Strength, toughness and aging stability of highly-translucent Y-TZP ceramics for dental restorations

Optical properties evaluation of rapid sintered translucent zirconia with two dental colorimeters

Background/purpose

The efficient rapid sintering technique has employed to dental zirconia ceramics for shortening the fabrication time of zirconia restorations. The purpose was to compare the optical properties of two generations of rapid sintered translucent zirconia using two dental colorimeters.

Materials and methods

Two generations of translucent zirconia ceramics, 3 mol% yttria-tetragonal zirconia polycrystal (3Y-TZP): Copran Zr-i Ultra-T (UT) and Cercon HT (HT), and 5 mol% yttria-tetragonal zirconia polycrystal (5Y-TZP): Cercon xt (XT), of different thicknesses (0.5, 0.8, and 1.2 mm; n = 5) underwent rapid sintering (RS) or conventional sintering (CS). The CIELAB values were measured on the white and black backgrounds, respectively, by digital colorimeters, shadepilot, DeguDent (DD) and Easyshade V, Vita (Vita). Translucency parameter (TP), color difference (ΔE), surface morphology, and surface roughness were evaluated.

Results

RS resulted in reduced lightness, except in the XT group. The chromaticity increased slightly after RS. Translucency decreased with increasing material thickness. ΔE values differed between both sintering processes but were clinically acceptable (ΔE < 5). Grain size of XT decreased after RS. RS did not affect the surface roughness.

Conclusion

RS is a feasible method for shortening the manufacturing time of zirconia restorations. A significant difference in TP value was only in the XT group between both sintering methods as measured on DD. Color differences in rapid sintered translucent zirconia materials are imperceptible and acceptable. The specimen thickness affected more in the TP values of Vita than DD. DD has higher sensitivity to translucency and color compared with Vita.

Biaxial Flexural Strength of Different Monolithic Zirconia upon Post-Sintering Processes

OBJECTIVE

 Different post-sintering processes are expected to be a reason for alteration in the strength of zirconia. This study evaluated the effect of post-sintering processes on the flexural strength of different types of monolithic zirconia.

MATERIALS AND METHODS

 A total of 120 classical- (Cz) and high-translucent (Hz) monolithic zirconia discs (1.2 mm thickness and 14 mm in Ø) were prepared, sintered, and randomly divided into four groups to be surface-treated with (1) as-glazed (AG); (2) finished and polished (FP); (3) finished, polished, and overglazed (FPOG); and (4) finished, polished, and heat-treated (FPHT) technique (n = 15). Biaxial flexural strength (σ) was determined on a piston-on-three ball in a universal testing machine at a speed of 0.5 mm/min.

STATISTICAL ANALYSIS

 Analysis of variance, and post hoc Bonferroni multiple comparisons were determined for significant differences (α = 0.05). Weibull analysis was applied for survival probability, Weibull modulus (m), and characteristic strength (σ₀). The microstructures were examined with a scanning electron microscope and X-ray diffraction.

RESULTS

 The mean ± standard deviation value of σ (MPa), m, and σ₀ were 1,626.43 ± 184.38, 9.51, and 1,709.79 for CzAG; 1,734.98 ± 136.15, 12.83, and 1,799.17 for CzFP; 1,636.92 ± 130.11, 14.66, and 1,697.63 for CzFPOG; and 1,590.78 ± 161.74, 10.13, and 1,663.82 for CzFPHT; 643.30 ± 118.59, 5.59, and 695.55 for HzAG; 671.52 ± 96.77, 3.28, and 782.61 for HzFP; 556.33 ± 122.85, 4.76, and 607.01 for HzFPOG; and 598.36 ± 57.96, 11.22, and 624.89 for HzFPHT. The σ was significantly affected by the post-sintering process and type of zirconia (p < 0.05), but not by their interactions (p > 0.05). The Cz indicated a significantly higher σ than Hz. The FP process significantly enhanced σ more than other treatment procedures.

CONCLUSION

 Post-sintering processes enabled an alteration in σ of zirconia. FP enhanced σ, while FPOG and FPHT resulted in a reduction of σ. Glazing tends to induce defects at the glazing interface, while heat treatment induces a phase change to tetragonal, both resulted in reducing σ. Finishing and polishing for both Cz and Hz monolithic zirconia is recommended, while overglazed or heat-treated is not suggested.

Mechanical behavior and microstructural characterization of different zirconia polycrystals in different thicknesses

PURPOSE

To characterize the microstructure of three yttria partially stabilized zirconia ceramics and to compare their hardness, indentation fracture resistance (IFR), biaxial flexural strength (BFS), and fatigue flexural strength.

MATERIALS AND METHODS

Disc-shaped specimens were obtained from 3Y-TZP (Vita YZ HT), 4Y-PSZ (Vita YZ ST) and 5Y-PSZ (Vita YZ XT), following the ISO 6872/2015 guidelines for BFS testing (final dimensions of 12 mm in diameter, 0.7 and 1.2 ± 0.1 mm in thicknesses). Energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed, and mechanical properties were assessed by Vickers hardness, IFR, quasi-static BFS and fatigue tests.

RESULTS

All ceramics showed similar chemical compositions, but mainly differed in the amount of yttria, which was higher as the amount of cubic phase in the diffractogram (5Y-PSZ > 4Y-PSZ > 3Y-TZP). The 4Y- and 5Y-PSZ specimens showed surface defects under SEM, while 3Y-TZP exhibited greater grain uniformity on the surface. 5Y-PSZ and 3Y-TZP presented the highest hardness values, while 3Y-TZP was higher than 4Y- and 5Y-PSZ with regard to the IFR. The 5Y-PSZ specimen (0.7 and 1.2 mm) showed the worst mechanical performance (fatigue BFS and cycles until failure), while 3Y-TZP and 4Y-PSZ presented statistically similar values, higher than 5Y-PSZ for both thicknesses (0.7 and 1.2 mm). Moreover, 3Y-TZP showed the highest (1.2 mm group) and the lowest (0.7 mm group) degradation percentage, and 5Y-PSZ had higher strength degradation than 4Y-PSZ group.

CONCLUSION

Despite the microstructural differences, 4Y-PSZ and 3Y-TZP had similar fatigue behavior regardless of thickness. 5Y-PSZ had the lowest mechanical performance.

Light Transmission of Various Aesthetic Posts at Different Depths and Its Effect on Push-Out Bond Strength, Microhardness of Luting Cement

Background and Objectives: One requirement for the cemented post is the light transmittance on its entire length up to the deepest portion of a root canal to ensure the complete polymerization of resin cement. This study aimed to determine the light transmission ability in different aesthetic posts at different depths and its effect on the push-out bond strength and microhardness of luting cement at the corresponding interface. Materials and Methods: Twenty endodontic posts from glass fiber posts (GFP), zirconia ceramic posts (ZCP), and highly translucent zirconium oxide posts (HTZP) were sequentially sectioned into 12.8 and 4 mm lengths after recording the light intensity using a dental radiometer. Sixty single rooted premolar teeth root canals were treated and implanted vertically in a resin block. The post space was prepared and cemented with GFP, ZCP, and HTZP posts with twenty samples each. The root portion of teeth samples were sectioned into cervical, middle, and apical portion. A universal testing machine was utilized for the push-out bond strength test for the first ten samples from each group. The remaining ten samples from each group were used for the microhardness test using a micro-indenter instrument. The data were statistically analyzed using one-way Analysis of variance and Tukey HSD tests at p < 0.05. Results: The GFP endodontic postpresented with significant highest light translucency compared to HTZP, which was significantly higher than ZCP. GFP posts showed significantly higher bond strength per unit area compared to ZCP at analogous cross sections. The hardness of luting cement was also significantly higher amongst all tested endodontic posts. Conclusions: GFP high light translucency enhanced the curing of the luting resin cement that resulted in harder cement and a stronger bond supported by hardness and push-out tests. These findings suggest that GFP is preferred to be used with light-cured luting cements for restoration of endodontically treated teeth.

Effect of finishing/polishing techniques and aging on topography, C. albicans adherence, and flexural strength of ultra-translucent zirconia: an in situ study

OBJECTIVE

To investigate the influence of different finishing/polishing techniques and in situ aging on the flexural strength (σ), surface roughness, and Candida albicans adherence of 5 mol% yttria-stabilized zirconia (ultratranslucent zirconia).

MATERIALS AND METHODS

A total of 120 zirconia bars (Prettau Anterior, Zirkonzahn) with dimensions of 8 × 2 × 0.5 mm were divided into 8 groups (n = 15) according to two factors: "in situ aging" (non-aged and aged (A)) and "finishing/polishing" (control (C), diamond rubber polishing (R), coarse grit diamond bur abrasion (B), and coarse grit diamond bur abrasion + diamond rubber polishing (BR)). Half of the samples from each group were subjected to a 60-day in situ aging by fixing the bars into cavities prepared in the posterior region of the base of complete or partial dentures of 15 patients. The samples were then subjected to the mini flexural (σ) test (1 mm/min). A total of 40 zirconia blocks (5 × 5 × 2 mm) were prepared and subjected to roughness (Ra) analyses and fungal adherence and complementary analyses (X-ray diffraction (XRD) and scanning electron microscopy (SEM)). The data of mean σ (MPa) and roughness Ra (μm) were statistically analyzed by two-way and one-way ANOVA, respectively, and Tukey's test. The Weibull analysis was performed for σ data. The fungal adhesion (Log CFU/mL) data were analyzed by Kruskal-Wallis tests.

