RECENT DEVELOPMENT OF

CERAMICS
PRESENTED BY-
DR. SOUMIK KARMAKAR
1ST YEAR PGT
DEPT. OF PROSTHODONTICS AND CROWN AND BRIDGE
GNIDSR

UNDER THE ABLE GUIDANCE OF :

Dr. (Prof) JAYANTA BHATTACHARYYA (HOD & PRINCIPAL)

Dr. (Prof) SAMIRAN DAS

Dr. (Prof) SOUMITRA GHOSH
Dr. (Prof) PREETI GOEL
Dr. SAYAN MAJUMDAR
CONTENTS
• INTRODUCTION
• IMPORTANCE
• DEFINITION
• HISTORY
• COMPOSITION
• PROPERTIES
• STRENGTHENING OF DENTAL CERAMICS
• CLASSIFICATION
• DENTAL IMPLANTS AND CERAMICS
• CONCLUSION
• REFERENCES
INTRODUCTION
• The word Ceramic is derived from the Greek word “keramos” which
literally means “burnt stuff” ,a material produced by burning or firing.

• Dental ceramics are materials that are designed to produce dental

prostheses to replace missing or damaged dental structures.

• For the last ten years, the application of high-technology allowed for
the development of new materials such as heat-pressed, injection-
molded, and slip-cast ceramics and glass-ceramics.

• The “chinese clay” of olden days have become the unavoidable

product in esthetic dentistry...
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
IMPORTANCE
• Though conventional ceramics provide esthetically pleasing restorations
they have many drawbacks which limit their use.

• With more and more studies coming in the field of ceramics and with the
advent of digital technology newer and better products are flooding the
market these days.

• The dental practitioner requires best knowledge concerning indications,

limitations, and correct use of started materials.

• The purpose is to overview advances in new ceramic materials and

processes, which are used in dentistry.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
DEFINITION
• A ceramic is an earthly material usually of silicate nature and may be defined as a combination of
one or more metals with a non-metallic element usually oxygen.

• The American Ceramic Society had defined ceramics as inorganic, non-metallic materials,
which are typically crystalline in nature, and are compounds formed between metallic and
nonmetallic elements such as aluminum & oxygen (alumina - Al2O3), calcium & oxygen (calcia -
CaO), silicon & nitrogen (nitride- Si3N4).

• Dental ceramics are usually referred to as nonmetallic, inorganic structures primarily containing
compounds of oxygen with one or more metallic or semi-metallic elements like aluminum,
calcium, lithium, magnesium, phosphorus, potassium, silicon, sodium, zirconium & titanium.

• The term porcelain is referred to a specific compositional range of ceramic materials made by
mixing kaolin, quartz and feldspar in proper proportioning and fired at high temperature.
Porcelain is essentially a white, translucent ceramic that is fired to a glazed state.
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
HISTORY
• In dentistry, ceramic was first introduced as restorative materials in the late
1700s.
• Later around 1710, Böttger introduced feldspar as the flux in Chinese
porcelains.
• The first use of porcelain was to make a complete denture by Alexis
Duchateau in 1774.
• French Dentist De Chemant patented the first porcelain tooth material in
1789.
• Pfaff from Germany developed a technique that allowed the porcelain teeth
to be used effectively in denture base construction in 1839.
• Dr. Charles Land patented the first Ceramic crowns in 1903.

Denry IL. Recent advances in ceramics for dentistry. Critical Reviews in Oral Biology & Medicine. 1996 Apr;7(2):134-43. BibTeXEndNoteRefManRefWorks
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Cont….
• Porcelain compositions suitable for metal-ceramic restorations were
introduced in 1962 (Weinstein and Weinstein, 1962).
• The development of aluminous core and veneer porcelains was first
described in 1965 (McLean and Hughes, 1965).
• Castable ceramics (Dicor) were later developed by Grossman in 1972
• The introduction of computer‑aided design and computer‑aided
manufacturing (CAD/CAM) technology to restorative dentistry was carried
out in the Cerec system (Sirona, Bensheim,Germany) and developed in
1982.
• In-Ceram system was introduced for the first all-ceramic core materials in
the Europe market in 1989.
• In 1993, Procera all-ceramic restorations was introduced(Nobel BiocareAB,
Gothenburg, Sweden).
Denry IL. Recent advances in ceramics for dentistry. Critical Reviews in Oral Biology & Medicine. 1996 Apr;7(2):134-43. BibTeXEndNoteRefManRefWorks
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
COMPOSITION
• Dental ceramics are mainly composed with crystalline minerals and
a silicate glass matrix.

Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
PROPERTIES
• Excellent biocompatibility with the oral soft tissues
• Chemically inert in oral cavity
• Excellent aesthetics
• Very good resistance to the compressive stresses but very
poor under tensile and shear stresses
• Brittle in nature and tend to fracture under tensile stresses
• Surface hardness of ceramics is very high hence they can
abrade the opposing natural or artificial teeth
• Ceramics are good thermal insulators and their co-efficient
of thermal expansion is almost close to the natural tooth
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
STRENGTHENING OF DENTAL CERAMICS
• The major drawbacks of ceramics are brittleness,
low fracture toughness and low tensile strength.
• Methods used to overcome the deficiencies of
ceramics fall into two categories including-
1. Methods of strengthening brittle materials and
2. Methods of designing components to minimize
stress concentration and tensile stress
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
• Chemical tempering involves replacement of smaller
Na+ ions with the larger K+ ions. Replacement of these
ions create larger residual compressive stresses (700
MPa) in the surface of the glass as the K+ ions are 35%
larger than the Na+ ions.
• Thermal tempering involves rapid cooling of the
restoration surface from the molten state. The rapid
cooling produces skin of glass surrounding soft (molten)
core, which will shrink later during solidification which
creates the residual tensile stress in the core and
residual compressive stresses within the outer surface.
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
• Thermal compatibility method applies to
porcelain fused to metals. The metal and
porcelain should be selected with slight
mismatch in their thermal contraction coefficient
(Usually the difference of 0.5 × 10–6/°C) which
causes the metal to contract slightly more than
does the ceramic during cooling after firing the
porcelain which results in development of
residual compression in the ceramic surface.
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
• A dispersed crystalline phase is reinforced into
the glasses or ceramics to strengthen them by
interrupting the crack propagation through the
material. Two different types of dispersions are used
to interrupt the crack propagation such as alumina
(Al2O3) or Partially Stabilized Zirconia (PSZ)
• In transformation-toughening, surface stresses
encountered during wear induce the particles to
transform, putting the surface into compression.
This transformation strengthens the surface.
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
Mason, Thomas O.. "tribological ceramics". Encyclopedia Britannica, 25 Sep. 2012, [Link] Accessed 24 March 2022.
Mason, Thomas O.. "tribological ceramics". Encyclopedia Britannica, 25 Sep. 2012, [Link] Accessed 24 March 2022.
CLASSIFICATION
Metal free ceramics can be broadly classified as:
• Based on composition and fabrication:
1. Conventional (powder-slurry) ceramics;
2. Castable ceramics;
3. Machinable ceramics;
4. Pressable ceramics;
5. Infiltrated ceramics.

• Based on the presence of specific attributes within their

formulation:
1. Glass-matrix ceramics
2. Polycrystalline ceramics
3. Resin-matrix
Pathrabe ceramics
A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
• According to their fusion temperature
1. high fusing
2. medium fusing
3. low fusing
4. ultra‑low fusing

Porcelain Type Fusion temperature range Clinical Applications

High fusing > 1300°C Denture Teeth

Medium Fusing 1000°C- 1300°C Jacket Crowns, Bridges and Inlays

Low Fusing 850°C - 1000°C Veneers over cast metal crowns

Ultra-low fusing
Babu PJ, Alla RK, Alluri < 850°C
VR, Datla SR, Konakanchi Usedandwith
A. Dental ceramics: part I–an overview of composition, structure Titanium
properties. and2015;3(1):13-8.
Am J Mater Eng Technol. its
alloys
• Based on chemical compositions
1. Silicon oxide ceramics
2. Aluminum oxide ceramics
3. Aluminum oxide ceramics reinforced with zirconium oxides
4. Zirconium oxides ceramics
5. Hybrid ceramics
• Based on processing methods
1. Casting
2. Sintering
3. Partial sintering
4. Glass infiltration
5. Slip casting and sintering
6. Hot isostatic pressing
7. CAD/CAM milling and copy milling
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
• According to structure
a) Non crystalline (Amorphous Solids or glasses)
b) Crystalline ceramics.

