Current status of zirconia restoration

Full-ceramic resin-bonded fixed dental prostheses: A systematic review

Despite the development of implant-supported prostheses, there are still patients for whom conservative treatments such as resin-bonded fixed dental prostheses (RBFDPs) are more appropriate. This study's objective was to analyze the available research on full-ceramic RBFDPs. In this study, Web of Science, MEDLINE/PubMed, Scopus, Embase, Cochrane Library, and Google Scholar databases were searched for articles published in English between 2010 and 2020. A total of 14 studies were reviewed based on the eligibility criteria. The results showed that using a cantilever design with one abutment had an advantage over two abutments. Additionally, it was proposed that preparations designed with retentive aids, such as a proximal box, groove, and pinhole, could improve RBFDP survival rates. IPS e.max ZirCAD, In-Ceram alumina, and zirconia CAD/CAM were the most commonly used framework materials. Most studies used air abrasion, salinization, or hydrofluoric acid for surface treatment. Adhesive resin cements were the most frequently used type of cement. The survival rate of In-Ceram ceramics (85.3%-94.8%) was lower than that of In-Ceram zirconia and IPS e.max ZirCAD. Debonding, followed by framework fracture, was the leading cause of failure. Following 3-10 years follow-up, the survival percentage of all-ceramic RBFDPs ranged from 76% to 100%. Although RBFDPs have demonstrated satisfactory success as a conservative treatment, long-term follow-ups and higher sample sizes in clinical research are required to gain more reliable outcomes on the clinical success rate of various RBFDP designs.

Mechanical characteristics of zirconia produced additively by 3D printing in dentistry - A systematic review with meta-analysis of novel reports

OBJECTIVES

This study was aimed at comparing the mechanical parameters of ceramics made using the addition and subtraction technique.

METHODS

A search was performed on four search engines on 5th April 2023. Quality assessment was performed using study type-specific scales. Where possible, a meta-analysis was performed.

SOURCES

Data were extracted from four search engines: PubMed, PubMed Central, Embase, Web of Science, Scopus.

STUDY SELECTION

The search strategy identified 686 potential articles. 19 papers were subject to qualitative analysis, and data from 11 papers were meta-analysed. The included studies were of high or medium quality. All included papers were in-vitro studies. No clinical trials were found in the literature.

SIGNIFICANCE

Ceramics made in the additive technology in terms of mechanical parameters can compete with ceramics made in the milling technology. There are no clinical studies yet that would indicate the use of this type of material for permanent restorations in patients. Studies presented in the literature vary greatly in terms of study design and reporting of results. The research did not receive external funding.

A comparative study of the cutting efficiency of diamond rotary instruments with different grit sizes with a low-speed electric handpiece against zirconia specimens

STATEMENT OF PROBLEM

The use of zirconia in dentistry has increased. However, little attention has been given to the difficulty experienced by clinicians when cutting zirconia restorations intraorally. Evidence for which grit size and type of rotary instrument is best for cutting zirconia intraorally is lacking.

PURPOSE

The purpose of this in vitro study was to identify the most efficient diamond rotary instrument grit size for cutting zirconia intraorally.

MATERIAL AND METHODS

Efficiency was measured by comparing the cutting depth of each rotary instrument into zirconia, analyzing zirconia specimens for surface damage after cutting, and measuring instrument deterioration. Thirty zirconia specimens of the same measurements were used as test specimens and cut with 30 diamond rotary instruments with different grit sizes. An electric handpiece was used with constant force (1.7 N), speed (40 000 rpm), time (1 min), and water flow rate (25 mL/min) to produce comparative data. The mean cutting efficiency values were compared by analysis, and the median values were compared by the nonparametric Kruskal-Wallis test (α=.05). Each test was followed up with pair wise comparisons of the mean or median values if significance was indicated.

RESULTS

The greatest cutting depth was achieved with a fine-grit instrument with a mean cutting depth of 5.79 mm compared with 4.54 mm for the coarse-grit instrument (P=.032). The greatest damage to zirconia was done by the coarse- and supercoarse-grit instruments (both 33%), with no substrate damage by the superfine-, fine-, and medium-grit instruments. The greatest instrument deterioration was found on the supercoarse rotary instruments (9.05%). With only 3 exceptions, the power calculations were all sufficient and above 83%.

CONCLUSIONS

The fine grit rotary instrument (between 40 and 50 µm) was the most efficient, achieving the greatest cutting depth, with no detectable macroscopic damage to the zirconia and minimal instrument deterioration.

Longevity of extrinsic stains on monolithic zirconia restorations: An in vitro study

STATEMENT OF PROBLEM

Three-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) has been commonly used for fixed prosthodontic restorations. The opacity of 3Y-TZP may be masked with external staining, although the longevity of extrinsic stains applied to monolithic zirconia is unclear.

PURPOSE

The purpose of this in vitro study was to analyze the color and surface roughness of extrinsically stained zirconia specimens after thermocycling and toothbrushing.

MATERIAL AND METHODS

Monolithic Ø12.5×1.25-mm zirconia disks were milled from 3Y-TZP blocks, sintered according to manufacturer instructions, and then divided into 3 groups (C, J, and O; n=16) for application of stain and glaze. All specimens underwent 10 000 thermocycles in distilled water before being further divided into 2 dentifrice groups (n=8): normal grit, low relative dentin abrasivity (RDA) (Subgroup N) and abrasive grit, high RDA (Subgroup A). Specimens were brushed in a multistation brushing machine under 1.47 N of force using a 5:8 toothpaste and distilled water slurry for 10 000 cycles with a straight (American Dental Association Standard) toothbrush to simulate 1 year of toothbrushing. Color and surface roughness measurements were obtained at 3 time points: baseline, after thermocycling, and after brushing. A 2-way repeated measures ANOVA was used to independently assess changes in color and surface roughness with respect to thermocycling and brushing (α=.05).

RESULTS

Group J displayed no significant change in color for either dentifrice system (P>.05). However, a significant change in surface roughness was observed for both dentifrice subgroups (P<.001). Group C specimens displayed significant changes in color (P<.001) and surface roughness (P<.001) for both dentifrice systems. Group O specimens displayed significant changes in color (P<.025) for both dentifrice systems and significant changes in surface roughness (P<.004) for subgroup A, but no significant changes for subgroup N (P=.075).

CONCLUSIONS

Artificial aging of monolithic zirconia resulted in changes in color and surface roughness that did not surpass the thresholds for perceptibility and acceptability. This study failed to establish durability limits for extrinsic stains applied to 3Y-TZP.

Clinical evaluation of zirconia crowns cemented with two different resin cements: A retrospective study

BACKGROUND

Self-adhesive resin cement has been used extensively with zirconia crowns. Several in vitro studies showed that adhesive resin cementation may increase zirconia crowns' retention and their fatigue resistance.

OBJECTIVES

This retrospective study aimed to evaluate the clinical performance, survival and success rates and complications encountered with zirconia crowns cemented with two different self-adhesive resin cements.

METHODS

A total of 112 patients who received 176 monolithic zirconia crowns were evaluated. Crowns were cemented with RelyX Unicem 2 (n = 74) and Panavia SA (n = 102) self-adhesive resin cements. Clinical assessments of the crowns and supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Intraoral photographs and periapical and bitewing radiographs were obtained for further assessment by two evaluators. Descriptive statistics, McNemar, t-test, log rank (Mantel-Cox) tests and Kaplan-Meier survival analyses were performed (a = .05).

RESULTS

The 5-year survival and success rates were 100% and 96.4%, respectively. The complications encountered were recurrent caries (2.2%) and the need for endodontic treatment (0.5%). No technical complications, such as fracture or loss of retention, were observed. The type of cement and patient-related factors did not influence the survival and success rates of the crowns.

CONCLUSIONS

Survival rate of zirconia crowns cemented with two different self-adhesive resin cements was 100% after 5 years.

