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INTRODUCTION: Esthetics, durability of the material and its biocompatibility in oral environment has always been and will be the foremost concern of the dentist. Esthetically ceramic can be considered as "better than the best�. Its color, translucency and vitality cannot as yet be matched by any materials except other ceramics further material is durable and biocompatible thus it holds a special place in dentistry and is widely used. Ceramic substances are not new. Infact our ancestors discovered ceramics thousands of years ago. Examples are many, earthen pots, bricks, crackers, wash basins, tiles sanitary etc. Term ceramic is defined as any product made essentially from a nonmetallic material by firing at high temperature to achieve desirable properties. Porcelain refers to a family of ceramic materials composed essentially of Kaolin, Quartz, Feldspar also fixed at high temperatures. TERMINOLOGIES: Dental ceramic: An inorganic compound with non metallic properties typically consisting of oxygen and one or more metallic or semimetallic elements (eg. aluminum, calcium, lithium, magnesium, potassium, silicon, sodium, tin, titanium and livconium) that is formulated to produce the whole or part of a ceramic based dental prosthesis. Glass ceramic: A ceramic consisting of a glass matrix phase and at least one crystal phase that is produced by the controlled crystallization of the glass.
Ceramic: An inorganic compound with non metallic properties typically composed of metallic and nonmetallic elements. HISTORY: 700 BC : Etruscans made teeth of Ivory and bone that were held in place by a gold framework. 1774 : French pharmacist – Duchateau. Procelain material called mineral paste teeth. 1789 : de Chemant-French dentist in collaboration with Duchateau – improved version of mineral paste teeth – but not used to produce individual teeth because there was no effective way at that time to attach the teeth to a denture base material. 1808 : Fronzi – Italian dentist "Ferrometallic" porcelain tooth that was held in place by a platinum pin or frame. 1817 : Plateau-French dentist introduced porcelain teeth to USA. 1822 : Peale on artist developed, a baking process in Philadelphia for these teeth. 1825 : Commercial production of these teeth began in Stockton. 1903 : Dr. Charles land introduced first ceramic crown to dentistry in 1903. Using platinum foil matrix and high fusing feldspathic porcelain low flexural strength – increased incidence of failure. 1962 : Weinstein and Weinstein – formulation of fedlspathic porcelain that allowed systematic control of the sintering temperature and thermal expansion coefficient – patient. 1962 : Weinstein et al components that could be used to produce alloys that bonded chemically to and were thermally compatible with feldspathic porcelain – patient. 1963: first commercial porcelain developed by "Vita Zahnafabrik".
1965 : Mc Lean and Hughes – Aluminous core ceramic Al2O3–40 to 50 wt %. 1984 : Adair and Grossman – Dicor glass ceramic consisting of tetrasilicic fluoramica crystal in glass matrix. Machinable glass ceramic : Dicor MGC which has tetrasilicic fluoromica crystal volume of 70%. Early 1990 : Pressable glass ceramic i.e. IPS Empress 34 Vo. % leucite. IPS empress 2 – Containing 70% volume of Lithia disilicate crystals could be used for 3 unit FPD upto II premolar – fracture toughness was 3.3 MPa M1/2 3 times more than Empress 1. 1992 : Duceram LFC – low fusing ceramic – 3 unique feature. a) Hydrothermal glass – in which water is incorporated into the silicate glass structure to produce non bridging hydroxyl groups that disrupts the glass network, thereby increases the glass transition temperature, Viscosity and firing temperature increasing the thermal expansion coefficient to allow its use a veneer for certain low expansion metals. b) Self healing: By forming 1 µm thick hydrothermal layer along the ceramic surface. c) Extremely small size of the crystal particles (400-500 nm) enhances opalescence of ceramic by reflecting blue light hues from the surface and yellow hues from the interior of the ceramic. Other ultralow fusing ceramics now referred as low fusing ceramics have been introduced as veneering glass – are claimed to be kinder to opposing tooth enamel – due to glass phase or very small crystal particles. 1980's: Level 1 System introduced and improvements in software and hardware led to level 2 and level 3. 3 system for production of ceramic inlays, onlays and veneers.
The future of dental ceramic is bright because the increased demand for tooth colored restorations will lead to an increased demand for ceramic based and polymer based restorations and the reduced use of amalgam and traditional cast metals. OVERVIEW OF DENTAL CERAMICS: Classification of dental ceramics: 1) Use or indications – anterior, posterior, crowns, veneers, post and cores and glaze ceramic. 2) Composition (Pure alumina, pure Zirconia, silica glass, leucite based glass ceramic and Lithia based glass ceramic). 3) Processing methods : Sintering, partial sintering and glass infiltration, CAD-CAM, and copy milling. 4) Fusing tamperature : low fusing 800-10500C : Medium fusing 1050-17000C : high fusing 1200-14000C 5) Microstructure : Glass, crystalline and crystal containing glass. 6) Transluscency : Opaque, transluscent and transparent. 7) Fracture resistance or abrasiveness Firing temperature: High fusing 13000C Medium fusing 1101-13000C Low fusing 850-11000 C Ultra low fusing 8500C
Crown and bridge construction
Production of denture teeth
Craig 11th edition Fabrication Machined
All ceramic
Crystalline phase Alumina Feldspar
Ceramic-metal Denture teeth
Slip Cast
Mica Alumina
Heat pressed
Spinel Leucite
Lithium disilicate Alumina
Sintered Manufactured
Leucite Lucite Feldspar
Ceramics – Greek word "Kerami Kos" – meaning burnt earth. Porcelain-portuguese = Porcelong "little pig" = "Cowrie shell – Shell of molusca. The shape of cowrie shell and little pigs back are alike. The smoothness of cowrie shell and this earthen material were alike. So the name porcelain. Kaolin – from mountain Kao-ling in China. Kao-high
Ling – ridge.
Vitrous latin – Vitrous = Glass (amorphous) Devitrification – gradual formation of very small crystals in a glass and minerals so that glass becomes less transparent. Transparent – latin – trans = through. Parora = to appear = able to see through
Transsluscent – latin – lucis = lighting shine = Shining through. Veneer – French fournir = to fumish = to overlay a thin sheet of fine wood or other substance. Vitrification – converting into glass. Feldspar – is the name given to a group of rocks containing aluminosilicate along with sodium, potassium or calcium. It is found in igneous rock eg. granite and metamorphic rocks. High potassium containing feldspar is potaspar high sodium containing feldspar is sodaspar. High fusing
Medium fusing
1101 – 1300
Low fusing
Ultra low
Denture teeth Crown and bridge construction
Used for titanium alloys because of their low contraction coefficient that closely match those of these metals and because the low firing temperatures reduce the risk for growth of metal oxide. Advance reduction in sintering times, decrease in sag deformation of FPD frame work, less thermal degradation of ceramic firing ovens, and less wear of opposing enamel surfaces. Porcelain manufacture: is produced from a blend of quartz, Feldspar and other oxides. During manufacture the materials are heated to high temperature to form a glassy mass and then rapidly cooled by quenching them in water, which causes the glassy mass to fracture. The resulting product is called frit. This process may be repeated several times, after which the frit is ball milled until the desired particle size distribution is obtained. Because fritting takes place at temperature much higher than those used in the fabrication of dental restoration, most of the chemical
reactions between raw materials occur before they are used in the dental laboratory. Most formulations designed for metal ceramic consists of mixture of two frits, a low fusing glass frit and a high expansion frit consisting of crystalline leucite with tetragonal geometry. This combination overcomes the two principal difficulties in veneering metal with ceramic-having a porcelain firing temperature well below the melting range of the metal and having a sufficiently high thermal expansion compatible with the metal. After firing in the laboratory, dental ceramic consists of about 20 volume percent tetragonal leucite crystals dispersed in a glassy matrix. The structure of this glassy matrix. The structure of this glassy matrix is a random Si-O network. The silicon atom combines with four oxygen atoms in a tetrahedral configuration. These tetrahedral may be linked into a chain with both covalent and atomic bonds, leading to stable structure. However such a Si-O network would have a very high melting point. Usually potassium and sodium are added to the glass composition to help break down the Si-O network and are therefore known as glass modifiers. In dental ceramics, potassium and sodium are initially provided by the feldspars. Two desirable consequences result 1) The softening temperature of the glass is reduced 2) the coefficient of thermal expansion is increased. The manufacturer adjusts the oxide constant so that the dental ceramics coefficient of thermal expansion will be close to the corresponding value for the alloys used to make the substructure. If the composition of the glass is not properly adjusted, extensive breakdown and reorganization of the Si-O network may occur leading to the crystallization / devitrification. This phenomenon may occur partially
in dental ceramics if a ceramic restoration is fired too often, and it is typically associated with an increase in the coefficient of thermal expansion and opacity. Feldspar also contains alumina which acts as an intermediate oxide to increase the viscosity and hardness of the glass. As a result, dental porcelain has a good resistance to slump or pyroplastic flow, which is necessary to obtain the desired configuration of the restoration. Dental porcelain are available as fine powders to be used with liquid water or a water based glycerine to form a paste of workable consistency. This is then shaped / moulded into a desired shape. It is then fired at a high temperature in order to fuse the particles together to form a ceramic body which is esthetically like a natural crown. Mode of supply: Supplied as a kit containing 1) Fine ceramic powders in different shade – Dentin – Enamel – Opaquer 2) Special liquid / distilled water 3) Stains or color modifier 4) Glaze. Feldspar: Naturally occurring mineral and is a double silicate of potassium and aluminium. Basic glass former during firing feldspar fuses and acts as a matrix and binds silica and kaolin. Feldspar has two important properties:
1) When fused at higher temperature it retains its form without rounding – due to increase content of potash which is more viscous. 2) Between 11500 and 15300C it undergoes incongruent melting and forms crystals of leucite in a liquid glass. Leucite is a potassium aluminium silicate mineral with a large coefficient of thermal expansion compared with feldspar glasses. Incongruent melting is a process by which one material melts to form a liquid plus a different crystalline material. Kaolin:
White clay like material Hydrated aluminum silicate Binder Increase opacity of mass
Silica: Obtained by grinding pure quartz. Silica acts as a refractive skeleton and provides strength and hardness to porcelain during fusing. It remains unchanged during firing. Aluminum oxide: Replaces some silica in glass matrix. It brings strength and opacity to the porcelain. It alters softening point and increases the viscosity of porcelain during fixing. Coloring frits: These are produced by fusing various metallic oxides with fine glass and feldspar and then grinding to powder. They are added to dental porcelain to obtain various shades to match natural tooth color. They are oxides of tin, nickel, cobalt, titanium, iron or gold.
