the NobelProcera™ system

The Nobel Biocare NobelProcera™ system was developed for manufacturing of individualized dental restorations. Utilizing the latest scanning, CAD/CAM and manufacturing technologies, high accuracy of technologies, a perfect precision fit is ensured and a perfect precision of fit is ensured. By combining the NobelProcera™  manufacturing technology with the use of alumina and zirconia ceramics, which are biocompatible materials with good mechanical properties, Nobel Biocare provides individualized, highly esthetic dental solutions (1-13).

References

1 Al-Dohan HM, Yaman P, Dennison JB, Razzoog ME, Lang BR. Shear strength of core-veneer interface in bi-layered ceramics. J Prosthet Dent 2004;91(4):349-55. Abstract in PubMed

2 Andersson M, Odén A. A new all-ceramic crown. A dense-sintered, high-purity alumina coping with porcelain. Acta Odontol Scand 1993;51:59-64. Abstract in PubMed

3 Anusavice KJ. Degradability of dental ceramics. Adv Dent Res 1992;6:82-9. Abstract in PubMed

4 Chai J, Takahashi Y, Sulaiman F, Chong K, Lautenschlager EP. Probability of fracture of all-ceramic crowns. Int J Prosthodont 2000;13(5):420-4. Abstract in PubMed

5 Esquivel-Upshaw JF, Chai J, Sansano S, Shonberg D. Resistance to staining, flexural strength, and chemical solubility of core porcelains for all-ceramic crowns. Int J Prosthodont 2001;14(3):284-8. Abstract in PubMed

6 Harrington Z, McDonald A, Knowles J. An in vitro study to investigate the load at fracture of Procera AllCeram crowns with various thickness of occlusal veneer porcelain. Int J Prosthodont 2003;16(1):54-8. Abstract in PubMed

7 Hegenbarth EA. Procera aluminum oxide ceramics; A new way to achieve stability, precision and esthetics in allceramic restorations. Quintessence Dent Technol 1996;19:21-34.

8 Pallis K, Griggs JA, Woody RD, Guillen GE, Miller AW. Fracture resistance of three all-ceramic restorative systems for posterior applications. J Prosthet Dent 2004;91(6):561-9. Abstract in PubMed

9 Potiket N, Chiche G, Finger IM. In vitro fracture strength of teeth restored with different all-ceramic crown systems. J Prosthet Dent. 2004 Nov;92(5):491-5. Abstract in PubMed

10 Wagner WC, Chu TM. Biaxial flexural strength and indentation fracture toughness of three new dental core ceramics. J Prosthet Dent. 1996 Aug;76(2):140-4. Abstract in PubMed

11 Webber B, McDonald A, Knowles J. An in vitro study of the compressive load at fracture of Procera AllCeram crowns with varying thickness of veneer porcelain. J Prosthet Dent 2003;89(2):154-60. Abstract in PubMed

12 Zeng K, Oden A, Rowcliffe D. Flexure tests on dental ceramics. Int J Prosthodont 1996;9(5):434-9. Abstract in PubMed

13 Zeng K, Oden A, Rowcliffe D. Evaluation of mechanical properties of dental ceramic core materials in combination with porcelains. Int J Prosthodont. 1998 Mar-Apr;11(2):183-9. Abstract in PubMed

14 Snyder MD, Hogg KD. Load-to-fracture value of different all-ceramic crown systems. J Contemp Dent Pract. 2005 Nov 15;6(4):54-63. Abstract in PubMed

15 Thomas P, Barnstorf S, Summer B, Willmann G, Przybilla B. Immuno-allergological properties of aluminium oxide (Al203) ceramics and nickel sulfate in humans. Biomaterials. 2003 Mar;24(6):959-66. Abstract in PubMed

16 Stappert C.F, Park D.-W, Stappert D, Rekow E.D, Thompson V.P. Damage modes and reliability of Alumina and Zirconia ceramic-layer-structures. J Dent Res 2006;85 (Spec Iss B):abstract 2092.

17 Thompson V.P, Stappert C.F, Kim B, Stappert D, Park D.-W, Pines M, Rekow E.D. Damage and reliability of ceramic and metal-ceramic layer structures. J Dent Res 2006;85(Spec Iss A):abstract 0076.

NobelProcera™ Crown Alumina

The NobelProcera™ Crown Alumina was introduced in 1991, and clinical long-term studies have shown cumulative success rates of 98 % after 5 years, and 92 % after 10 years in function 20-34. Results from long-term studies have also revealed a good prognosis for NobelProcera™ Crown Alumina on posterior teeth (25, 30, 34). In addition, the good precision of fit of the NobelProcera™ Crown Alumina has been repeatedly reported (35-39).