Translucent Zirconia in Fixed Prosthodontics-An Integrative Overview

Over the past two decades, dental ceramics have experienced rapid advances in science and technology, becoming the fastest-growing field of dental materials. This review emphasizes the significant impact of translucent zirconia in fixed prosthodontics, merging aesthetics with strength, and highlights its versatility from single crowns to complex bridgework facilitated by digital manufacturing advancements. The unique light-conducting properties of translucent zirconia offer a natural dental appearance, though with considerations regarding strength trade-offs compared to its traditional, opaque counterpart. The analysis extends to the mechanical attributes of the material, noting its commendable fracture resistance and durability, even under simulated physiological conditions. Various zirconia types (3Y-TZP, 4Y-TZP, 5Y-TZP) display a range of strengths influenced by factors like yttria content and manufacturing processes. The study also explores adhesive strategies, underlining the importance of surface treatments and modern adhesives in achieving long-lasting bonds. In the realm of implant-supported restorations, translucent zirconia stands out for its precision, reliability, and aesthetic adaptability, proving suitable for comprehensive dental restorations. Despite its established benefits, the review calls for ongoing research to further refine the material's properties and adhesive protocols and to solidify its applicability through long-term clinical evaluations, ensuring its sustainable future in dental restorative applications.

Chairside posterior cantilevered fixed partial denture: Case report

The cantilevered fixed partial denture (CFPD) is gaining recognition as a sound method of replacing missing teeth in the posterior sector. The purpose of this case report is to demonstrate that this type of restoration can be performed in a single appointment. A 39-year-old patient presented herself to the dental department; she showed agenesis of the two first maxillary premolars with a totally closed mesio-distal gap and a recent loss of the 2 s maxillary premolars. This case report concerns the replacement of the upper left second premolar. The patient was treated with a mesial CFPD resting on an "onlay-like" retainer on the first molar and replacing the missing premolar with a cantilevered pontic. The dimensions of the connection's cross-section were maximized as much as possible (>20 mm2). The restoration was designed and produced using chairside CAD-CAM from a milled-reinforced glass-ceramic block (Emax CAD, Ivoclar Vivadent). The aesthetic and functional integration of the prosthesis was successful. The patient was examined at 11 months for a follow-up. At this early stage, satisfactory dental hygiene was observed, associated with a smooth prosthetic fit, no periodontal inflammation, normal probing, and no abnormal dental mobility.

MC design and FIB preparation of a YSZ biochemical material microstructure

Aiming at the difficulty of traditional machining of Y2O3-ZrO2 (YSZ) inert ceramic materials, a different method using focused ion beam to selectively create nanoscale microscale structures on the surface of materials was proposed. The sputtering yield, surface damage, and the energy loss of YSZ materials was investigated using the SRIM software using the Monte Carlo method. It is shown that the sputtering yield increases with ion energy in the range 0-30 keV, reaching a maximum of 9.4 atoms/ion at 30 keV. At an ion beam voltage of 30 keV, the most severe damage to the material is 8 mm on the surface. At the same time, the main forms of energy loss in the treatment are phonon energy loss and ionization energy loss, of which phonon energy loss due to the recoil atoms is the largest. In addition, we continue to perform focused ion beam processing experiments on YSZ materials, combining previous MC modeling to optimize different operating conditions such as ion beam, voltage and processing mode. The optimized processing parameters are 30 keV and 2.5 nA. It is shown that the quality of the deep grooves gradually improves with decreasing ion beam current at the same ion beam voltage. However, an excessively small ion beam current leads to an excessively large depth of the deep grooves and lengthy processing times.

Do zirconia single-retainer resin-bonded fixed dental prostheses present a viable treatment option for the replacement of missing anterior teeth? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Zirconia has been widely used in restorative dentistry because of its favorable strength and esthetics. However, its polycrystalline structure presents a challenge for resin bonding. Significant research into surface treatments of zirconia to improve bonding has been reported, yet a universally accepted protocol remains elusive.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the performance of anterior single-retainer zirconia resin-bonded fixed dental prostheses (RBFDPs) and review the bonding protocols used in the published data.

MATERIAL AND METHODS

An electronic search of English language literature was conducted in the PubMed and Ovid (MEDLINE) databases. Following the application of inclusion and exclusion criteria, the research was evaluated to assess the quantitative data.

RESULTS

Of the included studies, 1 randomized controlled trial, 3 prospective cohort studies, and 2 retrospective cohort studies reporting on anterior single-retainer zirconia RBFDPs were evaluated. Over a 3- to 10-year period, the success rate of anterior single-retainer zirconia RBFDPs was over 80%. Although there were reports of debonds, this is a minor complication as rebonding is usually possible. Furthermore, catastrophic fractures of the entire prosthesis were rare.

CONCLUSIONS

Evidence for the use of single-retainer zirconia RBFDPs as a suitable treatment option for the replacement of anterior missing teeth is considerable. Based on the findings of this systematic review and meta-analysis, a 2-step process comprising micromechanical retention using airborne-particle abrasion and subsequent resin-zirconia adhesion by the application of 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) can be recommended.

Clinical Effectiveness of 3D-Milled and 3D-Printed Zirconia Prosthesis-A Systematic Review and Meta-Analysis

BACKGROUND

Additive manufacturing (three-dimensional (3D) printing) has become a leading manufacturing technique in dentistry due to its various advantages. However, its potential applications for dental ceramics are still being explored. Zirconia, among ceramics, has increasing popularity and applications in dentistry mostly due to its excellent properties. Although subtractive manufacturing (3D milling) is considered the most advanced technology for the fabrication of zirconia restorations, certain disadvantages are associated with it.

METHODS

A systematic review was piloted to compare the clinical performance of zirconium crowns that were fabricated using three-dimensional (3D) milling and 3D printing. A meta-analysis was performed, and studies published up to November 2022 were identified. The terms searched were "Zirconium crowns", "3D printing", "CAD/CAM" (Computer-Aided Design and Computer-Aided Manufacturing), "Milling", "dental crowns", and "3D milling". The characteristics that were compared were the year in which the study was published, study design, age of the patient, country, the number of crowns, the type of crown fabrication, marginal integrity, caries status, and outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to structure this systematic review. Out of eleven hundred and fifty titles identified after a primary search, nine articles were included in the quantitative analysis. The research question based on PICO/PECO (Participant, Intervention/exposure, Comparison, and Outcome) was "Do 3D-printed and milled (P) zirconia crowns and FDPs (I) have a better survival rate (O) when conventional prosthesis is also an option (C)"? The data collected were tabulated and compared, and the risk of bias and meta-analysis were later performed. Only nine articles (clinical research) were selected for the study. Since there were no clinical studies on the 3D printing of zirconium crowns, six in vitro studies were considered for the comparison. Zirconium crowns in the milling group had an average minimum follow-up of 6 months.

RESULTS

A moderate risk of bias was found, and survival was significant. A high heterogeneity level was noted among the studies. Marginal integrity, periodontal status, and survival rate were high. Linear regression depicted no statistical correlation between the type of cement used and the survival rate.

CONCLUSIONS

It can be concluded that the milled crowns had a higher performance and satisfactory clinical survival.

Investigating the effect of solid loading on microstructure, mechanical properties, and translucency of highly translucent zirconia ceramics prepared via stereolithography-based additive manufacturing

A study was conducted to explore the potential of 5 mol% yttria-partially stabilized zirconia (5Y-PSZ) ceramics for dental restorations, using stereolithography (SLA) printing technique. Four different solid loadings were established in the ceramic paste systems to study their effects on microstructure, mechanical properties, and translucency. The study examined the rheological behavior and photopolymerization performance of the ceramic pastes with varying solid loadings. Results showed that, an increase in powder concentration resulted in a decrease in cure depth (Cd) and penetration depth (Dp). A narrower pore size distribution was observed in the green bodies with a high solid loading, facilitating the achievement of final densification. The green and sintered densities were highest at 52 vol%, with values of 3.46 ± 0.01 g/cm3 and 6.01 ± 0.02 g/cm3, respectively. Additionally, all of the green strengths exceeded 30 MPa, with a maximum of 35.09 ± 2.02 MPa obtained at 44 vol%. The maximum flexural strength and minimum contrast ratio (CR) value of 746 ± 75 MPa and 0.40 ± 0.01 were achieved at 52 vol% after sintering. No significant differences were observed in the phase composition and hardness of the as-sintered ceramics. Though significant differences were observed in photopolymerization performance, four materials showed similar structural reliability considering Weibull modulus and characteristic strength.

Mechanical and surface properties of additive manufactured zirconia under the different building directions

PURPOSE

This study investigates the mechanical and surface properties of zirconia manufactured using additive manufacturing (AM) technology and the effect of the building direction on the mechanical and surface properties.