TYPES OF PORCELAIN: • Following porcelain blends are produced for the different roles they play in the fabrication of metal ceramic restoration: opaque, body and incisal porcelains.
Opaque porcelain: Applied as I ceramic coat and performs two major functions. • Masks the color of the alloy • Responsible for metal ceramic bond. The density of the oxides is greater than that of glass matrix. Consequently, the oxides of tin, titanium and zirconium have a high refractive index than the components of the glass matrix. (Feldspar and
-> 2.01 to 2.61 and 1.52 to 1.54) when a specific
range of oxide particle size is used. Most of the incident light is scattered and reflected rather than transmitted through the porcelain, effectively masking the color of the alloy substrate. A SEM of alloy-porcelain interface for a high noble alloy. When a region around the interface is examined for specific elements – a technique called elemental mapping the concentration of aluminium and titanium can be identified. These appear as dense region in the figure, indicating that discrete oxide particles of Al and Ti are in opaque porcelain. Body porcelain:
Fired onto the opaque layer, usually in conjunction with the incisal porcelain. It provides some translucency and contains oxide that aid shade matching. Body porcelains are available in a wide selection of shades matching. Body porcelains are available in a wide section of shades to match adjacent natural teeth. Most porcelain manufactures provide an opaque shade for each body shade. Incisal porcelain: Usually translucent. As a result, the perceived color of the restoration is significantly influenced by the color of the underlying body porcelain. Porcelain – alloy bonding: • Oxide layer formation degassing conditioning bake oxidation • The linear coefficients of thermal expansion for the metal and ceramic must closely match to achieve a strong interfacial bond. αm = 13.5 to 14.5 x 10-6/0C αl = 13.0 to 14.0 x 10-6/0C The slightly higher coefficient for the metal causes the ceramic to be in a beneficial state of residual compressive stress at room temperature. Interfacial bond should be strong enough so that fracture occurs entirely with in porcelain. • Metal ceramic bond should exceed (28 mpa) to have cohesive failure through the porcelain rather than failure at interface. • Another philosophical change in the recommended method for evaluating the metal-ceramic bond appears to be underway with the introduction of ISO standard No 9693 for dental porcelain
fused to metal restoration, which contains a three point bending test. • Oxidation step for the alloy can be performed in air or by using the reduced atmospheric pressure (approximately 0.1 atm) available. A much thinner oxide layer will be formed if the alloy is oxidized at this reduced atoms pressure compared to the thickness for oxidation in air.
Porcelain alloy bonding Bond failure
ADVANCES IN DENTAL CERAMIC: Coping for metal ceramic prosthesis: 1. Electrodeposition of gold or other metal on a duplicate die.
2. Burnishing and heat-treating metal foils on a die. 3. CAD-CAM processing of a metal ingot. 4. Casting of pure metal or an alloy through lost wax technique.
Metal ceramics: Metal and porcelain veneer exhibit similar contraction curves and an average contraction coefficient difference of 0.5 ppm/ 0C or less fracture is unlikely to occur except in cases of extreme stress concentration or extremely high intraoral forces. These metal-ceramic combinations are known as thermally compatible system. 1984 ADA classification of dental casting alloys: Alloy type High noble
Most contain ≥ 40 wt% Av and ≥ 60 wt% of noble metal elements / Au, Pt, Pd, Rh, Ru, Iv, OS) Must contain ≥ 25 wt% of noble metal
Noble Predominantly
elements. base Contain a 25wt% of noble metal elements.
metal The term precious and semiprecious should be avoided because they are imprecise terms. Rather, term high noble, noble and predominantly base metal should be used. The principal reason that alloys for all metal restorations cannot be used for metal-ceramic restorations are as follows.
1. The alloys may not form thin, stable oxide layers to promote atomic bonding to porcelain. 2. Their melting range may be too low to resist. Sag deformation or melting at porcelain firing temperatures. 3. Their thermal contraction coefficient may not be close enough to those of commercial porcelain. For metal ceramic prosthesis: Metal type High noble
Metal ceramic prosthesis Pure Au (99.7 wt %) Au-Pt-Pd Au-Pd-Ag (5-12 wt% Ag) Au-Pd-Ag (>12 wt% Ag)
Au-Pd Pd-Au Pd-Au-Ag Pd-Cu-Ga Pd-Ga-Ag
Pd-Ag CPTi Ti-Al-U, Mi-Cr-Mo-Be, Mi-Cr-Mo, Co-Cr-Mo, Co-Cr. Base metal alloys were introduced originally during the upward
spiral of gold prices in the late 1970s and early 1980s, base metal alloys have been developed to the point where they are superior to high noble and noble alloys in social respects. Presently 40% of metal ceramic prosthesis are made of base metal alloys. When an alloy is identified according to the elements it contains, the components are listed in decreasing order of concentration with
largest constituent first followed by II largest and so on. An exception to this rule is the identification of certain alloys by elements that significantly affect physical properties or that represent potential biocompatibility concerns or both. E. g. : Ni-Cr-Mo be are after designated as Ni-Cr-Be alloys because of the contribution of beryllium to the control of castability and surface oxidation at high temperatures and because of the relative toxicity potential of beryllium compared to other metals. ALLOY SYSTEMS: High noble metal alloys: • Au-Pt-Pd I casting alloys Strengthened by precipitates of Fe-Pt intermetallic compound as copper could not be used due to color concern. Tin + indium for porcelain bonding undergo dimensional changes and not recommended for multiple unit FPD restorations. • Au-Pd-Ag : First lower gold content alternative alloys to be widely used in the 1970s. Platinum was eliminated from the alloy composition, gold content was reduced to about 50%, with corresponding increase in palldium and silver. • Tin + Indium oxidation • Green discoloration has been reported resulting from diffusion of silver atoms into the porcelain. The discolored region can be ground away but this involves an additional processing step.
• Silver vapor generated in the porcelain furnace during processing can contaminate the muffle, and periodic purging of the furnace with carbon block is required. • Green discoloration has been apparently been eliminated in some porcelain composition by substituting K
for Ma- the larger
potassium ions impede the diffusion of silver into the porcelain Discussion: Au-Pd and Au-Pd-Aq alloys have higher values of Y.S and MOE along with lower density than Au-Pt-Pd thus FPD will be more resistant to masticatory forces and undergo less bending. Noble metal alloys: Minimum of 25% wt. of noble metal. Pd-Aq – Presence of palladium, silver appears to assume noble metal character which is beneficial for corrosion resistance. • Increases silver can cause porcelain greening and furnace contamination. • Gold metal conditioners or ceramic coating agents may minimize this effect. • Compared to high noble they have similar values of yield strength, and modulus of elasticity and much lower density values. • Some of these alloys may form internal rather than external oxides. Instead of formation of the desired external oxide. Pd-Ag nodules may develop on the surface which enhance retention by mechanical then chemical.
Pd-Cu-Ga: Increases than 70% wt. palladium Melting point Pa + 15550C, Gold + 10640C.
