Aging resistance, mechanical properties and translucency of different yttria-stabilized zirconia ceramics for monolithic dental crown applications

Effect of different CAD/CAM cutting depths on the post-fatigue load-bearing capacity of novel multilayer zirconia restorations

OBJECTIVES

To investigate the post-fatigue load-bearing capacity of restorations milled at various cutting depths in a novel strength- and color-gradient multilayer zirconia CAD/CAM disk.

METHODS

Identical crowns were divided into 4 groups (n = 25 per group): crowns milled at 3 CAD/CAM cutting depths in multilayer zirconia disks as 3 experiment groups and homogeneous zirconia crowns as a control group. The color differences between various cutting depths were measured. In each group, crowns were tilted at 15° and subjected to fatigue loading for various numbers of cycles (0, 10⁶, 2 × 10⁶, 3 × 10⁶ or 4 × 10⁶, n = 5 per subgroup). All surviving crowns were subsequently submitted to a static fracture test to determine load-bearing capacity. The data were analyzed by ANOVA and Weibull distribution analysis. Failure modes were observed with SEM.

RESULTS

For a novel multilayer zirconia, a deeper CAD/CAM cutting depth corresponded to a higher load-bearing capacity but a darker color. After 10⁶ cycles of fatigue loading, there was not a significant reduction in fracture load. However, after 4 × 10⁶ cycles, the load-bearing capacity of all crowns decreased significantly by approximately 50%. For multilayer and homogeneous zirconia materials, similar failure mode and Weibull modulus were identified.

CONCLUSIONS

Restorations can be milled at various CAD/CAM cutting depths in a novel multilayer zirconia disk depending on the durability and esthetic requirements. The load-bearing capacity of multilayer restorations degraded significantly after 4 × 10⁶ cycles of fatigue loading, but not after 10⁶ cycles.

CLINICAL SIGNIFICANCE

For a novel multilayer zirconia disk, a posterior restoration can be milled from the middle or bottom of the disk to improve its load-bearing capacity. For an anterior restoration, to meet the esthetic requirements, milling the entire thickness of a multilayer disk is recommended.

Effect of sintering and aging processes on the mechanical and optical properties of translucent zirconia

STATEMENT OF PROBLEM

Sintering holding times and aging conditions may affect the optical, mechanical, and structural properties of polychromatic multitranslucent zirconia. However, a consensus on the ideal sintering condition for this material is lacking.

PURPOSE

The purpose of this in vitro study was to investigate the effect of different sintering holding and autoclave aging times on the flexural strength (FS), grain size, and translucency parameter (TP₀₀) of a translucent zirconia.

MATERIAL AND METHODS

Sixty bar-shaped and 60 rectangular-shaped specimens were prepared from computer-aided design and computer-aided manufacturing (CAD-CAM) zirconia blocks and split into 2 groups to be sintered at 1550 °C for different holding times (regular: 2 hours, prolonged: 5 hours). The specimens were then divided into 3 subgroups and subjected to aging processes (control, aging for 60 minutes, aging for 120 minutes). FS values were obtained by using a 3-point bend test and Weibull analysis was conducted. Grain size evaluations were performed by using scanning electron microscope (SEM) observations. TP₀₀ was measured with a spectrophotometer. Statistical evaluation included the Kolmogorov-Smirnov, 2-way ANOVA, and Tukey HSD tests (α=.05).

RESULTS

The sintering procedure, aging, and their interaction significantly influenced the TP₀₀ (P<.05). FS values and grain sizes were affected by aging only (P<.001). Both aging times resulted in reduced FS and increased grain sizes. Prolonged sintering in combination with 120 minutes of aging negatively affect the TP₀₀ scores (P<.05).

CONCLUSIONS

FS values were similar under regular and prolonged sintering. Prolonged sintering led to a decrease in translucency after 120 minutes of aging. Steam autoclave aging can affect the optical and mechanical properties of translucent zirconia.

Modifying an Implant: A Mini-review of Dental Implant Biomaterials

Dental implants have been used as far back as 2000BC, and since then have developed into highly sophisticated solutions for tooth replacement. It is becoming increasingly important for the materials used in dental implants to exhibit and maintain favorable long-term mechanical, biological and more recently, aesthetic properties. This review aims to assess the biomaterials used in modern dental implants, introducing their properties, and concentrating on modifications to improve these biomaterials. Focus is drawn to the prominent biomaterials, titanium (Ti) and zirconia due to their prevalence in implant dentistry. Additionally, novel coatings and materials with potential use as viable improvements or alternatives are reviewed. An effective dental biomaterial should osseointegrate, maintain structural integrity, resist corrosion and infection, and not cause systemic toxicity or cytotoxicity. Current materials such as bioactive glass offer protection against biofilm formation, and when combined with a titanium‐zirconium (TiZr) alloy, provide a reliable combination of properties to represent a competitive alternative. Further long-term clinical studies are needed to inform the development of next-generation materials.Significance StatementBiomaterials have become essential for modern implants. A suitable implant biomaterial integrates into the body to perform a key function, whilst minimizing negative immune response. Focusing on dentistry, the use of dental implants for tooth replacement requires a balance between bodily response, mechanical structure and performance, and aesthetics. This mini-review addresses the use of biomaterials in dental implants with significant comparisons drawn between Ti and zirconia. Attention is drawn to optimizing surface modification processes and the additional use of coatings. Alternatives and novel developments are addressed, providing potential implications of combining biomaterials to form novel composites that combine and synergize the benefits of each material.

Impact of varying step-stress protocols on the fatigue behavior of 3Y-TZP, 4Y-TZP and 5Y-TZP ceramic

OBJECTIVE

To test the impact of three varying step-stress protocols on the fatigue behavior of two 3Y-TZP, one 4Y-TZP and one 5Y-TZP zirconia materials.

METHODS

Eight specimens per zirconia material (N = 32) were selected for static testing to determine the start load for dynamic tests (30% of the mean value of static fracture load). 45 specimens per material (N = 180) were used for dynamic load tests using three step-stress protocols: 1. 50 N/5000 cycles; 2. 5% of static load/5000 cycles, and 3. 10 N/1000 cycles. Following materials were tested: 3Y-TZP_{(<0.25 Al2O3)} (O: opaque) 3Y-TZP_{(<0.05 Al2O3)} (T: translucent), 4Y-TZP_{(<0.01 Al2O3)} (ET: extra translucent) and 5Y-TZP_{(<0.01 Al2O3)} (HT: high translucent). The specimens (4 ± 0.02 × 3 ± 0.02 × 45 mm) were placed centrally on the support rolls and the load was applied perpendicularly over the 4 mm specimen side (∼4-point flexural strength according to the DIN 6872:2019). Data was analyzed with Kolmogorov-Smirnov-test, t-test, one-way ANOVA with post-hoc Scheffé-test, Chi-square-test, Kaplan-Meier with Log-Rank-test and two-parametric Weibull analysis (p < 0.05).

RESULTS

The step-stress protocols showed no impact on the fracture load or Weibull modulus within one zirconia material. However, the zirconia materials T, ET and HT showed differences in cycle number to fracture between the step-stress protocols (T: 3 > 2 > 1; ET: 2 > 3 > 1; HT: 2, 3 > 1) with lowest cycle number to fracture for protocol 1. Within one step-stress protocol, the cycle number to fracture varied according to the zirconia material as follows: 1: T, O ≥ O, ET > HT; 2: ET > O, T, HT; 3: O, T, ET > HT. Cracking started at the tensile side of the specimens at all times. All specimens showed typical compression curls (single or double). Fragmentation patterns were similar for all materials with a lot of crack branching and fragmentation due to secondary cracks indicating high energy fractures.

