as the time of storage increased. In-Ceram crowns were significantly stronger (140 +/- 21.5 kg) than porcelain jacket crowns (98.6 +/- 17.8 kg) at P <.05. For In-Ceram crowns, cement type did not influence failure load while for porcelain jacket crowns, Fuji I (110.5 kg) was significantly higher than Vitremer (86.6 kg) at P <.05.

CONCLUSIONS

For the cements studied, only crowns cemented with Advance cement demonstrated fracture during 2-month storage. Results for the true resin-modified glass ionomer cements do not support anecdotal reports of fracture of all-ceramic crowns cemented with these materials.

Investigation of human enamel wear against four dental ceramics and gold

OBJECTIVES

This in vitro study compared the wear of enamel against aluminous porcelin, bonded porcelain, low fusing hydrothermal ceramic, feldspathic machinable ceramic, and cast gold.

METHODS

Fifty pairs of tooth-material specimens were tested in a dental wear machine, under a standard load (40 N), rate (80 cycles min-1) and for 25,000 cycles in distilled water. The amount of wear was determined by measuring the height loss of the tooth, and the depth of wear track of the restorative materials.

RESULTS

There was a significant difference in wear among the groups for both enamel and materials (p < 0.001). Follow-up comparisons (95% CI significance level) showed that gold caused significantly less enamel wear than all ceramics tested. The amount of enamel wear in the aluminous and bonded porcelain groups was significantly higher than with the hydrothermal and machinable ceramic groups. There was no significant difference between the amount of enamel wear produced by the aluminous and bonded porcelains nor between that produced by the hydrothermal and machinable ceramics. Furthermore, the wear of the aluminous and bonded porcelains was significantly greater than that of the hydrothermal ceramic, the machinable ceramics and gold. No significant difference in wear was found between aluminous and bonded porcelains, hydrothermal and machinable ceramics, or between machinable ceramic and gold. However, the hydrothermal ceramic had significantly greater wear than gold.

CONCLUSIONS

It was concluded that the hydrothermal and the machinable ceramics were significantly less abrasive and more resistant to wear than the conventional aluminous and bonded porcelains. Gold was the least abrasive material and most resistant to wear, although the difference in wear between the machinable ceramic and gold was not statistically significant.

An update on fixed prosthodontics

The practice of fixed prosthodontics has continually evolved as a result of progress in laboratory and biomaterials science, clinical technologies and adjunctive multidisciplinary treatment advancements. This brief review describes those enhancements and how they affect the state-of-the-art practice of fixed prosthodontics.