METHODS

Specimens were prepared using ZrO₂ paste (3DMix ZrO₂; 3DCeram) and a three-dimensional printing system (CeraMaker 900; 3DCeram) based on the principles of stereolithography (SLA). The mechanical properties (flexural strength, Vickers hardness, fracture toughness, elastic modulus, and Poisson's ratio) and surface properties (chemical composition and surface observation) were evaluated for three building directions (parallel, diagonal, and perpendicular) to investigate the relationship between the building directions and the anisotropy of the mechanical and surface properties of SLA-manufactured zirconia. Statistical analysis was performed using a one-way analysis of variance and Tukey's honestly significant difference test.

RESULTS

The highest flexural strength was obtained for a perpendicular building direction. The flexural strength was significantly higher in the perpendicular direction than in the parallel and diagonal directions; it was also significantly higher in the diagonal direction than in the parallel direction (P<0.05). The Vickers hardness, fracture toughness, elastic modulus, Poisson's ratio, and chemical composition did not differ significantly. Microstructural observations revealed that the layers, large crystals, and pores were more prominent in the parallel direction.

CONCLUSIONS

The flexural strength and surface structure of the tested SLA-manufactured zirconia were influenced by the building direction; however, other mechanical properties remained unaffected. The layer boundaries affected the anisotropic behavior of the builds to a certain extent, owing to the layer-by-layer production method.

Current classification of zirconia in dentistry: an updated review

Zirconia, a crystalline oxide of zirconium, holds good mechanical, optical, and biological properties. The metal-free restorations, mostly consisting of all-ceramic/zirconia restorations, are becoming popular restorative materials in restorative and prosthetic dentistry choices for aesthetic and biological reasons. Dental zirconia has increased over the past years producing wide varieties of zirconia for prosthetic restorations in dentistry. At present, literature is lacking on the recent zirconia biomaterials in dentistry. Currently, no article has the latest information on the various zirconia biomaterials in dentistry. Hence, the aim of this article is to present an overview of recent dental zirconia biomaterials and tends to classify the recent zirconia biomaterials in dentistry. This article is useful for dentists, dental technicians, prosthodontists, academicians, and researchers in the field of dental zirconia.

Ultrashort pulse laser patterning of zirconia (3Y-TZP) for enhanced adhesion to resin-matrix cements used in dentistry: An integrative review

Surface modification of yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) using lasers for adhesion enhancement with resin-matrix cement has been increasingly explored. However, Y-TZP is chemically inert and non-reactive, demanding surface modification using alternative approaches to enhance its bond strength to resin-matrix cements. The main aim of this study was to conduct an integrative review on the influence of ultrashort pulse laser patterning of zirconia (3Y-TZP) for enhanced bonding to resin-matrix cements. An electronic search was performed on web of science, SCOPUS, Pubmed/Medline, Google Scholar and EMBASE using a combination of the following search items: zirconia, 3Y-TZP, surface modification, laser surface treatment, AND laser, ultrashortpulse laser, bonding, adhesion, and resin cement. Articles published in the English language, up to January 2022, were included regarding the influence of surface patterning on bond strength of Y-TZP to resin-matrix cements. Out of the 12 studies selected for the present review 10 studies assessed femtosecond lasers while 2 studies assessed picosecond lasers. Ultrashort pulsed laser surface patterning successfully produced different surface morphological aspects without damaging the bulk properties of zirconia. Contrarily, defects such as micro-cracks occurs after surface modification using traditional methods such as grit-blasting or long-pulsed laser patterning. Ultrashort pulsed laser surface patterning increase bond strength of zirconia to resin-matrix cements and therefore such alternative physical method should be considered in dentistry. Also, surface defects were avoided using ultrashort pulsed laser surface patterning, which become the major advantage when compared with traditional physical methods or long pulse laser patterning.

Effects of ceramic microbeads on bonding between a zirconia framework and layered resin composite

This study was conducted to evaluate the effects of ceramic microbeads on the bond strength between resin and zirconia. Microbeads made of zirconia (TZ) and zircon (ZS) were treated with and without hydrofluoric acid (HF). The microbeads were sintered to zirconia disks using intermediate feldspathic porcelains. Two control groups, NB (without microbeads) and AS (without porcelain and microbeads), were also prepared. All specimens were treated with a phosphate primer and veneered with a light-curing resin composite. The 24-h shear bond strengths were determined and analyzed by the Tukey-Kramer test (α=0.05, n=10). The TZ-HF specimen exhibited the highest bond strength, followed by TZ, ZS-HF, ZS, AS, and NB. Scanning electron microscopy observations revealed that the TZ-HF specimen had a complicated debonded surface, and it included microconcavities where the microbeads were detached. Sintering etched zirconia beads onto a zirconia framework with feldspathic porcelains is useful for bonding layered resin composite materials.

Survey of Indian Dental Professionals Regarding the Use of Computer-Aided Design/Computer-Aided Manufacture (CAD/CAM) Technology

Objective In recent years, digital processes like computer-aided design/computer-aided manufacture (CAD/CAM) have been implemented in dentistry. On the use and reporting of this technology by dentists, there is no published information. The goal of this study was to determine whether CAD/CAM technology had infiltrated Indian dentistry practices and to look into the relationship between various demographic parameters and respondents' answers about using or not using this technology. Materials and methods A sample of Indian dentists, both users and non-users of CAD/CAM, were sent about 500 online surveys. It sought to shed light on the usage style, materials, advantages, and limitations of CAD/CAM dentistry, as well as their perceived advantages and access hurdles. Statistical analysis was conducted to determine the impact of numerous demographic factors, including country of employment, dentist experience, educational attainment, and the nature of the job. Results There were 132 total replies that were finished. The majority of respondents didn't use any aspect of a digital workflow, and the biggest obstacles to using CAD/CAM were the upfront expenses and a lack of perceived advantages over traditional techniques. The likelihood of using CAD/CAM technology was highest among dentists who primarily performed private practice (P<0.0001). A third of users thought that their training was insufficient, even though the majority of users were either self-taught or schooled by firms. The majority of respondents (60.6%) believed that CAD/CAM would have a significant future role. Conclusion Most respondents said they had never used any aspect of a digital process. Although most dentists who responded to the study thought CAD/CAM would play a significant role in the future, the majority were still interested in integrating it into their workflow. Dentists continue to have certain concerns regarding the chairside CAD/CAM restorations' quality.

Shear bond strength of orthodontic brackets bonded to a new version of zirconium all ceramic restoration: An in vitro comparative study

Objectives

Esthetic restorations such as monolithic zirconia crowns are highly requested for adults nowadays. Bonding orthodontic braces on this type of material became a challenge for orthodontists, because of the special surface treatment needed. This study aims to assess the shear bond strength (SBS) of metal, and ceramic brackets bonded on two types of zirconia ceramics, surface roughness (SR) after different surface treatments for their surfaces, and adhesive remnant index (ARI).

Materials and methods

Brackets' base surface area (BSA) was scanned by an extra-oral scanner, then measured. The doubled labial surface of monolithic zirconia crowns (n = 30) and monolithic high translucent zirconia crowns (n = 30) were prepared and each was divided into three groups (n = 10) depending on surface treatment (hydrofluoric acid etching, no treatment, and rocatec airborne abrasion). Extracted lower central incisors (n = 20) were prepared. Each of them was divided into two subgroups depending on the type of bracket bonded on their surfaces (metal and ceramic). The SR, SBS, and ARI were assessed.

Statistical analysis used

Tests used are independent-samples t-test, Fisher's exact test, One-Way ANOVA, and Kruskal-Wallis test.

Results

The highest SBS and SR were observed in Enamel/Metal and Zirconia/Metal/Rocatec subgroups, respectively.

Conclusion

Adequate bond strength could be obtained with the high translucent zirconia group if bonded with ceramic or metal brackets even if no treatment was used.

Clinical significance

A proportion of simulation was done like practicing inside the dental clinic to reach the best results regarding the adhesion strength of orthodontic brackets.