References

20 Andersson M, Odén A. A new all-ceramic crown. A dense-sintered, high-purity alumina coping with porcelain. Acta Odontol Scand 1993;51:59-64. Abstract in PubMed

21 Andersson M, Razzoog ME, Oden A, Hegenbarth EA, Lang BR. Procera: a new way to achieve an all-ceramic crown. Quintessence Int. 1998 May;29(5):285-96. Abstract in PubMed

22 Bonnard P, Hermans M, Adriaenssens P, Daelemans P, Malevez C. Anterior esthetic rehabilitation on teeth and dental implants optimized with Procera technology: a case report. J Esthet Restor Dent. 2001;13(3):163-71. Abstract in PubMed

23 Brunton PA, Smith P, McCord JF, Wilson NH. Procera all-ceramic crowns: a new approach to an old problem? Br Dent J. 1999 May 8;186(9):430-4. Abstract in PubMed

24 Chai J, McGivney GP, Munoz CA, Rubenstein JE. A multicenter longitudinal clinical trial of a new system for restorations. J Prosthet Dent 1997;77(1):1-11. Abstract in PubMed

25 Fradeani M, D'Amelio M, Redemagni M, Corrado M. Five-year follow-up with Procera all-ceramic crowns. Quintessence Int. 2005 Feb;36(2):105-13. Abstract in PubMed

26 Haag P, Andersson M, Vult von Steyern P, Odén A. 15 years of clinical experience with Procera^® Alumina. A Review. Appl Osseointegrat Res 2004;4:7-12

27 Hegenbarth EA. Procera aluminium oxide ceramics. A new way to achieve stability, precision, and esthetics in allceramic restorations. 1996 QDT(19): 21-34.

28 Jokstad A. A split-mouth randomized clinical trial of single crowns retained with resin-modified glass-ionomer and zinc phosphate luting cements. Int J Prosthodont. 2004 Jul-Aug;17(4):411-6. Abstract in PubMed

29 Naert I, Van der Donck A, Beckers L. Precision of fit and clinical evaluation of all-ceramic full restorations followed between 0.5 and 5 years. J Oral Rehabil. 2005 Jan;32(1):51-7. Abstract in PubMed

30 Oden A, Andersson M, Krystek-Ondracek I, Magnusson D. Five-year clinical evaluation of Procera AllCeram crowns. J Prosthet Dent 1998;80(4):450-6. Abstract in PubMed

31 Ottl P, Piwowarczyk A, Lauer HC, Hegenbarth EA. The Procera AllCeram system. Int J Periodontics Restorative Dent 2000;20(2):151-61. Abstract in PubMed

32 Razzoog ME, Lang LA, McAndrew KS. AllCeram crowns for single replacement implant abutments. J Prosthet Dent 1997;78(5):486-9. Abstract in PubMed

33 Zarone F, Sorrentino R, Vaccaro F, Russo S, De Simone G. Retrospective clinical evaluation of 86 Procera AllCeram™ anterior crowns on natural and implant-supported abutments. Clin Implant Dent Relat Res. 2005; 7(Suppl 1) 95-103. Abstract in PubMed

34 Ödman P, Andersson B. Procera AllCeram crowns followed for 5 to 10.5 years: a prospective clinical study. Int J Prosthodont. 2001 Nov-Dec;14(6):504-9. Abstract in PubMed

35 Gottlander R, Adielsson B, Haag P. Efficient manufacturing, precision fit and biocompatibility in the Procera technique for fabrication of dental prosthesis. QDT 1994;17:9-17.

36 May KB, Russell MM, Razzoog ME, Lang BR. Precision of fit: the Procera AllCeram crown. J Prosthet Dent 1998;80(4):394-404. Abstract in PubMed

37 Quintas AF, Oliveira F, Bottino MA. Vertical marginal discrepancy of ceramic copings with different ceramic materials, finish lines, and luting agents: an in vitro evaluation. J Prosthet Dent. 2004;92(3):250-7. Abstract in PubMed

38 Sulaiman F, Chai J, Jameson LM, Wozniak WT. A comparison of the marginal fit of In-Ceram, IPS Empress, and Procera crowns. Int J Prosthodont 1997;10(5):478-84. Abstract in PubMed

39 Takahashi T, Gunne J. Fit of implant frameworks: an in vitro comparison between two fabrication techniques. J Prosthet Dent. 2003 Mar;89(3):256-60. Abstract in PubMed

40 Begazo CC, Van Waas M, Feilzer AJ. Two-year Clinical Evaluation of All-Ceramic Crowns. J Dent Res 2004;83(Spec Iss B):abstract 0229. Abstract

41 Galindo ML, Hagmann E, Marinello CP, Zitzmann NU. Long-term clinical results with Procera AllCeram full-ceramic crowns. Schweiz Monatsschr Zahnmed 2006;116:804-809. Abstract in PubMed

42 Hochstedler JL, Sadan A, Chiche GJ, Mercante DE, Blatz MB. Clinical Survival of Procera AllCeram Ceramic Crowns in Student Clinics. J Dent Res 2005;84(Spec Iss A):abstract 0427. Abstract

43 Kohal RJ, Klaus G, Strub JR. Zirconia-implant-supported all-ceramic crowns withstand long-term load: a pilot investigation. Clin Oral Implants Res 2006;17:565-571. Abstract in PubMed

44 Schmidt AE, Wolf BH, Walter MH, Boening KW. Clinical Performance of Procera AllCeram Crowns. J Dent Res 2002;81(Spec Iss A):abstract 1695. Abstract

45 Walter MH, Wolf BH, Wolf AE, Boening KW. Six-year clinical performance of all-ceramic crowns with alumina cores. Int J Prosthodont. 2006 Mar-Apr;19(2):162-3. Abstract in PubMed

46 Kokubo Y, Ohkubo C, Tsumita M, Miyashita A, Vult von Steyern P, Fukushima S. Clinical marginal and internal gaps of Procera AllCeram crowns. J Oral Rehabil 2005;32:526-530. Abstract in PubMed