Gallium melting 300C • Multi orifice torches are required to fuse high palladium alloys. Ceramic crucibles dedicated to individual alloys is recommended. • Carbon containing investments – cause incorporation of very small amount of carbon degrading the bond strength with porcelain. • Some Pd-Cu-Ga have increases hardness than enamel-casting from these alloy difficult to finish in lab. Substituting indium for tin yields Pd-Cu-Ga alloys with much lower hardness VHN = 270. Yield strength 690.0 MOE 140 YS 970, Elong 20, VH N 340. Pd-Ga : 1980 to provide lower hardness than that of initial Pd-Cu-Ga formulations. The hard Pd5GO2 phase absent Pd-Ga-CO alloy has particular dark oxide that is more difficult to mask with dental porcelain Legacy (Jelenko)
Pd 85.2
Ga 10.0
In 1.1
Au 2.0
YST 720, MOE 130, TS 970, Elong 25, VHN 280, Density 10.9 Protocol (Jelenko)
Pd 75.2
Ga 6.0
In 6.0
Au 6.0
Ag 6.5
Y.S 500, MOE 100, TS 760, Elong 34, VHN 240, Das 11.0 Predominantly base metal: Ni-Cr • ↑ MOE – so ↓ flexure • ↑ technique sensitive and difficult to cast compared to base metal.
Yield strength, modulus of Elasticity, can greatly be affected by small differences in weight percentages of minor elemental components among composition of these alloy. • Many Ni-Cr has 2% by weight berrylium – it ↓↓ the melting range and to decrease the viscosity of molten alloy ↑↑ its castability also effects strengthening and thickness of oxide layer. • Berrylium vapor exposure and dust exposure is more significant especially to lab technicians. • Potential hazard of berrylium is based on atomic considerations than its wt % in alloy. I.P % wt Be = 10.7% Be on an atomic basis Risk is greatest during alloy melting adequate exhaust and filtration system. OSHA – recommendation 24g/m3 of air determined from an 8 hr time weighted average. •
Physiological response vary from contact dermatitis to severe domical pneumonitis, which can be fatal symptoms also range from coughing, chest pain, general weakness to pul dysfunction.
Nickel - OSHA 15µg/m3 for 10hr / day Occupational exposure in referring markers has led to lung and nasal cancer. Acute effects – skin sensitization that can lead to chronic eczema therefore operator should neat mask and use efficient suction when grinding and finishing a nickel base alloy. Ni – carcinogenic - ↑ for dental technician ADA states that Ni alloys should not be used in individuals with known nickel sensitivity.
20 patient clinical study 10 control – no sensitivity to nickel – reresponse 10 – known sensitivity P showed positive dermal response to alloy and on nearing intraoral appliance 30% manifested an allergic response within 48 hrs Rexillium III (Penton)
YS – 830, MOE 180, TS 1100, Elong 15, VHM 360, Rens 7.8. Microband MP2 (Astenal)
YS – 260, MOE 170, TS 640, Elong 19, VHM 170, Density 8.6 For Mickel allergy take proper history Co-Cr – The potential health problems associated with the Berrylium and Nickel containing alloys have led to the development of CoChromium. MOE is highest, very less elongation So decreases elongation and increases hardness suggest finishing restorations made with it may be difficult. Genesis II (Jelenko)
Co 53
Cr 27
Ru 3
Ga 3
Cu 1
Ys – 520, MOE 170, TS 760, Elong 15, VHM 350, D 8.8 Movavex (Pentron)
Co 55
Cr 25
YS – 620, MOE 220, TS 760, Elong 7, VHM 350, D 8.8. Ti – Titanium based alloy adv.
Mb 1
Ta 1
Excellent biocompatibility, corrosion resistance due to thin passivating surface layer i.e TiO2 Low density 4.5 gm/cm3 + results in lighter and potentially less expensive restoration. Alloys used are : Cp (Commercially pure) Ti Ti-6Al-4V. Casting problem due to increasing melting point 16680C Strong tendency to oxidize with other materials. Special casting machine: With vacuum / argon pressure Argon are melting / induction melting. A very hard near surface region that can exceed 50 µm in thickness is also present on the lasting due to reaction of titanium alloy with investment and perhaps residual atmosphere in casting machine called as α case. To overcome – A system developed by manufacturers copings from blocks of pure titanium by machine duplication and spark erosion procera. Because of presence of α case – special surface modification of last titanium using castic mooh based solutions or silicon nitride coatings have been employed to improve bond between cast Ti and dental porcelain. Alternatives: 1) Sintering / diffusion bonding of burnished metal foil Most commonly used i.e. captek requires 3 pairs of material to form composite metal structure.
Captek P and Captek G which are used to fabricate crown coping and fixed partial denture abutments.
Capcon and capital which are used to connect copings
Captek repair paste and copfil which are used to add material to captek structures.
The copings thickness 0.25mm – anterior crown 0.35 mm – posterior crown Coping contains 88.2 wt % Au 9 wt % platinum group metals 28 wt % Ag. Captek p layer is adapted first to the die and find at a temperature of 10750C. During this firing cycle adhesive and binders are eliminated, and the Pd and Pt particles becomes interconnected by sintering to form 3 dimensional network of capillary channels. Capteck G is applied over captek P .Captek G is drawn by capillary action into the network structure of captek P coping vacated by the adhesive binder. 0.35 mm thick layer of procelain is applied to the coping, which may or may not require capbond bonding agent. Advantage: very low metal thickness can be achieved thus minimal tooth reduction / increase esthetics Ex : Metal margin of captek coping can be ground to a thickness of 50 µm and total thickness of PFM can be as low as 0.3 mm. Although anterior 0.7 – 1 mm for optimal esthetics Posterior crown 1.2 mm to resist fracture. CAD CAM processing:
Provides an alternative method to produce metal, ceramic or composite restoration without need for 2 / more appointment.
Although CAD CAM for metal crown is not commonly used.
Milled or ground metal block more widely used
Electrolytic or electrical discharge removal of metal.
Copy milling: This process is based on the principle of tracing the surface of a pattern that is then replicated from a blank of ceramic, composite or metal that is ground, cut or milled by a rotating wheel whose motion is controlled by a link through the tracing device. The process is similar to that associated with cutting a key blank using a tracing of a master key. Commercial
Switzerland. Electroforming: •
Helioform HF 600 system – thin pure gold coping.
Step by step procedure: •
A master cost of the prepared tooth is prepared and coated with a special die spacer to facilitate separation of the duplicating material.
Dies are duplicated with a gypsum product and having setting expansion 0.1% to 0.2%.
Apply an even coat of the silver spacer to the preparation and allow it to dry.
Insert the dies into the plating equipment a magnetic stirrer ensures circulation of the cyanide free gold sulfite solution.
Turn on the electric current and gold will be deposited on the die at an approximate rate of 0.02 mm/hr.
Remove the plated copings by heating the dies and remove the silver spacer with nitric acid or air abrasion.
Seat the coping on the die
Air abrade the surface and apply special bonding paste before porcelain application.
Ceramic for PFM: •
The major drawback with conventional PFM restorations was poor bond strength between the metal substrate and the veneering porcelain due to difference in co-efficient of thermal expansion of the two.
The crystalline mineral leucite is included in procelain for metal ceramic restorations to elevate their thermal expansion coefficient to match that of casting alloys.
Glass modifies - Bonds between the silica tetrahedra can be broken by the addition of alkali metal ions such as Na, K and Ca. These ions are associated with the oxygen atoms at the corners of the tetrahedra and interrupt the oxygen silicon bonds. As a result, the 3 dimensional silica network contains many linear chains of silica tetrahedra that are able to move more easily at lower temperature than the atoms that are locked into the 3 dimensional structure of silica tetrahedra. This ease of movement is responsible for the increased fluidity, decrease softening temperature and increase thermal expansion conferred by glass modifiers. Too high a modifier
concentration, decrease chemical durability that is resistance to attack by water acids and alkalis, if too many tetrahedral are disrupted the glass may crystallize during porcelain firing. •
Another important glass modifier is water the hydronium ion H3O+ can replace sodium or other metal ions in a ceramic that contains glass modifiers. This fact accounts for the phenomenon of "slow crack growth" of ceramics that are exposed to tensile stresses and moist environments. It also may account for the occasional long term failure of porcelain restoration after several yrs of service.
Metal substructure design: Porcelain labial margins: Many patient object to the grayness at the margin associated with metal ceramic restorations. If esthetics is of prime importance a collarless metal-ceramic crown should be considered. Advantages: •
Esthetic improvement
Plaque removal also is easier when gingival tissues are in contact with vaccum fired glazed porcelain than when they are contacting highly polished gold. Therefore porcelain material of choice for restorations that will contact gingival tissues.
Disadvantages: •
Difficulty in fabrication
Marginal adaptation of these restoration is slightly inferior to cast metal
Fracture of margin during handling
Increase time and so increase cost.
Indications: •
Indicated when conventional metal ceramic restoration will not create the desired esthetic result.
Contraindications: When an extremely smooth, 1 mm-wide shoulder cannot be prepared in the area of ceramic veneer and in this respect conventional metal ceramic restoration is somewhat more forgiving.
