Zirconia in biomedical applications

Oral Tissue Interactions and Cellular Response to Zirconia Implant-Prosthetic Components: A Critical Review

Background: Dental components manufactured with zirconia (ZrO₂) represent a significant percentage of the implant prosthetic market in dentistry. However, during the last few years, we have observed robust clinical and pre-clinical scientific investigations on zirconia both as a prosthetic and an implantable material. At the same time, we have witnessed consistent technical and manufacturing updates with regards to the applications of zirconia which appear to gradually clarify points which until recently were not well understood. Methods: This critical review evaluated the “state of the art” in relation to applications of this biomaterial in dental components and its interactions with oral tissues. Results: The physico-chemical and structural properties as well as the current surface treatment methodologies for ZrO₂ were explored. A critical investigation of the cellular response to this biomaterial was completed and the clinical implications discussed. Finally, surface treatments of ZrO₂ demonstrate that excellent osseointegration is possible and provide encouraging prospects for rapid bone adhesion. Furthermore, sophisticated surface treatment techniques and technologies are providing impressive oral soft tissue cell responses thus leading to superior biological seal. Conclusions: Dental devices manufactured from ZrO₂ are structurally and chemically stable with biocompatibility levels allowing for safe and long-term function in the oral environment.

Recent research and progress of biodegradable zinc alloys and composites for biomedical applications: Biomechanical and biocorrosion perspectives

Biodegradable metals (BMs) gradually degrade in vivo by releasing corrosion products once exposed to the physiological environment in the body. Complete dissolution of biodegradable implants assists tissue healing, with no implant residues in the surrounding tissues. In recent years, three classes of BMs have been extensively investigated, including magnesium (Mg)-based, iron (Fe)-based, and zinc (Zn)-based BMs. Among these three BMs, Mg-based materials have undergone the most clinical trials. However, Mg-based BMs generally exhibit faster degradation rates, which may not match the healing periods for bone tissue, whereas Fe-based BMs exhibit slower and less complete in vivo degradation. Zn-based BMs are now considered a new class of BMs due to their intermediate degradation rates, which fall between those of Mg-based BMs and Fe-based BMs, thus requiring extensive research to validate their suitability for biomedical applications. In the present study, recent research and development on Zn-based BMs are reviewed in conjunction with discussion of their advantages and limitations in relation to existing BMs. The underlying roles of alloy composition, microstructure, and processing technique on the mechanical and corrosion properties of Zn-based BMs are also discussed.

Hydrogel-based Additive Manufacturing of Lithium Cobalt Oxide

Three-dimensional (3D) multicomponent metal oxides with complex architectures could enable previously impossible energy storage devices, particularly lithium-ion battery (LIB) electrodes with fully controllable form factors. Existing additive manufacturing approaches for fabricating 3D multicomponent metal oxides rely on particle-based or organic-inorganic binders, which are limited in their resolution and chemical composition, respectively. In this work, aqueous metal salt solutions are used as metal precursors to circumvent these limitations, and provide a platform for 3D printing multicomponent metal oxides. As a proof-of-concept, architected lithium cobalt oxide (LCO) structures are fabricated by first synthesizing a homogenous lithium and cobalt nitrate aqueous photoresin, and then using it with digital light processing printing to obtain lithium and cobalt ion containing hydrogels. The 3D hydrogels are calcined to obtain micro-porous self-similar LCO architectures with a resolution of ~100μm. These free-standing, binder- and conductive additive-free LCO structures are integrated as cathodes into LIBs, and exhibit electrochemical capacity retention of 76% over 100 cycles at C/10. This facile approach to fabricating 3D LCO structures can be extended to other materials by tailoring the identity and stoichiometry of the metal salt solutions used, providing a versatile method for the fabrication of multicomponent metal oxides with complex 3D architectures.

Accuracy of 3-dimensional printing of dental casts: A proposal for quality standardization

STATEMENT OF PROBLEM

A digital workflow in fixed prosthodontics may use a 3D printer to obtain a cast for porcelain application. Standards exist that define the accuracy of traditional casts, but the accuracy requirements of 3D-printed casts have not been defined.

PURPOSE

The purpose of this retrospective study was to investigate how the accuracy of 3D-printed casts affected prosthesis fit and whether they correctly reproduced interproximal contacts.

MATERIAL AND METHODS

Copings with different die spacings were used to test different 3D-printed casts of the same dental arch. The accuracy of the 3D casts was assessed by imaging and comparing the resulting standard tessellation language (STL) files with the original through a matching software program. Accuracy scores were then correlated with a score measuring how well the copings fit the casts. The first data set was obtained from a patient receiving restoration of the 4 maxillary incisors. The teeth were prepared, the dental arch was imaged intraorally, and 10 resin casts were printed with four 3D printers. Two sets of 4 zirconia test copings were prepared, and 3 clinicians assessed their fit on each cast. A further set of casts was created from a second patient requiring prosthetic restoration for 5 adjacent teeth to assess whether undersizing affected the best fit of the copings on their dies.

RESULTS

The clinical scores and accuracy scores did not correlate. The results suggested that printed dies showing a certain degree of undersizing might provide a better fit than those showing better correspondence to the actual anatomic structure. The oversized dies were the worst. Only 7 of 17 casts being assessed were deemed suitable for veneering of the copings. The undersized casts tested clinically better than casts printed by using the same printer under standard settings.

CONCLUSIONS

This retrospective study indicated that 3D-printed casts that do not allow copings to fit appropriately usually show mean excess oversizing. Axially undersizing the printed dies on casts might allow a better fit of copings to be veneered.