Effect of Various Airborne Particle Abrasion Conditions on Bonding between Polyether-Ether-Ketone (PEEK) and Dental Resin Cement

The effects of alumina particle size and jet pressure on the bond strength of polyetheretherketone (PEEK) were examined to determine the airborne particle abrasion parameters with minimal effects on PEEK and to achieve optimal bond strength, as a reference for future clinical use. An alumina particle with four particle sizes and three jet pressures was used to air-abrade PEEK. Surface roughness (R_a), morphology, chemical structure, and wettability were analyzed using a stylus profilometer, scanning electron microscope, X-ray diffractometer, and contact angle analyzer, respectively. The shear bond strength (SBS) of PEEK and dental resin cement was analyzed using a universal testing machine (n = 10). The failure modes and debonded fracture surfaces were observed using optical microscopy. Airborne particle abrasion increased the R_a and hydrophobicity of PEEK and deposited alumina residues. The SBS generally decreased after thermal cycling. A large particle size damaged the PEEK surface. The effects of different particle sizes and jet pressures on the SBS were only significant in certain groups. Adhesive failure was the main mode for all groups. Within the limitations of this study, 110 μm grain-sized alumina particles combined with a jet pressure of 2 bar prevented damage to PEEK, providing sufficient SBS and bonding durability between PEEK and dental resin cement.

Four-point flexural strength and microtensile bond strength of digitally and conventionally veneered zirconia

This study intended to evaluate the effect of digital veneering on four-point flexural strength (FS) and microtensile bond strength (μTBS) of veneered zirconia. Two different zirconia blocks, a lithium disilicate and a feldspathic ceramic block, and two different layering ceramics were used. IPS e.max Zir CAD (ZC) and Vita In-Ceram YZ (YZ) with yttria stabilized tetragonal zirconia polycrystals (3Y-TZP) were used as substructures. IPS e.max CAD (LD), Vita Mark II (VMII), IPS e.max Ceram (EC) and Vita VM9 (VM9) were used for veneering. Resin cement and fusion ceramic were placed between veneer and zirconia substructure for digital veneering. A total of one hundred and fifty specimens in five groups (n = 30) were prepared for FS and tested in universal machine at 1.0 mm/min. One hundred specimens in five groups (n = 20) were obtained for the μTBS and tested at 1.0 mm/min. Statistical analysis was made by one way ANOVA and Tukey HSD. Conventional veneering showed statistically significant FS. ZC veneered with EC had the highest mean FS and the lowest was obtained in groups veneered through resin cement. YZ layered with VM9 had the highest mean μTBS. ZC veneered through fusion ceramic and YZ veneered through resin cement showed significantly lower and similar μTBS.

Different Designs of Deep Marginal Elevation and Its Influence on Fracture Resistance of Teeth with Monolith Zirconia Full-Contour Crowns

Background and objectives: Even with the demand for high esthetics, the strength of the material for esthetic applications continues to be important. In this study, monolith zirconia (MZi) crowns fabricated using CAD/CAM were tested for fracture resistance (FR) in teeth with class II cavity designs with varying proximal depths, restored through a deep marginal elevation technique (DME). Materials and Methods: Forty premolars were randomly divided into four groups of ten teeth. In Group A, tooth preparation was conducted and MZi crowns were fabricated. In Group B, mesio-occluso-distal (MOD) cavities were prepared and restored with microhybrid composites before tooth preparation and the fabrication of MZi crowns. In Groups C and D, MOD cavities were prepared, differentiated by the depth of the gingival seat, 2 mm and 4 mm below the cemento-enamel junction (CEJ). Microhybrid composite resin was used for DME on the CEJ and for the restoration of the MOD cavities; beforehand, tooth preparations were conducted and MZi crowns were and cemented using resin cement. The maximum load to fracture (in newtons (N)) and FR (in megapascals (MPa)) were measured using the universal testing machine. Results: The average scores indicate a gradual decrease in the load required to fracture the samples from Groups A to D, with mean values of 3415.61 N, 2494.11 N, 2108.25 N and 1891.95 N, respectively. ANOVA revealed highly significant differences between the groups. Multiple group comparisons using the Tukey HSD post hoc test revealed that Group D had greater DME depths and showed significant differences compared with Group B. Conclusions: FR in teeth decreased when more tooth structure was involved, even with MZi crowns. However, DME up to 2 mm below the CEJ did not negatively influence the FR. Strengthening the DME-treated teeth with MZi crowns could be a reasonable clinical option, as the force required to fracture the samples far exceeded the maximum recorded biting force for posterior teeth.

Fracture Resistance of Repaired 5Y-PSZ Zirconia Crowns after Endodontic Access

This study analyzed the fracture load before and after a chewing simulation of zirconia crowns that were trepanned and repaired using composite resin. Overall, 3 groups with 15 5Y-PSZ crowns in each group were tested. For group A, the fracture load of the unmodified crowns was evaluated. For group B, the crowns were trepanned and repaired using composite resin, also followed by a fracture test. For group C, crowns were prepared like in group B but received thermomechanical cycling before the final fracture tests. Furthermore, scanning electron microscopy (SEM) and X-ray microscopy (XRM) analysis were performed for group C. The mean fracture loads and standard deviation were 2260 N ± 410 N (group A), 1720 N ± 380 N (group B), and 1540 N ± 280 N (group C). Tukey-Kramer multiple comparisons showed a significant difference between groups A and B (p < 0.01) and groups A and C (p < 0.01). After ageing, surface fissures were detected via SEM, but no cracks that reached from the occlusal to the inner side of the crown were detected via XRM. Within the limitations of this study, it can be stated that trepanned and composite-repaired 5Y-PSZ crowns show lower fracture loads than 5Y-PSZ crowns without trepanation.

Manufacturing and Characterization of Dental Crowns Made of 5-mol% Yttria Stabilized Zirconia by Digital Light Processing

We herein report manufacturing of dental crowns made of 5-mol% yttria partially stabilized zirconia (5Y-PSZ) with desired mechanical properties, optical translucency and dimensional accuracy using digital light processing (DLP). To this end, all processing parameters were carefully controlled and optimized. First, 5Y-PSZ particles with a bimodal distribution were prepared via calcination of as-received granules and subsequent ball-milling and then used to formulate 5Y-PSZ suspensions with a high solid loading of 50 vol% required for high densification after sintering. Dispersant content was also optimized. To provide high dimensional accuracy, initial dimensions of dental crowns for 3D printing were precisely determined by considering increase and decrease in dimensions during photopolymerization and sintering, respectively. Photopolymerization time was also optimized for a given layer thickness of 50 μm to ensure good bonding between layers. A multi-step debinding schedule with a slow heating rate was employed to avoid formation of any defects. After sintering at 1500 °C for 2 h, 5Y-PSZ could be almost fully densified without noticeable defects within layers and at interfaces between layers. They had high relative densities (99.03 ± 0.39%) with a high cubic phase content (59.1%). These characteristics allowed for achievement of reasonably high mechanical properties (flexural strength = 625.4 ± 75.5 MPa and Weibull modulus = 7.9) and % transmittance (31.4 ± 0.7%). In addition, 5Y-PSZ dental crowns showed excellent dimensional accuracy (root mean square (RMS) for marginal discrepancy = 44.4 ± 10.8 μm and RMS for internal gap = 22.8 ± 1.6 μm) evaluated by the 3D scanning technique.

3D Printing of Dental Prostheses: Current and Emerging Applications

Revolutionary fabrication technologies such as three-dimensional (3D) printing to develop dental structures are expected to replace traditional methods due to their ability to establish constructs with the required mechanical properties and detailed structures. Three-dimensional printing, as an additive manufacturing approach, has the potential to rapidly fabricate complex dental prostheses by employing a bottom-up strategy in a layer-by-layer fashion. This new technology allows dentists to extend their degree of freedom in selecting, creating, and performing the required treatments. Three-dimensional printing has been narrowly employed in the fabrication of various kinds of prostheses and implants. There is still an on-demand production procedure that offers a reasonable method with superior efficiency to engineer multifaceted dental constructs. This review article aims to cover the most recent applications of 3D printing techniques in the manufacturing of dental prosthetics. More specifically, after describing various 3D printing techniques and their advantages/disadvantages, the applications of 3D printing in dental prostheses are elaborated in various examples in the literature. Different 3D printing techniques have the capability to use different materials, including thermoplastic polymers, ceramics, and metals with distinctive suitability for dental applications, which are discussed in this article. The relevant limitations and challenges that currently limit the efficacy of 3D printing in this field are also reviewed. This review article has employed five major scientific databases, including Google Scholar, PubMed, ScienceDirect, Web of Science, and Scopus, with appropriate keywords to find the most relevant literature in the subject of dental prostheses 3D printing.