Methods of fabrication: •
Porcelain labial margins
Metal-ceramic restorations
Platinum foil matrix
Direct lift / cyanoacrylate resin
Procelain wax
Platinum foil matrix technique: Procedure: a) Wax the metal substructure and cast it in the conventional manner. Some technicians prefer to cast a conventional restoration and trim the collar off the casting; others wax the substructure exactly as desired and cast it.
b) To prevent the foil from becoming distorted on removal block out undercuts apical to the margin, modelling compound is suitable for this step. Amy excess that may have covered the shoulder of tooth preparation must be carefully cleaned off. c) Burnish a small piece of platinum foil onto the facial portion of the die where the porcelain margin is to be placed and extend it a few millimeters onto the axial wall of the preparation. d) After burnishing trim it so there is a 2 to 3 mm skirt lying cervical to the margin. e) Carefully place the coping over the foil and if necessary, scrape the die in the cervical area to allow the casting to seat. To help stabilize the foil, a drop of sticky wax may be applied. f) Remove the casting from the die, together with the foil, and position the assembly between the electrodes of an orthodontic spot welder. The foil can now be welded to the framework, which should be done as close as possible to the edge of the metal. Four or five welds are usually adequate to attach the foil to the substructure. The restoration is then fabricated in a conventional manner, although the facial margin is similar to that for the porcelain jacket crown. The foil itself is not covered with opaquer at this time. However, The restoration is build to contour, and the marginal portion is ditched as for the porcelain jacket crown, some technicians prefer to pain a thin coat of separating liquid on foil instead of ditching. g) When the coronal portion has been shaped to a satisfactory contour, burnish the foil and fill in the ditched portion with cervical porcelain. h) When the desired contour has been obtained after-timing, trim the platinum skirt.
i) When satisfied with characterization, staining and glazing, remove the foil and cement the restoration after verifying the fit one more time. Direct lift / cyanoacrylate technique: •
Less time consuming
Easy to perform Difficulty associated during staining and glazing firing because
porcelain is not supported as in the platinum foil technique, the margin tends to round off slightly, therefore, special shoulder powders are needed. Procedure: a) Apply cyanoacrylate resin to the labial margin area of the die. This acts as a sealant of the porous stone, compressed air should be used to minimize the thickness of the film. b) Apply porcelain release agent to the shoulder of the prepared die. c) Seat the opaqued casting on the die. d) Mix shoulder porcelain and apply it directly to the die and the opaque porcelain. Light tapping will assists in condensation and should be done before separating the dry buildup from the die. e) After the first firing of the shoulder porcelain reseat the crown on the die. At this time, the restoration should be examined for margin discrepancies. A second shoulder firing is usually necessary. f) Relubricate the die, reseat the crown and apply a thinner mix of shoulder powder to the margin. Vibration will help the porcelain fill the defect completely. After blotting, the restoration can be separated from the die.
g) After firing is completed, proceed with the conventional build up of body and incisal porcelains, followed by glazing of the final restoration. Porcelain wax technique: A mixture of body porcelain and wax (6:1 by wt) is applied to the die for final adaptation of porcelain labial margin. Procedure: a) After coating the substructure with opaque porcelain, lubricate the die with a porcelain release agent. b) Apply the porcelain-wax mixture to the cervical shoulder use an electric waxing instrument to flow it into the proper areas. c) With a conventional wax-carving instrument, shape the material and blend it into the opaque. It will separate easily from the die and can be fired in the conventional manner. d) A second application will be needed using the electric waxing instrument, keep the mixture liquid long enough so that capillary action can draw it into the marginal discrepancies. The restoration is completed in the conventional manner. If rounding of the margins is experienced during glazing, using a shoulder porcelain rather than a body porcelain in the wax mixture is recommended. Advantages and disadvantages: Method Platinum foil
Advantages No shoulder • porcelain esthetics
Disadvantages Time consuming
Good marginal adaptation
• Wax suspension
surface, increase plaque Separates easily
Shoulder porcelain needed
• Direct left
Least time consuming
accurate fit • Shoulder porcelain needed •
Rougher margins
The chief disadvantage of the early restorations was their low strength, which limited their use to low stress situation, such as anterior teeth. Even so, fracture was a fairly common occurrence, which prompted the development of higher-strength material.
These development have followed two path o Two ceramic material a high strength but nonesthetic core material is veneered with esthetic porcelain but color of ceramic core is easily masked o Development of a ceramic that combines good esthetics with high strength.
All ceramic systems Aluminous core ceramics: •
McLean and Hughes 1965.
Advocated using aluminous porcelain, which is composed of aluminum oxide crystals dispersed in a glassy matrix. Their recommendation was based on the use of alumina reinforced porcelain in the electrical industry and the fact that alumina has increase fracture toughness and hardness.
Method consists of bonding aluminous porcelain to platinum foil copings. Attachment of the porcelain is secured by electroplating the platinum foil with a thin layer of tin and then oxidizing it in the furnace to produce a continuous film of tin oxide for porcelain bonding.
The rationale - foil act as inner skin decrease subsurface porosity and formation of micro cracks in the porcelain, increase strength.
Procedure: a) Core porcelain buildup. b) Thin blade is used to form a cervical ditch which will prevent the matrix from becoming distorted during the first firing. c) The fired cure should be checked with a thickness guage. d) Foil is readapted to the margin and the ditch is filled with additional porcelain. Core should be much thinner on the facial surface for esthetic reason. e) Core is seated on the working cast before the application of body and incisal porcelains. Advantages: Better in esthetics compared to metal ceramic that employs a metal coping.
Disadvantages: Strength is inadequate to be used for posterior teeth Mclean has reported a fracture rate of molar aluminous porcelain crown of approximately 15% after 54 years. Slip cast ceramics – In- Ceram Alumina, In- Ceram Spinell and In- Ceram Zirconia a) Slurry of one of these materials is slip-cast on a porous refractory die and heated in a furnace to produce a partially sintered coping or framework. b) The partially sintered core is infiltrated with glass at 1100 for 4 hrs to eliminate porosity and to strength slip cast core. c) Decreased shrinkage thus good fit. d) Flexural strength ICS –350 Mpa, ICA—500 Mpa, ICZ—700 Mpa
STEPS FOR FABRICATION OF IN-CERAM PROSTHESIS: 1) Prepare teeth with an occlusal reduction of 1.5-2mm and a heavy circumferential chamfer(1.2). 2) Make an impression and pour 2 dies 3) Apply aluminium oxide on a porous duplicate die 4) Heat at 120 for 2 hrs to dry aluminium oxide 5) Sinter the coping for 10 hrs at 1120 6) Apply a sodium lanthanum glass slurry mixture on the coping 7) Fire for 4 hrs at 1120 to allow infiltration of glass 8) Trim excess glass from the coping with diamond burs 9) Build up the core with dentin and enamel porcelain and fire .
Hot pressed ceramic – Glass ceramic is a material that is formed into desired shape as a glass , then subjected to heat treatment to induce partial devitrification. The crystalline particles, needles or plates formed during the ceramming process serve to interrupt the propagation of cracks in the materials. --Glass ceramic in dentistry was first proposed by Mac Culloch in 1968. Pressable ceramic uses a piston to force a heated ceramic ingot through a heated into a mould, where the ceramic form cools and hardens to the shape of the mould. when the object has solidified , the refractory mold is broken apart and ceramic piece is removed. Then it is stained , glazed or veneered with one or more layer of thermally compatible ceramics. eg IPS Empress
1– contains increased concentration of leucite 35
volume % that increases the resistance to crack propagation. Advantage –translucent ceramic core , moderately increased flexural strength and excellent fit and esthetics. IPS Empress 2 --- Lithia disilicate crystals reinforces glass ceramic.Veneering ceramic contains apatite crystals causes light scattering in a way that resembles the scattering by the structure and components of tooth enamel Both IPS Empress 1 and 2 have low to moderately increase flexural strength and fracture toughness. These properties limit their use to conservative designs on low and moderate stress environment.
Procedure: a) Wax the restoration to final contour. Sprue and invest as with conventional gold castings. If veneering technique is used only the body porcelain shape is waxed. b) Heat the investment to 8000C to burn out the wax pattern. c) Insert a ceramic Ignot of the appropriate shade and alumina plunger in the sprue and place the refractory in the special pressing furnace. d) After heating to 11500C, the softened ceramic is slowly pressed into the mold under vacuum. e) After pressing, recover the restoration from the investment by airborne particle abrasion, remove the sprue and refit it to the die. Esthetics can be enhanced by applying an enamel layer of matching porcelain or by adding surface characterization.
Fabrication of restoration.
Life expectancy of dicor crowns in high stress areas is not as good as that of PFM crown.
Two veneering materials to improve color of dicor are. Dicor plus Consisted of pigmented feldspathic porcelain veneer
Willi's Glass Veneer of vitadur N aluminous porcelain
Tooth preparation: Same as PFM except that for I and II molars a reduction of 2mm is recommended. •
Axial surfaces should be reduced a minimum of 1mm preparation should be either a shoulder with a rounded gingivoaxial line angle / heavy chamfer.
Mormann and Brandestini for the first time used a CADCAM device to digitize and store cavity parameters, and a computer milling device to then shape a restoration out of the ceramic block.
Commercially available as integrated CAD-CAM unit for dental use in 1988 by Siemens known as CEREC. This came to known as CEREC 1 when in sept 1994 an improved version CEREC 2 was introduced.
The unit consists of 3 dimensional video cameras (Scan head). An electronic image processor memory unit and a processor (computer) which is connected to miniature milling machine.