Material modifications enhancing the antibacterial properties of two biodegradable poly(3-hydroxybutyrate) implants

The aim of this study was to evaluate the antimicrobial efficacy of adding a gentamicin palmitate (GP) coating and zirconium dioxide (ZrO₂) to biodegradable poly(3-hydroxybutyrate) (PHB) to reduce biofilm formation. Cylindrical pins with and without a coating were incubated in Müller-Hinton broth inoculated with 2 × 10⁵ colony-forming units (CFU) ml-1 of Staphylococcus aureus for 2 d or 7 d, then sonicated to disrupt biofilms. Pure PHB (PHB + GP) and PHB pins with ZrO₂ added (PHBzr + GP) were coated with GP and compared with PHB pins lacking a coating (PHB). Cells (CFU) were counted to quantify the number of bacteria in the biofilm and a cell proliferation assay was employed to evaluate metabolic activity, and scanning electron microscopy (SEM) was performed to visualize the structure of the biofilm. After 2 d of incubation there were significantly more cells in biofilms on PHB pins than PHB + GP and PHBzr + GP pins (p < 0.0001), and cells in the sonication fluid obtained from GP-coated pins exhibited significantly lower metabolic activity than cells from uncoated PHB pins (p < 0.0001). After 7 d of incubation metabolic activity was lowest for PHBzr + GP, with significant differences between PHB and PHBzr + GP (p = 0.001). SEM revealed more cells attached to the surface, and more structured biofilms, on pins without a coating. Coating pins with GP significantly reduced early biofilm formation on PHB implants. This could lower the potential risk of surgical site infections when using PHB implants. Addition of ZrO₂ might further enhance the antibacterial properties. Such modification of the implant material should therefore be considered when developing new biodegradable PHB implants.

High Potency of Organic and Inorganic Nanoparticles to Treat Cystic Echinococcosis: An Evidence-Based Review

Since there is no potential, effective vaccine available, treatment is the only controlling option against hydatid cyst or cystic echinococcosis (CE). This study was designed to systematically review the in vitro, in vivo, and ex vivo effects of nanoparticles against hydatid cyst. The study was carried out based on the 06- PRISMA guideline and registered in the CAMARADES-NC3Rs Preclinical Systematic Review and Meta-analysis Facility (SyRF) database. The search was performed in five English databases, including Scopus, PubMed, Web of Science, EMBASE, and Google Scholar without time limitation for publications around the world about the protoscolicdal effects of all the organic and inorganic nanoparticles without date limitation in order to identify all the published articles (in vitro, in vivo, and ex vivo). The searched words and terms were: “nanoparticles”, “hydatid cyst”, “protoscoleces”, “cystic echinococcosis”, “metal nanoparticles”, “organic nanoparticles”, “inorganic nanoparticles, “in vitro”, ex vivo”, “in vivo”. Out of 925 papers, 29 papers including 15 in vitro (51.7%), 6 in vivo (20.7%), ex vivo 2 (6.9%), and 6 in vitro/in vivo (20.7%) up to 2020 met the inclusion criteria for discussion in this systematic review. The results demonstrated the most widely used nanoparticles in the studies were metal nanoparticles such as selenium, silver, gold, zinc, copper, iron nanoparticles (n = 8, 28.6%), and metal oxide nanoparticles such as zinc oxide, titanium dioxide, cerium oxide, zirconium dioxide, and silicon dioxide (n = 8, 28.6%), followed by polymeric nanoparticles such as chitosan and chitosan-based nanoparticles (n = 7, 25.0%). The results of this review showed the high efficacy of a wide range of organic and inorganic NPs against CE, indicating that nanoparticles could be considered as an alternative and complementary resource for CE treatment. The results demonstrated that the most widely used nanoparticles for hydatid cyst treatment were metal nanoparticles and metal oxide nanoparticles, followed by polymeric nanoparticles. We found that the most compatible drugs with nanoparticles were albendazole, followed by praziquantel and flubendazole, indicating a deeper understanding about the synergistic effects of nanoparticles and the present anti-parasitic drugs for treating hydatid cysts. The important point about using these nanoparticles is their toxicity; therefore, cytotoxicity as well as acute and chronic toxicities of these nanoparticles should be considered in particular. As a limitation, in the present study, although most of the studies have been performed in vitro, more studies are needed to confirm the effect of these nanoparticles as well as their exact mechanisms in the hydatid cyst treatment, especially in animal models and clinical settings.

Effect of aging on fracture resistance and torque loss of restorations supported by zirconia and polyetheretherketone abutments: An in vitro study

STATEMENT OF PROBLEM

New materials have been developed for digital processing, including implant abutments, but studies on their mechanical properties are lacking.

PURPOSE

The purpose of this in vitro study was to compare the effect of aging on the fracture resistance, failure mode, and torque loss of restorations made of zirconia and ceramic-reinforced polyetheretherketone (PEEK) abutments with titanium bases.

MATERIAL AND METHODS

Titanium-based PEEK and zirconia abutments were milled and veneered with composite resin or feldspathic porcelain in the form of maxillary first premolars (n=10). All the specimens were subjected to an aging process and were assessed after every 250 000 cycles under a stereomicroscope, and torque loss was recorded with an electronic torque meter. Fracture resistance was measured under static load (crosshead speed of 1 mm/min), and failure modes and final torque were determined. A t test was conducted for statistical analyses (α=.05).

RESULTS

The fracture resistance of the zirconia restorations was significantly greater than the PEEK-based restorations (P=.001). Torque losses were not significantly different after aging (P=.18); however, significant difference was recorded after the fracture test (P=.007). The effect of fracture load was significantly greater for the zirconia group (P<.001). Unlike with the zirconia group, the failure mode in the PEEK-based restorations was mainly adhesive and favorable (9 of 10 specimens).

CONCLUSIONS

Ceramic-reinforced PEEK abutments had acceptable resistance to fracture, a favorable failure mode, and successfully sustained the aging process.

