12 Cerâmica e cimentação adesiva

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Cerâmicas Odontológicas 
Vinicius de Magalhães Barros 
 
Objetivos de Aprendizado 
!  Reconhecer	vantagens	e	desvantagens	das	cerâmicas	
!  	Conhecer	a	composição	básica	das	cerâmicas	
!  	Classificar	os	sistemas	cerâmicos	em	ácido	sensíveis	ou	resistentes	
!  	Saber	as	indicações	clínicas	dos	sistemas	cerâmicos		
!  	Conhecer	as	técnicas	de	cimentação	adesiva	e	o	tratamento	do	substrato		
	cerâmico	de	acordo	com	sua	sensibilidade	ao	condicionamento	ácido	
 Material restaurador de uso indireto, 
composto por óxidos metálicos e não metálicos, unidos 
 por ligações covalentes de forte caráter iônico. 
Cerâmicas 
!  	Biocompa@bilidade	
!  	Esté@ca	
!  	Estabilidade	de	cor		
Cerâmicas		-	Vantagens		
!  	Radiopacidade		
Cerâmicas		-	Vantagens		
!   Resistência à compressão 
!   Resistência à abrasão 
!   Coeficiente de expansão térmica linear e 
condutibilidade térmica semelhantes ao dente 
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Cerâmicas		-	Desvantagens		
!   Alto módulo de elasticidade 
!   Pode desgastar os dentes antagonistas 
!   Friabilidade 
Cerâmicas		-	Desvantagens		
!   Baixa resistência à tração 
!   Tempo de confecção longo 
!   Alto custo 
Fase Cristalina Fase Vítrea 
1. Arranjo espacial 
indefinido 
2. Baixa resistência 
mecânica 
3. Alta transmissão de luz 
 