Cerec 1 cannot prepare the occlusal anatomy
Cerec 2 is also equipped with a cylindrical diamond stone which as able to finish off undercuts at buccal extensions, curved shoulders at cusp preparations and the proximal areas.
Cavity consideration for CAD-CAM inlays: •
modifications to accommodate computerized milling device. •
No convexities should be present on pulpal and gingival floor – Either flat / concave buccolingually.
Occlusal step should be prepared 1.5-2 mm in depth and any isthmus or groove extension should be 1.5mm wide to decrease the possibility of the fracture of the restoration.
Buccal and lingual walls of occlusal portion of the preparation may converge towards the occlusal. This feature is unique to CEREC system as it can automatically block out any undercuts during the optical impression. A more conservative cavity preparation is therefore permissible along the occlusal aspect especially when replacing old amalgam restorations where undercuts were purposely given for retention. The facial and lingual walls in the proximal box are prepared in the usual fashion with slight divergence towards the occlusal, convergence is not given there so as to avoid excessively thick composite cement lines.
Axial wall straight and not follow convex contour of the proximal surface of the tooth.
No cavosurface or marginal bevels.
Five steps are basically involved in any type of CAD-CAM system: 1) Computerized surface digitization
After tooth preparation a scanning device is used to collect information on the shape of the preparation called as "Optical impression". •
An image of the preparation is displayed on the monitor. Repeated optical impressions are taken until the most ideal is found and stored in the computer.
Scanning devices can be either Mechanical - By profilometer / pin point sensors are very precise. However they have shortcoming - Scanning tip produces errors in measuring steep flanks and distort easily. - Undercut areas and marrow gaps like fissure also cannot be explored and have to be blocked out.
Optical (Infrared video camera) - Not able to measure highly transparent reflective surfaces and so enamel has to be covered with powder or water soluble colour. -
Can be prepared directly / indirectly
Advantages: •
From cavity preparation to bonding one session.
Adjustment done in mouth obviating the need for opposing cast and articulator mounting, lab facilities not required.
Interim restoration not necessary, no lost temporary, sensitiveness and microleakage.
Disadvantages: •
Waste of expensive chair time in case of difficulty during milling or designing
Time required is increased.
simultaneous appointment cannot be given. 2) Computer aided designing: involves three dimensional image processing. •
The operator enters data and confirms the features of the preparation like boundaries of the restoration, position of the gingival margins, proximal contacts and contours, buccal and lingual extensions etc.
The collected data is further processed by curve smoothening and if necessary by data reduction. Undercuts can be blocked at this stage.
3) Computer aided manufacturing (CAM) •
The cavity surface of inlays, onlays and crowns are milled to the dimensions of the scanned image with diamond disks or other instruments that are electrically driven and lubricated with water.
Cerec 1 occlusal surface cannot be ground – is completed later by the operator using Diamond burs.
Cerec 2 can form occlusal surface also. Controlled cutting of the ceramic is done by rotation of the block, horizontal movement of the block into the wheel and vertical movement of the cutting wheel. The fit of the restoration is confirmed in the patients mouth and any necessary adjustments made.
The inlay is then prepared for bonding which includes preparation of the restoration and the tooth. Etching is done on the cavity surface of the inlay either with a microetcher and / or ammonium bifluride or hydrofluoric acid. After etching, a silane
bonding enhancer is painted onto the surface. Depending on the bonding system used, the appropriate primer and bonding agent are applied to the tooth surface and then cemented. •
Glazing may not be required in these restoration as they are easily polished.
• Disadvantages CAD-CAM: 1) Initial high cost for the purchase of unit 2) Time and cost must be invested to master the technique. 3) Contouring of the occlusal surface may still have to be carried out by the clinician. Cerce 2 system: 3 materials can be used with this system. Vita mark II : Contains sanidine (KAISi3O8) as a major crystalline phase within a glassy matrix. Dicor MGC: Mica-based machinable glass ceramic that contains 70 vol % of crystalline phase "House of cards" Microstructure found in Dicor MGC is due to the interlocking of the small platelet. Shaped mica crystals with an average size of 1 to 2ùm. This particular microstructure leads to multiple crack deflection and ensures a greater strength than leucite-containing ceramics. •
Procad is leucite-containing ceramic designed for making machine restorations.
Fabrication time for crown is about 20 min
Copy milling technique:
Best known copy grinding system is celay (Mikrons Switzerland) 1991 commercially
Originally, the system was developed to produce inlays and onlays, however recent crown copings, bridge substructure and veneers.
Celay blocks, inceram spinel and inceram used.
Copy milling technique is based on the idea of first fabricating a prototype inlay-called pro-inlay which is then copied using a scanning tool or micropalpation method. The final restoration is then milled from a preformed ceramic block. It is highly necessary to stress here that any carving / tooth preparation should be free of undercuts.
Conservative approach is the blocking of undercuts in the cavity by using a resin modified glass ionomer on the die if an indirect method of manufacturing is used.
Proinlay is fabricated with a blue resin based composite (celay tech) made directly on a prepared tooth or indirectly on a die made from the impression. The prototype is fixed into the celay unit. As the surface of the proinlay is scanned with a tracing tool (smooth disc), a coarse diamond coated disc (124 µm grain size) simultaneously roughs out the shape of the ceramic restoration.
A true white powder is applied to the proinlay and the scanning is again done using a smooth disc and fissured and tapered burs. Matching fine diamond disc and burs (60-70 µm grain size) refine the shape of the gross ceramic restoration.
Once the white powder is completely traced off, milling of ceramic inlay is considered complete.
Average time taken is 20-30 min.
One problem frequently encountered is difficulty in obtaining proinaly.
Marginal accuracy seems to be good, a little better than CEREC 2 system.
Cerce 3: new •
View all surface of the restoration from all angles and make any modifications required with the possibility to immediately viewing and assessing the effects on the entire restoration.
Has ability to superimpose optical impressions of the preparation and the antagonists permits optimal adjustments of the proximal and occlusal contacts to the neighboring and opposing teeth.
Professor Korda from university of Greifswald, provided a break through in which a crown with suitable occlusal surface erupts into the occlusal surface of the antagonists until it has reached a stable position with maximum intercuspation called Biomimetic process.
CEREC shows a list of available tooth database after selection of the most appropriate database, CEREC automatically fits the crown between the neighboring teeth, and use them to adjust the position and height of the occlusion. Thus above mentioned biomimetic procedure take place.
CEREC turns and shifts the occlusal surface of the selected database crown in all direction until it fits optimally to the opposing teeth.
CEREC 3D – process not only copied from the nature but also is much faster and more efficient than all existing method for developing occlusion.
Other advantages: •
Second restoration can be designed while first is being milled.
The grinding unit is also equipped with a laser scanner and can also be used for indirect application.
Equipped with intraoral video camera / digital radiography unit for patient education and for user training.
CAD/CAM process. The Die is mechanically scanned by the technician, and the data are sent to a work station where an enlarged die is milled using a computer controlled milling machine. This enlargement is necessary to compensate for the sintering shrinkage. •
Aluminium oxide powder is then compacted onto the die, and the copying is milled before sintering at very high temperature (>15500C).
The coping is further veneered with an aluminous ceramic with matched thermal expansion.
Good clinical performance and marginal adaptation.
May be suitable for posterior crowns and FPD although long term data are needed.
Procedure: •
Tooth preparation
Cast made in conventional way but the die is ditched to make the margin easier to identify during scanning.
Die is mapped using contact scanner.
Design of the restoration is transferred to the manufacturer via computer line.
Production process starts with milling an enlarged die to compensate for the sintering shrinkage
An enlarged high-alumina coping is milled that shrinks to the desired shape after sintering.
The coping is returned to the laboratory, and bondy and incisal porcelain are applied in the conventional manner.
Cicero Dental Systems B.V. Cicero-computer
Netherlands. •
Uses optical scanning, ceramic sintering and computer assisted milling techniques to fabricate restorations with maximum static and dynamic occlusal contacts relation.
Technique consists of optically digitizing a gypsum die, designing the crown layer build up, and subsequent pressing, sintering and milling consecutive layers of shaded high strength alumina core material, a layer of dentin porcelain, and a final layer of incisal
porcelain. Final finishing is performed in the dental
laboratory. •
Allows efficient production of all ceramic restorations without compromising on esthetic or function.
Although predictably stronger materials have been developed the universal use of all ceramic restorations is not yet a reality. However clinical evaluation of recent developments may indicate their wider usage. It is no exaggeration to state that the last century saw a revolution in dental esthetics and is expected to continue, which will be influential in determining the range of ceramic products made available.
1) Phillips science of dental material --- Anusavice, XI edition 2) Restorative dental material—Craig,Powers XI edition. 3) Contemporary fixed prosthodontics—Rosenstiel, Land and Fujimoto 4) Fundamentals of fixed prosthodontic—Shillingberg III edi. 5) Advances in clinical prosthodontics—Gent, Geneve. 6) Fixed prosthodontics.DCNA2004 vol48,no 2. 7) Art and science of dental ceramic---John Mclean.
Published on Apr 30, 2014
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide r...