Anatomical Shaping for Zirconia Custom Implant Abutment to Enhance Anterior Esthetic: A Clinical Technique

Abutments are used in dentistry to attach dental crowns to dental implant. Currently, zirconia custom abutment is the one which is mostly used in restorations, since it offers several advantages, especially better esthetics and prevention from infection. Several innovations are done in the implant designs and procedures to achieve better esthetics. Computer-aided design & computer-aided manufacturing (CAD/CAM) system is widely used innovative technology in dentistry. This technology offers custom implants that help to achieve better esthetics and good internal fit. This procedure used a novel technique of anatomical modification of the final abutment incisal edge from straight anatomical edge to irregular one with a mamelon-incisal effect to enhance esthetic, shade matching, and anatomical replication of incisal structure that resembles the natural incisor. Usually, dental technicians will perform facial and incisal cut-back and apply porcelain layers to the crown in order to reproduce the translucency and the other optical effects that most closely match that of natural dentin and enamel, especially at the incisal edge. These optical effects will make the prosthetic crown look more natural and esthetically pleasant. By this presented technique will help the dental technician to achieve highly esthetic crown with completely digital workflow without the need for porcelain layering. The procedure was also followed up to 3, 6, and 12 months after the surgery and found no complications or complaints from the patient and esthetically satisfied.

Insight into the Role and Mechanism of Nano MgO on the Hot Compressive Deformation Behavior of Mg-Zn-Ca Alloys

Aiming to investigate the role and mechanism of nano MgO on the hot compressive deformation behavior of Mg alloys, the Mg-3Zn-0.2Ca alloy (MZC, in wt%) and the 0.2MgO/Mg-3Zn-0.2Ca alloy (MZCM, in wt%) were investigated systematically in the temperature range of 523–673 K and the strain rate range of 0.001–1 s−1. MZCM shows finer grains and second phase because of the refinement effects of added MgO. Flow behavior analysis shows that the addition of nano MgO promotes the dynamic recrystallization (DRX) of MZC. The flow stress of MZCM is lower than that of MZC during deformation at 523–623 K but exhibits a reverse trend at 673 K and 0.1–1 s−1. The constitutive analysis indicates that dislocation climb is the dominant deformation mechanism for MZC and MZCM. The addition of nano MgO particles decreases the stress sensitivity and deformation resistance for thermal deformation and improves the plasticity of the MZC. Besides, according to the processing map constructed at strains of 0.7 and corresponding microstructure evolution, MZCM exhibits higher power dissipation efficiency and smaller instability regions than MZC, and the optimum hot working condition for MZCM was determined to be at 623–653 K and 0.01–0.001 s−1.

Acoustic emission and finite element study on the influence of cusp angles on zirconia dental crowns

OBJECTIVE

The effect of cusp angle on the load-carrying capacity and failure behaviour of BionZ Diamond zirconia crowns is carried out using experimental and numerical investigations.

METHODS

The experimental program using monolithic crowns were divided into three groups (n = 14) for three cusp angles, 60, 80 and 120 degrees and were tested to failure under the static load. A 2-channel acoustic emission (AE) system was used to monitor the failure process while the piezo sensors were attached to the rigid stainless-steel jig for recoding the AE events. Load-displacement and AE response were simultaneously monitored until failure of specimens. Parametric AE analysis was conducted for the factors such as amplitude, energy released, signal duration and cumulative counts, for each AE signal. Fast Fourier transform (FFT) was conducted to assess the frequency at failure. Linear finite element analysis (FEA) was carried out using commercial software Ansys Workbench 19.1 to present the stress distribution and failure modes. Post-failure surface morphology study was carried out using scanning electron microscopy (SEM) and statistical analysis was performed using Weibull analysis.

RESULTS

All the samples in three different groups have failed at the mid-line, splitting the zirconia crowns into two equal pieces. The load to failure was directly proportional to the cusp angle in crowns; 120° group had the highest load-carrying capacity of 2.93 ± 0.26 kN while 60 and 80° groups had a failure load of 2.46 ± 0.53 and 2.52 ± 0.16 kN, respectively. Parametric AE analysis revealed that the failure was instantaneous and 60-degree samples had higher AE signature. FE analysis showed the crack initiation at the occlusal surface of the crown which is in agreement with the SEM images. A close agreement of results for the load and stress distribution from FEA complemented with the experimental study.

SIGNIFICANCE

Optimisation of cusp-angle could help clinicians to accurately design the monolithic zirconia crown focussing on maximum load-carrying capacity, increasing the restoration life.

Bactericidal surfaces prepared by femtosecond laser patterning and layer-by-layer polyelectrolyte coating

Antimicrobial surfaces are important in medical, clinical, and industrial applications, where bacterial infection and biofouling may constitute a serious threat to human health. Conventional approaches against bacteria involve coating the surface with antibiotics, cytotoxic polymers, or metal particles. However, these types of functionalization have a limited lifetime and pose concerns in terms of leaching and degradation of the coating. Thus, there is a great interest in developing long-lasting and non-leaching bactericidal surfaces. To obtain a bactericidal surface, we combine micro and nanoscale patterning of borosilicate glass surfaces by ultrashort pulsed laser irradiation and a non-leaching layer-by-layer polyelectrolyte modification of the surface. The combination of surface structure and surface charge results in an enhanced bactericidal effect against both Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli bacteria. The laser patterning and the layer-by-layer modification are environmentally friendly processes that are applicable to a wide variety of materials, which makes this method uniquely suited for fundamental studies of bacteria-surface interactions and paves the way for its applications in a variety of fields, such as in hygiene products and medical devices.