RESULTS

For flexural resistance, the "finishing/polishing" factor was statistically significant (P = 0.0001); however, the "in situ aging" factor (P = 0.4458) was not significant. The non-aged (507.3 ± 115.7 MPa) and aged (487.6 ± 118.4 MPa) rubber polishing groups exhibited higher mean σ than the other techniques. The non-aged (260.2 ± 43.3 MPa) and aged (270.1 ± 48.8 MPa) bur abrasion groups presented lower σ. The coarse-grit diamond bur abrasion group (1.82 ± 0.61 µm) presented the highest roughness value (P = 0.001). Cell adhesion was not different among groups (P = 0.053). Group B presented the most irregular surface and the highest roughness Ra of 0.61 m.

CONCLUSIONS

The finishing of ultratranslucent zirconia might be preferably done with a diamond rubber polisher. Moreover, the protocols used did not interfere with Candida albicans adhesion.

CLINICAL RELEVANCE

Coarse-grit diamond burs might be avoided for finishing ultratranslucent monolithic zirconia, which might be preferably performed with a diamond rubber polisher.

Cellular properties of human gingival fibroblasts on novel and conventional implant-abutment materials

OBJECTIVES

To characterize human-gingival-fibroblast-(HGFs) viability, proliferation and adhesion on polymer-infiltrated-ceramic-network-(PICN), polyetheretherketone-(PEEK), hydroxyapatite-reinforced-polyetheretherketone-(HA-PEEK), polyetherketoneketone-(PEKK), as well as conventional titanium-(Ti) and zirconia ceramic-(Zr) implant materials in-vitro.

METHODS

Six materials (n = 40/group, 240 specimens) were standardized for surface roughness, assessed employing water contact angle measurements (WCA) and loaded with HGFs. HGF viability and proliferation were assessed at 24 and 72 h. Cell adhesion strength was evaluated after 24 h exposure to lateral shear forces using a shaking-device at 320 and 560-rpm.and qualitatively tested by scanning-electron-microscopy-(SEM) at 3, 24 and 72 h.

RESULTS

PICN demonstrated the lowest mean WCA (48.2 ± 6.3º), followed by Zr (73.8 ± 5.1º), while HA-PEEK showed the highest WCA (87.2 ± 1.5º; p ≤ 0.05). After 24 h, Zr showed the highest mean HGFs-viability rate (88 ± 14%), while PEKK showed the lowest one (78 ± 7%). At 72 h, Zr continued to show the highest HGF-viability (80 ± 6%) compared to PEKK (67.5 ± 6%) and PEEK (67%±5). SEM did not reveal differences between different materials with respect to cell attachment at 3, 24 or 72 h. At 320 rpm shaking, HGFs showed to be best attached to PICN (mean%-of-detached-cells ± SD; 26 ± 11%) and worst to PEEK (54 ± 18%). At 560 rpm shaking, Zr showed the least detached cells (32 ± 4%), while HA-PEEK revealed the highest number of detached cells (58 ± 3%; ANOVA/Tukey-post-hoc-test, differences not statistically significant).

SIGNIFICANCE

Dental implant abutment materials and their wettability strongly affect HGF proliferation and adhesion properties. Although, PICN showed the best wettability properties, Zr exhibited the strongest adhesion strength at high shaking. Within the current study's limitations, Zr remains the most biocompatible abutment material.

Effects of Different Air Particle Abrasion Protocols on the Biaxial Flexural Strength and Fractography of High/Ultra-Translucent Zirconia

In this study, the biaxial flexural strength (BFS) and fractography of high/ultra-translucent monolithic zirconia ceramics subjected to different mechanical surface pretreatments were evaluated. A total of 108 disc-shaped samples (12 mm diameter, 1.2 mm thickness) of three zirconia materials (5Y-ZP KATANA Zirconia UTML (ML), 3Y-TZP DD Bio ZX2 (DB), and 5Y-ZP DD cube X2 (DC)) were used. The BFS was investigated after subjecting the samples to surface treatment using air abrasion particles of two types (aluminum oxide or glass microbeads). The data were analyzed using two-way analysis of variance, followed by Scheffe's post hoc test for multiple comparisons. The mean ± standard deviation BFS for DB was highest after treatment with 50 µm Al₂O₃ (1626.05 ± 31.9 MPa), with lower values being observed following treatment with 50 µm glass microbeads (1399.53 ± 24.2 MPa) and in the control sample (1198.51 ± 21.1 MPa). The mean ± standard deviation (SD) BFSs for DC and ML were the highest in the control groups. Surface air abrasion with 50 µm Al₂O₃ particles and 2 bar pressure is recommended for 3Y-TZP translucent zirconia, while no abrasion of 5Y-ZP translucent zirconia ceramic.

Surface Roughness and Translucency of Various Translucent Zirconia Ceramics after Hydrothermal Aging

OBJECTIVE

 This study investigated the effect of hydrothermal aging on surface roughness and translucency of various translucent zirconia materials.

MATERIALS AND METHODS

 Four types of zirconia were tested. Group 1 was translucent zirconia with no cubic structure. Group 2, 3, and 4 included cubic-containing zirconia with different amounts of cubic structures (less than 30%, 30-50%, and more than 50%, respectively). Each group contained 15 disk-shape specimens with dimensions of 15 mm in diameter and 1 mm in thickness. As-sintered surface roughness, translucency parameter, and contrast ratio were evaluated in the two different sessions, before and after aging.

STATISTICAL ANALYSIS

 Two-way repeated measures ANOVA with Bonferroni test was used to analyze statistically significant difference in those tested parameters. Phase structure before and after aging was analyzed by X-ray diffraction analysis (XRD).

RESULTS

 Groups 1 and 2 showed significant increased surface roughness after aging while groups 3 and 4 showed no alteration of surface. There was no effect of aging on translucency in all groups. After aging, group 1 and 2 presented monoclinic structure (16.63 and 5.01%, respectively).

CONCLUSION

 Hydrothermal aging caused phase transformation and increasing surface roughness in group 1 and 2 but did not affect translucency in all groups.

Effect of Cooling Rate during Glazing on the Mechanical and Optical Properties of Monolithic Zirconia with 3 mol% Yttria Content

Glazing is the final heat treatment process in the manufacturing of a monolithic zirconia prosthesis. Herein, the effect of cooling rate during zirconia glazing was investigated. A 3 mol% yttria-stabilized tetragonal zirconia polycrystal was glazed at the general cooling rate suggested by the manufacturer, as well as at higher and lower cooling rates, and the differences in flexural strength, hardness, optical properties, and crystal structure were evaluated. A higher cooling rate did not affect the flexural strength, hardness, grain size, optical properties, or crystal structure; however, the Weibull modulus decreased by 1.3. A lower cooling rate did not affect the flexural strength, optical properties, or crystal structure; however, the Weibull characteristic strength increased by 26.7 MPa and the Weibull modulus increased by 0.9. The decrease in hardness and the increase in grain size were statistically significant; however, the numerical differences were negligible. This study revealed that a lower cooling rate provides more reliable flexural strength. Therefore, glazing can proceed at a general cooling rate, which takes 3-4 min; however, glazing at a lower cooling rate will provide a more consistent flexural strength if desired, despite being time-consuming.

The effects of different silicatization and silanization protocols on the bond durability of resin cements to new high-translucent zirconia

OBJECTIVE

The aim of this study was to assess the influence of different silicatization protocols with various silane treatment methods on the bond performance to high-translucent zirconia.

MATERIALS AND METHODS

High-translucent zirconia specimens were assigned to five groups according to mechanical surface pretreatment: as-sintered (Con), 0.2 MPa alumina sandblasting (AB2), tribochemical silica coating (TSC), 0.2 and 0.4 MPa glass bead air abrasion (GB2) and (GB4). Each group was subjected to 4 different cementation protocols: Panavia SA Universal (SAU), Panavia SA plus (SAP), silane + SAP (S-SAP), and Universal adhesive + SAP (U-SAP). Tensile bond strength (TBS) was measured after 24 h and 10,000 thermocycling (TC). Surface topography, surface energy, and elemental composition of the abraded zirconia surface analyses were completed. TBS data was analyzed using the Weibull analysis method. Surface roughness and surface energy were compared by one-way ANOVA analysis of variance (α = 0.05).

RESULTS

After 24 h, higher TBS was achieved with all cementation protocols in AB2 and TSC, also, in GB2 with all protocols except U-SAP, and in GB4 with SAU and S-SAP. After aging, GB4/S-SAP, GB2/S-SAP, AB2/U-SAP, and TSC/S-SAP showed the highest bond strength. GB groups showed the lowest surface roughness and highest surface energy.

CONCLUSION

Glass bead abrasion achieved the durable bond strength to high-translucent zirconia using a separate silane coupling agent while altered surface chemistry, surface energy, and roughness without effect on morphology.

CLINICAL RELEVANCE

Glass bead air abrasion is an alternative to alumina sandblasting and tribochemical silica coating and improves bond strength to high translucent zirconia.

Surface and bulk properties of zirconia as a function of composition and aging

Yttria-stabilized zirconia (Y-SZ) materials with different levels of translucency have been used for indirect dental restorations. Y-SZ composition and microstructure are modified to improve translucency, and it is not clear how these materials respond to aging. This study evaluated the effect of hydrothermal aging (HA) performed in an autoclave on the properties of four dental Y-SZ materials with different compositions. Sintered bar-shaped specimens (14 x 4 x 2 mm) were prepared from four different zirconia-based materials (n = 40): low translucency 3 mol % Y-SZ (3Y-LT; Ceramill ZI, Amann Girrbach); high translucency 4 mol % Y-SZ (4Y-HT; Ceramill Zolid); and two high translucency 5 mol % Y-SZ (5Y-HT - Lava Esthetic, 3M; 5Y-SHT - Ceramill Zolid FX). Fully sintered specimens were exposed to HA for different times (control - 0 h, 5 h, 10 h, or 15 h at 134 °C, 2 bar pressure) and characterized for surface roughness, flexural strength (three-point bending), hardness and elastic modulus (nanoindentation), surface wettability (sessile drop technique) and crystalline content (x-ray diffraction, XRD). Data was analyzed by two-way ANOVA and Tukey HSD (p < 0.05). Zirconia composition significantly affected roughness (p = 0.016). Zirconia*aging interaction affected flexural strength (p = 0.012), surface wettability (p < 0.001), and hardness (p = 0.002). Zirconia composition (p = 0.011) and aging (p = 0.001) affected elastic modulus, while the interaction effect was not significant (p = 0.94). HA affects zirconia-based materials in different degrees. For 3Y-LT and 4Y-HT, surface and bulk properties were affected by aging to a similar extent. However, surface and bulk properties may change during clinical use as a result of prolonged degradation of Y-SZ.