47 Zitzmann, N., Galindo, M., Hagmann, E., Marinello, C. Clinical Evaluation of Procera^® AllCeram™ Crowns in the Anterior and Posterior Regions. Int J Prosthodont. 2007;20:239-41. Abstract in PubMed

48 Ödman P, Andersson B. Procera^® AllCeram™ crowns followed for 5 to 10.5 years: a prospective clinical study. Int J Prosthodont. 2001 Nov–Dec;14(6):504-9. Abstract in PubMed

49 May KB, Russell MM, Razzoog ME, Lang BR. Precision of fit: the Procera^® AllCeram crown. J Prosthet Dent 1998;80(4):394-404. Abstract in PubMed

50 Quintas AF, Oliveira F, Bottino MA.Vertical marginal discrepancy of ceramic copings with different ceramic materials, finish lines, and luting agents: an in vitro evaluation. J Prosthet Dent. 2004 Sep;92(3):250-7. Abstract in PubMed

51 Osório AB, Camacho GB, Demarco FF, Powers JM. Microleakage in full-crown all-ceramic restorations: influence of internal surface treatment, silane application, alumina system, and substrate. Int J Prosthodont. 2007 Mar-Apr;20(2):123-4.

52 Vult von Steyern P, Ebbesson S, Holmgren J, Haag P, Nilner K. Fracture strength of two oxide ceramic crown systems after cyclic pre-loading and thermocycling. J Oral Rehabil. 2006 Sep;33(9):682-9.

53 Zitzmann NU, Galindo ML, Hagmann E, Marinello CP. Clinical evaluation of Procera AllCeram crowns in the anterior and posterior regions. Int J Prosthodont. 2007 May-Jun;20(3):239-41.

54 Rao W, Benzi R. First single lower molar implants with flap-less guided surgery and immediate function: clinical and radiographic preliminary results of a prospective study. J Prosthetic Dent 2007;97 (suppl1):S3-S14

55 Villa R, Rangert B. Immediate and early function of implants placed in extraction sockets of maxillary infected teeth: A pilot study. J Prosthetic Dent 2007;97 (suppl1):S96-S108

56 Rompen E, Raepsaet N, Domken O, Touati B, Van Dooren E. Soft tissue stability at facial aspect of gingivally-converging abutments in the esthetic zone: A pilot clinical study. J Prosthet Dent., 2007; 97(suppl):S119-S125.

NobelProcera™ Bridge Alumina

The NobelProcera™ Bridge Alumina was introduced in 1999. Tests have shown that the restorations exceed the biomechanical requirements for all-ceramic fixed partial dentures, and excellent esthetic and functional outcomes have been reported (40).

References

40 Lang B, Maló P, Guedes C, Wang RF, Kang B, Lang L, Razzoog ME. Procera^® AllCeram Bridge. Appl Osseointegrat Res 2004;4:13-21.

NobelProcera™ Crown Zirconia and NobelProcera™ Bridge Zirconia

The NobelProcera™ Crown Zirconia was introduced in 2001, and in 2004 the NobelProcera™ Bridge Zirconia was launched. Zirconia has a flexural strength and fracture toughness almost twice as high as that of alumina, which makes zirconia very resistant to masticatory forces, while still maintaining an exact precision fit (41).

References

41 Sierraalta M, Odén A, Razzoog ME. Material strength of zirconia produced with two methods. J Dent Res 2003;82(Spec Iss A):AADR abstract # 0450 Abstract

42 Att W, Kurun S, Gerds T, Strub JR. Fracture resistance of single-tooth implant-supported all-ceramic restorations after exposure to the artificial mouth. J Oral Rehabil 2006;33:380-386. Abstract in PubMed

43 Cabrera M, Hegenbarth E, Thompson VP, Rekow ED, Stappert CF. Fatigue Analysis of Individualized Zirconia Implant-Abutments and Crowns. J Dent Res  2007;86(Spec Iss A):abstract 0392. Abstract

44 Hogg KD. Load to Fracture of Different All-Ceramic Crown Systems. J Dent Res 2004;83(Spec Iss A):abstract 1825. Abstract

45 Kessler-Liechti G, Mericske-Stern R. Rehabilitation of an abraded occlusion with Procera-ZrO2 all-ceramic crowns. A case report. Schweiz Monatsschr Zahnmed 2006;116:156-167. Abstract in PubMed

46 Sierraalta M, Razzoog ME. Load to Fracture of Procera Zirconia Bridges. J Dent Res 2006;85(Spec Iss A):abstract 1871. Abstract

47 Sowka M, Thompson VP, Rekow ED, Stappert CF. Damages Modes and Fatigue Analysis of Y-TZP Three-Unit Fixed-Partial-Dentures. J Dent Res  2007;86(Spec Iss A):abstract 0888. Abstract in PubMed

48 Balmer S, Mericske-Stern R. Implant-supported bridges in the edentulous jaw. Clinical aspects of a simple treatment concept. Schweiz Monatsschr Zahnmed 2006;116:728-739. Abstract in PubMed

49 Engquist B, Åstrand P, Anzen B, Dahlgren S, Engquist E, Feldman H, Karlsson U, Nord PG, Sahlholm S, Svanström P. Simplified method of implant treatment in the edentulous jaw. A controlled prospective study. Part 1: one-stage versus two-stage surgery. Clin Implant Dent Relat Res 2002;4(2):93-103. Abstract in PubMed

50 Sierraalta M, Odén A, Razzoog ME. Material strength of Zirconia produced with two methods. J Dent Res 2003;82(Spec Iss A): abstract # 0450. Abstract

51 Att W, Grigoriadou M, Strub JR. ZrO2 three-unit fixed partial dentures: comparison of failure load before and after exposure to a mastication simulator. J Oral Rehabil. 2007 Apr;34(4):282-90

52 Att W, Stamouli K, Gerds T, Strub JR. Fracture resistance of different zirconium dioxide three-unit all-ceramic fixed partial dentures. Acta Odontol Scand. 2007 Feb;65(1):14-21.