Fracture Resistance of Zirconia-Reinforced Lithium Silicate Ceramic Crowns Cemented with Conventional or Adhesive Systems: An In Vitro Study

In recent years, Zirconia-reinforced Lithium Silicate ceramic (ZLS), combining lithium-silicate and zirconia features, has shown to have excellent mechanical and aesthetic characteristics. Thus, the aim of this study was to compare the fracture strength of ZLS single crowns cemented with two different cementation techniques. Twenty crowns were realised and cemented on teeth replicas achieved from an extracted premolar human tooth. The samples were divided into two groups of 10 specimens each, Glass-ionomeric cement (GIC) group and Self-Adhesive Resin Cement (ARC) group. The mechanical test was performed using a universal testing machine. The specimens were then evaluated with a scanning electron microscope (SEM) to identify for all crowns and related abutments the pattern of fracture after the breaking point. The data obtained were statistically analysed. The mean fracture toughness values and standard deviations (±SD) were 2227 ± 382 N and 3712 ± 319 N respectively for GIC and ARC groups. In fact, t-test showed a statistically significant difference between the two groups (p < 0.001). Moreover, the SEM results demonstrated portions of abutments still attached to the crown fragments in the ARC group, whilst these were not present in the GIC group. Within the limitations of this study, these results suggest the use of adhesive cementation for ZLS crowns, which significantly increase the compressive strength of ZLS restorations compared to GIC.

Improved Microstructure and Hardness Properties of Low-Temperature Microwave-Sintered Y2O3 Stabilized ZrO2 Ceramics with Additions of Nano TiO2 Powders

This paper reports the improvement of microstructural and hardness properties of 3 mol% yttria-stabilized zirconia (3Y-TZP) ceramics with nano TiO₂ powders (with 0, 0.9, 1.8, and 2.7 wt%) added using a low-temperature microwave-assisted sintering of 1250 °C. Even at such a low sintering temperature, all sintered samples had the main phase of tetragonal zirconia (t-ZrO₂) without the appearance of the secondary monoclinic phase or TiO₂ phase, and had high relative densities, larger than 95%. The grain growth was well developed, and the grain sizes were around 300–600 nm. The Ti and O elements appeared at the grain and grain boundary and increased with the increased nano TiO₂ contents identified by the element analysis, although the TiO₂ phase did not appear in the X-ray pattern. The Vickers hardness was in the range of 10.5 to 14.5 GPa, which first increased with increasing content till 0.9 wt% and then decreased. With citric acid corrosion treatment for 10 h, the Vickers hardness only decreased from 14.34 GPa to 13.55 GPa with the addition of 0.9 wt% nano TiO₂ powder. The experiment results showed that 0.9 wt% nano TiO₂ addition can improve the densification as well as the Vickers hardness under a low temperature of microwave-assisted sintering.

Artificial intelligence in fixed implant prosthodontics: a retrospective study of 106 implant-supported monolithic zirconia crowns inserted in the posterior jaws of 90 patients

Background

Artificial intelligence (AI) is a branch of computer science concerned with building smart software or machines capable of performing tasks that typically require human intelligence. We present a protocol for the use of AI to fabricate implant-supported monolithic zirconia crowns (MZCs) cemented on customized hybrid abutments.

Methods

The study protocol consisted of: (1) intraoral scan of the implant position; (2) design of the individual abutment and temporary crown using computer-aided design (CAD) software; (3) milling of the zirconia abutment and the temporary polymethyl-methacrylate (PMMA) crown, with extraoral cementation of the zirconia abutment on the relative titanium bonding base, to generate an individual hybrid abutment; (4) clinical application of the hybrid abutment and the temporary PMMA crown; (5) intraoral scan of the hybrid abutment; (6) CAD of the final crown with automated margin line design using AI; (7) milling, sintering and characterisation of the final MZC; and (8) clinical application of the MZC. The outcome variables were mathematical (quality of the fabrication of the individual zirconia abutment) and clinical, such as (1) quality of the marginal adaptation, (2) of interproximal contact points and (3) of occlusal contacts, (4) chromatic integration, (5) survival and (6) success of MZCs. A careful statistical analysis was performed.

Results

90 patients (35 males, 55 females; mean age 53.3 ± 13.7 years) restored with 106 implant-supported MZCs were included in the study. The follow-up varied from 6 months to 3 years. The quality of the fabrication of individual hybrid abutments revealed a mean deviation of 44 μm (± 6.3) between the original CAD design of the zirconia abutment, and the mesh of the zirconia abutment captured intraorally at the end of the provisionalization. At the delivery of the MZCs, the marginal adaptation, quality of interproximal and occlusal contacts, and aesthetic integration were excellent. The three-year cumulative survival and success of the MZCs were 99.0% and 91.3%, respectively.

Conclusions

AI seems to represent a reliable tool for the restoration of single implants with MZCs cemented on customised hybrid abutments via a full digital workflow. Further studies are needed to confirm these positive results.

Immediate implant placement in molar extraction sites: a 1-year prospective case series pilot study

Background

There is a growing tendency to place single tooth implants immediately after extracting a failing tooth in the posterior region. The aim of this prospective case series pilot study was to evaluate immediate implant placement in molar post-extraction sites during a 1-year follow-up period.

Materials and methods

Fifteen consecutive patients with a single failing molar in the maxilla or mandible, and presenting enough bone to expect primary implant stability and an implant site free of infection, were included. The implants, with a large thread depth and sharp thread edges, were placed in each patient according to a two-staged surgical procedure. Three months later, a full contour screw-retained zirconia restoration with an angulated screw channel abutment was provided. Clinical and radiographic examinations were performed 1 month and 12 months after placing the restoration. In addition, the patients’ satisfaction with the restoration was scored after 12 months.

Results

Four out of 15 of the mobile implants had to be removed before the 1-year evaluation. The implant and restoration survival rates were 73.3% at the 1-year evaluation (n = 15). The mean marginal bone loss, from loading to the 12-month follow-up, was 0.17 mm (n = 11). The mean plaque, calculus, peri-implant mucosa, bleeding, and pocket probing depth scores were low, depicting healthy peri-implant conditions. The patients were very satisfied.

Conclusion

It was demonstrated, within the limitations of this study, that immediate placement of regular diameter implants in molar post-extraction sites in the maxilla and mandible resulted in a high implant failure rate during a 1-year follow-up period.

