Tooth Coloured Restorations - Non Ceramic - Ceramage
Ceramage from Shofu
the next generation indirect composite.
The “next generation” of indirect composites, Ceramage , incorporates advanced nano-particle and submicron filler technology, creating the most significant development in composites in the last ten years, surpassing previous benchmarks and setting new industry standards for polish, shine and wear. Developed by the same team of chemists and researchers who created Herculite, Prodigy and Point 4, today’s standards for high quality direct composite materials.
Light, heat and pressure produce the highest degree of material conversion(98.5%), giving Ceramage superior strength and wear characteristics. The opaceous dentine’s high filler content exceeds 87%, providing exceptional strength and shrinkage of less that 0.94%, which means better marginal integrity and less chance of microleakage.
The opalescent appearance more closely characterizes natural enamel like no other composite based material. Ceramage restorations provide less wear to opposing dentition than porcelain because they are not as hard or abrasive.
After 2 years of successfully completed clinical trials, clinical feedback points to this indirect hybrid restoration being superior to porcelain for intracoronal posterior aesthetic restorations for the following reasons:
- Significantly lower fracture rates and less technique sensitive
- Less wear on opposing tooth structure
- Better marginal adaptation
- Easier to polish if adjusted
- Lower laboratory fee
- Superior bonding strengths
Indirect composites are superior to direct composites due to the fact that most of the polymerization shrinkage takes place outside of the mouth. Consequently, there is less stress at the tooth-restoration margin.
This leads to the following advantages:
- Less microleakage
- Less marginal breakdown
- Less post operative sensitivity
- Less marginal staining
Due to concerns about polymerization shrinkage in the tooth, proximal contacts and technique difficulties, direct composites should be used only for small Class I and II restorations.
Indications
Ceramage hybrid restorations are ideally indicated for Inlays, Onlays, Full Crowns and Implant Crowns. Since intracoronal composite and porcelain restorations should be bonded in place, not cemented, it is important that the bonding area be kept dry during the bonding procedure. Consequently, deep subgingival margins pose a problem. Rubber dam is the method of choice for isolation. If the restoration cannot be kept dry during bonding, another treatment option is preferred.
Preparation
Butt joint margins are recommended throughout the preparation.
The reasons for this are:
- Thin bevelled margins can break off during seating
- Bevelled margins are more likely to fracture under occlusal forces
- Bevelled margins are more difficult to prepare in the mouth
- Bevelled margins are more difficult to finish to in the lab
- Bevelled margins remove more tooth structure.
Inlays
Observe antagonist contacts carefully. The preparation depth should be approximately 2.5mm in the fissure area. The same is required for the isthmus.
Rounded internal line angles are preferred.
All internal undercuts do not have to be removed.
Onlays
Use the same procedure as for inlays.
An onlay with a reduction of 2.5mm for cuspal coverage can be prepared as shown. Adequate thickness of material is essential as strength is directly proportional to bulk of material when loaded vertically.
Butt joins are essential. Forget your gold inlay preparations - this is a totally different material that needs bulk at the margins where possible!
A dual curing glass ionomer lining cement can be placed over all deep dentine, and can also fill in undercuts and as an insurance policy against recurrent decay. At the same time, any undercuts in the enamel (on the cavo-surface margin) are removed so the entire preparation will draw. Dentinal undercuts do not have to be removed as they will be blocked out in the lab and filled with resin luting agent at cementation.
10 to 14 degrees of taper towards the occlusal is recommended. Since 100% of the restoration will be bonded, nearly parallel walls are not needed, and in fact, could pose a problem during seating.