53 Larsson C, Holm L, Lövgren N, Kokubo Y, Von Steyern PV. Fracture strength of four-unit Y-TZP FPD cores designed with varying connector diameter. An in-vitro study. J Oral Rehabil. 2007 Sep;34(9):702-9.

54 Vult von Steyern P, Ebbesson S, Holmgren J, Haag P, Nilner K. Fracture strength of two oxide ceramic crown systems after cyclic pre-loading and thermocycling. J Oral Rehabil. 2006 Sep;33(9):682-9. PMID: 16922742

NobelProcera™ Laminates

NobelProcera™ Laminates are thin (0.25-0.40 mm) alumina shells, used for patients with discolored anterior teeth, providing possibilities for excellent esthetics (52). 

References

52 Hager B, Oden A, Andersson B, Andersson L. Procera AllCeram laminates: a clinical report. J Prosthet Dent 2001;85(3):231-2. Abstract in PubMed

53 Adolfi D, de Freitas AJ, Groisman M. Achieving aesthetic success with an immediate -function implant and customized abutment and coping. Pract Proced Aesthet Dent. 2005 Oct;17(9):649-54. Abstract in PubMed

54 Hager B, Oden A, Andersson B, Andersson L. Procera^® AllCeram™ laminates: a clinical report. J Prosthet Dent 2001;85(3):231-2. Abstract in PubMed

Alumina and Zirconia

The increased demand for improved esthetics, along with the preference for non-metal restorative materials have increased the use of dental ceramics. The ceramic materials used for Nobel Biocare’s all-ceramic crowns, bridges, laminates and abutments consist of densely sintered, high purity (99.5%) aluminum oxide (alumina) and yttria-stabilized zirconium oxide (Y-TZP zirconia). These ceramic materials possess several desirable characteristics for use in modern dentistry, including biocompatibility and good mechanical properties1-16.

Alumina
Studies focused on evaluating the clinical performance of all-ceramic alumina crowns, bridges, and abutments in dental practice have shown good results2,17-45. Cumulative success rates of 98% and 92% after 5 and 10 years, respectively, have been reported for alumina crowns22,26,30,31. Tests have shown that the alumina crowns and bridges exceed the biomechanical requirements for all-ceramic fixed partial dentures33. Moreover, both short and long-term clinical studies have shown good results for the alumina abutments35-45; a cumulative success rate of 98% after 5 years43, favourable marginal bone levels, and healthy surrounding soft tissue have been reported41-43.

Zirconia
Zirconia has a flexural strength and fracture toughness almost twice as high as that of alumina, which makes zirconia very resistant to masticatory forces, with maintained exact precision of fit46,47,56. Clinical studies aiming at evaluating zirconia abutments have shown high success rates and good esthetic results, with healthy mucosal conditions and stable marginal bone levels48-52. Furthermore, compared to titanium, zirconia has been shown to accumulate less bacteria in vivo in terms of presence and total number of potential putative pathogens53,54. Data also reveal that the tissues around zirconia healing caps undergo a lower rate of inflammation-associated processes compared to titanium55. Clinical studies evaluating the long-term performance of zirconia crowns and bridges are ongoing.

References

1 Al-Dohan HM, Yaman P, Dennison JB, Razzoog ME, Lang BR. Shear strength of core-veneer interface in bi-layered ceramics. J Prosthet Dent 2004;91(4):349-55. Abstract in PubMed

2 Andersson M, Odén A. A new all-ceramic crown. A dense-sintered, high-purity alumina coping with porcelain. Acta Odontol Scand 1993;51:59-64. Abstract in PubMed

3 Anusavice KJ. Degradability of dental ceramics. Adv Dent Res 1992;6:82-9. Abstract in PubMed

4 Chai J, Takahashi Y, Sulaiman F, Chong K, Lautenschlager EP. Probability of fracture of all-ceramic crowns. Int J Prosthodont 2000;13(5):420-4. Abstract in PubMed

5 Esquivel-Upshaw JF, Chai J, Sansano S, Shonberg D. Resistance to staining, flexural strength, and chemical solubility of core porcelains for all-ceramic crowns. Int J Prosthodont 2001;14(3):284-8. Abstract in PubMed

6 Harrington Z, McDonald A, Knowles J. An in vitro study to investigate the load at fracture of Procera AllCeram crowns with various thickness of occlusal veneer porcelain. Int J Prosthodont 2003;16(1):54-8. Abstract in PubMed

7 Hegenbarth EA. Procera aluminum oxide ceramics; A new way to achieve stability, precision and esthetics in all-ceramic restorations. Quintessence Dent Technol 1996;19:21-34.