Trial registration

Netherlands Trial Register, NL8117. Registered 24 October 2019 - Retrospectively registered, https://www.trialregister.nl/trial/8117.

Covalent attachment of resveratrol to stainless steel toward the development of a resveratrol-releasing bare-metal stent

Herein, we describe the covalent attachment of resveratrol, a naturally occurring antioxidant, to the surface of stainless-steel as a model for designing a novel bare-metal stent to treat coronary artery disease. Resveratrol has been shown to reduce oxidative stress in dysfunctional endothelial cells, and stimulate arterial healing. Resveratrol treatments, however, are limited by low water solubility, such that a localized delivery to the site of arterial narrowing via a coated stent presents a promising strategy for improving stent outcomes. Our attachment strategy utilizes zirconium vapor deposition to lay down a thin layer of zirconium oxide with labile hydrocarbon groups at the surface. Resveratrol can displace these hydrocarbons in aprotic solvent to afford a covalently attached layer of resveratrol. We evaluated the release of resveratrol under a range of pH levels, including physiological conditions (pH = 7.4 and 37 °C). Furthermore, we established that endothelial cells grown on a resveratrol-bound surface release elevated nitric oxide levels compared to controls, a key endothelial signaling molecule responsible for arterial health. These results are promising toward the development of a resveratrol-coated bare-metal stent to improve patient outcomes.

Full-zirconia single-tooth molar implant-supported restorations with angulated screw channel abutments: A 1-year prospective case series study

Background

Implant‐supported restorations in the posterior region are subjected to various complications that could be prevented by changing either the design or the material.

Purpose

The aim of this prospective case series study was to evaluate full‐zirconia implant‐supported restorations with angulated screw channel abutments in the molar region of the maxilla and mandible and their effect on hard and soft peri‐implant tissues, during a 1‐year follow‐up period.

Materials and Methods

Thirty consecutive patients with a single missing molar, sufficient bone height, and implant site free of infection were included. Each patient was to receive a parallel‐walled implant with conical connection according to a two‐staged surgical protocol. After 3 months, a full‐contour screw‐retained zirconia restoration with angulated screw channel abutment was provided. Clinical and radiographic examinations were performed 1 and 12 months after placement of the restoration. Patients' satisfaction was scored prior to treatment and after 12 months with the restoration in function. Primary outcome measure was success of the restoration.

Results

All patients could be evaluated after 12 months. Success of the restorations was 100%. From loading to the 12‐month follow‐up, the mean marginal bone loss was 0.16 mm (SD: 0.26). Mean scores for plaque, calculus, peri‐implant mucosa, bleeding, and pocket probing depth were low, depicting healthy peri‐implant conditions. Patients' satisfaction was high and had improved after treatment.

Conclusion

Full‐contour zirconia implant‐supported restorations with angulated screw channel abutments in the molar region have an excellent clinical performance after 1 year of function.

Novel Oxygen-Deficient Zirconia (ZrO2-x) for Fluorescence/Photoacoustic Imaging-Guided Photothermal/Photodynamic Therapy for Cancer

Theranostic nanoplatforms that integrate therapy and diagnosis in a single composite have become increasingly attractive in the field of precise and efficient tumor treatment. Herein, a novel oxygen-deficient zirconia (ZrO_2-x) nanosystem based on the conjugation of thiol-polyethylene glycol-amine (SH-PEG-NH₂) and chlorin e6 (Ce6) was elaborately designed and established for efficacious photothermal/photodynamic therapy (PTT/PDT) and fluorescence/photoacoustic (FL/PA) bimodal imaging for the first time. The crystalline-disordered, PEGylated ZrO_2-x nanoparticles (ZP NPs) displayed strong optical absorption in the near-infrared (NIR) window and were featured with significant photothermal conversion capacity. The ZP NPs were further covalently conjugated with Ce6 to form ZrO_2-x@PEG/Ce6 (ZPC) NPs, which displayed a long circulatory half-life, efficient tumor accumulation, and outstanding FL/PA imaging performance. Moreover, the nanocomposites effectively generated cytotoxic intracellular reactive oxygen species (ROS) responsive to laser activation. Both cell studies and animal experiments explicitly demonstrated that ZPC NPs mediated remarkable tumor ablation with minimal systemic toxicity thanks to their tumor-specific PTT/PDT effect. Collectively, these findings may open up new avenues to broaden the application of oxygen-deficient ZrO_2-x nanostructures as high-performance photothermal agents in tumor theranostics through rational design and accurate control of their physiochemical properties.

A Turn-On Luminescence Method for Phosphate Determination Based on Fast Green-Functionalized ZrO2:Yb,Er@ZrO2 Core@Shell Upconversion Nanoparticles

The development of practical and sensitive tools for detecting phosphate deficiency could facilitate engineering approaches to enhance crop yield and quality in phosphate-stressed environments, reducing the misuse of nonrenewable fertilizers and their consequent ecological impact. Herein, a 975 nm-activated method based on ZrO₂:Yb,Er@ZrO₂ core@shell upconversion nanoparticles is presented for rapid visualization and determination of the phosphate ions in aqueous solutions and extracts. At optimized thickness, the nondoped ZrO₂ shell not only enhances the emission of the ZrO₂:Yb,Er but also provides an active surface for the intense interaction with the phosphate group, allowing a "label-free" determination that avoids the use of additional phosphate-recognizing elements like ligands or antibodies. According to the experimental evidence, the optical output of the ZrO₂:Yb,Er@ZrO₂ nanoparticles specifically matches with the absorption spectrum of the fast green alimentary dye (FG) electrostatically attached to the nanoparticle surface, activating the Förster resonance energy transfer (FRET) and thereby the upconversion luminescence quenching. Upon addition of the phosphate ions and the covalent interaction with the ZrO₂:Yb,Er@ZrO₂-FG nanocomplex, the FG is gradually removed, displaying a fast and reproducible "turn-on" luminescence which allows measurements in a few minutes. This rapid response is due to the stronger coordination between the ZrO₂ shell and the phosphate compared to the FG molecules (-31.97 and -5.99 eV, respectively). The detection method was then effectively modulated in a 20-1000 nM linear response range without interfering effects of commonly coexisting ions, achieving a detection limit up to 15 times lower than that obtained with the conventionally used colorimetric methods.

