Sinus lift carried out with phycogenic bone substitute was shown to be an effective method with limited invasiveness and a high survival rate of implants (97.8%).

Over the past 35 years, multiple types of all-ceramic materials have been introduced as an ideal alternative for metal-fused to ceramic. This review covers state-of-the-art development of all-ceramic systems in terms of history, material composition, fabrication technologies, and structural and strength properties. These materials are proved to be ideal in terms of mechanical properties and biocompatibility, making metal-free ceramic restorations a realistic clinical alternative for conventional metal-fused-to ceramic.

Advantages of all-ceramics over metal ceramic systems• Aesthetic advantages of all-ceramic systems are proved by replacing the light blocking metal substructure by more opaque high strength ceramic. • Wide range of patients' tooth shades ('value' in Munsell scale) can be satisfied.• Because of colour, finish line can be at gingival margin or 0.5 mm subgingival without compromising aesthetics.• All-ceramic systems have reduced thermal conductivity, resulting in less thermal sensitivity and pulpal irritation.• Because of lesser accumulation of bacteria on ceramic surfaces, it can be used over implants in the sub gingival area (20). • More biocompatible.• Emergent profile of all-ceramic crowns is less likely to be over-contoured. In vitro and in vivo dataAll-ceramic crowns/bridges The metal ceramic system is the longest studied FPD system; it would be better to compare the all-ceramic system with the data of metal ceramic system. Walton's retrospective study of 515 metal-ceramic FPDs showed the cumulative survival rate of FPDs was 96 % for 5 years, 87 % for 10 years, and 85 % for 15 years. Reported modes of failure for metal ceramic FPDs were tooth fracture (38 %), periodontal breakdown (27 %), loss of retention (13 %), and Caries (11 %) (24). In literature review there are 5 ceramic systems which were studied in detail. They are: a. Glass infiltrated alumina (In-ceram alumina, Vita). b. Leucite-reinforced glass (Empress, Ivoclare), c. Glass infiltrated magnesium aluminate spinell (In ceram spinell, Vita), d. Poly crystalline alumina (Procera, Noble Biocare) e. Zirconium-oxide Ceramics A reported failure rate appears to be lower for anterior crowns than molar crowns. The least amount of failure was reported for posterior restorations manufactured by high strength all-ceramic systems (All Ceram alumina; Procera, In-Ceram Alumina; Vita). Documented data is in agreement with reported data of metal ceramic systems. Long term follow up of newer Zirconium system results are widely expected. Selection criteriaAn ideal ceramic material for the fabrication of artificial replacement should allow for control of substrate colour Summary: Current all-ceramic materials offer a accepted level of fracture resistance, fit and aesthetics. High fracture resistance recommends it to be a material to support fixed partial denture (FPD) in a stress bearing area with clinical success. This part of the present literature review covers the success rate, selection criteria of all ceramic systems, cementation technique, finishing and polishing. In vitro and in vivo studies of new high strength ceramics were well documented. Data suggest that single crowns in the anterior and posterior region are more predictable than bridges. Well-studied longterm success rate for FPDs are very limited.

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