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The Power of Persuasion
How Edward Bernays's 1923 book, Crystalizing Public Opinion, still influences today's hyperconnected modern age.
We may be quicker at receiving information — one flick of a radio wave and we know what's happened across the globe. And we may be niftier in our communication techniques — trimming a thought to 140 characters is quite the talent. But when it comes to the power of mass persuasion, we're still living in the '20s.
Dubbed the father of public relations, Edward Bernays mapped out what have become the primary public relations strategies practiced on a global scale. And he did it by tapping into the universal nature of humankind. Ever watched a Coca-Cola ad, then found yourself sharing one with a friend? Or changed your vote based on a televised political campaign? That's the work of Bernays, which he divulges in Crystalizing Public Opinion. Read on to learn how a book published in 1923 is still influencing how we live today.
Have you ever read an article, seen a movie, or read a book because someone you follow on Twitter mentioned it? Bernays was one of the first public figures to understanding the importance of social influencers in mass persuasion. Recognizing our tendency to follow the herd and put trust in a group leader, Bernays saw that forming an alliance with a group leader could be a powerful vehicle for influencing a large group in favor of a client.
"The gregarious instinct in man gives the public relations counsel the opportunity for his most potent work," he said. "… A group leader of any given cause will bring to a new cause all those who have looked to his leadership."
Have you ever snacked on rice cakes because you heard gluten was bad for you? Bernays saw that the human instinct for self-preservation is one of the easiest traits to manipulate. Self-preservation includes the desire for shelter, sex, food, and health, and most advertising appeals in some way to this instinct.
Bernays gives the example of how a raisin company changed its advertising following the advice of its press agent:
"The dispensers of raisins, upon the advice of an expert on public opinion, adopted a slogan to appeal to this instinct: 'Have you had your iron today?' Iron presumably strengthening a man and increasing his powers of resistance. The same man appealed to here will respond to the sales talk, which persuades him that insurance may save him at a time of need."
Have you bought extra moves in Candy Crush in order to beat your friend's high score on Facebook? Understanding human need to be recognized for their actions, Bernays utilized the self-display-elation motive to give people a greater interest in a cause or product.
"It is often found to be true that when a man's adherence or allegiance to a movement is lukewarm and he is publicly praised for his adherence to it, he will become a forceful factor in it. "
This is why museum wings are named after their donors, why brands run contests and why gamers continue to unlock new "achievements" as they make their way through the latest Xbox game.
Will articles you read in The New York Times, The Wall Street Journal, or USA Today influence who you vote for in 2016? Understanding the value of the daily newspaper in providing the public with up-to-the-minute news, Bernays saw it was essential for the public relations counsel to have a seamless relationship with journalists. It became a press agent's job to help journalists extract a good story from a mass of facts.
"He is not merely the purveyor of news. He is more logically the creator of news."

subset: commoncrawl


text: a huge bowel motion caused by consuming those 99 cent half pound burritos off the "Bell Grande Vaule Menu" at Taco Bell aka taco hell. The volatile shit that aerosols the toilet appears just like the within of one of their burritos, and if you got consumed enough of them (ususally in a drunken haze), the shit will actually smell like beans. After a bell grande shit, it requires half a roll of rest room paper to wipe correctly.


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Dr. Heresy def. Amazin' Jay to become #1 contender, then...
Jason "the Slasher" retained the PLW Championship by def. Dr. Heresy, after Heresy challenged Jason to a match immediately following his match with Jay.
L.A. Studs def. The Big Islanders
Tim Kilgore def. Triplelicious
Michael Sain def. T.C. Stalker
Chris Blackheart & Gary Gold def. Nero & Manic Martin
T.J. Richter def. Shawn Haynes (a fan challenged by Richter)
Kid Krazy & Frankie Armadillo def. Bryce Andrews & Doug Summers
Vain & Huey McGraw def. "Nightmare" Nick Steel & Gregory Edwards


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Recorder classes became part of the Instrumental Music Program in 2005.
IMPACT administers a valuable pool of resources that allow a number of ACT Government primary schools to offer group lessons on recorder. These resources include skilled and qualified teachers, musical instruments and print music. These Classes are offered to selected students from Years 4, 5 & 6 depending on school numbers. The Classes are held during school time and in groups of up to 25 students. Recorder students develop skills on recorder, tuned and untuned percussion with some students moving on to treble and tenor recorder in their second year. A school-based teacher assists with the management of the Class and is the Director of the school group at performances.
Participating schools hold combineds rehearsals in terms 2, 3 & 4 - Term 2 during week 4, term 3 as pairs and Term 4 in preparation for Bandstravaganza.
Parent information letter
Letter to parents of students explaining what will happen with the selection for Recorder classes.
recorder and ukulele for parents.doc ( 616.0 KB)
Practice Record
Even though we include a practice record in each student journal there may be an occasion where a special record sheet is required. Here it is.
Selection for classes
A multi page document explaining the procedure to be adhered to by client schools in the selection of students for the Fife and Recorder classes.
Select recorder.doc ( 623.0 KB)
Welcome Letter
A letter to parents of students welcoming them to the IMP.
Recorder and ukulele welcome.docm ( 611.8 KB)
Recorder offer
A letter to parents of recorder students offering a position in the IMP class.
Recorder_offer_of_place_2016.docm ( 605.9 KB)


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84 Oak Street, Needham, MA - SOLD
$615,000. USD - Call 617-610-0716 for more information.
Open Houses Saturday 2 - 4pm & Sunday 11:30 - 1:30pm
Rarely available 3 bedroom colonial, just steps to Needham Center and the train to Boston!!
This classic center entrance colonial welcomes guests with a front to back living room, dining room and updated kitchen. Everything you need to enjoy the comforts of home and the benefits of Needham are under this roof ... hardwood floors throughout (except for the bright and airy 4-season sunroom which has become the preferred TV and gathering room), fireplace, an ideal size yard (nicely manicured and complete with a natural border that surrounds much of the lot for additional privacy), and a basement which has been divided and now lends itself as the perfect media or play room.
The current owner has installed replacement double-pane windows and a high end Buderus heating and hot water system.
Don't miss this unique opportunity to take advantage of the benefits of living on a quiet side street within walking distance from the heart of Needham!!
- 7 Minute walk to Needham Center Train Station
- Replacement windows
- Hardwood flooring throughout
- Separate family/ sunroom
- Close to shops and town center, yet on quiet side street
Neighborhood Features
- Quiet side street, yet close to the town center
- Picturesque quintessential New England tree lined street with family friendly sidewalks
- Ideal commuter location
- Easy access to the Needham Center train
- Easy access to Route 95 & 128
Neighbor Testimonial
- Michelle F.
Additional Links
Needham, MA - Official City Website
Needham, MA - Mass.gov Website
Needham, MA - Wikipedia
Great Schools
Needham Public Schools
Greater Boston Public Transportation
__Mike Hughes


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Watch Jeff Dunham: All Over the Map (2014)
Director: Rob Dipple (as Robb Dipple)
Production Co:Levity Entertainment Group,Red Wire Blue Wire
Genre: Comedy
Country: USA
Duration: 83 Min
Quality: HD
Release: 16 Nov 2014
View: 1099


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|English ▼
|Player: 35931
Guild: Banksters in Space
Title/Rank: 1 eyed
Level: 141.82 (Rank 36)
Economy: 12,180
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Account Age: 2,628 Days
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too-sicks C. W. Nimitz Quote - Msg - Report Sep 1 2013, 23:00:42
okay. Im sorry, Im not very fluent in monster speak yet


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Family Medicine physician - Anchorage area
Global Medical Staffing
Job Details
Job Details
Family Medicine physician - Anchorage area
Job Quick Facts
- Medical Specialty: Family Medicine
- Job Number: 4121-FM-USAK
- Location: Alaska
- City/Region: Anchorage area
- Facility: Outpatient, Single Specialty Group
- Call: No
- Schedule: M-F
- Shift: 8a-5p
- Patients/Day: 10-15
Global Medical Staffing Benefits
- Competitive compensation
- Pre-paid travel and housing
- Paid AAA-rated occurrence-based malpractice
- Licensing assistance and cost reimbursement
- Member of NALTO
We have an opportunity for a Family Medicine physician to practice directly in the Anchorage area. You'll work M-F, 8a-5p seeing 10-15 patients (5% adult, 95% geriatric) per day. No call coverage is required. You can get started soon. A minimum commitment of 10-12 weeks is required, with the possibility to extend.
Not licensed in the Last Frontier? Not a problem! We'll get you a license and even pay the fees. On top of that, your travel will be paid for, housing and rental car provided and occurrence malpractice coverage included.
There are places so incredible that when you visit them the only thing you're thinking is how can I live here? Alaska is one of those places. It screams epic from mountain to coast. Here, waves crash against glaciers. Glaciers crash against mountains. Mountains crash against sky.
Give us a call to learn more.
Call about this job: 866.858.6269
Whether you're a North American or European licensed doctor looking for an overseas locum adventure, or a U.S. licensed doctor looking for a domestic locum assignment, we can help.


