Dental Materials Assis. Prof. Dr.

Ibrahim Alfahdawi
Ceramics and Porcelain Fused to Metal (PFM)
The word ceramic is derived from the Greek word keramos which literally
means ‘burnt stuff’ but which has come to mean more specifically a material
produced by burning or fi ring. The first ceramics fabricated by man were
earthenware pots used for domestic purposes. This material is opaque,
relatively weak and porous and would be unsuitable for dental applications. It
consisted mainly of kaolin. The blending of this with other minerals such as
silica and feldspar produced the translucency and extra strength required for
dental restorations. Material containing these additional important ingredients
was given the name porcelain. Although the favorable aesthetic properties and
excellent biocompatibility of porcelain has never been in doubt, its use is
somewhat restricted by the relatively brittle nature of the material and the
large shrinkage, which occurs during processing.
Some recent developments offer a potential for overcoming these problems.
The set decorative porcelain is essentially a mixture of this with silica, bound
together by a flux or binder such as feldspar, which is a mixture of potassium
and sodium alumina-silicates.
K2O·Al2O3·6SiO2 and Na2O·Al2O3·6SiO2
Feldspar is the lowest fusing component and it is this that melts and flows
during firing, uniting the other components in a solid mass. The fusion
temperature of feldspar may be further reduced by adding to its other low-
fusing fluxes such as borax.
Of the two types of dental porcelain, the high fusing materials fuse in the range
1300–1400ºCwhilst the low-fusing materials fuse in the range 850–1100ºC.
The latter materials are by far the more commonly used products. The
powders supplied to the dentist or technician are not just mixtures of the
various ingredients. During manufacture, the constituents are mixed together
and then fused to form a frit. This is broken up, often by dropping the hot
material into cold water. It is then ground into a fine powder ready for use
more commonly used products. Porcelain powders are sometimes pigmented
in order that natural tooth shades can be matched. The pigments used are
normally metal oxides, which are stable at the fusion temperature.
A low-fusing, transparent glass may be used as a glaze over the completed
body of the porcelain restoration. The glaze gives the crown an impervious,

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
smooth surface and imparts greater translucency. A smooth surface can be
obtained without using a glaze. By careful control of the furnace temperature,
the surface of the normal porcelain will flow and glaze with only a slight
rounding of the contours of the restoration.
Unfortunately, any overheating will cause gross distortions of the shape. The
porcelain powders are mixed with water to produce a plastic mass of material,
which can be molded and carved before fi ring. To improve the working
properties a binder such as sugar or starch is added to some powders. At the
elevated temperatures of the furnace, the starch or sugar binder ignites and the
surface of the structure blackens. The door of the furnace isleft slightly ajar
during this stage to allow the products of combustion to escape. The furnace
door is then closed and fi ring is completed. Shrinkage takes place as the
fluxes bind the particles together causing a uniform inward contraction of the
whole mass. The use of porcelain for constructing inlays is a most exacting
technique because, in this case, firing shrinkage has a direct effect on the fit
of the inlay. For this reason, the porcelain inlay was a very rare restoration.

Properties of porcelain
Esthetically, porcelain is an almost perfect material for the replacement of
missing tooth substance. It is available in a range of shades and at various
levels of translucency such that a most life-like appearance can be achieved.
The inner layer of the porcelain crown, for example, is normally constructed
from an opaque ‘core’ material. This is overlaid with a more translucent
‘dentine’ material with a final coating of translucent’ enamel’ porcelain
forming the outermost layer.
Porcelain is a very rigid, hard and brittle material whose strength is reduced
by the presence of surface irregularities or internal voids and porosities. Fine-
grained powders give more uniform surfaces than coarser grains, and firing at
reduced pressures can reduce porosity. The formation of superficial cracks
due to thermal stresses are best avoided by slow cooling from the firing
temperature. Fracture can be initiated from small surface scratches caused by
grinding and these should be laminated by smoothing or by further fusing.
The brittleness of dental ceramics is compounded by their tendency to
undergo static fatigue. This is a time-dependent decrease in strength, even in