SIGNIFICANCE

Dynamic fatigue tests seem to provide important information on the long-term stability of zirconia materials. Zirconia materials with higher opacity seem to be more robust towards varying step-stress protocols than translucent zirconia materials. Regarding expenditure of time, a step-stress protocol with a load increase of 50 N every 5000 cycles seems favorable to gain information on the long-term stability of zirconia materials.

Intraoral low-temperature degradation of monolithic zirconia dental prostheses: Results of a prospective clinical study with ex vivo monitoring

OBJECTIVE

To investigate the intraoral development and kinetics of low-temperature degradation (LTD) in second-generation 3 mol.% yttria-doped tetragonal zirconia polycrystal (3Y-TZP) monolithic prostheses, as well as the influence of masticatory mechanical stress and glaze layer on it.

METHODS

A total of 101 posterior tooth elements were included in a prospective clinical study, which included ex vivo LTD monitoring (at baseline, 6 months, 1 year, and 2 years) using Raman spectroscopy (n = 2640 monoclinic phase measurement points per evaluation time) and SEM. Four types of areas (1-2 mm² surface, 6 on molars, and 4 on premolars) were analyzed on each element surface: occlusal, axial, glazed, or unglazed. Raman depth mapping and high-resolution SEM were performed on the selected samples.

RESULTS

LTD developed in 3Y-TZP monolithic restorations 6 months after intraoral placement and progressed with time. After two years, the tetragonal-to-monoclinic transformation was non-uniform, with the presence of localized clusters of transformed grains. In axial areas, the grain aspect was typical of the classical nucleation-growth process reported for LTD, which progresses from the surface to a depth of several tens of microns. However, in occlusal areas, tribological stress generated surface crushing and grain pull-out from the clusters, which induced an underestimation of the aging process when the evaluation was limited to monoclinic phase quantification. Glazing cannot be considered a protection against LTD.

SIGNIFICANCE

If LTD occurs in dental prostheses in the same way as in orthopedic prostheses, its clinical impact is unknown and needs to be further studied.

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.

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.

Fracture strength of endodontically treated premolars restored with different post systems and metal-ceramic or monolithic zirconia crowns

The purpose of this study was to investigate the fracture strength of endodontically treated human maxillary premolars (ETP) restored with posts and metal ceramic (MC) or monolithic zirconia (MZ) crowns. Sixty ETP were randomly divided into 3 groups. Teeth in control group (C) received a resin filling. ETP in the MC group were restored with prefabricated metal posts, composite cores and MC crowns while in the MZ group with glass-fiber posts, composite cores and MZ crowns. Half of the specimens were loaded at a 135° angle and half under axial loading until fracture. The fracture modes were divided in repairable and irreparable using optical microscopy. Mean fracture strength was significantly higher for MC than for MZ crowns and control group only under axial loading. The distribution of repairable and irreparable failures presented no significant differences. Crown placement significantly improved the fracture strength of ETP irrespectively of post and crown type.

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.

Alumina-toughened zirconia for dental applications: Physicochemical, mechanical, optical, and residual stress characterization after artificial aging

To characterize the physicomechanical properties of an alumina-toughened zirconia (ATZ). ATZ synthesis consisted of the addition of alumina particles in an yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) matrix. Specimens were obtained by uniaxial and isostatic pressing ATZ and 3Y-TZP powders and sintering at 1600°C/1 h and 1550°C/1 h, respectively. Crystalline content and residual stress were evaluated using X-ray diffraction (XRD). Microstructure was characterized by scanning electron microscopy (SEM). Optical properties were determined by reflectance test. Mechanical properties were assessed by biaxial flexural strength test. All analyses were performed before and after aging (134°C, 20 h, 2 bar). XRD and SEM revealed a typical ATZ and 3Y-TZP crystalline content, chiefly tetragonal phase, with a dense polycrystalline matrix, though a smaller grain size for ATZ. Aging triggered a similar monoclinic transformation for both systems; however, ATZ exhibited higher residual compressive stresses than 3Y-TZP. While as-processed 3Y-TZP demonstrated significantly higher characteristic strength relative to ATZ, no significant difference was observed after aging (~215 MPa increase in the ATZ strength). ATZ presented significantly higher opacity relative to 3Y-TZP, although aging significantly increased the translucency of both systems (increase difference significantly higher in the 3Y-TZP compared to ATZ). ATZ physicomechanical properties support its applicability in the dental field, with a lower detrimental effect of aging relative to 3Y-TZP.

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.

Biaxial flexural strength, crystalline structure, and grain size of new commercially available zirconia-based ceramics for dental appliances produced using a new slip-casting method

OBJECTIVE

The aim of this study was to evaluate the biaxial flexural strength, the crystalline structure, and the grain size of zirconia-based ceramics produced using a new slip-casting method.

MATERIALS AND METHODS

Yttria-stabilized Tetragonal Zirconia Polycrystal (Y-TZP) and Alumina Toughened Zirconia (ATZ) ceramics were purchased from different manufactures. For the experimental group, ceramics produced using a patent pending slip-casting method (Slurry, Decema GmbH) was used. Slurry ceramics (n = 42) with a diameter of 14 ± 0.2 mm were produced by a proprietary colloidal shaping process, sintered, and subsequently polished with a lapping process using 15 μm diamond particles to a thickness of 1.2 ± 0.2 mm. For the control group, ceramics produced using the hot isostatic pressure method (HIP, Metoxit AG) were used. HIP ceramics discs (n = 42) with a diameter of 15.5 ± 0.02 mm were produced by classical HIP method and subsequently machined to a thickness of 1.99 ± 0.04 mm 32 discs of each ceramic were submitted to a biaxial flexural strength test using an universal testing machine at a crosshead speed of 0.5 mm/min. Statistical analyses using two-way ANOVA and Weibull distribution were performed. 2 discs of each ceramic were analyzed using X-ray diffraction for grain crystalline phase quantification. 2 discs of each ceramic were thermally etched and scanning electron microscopy images were obtained for grain size analysis (ISO 13383-1:2012). 6 discs of each ceramic were used for density measurement using the Archimedes' method.

RESULTS

For both ATZ and Y-TZP ceramics, the biaxial flexural strength and the characteristic strength of ceramics produced using the Slurry method were significantly higher than ones of the ceramic produced using HIP. The structure analysis confirmed the superiority of the Slurry ceramics which had only 1.2% tetragonal phase compared to 11-16% for the HIP ceramics. Grain size distributions covered a wide range 50-800 nm; the ZrO₂ grains of the Slurry ceramics were significantly smaller than the ones of the control ceramics, while the Al₂O₃ grain distributions were not affected by the manufacturing process. The manufacturing process had no influence on the density of both materials.

CONCLUSIONS

The Slurry method using a new proprietary slip-casting method to produce Y-TZP and ATZ dental ceramics presented higher biaxial flexural strength, less monoclinic phase and smaller ZrO₂ grains.