Effects of milling method and artificial ageing on optical properties of high translucent zirconia for chairside restorations

OBJECTIVES

This study aimed to evaluate the optical properties of highly translucent 5 mol% yttria, partially stabilised monolithic zirconia, and 3 mol% yttria-stabilised tetragonal zirconia after their subjection to different milling methods and artificial ageing.

METHODS

Two types of pre-shaded zirconia materials were used: inCoris TZI C and Katana STML. A total of 120 specimens were categorised according to the milling method (dry or wet-milling) and the solution used for milling (fresh distilled water or impregnated water with residues of CAD/CAM ceramic materials). The translucency and contrast ratios of all specimens were calculated after they were subjected to sintering and accelerated ageing. The material phase composition was tested before and after ageing, using X-ray diffraction analysis to evaluate T-M phase transformation. Data were statistically analysed via a three-way analysis of variance between the subject factors, the material and milling method, and the within-subject factor, ageing. The analysis of covariance model was used to analyse the changes in translucency and contrast ratio between baseline and ageing, with statistical significance set at p < 0.05.

RESULTS

Katana STML and inCoris TZI C showed the highest translucency when dry-milled (21.9 ± 1.4, and 11.8 ± 0.7, respectively), and the lowest when milled with used impregnated water (5.4 ± 1.2 and 10.7 ± 1.3, respectively). Wet-milling using impregnated water, should be avoided owing to the saturation of alumina particles. Accelerated ageing resulted in the same pattern for both materials. Significance Dry milling of highly translucent zirconia can result in higher translucency and lower contrast ratio values.

Effect of Two Brands of Glaze Material on the Flexural Strength and Probability of Failure of High Translucent Monolithic Zirconia

(1) Background: The effect of glazing on the mechanical properties of monolithic high translucent zirconia is not well reported. Therefore, the purpose of this study was to evaluate the effect of glazing on the flexural strength of high translucent zirconia; (2) Methods: Ninety specimens were prepared from second-generation 3Y-TZP high translucent blocks and divided into three groups. Glaze materials were applied on one surface of the specimen and subjected to a four-point bending test and flexural stress and flexural displacement values were derived. Descriptive fractographic analysis of surfaces was conducted to observe the point of failure and fracture pattern.; (3) Results: Control-nonglazed (647.17, 1σ = 74.71 MPa) presented higher flexural strength values compared to glaze I (541.20, 1σ = 82.91 MPa) and glaze II (581.10, 1σ = 59.41 MPa). Characteristic strength (σ_Ɵ) from Weibull analysis also observed higher (660.67 MPa) values for the control specimens. Confocal microscopy revealed that glazed surfaces were much rougher than control surfaces. Descriptive fractographic analysis revealed that there was no correlation between the point of failure initiation and flexural strength; (4) Conclusions: The test results demonstrated that glazing significantly decreased the flexural strength and flexural displacement of the zirconia specimens.

Monolithic zirconia crowns: effect of thickness reduction on fatigue behavior and failure load

PURPOSE

The objective of this study was to evaluate the effect of thickness reduction and fatigue on the failure load of monolithic zirconia crowns.

MATERIALS AND METHODS

140 CAD-CAM fabricated crowns (3Y-TZP, inCorisTZI, Dentsply-Sirona) with different ceramic thicknesses (2.0, 1.5, 1.0, 0.8, 0.5 mm, respectively, named G2, G1.5, G1, G0.8, and G0.5) were investigated. Dies of a mandibular first molar were made of composite resin. The zirconia crowns were luted with a resin composite cement (RelyX Unicem 2 Automix, 3M ESPE). Half of the specimens (n = 14 per group) were mouth-motion-fatigued (1.2 million cycles, 1.6 Hz, 200 N/ 5 – 55℃, groups named G2-F, G1.5-F, G1-F, G0.8-F, and G0.5-F). Single-load to failure was performed using a universal testing-machine. Fracture modes were analyzed. Data were statistically analyzed using a Weibull 2-parameter distribution (90% CI) to determine the characteristic strength and Weibull modulus differences among the groups.

RESULTS

Three crowns (21%) of G0.8 and five crowns (36%) of G0.5 showed cracks after fatigue. Characteristic strength was the highest for G2, followed by G1.5. Intermediate values were observed for G1 and G1-F, followed by significantly lower values for G0.8, G0.8-F, and G0.5, and the lowest for G0.5-F. Weibull modulus was the lowest for G0.8, intermediate for G0.8-F and G0.5, and significantly higher for the remaining groups. Fatigue only affected G0.5-F.

CONCLUSION

Reduced crown thickness lead to reduced characteristic strength, even under failure loads that exceed physiological chewing forces. Fatigue significantly reduced the failure load of 0.5 mm monolithic 3Y-TZP crowns.

Optical properties of CAD-CAM monolithic systems compared: three multi-layered zirconia and one lithium disilicate system

Objective

this in vitro investigation aims to evaluate and compare optical properties of three types of esthetic CAD-CAM monolithic multi-layered zirconia materials with a control (conventional lithium disilicate, IPS e. max CAD).

Methods

Four monolithic CAD-CAM ceramic materials were investigated: Ceramill Zolid® FX Multilayer (ZF), IPS e. max® ZirCAD MT Multi (ZM), Katana® STML (KS) and one lithium disilicate glass-ceramics as a control (IPS e. max® CAD LT; LC). A total of 72 (15 × 15 × 1 mm) samples were CAD CAM fabricated and sintered based on sample-size power calculations, and each material comprised 18 samples. The translucency and opalescence parameters with the contrast ratio were evaluated with a dental spectrophotometer over the backgrounds of black and white. The data were analyzed by ANOVA, then Bonferroni post hoc comparison test was made between groups. The statistical significance was set at p < 0.05.

Results

Zirconia materials revealed lower optical properties than the lithium disilicate control LC (P < 0.05). TP values ranged from 14.174 to 20.439. No differences were detected between the zirconia products in terms of TP and CR (P = 1.000). OP values ranged from 5.068 to 10.097. The lowest OP values were found statistically significant for ZF followed by KS and ZM (P = 1.000). LC had the highest TP and OP values, as well as the lowest CR (p < 0.05).

Conclusions

The optical properties of monolithic zirconia systems tested here are still lower than those of lithium disilicate glass-ceramics. The only difference observed between the monolithic CAD CAM zirconia materials, was for the low opalescence parameter for the ZF.

Clinical significance

Multi-layered monolithic zirconia systems have better esthetics by shade layers resembling natural tooth color gradients. CAD-CAM technology allowed for in-office milling and shaping of restorations using these systems. This study reports on their optical properties affecting human vision/perception of natural tooth shade to conclude about their use in the esthetic zones.

Effect of cementation techniques on fracture load of monolithic zirconia crowns

Aim

The aim of this study was to evaluate the effect of cement on the fracture load of monolithic zirconia crowns with different yttria content (3 and 5 mol%).

Methods

A total of 62 monolithic zirconia crowns, 40 3Y-zirconia crowns (Prettau^® Zirconia, Zirkonzahn) and 22 5Y-zirconia crowns (Prettau^® 4 Anterior^®, Zirkonzahn) were produced to a shallow chamfer molar preparation. The 3Y-crowns were divided into four groups and attached to composite abutment duplicates (SDR^® flow+, Dentsply DeTrey GmbH) using the following four cementation techniques; (1) Self-adhesive resin-based cement, (2) Pre-treatment with air-abrasion and self-adhesive resin-based cement, (3) Zinc phosphate cement, (4) Glass-ionomer cement. The 5Y-crowns were divided into two groups and attached to the duplicates with; (1) Self-adhesive resin-based cement, or (2) Air-abrasion pre-treatment and self-adhesive resin-based cement. All crowns were loaded axially (0.5 mm/min) on the occlusal surface until fracture occurred.

Results

Among the 3Y-zirconia groups, the zinc phosphate cement group fractured at lower loads compared to the resin-based cement groups, with and without air-abrasion, (p < .012). Among the 5Y-groups the air-abraded crowns fractured at statistically significant lower loads compared to the untreated crowns (p < .028). Load at fracture values were significantly different between the two zirconia materials (p < .001), with fracture loads ranging from 3873 to 7500 N in the 3Y-groups, and 2100 to 4948 N in the 5Y-groups.

Conclusions

Resin-based cementation increased the fracture load compared to non-adhesive cementation. The 3Y-crowns fractured at almost twice the loads of the 5Y-crowns. Pre-treatment with air abrasion reduced the strength of the 5Y-crowns only, showing the importance of differentiating the treatment of the two materials.