One-Piece Zirconia Oral Implants for the Support of Three-Unit Fixed Dental Prostheses: Three-Year Results from a Prospective Case Series

The objective was to investigate the clinical and radiological outcome of one-piece zirconia oral implants to support three-unit fixed dental prostheses (FDP) after three years in function. Twenty-seven patients were treated with a total of 54 implants in a one-stage surgery and immediate provisionalization. Standardized radiographs were taken at implant placement, after one year and after three years, to evaluate peri-implant bone loss. Soft-tissue parameters were also assessed. Linear mixed regression models as well as Wilcoxon Signed Rank tests were used for analyzing differences between groups and time points (p < 0.05). At the three-year evaluation, one implant was lost, resulting in a cumulative survival rate of 98.1%. The mean marginal bone loss amounted to 2.16 mm. An implant success grade I of 52% (bone loss of ≤2 mm) and success grade II of 61% (bone loss of ≤3 mm) were achieved. None of the evaluated baseline parameters affected bone loss. The survival rate of the zirconia implants was comparable to market-available titanium implants. However, an increased marginal bone loss was observed with a high peri-implantitis incidence and a resulting low implant success rate.

Aging resistance of highly translucent zirconia ceramics with rapid sintering

PURPOSE

Rapid sintering technology has become one of the most direct methods for shortening the manufacturing time of zirconia restorations. This study aimed to explore the aging resistance of rapid-sintered 5 mol% yttria-partially-stabilized zirconia (5Y-PSZ).

METHODS

Specimens were made from two types of 5Y-PSZ material and subjected to rapid sintering (RS) and conventional sintering (CS). After in vitro aging for 5 h, morphology observation, grain size measurement, and phase composition analysis were performed. The mechanical properties were evaluated by biaxial, three-point flexural tests, and the Vickers microhardness test. Results were analyzed by 3-way ANOVA.

RESULTS

Both the RS group and the CS group had a dense microstructure. The tested zirconia ceramics had different grain sizes, which were affected by the interaction between the sintering method and aging. Both groups revealed the same characteristic peaks of the cubic phase after aging. Regardless of the sintering method used, there was no significant difference in the mechanical properties of the tested zirconia before and after aging.

CONCLUSION

The rapid-sintered 5Y-PSZ materials had a microstructure, phase composition and mechanical properties similar to those of conventional sintered materials. The characteristics of the materials prepared using the two sintering methods did not change significantly after aging.

Effect of Ga2O3 Dopant on High Speed Sintered 5 mol% Y2O3 Stabilized Dental Zirconia

The high-speed sintering of zirconia has become essential for ceramic dental prosthesis treatment in a single visit. Previous studies have shown that 5 mol% yttria-stabilized zirconia (5Y zirconia), with the exception of some types, loses strength and translucency with high-speed sintering. In this study, 0.15-0.92 wt% Ga₂O₃, which is expected to promote the sintering of zirconia, was added to improve the properties of 5Y zirconia high-speed sintered bodies, and the effect of its addition was evaluated. The specimens were characterized by density and translucency measurements, a three-point bending test, X-ray diffraction (XRD), scanning electron microscopy (SEM), and shrinkage measurement. The addition of Ga₂O₃ improved both translucency and flexural strength of 5Y zirconia high-speed sintered bodies. XRD and SEM observations revealed that this improvement in properties was due to the change in the crystal phase composition and the decrease in the amount and size of pores due to the addition of Ga₂O₃. Shrinkage measurements also revealed that the addition of Ga₂O₃ changed the sintering behavior of 5Y zirconia, suggesting that this change led to a reduction in porosity. From the above results, it was concluded that Ga₂O₃ addition is effective in improving the properties of 5Y zirconia high-speed sintered bodies.

Digital Light Processing of Zirconia Suspensions Containing Photocurable Monomer/Camphor Vehicle for Dental Applications

This study reports the utility of solid camphor as a novel diluent in photocurable hexanediol diacrylate (HDDA) monomer to manufacture 4 mol% yttria partially stabilized zirconia (4Y-PSZ) components for dental applications by digital light processing (DLP). The use of a 65 wt% HDDA-35 wt% camphor solution allowed 4Y-PSZ suspensions to have reasonably low viscosities (1399 ± 55.8 mPa·s at a shear rate of 75 s-1), measured by a cone/plate viscometer, at a high solid loading of 48 vol%, where 4Y-PSZ particles prepared by calcination of as-received 4Y-PSZ granules, followed by a ball-milling process, were used with assistance of a dispersant. These 4Y-PSZ suspensions could be successfully applied to our custom-made DLP machine for manufacturing 4Y-PSZ components. To this end, several processing parameters, including layer thickness of 4Y-PSZ suspension, UV illumination time for layer-by-layer photocuring process, and initial dimensions of 4Y-PSZ objects, were tightly controlled. As sintering temperature increased from 1300 °C to 1500 °C, relative density and grain size of 4Y-PSZ objects increased, and cubic phase content also increased. Thus, after sintering at the highest temperature of 1500 °C for 3 h, high mechanical properties (biaxial flexural strength = 911 ± 40.7 MPa, hardness = 1371 ± 14.4 Hv) and reasonably high optical transmittance (translucency parameter = 7.77 ± 0.32, contrast ratio = 0.809 ± 0.007), evaluated by a spectrophotometer, were obtained due to a high relative density (97.2 ± 1.38%), which would be useful for dental applications.

Effect of different surface treatments on the biaxial flexural strength of zirconia ceramics

STATEMENT OF PROBLEM

Different surface treatments have been applied to zirconia restorations in clinical practice to increase the bond strength between zirconia and cement, but their effect on flexural strength is unknown.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different surface treatments before and after sintering on the flexural strength of zirconia.

MATERIAL AND METHODS

Sixty disk-shaped specimens with an initial diameter of 18.6 ±0.1 mm and thickness of 2 ±0.1 mm were prepared from preshaded presintered 3Y-TZP blocks. The specimens were randomly divided into 3 groups (n=20) according to surface treatments (Group Laser, Group APA, Group Rocatec), and the groups were then divided into 2 subgroups (n=10) according to surface treatment before and after sintering. The phase compositions of the groups were examined by using an X-ray diffractometer (XRD) with 3 randomly selected specimens from each group. Biaxial flexural strength testing was conducted using a universal testing machine to examine the flexural strength of the zirconia specimens. Two-way ANOVA and post hoc least significant difference tests were performed (α=.05).

RESULTS

According to the XRD analysis, no monoclinic phases were determined on the surface of the presintered laser-treated specimens, but tetragonal phases were observed on the surface of the postsintered specimens. Surface treatment type and application stage (presintering to postsintering) have a significant effect on the biaxial flexural strength of the specimens (P<.05). The lowest biaxial flexural values were observed in the Laser group, and postsintered specimens showed higher biaxial flexural strength than presintered specimens (P<.05).

CONCLUSIONS

Postsintered specimens showed higher monoclinic content than presintered specimens. Laser-treated specimens showed the lowest biaxial flexural strength for both presintered and postsintered specimens.

The Effect of Preceramic Soldering on Fracture Resistance of 4-Unit Zirconia Fixed Dental Prostheses

PURPOSE

Preceramic soldering of zirconia may deliver better fitting restorations. However, there is not sufficient evidence regarding the influence of preceramic soldering of zirconia restorations on mechanical strength. The aim of this study was to evaluate the effect of preceramic soldering on the fracture load of 4-unit zirconia fixed dental prostheses (FDPs).

MATERIALS AND METHODS

Eighty samples of 4-unit FDPs between maxillary right first premolar and maxillary right second molar were prepared and two restorative materials were used as a framework (Z) and monolithic restoration (M). The samples were divided into two subgroups as control (C) and study (S). The restorations of study groups (S) were divided into two pieces and soldered with a bonding material (DCM HotBond Zirkon). The groups were divided into two subgroups for thermal cycle (T) application. After soldering and thermal cycling application, 4-point bending test was applied to the samples at a cross-head speed of 1 mm/min in a universal testing machine and the fracture load was recorded. The data was analyzed statistically, and the level of significance was set at α = 0.001.