Effect of artificial aging on high translucent dental zirconia: simulation of early failure

Higher yttria content enhances the translucency and appearance of dental zirconia materials. Alterations in material composition also affect mechanical properties. The aim of this study was to compare the fracture load after artificial short-term aging of monolithic, full-contour zirconia crowns with different amounts of yttria-stabilization. Sixty crowns (thirty super high translucent crowns (5Y-Z) and thirty high translucent crowns (3Y-Z)) were produced to fit a model of a premolar with a shallow chamfer preparation. The crowns were cemented with self-adhesive resin cement on composite abutments. For each zirconia type, three groups of crowns (n = 10) were allocated to: (i) cyclic loading (200 N, 1 Hz, 30,000 cycles), (ii) hydrothermal aging (3 × 20 min, 134°C 3.2 bar), or (iii) no treatment (control). Surviving crowns from the aging process were quasistatically loaded until fracture. The 3Y-Z crowns had statistically significantly higher fracture values (3,449 N) than the 5Y-Z crowns (1,938 N). The aging procedures did not affect load at fracture. Fractographic analysis showed that fractures started either at the crown margin or at the occlusal intaglio area. Higher yttria content leads to a reduction in material strength and damage tolerance, and this should be reflected in recommendations for clinical use.

Flexural properties, bond ability, and crystallographic phase of highly translucent multi-layered zirconia

This study investigated the mechanical properties, bond ability, and crystallographic forms of different sites in a highly translucent, multi-layered zirconia disk. Flexural properties, bond ability to resin cement, and phase composition were investigated at three sites of a highly translucent, multi-layered zirconia disk: incisal, middle, and cervical. Flexural strength (FS) and flexural modulus (FM) were measured with static three-point flexural test. Shear bond strength (SB) to resin cement was measured after 24 h storage (37°C). Phase composition under mechanical stress was analyzed using X-ray diffraction. Without air abrasion, FS at the incisal site yielded the lowest value and was significantly lower than the middle and cervical sites. Air abrasion lowered the FS of each site. FM at the incisal site without air abrasion showed the significantly lowest value, and air abrasion increased its FM value. At the middle and cervical sites, their FM values were higher than the incisal site but were not significantly affected by air abrasion. SB value did not show significant differences among the sites. After sintering, cubic zirconia was detected at each site. Rhombohedral phase transformation occurred after mirror polishing. In highly translucent, multi-layered zirconia which was mainly composed of cubic zirconia, rhombohedral phase transformation occurred under mechanical stress and resulted in weakened mechanical properties.

Wear behavior and microstructural characterization of translucent multilayer zirconia

OBJECTIVE

To characterize the composition, microstructure and wear properties of a multilayer translucent zirconia relative to the conventional 3Y-TZP.

METHODS

Two types of ceramics were evaluated: a multilayer zirconia (MULTI, IPS e.max ZirCAD Multi, Ivoclar Vivadent) and a control 3Y-TZP (IPS e.max ZirCAD LT, Ivoclar Vivadent). Pre-sintered CAD-CAM blocks were cut, ground, sintered and polished to 1 μm finish. The phase fraction and grain size were measured using XRD and FE-SEM. For wear testing (n = 12), square-shaped specimens (16 × 16 × 1 mm) were adhesively bonded to a dentin analog. Sliding wear tests were performed using a spherical zirconia antagonist (r = 3.15 mm), with 30 N load at 1.5 Hz for 500,000 cycles in water. Optical and scanning electron microscopes and 3D laser scanner were used for quantitative wear analyses. Data were analyzed using Student's t-test (α = 0.05).

RESULTS

For MULTI, the enamel layer had the highest cubic content and the largest grain size, followed by the two transition layers, and the dentin layer. 3Y-TZP showed the smallest grain size and cubic content. A significant amount of wear was observed in both materials up to 50,000 cycles until it reached a plateau. MULTI showed higher volume loss and greater wear depth than 3Y-TZP (p < 0.01). The higher volume loss was associated with extensive lateral fracture, leading to material spalling from the surface of cubic-containing zirconias.

SIGNIFICANCE

The wear pattern in multi-layered zirconia was more severe than 3Y-TZP. Additionally, the different layers of the multi-layered zirconia had similar wear behavior.

Damage tolerance of six dental zirconias with different translucencies

Purpose

High-translucent dental zirconia has been introduced as a suitable material for anterior monolithic restorations. The material composition differs from traditional 3Y-TZP both with regard to yttria content and grain size. Little is known regarding how these alterations affect other properties than translucency and flexural strength. The aim of this study was to evaluate the crack propagation resistance and hardness of dental zirconias with different yttria content and different manufacturing methods.

Materials and methods

Measurement of hardness (HV2/5) and crack propagation from the indents (damage tolerance) was performed using a hardness tester(Vicker) on a flat polished surface of five crowns from six different commercial dental zirconias; one hard-machined 3Y-TZP, three soft-machined 3-5% yttria-stabilized zirconias and two soft-machined zirconias with ≥5% yttria content.

Results

Damage control varied greatly among dental zirconias with different compositions and fabrication methods. The hard-machined 3Y-TZP had better crack propagation resistance than soft-machined, 3-5% yttria-stabilized zirconias

Conslusion

The ultra-translucent zirconias with ≥5% yttria content had the lowest crack propagation resistance. Hardness is not a suitable indicator for damage tolerance.

Hydrothermal degradation methods affect the properties and phase transformation depth of translucent zirconia

OBJECTIVES

To characterize the optical and mechanical properties of a commercial and in-house translucent Y-TZP before and after aging in autoclave or hydrothermal reactor.

METHODS

In-house experimental discs were obtained through uniaxial and isostatic pressing a translucent Y-TZP powder and sintering at 1,550 °C/1 h. Commercial discs were milled from pre-sintered blocks fabricated with the same powder through uniaxial and isostatic pressing and sintering. Discs were allocated into three groups according to aging condition: immediate, aged via autoclave, or reactor (134 °C, 20 h, 2.2 bar). Crystalline content and microstructure were evaluated using X-ray diffraction (XRD) and scanning electron microscopy (SEM). Residual compressive stress (CS) was determined by Raman spectroscopy. Optical properties were determined by the contrast ratio (CR) and translucency parameter (TP) using reflectance data. Mechanical properties were assessed by Vickers hardness, fracture toughness and biaxial flexural strength tests.

RESULTS

XRD and SEM revealed a typical Y-TZP crystalline content, chiefly tetragonal phase, and a dense crystalline matrix for both processing protocols. Reactor aging triggered a more pronounced t-m transformation relative to autoclave. In-house and commercial Y-TZPs demonstrated similar CR and TP, with reactor aging significantly increasing their translucency. Similarly, reactor aging influenced Vickers hardness and fracture toughness. In-house processed Y-TZP clearly demonstrated the presence of CS, whereas commercial Y-TZP showed no presence of CS. Non-aged in-house Y-TZP resulted in significantly lower characteristic strength relative to commercial Y-TZP. While aging protocols significantly increased the characteristic strength of in-house Y-TZP, reactor significantly decreased commercial Y-TZP characteristic strength. Both Y-TZP processing protocols demonstrated high reliability at high-stress missions, with no detrimental effect of aging.

CONCLUSIONS

Laboratory aging methodology significantly influenced optical and mechanical properties of a commercial and in-house translucent Y-TZP.