The mechanical and optical properties of dental ceramics mainly depend on the
nature and the amount of crystalline phase present.
More the glassy phase more the translucency of ceramics; however, it weakens
the structure by decreasing the resistance to crack propagation.
On the other hand, more the crystalline phase better will be the mechanical
properties which in turn would alter the aesthetics.

Conventional or feldspathic porcelains are usually non-crystalline ceramics.

These conventional porcelains are very weak and brittle in nature leading
to fracture even under low stresses.
Recent developments in the processing technology of dental ceramics have led
to the development of crystalline porcelains with suitable fillers such as
Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an overview of composition, structure and properties. Am J Mater Eng Technol. 2015;3(1):13-8.
Based on composition and fabrication:
1. Conventional (powder-slurry) ceramics:
• These products are available in powder form to which water is
added by the technician to produce slurry.
• Slurry is built up in layers on a die and then sintered to produce
the restoration.
• Feldspathic porcelains are brittle and have low flexural strength
(approx. 60 to 70 Mpa), hence, leucite-reinforced feldspar
porcelains were developed using the same powder-slurry
technique. The presence of leucite in the glass matrix will slow
down crack propagation and enhance the fracture toughness.
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
a)Duceram LFC
• Duceram LFC was developed in mid-1980’s for use in all ceramic
prostheses, ceramic/metal-ceramic inlay, and partial crowns.
• It has greater density, higher flexural strength, greater fracture
resistance and lower abrasion than feldspathic porcelain.
• The restoration is made in two layers. The base layer is Duceram
MC ( Duceram Metal Ceramic ); containing Leucite, followed by
the veneer - Duceram LFC (Duceram Low Fusing Ceramic).
• Duceram MC is condensed on a refractory die using
conventional powder slurry technique and sintered at 930°C.
• Duceram LFC is condensed with this base layer and sintered at
660°C. Being highly polishable they do not require glazing.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
b) Optec HSP
• It is a leucite reinforced feldspathic porcelain which is
condensed and sintered like aluminous and traditional
feldspathic porcelain over a refractory die rather than
platinum foil.
• Its moderate strength is derived from the nucleation and
growth of fine dispersion of a higher volume fraction of
leucite crystals.
• In spite of the rise in crystallization, the material retains
its translucency apparently as a result of closeness of the
refractive index of leucite with that from the glass matrix.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
2. Castable ceramics:
• These products are supplied as solid ceramic ingots, which
are used for fabrication of cores or full-contour restorations
using a lost wax and centrifugal casting technique.
• Yttrium tetragonal zirconia polycrystal (Y-TZP) is a recently
developed ceramic core in which yttrium oxide is mixed with
pure zirconium oxide (ZrO2) at room temperature to
produce a multiphase product known as partially stabilised
zirconia.
• Y-TZP ceramics exhibited higher values of flexural strength
of up to 900– 1200 MPa and fracture toughness of 9–10
MPa. Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
a) Dicor
• The term “DICOR” is derived from the combination of
manufacturer’s names: Dentsply International & Corning glass.
• Dicor will be castable polycrystalline fluorine containing
tetrasilic mica glass-ceramic material, initially cast as a glass by a
lost-wax technique and subsequently heat - treated resulting in a
controlled crystallization to produce a glass - ceramic material.
b) Cerapearl
• It contains a glass powder distributed in a vitreous or non-
crystalline state.
• Properties of cerapearl are similar to natural enamel in
composition, density, refractive index, thermal conductivity,
coefficient of thermal expansion and hardness.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
3. Machinable ceramics:
• These products are supplied as ceramic ingots in various
shades and are used in computer aided design - computer
aided manufacturing, or CAD-CAM, procedures.
• Machining process reduce the considerable time involved
in the fabrication of all-ceramic restorations.
• The machined restoration can be stained and glazed to
obtain the desired characterization.
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
a) Digital Systems (CAD/ CAM):
• To automate the fabrication of the equivalent of cast restorations,
Computer aided design and computer aided manufacturing (CAD/
CAM) technologies have been combined into a whole system.
• By using digital information about the tooth preparation or a
pattern of the restoration a computer-aided design (CAD) is
created on the video monitor for inspection and modification.
• The image acts as reference for designing a restoration on the video
monitor.
• After acceptance of 3-D image for the restoration design, the
computer translates the image into a set of instructions to guide a
milling tool (computer-assisted manufacturing [CAM]) in cutting
the restoration from a ceramic block.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
i. Direct:
A. Cerec System
• The CEREC (Ceramic
Reconstruction) system was
originally formulated by Brains
A.G. in Switzerland and first
demonstrated in 1986.
• CEREC CAD/CAM had been
produced in West Germany and
marketed by the Siemens group
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
ii. Indirect:
A)The Duret System
• The Duret CAD-CAM system was formulated by Francois Duret and
produced by Sopha (Lyon, France).

