The desire for esthetics in dentistry has never been more top of mind than it is today. In fact, according to a recent report, the market for indirect restorative materials of dental consumables, which includes all-ceramic restorations, porcelain-fused-to-metal, cast gold and cast metal, will reach $280 million by 2023, increasing from $180 million in 2017. More than half of that market share was attributed to all-ceramic materials in 2017. 1NxtGen Reports. 2018–2023 Global Indirect Restorative Materials of Dental Consumables Consumption Market Report. Available at: https://www.nxtgenreports.com/market-research-reports/2018-2023-global-indirect-restorative-materials-of. Accessed October 11, 2018.
Indeed, times have changed since the days when master craftsmen fabricated indirect dental prostheses out of feldspathic porcelain in the lab. And while these hand-built restorations, with their realistic-looking gradations, characterizations, and translucencies, continue to be a popular choice for anterior work, they are brittle. Even with metal substrates, they are prone to fracturing under compressive forces, making them unsuitable in posterior applications. 2Stone R. Haute pursuit. Mentor. 2017;8(5):22–24,27–29.
Restorative Materials for the 21st Century
Available in blocks or ingots for use in subtractive manufacturing, new ceramic materials are so strong they can be used to build full-contour monolithic crowns that don’t require metal copings. In fact, one of the beauties of these materials is that because of their strength, they can be made thinner. This translates into the removal of less natural tooth structure in the course of a prep. 3Stone R. Haute pursuit. Mentor. 2017;8(5):22–24,27–29.
Several types of materials have been available to make this particular brand of magic possible. The three categories of dental ceramics include feldspathic porcelain, which is silica-based; those such as leucite and lithium disilicate, which are silica reinforced with crystalline fillers; and crystalline materials, which include alumina and zirconia. The two getting the most mileage these days appears to be lithium disilicate and zirconia. 4Stone R. Haute pursuit. Mentor. 2017;8(5):22–24,27–29. 5Vallee J, Noble WH, Gupta S, Schulze KA, Hakim F. Selection guidelines for all-ceramic restorations. Decisions in Dentistry. 2017;3(3)24–28.
Made of silica that’s been reinforced with crystalline fillers, lithium disilicate has long been considered the more esthetic of these two new ceramic options. It can be milled via computer-aided design/computer-aided manufacturing or pressed. 6Stone R. Haute pursuit. Mentor. 2017;8(5):22–24,27–29.
With enhanced translucency, opalescence, and the ability to diffuse light, lithium disilicate can masquerade as a real tooth. It can also be stained, glazed and cut back to accommodate porcelain layering so that incisal areas better match those of real anteriors. 7 Vallee J, Noble WH, Gupta S, Schulze KA, Hakim F. Selection guidelines for all-ceramic restorations. Decisions in Dentistry. 2017;3(3)24–28.
As lovely as lithium disilicate restorations are, they have also demonstrated durability over time. 8Kern M, Sasse M, Wolfart S. Ten-year outcome of three-unit fixed dental prostheses made from monolithic lithium disilicate ceramic. J Am Dent Assoc. 2012;143:234–240. The development of lithium disilicate is widely considered to be among the major game changers in dentistry. 9Stone R. Haute pursuit. Mentor. 2017;8(5):22–24,27–29.
When it comes to strength and durability, zirconia is proving its mettle.5 Thanks to its crystalline structure, zirconia restorations are less likely to chip or fracture than other materials. And though esthetics have been a problem due to zirconia’s high density and the fact that it contains no glass, this has been changing. 10Stone R. Haute pursuit. Mentor. 2017;8(5):22–24,27–29.
Newer formulations of zirconia feature better translucency, though this can reduce strength to a degree. In one recent development, however, cubic zirconia was added to the mix to boost translucency while maintaining material strength. Zirconia restorations can also be layered, offering gradual changes in shades, or used in lamination. 11Stone R. Haute pursuit. Mentor. 2017;8(5):22–24,27–29.
Isolation and All-Ceremic Restorations
New indirect materials are emerging all the time, with combinations ranging from resin and ceramic to fiberglass, to the use of nano-ceramic fillers. But no matter what you choose, when performing restorative dentistry, a good isolation system gives you the winning hand in positive outcomes. And comprehensive systems such as the Isolite or Isodry provide not only the dry field so many adhesive systems require, but also lend a hand during impressioning and prepping, with retraction, illumination, suction, safety and comfort — all centered around a soft, patient-friendly mouthpiece.
In the quest to further capture the complexities of natural tooth structure, all-ceramic materials are giving clinicians the ability to create restorations for their patients that are both functional and beautiful. And that’s a winning combination.