1.  Alta resistência 
mecânica 
2.  Temperatura cocção 
elevada 
3.  Translucidez 
reduzida 
 
Coroas Metalocerâmicas 
Coroas Metal Free 
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“As restaurações livres de metal permitem uma maior 
transmissão da luz na região cervical favorecendo o 
aspecto natural dos tecidos gengivais.” 
A systematic review of the survival and
complication rates of all-ceramic and
metal–ceramic reconstructions after an
observation period of at least 3 years.
Part I: single crowns
Bjarni E. Pjetursson
Irena Sailer
Marcel Zwahlen
Christoph H. F. Ha¨mmerle
Authors’ affiliations:
Bjarni E. Pjetursson, Department of Periodontology
and Fixed Prosthodontics, University of Berne
School of Dental Medicine, Berne, Switzerland
Irena Sailer, Christoph H. F. Ha¨mmerle,
Department of Fixed and Removable Prosthodontics
and Dental Material Science, University of Zurich,
Zurich, Switzerland
Marcel Zwahlen, Research Support Unit,
Department of Social and Preventive Medicine,
University of Berne, Berne, Switzerland
Correspondence:
Bjarni E. Pjetursson, DDS
Department of Periodontology and Fixed
Prosthodontics
University of Berne
Freiburgstrasse 7
CH 3010 Berne, Switzerland
Tel.: þ41 31 632 2577
e-mail: bjarni.pjetursson@zmk.unibe.ch
Key words: all-ceramic, biological complications, ceramic, complication rates, failures,
longitudinal, metal–ceramic, single crowns, success, survival, systematic review, technical
complications
Abstract
Objectives: The objective of this systematic review was to assess the 5-year survival rates of
all-ceramic single crowns and to compare it with the survival rates of metal–ceramic crowns
and to describe the incidence of biological and technical complications.
Methods: An electronic Medline and Dental Global Publication Research System search
complemented by manual searching was conducted to identify prospective and
retrospective cohort studies on all-ceramic and metal–ceramic crowns with a mean follow-
up time of at least 3 years. Patients had to have been examined clinically at the follow-up
visit. Assessment of the identified studies and data abstraction was performed
independently by two reviewers. Annual failure rates were analyzed using standard and
random-effects Poisson regression models to obtain summary estimates of survival
proportions.
Results: The search provided 3473 titles and 177 abstracts. Full-text analysis was performed
for 86 articles, resulting in 34 studies that met the inclusion criteria. In meta-analysis, the 5-
year survival of all-ceramic crowns was estimated at 93.3% (95% confidence interval (CI):
91.1%–95%) and 95.6% (95% CI: 92.4%–97.5%) for metal–ceramic crowns.
All-ceramic crowns were also analyzed according to the material utilized. Densely
sintered alumina (Procera
s
technique) crowns showed the highest 5-year survival rate of
96.4%, followed by reinforced glass–ceramic crowns (Empress
s
technique) and InCeram-
crowns with survival rates of 95.4% and 94.5%, respectively. A significantly lower survival
rate of 87.5% was calculated for glass–ceramic crowns after 5 years.
All-ceramic crowns were also grouped and analyzed regarding the position in the mouth.
All four types of all-ceramic crowns showed lower survival rates when seated on posterior
teeth. Moreover, for glass–ceramic crowns (84.4%) and InCeram-crowns (90.4%), this
difference reached statistical significance (P¼0.009, P¼0.028).
Conclusion: Based on the present systematic review, all-ceramic crowns, when used for
anterior teeth, showed survival rates at 5 years comparable to those seen for metal–ceramic
crowns.
When used for posterior teeth, the survival rates at 5 years of densely sintered alumina
crowns (94.9%) and reinforced glass–ceramic crowns (93.7%) were similar to those obtained
for metal–ceramic crowns. Furthermore, lower survival rates of 90.4% and 84.4% can be
expected for InCeram crowns and glass–ceramic crowns when utilized for premolars and
molars.
To cite this article:
Pjetursson BE, Sailer I, Zwahlen M, Ha¨mmerle CHF. A
systematic review of the survival and complication rates
of all-ceramic and metal–ceramic reconstructions after
an observation period of at least 3 years. Part I: single
crowns.
Clin. Oral Impl. Res. 18 (Suppl. 3), 2007; 73–85
doi: 10.1111/j.1600-0501.2007.01467.x
c# 2007 The Authors. Journal compilation c# 2007 Blackwell Munksgaard 73
A systematic review of the survival and
complication rates of all-ceramic and
metal–ceramic reconstructions after an
observation period of at least 3 years.
Part I: single crowns
Bjarni E. Pjetursson
Irena Sailer
Marcel Zwahlen
Christoph H. F. Ha¨mmerle
Authors’ affiliations:
Bjarni E. Pjetursson, Department of Periodontology
and Fixed Prosthodontics, University of Berne
School of Dental Medicine, Berne, Switzerland
Irena Sailer, Christoph H. F. Ha¨mmerle,
Department of Fixed and Removable Prosthodontics
and Dental Material Science, University of Zurich,
Zurich, Switzerland
Marcel Zwahlen, Research Support Unit,
Department of Social and Preventive Medicine,
University of Berne, Berne, Switzerland
Correspondence:
Bjarni E. Pjetursson, DDS
Department of Periodontology and Fixed
Prosthodontics
University of Berne
Freiburgstrasse 7
CH 3010 Berne, Switzerland
Tel.: þ41 31 632 2577
e-mail: bjarni.pjetursson@zmk.unibe.ch
Key words: all-ceramic, biological complications, ceramic, complication rates, failures,
longitudinal, metal–ceramic, single crowns, success, survival, systematic review, technical
complications
Abstract
Objectives: The objective of this systematic review was to assess the 5-year survival rates of
all-ceramic single crowns and to compare it with the survival rates of metal–ceramic crowns
and to describe the incidence of biological and technical complications.
Methods: An electronic Medline and Dental Global Publication Research System search
complemented by manual searching was conducted to identify prospective and
retrospective cohort studies on all-ceramic and metal–ceramic crowns with a mean follow-
up time of at least 3 years. Patients had to have been examined clinically at the follow-up
visit. Assessment of the identified studies and data abstraction was performed
independently by two reviewers. Annual failure rates were analyzed using standard and
random-effects Poisson regression models to obtain summary estimates of survival
proportions.
Results: The search provided 3473 titlesand 177 abstracts. Full-text analysis was performed
for 86 articles, resulting in 34 studies that met the inclusion criteria. In meta-analysis, the 5-
year survival of all-ceramic crowns was estimated at 93.3% (95% confidence interval (CI):
91.1%–95%) and 95.6% (95% CI: 92.4%–97.5%) for metal–ceramic crowns.
All-ceramic crowns were also analyzed according to the material utilized. Densely
sintered alumina (Procera
s
technique) crowns showed the highest 5-year survival rate of
96.4%, followed by reinforced glass–ceramic crowns (Empress
s
technique) and InCeram-
crowns with survival rates of 95.4% and 94.5%, respectively. A significantly lower survival
rate of 87.5% was calculated for glass–ceramic crowns after 5 years.
All-ceramic crowns were also grouped and analyzed regarding the position in the mouth.
All four types of all-ceramic crowns showed lower survival rates when seated on posterior
teeth. Moreover, for glass–ceramic crowns (84.4%) and InCeram-crowns (90.4%), this
difference reached statistical significance (P¼0.009, P¼0.028).
Conclusion: Based on the present systematic review, all-ceramic crowns, when used for
anterior teeth, showed survival rates at 5 years comparable to those seen for metal–ceramic
crowns.
When used for posterior teeth, the survival rates at 5 years of densely sintered alumina
crowns (94.9%) and reinforced glass–ceramic crowns (93.7%) were similar to those obtained
for metal–ceramic crowns. Furthermore, lower survival rates of 90.4% and 84.4% can be
expected for InCeram crowns and glass–ceramic crowns when utilized for premolars and
molars.
To cite this article:
Pjetursson BE, Sailer I, Zwahlen M, Ha¨mmerle CHF. A
systematic review of the survival and complication rates
of all-ceramic and metal–ceramic reconstructions after
an observation period of at least 3 years. Part I: single
crowns.
Clin. Oral Impl. Res. 18 (Suppl. 3), 2007; 73–85
doi: 10.1111/j.1600-0501.2007.01467.x
c# 2007 The Authors. Journal compilation c# 2007 Blackwell Munksgaard 73
Touati, 2000 
“Em 10 anos de experiência observou-se 
que a taxa de insucesso das restaurações 
em cerâmica pura não excedeu a das 
restaurações metalocerâmicas” 
Suliiman, et al., 1997 
Neiva, et al., 1998 
Yeo, et al., 2003 
Procera AllCeram 64 µm 
InCeram Alumina 112 µm 
IPS Empress I 63 µm 
IPS Empress II 46 µm 
Adaptação Marginal 
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Feldspática Aluminizada 
Aluminizada infiltrada de vidro 
Aluminizada sinterizada 
Vidro ceramizado 
Feldspática ref. leucita 
Classificação das porcelanas 
Quanto à composição 
Garone Netto e Burger, 1998 
 
