II- Alternative technique to conventional casting for construction of

metal substructure in metal- ceramic restorations.

A. Electroforming (Galvanicformig) Technology:
It is the technique by which a thin layer of pure gold is deposited
on polyurethane dies that are coated with a silver spacer using computer
controlled plating equipment to control thickness. The coping is plated
with a noble paste primer before porcelain application. This technique has
been developed to produce bioesthetic metal-ceramic restorations, as
the metal used is pure gold. Clinical evaluation of inlays crowns and
bridges made with this technique has been found to be successful
regarding marginal fit, metal-ceramic bond strength,
biocompatibility and esthetics. Different types of alloys can be used to
form copings by this technique as gold alloys, palladium alloys and non-
precious alloys.
The following table shows the advantages and disadvantages of
electroforrnation technique.

Advantage Disadvantages
- Thin substructure -Uncertain bond quality of
- Economic and simplified procedure porcelain to metal.
-Coping strength is greater than other foils -Technique sensitivity
- Marginal adaptation of 15-20 m - Coping strength is lower
- No porosity than conventional casting
- No opportunity for shrinkage or expansion -Unknown problems with
of the coping creep

* Heliform HF 600 system:

This system uses an electroforming technology to produce a thin
pure gold coping. The gold is deposited on a polyurethane die that is
coated with a silver spacer using computer controlled led plating
equipment to control thickness. This system uses cyanide-free gold
sulphide solution. After plating, the die is removed by heating and the
silver spacer is removed with nitric acid or air abrasion. The surface of
the coping is air abraded, then coated with a noble metal paste primer
before porcelain application. This system has been adapted for fixed
partial dentures.

B. Metal foil technology:

These material systems reflect a technique by which a metal
ceramic restoration can be produced in a relatively short period of time.
Renaissance and Captek are products designed to fabricate the metal
ceramic crown without the use of the melting and casting process.
I. Bonded platinum foil coping
1- Twin foil restorations: Porcelain can be bonded to platinum foil in
such a way that the die is covered with a double layer of platinum. The
inner layer is adapted on the die while the second layer is placed overall
the die surfaces except the shoulder. This outer layer is bonded to the
porcelain after tin plating and it will prevent crack formation. The
inner platinum foil is removed prior to crown cementation.
2- Bonded single foil restorations: The single restoration utilizes only
one matrix, which is bonded to the core porcelain. In this technique,
the matrix is adapted till the cervical apron. Piece of rubber dam is
punched and stretched over the adapted matrix so that it covers the
shoulder and the matrix apron but not the axial walls. The matrix is then
air abraded with aluminous oxides, where the abrasive particles will
not affect the shoulder or the apron because of the rubber covering. The
abraded matrix is tin-plated and oxidized. Then opaque porcelain is
applied, followed by dentine and enamel. A scalpel is used to cut the
 single foil at the point where plating stops. Produced restorations show
improved internal adaptation and slightly greater strength when
compared with twin foil technique.
II. Swaged gold alloy foil coping
1- Renaissance: Renaissance system is a laminated gold-alloy foil that
is delivered to the user in a fluted shape. The foil is placed over an
epoxy die, adapted and burnished. The final adaptation is achieved by
swaging. The adapted , matrix is flame sintered to form a coping. An
interfacial alloy powder is applied and fired, and the coping is then
veneered with porcelain.
The renaissance system offers adequate strength, good marginal
adaptation and ease of use. If indicated for single anterior tooth only.
2- Sunrise: The sunrise system is another gold-foil-supported ceramic
system that uses ceramco II porcelain. This system offers a yellow
background to the porcelain ease of use low cost and good esthetics are
the main advantages of this system which can be used to single
restorations in which occlusal stress is minimal.
C- Captek system (capillary technology): Captek crown and bridges
employ optical effect that simulate vital teeth esthetics. Captek
fabrication technology employs capillary action produce strong,
accurate and highly biocompatible metal structure to support all
crown and bridge applications. In the captek system the coping is
produced from two metal impregnated wax sheets that are adapted to a
die and fired. The first sheet forms a porou Au-Pt-Pd layer that is
impregnated with 97% gold when the second layer is fired. Advantages of
the system include excellent esthetics and marginal adaptation.

D. Sintered powder technology:

 Degusint system: The degusint system is an innotative method for
manufacture of fixe dental prosthesis. This method involves direct
modeling and sintering of a precious metal alloy powder (Gold) to
form a restoration. The powder is first compacted, then sintered during
sintering process which is carried out below the liquidus temperature of
the alloy the powder particles form a compact material, resulting in
sintering shrinkage which be kept to a minimum in order to achieve a
precise fit. The degusint system achieves this by employing specific grain
size, shape and distribution. Degusint powder is spherical, the grain size
is adjusted so that the gaps between larger grains are filled with smaller
on resulting in high density. Degusint system is used for fabrication of
fully anatomical inlays on lays, crowns and metal substructure in metal-
ceramic restorations.