Influence of crystalline phase transformation induced by airborne-particle abrasion and low-temperature degradation on mechanical properties of dental zirconia ceramics stabilized with over 5 mol% yttria

Monolithic dental prostheses fabricated from 5 mol% yttria-stabilized zirconia (5YZ) have been developed to improve the translucency of conventional 3 mol% yttria-stabilized zirconia. In this study, we aimed to evaluate the influence of airborne-particle abrasion (APA) and low-temperature degradation (LTD) on the mechanical properties of 5YZ in association with the crystalline phase transformation. In total, 120 disc-shaped specimens of two brands of 5YZ (Lava Esthetic and Katana UTML) were prepared. The specimens were divided into four groups (n = 15 for each group): (i) control, (ii) APA, (iii) LTD, and (iv) APA + LTD groups. APA was performed with 50 μm alumina particles, and LTD was induced by autoclaving at 134 °C for 50 h. The biaxial flexural strength of the specimens was assessed using a piston-on-three-ball test according to ISO 6872:2015, and Vickers hardness was determined using a microhardness tester. The crystalline phase was analyzed by the Rietveld refinement of X-ray diffraction patterns. APA significantly increased the flexural strength of the Lava Esthetic specimens, whereas LTD hardly affected the strength of both materials. APA and APA + LTD significantly increased the Vickers hardness of both materials. According to Rietveld analysis, the pseudocubic phase was predominant in both materials, i.e., 66 mass% and 81 mass% in the Lava Esthetic and Katana UTML specimens, respectively. APA induced the rhombohedral phase at approximately 37 mass% in both materials, while LTD induced the monoclinic phase at 2.8 mass% in the Lava Esthetic specimens and 0.9 mass% in the Katana UTML specimens. APA + LTD weakly affected the amount of the rhombohedral phase but slightly increased the amount of the monoclinic phase. These findings suggest that APA may improve the mechanical properties of 5YZ, particularly hardness, via the generation of the rhombohedral phase. In contrast, the influence of LTD on the mechanical and microstructural properties of 5YZ was limited.

Fracture toughness of different monolithic zirconia upon post-sintering processes

Background

Surface treatments are expected to be a reason for alteration in fracture resistance of zirconia. This study evaluated the effect of post-sintering processes on the fracture toughness of different types of monolithic zirconia.

Material and Methods

Classical- (Cz) and high-translucent (Hz) monolithic zirconia discs (1.2 mm thickness, 14 mm in Ø) were prepared, and randomly divided for surface treatments with 1) as-glazed (AG); 2) finished and polished (FP); 3) finished, polished, and overglazed (FPOG); and 4) finished, polished, and heat-treated (FPHT) technique (n=15/group). Fracture toughness (KIC) was determined with indentation fracture toughness method at load 1 kg for AG, FPOG and 10 kg for FP, FPHT with 15 sec dwelling time. Weibull analysis was applied for survival probability, Weibull modulus (m), and characteristic toughness (K0). Microstructures were examined with SEM and XRD. ANOVA and multiple comparisons were determined for significant differences (α=0.05).

Results

The mean±sd value of KIC (MPa.m1/2), m, and K0 were 1.60±0.19, 7.27, 1.71 for CzAG; 9.57±0.89, 9.97, 10.96 for CzFP; 1.61±0.15, 10.56, 1.68 for CzFPOG; 6.45±0.31, 20.31, 6.60 for CzFPHT; 1.45±0.13, 10.91, 1.51 for HzAG; 6.58±0.24, 27.00, 6.70 for HzFP; 1.24±0.05, 23.90, 1.27 for HzFPOG; and 5.07±0.16, 30.51, 5.15 for HzFPHT. The KIC was significantly affected by the post-sintering process, type of zirconia (p<0.05). The Cz indicated a significantly higher KIC than Hz. The FP significantly enhanced KIC, while OG was unable to raise KIC. HT reduced KIC due to reverse phase transformation.

Conclusions

Post-sintering processes caused alteration in fracture resistance of zirconia. Fracture toughness was enhanced with FP, but not with either OG or HT process for both Cz and Hz. Surface treatment of zirconia through a finished-polished process is recommended, while glazing and heat-treated are not suggested.

Key words:Fracture toughness, glazing, heat treatment, polishing, post-sintering process, zirconia.

Influence of masticating cycles and chewing patterns on inadvertent enamel wear caused by zirconia brackets

Little information is available about enamel wear caused by zirconia brackets, an inadvertent side effect of orthodontic treatment. The purpose of this study was to examine potential enamel damage induced by contact with zirconia brackets. Sliding and impact wear simulations were performed using bovine enamel specimens positioned at a 25° slant to a zirconium ball to determine wear behaviour. Different chewing patterns, tapping and grinding, were simulated. Specimens were profiled using confocal laser scanning microscopy, and the mean maximum depth and surface roughness were measured. Scanning electron microscopy was also performed. The mean maximum depth of wear values differed according to the number of mastication cycles, with a higher number of cycles producing higher depths of wear. The facet wear depth was significantly greater with the tapping pattern than with the grinding pattern. Scanning electron microscopic observation of the wear facets revealed that surface textures at the edges were rougher than those at the centre of all facets. The results of this study indicated that enamel wear was induced by contact with zirconia brackets during the early period of mastication, and that the patterns and number of cycles of mastication affected the wear progression of enamel.

Effects of shades of a multilayered zirconia on light transmission, monomer conversion, and bond strength of resin cement

OBJECTIVE

To evaluate the influence of shades of a multilayered zirconia on light transmission, resin cement degree of conversion, and shear bond strength of resin cement.

MATERIALS AND METHODS

The light transmission through opaque (OPQ) and translucent (TNS) regions of Katana UTML zirconia (Kuraray Noritake Dental) were evaluated for using a spectroradiometer (n = 5). Degree of conversion of dual-cure resin cement (Panavia V5, Kuraray Noritake Dental) was measured after light-activation through OPQ or TNS regions and direct exposure. Composition of the zirconia was analyzed with energy dispersive x-ray spectroscopy (EDS). Shear bond strength (SBS) was evaluated on the OPQ and TNS regions after 24 h and 1 year from specimen preparation (n = 15).

RESULTS

The OPQ region produced higher irradiance loss (95.1%) than TNS one (92.9%), and lower degree of conversion (52.4%) than TNS (71.2%) at 24 h post-light activation. EDS analysis did not show differences on the microstructure of the OPQ and TNS regions. There were no significant differences on the SBS between zirconia regions. For both zirconia regions, a significant reduction on the SBS occurred after aging, being 31.7% for OPQ and 38% for TNS.

CONCLUSION

Both OPQ and TNS regions affected the light transmission through the multilayered zirconia. The OPQ region yielded the highest light attenuation and the lowest degree of conversion of resin cement. Different regions of the zirconia did not influence the SBS. Clinical significance Although opaque and translucent regions of the multilayered zirconia reduced the light transmission from LED curing unit and the degree of conversion of resin cement, the regions did not affect the resin cement adhesion.

Microhardness of resin cements after light activation through various translucencies of monolithic zirconia

PURPOSE

This study aimed to investigate the Vickers Hardness Number (VHN) of light- and dual cured resin cements cured through monolithic zirconia specimens (VITA YZ) of various translucencies: translucent (T); high translucent (HT); super translucent (ST); and extra translucent (XT) at 0, 24, and 48 h after curing.

MATERIALS AND METHODS

Four zirconia specimens from each translucency were prepared. Two light-cured resin cements (Variolink N LC; VL and RelyX Veneer; RL) and two dual-cured resin cements (Variolink N DC; VD and RelyX U200; RD) were used. The cement was mixed and loaded in a mold and cured for 20 s through the zirconia specimen. The upper surface of cements was tested for VHN using a microhardness tester at 0, 24, and 48 h after curing. The VHN were analyzed using two-way repeated, Brown-Forsythe ANOVA with Games Howell post-hoc analysis and independent t-tests (P < .05).

RESULTS

All cements showed significantly higher VHN from 0 h to 24 h (P < .001). At 48 h, the VHN of light-cured cements were significantly lower when cured under the T groups than under XT groups (P = .001 in VL, P = .014 in RL). At each post curing time of each translucency, VD showed higher VHN than VL (P < .05), and RD also showed higher VHN than RL (P < .05).

CONCLUSION

The translucency of zirconia has an effect on the VHN for light-cured resin cements, but has no effect on dual-cured resin cements. Dual-cured resin cement exhibited higher VHN than the light-cured resin cement from the same manufacturer. All resin cements showed significantly higher VHN from 0 h to 24 h.

Comparison of optical and crystal properties of three translucent yttria-stabilized tetragonal zirconia polycrystals with those of lithium disilicate glass-ceramic material

Background/purpose

Among the ceramic materials used for all-ceramic crowns, zirconia has high biocompatibility and favorable mechanical properties, but its main drawbacks include low translucency and stress-induced phase transformation. To stabilize high-strength tetragonal zirconia polycrystal (TZP), 3–5 mol% yttria is usually added to prepare yttria-stabilized TZP (Y-TZP). In this study, the optical properties of three commercial Y-TZP ceramics were compared with those of the clinically available glass-ceramic material of lithium disilicate, and the relationship between translucency and crystal properties was analyzed in vitro.

Materials and methods

Twelve 5-mm-thick standardized disks were prepared from three Y-TZP ceramics and one lithium disilicate block. Absolute translucency was measured using a spectrophotometer with an integrating sphere. X-ray diffraction was used to quantify the main structural parameters (i.e., preferred plane, quantitative phase, and grain size) of Y-TZP crystals.

Results

The product-dominated phase of Y-TZP exhibited a tetragonal lattice pattern, and the preferred planes had minor variations. The diffraction patterns of the three Y-TZP ceramics demonstrated minor effects on translucency, without significant differences (p > 0.05). The grain size of 54–70 nm was negatively related to translucency in Y-TZP. Lithium disilicate specimens had significantly higher translucency than the three Y-TZP specimens (p < 0.001).

