Table Of ContentAdvanced Ceramics for Dentistry
Advanced Ceramics
for Dentistry
James Zhijian Shen and Tomaž Kosmacˇ
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List of Contributors
Erik Adolfsson Ceramic Materials, Swerea IVF, Box 104, SE-431 22 Mölndal,
Sweden
Matts Andersson Chalmers University of Technology, SE-412 96 Göteborg, Sweden
Thomas Beikler Department of Operative and Preventive Dentistry and Periodontics,
Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf,
Germany
Dag Henrik Bergsjö Chalmers University of Technology, SE-412 96 Göteborg,
Sweden
Johan Carlson Fraunhofer-Chalmers Research Centre for Industrial Mathematics,
Chalmers Science Park, SE-412 88 Göteborg, Sweden
Haifeng Chen Department of Biomedical Engineering, College of Engineering,
Peking University, Beijing, China
Saverio Giovanni Condo Department of Clinical Sciences and Translational
Medicine, University of Rome Tor Vergata, Rome, Italy
Robert Danzer Institut für Struktur- und Funktionskeramik, Montanuniversität
Leoben, 8700 Leoben, Austria
Jenny Fäldt Nobel Biocare AB, P.O. Box 5190, SE-402 26 Göteborg, Sweden
Boštjan Jančar Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
Tomaž Kosmač Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
Danjela Kuscer Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
Yihong Liu Peking University School and Hospital of Stomatology, National
Engineering Laboratory for Digital and Material Technology of Stomatology,
Beijing 100081, China
Tanja Lube Institut für Struktur- und Funktionskeramik, Montanuniversität Leoben,
8700 Leoben, Austria
Karel Maca Department of Ceramics and Polymers, Brno University of Technology,
Czech Republic
Corrado Piconi Orthopedics Institute, Sacred Heart Catholic University, Rome, Italy
Belinda Reinhardt Department of Operative and Preventive Dentistry and
Periodontics, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225
Düsseldorf, Germany
Simon Jegou Saint-Jean a
David Salamon CEITEC-Central European Institute of Technology, Brno University
of Technology, Technická 3058/10, 61600 Brno, Czech Republic
Rikard Söderberg Chalmers University of Technology, SE-412 96 Göteborg, Sweden
xi
xii List of Contributors
Peter Schüpbach Schupbach Ltd, Service and Research Laboratory, Zugerstraße 64,
CH-8810 Horgen, Switzerland
James Zhijian Shen Berzelii Center EXSELENT on Porous Materials, and
Department of Materials and Environmental Chemistry, Arrhenius Laboratory,
Stockholm University, SE-106 91, Stockholm, Sweden
Martin Stefanic Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
Saso Sturm Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
Martin Trunec Department of Ceramics and Polymers, Brno University of
Technology, Czech Republic
Xinzhi Wang Department of Prosthedontics, Peking University School and Hospital
of Stomatology, 100081 Beijing, China
Jing Zhao Department of Prosthedontics, Peking University School and Hospital of
Stomatology, 100081 Beijing, China; Department of Materials and Environmental
Chemistry, Arrhenius Laboratory, Stockholm University, Stockholm SE-106 91,
Sweden
Preface
Nowadays, you are likely to find references to the topics covered in this book,
in two types of publication: reference books about bioceramics or dental
ceramics; or about dental materials. However, whilst books covering the sub-
ject of bioceramics might provide indepth coverage of the topic, books in the
latter category will more likely present ceramics in an over simplified manner.
In a way, neither type reflects the current status of the field, particularly the
actions that are rapidly being taken for future developments. This is because
the majority of ceramics currently in use in restorative dentistry are regarded
neither as bio-oriented nor as being developed for dental purposes only, at
least not at the moment of introduction into the field of dentistry.
It was during close collaboration with dental practitioners and the dental
industry that the editors of this book recognized a dissymmetry of knowledge
concerning ceramics and the demands for ceramics. They felt a similar knowl-
edge gap existed between ceramics and, in general, the practical demands of
ceramics, in the fields of materials science and engineering. Advanced ceram-
ics for dentistry appears to be such a topic. The original motivation for this
book was to integrate two topics (advanced ceramics and the demand for
advanced ceramics in restorative dentistry) into a single, comprehensive
resource. We were encouraged by the favorable responses received during a
successful symposium on “Advanced Ceramics and Ceramic Processes for
Dentistry,” which we organized together with Horst Fisher, Leif Hermansson,
and Jenny Fäldt in association with the 12th Conference of the European
Ceramic Society that was held in Stockholm in June 2011.