8 Pallis K, Griggs JA, Woody RD, Guillen GE, Miller AW. Fracture resistance of three all-ceramic restorative systems for posterior applications. J Prosthet Dent 2004;91(6):561-9. Abstract in PubMed

9 Potiket N, Chiche G, Finger IM. In vitro fracture strength of teeth restored with different all-ceramic crown systems. J Prosthet Dent. 2004 Nov;92(5):491-5. Abstract in PubMed

10. Snyder MD, Hogg KD. Load-to-fracture value of different all-ceramic crown systems. J Contemp Dent Pract. 2005 Nov 15;6(4):54-63.

11. Thomas P, Barnstorf S, Summer B, Willmann G, Przybilla B. Immuno-allergological properties of aluminium oxide (Al2O3) ceramics and nickel sulfate in humans. Biomaterials. 2003 Mar;24(6):959-66.

12. Wagner WC, Chu TM. Biaxial flexural strength and indentation fracture toughness of three new dental core ceramics. J Prosthet Dent. 1996 Aug;76(2):140-4.

13. Webber B, McDonald A, Knowles J. An in vitro study of the compressive load at fracture of Procera AllCeram crowns with varying thickness of veneer porcelain. J Prosthet Dent 2003;89(2):154-60.

14. Wood KC, Berzins DW, Luo Q, Thompson GA, Toth JM, Nagy WW. Resistance to fracture of two all-ceramic crown materials following endodontic access. J Prosthet Dent. 2006 Jan;95(1):33-41.

15. Zeng K, Oden A, Rowcliffe D. Evaluation of mechanical properties of dental ceramic core materials in combination with porcelains. Int J Prosthodont 1998;11(2):183-9.

16. Zeng K, Oden A, Rowcliffe D. Flexure tests on dental ceramics. Int J Prosthodont 1996;9(5):434-9.

17. Andersson M, Razzoog ME, Oden A, Hegenbarth EA, Lang BR. Procera: a new way to achieve an all-ceramic crown. Quintessence Int. 1998 May;29(5):285-96.

18. Bonnard P, Hermans M, Adriaenssens P, Daelemans P, Malevez C. Anterior esthetic rehabilitation on teeth and dental implants optimized with Procera technology: a case report. J Esthet Restor Dent. 2001;13(3):163-71.

19. Brunton PA, Smith P, McCord JF, Wilson NH. Procera all-ceramic crowns: a new approach to an old problem? Br Dent J. 1999 May 8;186(9):430-4.

20. Chai J, McGivney GP, Munoz CA, Rubenstein JE. A multicenter longitudinal clinical trial of a new system for restorations. J Prosthet Dent 1997;77(1):1-11.

21. Fradeani M, D'Amelio M, Redemagni M, Corrado M.  Five-year follow-up with Procera all-ceramic crowns. Quintessence Int. 2005 Feb;36(2):105-13.

22. Galindo ML, Hagmann E, Marinello CP, Zitzmann NU. Long-term clinical results with Procera AllCeram full-ceramic crowns. Schweiz Monatsschr Zahnmed 2006;116:804-809.

23. Haag P, Andersson M, Vult von Steyern P, Odén A. 15 years of clinical experience with ProceraÒ Alumina. A Review. Appl Osseointegrat Res 2004;4:7-12

24. Jokstad A. A split-mouth randomized clinical trial of single crowns retained with resin-modified glass-ionomer and zinc phosphate luting cements. Int J Prosthodont. 2004 Jul-Aug;17(4):411-6.

25. Naert I, Van der Donck A, Beckers L. Precision of fit and clinical evaluation of all-ceramic full restorations followed between 0.5 and 5 years. J Oral Rehabil. 2005 Jan;32(1):51-7.

26. Oden A, Andersson M, Krystek-Ondracek I, Magnusson D. Five-year clinical evaluation of Procera AllCeram crowns. J Prosthet Dent 1998;80(4):450-6.

27. Ottl P, Piwowarczyk A, Lauer HC, Hegenbarth EA. The Procera AllCeram system. Int J Periodontics Restorative Dent 2000;20(2):151-61.

28. Razzoog ME, Lang LA, McAndrew KS. AllCeram crowns for single replacement implant abutments. J Prosthet Dent 1997;78(5):486-9.

29. Walter MH, Wolf BH, Wolf AE, Boening KW. Six-year clinical performance of all-ceramic crowns with alumina cores. Int J Prosthodont. 2006 Mar-Apr;19(2):162-3. 

30. Zarone F, Sorrentino R, Vaccaro F, Russo S, De Simone G. Retrospective clinical evaluation of 86 Procera AllCeramÔ anterior crowns on natural and implant-supported abutments. Clin Implant Dent Relat Res. 2005; 7 2005;7 (Suppl 1):S95-103.

31. Ödman P, Andersson B. Procera AllCeram crowns followed for 5 to 10.5 years: a prospective clinical study. Int J Prosthodont. 2001 Nov-Dec;14(6):504-9.

32. Sadan A, Blatz M, Lang B. Clinical considerations for densely sintered alumina and zirconia restorations: Part 1. Int J Periodontics Restorative Dent 2005; 25:213-19.

33. Lang B, Maló P, Guedes C, Wang RF, Kang B, Lang L, Razzoog ME. ProceraÒ AllCeram Bridge. Appl Osseointegrat Res 2004;4:13-21.

34. Att W, Kurun S, Gerds T, Strub JR. Fracture resistance of single-tooth implant-supported all-ceramic restorations: an in vitro study. J Prosthet Dent. 2006 Feb;95(2):111-6.