Conclusion

Grain size reduction played an essential role in developing highly translucent Y-TZP ceramics. The three Y-TZP ceramics were essentially opaque but exhibited poorer translucency than lithium disilicate in terms of esthetics.

Comparison of surface topography and roughness in different yttrium oxide compositions of dental zirconia after grinding and polishing

PURPOSE

The purpose of this study was to compare the surface roughness, phase transformation, and surface topography of dental zirconia with three different yttrium oxide compositions under same grinding and polishing conditions.

MATERIALS AND METHODS

Three zirconia disks (IPS e.max ZirCAD LT, MT, MT multi, Ivoclar Vivadent AG, Schaan, Liechtenstein) were selected for experimental materials. Sixty-nine bar-shaped specimens were fabricated as 12.0 × 6.0 × 4.0 mm using a milling machine and glazing was conducted on 12.0 × 6.0 mm surface by same operator. With a custom polishing device, 12.0 × 6.0 mm surfaces were polished under same condition. Surface roughness (Ra[µm]) was measured before grinding (C), after grinding (G), and at every 3 steps of polishing (P1, P2, P3). X-ray diffraction and FE-SEM observation was conducted before grinding, after grinding, and after fine polishing (P3). Statistical analysis of surface roughness was performed using Kruskal-Wallis test and Mann-Whitney-U test was used as a post hoc test (α = .05).

RESULTS

There were no significant differences of surface roughness between LT, MT, and MM groups. In LT, MT, and MM groups, P3 groups showed significantly lower surface roughness than C groups. X-ray diffraction showed grinding and polishing didn't lead to phase transformation on zirconia surface. In FE-SEM images, growths in grain size of zirconia were observed as yttrium oxide composition increases.

CONCLUSION

Polished zirconia surface showed clinically acceptable surface roughness, but difference in yttrium oxide composition had no significant influence on the surface roughness. Therefore, in clinical situation, zirconia polishing burs could be used regardless of yttrium oxide composition.

Influence of sintering conditions on translucency, biaxial flexural strength, microstructure, and low-temperature degradation of highly translucent dental zirconia

There is limited research on the influence of different sintering temperatures on the properties of highly translucent zirconia ceramics. This study demonstrated the influence of different sintering temperatures on the translucency, crystallographic structure, biaxial flexural strength, microstructure, and low-temperature degradation (LTD) of three highly translucent zirconia grades, i.e., 3 mol% yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP), 4 mol% yttria-partially-stabilized zirconia (4Y-PSZ), and 5 mol% yttria-PSZ (5Y-PSZ). The specimens were characterized using colorimetry, X-ray diffraction, scanning electron microscopy, Weibull analysis, and LTD tests (134°C; 20 h). The increase in the sintering temperature did not affect the translucency of 3Y-TZP, whereas it increased the translucencies of 4Y-PSZ and 5Y-PSZ. All the zirconia grades exhibited grain enlargement and unchanged biaxial flexural strengths with the increase in the sintering temperature. The degradation of 3Y-TZP and 4Y-PSZ at a sintering temperature of 1,600°C was faster than that at other sintering temperatures.

Comparison of the shear bond strength of composite resins with zirconia and titanium using different resin cements

PURPOSE

The shear bond strength of conventional zirconia (3Y-TZP), translucent zirconia (5Y-PSZ), and titanium alloy (Ti6Al4V) thermocycled using different phosphate monomer resin cements were investigated.

METHODS

In this study, 120 specimens of 3Y-TZP, 5Y-PSZ, and Ti6Al4V were cemented to nanocomposite resin cylinders using PANAVIA™ V5 and Rely X™ U200. The bond area and resin cement thickness were controlled as per ISO 29022:2013 and 4049:2009. Each resin cement group was used with/without the Clearfil ceramic primer plus. The shear bond strength of the 12 groups was statistically analyzed using two and one-way ANOVA to determine the properties of the different materials and resin cements (α = 0.05). The mode of failure was observed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS).

RESULTS

The titanium alloy groups showed better shear bond strength than the zirconia groups (p < 0.05). PANAVIA™ V5 without primer showed significantly lower shear bond strength than other cements in zirconia and titanium alloy specimens (p < 0.05). Titanium alloy with Rely X™ U200 with a Clearfil ceramic primer plus showed the highest shear bond strength (6.37 ± 1.60 MPa). SEM images showed mixed failures in zirconia groups and cohesive failures in titanium alloy groups.

CONCLUSIONS

The titanium alloy showed better shear bond strength than zirconia when the Clearfil ceramic primer plus was used. The primer solution containing MDP and resin cement with phosphoric methacrylate ester showed similar shear bond strength with 3Y-TZP and 5Y-PSZ. The resin cement without phosphate monomers demonstrated the least shear bond strength.

Influence of the chemical composition of monolithic zirconia on its optical and mechanical properties. Systematic review and meta-regression

PURPOSE

This systematic review set out to investigate the influence of chemical composition and specimen thickness of monolithic zirconia on its optical and mechanical properties. Meta-analysis and meta-regression analyzed the effects of variations in percentages of yttrium, aluminum, and specimen thickness of monolithic zirconia.

STUDY SELECTION

The review followed recommendations put forward in the PRISMA checklist. An electronic search for relevant articles published up to October 2019 was conducted in the Pubmed, Cochrane, Scopus, Scielo, and Web of Science databases, with no language limits and articles published in the last 10 years. From 167 relevant articles; applying inclusion criteria based on the review's PICO question, 26 articles were selected for qualitative synthesis (systematic review) and 24 for quantitative synthesis (meta-analysis). Experimental in vitro studies published were selected and their quality was assessed using the modified Consort scale for in vitro studies of dental materials.

RESULTS

The variables yttrium, aluminum and thickness were analyzed in random effects models, observing high heterogeneity ( > 75%), and finding statistically significant influences on the properties of monolithic zirconia (p<0.05).

CONCLUSIONS

Within the review's limitations, it may be concluded that variations in the percentage of yttrium and aluminum influence the optical and mechanical properties of monolithic zirconia, making it more or less esthetic and resistant in relation to each variable. The clinical implications of these findings can help select the most appropriate type of zirconia to meet the different clinical needs when restoring different regions (posterior or anterior).

Effect of Aging on the Microstructure and Optical Properties of Translucent ZrO 2 Ceramics

Objectives

The development and placement of translucent zirconia ceramics on the dental materials market is in full swing. This research aimed to investigate how aging protocols affect the microstructure, color parameters and translucency of a new-generation monolithic zirconia ceramic.

Material and methods

Translucent zirconia ceramics KATANA-Zirconia STML with different surface treatments (as sintered - control, glazed, polished) was tested using two aging protocols (hydrothermal degradation in autoclave at 134 °C and 2 bars for three hours, chemical degradation in four-percent acetic acid at 80 °C for 16 hours) in order to examine phase composition using X-ray diffraction analysis and ΔE, ΔL and ΔC color parameters through spectrophotometry. The translucency parameter (TP) was calculated using parameters L*, a* and b* on a black and white surface.

Results

Regardless of the surface treatment, aging protocols did not cause a tetragonal-to-monoclinic phase transformation, although hydrothermal degradation in the autoclave transformed the hybrid tetragonal-cubic structure of all specimens to a tetragonal one. All polished and glazed specimens during chemical degradation demonstrated a significant color change ΔE. Lightness ΔL significantly changed in polished specimens aged in the autoclave. In all specimens, ΔC underwent a change manifested through statistically insignificant yellowing. None of the aging protocols altered the translucency of specimens.

Conclusions

Aging, regardless of the final surface treatment, did not manifest a monoclinic phase in the specimens. A tetragonal-cubic microstructure dominates. Unlike polishing, glazing the surface of translucent zirconia ceramics contributed to minor changes in color, lightness and chromaticity. The translucency of translucent zirconia ceramics remains stable regardless of aging and surface treatment.

Impact of changes in sintering temperatures on characteristics of 4YSZ and 5YSZ

OBJECTIVES

The aim of this study was to evaluate the effect of different sintering temperatures on biaxial flexural strength (BFS), dynamic loading, surface hardness, color reproduction, translucency, surface roughness and microstructure of zirconia with 4 mol% yttria (4YSZ) compared to zirconia with 5 mol% yttria (5YSZ).

METHODS

Zirconia discs with 12 mm diameter and 1.2 mm thickness were prepared and divided into three groups (n = 53) according to different sintering temperatures (1400 °C, 1500 °C and 1600 °C). Each group was divided into five subgroups (n = 10) according to the dynamic loading procedure (none, 50%, 65%, 75% and 80%) conducted before the quasi-static BFS test and another subgroup (n = 3) used for X-ray-diffraction (XRD) microstructure analysis. BFS test and dynamic loading were performed with a piston-on-three-ball test. The surface hardness was evaluated according to Vickers. Color reproduction and translucency were measured with a spectrophotometer. A 3D laser scanning microscope was used to determine the surface roughness. Grain size measurements were performed using SEM.

RESULTS

A significant increase in biaxial flexural strength was observed while the sintering temperature decreased. 4YSZ had significantly higher results in biaxial flexural strength than 5YSZ. A decrease in sintering temperature resulted in a significant increase in Vickers hardness. Furthermore, 4YSZ showed significantly better color reproduction with increasing sintering temperature. At higher temperatures (1500 °C and 1600 °C), 4YSZ showed better color reproduction than 5YSZ. Compared to 4YSZ, specimens of 5YSZ exhibited significant higher translucency. Using XRD, a distorted tetragonal phase was detected in addition to regular tetragonal and cubic phases in specimens without any stress and at a low sintering temperature. The grain sizes of both materials increased with an increase in sintering temperature.