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Time for one more knitting project. For Christmas my awesome brother in law bought me an unexpected gift. He wasn't sure what to get me so he read my blog and noticed a post about my craving for chunky blankets and a company I mentioned called Loopy Mango They have incredible knitted creations and supplies to make your own. He very kindly sent away to New York for my very own Loopy Mango needles. I don't know who was more excited me to receive such a thoughtful gift or Trev to give them to me. He is a great guy and single too by the way ladies!! ( Sorry Trev!)
I bought 6 balls of yarn at Michaels on sale for $5. I wanted a natural creamy colour and found the perfect one. Then I cast on 45 stitches and did a regular knit stitch. It took a little while to get used to the circular needle as I'm a newbie with them. However soon I was happily knitting a little slower than usual but after a few days ( maybe 8 hours total) I had my new blanket. Here's my finished baby- it's so soft and cozy I think I need to take a nap immediately
Now I have one in cream I want to try another one in black or grey this time using knit and pearl stitches to make a ribbed blanket. If you are not a knitter you can search for beginner info and video instructions like this link here-http://www.knittinghelp.com/. Happy Knitting!


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Oral B FlexiSoft
5 pack of the original Oral B FlexiSoft that fits all Oral-B electric toothbrushes.
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Call our expert advisers on 01442 275789
SJD Accountancy Acknowledged For Excellence
SJD Accountancy have been shortlisted for 'Mid Tier Firm of the Year' in the forthcoming British Accountancy Awards.
Acknowledging companies who set the standards within the accountancy sector, the award ceremony and announcement of winners will take place on 20 November in Central London. SJD is one of a handful of companies nationwide who have got through to the final stage of these renowned awards.
As part of the submission process, entrants had to demonstrate how their company meets a criteria that included profitability and growth, professionalism, measurable success, innovation, people and responsibility.
Organic Growth Year on Year
SJD has seen unprecedented growth year on year since its launch 21 years ago driven by great customer service and innovation. Organically expanded through recommendation and word of mouth, it has gone from a client base of 6,000 in 2007 to over 12,500 this year and a predicted 13,500 clients by 2014.
Known for its unique approach, SJD prides itself on pursuing outstanding customer service, new business development and dynamic marketing with examples of its leading edge practice with initiatives such as its 'How do I make my clients' lives easier?' campaign with balanced score cards and one-to-one coaching sessions. The SJD team also runs a client satisfaction survey throughout the year allowing customers to have a voice and help evolve the business.
Complete Client Reassurance
To ensure complete reassurance to their clients, SJD Accountancy continues to offer a guaranteed money back service if customers feel they are not receiving the service standards expected.
It also operates a 'home grown' team policy with nearly all the senior managers, including the MD, having been accountants within the firm previously, therefore understanding the needs of the customers from the ground up.
Past Successes
SJD's excellence has already been acknowledged in the past having won awards from Accountancy Age three times and having been a finalist in all the years since 2003. The company has also been winner of the 'Best Contractor Accountant' by Contractor UK, voted by their site visitors for six years on the run as well as winners of two National customer service awards.
MD Claire Johnson comments, "We are delighted to be shortlisted again for this prestigious award which recognises excellence within the accountancy sector. Innovation and customer service is integral to who we are and we feel that getting it right for the customer is one of the reasons for our success in growing our share of the market in the two decades since we launched."
For all the latest news from SJD Accountancy visit our News and Views section here.
If you have any questions about contracting or would like further tax and Limited Company advice please contact our New business team on 01442 275789 or email email@example.com.
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SJD Accountancy
SJD Accountancy are the UK's largest specialist provider of fixed fee, Limited company accountancy services to contractors; we've been acting for contractors across the UK since 1992 and have more than 15,000 clients.
We are the only national specialist firm of contractor accountants with offices nationwide. SJD Accountancy has more qualified staff than any other firm in our market with qualifications from the following major tax and accountancy bodies - ATT, AAT, CTA, ACCA, CA, ACA and FCCA.
- Unlimited face to face meetings. This is a unique service only SJD Accountancy offers - unlimited face to face meetings across the UK - tax is complicated and sometimes only a meeting will do.
- UK's largest contractor accountants with more qualified staff. No call centres, no outsourcing, no automated call handling. Simply telephone, email or meet your own dedicated accountant face to face.
- Money back service guarantee. All your Emails received by 4pm on any normal working day will be answered the same day. Should it be necessary to leave a telephone message it will be answered same day/following day latest or we will make a full refund of that months fee.
- Outstanding reputation. We have won more awards for customer service and accountancy excellence than any other firm in our market, including: Best Accountant for Contractors, Accountant of the Year and Best Professional Service Team to name just a few.
- All inclusive low cost fixed fee accountancy package which includes completion of accounts*, payroll bureau, dividends and corporation tax computations, personal taxation, free bookkeeping software, your own dedicated accountant* and all company returns for a fixed fee starting from £120 plus VAT per month. Check our packages for more detail.
If you have any questions about contracting or would like any further advice please call our new business team on 01442 275789 or email: email@example.com. Our new business team is open Monday to Thursday (8am to 8pm), Friday (8am to 7pm) and Saturday (10am to 4pm)
Appoint SJD Accountancy and never worry about your tax or accountancy affairs again.
Form your own limited company with SJD - our same day online company formation service includes company bank account set up, VAT/PAYE registration and advice on optimum share structure.
You may also find the following pages, guides and case studies useful:
- Take home pay calculator - How much could you be taking home
- Contractor FAQ - All your frequently asked questions and their answers
- First time Contracting or Freelancing? - A summary of the alternatives along with pros and cons
- Choosing a contractor accountant - The factors to consider when choosing an accountant
- Step-by-step Guide to Contracting - Download a FREE copy of our guide
- Limited or Umbrella? Can't decide? - We help you decide which is best for you
- Guide to Contracting - All the best guides to contracting in one place
- Expenses Guide - Know exactly what you can claim
- Umbrella company guide - Everything you ever wanted to know about umbrella company services
- IR35 Guide - A great plain English guide to IR35
*If you would like us to complete your company year end accounts we simply ask that you have been a client of SJD for one year or have made 12 monthly payments. All accountants are part or fully qualified.
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The body of a 73-year-old Borough Park lawyer who disappeared from his office six days ago was found yesterday in a field of tall weeds along a creek in Brooklyn, where it had apparently been dumped. There was a plastic bag over his head and his hands had been bound, the authorities said.
The body of the lawyer, Sanford Silver, was found shortly after 11:30 a.m., about 20 feet from the edge of Coney Island Creek in a vacant lot next to a baseball field on the border of the Coney Island and Bath Beach neighborhoods, the police said. Three-quarters of his body was covered by a large plastic bag, and he had apparently been struck in the head, the police said.
A police spokesman would not not confirm yesterday that the body had been formally identified as that of Mr. Silver. But officials and investigators, speaking on the condition of anonymity, said that the body found was Mr. Silver's.
A probate and real estate lawyer, Mr. Silver was reported missing Monday night by a cousin, Justice Edward M. Rappaport of the State Supreme Court in Brooklyn, after he failed to return home, the police said. With the help of police, the judge went into his cousin's office on 48th Street in Borough Park, and he and the officers found a small amount of blood on the wall and floor beside Mr. Silver's desk.
The area where the lawyer's body was found, about 300 yards from Bay 52nd Street and Cropsey Avenue, is more than two miles from his office. The police said it appeared he had been dead for several days, and an autopsy scheduled for today should help determine the cause and narrow the time of his death, the police said.Continue reading the main story
The body was found by a man who frequents the area, which is strewn with rusted machine parts and trash and near the Belt Parkway, the police said. The man called 911 from a convenience store nearby, said Sgt. Brian Burke, a police spokesman.
After Mr. Silver disappeared, the police initially said he had last been seen near his office around 11 a.m. Monday. Two hours later, he spoke by telephone with his wife, telling her that he could not take her to a doctor's appointment, as he had planned, the judge said. Mr. Silver's 2000 gray Buick was found Monday near his office building, blanketed that day by a snowfall.
The investigation began to intensify at the end of the week, and on Friday, the police released a photograph of Mr. Silver to the news media and asked for the public's help. Later that day, detectives learned that the lawyer had been seen near the Criminal Court building in Brooklyn at about 4 p.m. Monday, and the police searched the courthouse.
Karen Rappaport, Justice Rappaport's daughter, said last night that the police had notified the family that Mr. Silver's body had been found. She said they were struggling to cope with the news that he had been killed. ''We're devastated, and that's all we're going to say right now,'' she said. ''We just want to know who's responsible for this.''
Ms. Rappaport said that Mr. Silver's daughter, Marsha Heit, who lives in Philadelphia, had been in Brooklyn but left to return home a short while before the family was notified of the body's discovery.
Earlier yesterday, before he had learned that his cousin's body had been found, Justice Rappaport described Mr. Silver as a man of habit who rarely left Brooklyn except to visit his daughter in Philadelphia and make rare Manhattan court appearances. ''He only left the country once, and that was for his honeymoon in Canada,'' the judge said.
