(crystalline) (partial crystalline)(amorphous) (sintering) (Fig.1) (Porcelain) (Kaolin)(Feldspar)(Quartz) (Fig.2) (Fig.3) Crow n, FP

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1 CAD-CAM University of Iowa CAD-CAM Land (1889) Porcelain jacket crown Dicor castable crownempress pressable glass ceramics Inceram slip casting crown CAD-CAM (Y-TZP) (Modified lithium disilicate) 1774 Alexis Duchateau First attempt to use ceramic for making denture teeth Charles H. Land All-porcelainjacketcrowns (platinum foil matrix technique) 1940s Acrylic resin was introduced 1950s Abraham Weinstein Porcelain fused to metal(pfm) crowns 1950s Corning Glass Work Dicor castable crown(tetra silicic fluoromica crystals) 1962 Weinstein and Weistein Leucite-containing porcelain and vacuum firing 1965 W. McLean and T.H. Hughes Industrial aluminous porcelain(>50%) added to feldspathic porcelain 1980s Heat pressing. Leucite reinforced feldspathic porcelain. Empress I and OPC 1980s Vita Slip-casting. Glass-infiltrated ceramic core system. Inceram Alumina/Spinel/Zirconia 1990s Nobel Biocare Procera Allceram (Al). First CAM/ CAD core. 1990s 3M Lava, Nobel Biocare Procera Forte, Dentsply Cercon 1998 Ivoclar Lithium disilicate reinforced IPS Empress II (70% success rate in 5 years) 1998 Ceramay GmbH & Co Press to metal. Secondgeneration, low-fusing, high-expansion, leucite glassreinforced ceramic. Authentic. Press to Zr 2006 Ivoclar Lithium disilicate re-emerged as pressable ingot and CAD-CAM milling block Now - Improved strength and esthetics of bilayered Zr restoration - Milled monolithic posterior bridge material (Ceramics)(Porcelain) () (sintering) 58

2 (crystalline) (partial crystalline)(amorphous) (sintering) (Fig.1) (Porcelain) (Kaolin)(Feldspar)(Quartz) (Fig.2) (Fig.3) Crow n, FPD, Post/core, Veneer, Inlay/onlay, implant abutment Resin-bonded FPD Fabrication technique Condensation and sintering: Porcelain jacket crown 1889 Casting and ceramming: Dicor 1950 Heat-pressing and sintering: Empress, Empress II, Emax Sintering and glass infiltration: Inceram 1980 CAD-CAM processing: Procera,Cerec,Cercon,Lava EmaxLithium disilicate Emax Zr Heat-pressingCAD-CAM processing Glass c eramics Empress/Emax Fig. 1 Fig. 2SiO2 Al2O3 Fig. 3 The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 59

3 Composition Feldspathic porcelain: glass matrix and crystalline Porcelain jacket crown 1889 Vitablock Mark II 1991 /TriLuxe 2003 /TriLuxe Forte 2007 Glass ceramics: controlled nucleation and crystal formation Dicor 1950; Empress, Empress II, Emax ; Inceram 1980 Polycrystal ceramics: Procera,Cerec,Cercon, Lava Densely sintered Alumina - Yttrium-stabilized Tetragonal Zirconia Feldspathic porcelain Glass ceramics Glass ceramics InceramSlip casting technique Die (Alumina, Spinel or Zirconia/Alumina) C Glass ceramics Glass ceramics(fig.4d) Polycrystal ceramics Procera Alumina Fig. 4 A Feldspathic porcelain; B Empress I; C Empress II; D Inceram Spinel; E Feldspathic porcelain machinable; F Polycrystal zirconia 60

4 F l e x u r a l s t r e n g t h veneering porcelain(<100mpa)glass ceramics( mpa)inceram ( MPa) AluminaZirconiaZirconia 1200MPa (Fig.5) IPS Emax lithium disilicateheatpressing CAD-CAM HT (High Translucency), LT(Low Translucency), MO(Medium opacity), Impulse (Value, Opal) Blocks CAD-CAMSoft intermediate state840 20min Dimensional change Zirconia Polycrystal() Ceramic steel Transformation toughening Tetragonal form (crack)tetragonal zirconia Monoclinic form(fig.7)3% Crack Crack propagation(fig.8) Fig.5 Strength evolution of dental ceramics Lithium Disilicate () (Fig.6) 70%Empress IIEmax (Refractive index) Fig.7 Tetragonal and monoclinic form Fig.6 Fig.8 Crack propagation and transformation toughening The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 61