This book is still materials-oriented, but with a strong focus on the latest
applications of advanced ceramics for solving the problems encountered in
restorative dentistry. By highlighting existing problems and emphasizing new
needs, we hope this book can, besides facilitating a better understanding of
state-of-the-art solutions in both ceramics and dentistry, encourage interdis-
ciplinary efforts for developing new concepts, materials, and technologies for
the future. We realized the challenge at the very beginning of this initiative,
when selecting activities across disciplines. Accordingly, efforts were made
to create a balance between dental demands and materials demands, between
fundamentals and practice, between coverage and depth, and between the cur-
rent status of the field and future development.
It would not have been possible to write a book with such broad cover-
age without the understanding and collaboration of all the individual authors
involved. We sincerely appreciate the time and effort they have dedicated to
this work. We would like to acknowledge the JECS Trust for the financial
support that made it possible to arrange the topical symposium “Advanced
xiii
xiv Preface
Ceramics and Ceramic Processes for Dentistry.” It was during this multidis-
ciplinary symposium that most of the topics in this book were discussed. We
would also like to thank Professor Daniel van Steenberghe for encouraging
discussions and for suggesting topics, particularly those that relate to dental
implants. One of us (Shen) would like to take this opportunity to acknowledge
Professor Matts Andersson (the inventor of Procera®) and Professor Hailan
Feng (School and Hospital of Stomatology, Peking University) for their inspir-
ing discussions and close collaborations over the years.
James Zhijian Shen
Tomaž Kosmač
Chapter 1
Introduction
James Zhijian Shen* and Tomaž Kosmač†
*Berzelii Center EXSELENT on Porous Materials; and Department of Materials and
Environmental Chemistry, Arrhenius Laboratory, Stockholm University,
Sweden; †Jožef Stefan Institute, Ljubljana, Slovenia
Ceramic materials are currently used in two categories of application for restora-
tive dentistry, namely, all-ceramic fixed-partial dentures (FPDs) and implantable
components. While the former mainly demand integrated and balanced properties
of mechanical and aesthetic origins, the latter also rely a great deal on the bio-
oriented properties of materials. Innovations in ceramics and ceramic processes
are vital to ensure reliable and affordable dental-restoration solutions with aes-
thetically pleasing outcomes.
A broad range of issues is challenging researchers and engineers in the
ceramics community. These include developing bioactive surfaces on otherwise
inert but load-bearing ceramics for implants; combining inherently chemically
stable and physically stiff ceramics into highly coherent laminate composites
for prosthetic crowns and bridges; improving the optical translucency of load-
bearing ceramics for the manufacture of fully anatomic restorations (without the
need for aesthetic veneering porcelain); and integrating feasible techniques for
producing (in cost-effective and material-saving ways) long-lasting, individual-
ized ceramic components with biocompatibility, complexity, and high precision.
The development of advanced ceramics for dentistry is a topic of prac-
tice-motivated science that requires a multidisciplinary approach, and calls
for collaborations across the disciplines of materials science, product design,
mechanical engineering, imaging technologies, biology, chemistry, and clinical
technologies for the development of new concepts, new materials, and new tech-
nologies. This is a never-ending journey, pursuing optimized clinical solutions
through better understanding, better materials, and better processes to satisfy the
increasing demands of patients, dentists, and social and environmental concerns.
In general, patients are looking for affordable treatments by applying long-
lasting prostheses that can restore or enhance their natural appearance and ful-
fill all the necessary functions. Dentists would prefer to achieve the above goals
through less invasive, less painful, more comfortable, and quicker procedures. In
addition, social and environmental concerns place strong demands on green and
material-saving approaches.