B)CICERO System
• The computer integrated crown reconstruction was only marketed with the
three systems resourceful of producing finished crowns and FPDs, namely
Duret (French) system, Sopha Bioconcept and the Minnesota system (Denti
CAD).

C)COMET System
• This system generates a 3-dimensional data record for each superstructure
with or without the use of a wax pattern. It simplifies the 3-dimensional
representation of tooth shapes while allowing individual customization and
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
correction in the visualized monitor image.
b) Analogous systems (Copying methods):
• It is the mechanical shaping of an industrially
prefabricated ceramic material, which has consistent
quality and improved mechanical properties.
• In this method after taking the impression, model is
prepared for fabrication of a prototype (pro-inlay or
crown).
• Based on the model, a replica of inlay/ crown is made.
• It is then fixed in the copying device and transferred
1:1 into the selected material such as ceramic.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
i. Sono erosion:
• It is based on ultrasonic methods.
• First, metallic negative moulds (so-called sonotrodes) of the
desired restoration are produced.
• After connecting to an ultrasonic generator, both sonotrodes
fitting exactly together in the selected restoration are guided
under slight pressure onto a ceramic blank.
• This ceramic blank is surrounded by an abrasive suspension
of hard particles, such as boron carbide, which are
accelerated by ultrasonics thus erosion of the restoration
takes place from the ceramic blank.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
ii. Spark Erosion:
• It refers to 'Electrical Discharge Machining' (EDM),
adapted into dentistry in 1982.
• In this process under carefully controlled conditions,
by using a series of sparks, material is removed from
a work place by erosion in a liquid medium.
• Generally the liquid medium is light oil called the
“dielectric fluid”. It functions as an insulator, a
conductor, and a coolant and flushes out all the
particles of metal generated by the sparks.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
4. Pressable ceramics:
• Also supplied as ceramic ingots, these products are
melted at high temperatures and pressed into a
mold created using the lost-wax technique.
• There are various types of pressable ceramics which
are available; IPS Empress, IPS ProCAD, IPS
Empress 2 and IPS [Link] Press.
• The pressed form can be made to full contour, or
can be used as a substrate for conventional
feldspathic porcelain buildup.
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
• a. IPS EMPRESS
• IPS Empress is a leucite crystal. High
crystallinity of leucite results in high opacity
with improved strength with slight compromise
aesthetics.
• The IPS Empress system is designed for the
fabrication of single crowns, inlays, onlays, and
veneers.
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
b. IPS ProCAD
• It was introduced in 1998 which similar to IPS
Empress.
• It has a fine leucite particle size, therefore it is
designed to be used with the CEREC inLab
system (Sirona Dental Systems, Germany) and is
available in numerous shades to achieve better
aesthetic.

Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
c. IPS EMPRESS 2
• It’s a second generation of pressable materials for all-ceramic bridges.
• IPS Empress 2 comprises lithium disilicate (Li2Si2O5) crystal-reinforced
glass ceramic.
• IPS Empress can resist 148 MPa, whereas IPS Empress 2 can resist 340
MPa. The fracture toughness of IPS Empress and IPS Empress 2 was 13
MPa·m1/2 and 33 MPa·m1/2 respectively.
• Hence, the IPS Empress 2 has been recommended for the construction
of FPDs in the anterior and premolar regions.
• The glass-ceramic ingots are manufactured from lithium silicate glass
crystals with crystal content greater than 60% by volume. The apatite
crystals incorporated are mainly responsible for the improved optical
properties (translucency, light scattering) which give rise to the unique
chameleon effect of leucite glass-ceramic materials.
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
• d. IPS [Link] Press
• It is developed in 2005 as an improved press-
ceramic material compared to IPS Empress 2
• Its physical properties and translucency are
improved through a different firing process.
Therefore, IPS Empress 2 has now been replaced
by IPS [Link] Press.

Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
5. Infiltrated ceramics:
• These products are supplied as two components: a
powder (aluminum oxide or spinel) fabricated into
a porous substrate and a glass infiltrated into the
porous substrate at high temperature.
• The infiltrated ceramic will then be veneered while
using conventional feldspathic porcelain
technique.
• Addition of high alumina content with infiltration
in glass ceramics improved the fracture strength of
the current all-ceramic fixed prostheses.
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
a. In–ceram Alumina
• Aluminum oxide (Al2O3) is most widely known as corundum.
• This material consists of 75 wt% polycrystalline alumina and
25% infiltration glass.
• As a result of the homogeneous framework structure made
from ultrafine Al2O3 particles, whose cavities are filled up
with a special glass, the degree of tensile bending strength is
significantly higher compared to all other ceramic systems.
• It has high strength and fracture toughness of 500 MPa and
3.1 MPa·m1/2 respectively, with medium translucency, which
makes it suitable for posterior crowns and anterior bridges.

Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
b. In-Ceram Spinell
• This material consists of 78 wt% magnesium aluminum
oxide (MgAl2O4) and 22 wt% infiltration glass.
• Introduction of magnesium aluminate (MgAl204) leads to
the improved optical properties characterized by increased
translucency about 25% , decrease in flexural strength.
• Spinel or Magnesium aluminate (Mg Al2O4) is a
composite containing Al2O3 and Mg2O (a natural oxide of
Mg2+ AI3+).
• It has flexural strength and fracture toughness of 400 MPa
and 2.7 MP am1/2, respectively but it exhibits the highest
aesthetic requirements. Therefore, In-Ceram spinell is
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
c. In-Ceram Zirconia
• This material is based on In-Ceram alumina of 67 wt% with the
addition of CeO2 stabilized zirconia of 33 wt%.
• The In-Ceram technique was improved to include its modified
form with zirconia.
• Using a combination of zirconium oxide/aluminium oxide being a
framework material, the physical properties were improved.
• The In-Ceram Zirconia material has a high flexural strength,
excellent marginal accuracy and biocompatibility.
• The material is also opaque, so it is recommended for crowns and
posterior three-unit bridges.
• It has a flexural strength and fracture toughness of 600 MPa and
4.8 MPa·m1/2 respectively It is currently the strongest material of
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
the In-Ceram.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
d. TURKOM-CERA
• Turkom-Cera fused alumina consists of two
components, namely, alumina gel (99.98%
Al2O3) and the crystal powder of lanthanum
oxide-based glass.
• It has flexural strength and hardness of 506 MPa
and 10 GPa, respectively.
• This material used as a core material for all-
ceramic anterior and posterior crowns.
Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past, Present and Future: A Review.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
Based on the presence of specific attributes within
their formulation:

1. Glass-matrix ceramics: nonmetallic inorganic

ceramic materials which contain a glass phase
2. Polycrystalline ceramics: nonmetallic inorganic
ceramic materials that won’t contain any glass phase.
3. Resin-matrix ceramics: polymer-matrices were
containing predominantly inorganic refractory
compounds that could include porcelains, glasses,
ceramics, and glass-ceramics.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
Pathrabe A, Lahoti K, Gade JR. Metal free ceramics in dentistry: A review. Int J Oral Health Med Res. 2016;2(5):154-58.
Based on chemical compositions
1. Silicon oxide ceramics
• Widely employed in biomedical applications because of its
mechanical stability, biocompatibility.
• The Porous silicon (pSi) is a biocompatible and biodegradable
material in plasma, blood, and tissue and then stable.
• Additionally, the internalization of pSi particles by endothelial
cells and macrophages in vivo and in vitro with no adverse
effects.
• pSi particles are also non-immunogenic. Hence, no toxicity has
been revealed in healthy individuals.
• Indeed, polymers coatings have been employed to coat pSi
particles to protect them from cellular degradation.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
2. Aluminum oxide ceramics
• Bioceramics (like alumina, zirconia, etc.) are mainly employed in
orthopedic and dental reparation.
• A third generation ceramic materials, characterized by high purity,
full density, and finer microstructure.
• It is shown that the degree of tensile bending strength of ultrafine
Al2O3 particles is remarkably high over that of all other ceramics.
• The ceramics for substructures of “jacket crowns” enriched by
alumina (up to 60% of weight) of different grain size (10–30 μm)
have been used to increase the stability.
• Hence, intense refraction of light takes place at the alumina due to
the difference in the refraction index between feldspar and
corundum.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
3. Aluminum oxide ceramics reinforced with zirconium oxides
• Mechanical properties of alumina were improved by addition of
reinforcing agents, like zirconia.
• Generally, these ceramic–ceramic composites present a great hardness
as compared to the all composites.
• Al2O3-SiC nanocomposite has been reported to have the most
improved properties. Thus, it has been shown that SiC increases
significantly the wear resistance of aluminum oxide.
• However, the zirconia system uses a mixture of zirconium oxide and
aluminum oxide as a framework to achieve a marked increase in the
flexural strength and fracture toughness.
• Zirconia particles protect the structure against crack propagation.
• It has a very high strength of around 700 MPa and very poor
translucency.
• Alumina-zirconia composites
Mhadhbi M, Khlissa F, Bouzidi have
C. Recent Advances in Ceramic received
Materials great
for Dentistry. Advanced attention
Ceramic Materials. 2021 Marin
28. dentistry
4. Zirconium oxides ceramics
• Zirconia (ZrO2) is a ceramic material which is distinguished by its high
mechanical properties, biocompatibility, and chemical stability.
• The polycrystal tetragonal zirconia, stabilized with yttria (3Y-TPZ)
contains 3 mol% yttria oxide (Y2O3), was first applied in the field of
medical.
• The 3Y-TPZ was fabricated in small grains (0.2–0.5 mm in diameter),
which minimizes the phenomenon of structural deterioration or
destabilization in the presence of saliva, decreasing the subcritical crack
growth.
• Similar to that of stainless steel, zirconia is characterized by good
chemical stability, good biocompatibility, mechanical strength, toughness,
and Young’s modulus.
• No adverse reactions have been found, when osteoblasts were seeded on
zirconia and were able to proliferate and differentiate on it .
• ZirconiaMhadhbi
ceramics are becoming a prevalent biomaterial in dentistry and
M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
5. Hybrid ceramics
• A range of ceramic systems are commercially available like
leucite, alumina, zirconia, and feldspar based ceramics. Thus,
many indirect composites categories, with various size of
filler particles, are also used.
• The use of mixed materials enhances crack propagation and
reduces fracture stress.
• Recent studies showed that hardness of hybrid ceramic
materials was given from the ceramic content.
• New hybrid ceramics filled and un-filled polyamide 12 (PA
12) were developed by a fused deposition modeling
framework.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
Based on processing methods
In the last few decades, there have been remarkable advances
in the mechanical properties and methods of fabrication of
ceramic materials.

1. Casting
• Casting is based on the solidification of a fluid that has been
poured or injected into a mold. The final product is also
known as a casting. Thus, casting process consists of three
steps: melting, casting, and recovery.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
2. Sintering
• Sintering is a heat treatment under pressure applied to a
powders compact without melting. The final product is a
solid or porous mass with excellent properties.
• By increasing temperature, the mechanical properties of the
zirconia-toughened alumina (ZTA) were improved, the
crystal structure of ZrO2 was changed (from tetragonal into
monoclinic), and the porosity was decreased.
• However, the ceramics sintered at 1450 °C showed greatest
fracture toughness (5.23 MPa.m1/2) and greatest flexural
strength (348 MPa), the optimal temperature was about
1200–1250 °C.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
3. Partial sintering
• Partial sintering is considered as the most straightforward
processing route for macro-porous scaffolds and involves
the partial sintering of initially porous powder compacts.
• A homogenous although closed pore structure can be
produced when sintering is terminated before full
densification.
• The pore size and porosity are controlled by the size of the
powder particles and the degree of partial sintering.
• Partial sintering results in a good mechanical behavior:
high porosity (57.17–75.26%) and a high compressive
strength (9.32–34.78 MPa).
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
4. Glass infiltration
• The glass infiltration processing is a powerful technique for
the fabrication of ceramic/glass composite with exceptional
mechanical properties, low shrinkage, non-cytotoxic behavior
and low chemical solubility.