Classificação das porcelanas 
Quanto ao sistema de processamento 
Fundida 
Usinada 
Prensada e injetada 
Infiltrada 
Convencional 
(Álvarez-Fernández et al., 2003) 
Condicionáveis 
Feldspáticas 
Reforçadas com leucita 
Dissilicato de lítio 
 
Não 
Condicionáveis 
Alumina 
Zircônia 
 
Classificação das porcelanas 
Quanto à sensibilidade ao ácido fluorídrico 
Souza, Ozcan e Miyashita, 2011 
 
Controle 
Borges et al, 2003 
Dissilicato de lítio 
Ácido Fluorídrico 10% - 20s 
Controle 
Alumina 
Ácido Fluorídrico 10% - 2min 
Borges et al, 2003 
Indicações Clínicas 
Sistema cerâmico Resistência 
(Mpa) 
Situação clínica 
Feldspática 
(metalocerâmica) 
Coroa unitária anterior e posterior e PPF. 
Feldspática (metal free) 
 
 110 Coroa anterior, facetas, inlay e onlay 
Dissilicato de litio - 
Emax (metal free) 
300-400 Coroa unitária anterior e posterior, inlay, 
onlay, facetas, prótese adesiva e PPF de 3 
elementos (até 2 premolar) 
Y-TZP – zircônia (metal 
free) 
 