35. Heydecke G, Sieraalta M, Razzoog MF. Evolution and use of aluminium oxide single-tooth implant abutments: a short review and presentation of two cases. Int J Prosthodont 2002;15(5):488-93.

36. Kucey BK, Fraser DC. The Procera abutment--the fifth generation abutment for dental implants. J Can Dent Assoc 2000;66(8):445-9.

37. Marchack CB, Yamashita T. Fabrication of digitally scanned custom shaped abutment: a clinical report. J Prosthet Dent 2001;85(2):113-5.

38. Prestipino V, Ingber A. All-ceramic implant abutments. Esthetic indications. J Esthetic Dentistry 1996;8(6):255-262.

39. Prestipino V, Ingber A. Esthetic high-strength implant abutments. Part I. J Esthetic Dentistry 1993;5(1):29-36.

40. Prestipino V, Ingber A. Esthetic high-strength implant abutments. Part II. J Esthet Dent 1993;5(2):63-8.

41. Andersson B, Scharer P, Simion M, Bergstrom C. Ceramic implant abutments used for short-span fixed partial dentures: a prospective 2-year multicenter study. Int J Prosthodont 1999;12(4):318-24.

42. Andersson B, Taylor A, Lang BR, Scheller H, Scharer P, Sorensen JA, Tarnow D. Alumina ceramic implant abutments used for single-tooth replacement: a prospective 1- to 3-year multicenter study. Int J Prosthodont 2001;14(5):432-8.

43. Andersson B, Glauser R, Maglione M, Taylor A. Ceramic implant abutments for short-span FPDs: a prospective 5-year multicenter study. Int J Prosthodont 2003;16(6):640-6.

44. Henriksson K, Jemt T. Evaluation of custom-made procera ceramic abutments for single-implant tooth replacement: a prospective 1-year follow-up study. Int J Prosthodont 2003;16(6):626-30.

45. Sadoun M, Perelmuter S. Alumina-zirconia machinable abutments for implant-supported single-tooth anterior crowns. Pract Periodontics Aesthet Dent 1997;9(9):1047-53.

46. Yildirim M, Fischer H, Marx R, Edelhoff D. In vivo fracture resistance of implant-supported all-ceramic restorations. J Prosthet Dent 2003;90(4):325-31.

47. Sierraalta M, Odén A, Razzoog ME. Material strength of zirconia produced with two methods. J Dent Res 2003;82(Spec Iss A):AADR abstract # 0450

48. Att W, Kurun S, Gerds T, Strub JR. Fracture resistance of single-tooth implant-supported all-ceramic restorations after exposure to the artificial mouth. J Oral Rehabil 2006;33:380-386.

49. Cibirka RM, Nelson SK, Rueggeberg FA. Examination of the implant-abutment interface after fatigue testing. J Prosthet Dent 2001;85(3):268-75.

50. Glauser R, Sailer I, Wohlwend A, Studer S, Schibli M, Scharer P. Experimental zirconia abutments for implant-supported single-tooth restorations in esthetically demanding regions: 4-year results of a prospective clinical study. Int J Prosthodont 2004;17(3):285-90.

51. Lang LA, Sierraalta M, Hoffensperger M, Wang RF. Evaluation of the precision of fit between the Procera custom abutment and various implant systems. Int J Oral Maxillofac Implants 2003;18(5):652-8.

52. Tan PL, Dunne Jr JT. An esthetic comparison of a metal ceramic crown and cast metal abutment with an all-ceramic crown and zirconia abutment: a clinical report. J Prosthet Dent 2004;91(3):215-8.

53. Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A. Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study. J Periodontol 2004;75(2):292-6.

54. Rimondini L, Cerroni L, Carrassi A, Torricelli P. Bacterial colonization of zirconia ceramic surfaces: an in vitro and in vivo study. Int J Oral Maxillofac Implants 2002;17(6):793-8.

55. Degidi M, Artese L, Scarano A, Perrotti V, Gehrke P, Piattelli A. Inflammatory infiltrate, microvessel density, nitric oxide synthase expression, vascular endothelial growth factor expression, and proliferative activity in peri-implant soft tissues around titanium and zirconium oxide healing caps. J Periodontol. 2006 Jan;77(1):73-80.

56. Kessler-Liechti G, Mericske-Stern R. Rehabilitation of an abraded occlusion with Procera-ZrO2 all-ceramic crowns. A case report. Schweiz Monatsschr Zahnmed 2006;116:156-167.

Alumina

Studies designed to evaluate the clinical performance of all-ceramic alumina crowns, bridges, and abutments in dental practice have shown good results (14-44). Cumulative success rates of 98% and 92% after 5 and 10 years, respectively, have been reported for alumina crowns (24, 28), and tests have shown that the alumina crowns and bridges exceed the biomechanical requirements for all-ceramic fixed partial dentures 30.  

Moreover, both short and long-term clinical studies have shown good results for the alumina abutments (31-42); a cumulative success rate of 98% after 5 years (39), favorable marginal bone levels, and healthy surrounding soft tissue have been reported (37-39).