5 Fig. 9 (Fig.9) veneering porcelain crack initiationporcelain (Coefficient of thermal expansion, CTE)10 x 10-6 CTE (e.g.leucite or Fluoroapatite) Tetragonal form magnesium oxide (MgO), yttrium oxide, (Y2O3), calcium oxide (CaO), cerium oxide (Ce2O3)yttrium oxideyttria-stabilized tetragonal zirconia polycrystal(y-tzp) Metoxit ( metoxit.com) Tosoh( Yttrium oxide 3-10 mol% (Partially sintered or fully sintered) 3 mol% yttrium oxide (grain size) 3M (Fig.10) Fig.10 Zirconia processing workflow 62

6 CO-Precipitated( )Mixed Oxide ProcessGrain size Spray drying organic binder 2. (Pressing)CAD-CAM PressingAxial compactingisostatic c o m pac t i ng ()( bar) 3. (Presintering) 4. CAD-CAM 5. (Color) 6. (Final sintering) C8-14 Jiang et al(2011) 40nm particle size C 90nm particle size C (Fig.11A, B) (300 C/hr) (600 C/hr)(Fig.12) CAD-CAM (25-100m) Transformation tougheningcrack cracktransformation Machining Fig.11A,B Fig.12 Metoxit The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 63

7 veneering porcelain(chipping) porcelainzirconia core Zirconia core porcelainzirconia core cutbackporcelain double scanning cutback Crack propagationh+ Salazar Marocho et al(2010)in-ceram ZrIn-Ceram Alwet cyclic loading FPD connector connector area FPD7 mm FPD9-12 mm Emax Lithium Disilicate 9-12mm FPD PFM Liu et al(2011) 0.07 Contrast Ratio difference Contrast Ratio(CR) (chromatic) (achromatic)munsell system (Value)CR0 101 enamel dentin Spyropoulou et al. (2011) CRLight, mediumintense PFM crowncr 1.0Lithium Disilicate Emax lithium disilicate Lithium disilicate PFM CAD-CAM CAD-CAM (zirconia, lithium disilicate, wax, feldspathic porcelain, high density resin) (Multiple die scanning) CAM Implant abutment/suprastructuredouble scanning Marginal fit Scanner type (contact probe, laser strip line, optical scanner) Impression (zirconia) () Full contour zirconia Sinora Cerec 3D Long history of success Materials and technique support by IPS E.max, Vitablocs, etc. Intraoral optical scanner: Cerec Bluecam. Optical 64

8 impression superimposes separate images to create 3 D model Virtual articulator Biogeneric tooth model Cerec 3Dchairside scanner milling materials EmaxVitablocs 3M Lava Laser strip scanner Dry milling Translucent zirconia materials Shaded zirconia Good marginal fit Abundant research data Lava Chairside scanner Rocatec treatment (silanization) Lava Lava Ultimate namomer filler NobelProcera Conventional stylus type scanner NobelProcera scanner: Conoscopic technology - laser scanner - impression scanning 4 shade of zirconia, 2 shade of alumina Implant abutment: support miltple implant systems zirconia, alumina, titanium Crown, FPD, abutment, milled bar Good research data CAD-CAM Stylus type scanner Open design laser scanner Procera Implant systemnobel Biocare Straumann, SPI, Astraimplant abutment, FPD framework, milled bar and suprastructure scanbodyimplant connection zirconia abutment(fig.13) implant abutment metal basezirconia abutment (Fig.14) Fig.13 Implant abutment fabrication by Procera A. B. C. D. E. F. G. H. I-a. I-b. The Academy of Prosthetic Dentistry, Republic of China/ 中華民國贋復牙科學會 65

9 Fig.14 metal basezirconia abutment by Kavo Everest A. B. D. E. C. F. G. H. I-a I-b 66

1. Generalized chronic periodontitis. 2. Occlusal attrition. 3. Posterior bite collapse 4. Chronic apical periodontitis of 15, 44 Periodontal treatmen

1. Generalized chronic periodontitis. 2. Occlusal attrition. 3. Posterior bite collapse 4. Chronic apical periodontitis of 15, 44 Periodontal treatmen 1 1. 2. 3. addition silicone agar functional impression wax 56 Missing teeth of 11,12,14,18,21,22,24,25,26,27,28,34,37,38,46,47,48 Uneven occlusal plane and loss of vertical dimension Multiple occlusal