900-1200 Coroa unitária anterior e posterior, e PPF 
de 3 a 8 elementos, prótese adesiva e 
abtuments implantes 
Gomes et. al, 2008 e Amoroso et. al, 2012 
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A.S.L. 
 Coroas anteriores – 
cerâmica reforçada com 
dissilicato de lítio 
Vinicius de Magalhães Barros 
Laboratório Romanini 
 
16/07/2013 
06/11/2013 
Iniciais 
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Enceramento 
Mock up 
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Preparos 
Provisórias 
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Prova cerâmica 
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Cimentação Adesiva 
Dissilicato de lítio + cimento autocondicionante U200 
Controle 
Borges	et	al,	2003	
IPS Empress 2 – Condicionamento ácido 
Ácido Fluorídrico 10% - 20s 
Cimentação Adesiva 
Dissilicato de lítio + cimento autocondicionante U200 
Ácido	fluorídrico 10% 
20s 
Lavar 60s / secar Silano 
 
Cimento 
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Cimentação Adesiva 
Dissilicato de lítio + cimento autocondicionante U200 
Ácido	fluorídrico 10% Após 
condicionamento 
e secagem 
Silano Cimento 
Finais 
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N.C.L. 
 Coroas em zircônia 
Vinicius de Magalhães Barros 
Laboratório Chroma 
 
05/2013 
09/2013 
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Cimentação Adesiva 
Zircônia + cimento autocondicionante U200 
OPÇÃO 1 
Silicatização Sistema Rocatec 
3M ESPE 
Silicatização Sistema Rocatec 
3M ESPE 
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Ácido	fosfórico 37% 
20s 
(Limpeza) 
Lavar 60s / 
secar 
Silano 
 
Cimento Silicatização 
 
Cimentação Adesiva 
Zircônia + cimento autocondicionante U200 
OPÇÃO 1 
 
Ácido fosfórico	37% 
(limpeza) 
Após limpeza e 
secagem 
Silano Cimento 
Cimentação Adesiva 
Zircônia + cimento autocondicionante U200 
OPÇÃO 1 
 
Cimentação Adesiva 
Zircônia + cimento autocondicionante U200 
OPÇÃO 2 
 
Cimentação Adesiva 
Zircônia + cimento autocondicionante U200 
OPÇÃO 2 
 
Ácido	fosfórico 37% 
20s 
(Limpeza) 
Lavar 60s / secar Primer para 
metal 
(2 min) 
 
Cimento 
Ácido fosfórico	37% 
(limpeza) 
Após limpeza e 
secagem 
Primer para 
metal 
Cimento 
Cimentação Adesiva 
Zircônia + cimento autocondicionante U200 
OPÇÃO 2 
 
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ESTUDO DA INFLUÊNCIA DE 
DIFERENTES TRATAMENTOS DE 
SUPERFÍCIE DE SISTEMAS CERÂMICOS 
NA RESISTÊNCIA DE UNIÃO AO ENSAIO 
DE MICROTRAÇÃO EM DENTINA 
I – Felspática 
II – Empress 2 
III – In Ceram 
 
A – Jateamento 
B- Condicionamento ác. 
C - Silicatização 
Cimentação Adesiva 
Sistema cerâmico Ácido 
fluorídrico 
10% 
Silano 
 
Jateamento 
óxido de 
Alumínio 
Primer 
metálico 
 
Feldspática (metalocerâmica) X X 
Feldspática (metal free) X X 
Dissilicato de litio - Emax (metal free) X 
 
X 
 
Y-TZP – zircônia (metal free) 
(opção 1 – silicatização) 
X X 
 
 X 
 
Y-TZP – zircônia (metal free) 
(opção 2 – primer metálico) 
X 
 
X 
 ? 
? Estudos recentes tem demonstrado que o jatemento com óxido de alumínio na zircônia tem influenciado 
negativamente na sua resistência mecânica. 
Souza, Ozcan e Miyashita, 2011