References

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15 Andersson M, Razzoog ME, Oden A, Hegenbarth EA, Lang BR. Procera: a new way to achieve an all-ceramic crown. Quintessence Int. 1998 May;29(5):285-96. Abstract in PubMed

16 Bonnard P, Hermans M, Adriaenssens P, Daelemans P, Malevez C. Anterior esthetic rehabilitation on teeth and dental implants optimized with Procera technology: a case report. J Esthet Restor Dent. 2001;13(3):163-71. Abstract in PubMed

17 Brunton PA, Smith P, McCord JF, Wilson NH. Procera all-ceramic crowns: a new approach to an old problem? Br Dent J. 1999 May 8;186(9):430-4. Abstract in PubMed

18 Chai J, McGivney GP, Munoz CA, Rubenstein JE. A multicenter longitudinal clinical trial of a new system for restorations. J Prosthet Dent 1997;77(1):1-11. Abstract in PubMed

19 Fradeani M, D'Amelio M, Redemagni M, Corrado M. Five-year follow-up with Procera all-ceramic crowns. Quintessence Int. 2005 Feb;36(2):105-13. Abstract in PubMed

20 Haag P, Andersson M, Vult von Steyern P, Odén A. 15 years of clinical experience with Procera^® Alumina. A Review. Appl Osseointegrat Res 2004;4:7-12

21 Hegenbarth EA. Procera aluminium oxide ceramics. A new way to achieve stability, precision, and esthetics in all-ceramic restorations. 1996 QDT(19): 21-34.

22 Jokstad A. A split-mouth randomized clinical trial of single crowns retained with resin-modified glass-ionomer and zinc phosphate luting cements. Int J Prosthodont. 2004 Jul-Aug;17(4):411-6. Abstract in PubMed

23 Naert I, Van der Donck A, Beckers L. Precision of fit and clinical evaluation of all-ceramic full restorations followed between 0.5 and 5 years. J Oral Rehabil. 2005 Jan;32(1):51-7. Abstract in PubMed

24 Oden A, Andersson M, Krystek-Ondracek I, Magnusson D. Five-year clinical evaluation of Procera AllCeram crowns. J Prosthet Dent 1998;80(4):450-6. Abstract in PubMed

25 Ottl P, Piwowarczyk A, Lauer HC, Hegenbarth EA. The Procera AllCeram system. Int J Periodontics Restorative Dent 2000;20(2):151-61. Abstract in PubMed

26 Razzoog ME, Lang LA, McAndrew KS. AllCeram crowns for single replacement implant abutments. J Prosthet Dent 1997;78(5):486-9. Abstract in PubMed

27 Zarone F, Sorrentino R, Vaccaro F, Russo S, De Simone G. Retrospective clinical evaluation of 86 Procera AllCeram anterior single crowns on natural and implant-supported abutments. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S95-103. Abstract in PubMed

28 Ödman P, Andersson B. Procera AllCeram crowns followed for 5 to 10.5 years: a prospective clinical study. Int J Prosthodont. 2001 Nov-Dec;14(6):504-9. Abstract in PubMed

29 Sadan A, Blatz M, Lang B. Clinical considerations for densely sintered alumina and zirconia restorations: Part 1. Int J Periodontics Restorative Dent 2005; 25:213-19. Abstract in PubMed

30 Lang B, Maló P, Guedes C, Wang RF, Kang B, Lang L, Razzoog ME. Procera^® AllCeram Bridge. Appl Osseointegrat Res 2004;4:13-21.

31 Heydecke G, Sieraalta M, Razzoog MF. Evolution and use of aluminium oxide single-tooth implant abutments: a short review and presentation of two cases. Int J Prosthodont 2002;15(5):488-93. Abstract in PubMed

32 Kucey BK, Fraser DC. The Procera abutment--the fifth generation abutment for dental implants. J Can Dent Assoc 2000;66(8):445-9. CR 05:3030/0 May 2005 Abstract in PubMed

33 Marchack CB, Yamashita T. Fabrication of digitally scanned custom shaped abutment: a clinical report. J Prosthet Dent 2001;85(2):113-5. Abstract in PubMed

34 Prestipino V, Ingber A. All-ceramic implant abutments. Esthetic indications. J Esthetic Dentistry 1996;8(6):255-262. Abstract in PubMed

35 Prestipino V, Ingber A. Esthetic high-strength implant abutments. Part I. J Esthetic Dentistry 1993;5(1):29-36. Abstract in PubMed

36 Prestipino V, Ingber A. Esthetic high-strength implant abutments. Part II. J Esthet Dent 1993;5(2):63-8. Abstract in PubMed

37 Andersson B, Scharer P, Simion M, Bergstrom C. Ceramic implant abutments used for short-span fixed partial dentures: a prospective 2-year multicenter study. Int J Prosthodont 1999;12(4):318-24. Abstract in PubMed

38 Andersson B, Taylor A, Lang BR, Scheller H, Scharer P, Sorensen JA, Tarnow D. Alumina ceramic implant abutments used for single-tooth replacement: a prospective 1- to 3-year multicenter study. Int J Prosthodont 2001;14(5):432-8. Abstract in PubMed

39 Andersson B, Glauser R, Maglione M, Taylor A. Ceramic implant abutments for short-span FPDs: a prospective 5-year multicenter study. Int J Prosthodont 2003;16(6):640-6. Abstract in PubMed

40 Henriksson K, Jemt T. Evaluation of custom-made procera ceramic abutments for single-implant tooth replacement: a prospective 1-year follow-up study. Int J Prosthodont 2003;16(6):626-30. Abstract in PubMed