CONCLUSION

The sintering temperature has significant effects on the microstructure and thus on the mechanical and optical properties of the evaluated zirconia.

Failure Load and Fatigue Behavior of Monolithic Translucent Zirconia, PICN and Rapid-Layer Posterior Single Crowns on Zirconia Implants

This laboratory study aimed to evaluate the thermo-mechanical fatigue behavior and failure modes of monolithic and rapid-layer posterior single-crowns (SCs) supported by zirconia implants. Methods: 120 all-ceramic crowns supported by one-piece zirconia implants (ceramic.implant; vitaclinical) were divided into five groups (n = 24 each): Group Z-HT: 3Y-TZP monolithic-zirconia (Vita-YZ-HT); Group Z-ST: 4Y-TZP monolithic-zirconia (Vita-YZ-ST); Z-XT: 5Y-TZP monolithic-zirconia (Vita-YZ-XT); Group E: monolithic-polymer-infiltrated ceramic network (PICN,Vita-Enamic); Group RL (rapid layer): PICN-“table-top” (Vita-Enamic), 3Y-TZP-framework (Vita-YZ-HT). Half of the specimens of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198N, 1.2-million cycles) and simultaneous thermocycling (5–55 °C). Single-load-to-failure testing (Z010, Zwick) was performed for all specimens without/with fatigue application. Data analysis was performed using ANOVA, Tukey’s post-hoc test, two-sample t-test and Bonferroni correction (p < 0.05). Results: All specimens survived fatigue exposure. Significant differences in failure loads were detected among groups (p ≤ 0.004). Materials Z-HT and Z-ST showed the highest failure loads followed by Z-XT, RL and E. The influence of fatigue was only significant for material RL. Conclusions: All types of tested materials exceeded clinically acceptable failure load values higher than 900N and can be recommended for clinical use. Z-HT and Z-ST appear to be highly reliable towards fatigue. Rapid-layer design of PICN and YZ-HT might be an interesting treatment concept for posterior implant SCs.

Flexural strength and translucency characterization of aesthetic monolithic zirconia and relevance to clinical indications: A systematic review

OBJECTIVE

Optimizing monolithic zirconia (ZrO2) aesthetically without affecting the unique mechanical properties remains a major ongoing interest. The purpose of this review is to evaluate the improvement of recent monolithic ZrO2 generations to meet aesthetic optimization qualities. Additionally, for how the extent of the former modifications negatively affected their mechanical properties and the impact on their clinical indications.

METHODS

The current literature examines in-vitro studies evaluating both monolithic ZrO2 translucency and mechanical properties. The electronic search was done within these databases: Web of Science, ScienceDirect, Scopus, and PubMed within the period between 2009/10/01 and 2019/10/31. Search results that met eligibility criteria were classified into four groups; one for translucency parameter, two for uniaxial flexural strength and one for biaxial strength.

RESULTS

Articles that remained for comprehensive analysis were fifty-three. They reported a significant impact of composition, microstructure and surface treatment on translucency and flexural strength assessment. Aging was found to be of no concern for zirconia structures with high yttria content. Smooth surface polish was found to significantly enhance strength while coarse grinding and mechanical fatigue was found to do the reverse.

SIGNIFICANCE

Based on analyzing the previous in-vitro studies the following was found: Although significant improvement has occurred with recent monolithic zirconia types with higher yttria content having higher cubic/tetragonal ratio, they are still inferior to glass-ceramics' unique translucency. With improving zirconia aesthetically, some of mechanical performance was sacrificed. Care must be taken when dealing with thin sections of aesthetic zirconia structures especially when used in high bearing stress areas.

Fluorescence and physical properties of thulium and erbium co-doped dental zirconia

The fluorescence and physical properties of thulium and erbium co-doped dental zirconia were investigated. The high-translucency yttria-stabilized dental zirconia specimens co-doped with Tm₂O₃ powder 0.8 wt% and Er₂O₃ powder at proportions from 0.1 to 0.8 wt% were used. The specimens co-doped with Tm₂O₃ powder 0.8 wt% and Er₂O₃ from 0.3 to 0.5 wt% exhibited the fluorescence similar to that of natural tooth. All the specimens had a tetragonal peak and no major change in the Vickers hardness, fracture toughness and bending strength on addition of Tm₂O₃ and Er₂O₃. These results suggest that the method of co-doping trace amounts of Tm₂O₃ and Er₂O₃ into high-translucency dental zirconia powder can effectively improve the esthetics of zirconia monolithic fixed dental prothesis.

Laser surface texturing of zirconia-based ceramics for dental applications: A review

Laser surface texturing is widely explored for modifying the surface topography of various materials and thereby tuning their optical, tribological, biological, and other surface properties. In dentistry, improved osseointegration has been observed with laser textured titanium dental implants in clinical trials. Due to several limitations of titanium materials, dental implants made of zirconia-based ceramics are now considered as one of the best alternatives. Laser surface texturing of zirconia dental implants is therefore attracting increasing attention. However, due to the brittle nature of zirconia, as well as the metastable tetragonal ZrO₂ phase, laser texturing in the case of zirconia is more challenging than in the case of titanium. Understanding these challenges requires different fields of expertise, including laser engineering, materials science, and dentistry. Even though much progress was made within each field of expertise, a comprehensive analysis of all the related factors is still missing. This review paper provides thus an overview of the common challenges and current status on the use of lasers for surface texturing of zirconia-based ceramics for dental applications, including texturing of zirconia implants for improving osseointegration, texturing of zirconia abutments for reducing peri-implant inflammation, and texturing of zirconia restorations for improving restoration retention by bonding.

Edge chipping of translucent zirconia

STATEMENT OF PROBLEM

More translucent dental zirconias have been developed by incorporating the cubic phase and reducing the tetragonal phase content that undergoes transformation toughening, leading to reduced mechanical properties. Whether the clinically relevant mechanical property of the edge chipping toughness of the material is also reduced is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the edge chipping toughness and translucency of translucent zirconia, 3mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP), and lithium disilicate.

MATERIAL AND METHODS

Two translucent zirconia products, Katana and Lava Esthetic; one 3Y-TZP, Lava Plus; and one lithium disilicate, IPS e.max Press were prepared and tested for phase composition via X-ray diffraction (XRD) (n=3), translucency via a spectrophotometer (n=20), and edge chipping via a universal testing machine with a custom-machined specimen holder and diamond indenter (n=20). The 3Y-TZP and lithium disilicate served as the optimal control materials for edge chipping and translucency, respectively. Translucency was compared with 1-way ANOVA and edge toughness with ANCOVA (α=.05).

RESULTS

The XRD showed the 3Y-TZP to be almost completely tetragonal phase compared with the 2 translucent zirconia products that were predominantly cubic. Katana UTML and IPS e.max Press had a statistically similar (P>.05) translucency that was significantly (P<.05) greater than that of Lava Esthetic and Lava Plus. The edge toughness of Katana UTML was 304 N/mm, IPS e.max Press was 354 N/mm, Lava Esthetic was 394 N/mm, and Lava Plus was 717 N/mm, with significance rankings of Katana UTM<IPS e.max Press=Lava Esthetic<Lava Plus.

CONCLUSIONS

Some translucent zirconias had translucency similar to that of lithium disilicate; however, as translucency increased with increased cubic content, edge toughness decreased.

Novel Femto Laser Patterning of High Translucent Zirconia as an Alternative to Conventional Particle Abrasion

Background: currently applied surface treatments for zirconia bonding may create undesired microcracks and surface flaws. The aim of the present study was to evaluate the efficacy of alternative surface treatments on the shear bond strength of high translucency zirconia to 10-Methacryloyloxydecyl dihydrogen phosphate (MDP)-containing resin-based cement. Methods: fifty disk-shaped specimens (10 mm × 5 mm) were fabricated from a commercial yttria-stabilized zirconia with 5 mole% yttrium oxide tetragonal zirconia polycrystal (5Y-TZP), and underwent air-abrasion with alumina particles (50 μm-AL50 and 90 μm-AL90), glass beads (GB 10–60 μm), and ablation with femtosecond laser (FEMTO). Shear bond strength was evaluated with a universal testing machine under a crosshead speed of 0.5 mm/min until fracture. Fracture type was evaluated with an optical stereomicroscope. Differences among groups were evaluated by one-way ANOVA and Bonferroni pairwise comparison tests (p < 0.05). Results: the highest shear bond strength values were presented by the laser treated group (23.97 ± 3.7 MPa). No statistically significant differences were found among the Cl, Al50, Al90 and FEMTO groups. The lowest mean value was presented by the glass-beads treated group (11.93 ± 2.88 MPa) which was significantly lower compared to all other groups (p < 0.001). Conclusions: under the limitations of this in vitro study, femtosecond laser treatment of High-translucent monolithic zirconia (HTZ) ceramics is a promising alternative method for the mechanical retention of resin cements.

Effects of Aging on the Color and Translucency of Monolithic Translucent Y-TZP Ceramics: A Systematic Review and Meta-Analysis of In Vitro Studies

Background

Monolithic restorations made of translucent yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) have become popular over the past few decades. However, whether aging affects the color and translucency of monolithic translucent Y-TZP is unclear.

Objective

The aim of this systematic review and meta-analysis of in vitro studies was to evaluate the effects of aging on the color and translucency of monolithic translucent Y-TZP ceramics.

Materials and Methods

This systematic review/meta-analysis was reported according to the PRISMA statement and registered in the OSF registries (https://osf.io/5qjmu). Four databases including Medline via the PubMed, Embase, and Web of Science databases and the Cochrane Library were searched using no publication year and language limits. The last search was executed on November 20, 2020. In vitro studies comparing the translucency and/or color of monolithic translucent Y-TZP ceramics before and after simulated aging were selected. Meta-analyses were performed using Review Manager software (version 5.3, Cochrane Collaboration, Oxford, UK) with random-effects models at a significance level of 0.05. A risk-of-bias assessment was also performed for the included studies.