Structure change of monoclinic ZrO2 baddeleyite involving softenings of bulk modulus and atom vibrations

Monoclinic ZrO₂ baddeleyite exhibits anomalous softenings of the bulk modulus and atom vibrations with compression. The pressure evolution of the structure is investigated using neutron powder diffraction combined with ab initio calculations. The results show that the anomalous pressure response of the bulk modulus is related not to the change in the bonding characters but to the deformation of an oxygen sublattice, especially one of the layers made of oxygen atoms in the crystallographic a* plane. The layer consists of two parallelograms; one is rotated with little distortion and the other is distorted with increasing pressure. The deformation of this layer lengthens one of the Zr-O distances, resulting in the softening of some atom vibrational modes.

Current status on lithium disilicate and zirconia: a narrative review

Background

The introduction of the new generation of particle-filled and high strength ceramics, hybrid composites and technopolymers in the last decade has offered an extensive palette of dental materials broadening the clinical indications in fixed prosthodontics, in the light of minimally invasive dentistry dictates. Moreover, last years have seen a dramatic increase in the patients’ demand for non-metallic materials, sometimes induced by metal-phobia or alleged allergies. Therefore, the attention of scientific research has been progressively focusing on such materials, particularly on lithium disilicate and zirconia, in order to shed light on properties, indications and limitations of the new protagonists of the prosthetic scene.

Methods

This article is aimed at providing a narrative review regarding the state-of-the-art in the field of these popular ceramic materials, as to their physical-chemical, mechanical and optical properties, as well as to the proper dental applications, by means of scientific literature analysis and with reference to the authors’ clinical experience.

Results

A huge amount of data, sometimes conflicting, is available today. Both in vitro and in vivo studies pointed out the outstanding peculiarities of lithium disilicate and zirconia: unparalleled optical and esthetic properties, together with high biocompatibility, high mechanical resistance, reduced thickness and favorable wear behavior have been increasingly orientating the clinicians’ choice toward such ceramics.

Conclusions

The noticeable properties and versatility make lithium disilicate and zirconia materials of choice for modern prosthetic dentistry, requiring high esthetic and mechanical performances combined with a minimal invasive approach, so that the utilization of such metal-free ceramics has become more and more widespread over time.

Collective substitutions of selective rare earths (Yb3+, Dy3+, Tb3+, Gd3+, Eu3+, Nd3+) in ZrO2: an exciting prospect for biomedical applications

The study aims to understand the significance of collective rare earth (RE3+) substitutions in ZrO2 structures for biomedical applications. The RE3+ ions namely Yb3+, Dy3+, Tb3+, Gd3+, Eu3+, and Nd3+ were selected and their concentrations were adjusted to obtain three different combinations. The influence of RE3+ on the crystal structure of ZrO2 alongside the absorption, luminescence, mechanical, magnetic, computed tomography (CT), magnetic resonance imaging (MRI) properties was explored. The concomitant effect of the average ionic size and RE3+ concentration determines the crystallization behavior of ZrO2 at elevated temperatures. The collective RE3+ substitutions exhibit both up-conversion and down-conversion emissions with their respective excitation at 793 and 350 nm. Nevertheless, increment in the concentration of RE3+ is found to be detrimental to the mechanical stability of ZrO2. The collective characteristics of multiple RE3+ demonstrate the potential of the investigated system in multimodal imaging applications. The unique luminescence characteristics of Eu3+ and Tb3+ are promising for fluorescence imaging while the presence of Dy3+, Tb3+, Gd3+ and Nd3+ unveils a paramagnetic response required for MRI. In addition, Dy3+ and Yb3+ contribute to the high X-ray absorption coefficient values suitable for X-ray CT imaging.

Dry-bonding to dentin using alternative conditioners based on iron-containing solutions or nitric acid

OBJECTIVES

To evaluate the effect of experimental conditioners (10-3 solution - 10-3, 6.8% ferric oxalate - FOX, and 1.4% nitric acid - NI) on dentin elastic modulus, flexural strength, bond strength, failure mode, and adhesive interface morphology of two etch-and-rinse adhesives (XP Bond, Dentsply or One-Step, Bisco) applied on etched dry dentin.

METHODS

Sound human third molars were used for the microtensile bond strength test (n = 8), performed at 24 h and after one year of water storage. Failure modes were evaluated by scanning electron microscopy. Dentin bonding interface was analyzed by confocal laser scanning microscopy (n = 3). Adhesive systems were applied on phosphoric acid-etched, wet (positive control) and dry (negative control) dentin, and on etched and dry dentin previously treated with 10-3 (15s), FOX (60s), or NI (15s). Bovine dentin bars (n = 15) were immersed into the conditioning solutions and subjected to a three-point bending test.

RESULTS

XP Bond + 10-3 or NI resulted in lower bond strength than phosphoric acid. One-Step + 10-3 or NI resulted in bond strengths equivalent to the positive control. Experimental conditioners presented no bond strength reduction after one year, regardless of the bonding agent tested. One-Step resulted in more adhesive failures than XP Bond at 24 h, and mixed failures increased after storage. All experimental conditioners promoted hybridization and resin tags formation, except FOX. Dentin elastic modulus was not affected by the conditioners, whereas flexural strength was significantly reduced by FOX.

CONCLUSIONS

Adequate and stable dentin bonds were achieved when the bonding agents were applied on 10-3 or NI-treated dentin. None of the experimental conditioners reduced dentin elastic modulus, but dentin flexural strength was significantly reduced by FOX-conditioning.