RESULTS

Statistically significant differences were found among the groups, based on the results of maximum failure loads (p < 0.001). The highest mean failure load was observed in the ZCT(-) group (1094.1 + 139.77 N), while the lowest mean failure load was obtained in the ZST(+) group (627.7 + 82.14 N). No significant difference was found among the groups MC and MS, MC, and ZC groups (p > 0.001). Thermal aging application caused lower fracture resistance in control and soldering groups (p < 0.001).

CONCLUSIONS

The preceramic soldering applications affected zirconia group negatively. However, the values were above the clinically acceptable static load bearing capacity for posterior teeth. Soldering did not cause a statistically significant difference for the fracture strengths of monolithic zirconia groups. Thermal cycling affected the fracture strength of zirconia and monolithic zirconia restorations negatively.

Fit, Precision, and Trueness of 3D-Printed Zirconia Crowns Compared to Milled Counterparts

Precise fit of a crown and accurate reproduction of the digital design are paramount for successful treatment outcomes and preservation of clinician and technician time. The study aimed to compare the internal fit, marginal adaptation, precision, and trueness of 3D-printed zirconia crowns compared to their milled counterpart. A total of 20 monolithic 3 mol% yttria stabilized-zirconia crowns (n = 10) were made using computer-assisted design (CAD) followed by additive (3D-printed) and subtractive (milled) manufacturing. Digital scanning of the master die with and without a fit checker followed by image superimposition, and analysis was performed to evaluate internal and marginal adaptation in four areas (occlusal, axial, marginal, and overall). ISO 12836:2015 standard was followed for precision and trueness evaluation. Statistical analysis was achieved using a t-test at α = 0.05. Internal fit and marginal adaptation revealed no significant difference between the two test groups (p > 0.05). The significant difference in trueness (p < 0.05) was found between the two groups in three areas (occlusal, axial, and internal). The best and worst trueness values were seen with 3D-printed crowns at occlusal (8.77 ± 0.89 µm) and Intaglio (23.90 ± 1.60 µm), respectively. The overall precision was statistically better (p < 0.05) in the 3D-printed crowns (9.59 ± 0.75 µm) than the milled (17.31 ± 3.39 µm). 3D-printed and milled zirconia crowns were comparable to each other in terms of internal fit and marginal adaptation. The trueness of the occlusal and axial surfaces of 3D-printed crowns was better, whereas the trueness of fitting surface of milled crowns was better. 3D-printed crowns provided a higher level of precision than milled crowns. Although the internal and marginal fit of both production techniques were comparable, 3D printing of zirconia produced more precise crowns.

Y-TZP Physicochemical Properties Conditioned with ZrO2 and SiO2 Nanofilms and Bond Strength to Dual Resin Cement

Commercial Yttria-tetragonal zirconia polycrystalline (Y-TZP) was subjected to surface treatments, and the bond strength of dual resin cement to Y-TZP and failure modes were evaluated. Disks (12 mm × 2 mm), cylinders (7 mm × 3.3 mm), and bars (25 mm × 5 mm × 2 mm) were milled from Y-TZP CAD-CAM blocks, divided into seven groups, and subjected to different surface treatments; silicatization was used as control. On the basis of the literature, this study evaluated modifications with films containing SiO2 nanoparticles and silane; SiO2+ZrO2—SiO2 (50%) and ZrO2 (50%) nanoparticles, SiO2+ZrO2/Silane-SiO2 (50%) and ZrO2 (50%) nanoparticles, and silane. Specimens were analyzed by wettability (n = 3), surface free energy (n = 3), X-ray diffraction (n = 1), Fourier transform infrared spectroscopy (FTIR) (n = 1), roughness (n = 5), shear bond test (n = 10), and dynamic modulus (n = 3). Specimens treated with hydrofluoric acid—HF 40% presented significantly higher contact angle and lowest surface free energy (p < 0.05). The SiO2/Silane presented crystalline SiO2 on the surface. The surface roughness was significantly higher for groups treated with nanofilms (p < 0.05). Shear bond strength was significantly higher for silicatization, HF 40%/silicatization, SiO2/Silane, and SiO2+ZrO2/Silane groups. The proposed treatments with nanofilms had potentially good results without prejudice to the physicochemical characteristics of zirconia. Generally, groups that underwent silica surface deposition and silanization had better bond strength (p < 0.005).

Marginal and Internal Misfit of Occlusal Veneers Made in Resin-matrix Ceramics

Objective

Considering that misfit is a significant predictor of the clinical success of indirect restorations, the objective of this study was to evaluate the marginal and internal misfit of two computer-aided design and manufacturing (CAD/CAM) RMC ceramic materials used as occlusal veneers (OVs) of different thicknesses.

Methods and Materials

A CAD model of a mandibular first molar was obtained and OV preparations 0.5-, 1.0-, and 1.5-mm thick were modeled and milled in two different materials (n=10/group): resin nanoceramic (RNC) and polymer-infiltrated ceramic network (PICN). Using the same CAD model, tooth preparations were milled in fiber-reinforced epoxy resin (n=20/thickness). The marginal and internal misfit of the restorations was assessed by X-ray microtomography. The measurements of the marginal gap (MG) and absolute marginal discrepancy were performed in two locations on each slice, whereas internal gap (IG) measurements were performed at ten locations on each slice. The data obtained were analyzed using two-way analysis of variance and Tukey post-hoc tests (α=0.05).

Results

No significant effect was attributable to the material type or material–thickness interaction for the MG, absolute marginal discrepancy (AMD), or IG (p&gt;0.05). However, the thickness significantly affected the IG of the restorations (p&lt;0.05). CAD/CAM RNC and PICN systems presented similar MG and AMD for OVs 0.5-, 1.0-, and 1.5-mm thick. However, the IG varied between thicknesses.

Shear Bond Strength of Polypropylene Fiber in Orthodontic Adhesive on Glazed Monolithic Zirconia

This study aims to compare shear bond strength (SBS) and mode of failure (MOF) between ceramic and metal orthodontic brackets on glazed monolithic zirconia using non-woven polypropylene fiber adhesive. Sixty glazed and sintered zirconia blocks were divided into six groups and attached with orthodontic brackets as follows: CS, ceramic bracket with silane; CB, ceramic bracket with bonding agent; CBS, ceramic bracket with bonding agent and silane; MS, metal bracket with silane; MB, metal bracket with bonding agent; and MBS, metal bracket with bonding agent and silane. There was a statistically significant difference in mean SBS values (p < 0.001). The CS group showed the highest SBS value (23.42 ± 3.88 MPa). On the other hand, the lowest was found in the MB group, which was not statistically different from the CB group (3.26 ± 0.76 and 5.09 ± 1.50 MPa, respectively). The MS, MBS, and CBS groups showed no statistical difference compared to each other (15.57 ± 4.01, 13.23 ± 5.47, and 12.77 ± 4.43 MPa, respectively). SBS is highest when a ceramic bracket with silane is bonded to glazed monolithic zirconia.

Er:YAG laser removal of zirconia crowns on titanium abutment of dental implants: an in vitro study

BACKGROUND

This research aimed to explore feasibility and the time required when erbium-doped yttrium aluminum garnet (Er:YAG) laser as a non-invasive treatment modality to retrieve different thicknesses of zirconia material bonded by two dental cements from titanium implant abutments.

METHODS

Prepared 80 titanium blocks (length: 20 mm, width: 10 mm, height: 10 mm) and square zirconia sheets (length: 10 mm) with different thicknesses (1 mm, 2 mm, 3 mm, and 4 mm) were 20 pieces each. Resin modified glass ionomer cement (RelyX Luting 2; RXL) and resin cement (Clearfil SA luting; CSL) were used to bond zirconia sheet and titanium block. Specimens were kept in 100% humidity for 48 h. Er:YAG laser was used to retrieve the zirconia sheet and recorded the time. Universal testing machine was used to measure the residual adhesion of the samples that did not retrieve after 5 min of laser irradiation. Shear bond strength (MPa) and the time data (s) were analyzed using Kruskal-Wallis Test. The bonding surface and the irradiation surface of the zirconia sheet was examined with the scanning electron microscopy (SEM).