Results

Of the 188 potentially relevant studies, 13 were included in the systematic review. The hydrothermal aging duration ranged from 1 to 100 h at relatively similar temperatures (~134°C). In the general meta-analyses, the aged Y-TZP ceramics exhibited similar translucency parameter (TP), L^∗, and b^∗ values compared with the nonaged controls (P = .73, P = .49, and P = .62, respectively). Moreover, there was a significant difference between the aged and nonaged Y-TZP ceramics in the a^∗ value (P = .03; MD = −0.26; 95% CI = −0.51 to − 0.02), favoring the nonaged Y-TZP ceramics. The subgroup analyses showed that the duration of aging contributed to changes in the translucency and color of the Y-TZP ceramics.

Conclusions

The optical properties of monolithic translucent Y-TZP ceramics were stable after hydrothermal aging at 134°C and 0.2 MPa for ≤20 h. Moreover, clinically unacceptable changes in the translucency and color of monolithic translucent Y-TZP ceramics were found after hydrothermal aging for >20 h.

In vivo ageing of zirconia dental ceramics - Part II: Highly-translucent and rapid-sintered 3Y-TZP

OBJECTIVE

3Y-TZP ceramics with reduced alumina content have improved translucency and are used in monolithic dental restorations without porcelain-based veneers. The workflow can be further streamlined with rapid sintering. This study was designed to assess how these approaches affect ageing when the materials are exposed to the oral environment in vivo.

METHODS

43 discs were fabricated from 3Y-TZP powder with 0.05% Al₂O₃ and sintered with conventional or rapid regimens (1450 °C 2 h, 1530 °C 2 h, or 1530 °C 25 min). Their surfaces were polished or airborne-particle abraded with 50 μm Al₂O₃. The discs were incorporated in complete dentures of 16 volunteers and worn continuously for up to 48 months. Ageing changes on disc surfaces were monitored every 6 months by X-ray diffraction, scanning electron microscopy and atomic force microscopy. Data was statistically analysed with linear models.

RESULTS

The amount of monoclinic phase on polished surfaces increased linearly, reaching up to 40% after 48 months in vivo. The ageing process observed for rapid sintering was 1.6 times faster compared to conventional sintering. A nano-scale increase in roughness with microcracking was also detected on polished surfaces. Airborne-particle abraded surfaces did not exhibit clear signs of ageing during the course of the study.

SIGNIFICANCE

Highly-translucent 3Y-TZP ceramics are more susceptible to ageing than classic 3Y-TZP. After 4 years in vivo, the extent of degradation did not yet constitute grounds for clinical concern, but was more pronounced in materials prepared with rapid sintering.

Biaxial flexural strength of zirconia: A round robin test with 12 laboratories

OBJECTIVE

The aim of this interlaboratory round robin test was to prove the robustness of the DIN EN ISO 6872:2019 and to identify the influence of processing and testing variations.

METHODS

Each of the 12 laboratories participated (A-L) received 60 (n = 720) assigned zirconia specimens. All participants seperated the specimens from the blanks, sintered them, polished half of all specimens and performed the biaxial flexural test (DIN EN ISO 6872:2019). The surface roughness was determined by using tactile measuring device. Fractographic examination was performed under scanning-electron-microscopy (SEM). Data was analysed using Kolmogorov-Smirnov-, Kruskal-Wallis-, Mann-Whitney-U-test and two-parametric Weibull statistic (p < 0.05).

RESULTS

The results for both preparation methods (as-fired and polished) showed significant differences for some participants. The values for as-fired groups ranged between 513 (I) and 659 (E) MPa. H showed higher Weibull modulus than C, E and I. Within polished groups flexural strengths values from 465 (L) to 1212 (E) MPa were observed, with a tendency to clustered groups A, I, J, L (465-689 MPa) and remaining groups (877-1212 MPa). E presented the highest and H the lowest Weibull modulus. Within A and J, no impact of the preparation method on flexural strength values was observed. Within L, as-fired specimens showed higher flexural strength than polished ones. The flexural strength increase did only associate to a certain extent with measured surface roughness. Fractography showed defect populations depending on polishing techniques, associated to the strength level, especially for polished groups. Reduced strength is related to machining defects, regardless of the surface state.

SIGNIFICANCE

DIN EN ISO 6872:2019 can be seen as guidance to biaxial flexural strength testing but additional effort is necessary to ensure interlaboratory comparability. Calibrated furnaces and reliable sintering conditions are mandatory requirements together with detailed specifications on finishing or polishing procedures. Biaxial flexural testing is really a matter of understanding specimen preparation, alignment and mechanical testing by itself. DIN EN ISO 6872:2019 should further recommend reporting of mean surface roughness along with any biaxial flexural strength data. Fractography is a mandatory tool in interpretation and understanding of strength data.

The Effect of Aging on Composition and Surface of Translucent Zirconia Ceramic

Objectives

To examine the effect of two aging protocols on the chemical and phase composition as well as the surface state of monolithic translucent zirconia ceramics.

Material and Methods

Translucent zirconia ceramics KATANA-Zirconia STML with different surface treatments (no treatment, K1, K2; glazed, G1-G8; polished, P1-P8) underwent testing in order to examine how the two aging protocols (three-hour hydrothermal degradation in an autoclave at 134 °C and 2 bars: G1-G4, P1-P4, and sixteen-hour chemical degradation in four-percent acetic acid at 80 °C (ISO 6872): G5-G8, P5-P8) affect chemical composition, particularly the share of stabilizing yttrium oxide (Energy Dispersive X-Ray Fluorescence – EDXRF), phase composition (X-ray diffraction – XRD) and surface state in terms of roughness and gloss.

Results

Aging protocols did not affect the tested chemical composition stability of specimens and a high share of stabilizing yttrium-oxide (≥10% of total content), which correlates with the absence of monoclinic phase. A decrease in gloss on all specimens is statistically significant. Chemical degradation substantially increased the surface roughness of tested specimens.

Conclusions

Translucent monolithic zirconia demonstrated a stable chemical composition and resistance to tetragonal-to-monoclinic transformation. Surface gloss was significantly reduced, especially in polished specimens. Contrary to glazed specimens, the tested polished specimens manifested an increase in surface roughness. Glazing the surface of translucent monolithic zirconia produces better esthetic, tribological and hygienic effects than polishing.

Impact of sandblasting on the flexural strength of highly translucent zirconia

The objective of this study was to assess the influence of alumina sandblasting on the flexural strength of the latest generation of highly translucent yttria partially stabilized dental zirconia (Y-PSZ). Fully-sintered zirconia disk-shaped specimens (14.5-mm diameter; 1.2-mm thickness) of four Y-PSZ zirconia grades (KATANA HT, KATANA STML, KATANA UTML, all Kuraray Noritake; and Zpex Smile, Tosoh) were sandblasted at 0.2 MPa with 50-μm alumina (Al₂O₃) sand (Kulzer) or left as-sintered (control). For each zirconia grade, the yttria (Y₂O₃) content was determined using X-ray fluorescence (XRF). Surface roughness was assessed using 3D confocal laser microscopy. Micro-Raman spectroscopy (μ-Raman) and X-ray diffraction (XRD) were used to assess potentially induced residual stresses. Biaxial flexural strength (n = 20) was statistically compared by Weibull analysis. Focused ion beam - scanning electron microscopy (FIB/SEM) was used to observe the subsurface microstructure. Fracture surfaces after biaxial flexural strength testing were observed by SEM. KATANA UTML had the highest Y₂O₃ content (6 mol%), followed by KATANA STML and Zpex Smile (5 mol%), and KATANA HT (4 mol%). Al₂O₃-sandblasting significantly increased surface roughness of KATANA UTML and Zpex Smile. μRaman and XRD revealed the presence of residual compressive stress on all Al₂O₃-sandblasted surfaces. FIB/SEM revealed several sub-surface microcracks in the sandblasted specimens. Weibull analysis revealed that Al₂O₃-sandblasting increased the characteristic strength of KATANA HT, KATANA STML, whereas it decreased the strength of KATANA UTML. The strength enhancement after Al₂O₃-sandblasting of KATANA HT was the highest, followed by KATANA STML. For Zpex Smile, the influence was statistically insignificant. The impact of Al₂O₃-sandblasting on the Weibull modulus was controversial. The strength of zirconia after Al₂O₃-sandblasting is determined by the balance between microcrack formation (decreased strength) and surface compressive stress build-up (increased strength).

Cytotoxicity and biocompatibility of high mol% yttria containing zirconia

Objectives

Yttria-stabilized tetragonal phase zirconia has been used as a dental restorative material for over a decade. While it is still the strongest and toughest ceramic, its translucency remains as a significant drawback. To overcome this, stabilizing the translucency zirconia to a significant cubic crystalline phase by increasing the yttria content to more than 8 mol% (8YTZP). However, the biocompatibility of a high amount of yttria is still an important topic that needs to be investigated.

Materials and Methods

Commercially available 8YTZP plates were used. To enhance cell adhesion, proliferation, and differentiation, the surface of the 8YTZP is sequentially polished with a SiC-coated abrasive paper and surface coating with type I collagen. Fibroblast-like cells L929 used for cell adherence and cell proliferation analysis, and mouse bone marrow-derived mesenchymal stem cells (BMSC) used for cell differentiation analysis.

Results

The results revealed that all samples, regardless of the surface treatment, are hydrophilic and showed a strong affinity for water. Even the cell culture results indicate that simple surface polishing and coating can affect cellular behavior by enhancing cell adhesion and proliferation. Both L929 cells and BMSC were nicely adhered to and proliferated in all conditions.