Mechanical and microstructural properties of ultra-translucent dental zirconia ceramic stabilized with 5 mol% yttria

Monolithic dental prostheses fabricated from 3 mol.% yttria-stabilized zirconia (3YZ) are becoming increasingly popular. Recently, 5 mol.% yttria-stabilized zirconia (5YZ) which significantly improves the translucency of 3YZ has been prepared. However, its mechanical and microstructural properties, especially those affected by low-temperature degradation (LTD), have not been fully elucidated yet. The objective of the present study was to establish the relationship between the flexural strength of 5YZ with or without autoclave-induced LTD and its microstructural properties. For this purpose, a total of 320 bar-shaped specimens were cut from 5YZ and 3YZ blocks, and half of the specimens in each group were autoclaved at 134 °C for 50 h. Their flexural strengths were determined by conducting three-point bending tests, and the obtained results were analyzed by the Weibull statistical method. Grain sizes and crystalline structures of the specimens were analyzed by scanning electron microscopy (SEM) and X-ray diffraction, respectively. Additionally, the LTD-induced phase transformation was examined by Raman microscopy and cross-sectional surface analysis. The characteristic strengths of 5YZ and 3YZ were approximately 620 and 950 MPa, respectively, and 5YZ was found to be more resistant to LTD in terms of phase transformation than 3YZ. However, a low amount of the monoclinic phase was detected even in 5YZ after 50 h of autoclaving, which significantly decreased its flexural strength and reliability. The results of SEM analysis revealed that 5YZ was composed of two distinct regions: a dominant matrix with large grains (median size: 0.8 μm) and scattered areas with small grains (median size: 0.4 μm). Phase transformation analysis and fractography data indicated that the small-grain region was strongly affected by LTD and likely represented a fracture origin. The described properties should be considered during the clinical application of monolithic 5YZ dental prostheses.

Optical and Mechanical Properties of Highly Translucent Dental Zirconia

The aim was to evaluate the translucency, opalescence, and fluorescence of highly translucent zirconia, lithium disilicate, and bovine teeth. One mm-thick specimens of five monolithic zirconia systems, two glass-ceramics, and bovine enamel/dentin were investigated. A spectrophotometer (Ci7600) was used to measure the CIELab color coordinates, and the translucency and opalescence values were obtained. For evaluating the fluorescence emission, the differences in spectral reflectance by the UV component of illumination were calculated. The microstructures of ceramic specimens were examined with a scanning electron microscope and the chemical compositions were determined with an X-ray fluorescence spectrometer. Mechanical properties were appraised with three-point bending strength, indentation fracture toughness, and Vickers hardness. Data were analyzed using a one-way ANOVA, followed by Tukey’s multiple comparison test (α = 0.05). A higher yttria content (5 mol%) significantly improved the translucency of zirconia ceramics, while they were less translucent than lithium disilicate (p < 0.05). Lowering the alumina content below 0.05 wt.% enhanced the translucency (p < 0.05), but a small amount of alumina was still required to obtain full densification. 0.05 wt.% Fe was used to increase the chroma of zirconia specimens without compromising their mechanical properties. The Er-containing zirconia specimen showed a maximal fluorescence emission at 430 nm. The degree of opalescence was affected by the microstructures of ceramic materials. The microstructure, incorporation of a secondary phase, and sintering behavior can have a strong impact on the final mechanical and optical properties of dental ceramics. Addition of small amounts of metal oxides can affect the translucency, opalescence or fluorescence qualities of zirconia

Effect of surface treatment on the retention of zirconia crowns to tooth structure after aging

OBJECTIVE

To evaluate the effect of different surface treatments on the retention between zirconia crowns and tooth structure after in vitro aging.

MATERIALS AND METHODS

Human third molars (n = 44) received crown preparations and CAD/CAM zirconia crowns were manufactured. Specimens were divided into two groups: no aging, control (NAC, n = 11) or aging (A, n = 33). NAC were bonded with universal adhesive (UA). Aged specimens were divided into three subgroups (n = 11) according to surface treatment: Control: no abrasion + UA; Alumina: alumina abrasion + UA; Silica: tribochemical silica coating + UA. The crowns were cemented with dual-cure resin cement. Specimens in group A were aged by a combination of mechanical, thermal, and pH cycling. Retention strength values were obtained by tensile tests and results were analyzed by one-way analysis of variance (ANOVA) and Tukey test (P < .05).

RESULTS

Aging decreased the retention strength in control specimens (P < .001). Surface treatment improved the retention strength of aged specimens (P < .001), with similar results between alumina and tribochemical silica coating.

CONCLUSION

The chemical interaction between the universal bonding system and zirconia's surface was not sufficient to withstand artificial aging. Tribochemical silica coating did not promote additional retention in comparison to alumina blasting.

CLINICAL SIGNIFICANCE

The long-term retention of translucent zirconia crowns to tooth structure using phosphate-based materials is improved by means of mechanical surface treatments such as alumina blasting and tribochemical silica coating.

Effect of high-speed sintering on the flexural strength of hydrothermal and thermo-mechanically aged zirconia materials

OBJECTIVE

To investigate the influence of high-speed and conventional sintering on the flexural strength (FS) of three zirconia materials initial and after artificial aging.

METHODS

Milled zirconia specimens (3Y-TZP: ZI and Zolid; 4Y-TZP: Zolid HT+; Amann Girrbach AG; N = 288, n = 96/group) were sintered in a high-speed sintering protocol (final temperature 1580 °C, n = 48/subgroup) or a conventional sintering protocol (control group, final temperature 1450 °C, n = 48/subgroup). FS was tested initially and after artificial aging (10 h in an autoclave or 1,200,000 chewing cycles; n = 16/subgroup). Univariate ANOVAs, post-hoc Scheffé, partial eta-squared, Kolmogorov-Smirnov-, Kruskal-Wallis- and Mann-Whitney-U-test were performed (p < 0.05).

RESULTS

ZI showed the highest and HT+ the lowest FS, regardless of the sintering protocols and aging regimens (p < 0.001). High-speed sintered HT+ showed higher initial FS than the control group (p < 0.001). ZI (p < 0.001-0.004) and Zolid (p < 0.001-0.007) showed higher FS after thermo-mechanical aging. High-speed sintered HT+ showed higher FS in the initial stage (p < 0.001). The Weibull modulus of the three thermo-mechanically aged materials was negatively influenced by high-speed sintering.

SIGNIFICANCE

As shorter sintering times represent a cost and time efficient alternative, high-speed sintering is a valid alternative to conventional sintering protocols.

Mechanical properties, aging stability and translucency of speed-sintered zirconia for chairside restorations

OBJECTIVE

To evaluate the performance of zirconia ceramics sintered in a speed sintering induction furnace by comprehensive understanding of their optical and mechanical properties, microstructure, phase composition and aging stability, in comparison to ceramics sintered in a conventional furnace.

METHODS

Speed sintered (SS) Katana STML_SS (Kuraray Noritake) (total thermal cycle/sintering time/dwell temperature: 30min/16min/1560°C) and CEREC Zirconia (CEREC Zr_SS) (Dentsply Sirona) (15min/2min/1578°C) were compared to conventionally sintered (CS) Katana STML_CS (6.8h/2h/1550°C) and inCoris TZI_CS (4h/2h/1510°C). The translucency parameter (TP) and contrast ratio (CR) were measured with a spectrophotometer. The chemical composition of the materials was determined by XRF and phase composition was characterized using XRD. Hydrothermal aging behavior was evaluated by measuring the tetragonal-to-monoclinic ZrO₂ phase transformation after accelerated hydrothermal aging in steam at 134°C. The indentation fracture toughness, Vickers hardness and biaxial strength of the sintered ceramics were assessed.