Biomechanical and Histological Analysis of Titanium (Machined and Treated Surface) Versus Zirconia Implant Materials: An In Vivo Animal Study

OBJECTIVES

The aim of this study was to perform an in vivo histological comparative evaluation of bone formation around titanium (machined and treated surface) and zirconia implants. For the present study were used 50 commercially pure titanium implants grade IV, being that 25 implants with a machined surface (TiM group), 25 implants with a treated surface (TiT group) and, 25 implants were manufactured in pure zirconia (Zr group). The implants (n = 20 per group) were installed in the tibia of 10 rabbits. The implants distribution was randomized (n = 3 implants per tibia). Five implants of each group were analyzed by scanning electron microscopy and an optical laser profilometer for surface roughness characterization. Six weeks after the implantation, 10 implants for each group were removed in counter-torque for analysis of maximum torque value. The remaining samples were processed, included in historesin and cut to obtain non-decalcified slides for histomorphological analyses and histomorphometric measurement of the percentage of bone-implant contact (BIC%). Comparisons were made between the groups using a 5% level of significance (p < 0.05) to assess statistical differences. The results of removal torque values (mean ± standard deviation) showed for the TiM group 15.9 ± 4.18 N cm, for TiT group 27.9 ± 5.15 N cm and for Zr group 11.5 ± 2.92 N cm, with significant statistical difference between the groups (p < 0.0001). However, the BIC% presented similar values for all groups (35.4 ± 4.54 for TiM group, 37.8 ± 4.84 for TiT group and 34.0 ± 6.82 for Zr group), with no statistical differences (p = 0.2171). Within the limitations of the present study, the findings suggest that the quality of the new bone tissue formed around the titanium implants present a superior density (maturation) in comparison to the zirconia implants.

Drug-Loaded Biomimetic Ceramics for Tissue Engineering

The mimesis of biological systems has been demonstrated to be an adequate approach to obtain tissue engineering scaffolds able to promote cell attachment, proliferation, and differentiation abilities similar to those of autologous tissues. Bioceramics are commonly used for this purpose due to their similarities to the mineral component of hard tissues as bone. Furthermore, biomimetic scaffolds are frequently loaded with diverse therapeutic molecules to enhance their biological performance, leading to final products with advanced functionalities. In this review, we aim to describe the already developed bioceramic-based biomimetic systems for drug loading and local controlled release. We will discuss the mechanisms used for the inclusion of therapeutic molecules on the designed systems, paying special attention to the identification of critical parameters that modulate drug loading and release kinetics on these scaffolds.

Comparative study of the wear of the pair human teeth/Vita Enamic® vs commonly used dental ceramics through chewing simulation

Ceramic based prosthetic materials have been used in dental restorations due to their excellent aesthetic and biocompatibility. However, due to concerns related to their mechanical properties and abrasive action against natural teeth, a proper selection of these materials is crucial to preserve the occlusal interactions and prevent abnormal dental wear. The aim of this work is to compare the wear performance of Vita Enamic®, a polymer infiltrated ceramic (PIC), with that of other three commercial ceramic based dental materials - Zirconia, Leucite and Zirconia Veneered - when tested against natural teeth. The crystalline structure, wettability, topography and hardness of the prosthetic materials were characterized before wear testing. Chewing simulator experiments (360,000 cycles, load 49 N) against dental human cusps were carried out using artificial saliva as lubricant. The wear of both teeth and prosthetic materials was quantified and the involved wear mechanisms were analyzed by scanning electron microscopy. The results showed that Zirconia presented the most suitable tribological behavior, since it led to the lowest wear on both occlusal surfaces. The prosthetic material presenting the highest wear was Vita Enamic®. Regarding the cusps' wear, the highest values were found for both Leucite and Zirconia Veneered. Polishing wear was the main wear mechanism in Zirconia system (prosthetic material and opposing enamel), while in the remaining ones was fragile fracture associated with abrasive wear. No direct relation could be established between wettability, initial roughness and hardness of the prosthetic materials and the wear of the tribological systems. Contrarily, microstructure and toughness revealed to be critical parameters.

Effect of margin design on fracture load of zirconia crowns

Zirconia‐based restorations are showing an increase as the clinicians’ preferred choice at posterior sites because of the strength and esthetic properties of such restorations. However, all‐ceramic restorations fracture at higher rates than do metal‐based restorations. Margin design is one of several factors that can affect the fracture strength of all‐ceramic restorations. The aim of this study was to assess the effect of preparation and crown margin design on fracture resistance. Four groups of bilayer zirconia crowns (with 10 crowns in each group) were produced by hard‐ or soft‐machining technique, with the following four different margin designs: chamfer preparation (control); slice preparation; slice preparation with an additional cervical collar of 0.7 mm thickness; and reduced occlusal thickness (to 0.4 mm) on slice preparation with an additional cervical collar of 0.7 mm thickness. Additionally, 10 hard‐machined crowns with slice preparation were veneered and glazed with feldspathic porcelain. In total, 90 crowns were loaded centrally in the occlusal fossa until fracture. The load at fracture was higher than clinically relevant mastication loads for all preparation and margin designs. The crowns on a chamfer preparation fractured at higher loads compared with crowns on a slice preparation. An additional cervical collar increased load at fracture for hard‐machined crowns.

[Current trends of the choice and processing of materials for dental implantation]

For assessment of the modern situation about the choice of materials for manufacture of dental implants and the processing of their surface the scientific literature for the last 2 years was study. On the basis of a large number of contradictory results of the researches devoted to each of dental implantation problems it is possible to draw a conclusion that any of primal problems of implantology is finally not solved. There is no unique opinion at the choice of optimum material for manufacture of dental implants, at the way of processing and modification of their surface. The problem of improvement of quality of dental implantation and fight against complications of this procedure cannot be solved simple drawing other substances on the implanted material surface, this task more easily and more successfully is solved via changes of product structure and various modification of implant surface. Up to the present the researches of an opportunity to influence on characteristics of the implanted materials, changing their structure and character of a surface, continue. And the publications reporting about the considerable positive effect of artificially created roughnesses on product surfaces, and the articles claiming that there are no big differences between the rough and polished implants are confirmed by objective measurements with statistical processing of the obtained data. It should be noted that among articles there are very many works of the doubtful plan or with insufficiently valid conclusions. This review leads to the conclusion that further clinical and experimental studies and about the choice of materials for manufacture of implants and at the ways of processing of their surface are necessary.