E. CAD/CAM process
The process can be used to prepare metal inlays and crowns from
alloys that are difficult to cast, such as pure titanium and titanium alloys.
There is no need for either an impression the prepared tooth or casting
procedures. The dentist can record a video image (optic impression) of
the prepared tooth using a intra-oral camera. After the boundaries of the
restoration are selected on a video monitor, a command to cut the desired
restoration design transmitted by computer to a milling machine. The
inlay or crown is milled using a diamond coated disk. Depending on
the CAD-CAM system used. Proximal and occlusal contours need to be
finished by hand using rotary instrument. There are many systems used,
among which are Minnesota system, computer aided-prosthetic system
(CAP), Precident system, Micro-denta system, Titan system, Procera
system and Cicero system.
1- Procera system:
 This is a combination of copy milling and spark erosion
techniques. In which, the external contour of the crown or copping can be
shaped out of a solid piece of Cp To or Ti-alloys by milling machine.
While, the internal contour is spark eroded with a carbon electrode.
Spark Erosion (Electrical discharge machine) ; it is defined as a
metal removal process using series of sparks to erode material from a
work piece in a liquid medium under careful conditions. The liquid
medium, usually light oil, is called dielectric fluid. This process is used to
prepare attachments, crowns and inlays mainly from metals and alloys
which are difficult to be cast, such as pure titanium and titanium alloys.
The initial application of titanium in dentistry was machined Ti
dental implant. However, with the procera system single titanium crown
can be fabricated and laser welded the individual units together to make
multiple units.
After preparing the natural tooth, the dentist makes an impression
of the prepared tooth and adjacent structures then pour the impression in
an improved stone. The first step in the CAD system is canning of the die,
which should be placed in a holding device within the scanner. Data are
collected from the surface of the die as the holding device rotates with the
scanner and the die surface comes in contact with a specially positioned
spherical probe. After complete scanning of the die, data are sent to the
procera center for the production of the titanium restoration.
The master stone die is duplicated in graphite and plastic. The wax
pattern of the designed coping is constructed and luted on the plastic die.
The external contour of the coping is them milled from titanium block by
the use of computer controlled milling machine.
The internal contour of the coping is formed by spark erosion with
the use of spark discharge machine, where the titanium coping is coupled
with the graphite replica the master die and electricity passes through the
die- electrode electrolyte during local spots of extreme heat and erodes
the contour of the graphite replica forming the titanium coping.
Finally, titanium coping is veneered with special procera low
fusing porcelain that matches the requirements of bonding to pure
titanium. Porcelain-veneered procera titanium crowns can be used as an
alternative to other porcelain-fused to metal stems. However, there is a
problem with the surface and color stability of low fusing porcelain.
2- Titan system
It is a CAD/CAM system that produce metal copings for porcelain
fused to metal single and multiple restorations. The titan system uses
stone dies fabricated from regular impression technique. However, it uses
a computerized mechanical mill to fabricate coping on the bases of data
recorded directly from the die surface and does not require wax patterns.
Three main steps are involved:
Digitizing the data from the die surface.
Mathematical processing of data program the computerized mill.
Milling or production of the copings from discs or blocks of
titanium or any other dental alloys.
The milling procedure consists of three steps:
Rough milling the inside of the coping to remove the bulk of the
material.
Fine milling to increase the accuracy.
Rough external milling.
The multiple unit restorations constructed using this system are
done in the same way for the construction of the single unit restoration in
addition to the determination of the position of the pontics as well as, the
shape and the size of the connectors between the units. Then milling is
completed on single rectangular titanium alloy.
 Theorectically the mean working time of the different procedures is
3-8 minutes for digitizing, 8-12 minutes for mathematical processing, and
20-25 minutes for milling.

3. Cicero system:
It is CAD/CAM system produce ceramic fused to metal
restorations such as crowns, fixed partial dentures and inlays with
different layers as metal , dentin and incisal porcelain, for maximum
strength and esthetics.
Cicero system makes use of a fast laser-stripe scanning method to
measure the three dimensional geometry of the preparation and its
surrounding and opposing teeth. Video camera is used to scan the
preparation, a computer calculates the points by traingulation, and
information is digitized from a master cast. Data from the image and
design of the restoration are manipulated by the dentist to choose the best
design.
Factory standardized preformed Cicero refractory bock is fixed
with high precision in the milling machine and the inside surface of the
crown is milled thus creating a refractory mode then sintering of a thin
layer of alloy powder on the refractory model is done. The powder
consists of low melting high expansion gold alloy Carrana PDF (75% Au,
9% Pd, 14% Ag and 2% Zn).
The Cicero porcelain is then applied in the appropriate shade. A
paste porcelain tablet is pressed on the metal covered refractory die and
fired under standardized conditions vacuum in porcelain funace. The
refractory block is then replaced in the milling machine to the interface of
the porcelain and fired. The external surface of the crown is then milled
for characterization of the grooves, fossae and cusp lines.
 The last step in fabrication includes individual staining and glazing
of the external surface low glazing temperatures. Finally, refractory die is
removed by grinding and air abrasion in the usual manner.

It has to be noted that the Cicero system deviates from other

CAD/CAM systems in that makes a layered crown for better strength and
esthetics. Metal structure sintering technique will give a durable support
to crowns, fixed partial dentures and inlays made with the CAD/CAM
system.