RESULTS

Speed and conventionally sintered zirconia revealed similar density, microstructure, average strength and hydrothermal aging stability. Both Katana STML_SS/CS 5Y-PSZ ceramics were characterized with a higher content of cubic phase (≈53wt%), which resulted in a higher amount of Y₂O₃ in the remaining tetragonal ZrO₂ phases compared to the 3Y-TZP CEREC Zr_SS and inCoris TZI_CS (8 and 20wt%, respectively). The sintering program did not affect the hydrothermal aging behavior of Katana STML_SS and CEREC Zr_SS. TP of Katana STML_SS (TP≈32) was not affected by speed sintering, while the translucency of CEREC Zr_SS (TP=14) was significantly reduced. Hardness, fracture toughness and Weibull characteristic strength of Katana STML_SS and CEREC Zr_SS also reached the optimal level, but speed sintering substantially lowered their mechanical reliability.

SIGNIFICANCE

Speed sintering of 3Y-TZP and 5Y-PSZ in a speed sintering induction oven appeared suitable for clinical applications. However, further studies should focus on improving of translucency and mechanical reliability of the speed-sintered zirconia ceramics.

Translucency of Monolithic Zirconia after Hydrothermal Aging: A Review of In Vitro Studies

PURPOSE

Recent modifications in composition, structure, and fabrication methods have led to monolithic zirconia ceramics of superior translucency. However, during aging, intrinsic microstructural features, such as grain boundaries and pores, may affect light scattering and consequently the translucency of zirconia. The aim of this study was to systematically review if hydrothermal aging affects the translucency of monolithic zirconia.

MATERIALS AND METHODS

An electronic search in Medline and Scopus was conducted to identify the effect of hydrothermal aging on the translucency of zirconia. The search was limited to English-language publications and in vitro studies. The following search terms were used alone or in combination: "monolithic zirconia," "full contour zirconia," "Y-TZP zirconia," "tetragonal zirconia," "cubic zirconia," "aging," "hydrothermal aging," "steam autoclave," "translucency," "translucency parameter," and "contrast ratio." From the titles found after searching the electronic databases, only 10 articles met the inclusion criteria and were included in this review. The translucency parameter or total transmittance was used to extract data from the studies.

RESULTS

Aging reduced the translucency of monolithic zirconia in most of the studies; however, the differences varied according to the brand tested and the microstructure and thickness of the specimens. The thinner specimens presented higher translucency alterations. Although in all studies a change in translucency was recorded, its mean values suggest that the differences are within the acceptability threshold in most cases, independent of the color system used to calculate translucent parameter, so they are clinically undetectable. For longer aging times, beyond the perspective clinical life of the restorations, the change in translucency is higher than the acceptability threshold.

CONCLUSIONS

There is a controversy regarding how aging affects the translucency of monolithic zirconia ceramics; however, this may not be clinically important, as in most cases, changes (either decrease or increase) in translucency were within the acceptability thresholds.

High-Potential surface on zirconia ceramics for bacteriostasis and biocompatibility

Bacteria easily adhere, colonize, and form biofilm on oral implants subsequently causing periimplantation periarthritis and mechanical loosening. Previous studies show that a high potential surface on polymeric implants can achieve surface bacteriostasis without side effects. In this study, a high surface potential is introduced to zirconia ceramics to mitigate bacterial infection. Carbon and nitrogen plasma immersion ion implantation (C-PIII and N-PIII) are conducted on zirconia ceramic samples sequentially to elevate the surface potential. The surface with a high potential but without ion leaching exhibits excellent antibacterial effects against oral bacteria and little bacterial resistance is triggered. The surface also has high strength and excellent biocompatibility. The nitrogen-containing inorganic structure with high potential can actualize bacteriostasis and biocompatibility on zirconia ceramics simultaneously and this new strategy can enhance the antibacterial ability of oral implants.

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.

Silica infiltration in partially stabilized zirconia: Effect of hydrothermal aging on mechanical properties

It aimed to evaluate if silica infiltration might influence the hydrothermal degradation of zirconia by determining: the phases formed, hardness, microstructure, and flexural strength of a 3Y-TZP. Yttria partially stabilized zirconia discs (1.2 mm thickness x 13 mm diameter) (InCeram YZ, Vita Zanhfabrik) were produced and assigned into 6 groups, considering 2 factors: silica infiltration in 2 levels (as-sintered or infiltration) and hydrothermal aging (LTD-Low Temperature Degradation) in 3 levels (baseline, aging at 132 °C for 35 h or 140 h). All the groups were subjected to the biaxial flexural test (n = 30), and Vickers hardness (n = 42). Weibull analysis was performed to determine the Weibull moduli (m) and characteristic strenghts (σ₀). The specimens were characterized by scanning electron microscopy (SEM) to evaluate microstructure and X-ray diffraction (XRD) for phases percentages determination. For as-sintered condition: there was saturation of the amount of monoclinic zirconia after 35 h of hydrothermal aging, with 66% of monoclinic zirconia formed on the surface. LTD generated a progressive reduction in hardness over time; flexural strength was increased by the 35-h treatment (baseline: 974 MPa; 35 h: 1161.5 MPa), but, the 140 °C treatment was deleterious (698.5 MPa). On the other hand, the infiltrated specimens had an increase in the amount of cubic zirconia on the surface and showed 26% (35h) and 31% (140h) of monoclinic zirconia after the hydrothermal aging ; the strength was kept unaltered after LTD-35 h (935.9 MPa) and an increase was observed after LTD-140 h (1033.6 MPa); the hardness values had no statistically significant changes during the process. Thus, one can concludes that the silica infiltration can prevent the decrease in the mechanical properties due to the LTD on partially stabilized zirconia materials.

Impact of hydrothermal aging on the light transmittance and flexural strength of colored yttria-stabilized zirconia materials of different formulations

STATEMENT OF PROBLEM

Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) materials of different formulations (3Y-TZP, 4Y-TZP, and 5Y-TZP) can be colored by using color liquids. However, practically and clinically relevant factors such as modifications of sintering protocols and hydrothermal aging might affect the extent of light transmittance and flexural strength of zirconia materials of different formulations; studies on these outcomes, however, are lacking.

PURPOSE

The purpose of this in vitro study was to test the impact of hydrothermal aging on the light transmittance and flexural strength of colored zirconia materials compared with a lithium-disilicate (LiSi₂) ceramic.

MATERIAL AND METHODS

A total of 210 specimens were prepared from 3Y-TZP_0.25 (n=30), 3Y-TZP_0.05 (n=30), 5Y-TZP (n=30), 4Y-TZP (n=60), _pre4Y-TZP (preshaded, n=30), and LiSi₂ (n=30). All specimens, except for _pre4Y-TZP and LiSi₂, were manually colored, predried, and either conventionally sintered at 1450 °C (3Y-TZP_0.25, 3Y-TZP_0.05, 5Y-TZP, and half of 4Y-TZP) or high-speed sintered at 1580 °C (other half of 4Y-TZP and _pre4Y-TZP). Light transmittance was measured initially and after 2, 5, 10, 20, 40, and 160 hours of hydrothermal aging (134 °C, 0.2 MPa). Biaxial flexural strength was tested initially and after 160 hours of hydrothermal aging (n=15). The Kolmogorov-Smirnov test, multivariate analysis, and 1-way ANOVA with the Tukey HSD post hoc test, the t test, and linear mixed models were calculated (α=.05).