Molecular analysis of biocompatibility of anodized titanium with deposited silver nanodendrites

Titanium (>99.6% purity) and its anodically oxidized modifications, with and without deposited silver nanodendrites regarding its biocompatibility were evaluated. In human gingival fibroblasts and osteoblast cell lines grown on tested samples, the level of expression of genes encoding αV (ITGAV) and β1 (ITGB1) integrin subunits also genes encoding focal adhesion (FAK) and extracellular-signal regulated (ERK) kinases was assessed. For this purpose, the qualitative and quantitative PCR technique was used. The expression of studied genes was dependent on the origin of cell lines and the type of evaluated material. The high expression of PBGD and ITGAV genes in fibroblasts grown on the surface of anodically modified titanium with deposited silver nanodendrites indicates potentially high biocompatibility of these samples for soft tissue cells. The high expression of the ITGB1 and ERK1 genes and the enhanced expression of the FAK gene in osteoblasts cells grown on the tested material was also observed. Summarizing, the nanocrystalline Ti modified with silver deposits showed higher biocompatibility in comparison with the conventional pure Ti samples.

Complications with PMMA compared with other materials used in cranioplasty: a systematic review and meta-analysis

Polymethyl methacrylate (PMMA) has been considered a suitable material for cranioplasty. However, no consensus has been reached concerning the best material for cranioplasty with regard to minimizing complications. Thus, this systematic review and meta-analysis aimed to compare the complication rates of PMMA with those of autologous bone and titanium mesh. This review was registered with PROSPERO (CRD42016042725). Systematic searches were conducted on PubMed/MEDLINE, Scopus, and Web of Science. The focus question was, "Do PMMA prostheses used in cranioplasty have complications rates similar to those of autologous bone and titanium mesh?" A meta-analysis of complication rates was performed on the basis of dichotomous outcomes assessed by risk ratio (RR) with corresponding 95% confidence intervals (CI). From 1014 data sources, 11 articles were selected according to eligibility criteria. These articles involved 1,256 individuals and 1,278 cranioplasties using autologous bone (n = 408), PMMA (n = 379), or titanium (n = 151). The follow-up period ranged from 63 days to 54.3 months. No difference was observed between the complication rates of PMMA and autologous bone (p = 0.94; RR, 0.98; 95%CI, 0.54-1.75) or between PMMA and titanium (p = 0.38; RR, 1.59; 95%CI, 0.57-4.48). Sub-analysis of the reasons for craniotomy (trauma/non-trauma) was conducted, which revealed no significant difference (p = 0.91; RR, 0.95; 95%CI, 0.37-2.42). The meta-analysis indicated that the use of PMMA yields complication rates that are near those of autologous bone and titanium mesh.

Thermal cracks of implant-based zirconia four-unit restorations: A fractographic analysis of two restorations fractured during production

Two zirconia-based 4-unit restorations intended for the same patient fractured during the veneering process even though the prolonged cooling protocol recommended by the manufacturers was used. Fractographic analyses revealed that both restorations fractured as a result of thermal shock, but at different times during production. Further investigation is necessary to optimize the firing protocols for large zirconia-based restorations and avoid fracture due to thermal shock.

Micro-Raman Vibrational Identification of 10-MDP Bond to Zirconia and Shear Bond Strength Analysis

So far, there is no report regarding the micro-Raman vibrational fingerprint of the bonds between 10-methacryloyloxy-decyl dihydrogen phosphate (10-MDP) and zirconia ceramics. Thus, the aim of this study was to identify the Raman vibrational peaks related to the bonds of 10-MDP with zirconia, as well as the influence on microshear bond strength. Micro-Raman spectroscopy was employed to assess the vibrational peak of 10-MDP binding to zirconia. Microshear bond strength of the dual-cure resin cement to zirconia with the presence of 10-MDP in composition of experimental ceramic primer and self-adhesive resin cement was also surveyed. Statistical analysis was performed by one-way ANOVA and Tukey's test (p < 0.05). Peaks at 1545 cm⁻¹ and 1562 cm⁻¹ were found to refer to zirconia binding with 10-MDP. The presence of 10-MDP in both experimental ceramic primer and self-adhesive resin cement improved microshear bond strength to zirconia ceramic. It can be concluded that the nondestructive method of micro-Raman spectroscopy was able to characterize chemical bonds of 10-MDP with zirconia, which improves the bond strengths of resin cement.

Performance of a New Al₂O₃/Ce-TZP Ceramic Nanocomposite Dental Implant: A Pilot Study in Dogs

Although titanium remains as the prevalent material in dental implant manufacturing new zirconia-based materials that overcome the major drawbacks of the standard 3Y-yttria partially-stabilized zirconia (Y-TZP) are now emerging. In this study, a new ceramic nanocomposite made of alumina and ceria-stabilized TZP (ZCe-A) has been used to produce dental implants with the mechanic and topographic characteristics of a pilot implant design to evaluate bone and soft tissue integration in a dog model (n = 5). Histological cross-section analysis of the implanted ceramic fixations (n = 15) showed not only perfect biocompatibility, but also a high rate of osseous integration (defined as the percentage of bone to implant contact) and soft tissue attachment. This clinical success, in combination with the superior mechanical properties achieved by this Al₂O₃/Ce-TZP nanocomposite, may place this material as an improved alternative of traditional 3Y-TZP dental implants.