RESULTS

Within 5 min of laser irradiation, RXL group: 1 mm group all fell off, 2 mm group had 3 specimens did not fall off, there was no statistical difference in the average time between the two groups; CSL group: half of the 1 mm group fell off. Shear bond strength test results: there was no statistical difference between 1 and 2 mm in RXL group and 1 mm in CSL group, there was no statistical difference between 3 mm in RXL group and 2 mm in CSL group, and there were significant differences statistically in comparison between any two groups in the rest. SEM inspection showed that the bonding surface and the irradiation surface of the zirconia sheet had changes.

CONCLUSION

In this vitro study, the following could be concluded: it is faster to remove zirconia crowns with thickness less than 2 mm from titanium abutment when luted with RelyX Luting 2 compared to Clearfil SA luting.

The Effect of Simulated Chewing on the Surface Roughness of Direct and Indirect Resin-Composites Opposed by Zirconia: An In Vitro Study

Purpose

To assess the surface roughness of two different light-cured resin-composites when opposed by monolithic zirconia after simulated mastication.

Materials and Methods

Materials included a direct restorative nanohybrid (n = 10) and an indirect microhybrid (n = 10) resin-composite (Tetric EvoCeram and Sinfony, respectively). The antagonist material was 3 mol% yttria-stabilized tetragonal zirconia polycrystalline ceramic. Each material was subjected to in vitro chewing against zirconia using a chewing simulator for 250,000 cycles. A 3D profilometer was used to assess the surface roughness parameters of each resin-composite before and after the simulated chewing. Independent t-test and paired sample t-test were performed to compare roughness values for both materials and to compare baseline and after chewing simulation values (p = 0.05).

Results

Sinfony showed significantly greater roughness values compared to Tetric EvoCeram (p ≤ 0.025) before and after simulated chewing, except for Sa and Sv parameters after simulated chewing where the difference between the two materials was insignificant (p = 0.06 and 0.89, respectively). Surface roughness increased for both materials after simulated chewing compared to baseline values, but the difference was insignificant (p ≥ 0.065). However, Sa (p = 0.04) and Sv (p = 0.012) for Tetric EvoCeram were significantly higher after compared to before chewing simulation.

Conclusion

Tetric EvoCeram had a smoother surface than Sinfony before and after simulated chewing. Surface roughness for both materials was higher after simulated chewing compared to baseline values which represent surface damage that was significant for Tetric EvoCeram while Sinfony showed better resistance.

Case Report: A digital workflow in the treatment of bruxism in a young patient

Bruxism is increasingly common in today's stressful world and affects mainly young patients. It is a combined disease that involves dentition and its supporting structures, muscles, ligaments and the temporomandibular joint (TMJ). Here we present a complete combined analog and digital clinical protocol in a patient with parafunction.

A young patient sought help due to impaired aesthetics, as a result of abraded tooth surfaces and severe symptoms of TMJ. We implemented a therapeutic protocol of six stages: deprogramming of the muscles and determination of treatment position and digital optimization; realization of the morphological plan for the upper dentition; non-invasive repositioning of the lower jaw by splint therapy; splint placement and follow-up; morphological planning of the lower dentition and replacement of the splint with fixed prosthesis with follow-up; and completion of the case with ceramic restorations.

The digitally modeled temporary constructions for the upper jaw were made of PMMA and placed in the patient's mouth together with the splint on the lower jaw, made of Ceramill Splintec. After an adaptation period, all restorations were replaced by permanent zirconia.

We achieved restoration of the defects of the dental arches and hard dental tissues and recovery to normal height of the lower third of the face (vertical dimension occlusion), fixed a stable and balanced position of the lower jaw, and repaired the normal physiological position of the TMJ for the patient. Аfter a multi-stage treatment we received a result satisfying the patient, the dentist and the dental technician. Aesthetics and function were restored, and clinical symptoms were removed from the TMJ.

Fractographic analysis of 35 clinically fractured bi-layered and monolithic zirconia crowns

OBJECTIVES

The aim of this retrieval study was to analyze the fracture features and identify the fracture origin of zirconia-based single crowns that failed during clinical use.

METHODS

Thirty-five fractured single crowns were retrieved from dental practices (bi-layered, n=15; monolithic, n=20). These were analyzed according to fractographic procedures by optical and scanning electron microscopy to identify fracture patterns and fracture origins. The fracture origins were closely examined. The crown margin thickness and axial wall height were measured.

RESULTS

Three types of failure modes were observed: total fractures, marginal semilunar fractures, and incisal chippings. Most of the crowns (23) had fracture origins at the crown margin and seven of them had defects in the fracture origin area. The exact fracture origin was not possible to identify due to missing parts in four crowns. The crown wall thickness was 20% thinner and wall height 30% shorter in the fracture origin area compared to the opposite side.

CONCLUSIONS

The findings in this study show that fractography can reveal fracture origins and fracture modes of both monolithic and bi-layered dental zirconia. The findings indicate that the crown margin on the shortest axial wall is the most common fracture origin site.

CLINICAL SIGNIFICANCE

Crown design factors such as material thickness at the margin, axial wall height and preparation type affects the risk of fracture. It is important to ensure that the crown margins are even and flawless.

Effect of surface treatment, ferrule height, and luting agent type on pull-out bond strength of monolithic zirconia endocrowns

PURPOSE

To evaluate the effect of different surface treatments, ferrule heights, and luting agents on the pull-out bond strength (PBS) of computer-aided design/computer-aided manufacturing (CAD-CAM) monolithic endocrowns.

METHODS

After endodontic treatment and preparation for two endocrown designs (ferrule height 0 mm or 2 mm), CAD-CAM monolithic zirconia endocrowns were fabricated for 80 mandibular molars. Each endocrown design group was then divided on the basis of surface treatment into two groups: half were air-abraded and half were air-abraded/laser-irradiated. Then, all treated groups were further divided into two subgroups (n = 10) and cemented to teeth with either a 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing resin luting agent (Panavia SA) or a combination of MDP-containing primer and MDP-free resin luting agent (Monobond Plus/Multilink Automix). PBS was measured with a universal test machine after simulated chewing and thermocycling. Three-way ANOVA and the post-hoc Bonferroni test were used for statistical analysis.

RESULTS

PBS was significantly associated with type of surface treatment, type of luting agent, and ferrule height. Air-abraded/laser-irradiated endocrowns with a 2-mm ferrule that were cemented with Monobond Plus/Multilink Automix had the highest PBS (P < 0.05).

CONCLUSION

Surface treatment with air abrasion/laser irradiation, presence of a ferrule, and priming with an MDP-containing primer increased the PBS of monolithic zirconia endocrowns.

Evaluation of the Effect of High-Speed Sintering and Specimen Thickness on the Properties of 5 mol% Yttria-Stabilized Dental Zirconia Sintered Bodies

High-speed sintering of zirconia has become essential to single-visit dental prosthetic treatments. This important prosthetic dentistry technique demands a translucent material tougher than porcelain. Previous studies on high-speed sintered zirconia did not take heat and material thickness into consideration. We evaluated pre-sintered specimen thickness and the effect of high-speed sintering on the properties of 5 mol% Y₂O₃-stabilized zirconia (5Y zirconia). High-speed sintered bodies of 5Y zirconia were evaluated by density measurements, translucency measurements, three-point flexural and fracture toughness tests, X-ray diffraction (XRD), and scanning electron microscopy (SEM). High-speed sintering reduced the translucency and mechanical properties of 5Y zirconia. XRD and SEM observation results clarified that these reductions were due to the change in crystal phase composition and to the increase in residual pores, respectively, both resulting from high-speed sintering. Moreover, in high-speed sintering, as the thickness of the specimen increased, the number and size of internal pores increased, and the translucency and strength decreased. The threshold value for avoiding a reduction in translucency and mechanical properties was found to lie at ~4.4 mm. From the above results, it was concluded that 5Y zirconia is not suitable for high-speed sintering applications.