RESULTS

LiSi₂ showed the highest translucency, followed by 5Y-TZP, 4Y-TZP, _pre4Y-TZP_speed, 3Y-TZP_0.05, and 3Y-TZP_0.25. 4Y-TZP_speed was most opaque and matte. The decrease in translucency related to aging hours was higher for LiS₂ and conventional sintered zirconia materials than for 4Y-TZP_speed and _pre4Y-TZP_speed. Initially, 3Y-TZP_0.25 had the highest flexural strength, followed by 3Y-TZP_0.05, 4Y-TZP, and _pre4Y-TZP_speed. _pre4Y-TZP_speed was comparable with 4Y-TZP_speed but significantly higher than 5Y-TZP. LiSi₂ had the lowest biaxial flexural strength. Hydrothermal aging increased biaxial flexural strength for 3Y-TZP_0.25 and 3Y-TZP_0.05 (P<.001) but decreased it for 5Y-TZP (P=.005) and _pre4Y-TZP_speed (P<.001). After aging, 4Y-TZP_speed showed comparable values of flexural strength with 4Y-TZP (P=.06) and higher values than _pre4Y-TZP_speed after aging (P=.019).

CONCLUSIONS

Manually colored, conventionally sintered 4Y-TZP was resistant to hydrothermal aging regarding flexural strength. High-speed sintering inhibited color development for manually colored 4Y-TZP but did not affect the resistance to hydrothermal aging. The findings were reversed for industrially preshaded 4Y-TZP.

Effect of the Compositions on the Biocompatibility of New Alumina-Zirconia-Titania Dental Ceramic Composites

Dental implant biomaterials are expected to be in contact with living tissues, therefore their toxicity and osseointegration ability must be carefully assessed. In the current study, the wettability, cytotoxicity, and genotoxicity of different alumina-zirconia-titania composites were evaluated. The surface wettability determines the biological event cascade in the bioceramic/human living tissues interface. The measured water contact angle indicated that the wettability strongly depends on the ceramic composition. Notwithstanding the contact angle variability, the ceramic surfaces are hydrophilic. The cytotoxicity of human gingival fibroblast cells with materials, evaluated by an (3-(4,5 methylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) test, revealed an absence of any cytotoxic effect. A relationship was found between the cell viability and the wettability. It was subsequently deduced that the cell viability increases when the wettability increases. This effect is more pronounced when the titania content is higher. Finally, a comet test was applied as complementary biocompatibility test to detect any changes in fibroblast cell DNA. The results showed that the DNA damage is intimately related to the TiO₂ content. Genotoxicity was mainly attributed to ceramic composites containing 10 wt.% TiO₂. Our research revealed that the newly developed high performance alumina-zirconia-titania ceramic composites contain less than 10 wt.% TiO₂, and display promising surface properties, making them suitable for dental implantology applications.

Color matching of full ceramic versus metal-ceramic crowns - a spectrophotometric study

Background and aims

To verify the color match of metal-ceramic and full ceramic crowns, using instrumental methods.

Methods

A number of 153 teeth (anterior and posterior teeth), in 62 patients, were restored with metal ceramic (MC, n=119), pressed-ceramic (PC, n=28), and zirconia-ceramic (ZC, n=6) full coverage crowns. The shade of a reference natural tooth was recorded instrumentally with a dental spectrophotometer (Vitaeasyshade Advance 4.0) in “single tooth measurement”, which provided the base color in Vita Classic (VC) and Vita 3D Master shades (3D).

For verifying the outcome of the restoration “verify restoration” mode was used, and ΔE values were recorded for both VC and 3D Master shade guides. Moreover, matching symbols were also recorded (***=good, **=fair, *=poor). Descriptive statistics was performed and data were analyzed (One-sample z-Test, α=0.05) for comparison with visual thresholds in dentistry (Perceptibility Threshold – PT=1.2 and Acceptability Threshold – AT=2.7).

Results

The data did not follow a normal distribution (Kolmogorov-Smirnov test, p<0.05). Recorded color difference was significantly higher than PT and AT, for all types of restorations, regardless of the coding system (p<0.05). For MC crowns in 2.52% (4.20% for 3D) of the cases the color difference was smaller than PT, in 19.32% (the same for 3D) of cases was between PT and AT, and in 78.15% (76.47% for 3D) of cases was higher than the AT. For PC crowns in 3.57% (0% for 3D) of the cases the color difference was smaller than PT, in 25% (32.14% for 3D) of cases was between PT and AT, and in 71.42% (67.85% for 3D) of cases was higher than the AT. In the case of ZC crowns none of the restorations had color difference smaller than PT, but in 16.66% of cases was between PT and AT, and in 83.33% of cases was higher than the AT, for both VC and 3D.

Conclusion

Within the limitations of the study, a better color match was achieved in the case of pressed ceramic crowns, made of lithium disilicate. In most of the situations the color difference between the restoration and the reference tooth exceeded the perceptibility thresholds, but the matching was recorded as “fair” by the spectrophotometer.

Suitability of 3D printed pieces of nanocrystalline zirconia for dental applications

OBJECTIVES

The main goal of this work is to evaluate the suitability of nanostructured zirconia pieces obtained by robocasting additive manufacturing (AM), for dental applications.

METHODS

The density, crystalline structure, morphology/porosity, surface roughness, hardness, toughness, wettability and biocompatibility of the produced samples were compared with those of samples obtained by conventional subtractive manufacturing (SM) of a similar commercial zirconia material. Chewing simulation studies were carried out against dental human cusps in artificial saliva. The wear of the material was quantified and the wear mechanisms investigated, as well as the influence of glaze coating.

RESULTS

AM samples, that revealed to be biocompatible, are slightly less dense and more porous than SM samples, showing lower hardness, toughness and wettability than SM samples. After chewing tests, no wear was found both on AM and SM samples. However, the dental wear was significantly lower when AM samples were used as counterbody. Concerning the glazed samples, both coated surfaces and dental cusps suffered wear, being the cusps' wear higher than that found for unglazed samples. More, cusps tested against AM coated samples suffered less wear comparatively to those opposed to SM coated samples.

SIGNIFICANCE

Overall, the results presented in this paper show that AM processed nanostructured zirconia can be used in dental restorations, with important advantages from the point of view of processing and tribological performance. Moreover, the option for glaze finishing should be carefully considered both in SM and AM processed specimens.

[Translucent zirconia ceramics for fabrication monolithic restorations: review. Part 2]

Translucent zirconia ceramics for fabrication monolithic restorations is a ceramic material of latest generation. The objective of this literature review is discussing the ways to increase the transparency of zirconia, novel technologies of its manufacturing (part 1) and laboratory procedures for fabrication translucent zirconia restorations, factors affecting the transparency, optical and physico-mechanical properties of the material, as well as indications for its use (part 2).

The effect of different aging protocols on the flexural strength and phase transformations of two monolithic zirconia ceramics

Introduction:

The aim of the present study was to investigate how different aging protocols can affect the flexural strength and phase transformations of yttrium-stabilized zirconia ceramics (Y-TZP) for monolithic restorations.

Materials and methods:

Bar-shaped specimens from two zirconia ceramics bars were divided into three groups: a. no treatment (c), b. aging in an autoclave (a), and c. thermal cycling (t). The flexural strength was determined by the 3-point bending test and statistical analysis was performed to determine significant differences ( p< 0.05). Weibull statistics was used to analyze the dispersion of strength values while surface microstructural analysis was performed through X-ray diffraction analysis (XRD), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM).