5. Slip casting and sintering

• In-Ceram zirconia bulk composites were synthesized via slip
casting of alumina or zirconia. Slip was a dispersion of
particles of ceramic powders in a liquid (such as water).
• Kim et al. fabricated dense zirconia compacts by slip casting
and sintering from zirconia nanopowders.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
6. Hot isostatic pressing
• For a decade, hot isostatic pressing (HIP) has
been used successfully. HIP was used to
eliminate pores and remove casting defects to
dramatically increase the material properties.
• HIP was an effective process to prepare infrared-
transparent 3Y-TZP ceramics with small grain
size and with good optical and mechanical
properties.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
7. CAD/CAM milling and copy milling
• CAD/CAM milling and copy milling is an important field of dentistry and
prosthodontics to improve the design and creation of dental restorations.
• During the last two decades, dental CAD/CAM technology has been used to
replace the laborious and time consuming, conventional lost wax technique
for efficient fabrication of restorations. Hence, this technology enables
dentists to produce complex shapes of ceramics.
• Typically, CAD/CAM dental restorations are milled from solid blocks of
ceramic or composite resin that closely match the basic shade of the restored
tooth. Metal alloys including zirconia can also be milled.
• The software sends this data to a milling machine where the prosthesis was
milled. CAD/CAM allows easy production of precise, esthetic, and durable
prostheses by enhancing the speed of design and creation, making affordable
restorations etc.
• Nevertheless, chair-side CAD/CAM equipment requires more time on the
part of the dentists, and the fee was much higher than conventional
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
Photographs of (A) stainless steel abutment, (B) CAD design for a crown specimen, (C) CAD/CAM composite resin crown bonded to the abutment, (D) loading
points on the occlusal surface, and (E) the used machine.
DENTAL IMPLANTS AND CERAMICS
Ceramic materials are good biomaterials widely used in dental
implant because of their excellent biocompatibility and
mechanical properties.
• Bioglass implants -45S5 Bioglass
-58S bioglass
• β-Tricalcium phosphate implants
• Alumina implants
• Zirconia implants
• Hydroxyapatites implants
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
1. Bioglass implants
• For the first time, the bioglass implants were introduced
by Hench’s team at the late 1960s.
• Because of the great bioactivity of bioglasses, they are one
of the best biomaterials for renovation and bone repair.
• Moreover, to combine great mechanical strength and
excellent bioactivity of bioglasses, they can be successfully
used as coatings on inert substrates.
• A bioactive surface can be considered as important agent
to avoid many simultaneous reactions, which take place
between the implant and the implant surface.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
The bioactive glass with its composite
coatings can be classified as following
categorization :