41 Heydecke G, Sierraalta M, Razzoog ME. Evolution and use of aluminum oxide single-tooth implant abutments: a short review and presentation of two cases. Int J Prosthodont 2002;15(5):488-93. Abstract in PubMed

42 Sadoun M, Perelmuter S. Alumina-zirconia machinable abutments for implant-supported single-tooth anterior crowns. Pract Periodontics Aesthet Dent 1997;9(9):1047-53. Abstract in PubMed

43 Galindo ML, Hagmann E, Marinello CP, Zitzmann NU. Lióng-term clinical results with Procera All Ceram full-ceramic crowns. Schweiz Monatsschr Zahnmed 2006;116:804-809. Abstract in PubMed

44 Sierraalta M, Odén A, Razzoog ME. Material strength of zirconia produced with two methods. J Dent Res 2003;82(Spec Iss A):AADR abstract # 0450. Abstract

45 Walter MH, Wolf BH, Wolf AE, Boening KW. Six-year clinical performance of all-ceramic crowns with alumina cores. Int J Prosthodont. 2006 Mar-Apr; 19(2):162-3. Abstract in PubMed

46 Stappert C.F, Park D.-W, Stappert D, Rekow E.D, Thompson V.P. Damage modes and reliability of Alumina and Zirconia ceramic-layer-structures. J Dent Res 2006;85 (Spec Iss B):abstract 2092.

47 Thompson V.P, Stappert C.F, Kim B, Stappert D, Park D.-W, Pines M, Rekow E.D. Damage and reliability of ceramic and metal-ceramic layer structures. J Dent Res 2006;85(Spec Iss A):abstract 0076.

48 Stappert C.F, Park D.-W, Stappert D, Rekow E.D, Thompson V.P. Damage modes and reliability of Alumina and Zirconia ceramic-layer-structures. J Dent Res 2006;85 (Spec Iss B):abstract 2092.

49 Thompson V.P, Stappert C.F, Kim B, Stappert D, Park D.-W, Pines M, Rekow E.D. Damage and reliability of ceramic and metal-ceramic layer structures. J Dent Res 2006;85(Spec Iss A):abstract 0076.

Zirconia

Zirconia has a flexural strength and fracture toughness almost twice as high as that of alumina, which makes zirconia very resistant to masticatory forces, while maintaining an exact precision fit (43, 44). Clinical studies designed to evaluate zirconia abutments have shown high success rates and good esthetic results, with healthy mucosal conditions and stable marginal bone levels (45-50). Furthermore, compared to titanium, zirconia has been shown to accumulate less bacteria in vivo in terms of presence and total number of potential putative pathogens (51, 52). Clinical studies evaluating the performance of zirconia crowns and bridges are ongoing.

References

45 Cibirka RM, Nelson SK, Rueggeberg FA. Examination of the implant-abutment interface after fatigue testing. J Prosthet Dent 2001;85(3):268-75. Abstract in PubMed

46 Glauser R, Sailer I, Wohlwend A, Studer S, Schibli M, Scharer P. Experimental zirconia abutments for implant-supported single-tooth restorations in esthetically demanding regions: 4-year results of a prospective clinical study. Int J Prosthodont 2004;17(3):285-90. Abstract in PubMed

47 Degidi M, Artese L, Scarano A, Perotti V, Gehrke P, Piattelli A. Inflammatory infiltrate, microvessel density, nitric oxide synthase expression, vascular endothelial growth factor expression, and proliferate activity in peri-implant soft tissues around titanium and zirconium oxide healing caps. J Periodontol. 2006 Jan;77(1):73-80. Abstract in PubMed

48 Lang LA, Sierraalta M, Hoffensperger M, Wang RF. Evaluation of the precision of fit between the Procera custom abutment and various implant systems. Int J Oral Maxillofac Implants 2003;18(5):652-8. Abstract in PubMed

49 Kessler-Liechti G. Mericske-Stern R. Rehabilitation of an abraded occlusion with Procera-Zro2 all-ceramic crowns. A case report. Schweiz Monatsschr Zahnmed 2006;116:156-167

50 Tan PL, Dunne Jr JT. An esthetic comparison of a metal ceramic crown and cast metal abutment with an all-ceramic crown and zirconia abutment: a clinical report. J Prosthet Dent 2004;91(3):215-8. Abstract in PubMed

51 Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A. Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study. J Periodontol 2004;75(2):292-6. Abstract in PubMed

52 Rimondini L, Cerroni L, Carrassi A, Torricelli P. Bacterial colonization of zirconia ceramic surfaces: an in vitro and in vivo study. Int J Oral Maxillofac Implants 2002;17(6):793-8. Abstract in PubMed

53 Yildirim M, Fischer H, Marx R, Edelhoff D. In vivo fracture resistance of implant-supported all-ceramic restorations. J Prosthet Dent 2003;90(4):325-31. Abstract in PubMed

54 Stappert C.F, Park D.-W, Stappert D, Rekow E.D, Thompson V.P. Damage modes and reliability of Alumina and Zirconia ceramic-layer-structures. J Dent Res 2006;85 (Spec Iss B):abstract 2092.

55 Thompson V.P, Stappert C.F, Kim B, Stappert D, Park D.-W, Pines M, Rekow E.D. Damage and reliability of ceramic and metal-ceramic layer structures. J Dent Res 2006;85(Spec Iss A):abstract 0076.