Enhancing Resin Cement Adhesion to Zirconia by Oxygen Plasma-Aided Silicatization

The combinations of alumina particle air abrasion (AA) and a 10-methacryloyloxyidecyl-dihyidrogenphosphate (MDP) primer and a tribochemical silica coating (TSC) and a silane-base primer are contemporary pre-cementation treatments for zirconia restorations for bonding with resin cements. However, the stability of zirconia resists the mechanical or chemical preparations. The purpose of this study was to develop an atmospheric-pressure oxygen plasma (OP)-aided silicatization method to enhance the adhesion of resin cements to zirconia. Zirconia discs were prepared to receive surface treatments of different combinations: (1) AA or TSC (2) with or without OP treatment, and (3) a chemical primer (no primer, silane, or a silane-MDP mixture). The surface morphology, hydrophilicity, and chemical compositions were characterized, and the resin-zirconia bond strengths were examined either after 24 h or a thermocycling test. The results indicated that the OP treatment after the TSC facilitated the homogeneous distribution of silane and crosslinking of silica particles, and effectively improved the hydrophilicity. The OP increased the O and Si and reduced the C elemental contents, while the combination of TSC, OP, and silane induced SiO_x generation. Among the groups, only the TSC-OP-silane treatment effectively enhanced the bond strength and maintained the adhesion after thermocycling. With these results, the OP aided the silicatization protocol effectively, generated silane crosslinking, and resulted in superior resin-zirconia bond strength and durability compared to the current treatments.

Mechanical characterization of aesthetic orthodontic brackets by the dynamic indentation method

The objective of this study is to investigate the mechanical properties, such as the dynamic hardness and indentation elastic modulus, of commercially available aesthetic orthodontic brackets, such as ceramic and plastic brackets, by the dynamic micro-indentation method. Five ceramic brackets, which were made of alumina (both monocrystalline and polycrystalline forms) or zirconia, and two plastic brackets, which were made of glass fiber-reinforced polycarbonate or polyamide, were tested. There were significant differences in the mechanical properties of the monocrystalline and polycrystalline alumina brackets. The mechanical properties of the glass fiber-reinforced plastic bracket were significantly superior to these of the non-glass-fiber-reinforced plastic bracket. The differences in the crystal structures of the ceramic brackets surface affected the dynamic hardness and indentation elastic modulus. Furthermore, the short glass fibers contained in the plastic bracket might contribute to the improvement of the mechanical properties.

Shear Bond Strength of Two Repair Systems to Zirconia Ceramic by Different Surface Treatments

Introduction: Intraoral repair has been suggested as a treatment option to repair the chipping or fracture of veneered zirconia; the success of the procedure is mainly determined by the bonding between zirconia and composite resin. The present study aimed to investigate and compare the shear bond strength (SBS) of two intraoral repair systems to zirconia ceramic treated with a laser or air-abrasion surface modification. Methods: Ninety tube-shaped samples (diameter of 10 mm and height of 4 mm) were divided into three main groups: Group I (zirconia 100%, n=30); Group II (veneer ceramic 100% n=30); Group III (zirconia with a veneer ceramic n=30). Each main group was subdivided into two subgroups (n=15): Subgroup A: samples repaired with Ceramic Repair N; Subgroup B: samples repaired with the Cimara Repair System. The subgroup samples were further subdivided based on the treated surface (n=5 samples): Control (no surface modification), Er,Cr:YSGG laser surface modification, and air-abrasion surface modification. The SBS was employed using a universal testing machine. The mode of failure was observed using a stereomicroscope. Results: Significant differences were observed in the mean SBS values between the different surface modifications (P˂0.05). Tukey's post hoc test showed that the air-abrasion surface modification of the veneer ceramic repaired with the Ceramic repair N system had the highest mean value (13.74 MPa) among the different groups, while no surface modification of zirconia repaired with the Cimara repair system had the lowest mean value (2.84 MPa). The control group (no surface modification) had the lowest mean value among all the treated groups. Conclusion: The SBS is surface modification-dependent, and higher SBS is obtained by air-abrasion than Er, Cr:YSGG laser surface modifications with the selected parameters. The Ceramic repair N system had significantly higher SBS for all surface-treated substrates than the Cimara repair system.

Wear behavior and abrasiveness of monolithic CAD/CAM ceramics after simulated mastication

Objectives

To evaluate the wear resistance and abrasiveness of monolithic CAD/CAM ceramics.

Materials and methods

Rectangular-shaped specimens (12 mm × 6.5 mm × 1.5 mm) were sectioned from the following CAD/CAM blocks (n = 10); partially crystallized lithium disilicate (PLD), experimental fully crystallized lithium disilicate (FLD), zirconia-reinforced lithium silicate (ZLS), super-translucent monolithic zirconia (SMZ), and ultra-translucent monolithic zirconia (UMZ). Silicon carbide papers were used to mechanically flatten and polish the surfaces. PLD specimens were subjected to a combined crystallization/glazing firing cycle. Ceramic specimens were mounted to the wear device and tested for 200,000 cycles against human premolars at 20 N force and 2 mm sliding distance. Artificial saliva was used as a lubricant. The teeth were scanned using micro-CT before and after the wear test and the generated models were overlapped to determine the volumetric tooth loss. Before and after the test, specimens’ weights and surface roughness (R_a) values were measured, and the differences were calculated. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) were utilized for microstructural and chemical analysis. Statistical analysis was performed using one-way ANOVA or an equivalent test for non-parametric results. Significance level was set at P ≤ 0.05.

Results

The type of ceramic material affected the ceramic and antagonist wear rates (P < 0.001). PLD and ZLS had the highest ceramic and antagonist wear, whereas UMZ and SMZ demonstrated the lowest wear values. The FLD group showed comparable antagonist wear and significantly less ceramic wear than PLD and ZLS.

Conclusions

Monolithic zirconia demonstrated the best wear resistance and least abrasiveness to the antagonist. The experimental lithium disilicate was more wear-resistant than other glass–ceramic groups.

Clinical relevance

Monolithic zirconia is wear-resistant and gentle on the antagonist. In contrast, glass–ceramics are more abrasive to enamel.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-022-04611-w.

Rhombohedral Phase Formation in Yttria-Stabilized Zirconia Induced by Dental Technical Tools and Its Impact on Dental Applications

In the study the influence of different dental technical tools on the surface temperature and phase composition of fixed dental prostheses (FDPs) made of yttria-partially stabilized zirconia polycrystals (3Y-/4Y-/5Y-PSZ) was investigated. FDPs were fabricated by using computer-aided manufacturing (CAM). The FDPs were treated with a contra-angle handpiece equipped with different burs and polishers. The resulting surface temperatures were measured with a thermographic camera, and the resulting phase transformations were investigated by X-ray diffraction and quantified by Rietveld refinement. Processing with burs resulted in no phase transformation, but a preferred orientation shift. Using coarse polisher induced a phase transformation to the rhombohedral phase, while fine polishers produced no relevant phase transformations and no preferred orientation shift. Compared to the monoclinic phase (ca. 9% theoretical volume increase), which is associated with low-temperature degradation (LTD), the rhombohedral phase is much more voluminous (ca. 15% theoretical volume increase) and distorted and, therefore, has a greater degradation potential.

Effect of Helium Plasma Exposure on Wettability and Shear Bond Strength between the Zirconia Core and Feldspathic Veneering Ceramic: An In Vitro Study

Introduction. The present study aimed to evaluate the effect of helium plasma treatment on the wettability of zirconia surface and on the shear bond strength between the dental zirconia core and feldspathic veneering ceramic. Methods. 128 zirconia specimens were prepared, polished, and then divided into four groups: control, Zr, FC, and Zr/FC. In Zr and Zr/FC groups, the zirconia blocks were treated by helium plasma for 60 s. In FC and Zr/FC, the feldspathic ceramic powder received 60 s of plasma treatment. Then, the feldspathic powder was applied on the zirconia blocks. Half of the specimens in each group were sintered in a tube furnace, and the contact angle between the zirconia core and feldspathic ceramic was measured at different time intervals. The other half were sintered in a ceramic furnace and then subjected to thermocycling. The shear bond strength was measured using a universal testing machine. The failure mode was assessed using a stereomicroscope. Data were analyzed by one-way ANOVA test, and the statistical significance was considered less than 0.05. Results. There was no significant difference in the mean contact angle and the shear bond strength values of the experimental groups ( $P>0.05$ ). The mean contact angle decreased significantly in all groups over time ( $P<0.001$ ). The modes of failure were predominantly mixed in all groups. Conclusion. The helium plasma applied on either dental zirconia core or feldspathic ceramic powder could not improve the zirconia surface wettability and the shear bond strength between the two ceramics.