Results:

Aging did not significantly affect the flexural strength but differences were recorded between the two groups, with group A presenting higher strength values and m-phase percentages.

Conclusions:

The observed differences between the two ceramics could be attributed to variations in composition and processing.

Does the application of surface treatments in different sintering stages affect flexural strength and optical properties of zirconia?

OBJECTIVE

To investigate the influence of surface treatments conducted in presintering and postsintering stages on flexural strength and optical properties of zirconia.

MATERIALS AND METHODS

Specimens were milled from partially sintered zirconia blocks in different geometries and divided into three main groups as presintered, postsintered, and control groups. Test groups were further divided into three subgroups (n = 10) according to the surface treatments conducted (grinding, Er,Cr:YSGG laser irradiation, air-borne particle abrasion [APA]). Four-point flexural strength (σ) test and Weibull analysis were conducted. Color differences (ΔE₀₀ ) and translucency parameter (TP_ab ) were calculated with a spectrophotometer. Surfaces of specimens were scrutinized under FESEM. Data were statistically analyzed.

RESULTS

Postsintered groups exhibited higher σ values (P < .05). Within all groups, highest and lowest σ values were detected at postsintered and presintered APA groups, respectively (P < .05). All ΔE₀₀ values were above the perceptibility threshold (ΔE₀₀  > 0.8). Higher TP_ab values were obtained and deeper scratches were observed in presintered groups.

CONCLUSIONS

Surface treatments performed at postsintering stage had a favorable effect on the flexural strength of all specimens. Surface treatments performed before sintering increased translucency and caused higher ΔE₀₀ values.

CLINICAL SIGNIFICANCE

Surface treatments performed at different sintering stages can alter mechanical and optical properties of zirconia.

Alqahtani N, Alhassan Mujayri F. Effect of Hydrothermal Aging and Beverages on Color Stability of Lithium Disilicate and Zirconia Based Ceramics

Background and Objectives: All-ceramic prosthesis is widely used in modern dental practice because of its improved physico-mechanical and optical properties. These restorations are exposed to coloring agents from various nutrition and beverages in the oral cavity. Long-term color stability is critical for the success of these restorative materials. The purpose of this in vitro study was to assess the effect of common beverages and mouthwash on the color stability of lithium disilicate (LD), monolithic zirconia (MZ) and bilayer zirconia (BZ) surfaces. Materials and Method: Thirty disc-shaped specimens from each material were fabricated; each group was subdivided (n = 10) according to coffee, green tea and chlorhexidine immersion solutions. The baseline color of ceramic discs was recorded according to the CIE L*a*b* system with a portable spectrophotometer. The second measurement was recorded after 3000 thermocycling and immersion in coloring agents for 7 days. The mean color difference was calculated and data were compared with Kruskal-Wallis and Mann-Whitney post hoc tests (0.05). Results: ΔE values for LD with the immersion of coffee, tea, and Chlorhexidine gluconate (CHG) were 1.78, 2.241 and 1.58, respectively. Corresponding ΔE values for MZ were 5.60, 5.19, and 4.86; marginally higher than the clinically acceptable level of 3.5. Meanwhile, BZ showed better color stability compared to MZ with ΔE values of 4.22, 2.11 and 1.43. Conclusions: Among the ceramics evaluated, LD ceramic was found to be more color stable, while MZ ceramics displayed a higher susceptibility to discoloration. MZ and BZ ceramic colors were significantly altered with coffee immersion, while LD ceramics were more affected by green tea.

Strength and aging resistance of monolithic zirconia: an update to current knowledge

New zirconia compositions with optimized esthetic properties have emerged due to the fast-growing technology in zirconia manufacturing. However, the large variety of commercial products and synthesis routes, make impossible to include all of them under the general term of “monolithic zirconia ceramics”. Ultra- or high translucent monolithic formulations contain 3–8 mol% yttria, which results in materials with completely different structure, optical and mechanical properties. The purpose of this study was to provide an update to the current knowledge concerning monolithic zirconia and to review factors related to strength and aging resistance. Factors such as composition, coloring procedures, sintering method and temperature, may affect both strength and aging resistance to a more or less extend. A significant reduction of mechanical properties has been correlated to high translucent zirconia formualtions while regarding aging resistance, the findings are contradictory, necessitating more and thorough investigation. Despite the obvious advantages of contemporary monolithic zirconia ceramics, further scientific evidence is required that will eventually lead to the appropriate laboratory and clinical guidelines for their use. Until then, a safe suggestion should be to utilize high-strength partially-stabilized zirconia for posterior or long span restorations and fully-stabilized ultra-translucent zirconia for anterior single crowns and short span fixed partial dentures.

Probing the interfacial strength of novel multi-layer zirconias

OBJECTIVES

The rapidly increasing use of zirconia-based CAD/CAM multi-layer structures in dentistry calls for a thorough evaluation of their mechanical integrity. This work examines the effect of the multi-layering architecture as well as variations in composition and inclusion of pigments among the layers on the flexural strength of multi-layer zirconias.

METHODS

A modified 4-point bending test, aided by a Finite Element Analysis (FEA), was used to probe the interfacial strength of 3 classes of yttria-partially-stabilized zirconia: Ultra Translucent Multi-Layer (UTML-5Y-PSZ), Super Translucent Multi-Layer (STML-4Y-PSZ), Multi-Layer (ML-3Y-PSZ). In accord with the size limitation (22-mm height) of CAD/CAM pucks, test samples were prepared in the form of "long" (25×2×3mm) and "short" (17.8×1.5×2mm) beams. Homogeneous beams (both long and short) were produced from either the Enamel (the lightest shade) or Dentin (the darkest shade) layer, whereas multi-layer beams (short beam only) were obtained by cutting the pucks along their thickness direction, where the material components of various shades were stacked.

RESULTS

The Enamel and Dentin layers exhibited similar flexural strength for a given material class, with ML amassing the highest strength (800-900MPa) followed by STML (560-650MPa) and UTML (470-500MPa). The 3 classes of multi-layer zirconia showed a trade-off between strength and translucency, reflecting different yttria contents in these materials. The failure stress of the cross-sectional multi-layer beams was, however, ∼30% lower than that of their Enamel or Dentin layer counterparts, regardless of material tested.

SIGNIFICANCE

The weakness of interfaces is a drawback in these materials. Additionally, when measuring strength using short beam flexure, friction between the specimen and supporting pins and accuracy in determining loading span distances may lead to major errors.