Conclusions

The results demonstrate the biocompatibility of the cubic phase zirconia with 8 mol% yttria and suggest that yttria with a higher zirconia content are not toxic to the cells, support a strong adhesion of cells on their surfaces, and promote cell proliferation and differentiation. All these confirm its potential use in tissue engineering.

Long-term results of a randomized clinical trial of 2 types of ceramic crowns in participants with extensive tooth wear

STATEMENT OF PROBLEM

Evidence is sparse regarding the long-term outcomes of restorative treatment of patients with extensive tooth wear.

PURPOSE

The purpose of this long-term prospective randomized clinical trial was to evaluate the performance and success rate of pressed lithium disilicate (LD) and translucent zirconia (TZ) crowns in participants with extensive tooth wear.

MATERIAL AND METHODS

A total of 62 participants with extensive tooth wear (17 women, 45 men; mean age 44.8 years; range 25-63 years) received a total of 713 crowns, LD=362 and TZ=351. Both types of crowns had chamfer preparations and were adhesively luted with dual-polymerizing composite resin cement (PANAVIA F 2.0; Kuraray Noritake Dental Inc). The restorations were clinically reevaluated on average 14, 31, 39, 54, and 65 months after insertion of the crowns according to the modified United States Public Health Service (USPHS) criteria.

RESULTS

After an observation period of up to 6 years, the survival rate for both types of crowns was 99.7%, with 1 lost LD crown after 1 year as a result of loss of retention and 1 lost TZ crown after 3 years because of tooth fracture at the cemento-enamel junction. The success rates were similar for both types of crowns: 98.6% for LD and 99.1% for TZ. Reasons for failures were that 3 participants in each group developed apical lesions, minimal ceramic fractures, or their crowns were rebonded after loss of adhesion. Assessment of color at baseline was significantly different with a better match for LD (84.8% Alfa, 15.2% Bravo) than for TZ crowns (36.5% Alfa, 63.5% Bravo), including TZ crowns with veneered porcelain (P<.001). Secondary caries and cracks did not occur. A post hoc analysis of clinical performance did not indicate any significant differences between extensive tooth wear with primarily mechanical or chemical factors.

CONCLUSIONS

No differences were found between the 2 types of ceramic materials concerning the long-term success and clinical performance, except that TZ crowns were rated by a blinded clinician as less esthetic than LD crowns. The use of high-strength ceramic materials, as well as reliable adhesive bonding, are probably the key factors in the long-term success of ceramic crowns in participants with extensive tooth wear independent of the specific etiology.

Evaluation of translucency, Marten's hardness, biaxial flexural strength and fracture toughness of 3Y-TZP, 4Y-TZP and 5Y-TZP materials

OBJECTIVES

Testing and comparing of different non-shaded zirconia materials (3Y-TZP, 4Y-TZP and 5Y-TZP) on optical and mechanical properties.

MATERIALS AND METHODS

Zirconia materials (N = 320, Opaque O, Translucent T, Extra Translucent ET, High Translucent HT) were investigated on translucency, Martens parameter, biaxial flexural strength, Chevron-Notch-Beam (CNB) fracture toughness (K_IC) and grain size. The grain size was analyzed using a scanning electron microcopy (SEM). Univariate ANOVA, post-hoc Scheffé, partial eta-squared, Kolmogorov-Smirnov-, Kruskal-Wallis- and Mann-Whitney-U-tests (p < 0.05) were performed. The reliability of flexural strength was calculated with two-parametric Weibull analysis and 95 % confidence level.

RESULTS

The translucency of ET and HT increased with the thermo-mechanical aging (p < 0.001). The zirconia material and aging had no impact on the Martens hardness and the indentation modulus. ET showed the highest flexural strength values after initial and thermo-mechanical aging (p < 0.001 - 0.683). All four materials showed the highest flexural strength after thermo-mechanical aging after 1.2 Mio cycles. Thermo-mechanically (1.2 Mio cycles) aged HT presented the highest Weibull modulus (m = 15.0) regardless of aging. Within initial groups, T (p ≤ 0.001) showed the highest fracture toughness, followed by O (p ≤ 0.001), ET (p < 0.003) and HT (p ≤ 0.001).

SIGNIFICANCE

Translucency of ET and HT increases with thermo-mechanical aging. Chevron-Notch-Beam (CNB) is a valid alternative to the single-edge-V-notched beam (SEVNB) method for testing fracture toughness.

Damage sensitivity of dental zirconias to simulated occlusal contact

OBJECTIVE

Mechanical damages can occur from dental restoration processing and fitting, or while it is in-service. This study evaluates the damage sensitivity of translucent zirconia (5Y-PSZ) relative to conventional 3Y-PSZ following mouth-motion simulations at various loads.

METHODS

5Y-PSZ and 3Y-PSZ discs were adhesively bonded to a dentin-like substrate and divided into groups according to the load (50 N or 200 N) and number of cycles (up to 10⁶) used in the chewing simulation. Specimens were mounted with 30° inclination in an electrodynamic mouth-motion simulator, and subjected to contact-slide-liftoff cyclic loading in water. Surface and sub-surface damages were analyzed using a sectioning technique. After the simulation, specimens were removed from the substrate and loaded with the damaged surface in tension for biaxial strength testing to assess their damage tolerance.

RESULTS

The strength of both ceramics underwent significant degradation after mouth-motion simulations. For 5Y-PSZ, the strength degradation was greater (∼60%) and occurred at a lower number of cycles than 3Y-PSZ. Herringbone cracks emerged on 3Y-PSZ and 5Y-PSZ surfaces under a 200-N load after 50 and 10 cycles, respectively. Meanwhile at a 50-N load, cracks formed at ∼1000 cycles in both ceramics. Further increasing the number of cycles only had moderate effects on the strength of both ceramics, despite an increase in surface and sub-surface damage. More significantly, a 50-N occlusal load can debase the zirconia strengths as much as a 200-N load.

SIGNIFICANCE

Surface flaws produced during the chewing simulation are capable of significant strength degradation in zirconia, even after a small number of low-load cycles.

Effect of cementation and aging on the marginal fit of veneered and monolithic zirconia and metal-ceramic CAD-CAM crowns

STATEMENT OF PROBLEM

Marginal fit of zirconia restorations is an important criterion for their long-term success. However, in spite of the wide use of zirconia in dentistry, the relationship between marginal fit and low-temperature degradation from aging is unclear.

PURPOSE

The purpose of this in vitro study was to compare the marginal adaptation of veneered and monolithic zirconia and metal-ceramic computer-aided design and computer-aided manufacturing (CAD-CAM) crowns before and after cementation and to evaluate the influence of artificial aging on the adaptation of zirconia crowns.

MATERIAL AND METHODS

Seventy-two standardized dies were prepared to receive a posterior crown and randomly divided into 6 groups (n=12) as per the material and the presence or not of cement: metal-ceramic, veneered zirconia, and monolithic zirconia. The zirconia groups were subjected to accelerated low-temperature degradation through hydrothermal aging in an autoclave at 131 °C and 0.17 MPa for 5 and 20 hours. A scanning electron microscope with a magnification of ×1000 was used for marginal adaptation measurements, and X-ray diffraction (XRD) was used to characterize phase transformation degradation. The data were statistically analyzed using 2-way ANOVA, repeated measures ANOVA with Greenhouse-Geisser correction, and the t test (α=.05).

RESULTS

No significant differences in the marginal discrepancy were recorded among the analyzed groups. The presence of cement did not influence marginal fit in any treatment group. No significant differences were observed in the marginal adaptation values before and after aging (P>.05). After 20 hours of aging, the monoclinic phase increase to 8.3% on veneered zirconia and to 3.1% on monolithic crowns.

CONCLUSIONS

Monolithic and bilayer CAD-CAM zirconia crowns showed marginal gaps that were within an acceptable range of clinical discrepancy, regardless of cementation. Marginal adaptation was not influenced by aging. Low-temperature degradation did not lead to a significant transformation from the tetragonal to monoclinic phase.

An experimental study on hydrothermal degradation of cubic-containing translucent zirconia

PURPOSE

The aims of this study were to investigate mechanical properties and hydrothermal degradation behaviour of the cubic-containing translucent yttrium oxide stabilized tetragonal zirconia polycrystal (Y-TZP).

MATERIALS AND METHODS

Four groups of Y-TZP (T, ST, XT, and P), containing different amount of cubic crystal, were examined. Specimens were aged by autoclaving at 122℃ under 2 bar pressure for 8 h. Phase transformation was analyzed using X-ray diffraction (XRD) to measure phase transformation (t→m). Kruskal-Wallis test was used to determine the difference. Surface hardness, biaxial flexural strength, and fracture toughness in values among the experimental groups and verified with Wilcoxon matched pairs test for hardness values and Mann Whitney U for flexural strength and fracture toughness.

RESULTS

XRD analysis showed no monoclinic phase in XT and P after aging. Only Group T showed statistically significant decreases in hardness after aging. Hydrothermal aging showed a significant decrease in flexural strength and fracture toughness in group T and ST, while group XT and P showed no effect of aging on fractural strength and fracture toughness with P<.05.

CONCLUSION

Hydrothermal aging caused reduction in mechanical properties such as surface hardness, biaxial flexural strength, and fracture toughness of Y-TZP zirconia. However, cubic-containing zirconia (more than 30% by volume of cubic crystal) was assumed to have high resistance to hydrothermal degradation. Clinical significance: Cubic-containing zirconia could withstand the intraoral aging condition. It could be suggested to use as a material for fabrication of esthetic dental restoration.