Advanced Ceramics for Dentistry. DOI: http://dx.doi.org/10.1016/B978-0-12-394619-5.00001-8
© 22001144 Elsevier Inc. All rights reserved. 1
2 Advanced Ceramics for Dentistry
The purpose of this book is to provide an overview of the recent progress
made in this multidisciplinary field with a focus on the challenges presented to
future concepts as well as current and emerging technologies. It is not our inten-
tion to provide a history of the application of ceramics in dentistry, or to an in-
depth review of the ceramic materials and processes currently in use in dentistry,
although we will cover most of the ceramics and ceramic components used for
today’s dental restorations. This is why the book is entitled Advanced Ceramics
for Dentistry rather than Advanced Ceramics in Dentistry. It is our aim to cover
the topics of current focus and those of future interest. We hope that in this way
the developers and manufacturers of ceramics will gain a better understanding
of the exact demands of dental practices, while dentists and dental technicians
will become more aware of the limitations and the potential of ceramics and
ceramic processes in this field. In other words, by emphasizing the needs and
exposing the problems, we hope this book will inspire a new way of thinking
and encourage interdisciplinary efforts, rather than just be used as one more ref-
erence source.
Because we had in mind potential readers from two different disciplines:
materials science and dentistry (who have essentially different educational
backgrounds), the first thing we did was to balance the selected topics and opti-
mize their presentation. Efforts were made to establish a good structure for the
sequence of covered topics in order to avoid the obvious risks of disordering and
disintegration that can easily happen when handling a broad range of interdisci-
plinary topics. The book’s topics can thus be divided into seven groups:
1. Teeth as natural materials (Chapter 2).
In this chapter, we look at teeth as natural materials. The development;
formation; composition; microstructure; optical and mechanical properties;
common defects; and damage to human teeth are reviewed. This knowl-
edge set forms the basis of restorative dentistry for designing preventive
treatments in order to maintain tissue integrity and to replace damaged tis-
sues with synthetic materials (e.g. ceramics that mimic the natural appear-
ance and performance of teeth).
2. Dental prostheses and dental implants and their clinical failures
(Chapter 3–5).
In these chapters, the common problems and difficulties encountered in
restorative dentistry are described, including tooth defects and edentulism,
as well as the clinical failures of dental prostheses. Despite the fact that there
are no omnipotent prostheses, some general guidelines for prostheses selec-
tion are given. This is essential for readers with a materials background, and
is designed to help them get an understanding of the real-world problems that
can be encountered. We hope it will also refresh the existing knowledge of
readers with a dental background, and also present problems in such a way
that their counterparts in another field can easily understand them.
Chapter | 1 Introduction 3
3. Advanced ceramics, their processes and mechanical properties
(Chapters 6–9).
In these chapters, detailed descriptions are given to answer the gen-
eral questions that readers with a dental background might have about
advanced ceramics. How are they prepared? What are the relationships
between their properties and microstructures? How can their microstruc-
tures and properties be characterized? The main focus is on their mechani-
cal properties. This is essential materials knowledge used for dealing with
ceramics, and is presented in a way that is easy to follow for readers with a
dental background, but is still of interest to readers with a materials back-
ground when linked to clear application demands.
4. Interfaces between tissues and ceramics (Chapter 10).
This chapter stands alone. The information presented here is about the
interface between tissues and ceramics, and is also the interface of two
disciplines: dentistry and materials. In order to understand this chapter,
knowledge and skills from both disciplines are required.
5. Advanced ceramics currently in use in dentistry (Chapters 11–14).
These chapters review the ceramics currently used in dentistry. An
effort is made to not only describe where and how these ceramics are used,
but also to explain why certain ceramics are chosen for specific purposes
and what problems are typically encountered. Accordingly, the means of
improving the mechanical, bio-, and aesthetic properties of ceramics as
bulk, porous bodies, or surface-active layers are presented. We hope the
knowledge and philosophy presented in this part will pave the way towards
ceramics by design.
6. Industrial-scale production of customized ceramic prostheses (Chapter 15).
The current, highly flexible production processes used for customized
dental prostheses are reviewed in this chapter. These include digitaliza-
tion, computer-aided design, and milling. Quality issues are also addressed,
including prospects for further improvements: adapting new ceramic
materials, and using new materials processes and highly digital treatment
processes.
7. Concepts for the future (Chapters 16–18).
These chapters address material and process demands for solving
the problems encountered in current practice that indicate the direc-
tion of future development. In the near future, minimization of process-
ing defects will continuously appear as a major task for improving the
performance and reliability of dental prostheses. In the longer-term,
biomimetic materials and related processes will be topics of general
importance. Current subtractive manufacturing processes, which gener-
ate huge material waste, have encouraged the development of more sus-
tainable, material-saving, and cost-effective concepts (e.g. rapid additive
manufacturing processes).