Mr. Silver, who was passionate about his law practice, cared for his wife, who has a heart ailment, and would arrive home punctually at 5 p.m. every day, Justice Rappaport said. Ms. Rappaport said that Mr. Silver was a doting grandfather who lavished attention on Ms. Heit's daughter, Elizabeth.
Mr. Silver began practicing law in 1951, after graduating from Brooklyn Law School and Brooklyn College.Continue reading the main story


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The Molluscan Community Associated with the Scleractinian Coral Oculina Varicosa
The molluscan community associated with the scleractinian coral Oculina varicosa is compared among four reef sites: inner shelf (6 m), midshelf (27 m), outer shelf (42 m), and shelf edge (80 m). Enumeration of all the mollusks from 41 coral samples yielded 5,132 individuals and 230 species-level taxa, including 155 gastropods, 68 bivalves, 1 scaphopod, 5 polyplacophorans, and 1 cephalopod. Of these taxa, approximately 47% were free living (motile), 32% symbiotic (parasitic or commensal), 18% epilithic (fouling), and 3% endolithic (boring). The species assemblage at the 80-m reef was very distinct from that at 6 m. Approximately 75% of the individuals collected at 6 m were herbivores or detritivores; higher light levels and sedimentation from wave surge at this station may account for this dominance. Carnivores dominated at the 80-m station (62.1% of the individuals) but were uncommon at 6 m (4.8%). At the 80-m station, greater coral coverage permitted more coral-eating mollusks, and greater percentage of dead coral per colony enabled more epilithic species and associated symbionts to exist. The corallum of O. varicosa was denser at 80 m and the branches were generally thinner than at 6 m, possibly accounting for the fewer numbers and species of boring mollusks at the 80-m reef. Periodic coldwater upwelling and cooler average temperatures may account for the greater numbers of eurythermic tropical, temperate, and boreal species at the 80-m reef than at the 6-m reef.
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Document Type: Research Article
Publication date: 1987-01-01
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I love to shop as much as the next girl. In fact, I probably love to shop MORE than the next girl. But when I found out that Concord Mills was the #1 tourist attraction not only in the Charlotte region BUT IN THE ENTIRE STATE of North Carolina I wanted to head up to Concord and personally yell at the 17.5 million people who visit there annually. SERIOUSLY PEOPLE?
You'd rather shop at a giant mall than:
* Visit Biltmore Estate?
* See Chimney Rock State Park?
* Hike Grandfather Mountain?
* Check out the Billy Graham Library?
* Attend a race at Lowe's Motor Speedway?
* Smell the orchids at Daniel Stowe Botanical Gardens?
* See the lighthouse at Historic Ocracoke?
* Explore the Land of the Waterfalls?
* Wander through the Mint Museum?
* Take a walk down memory lane at the Old Salem Museum and Gardens?
* Scale the highest peaks of the Sauratown Mountains at Hanging Rock State Park?
* Play with the animals at the Lazy 5 Ranch in Mooresville?
* Drive through Christmas Town USA?
* Go rafting at the U.S. National Whitewater Center?
* Watch the Panthers lose at Bank of America Stadium?
* Play 18 holes at Grove Park Inn?
* Take a tour of historic Downtown Laurinburg?
* Visit the 1767 Chowan County Courthouse?
* Walk the Dismal Swamp Trail?
* Discover something new at Discovery Place?
I am stymied. Seriously. Especially because my one encounter with Concord Mills left me scrounging through the bottom of my purse for a spare Xanax and wishing that drive through daquiri stands were still a reality.
So here's the story. Back in May one of our local Rotary Groups hosted an exchange team from Chile and I wound up volunteering to accompany the group to Lowe's Motor Speedway for a tour. Which I did. And I blogged about it. At least - the tour part. What I failed to write about was the fact that after the tour I had to drive over to Concord Mills to meet up with the rest of the group who had opted to go shopping. OMG. Shoot. Me. Now.
Did you know that there are like a dozen entrances to Concord Mills? And I sort of turned into the first one I could find but then I had to find "Door 8" (or something) and I was at "Door 3" (or something) and I had no idea whether to go right or left and so I opted for one direction which turned out the be THE ENTIRELY WRONG DIRECTION and so then I turned around and basically drove around the ENTIRE PERIMETER of this ginormous mall and I couldn't fucking find Door 8 only Door 7 and then I was in some kind of loading dock area and Holy Hell y'all I had a handful of Chileans in the car with me and I was in the throes of a FULL ON ANXIETY ATTACK and so yeah...that's another reason why I hate Concord Mills.
And in case you actually care, I did finally manage to find the right door and we met up with the rest of the group. And then the cherry on the sundae known as The Day On Which Concord Mills Killed My Spirit was driving back on I-85 in rush hour at which point I seriously contemplated pulling my car over to the side of the road, getting out, and hurling myself into oncoming traffic only oncoming traffic WASN'T FUCKING MOVING and so it probably wouldn't have done any good anyways.
The upside to that day was that I got introduced to Baby Guinness.
And if Irish Whiskey for Jews doesn't totally save the day, I'll kiss your...
Hospice files: P. goes home
4 weeks ago


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1. Jim Baker and Jimmy Swaggert have written An impressive new book. It's called ........ 'Ministers Do More Than Lay People'
2. Transvestite: A guy who likes to eat, drink And be Mary.
3. The difference between the Pope and Your boss, the Pope only expects you To kiss his ring.
4. My mind works like lightning, One brilliant Flash and it is gone.
5. The only time the world beats a path to Your door is if you're in the bathroom.
6. I hate sex in the movies. Tried it once. The seat folded up, the drink spilled and that ice, well, it really chilled the mood.
7. It used to be only death and taxes.. Now, of course, there's shipping and handling, too.
8. A husband is someone who, after taking the trash out, gives the impression that he just cleaned the whole house.
9. My next house will have no kitchen - just Vending machines and a large trash can.
10.A blonde said, 'I was worried that my Mechanic might try to rip me off. I was relieved when he told me all I needed was turn signal fluid.
11.As you slide down the banister of life, may the splinters never point the wrong way
Thoughts on Autumn - Pine Needle Pathway From deep inside I feel the coming of winter. That time of magnificent transition in the northeast part of America is autumn. It has ...
29 minutes ago


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Mississippi Valley State University public health program
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Get the facts about Mississippi Valley State University public health program, and registering for elective seminars. Which college degrees give you the best chances of finding employment after graduation? Whether you are considering an associates degree (CNA, LVN, or LPN), or a bachelor of science in nursing (RN), you will find many doors opening after graduation. Concentrating on Mississippi Valley State University public health program, for example, you may gain an advantage in job recruiting on-campus. Check with the public health department for course registration deadlines, and global health program requirements. Please use the form above to request admissions info for Mississippi Valley State University.
The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. Agencies of HHS conduct health and social science research, work to prevent disease outbreaks, assure food and drug safety, and provide health insurance.
In addition to administering Medicare and Medicaid, which together provide health insurance to one in four Americans, HHS also oversees the National Institutes of Health, the Food and Drug Administration, and the Centers for Disease Control. The Secretary of Health and Human Services oversees a budget of approximately $700 billion and approximately 65,000 employees. The Department's programs are administered by 11 operating divisions, including 8 agencies in the U.S. Public Health Service and 3 human services agencies. Beyond major requirements within the public health department, you may consider Brigham Young University Hawaii online pharmacy degree as a complementary elective to your primary course of study.
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Assist nursing management with budgetary development and control. Must be knowledgeable of nursing and medical practices and procedures, as well as laws..
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Bachelor's degree from an accredited college or university with a concentration in early childhood education, psychology, nursing or related field, plus one (1)..
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Must be registered by the Washington State Nursing Commission as a Certified Nursing Assistant. Completion of an accredited Nursing Assistant program (or..
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Friday, February 24, 2017
Jennifer & David | Johnstown, Pennsylvania Wedding
Jennifer & David put out such a positive vibe throughout their wedding day, it was hard not to smile every time you looked at them. We had so much fun exploring the neighborhoods of Johnstown during their photo session and even the rain didn't stop these two love birds from having the perfect day! It was also our first time at the beautiful Grand Halle on Broad Street in downtown Johnstown and wow, it was so amazing to shoot there!
Thanks to Jennifer & David for having us capture their wedding day. We are excited to share your wedding highlights! Best of luck and enjoy!
Venue: The Grand Halle on Broad Street
Photos: Kevin Leonardis Photography
DJ: DJ Jack Labarko
Video: Altoona Video Production
1 comment:
You both are looking awesome in this video, Here videographer captures best moments of your most memorable day, It is really nice. Hire the professional videography service on the budget Wedding Video Packages.ReplyDelete
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This is the right call. Freedom of Religion in America doesn't mean the freedom to only practice the Christian faith. If anything, this is more of a poke in the eye to the Taliban that feeding into their propaganda of American hypocrisy and intolerance.
This is what Jeffersonian Democracy looks like. Religious tolerance is an American Value. This mosque will be on private property and there's already one close to Ground Zero. This is going to make the evangelicals crazy and fire up the Birthers. Hang on to your hats!
Friday, August 13, 2010
President Obama supports construction of Mosque near Groud Zero
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