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
the absence of any applied load. Attempts to overcome some of these
problems involved reducing the proportions of Na2O and K2O within the
materials. Hence, one method of strengthening ceramics is to generate
compressive stresses in these regions. One of two mechanisms can achieve
this; first, ion strengthening can be used. This involves soaking the fired
material in a molten salt in order to allow ion exchange at the surface.
A second method for strengthening involves putting the outer layer into
compression through thermal strengthening. During fi ring the outer layer
solidifies first as it cools more rapidly. The poor thermal conductivity of the
material dictates that the inner part of the material remains liquid for longer.
The relatively poor mechanical properties of porcelain can be improved using
alumina, or metal supporting structures. The hardness of porcelain contributes
its ability to resist forces of abrasion but may give rise to some concern over
the potential for porcelain restorations to abrade the opposing teeth.
Porcelain has excellent thermal properties and is a particularly good thermal
insulator. This fact is of importance when gross amounts of enamel and
dentine are to be replaced and the residual layer of dentine may be of minimal
thickness. Correctly formulated porcelain is very resistant to chemical attack,
being unaffected by the wide variations of pH which may be encountered in
the mouth.

CAD–CAM restorations
CAD-CAM stands for computer aided design computer aided manufacture.
This is a high-tech approach to providing patients with durable tooth colored
restorations. It involves recording an optical impression from which a
restoration can be designed using a computer. The design details are then used
to construct the restoration using a milling machine which cuts the desired
shape from a monolithic block of ceramic under the control of the computer.
Care is required during cavity preparation to ensure that are no undercuts
within the cavity. This technique is relatively flexible in terms of the shapes
of restorations that can be made with modern milling technology.
Complex 3 or 4 surface restorations are possible including the replacement of
cusps. In addition, it is possible to manufacture ceramic veneers using the

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
latest generations of these systems. The optical impression is recorded using
miniature video camera, which scans the prepared tooth for about 10 seconds.

CAD–CAM generated dental appliances

This shows a CAD–CAM equipment set up for manufacturing dental

appliances and restorations at the chair side using computer generated images
and computer controlled milling equipment. On the right of the figure is the
control unit and the computer, which is used for viewing the scanned images,
and on the left is the milling instrument in which the shapes are cut from a
variety of materials.

Milling of CAD–CAM restorations

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
Here we see the milling operation in progress. We can see that the blank has
already been cut near to the final shape and following the completion of this
process the dental restoration will be removed from the machine and will be
ready to be cemented into the patient’s mouth. The prepared tooth surface has
to be clean and dry and is coated in an optically reflective powder to maximize
image acquisition. For the sake of accuracy it is important that this layer is
uniform and kept as thin as possible. An optical image of the opposing teeth
can also be captured to allow the software to recreate the normal pattern of
interdigitation between the teeth and hence to create an appropriate surface
anatomy for the restorations concerned. The design of the restoration on the
computer screen takes between 10 and 25 minutes depending on the
complexity of the restoration and the extent to which the software is asked to
accommodate the patient’s occlusion. The milling process takes a further 5–
10 minutes, again varying with the size and complexity of the procedure. The
restoration is tried in and adjusted if necessary. The try in is made easier for
more complex shapes as there is a small spur on the finished restoration when
if comes out of the milling machine which can be used as a handle while
manipulating it. It is then normal to etch the ceramic fitting surface with
hydrofluoric acid and then apply a silane-coupling agent to aid retention
before final cementation using a dual cured resin cement. A final polishing
can be performed in situ. Obviously it is not possible to provide a glazed
ceramic surface with this technology.

Porcelain veneers
Porcelain veneers offer a means of improving the appearance of stained or
discolored teeth. The veneer consists of a thin shell-like structure, which is
ideally fabricated, in such a way that it can be closely adapted to the prepared
tooth. There is some controversy as to whether the veneers can be attached to
unprepared teeth–a technique that would obviously conserve sound tooth
substance, or whether some reduction in the tooth contour is necessary. Most
authorities do advise the removal of about 0.5 mm of labial enamel. The
veneers, which are normally 0.5–0.8 mm thick, may be constructed from feld
spathic porcelain, glass ceramic, pressed ceramic or CAD–CAM techniques
and are bonded to the tooth enamel using a composite resin luting agents. The

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
bonding is achieved by etching the enamel with a phosphoric acid solution or
gel. The fitting surface of the veneer is etched with a solution of hydrofluoric
acid, then dried and treated with a silane coupling agent to aid bonding to the
composite resin.