Are Metal-Free Monolithic Crowns the Present of Prosthesis? Study of Mechanical Behaviour

Purpose: To analyze in vitro the mechanical behavior of five types of complete coverage crowns fabricated from different materials. Materials and methods: Seventy-five full coverage crowns were divided into five groups according to material: Group I, metal core with feldspathic ceramic covering (MC- control group); Group II, zirconia core with feldspathic ceramic covering (CZ); Group III, tetragonal monolithic zirconia (TMZ); Group IV, cubic monolithic zirconia (CMZ); Group V, high molecular weight polymethyl methacrylate (PMMAG) doped with graphene nanoparticles. All crowns underwent in vitro fatiguing by dynamic loading in wet conditions to simulate the masticatory forces to which prosthodontic materials are subject in the oral medium. Lastly, fracture resistance was evaluated by static compression testing. Results: The fracture resistance values obtained were as follows: Group MC, 2443.6 ± 238.6 N; Group CZ, 2095.4 ± 329.2 N; Group TMZ, 2494.6 ± 236.6 N; Group CMZ, 1523.6 ± 325.2 N; and Group PMMAG, 1708.9 ± 386.6 N. Group MC presented higher strength with statistically significant differences in comparison with Groups CZ (P = 0.002), CMZ (P < 0.001), and PMMAG (P < 0.001). Weibull distribution showed less probability of cumulative biomechanical failure in Groups MC and TMZ. Conclusions: Metal-ceramic and tetragonal zirconia showed high fracture resistance, while cubic zirconia and PMMA doped with graphene nanoparticles obtained lower values.

Is a Zirconia Dental Implant Safe When It Is Available on the Market?

The market share of zirconia (ZrO2) dental implants is steadily increasing. This material comprises a polymorphous character with three temperature-dependent crystalline structures, namely monoclinic (m), tetragonal (t) and cubic (c) phases. Special attention is given to the tetragonal phase when maintained in a metastable state at room temperature. Metastable tetragonal grains allow for the beneficial phenomenon of Phase Transformation Toughening (PTT), resulting in a high fracture resistance, but may lead to an undesired surface transformation to the monoclinic phase in a humid environment (low-temperature degradation, LTD, often referred to as ‘ageing’). Today, the clinical safety of zirconia dental implants by means of long-term stability is being addressed by two international ISO standards. These standards impose different experimental setups concerning the dynamic fatigue resistance of the final product (ISO 14801) or the ageing behavior of a standardized sample (ISO 13356) separately. However, when evaluating zirconia dental implants pre-clinically, oral environmental conditions should be simulated to the extent possible by combining a hydrothermal treatment and dynamic fatigue. For failure analysis, phase transformation might be quantified by non-destructive techniques, such as X-Ray Diffraction (XRD) or Raman spectroscopy, whereas Scanning Electron Microscopy (SEM) of cross-sections or Focused Ion Beam (FIB) sections might be used for visualization of the monoclinic layer growth in depth. Finally, a minimum load should be defined for static loading to fracture. The purpose of this communication is to contribute to the current discussion on how to optimize the aforementioned standards in order to guarantee clinical safety for the patients.

Optical properties of currently used zirconia-based esthetic restorations fabricated with different techniques

OBJECTIVE

The aim was to evaluate the effects of different types of monolithic zirconia (MZ) and fabrication techniques on the optical properties of newly generated zirconia-based materials after aging.

MATERIAL AND METHODS

Sixty specimens (n = 10) were prepared. For the groups layering-veneering (LV), overpressing (OP), porcelain fused to zirconia (PFZ), and cutback (CB), 3Y-TZP, IPS e.max ZirCAD was prepared as the core material (0.5 ± 0.01 mm). For full-contour (FC) technique, 3Y-TZP was used for MZ-LT (low translucency) and 4Y-TZP was used for MZ-MT (medium translucency). L*, a*, b*, chroma (C), and relative translucency (RTP) were measured before (L₁ *, a₁ *, b₁ *, C₁ , RTP₁ ) and after (L₂ *, a₂ *, b₂ *, C₂ , RTP₂ ) UV aging. Statistical analyses were performed by one-way ANOVA with Tukey's test and paired sample t tests (P = .05).

RESULTS

Fabrication techniques significantly affected the L*, a*, b*, C, RTP, and ΔE₀₀ values (P ˂ .01). The highest L₁ * value was found in MZ-LT; followed, in order, by OP, PFZ, LV, CB, and MZ-MT. The highest b₁ * and C₁ values were found in OP, while MZ-MT had the lowest values (P ˂ .05). FC had the highest RTP values for MZ-MT (13 ± 0.9 RTP_1; 11.2 ± 0.9 RTP₂ ), and the lowest RTP values were found for MZ-LT (8.5 ± 0.9 RTP_1; 8.3 ± 1.2 RTP₂ ) (P ˂ .01). Aging caused significant differences in the L*, a*, b*, C, and RTP values (P < .05). The color changes were between 0.9 and 2.1 ΔE₀₀ .

CONCLUSIONS

The fabrication technique significantly affected the optical properties. UV aging caused zirconia-based restorations to become darker and more yellow, red, saturated, and opaque.

CLINICAL IMPLICATIONS

Fabrication techniques with different zirconia structures affected the optical properties of the restoration, even when the same shades were chosen. If more translucent restorations are needed, choosing 4-YTZP with the FC technique is better than veneering with 3-YTZP. Choosing 3-YTZP with the FC technique produces more esthetic results if brighter and more opaque restorations are needed.

Strength and translucency of zirconia after high-speed sintering

OBJECTIVES

To compare the strength and translucency of CAD/CAM zirconia blocks, with traditional and high-speed sintering, to lithium disilicate.

MATERIALS AND METHODS

Three zirconia materials (Katana STML Block, Prettau Anterior, and Zpex Smile) were tested with either traditional (7 hours) or high-speed (18 or 30 minutes in a SpeedFire furnace) sintering. A lithium disilicate material (IPS e.max CAD) was tested as a reference. Three-point bend flexural strength specimens (16 mm × 4 mm × 1.2 mm, n = 10) were tested on 14-mm-separated supports and loaded to failure at 1 mm/min. Specimens (1 mm thick, n = 10) were measured in a Color-i7 spectrophotometer against a black and white background to calculate translucency parameter. Zirconia specimens were thermally etched and a grain structure was observed with scanning electron microscopy. Data were analyzed with 1-way ANOVA and Tukey's post hoc analysis (α = 0.05).

RESULTS

There were significant differences between materials for flexural strength, translucency parameter, and grain size (P < .001). Grains became significantly larger and pores were present when two of the zirconia materials (Prettau Anterior and Zpex Smile) were sintered with a high-speed sintering program.

CONCLUSIONS

Two of the zirconia materials (Prettau Anterior and Zpex Smile) became less translucent and less strong using a high-speed sintering program, whereas another (Katana STML Block) was unaffected.

Monolithic Zirconia: An Update to Current Knowledge. Optical Properties, Wear, and Clinical Performance

The purpose of this paper was to update the knowledge concerning the wear, translucency, as well as clinical performance of monolithic zirconia ceramics, aiming at highlighting their advantages and weaknesses through data presented in recent literature. New ultra-translucent and multicolor monolithic zirconia ceramics present considerably improved aesthetics and translucency, which, according to the literature reviewed, is similar to those of the more translucent lithium disilicate ceramics. A profound advantage is their high strength at thin geometries preserving their mechanical integrity. Based on the reviewed articles, monolithic zirconia ceramics cause minimal wear of antagonists, especially if appropriately polished, although no evidence still exists regarding the ultra-translucent compositions. Concerning the survival of monolithic zirconia restorations, the present review demonstrates the findings of the existing short-term studies, which reveal promising results after evaluating their performance for up to 5 or 7 years. Although a significant increase in translucency has been achieved, new translucent monolithic zirconia ceramics have to be further evaluated both in vitro and in vivo for their long-term potential to preserve their outstanding properties. Due to limited studies evaluating the wear properties of ultra-translucent material, no sound conclusions can be made, whereas well-designed clinical studies are urgently needed to enlighten issues of prognosis and long-term survival.