45S5 Bioglass
• It has osseointegration capability,
bioactive surface and the ability of healing
bone damages.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
58S bioglass
• Ceramic 58S bioactive glass is a great bioactive,
biodegradable glass with the capability of bone bonding.
• It is able to receive specific attention as scaffold substance.
• The reaction of 58S bioactive glass with physiological
fluids occurs after implantation quickly and makes bond to
the tissue of bone. This happens without inflammatory,
toxicity and foreign-body reaction.
• With the release of calcium, silicon and phosphorous ions,
the gene expression and the proliferation of osteoblast
happens to form the bone quickly.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
2. β-Tricalcium phosphate implants
• β-tricalcium phosphate (β-Ca3(PO4)2) and hydroxyapatite
(Ca10(PO4)6(OH)2) belong to the family of calcium
ceramics, which are widely and successfully used
bioceramics for bone regeneration, drug delivery, biological
cement, and tissue engineering scaffolds.
• They exhibit pronounced resemblance to bone tissue
minerals, excellent biocompatibility, good cell attachment
properties for ensuring natural biodegradability, and
bioresorption.
• However, β-tricalcium phosphate is a bone substitute that
has high biocompatibility, favorable resorption properties,
and osteoconductivity.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
3. Alumina implants
• Alumina is very inert and resistant to corrosion in an in vivo environment.
• It elicits minimal response from the tissues, and remains stable for many
years.
• Few minutes after the implantation of alumina device, proteins and other
biomolecules adsorb on its surface, to form a fibrous capsule around the
implant that protects it from immune system.
• Hence, α-alumina is a dense, nonporous, and nearly inert material. It is
extremely hard and scratch resistant.
• Because of the better resistance to fracture and the higher bending
strength (13000 kg/cm2) of single crystal alumina, compared to that of
polycrystalline alumina (3500 kg/cm2), single crystal alumina is used for
dental implants.
• Thus, a typical alumina implant is made of single crystal alumina
cylindrical core around which polycrystalline alumina is fused.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
4. Zirconia implants
• The demand for zirconia dental implants are increasing recently.
• In comparison with the Ti dental implants, their increased esthetic, due to
similarity to the human tooth color, is the main benefit of these implants.
• Zirconia with better optical, esthetic, mechanical and biological
qualifications, is a hopeful substitute to traditional Ti implant system for
oral recovery, and is produced by the oxidation of zirconium also lack
electrically corrosion.
• Polyethylene and Ti show more inflammatory reactions than zirconia. Less
inflammatory response along with the lack of mutagenicity and toxicity in
zirconia, can be considered as the most attractive zirconia properties.
• Zirconia-based ceramics exhibit satisfying strength and toughness, allowing
them to contribute to solve the problem of the fragility encountered when
using alumina, as implant.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
• Zirconia owes stress-induced transformation of the
metastable tetragonal crystallites phase into monoclinic
phase, when it is localized around a propagating crack. This
transformation contributes to increase the fracture toughness
and the resistance to crack propagation by expanding the
volume (3–6%) and absorbing a part of the energy required
for crack propagation, which leads to crack shielding.

• The negative aspect of this transformation is “aging”, which

happens when it is localized on the surface of the implant, in
presence of acidic liquids. Hence, the surface of the implant
presents some signs of “aging”, such as the roughness and the
appearance of microcracks.
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
(a) Zirconia has the ability to phase change from a tetragonal phase to a monoclinic phase
to stop ensuing cracks, which is referred to as “transformation toughening” and (b) during
phase change, there is approximately 3 to 5% volume increase from tetragonal to
monoclinic phase
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
5. Hydroxyapatites implants
• Hydroxyapatite is a bioceramic of great clinical interest due to its
nontoxicity, bioactivity, good biocompatibility, osteoconductivity, and its
non-inflammatory nature.
• However, since it has a high elasticity modulus (brittle), hydroxyapatite is
usually associated to other materials to form an implant in load-bearing
applications.
• In fact, implants for load bearing, such as titanium screw, can be coated
with hydroxyapatite. The application of hydroxyapatite coatings is an
interesting surface amendment on dental implants.
• However, hydroxyapatite has osteogenic nature and is able to form strong
bond with host tissues, so it is widely used in biomedical field for
osteointegration, bone replacement and regeneration, coating metallic
implants, and to fill the defects generated in bones.

Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
Conclusion
• For over 200 years, ceramic materials have been utilized in
dentistry.
• The CAD/CAM technology is the most widely used in dentistry.
• Ceramic dentistry continues to evolve toward bright future with the
innovations and development of new materials, techniques, and
equipments.
• Several numbers of dental ceramic materials have been developed
with respect to strength, survival, applications, and esthetics.
• The success of dental ceramic materials depends on various factors
like design, type of material, cementation media, clinical data, etc.
• These factors help the dentist to choice the appropriate ceramic
material.
• Although the remarkable evolution of ceramics in dentistry not all
Mhadhbi M, Khlissa F, Bouzidi C. Recent Advances in Ceramic Materials for Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
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Dentistry. Advanced Ceramic Materials. 2021 Mar 28.
• Babu PJ, Alla RK, Alluri VR, Datla SR, Konakanchi A. Dental ceramics: part I–an
overview of composition, structure and properties. Am J Mater Eng Technol.
2015;3(1):13-8.
• Denry IL. Recent advances in ceramics for dentistry. Critical Reviews in Oral
Biology & Medicine. 1996 Apr;7(2):134-43.
• Sundaram RK, Varghese B. All Ceramic Materials in Dentistry: Past,Present and
Future: A Review.
• Mason, Thomas O.. "tribological ceramics". Encyclopedia Britannica, 25 Sep. 2012,
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