Porcelain veneer

The appearance of the veneered tooth depends on the color of the underlying
tooth structure, the aesthetic qualities of the ceramic and the use of the correct
shade of luting composite, which may be required to mask any discoloration
in the underlying tooth and give a natural appearance (figure, 48). The use of
a light activated luting composite is normal. These materials offer the
advantage of an extended working time during which the veneer can be placed
accurately. Alternatives to the use of porcelain veneers involve the use of pre-
formed acrylic veneers or polishable composite resin veneers.

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
The ceramic materials have the advantage of being more durable, probably
related to their greater hardness. The technique of fabrication is however
more time consuming than the direct method of using a veneering
composite. The preformed acrylic veneers seem to offer few advantages.
They combine an involved clinical and laboratory technique with poor
durability.

Porcelain fused to metal (PFM)

Porcelain fused to metal restorations involve marrying of the good mechanical

properties of cast dental alloys with the excellent aesthetic properties of
porcelain. A major requirement of the materials used in PFM restorations is
compatibility of the metal and ceramic used. Feld spathic porcelains used for
PFM work normally contain significant amounts of leucite.

Porcelain fused to metal

This increases the coefficient of thermal expansion of the porcelain to a value

that is closer to that for the metal. This helps to prevent the development of
thermal stresses during cooling from the fi ring temperature. The presence of
leucite also helps to strengthen the ceramic. The minimum flexural strength
requirement for PFM ceramics as specified in ISO Standards is 50 MPa,
which is equivalent to the requirement for dentine/enamel porcelains used in
all-ceramic restorations.

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
The requirements of the alloy used to form the substructure are similar to those
for non-porcelain bonding work with additional requirements as follows:
(1) The alloy, having been previously cast into the desired shape, should be
capable of withstanding porcelain firing without melting or suffering creep.
Hence, the alloy must have a high fusion temperature.
(2) The alloy should be sufficiently rigid to support a very brittle porcelain
veneer otherwise; fracture of the veneer is inevitable.
(3) The alloy should be capable of forming a bond with the porcelain veneer
in order that the latter does not become detached.
(4) The alloy should have a value of coefficient of thermal expansion similar
to that for the porcelain to which it is bonded.
There are four types of alloy currently available for porcelain bonding. These
are:
(a) high-gold alloys.
(b) low-gold-content alloys.
(c) silver–palladium alloys.
(d) nickel–chromium alloys.

Porcelain is built up on an alloy substructure.

Low-gold alloys
Low-gold porcelain-bonding alloys contain approximately 50-percentage
gold, 30% palladium to raise the melting temperature and lower the
coefficient of thermal expansion, 10% silver and 10% indium and tin for

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Dental Materials Assis. Prof. Dr. Ibrahim Alfahdawi
porcelain bonding. The mechanical properties of the low-gold alloys are
similar to those for the high-gold materials. They have a slightly greater
modulus of elasticity, which is an advantage for porcelain bonding. The higher
melting range produces better creep resistance for these materials during
porcelain firing. Good properties and a significant cost saving compared with
high-gold alloys account for the wide spread use of these materials for bonded
porcelain work.

Silver–palladium alloys
These alloys contain about 60% palladium, 30%silver and 10% indium and/or
tin to aid porcelain bonding. They have the advantages of a higher modulus
value and a higher melting range than the high-gold alloys. They offer a
suitable alternative to the high-gold materials for bonded porcelain work at a
considerable saving in cost, providing care is taken during casting to avoid
defects and gas inclusions. The taking up of a green hue in some ceramics in
contact with high silver content alloys (silver greening) has been reported,
although this appears to be as much a feature of the composition of the ceramic
as the composition of the alloy.

Nickel–chromium alloys
Nickel–chromium casting alloys typically contain 70–80% nickel and 10–
25% chromium with small quantities of other metals such as molybdenum,
tungsten and beryllium. Porcelain bonding is to the layer of ceramic oxide,
which forms on the surface of the alloy. These alloys have the advantages of
a very high modulus and high melting temperature. Their disadvantages are
as follows.
(1) A high casting shrinkage that may affect accuracy of fit if not fully
compensated by the investment.
(2) A tendency for poor cast ability, with voids in the castings.
(3) A bond strength with porcelain, which does not compare with that
achieved with the other alloys. Indeed, fractures in Ni/Cr–porcelain systems
invariably occur through the oxide layer whereas fractures in the other
systems generally occur cohesively in the porcelain.