Performance of dental ceramics: challenges for improvements

Fatigue survival and damage modes of lithium disilicate and resin nanoceramic crowns

Polymer-based composite materials have been proposed as an alternative for single unit restorations, due to their resilient and shock absorbing behavior, in contrast to the brittleness of ceramic materials that could result in failure by fracture.

Bond strength between MDP-based cement and translucent zirconia

The purpose was to evaluate the bond strength between adhesive cement and translucent zirconia in comparison to conventional zirconia. Four brands of translucent zirconia (BruxZir^® HT, Lava™ Plus, Prettau^® Anterior, and Prettau^® Zirconia) and one conventional zirconia (Kavo Everest^® ZS) were evaluated. Specimens were divided into groups depending on the pretreatment of the cementation surface of the zirconia: as-produced, hydrofluoric acid treatment, or sandblasted. The groups underwent three different procedures of artificial aging: water storage (24 h), 5,000 thermocycles, or long-term aging, (water storage 150 days including 37,500 thermocycles) before shear bond strength testing. Sandblasting treatment increased the bond strength significantly for all the brands of zirconia, irrespective of artificial aging procedures, in comparison to the control group. Bond strength between adhesive cement to translucent zirconia is equivalent to conventional zirconia. Sandblasting creates a cementation surface that is more durable than as-produced or hydrofluoric-acid-treated, irrespective of type of zirconia.

Effects of Finish Line Design and Fatigue Cyclic Loading on Phase Transformation of Zirconia Dental Ceramics: A Qualitative Micro-Raman Spectroscopic Analysis

Objectives: Stresses produced during the fabrication of copings and by chewing activity can induce a tetragonal-to-monoclinic (t–m) transformation of zirconia. As a consequence, in the m-phase, the material is not able to hinder possible cracks by the favorable mechanism known as “transformation toughening”. This study aimed at evaluating if different marginal preparations of zirconia copings can cause a premature phase transformation immediately after manufacturing milling and after chewing simulation. Methods: Ninety copings using three commercial zirconia ceramics (Nobel Procera Zirconia, Nobel Biocare Management AG; Lava Classic, 3M ESPE; Lava Plus, 3M ESPE) were prepared with deep-chamfer, slight-chamfer, or feather-edge finish lines (n = 10). Specimens were tested in a chewing simulator (CS-4.4, SD Mechatronik) under cyclic occlusal loads simulating one year of clinical service. Raman spectra were acquired and analyzed for each specimen along the finish lines and at the top of each coping before and after chewing simulation, respectively. Results: Raman analysis did not show any t–m transformation both before and after chewing simulation, as the typical monoclinic bands at 181 cm⁻¹ and 192 cm⁻¹ were not detected in any of the tested specimens. Conclusions: After a one-year simulation of chewing activity, irrespective of preparation geometry, zirconia copings did not show any sign of t–m transformation, either in the load application areas or at the margins. Consequently, manufacturing milling even in thin thickness did not cause any structural modification of zirconia ceramics “as received by manufacturers” both before and after chewing simulation.

Influence of resin cement thickness and temperature variation on mechanical behavior of dental ceramic fragment restoration

To evaluate the stress behavior of ceramic fragment restoration, varying the thickness of the cement layer and intraoral temperature variation. A solid model of a upper lateral incisor was obtained and a defect at enamel distal/incisal edge was restored with a ceramic fragment. Based on this initial model, 4 different models (M) were built: M1 - absence of cement layer (CL) (0 μm of thickness); M2 - CL with an uniform thickness of 50 μm; M3 - CL with 50 μm at the margin of ceramics and 100 μm in the inner area far from margins; M4 - CL with 50 μm at the margin of ceramics and 200 μm in the inner area far from margins. The environment temperature changed from 5 °C to 50 °C in 4 increments. The finite element analysis was performed. Increase the cement layer thickness generated higher stress levels on ceramic surface in all temperatures, as well as on cement interface. In general hot temperature was the worst scenario for ceramic fragments integrity, since tensile and compressive stress were more intense. The maximum principal stress on ceramic fragment was found 90 MPa for M4 at 50 °C, followed for M3 (87 Mpa). For CL, the peak of stress was found for M3 at 5 °C (47 MPa). Is it possible to conclude that thick resin cement layer contribute to higher stress concentration on ceramic fragment, and extremely hot temperatures increase the risk of structural failure, since both ceramic and \cl are exposed to higher compressive and tensile stresses.

A study on stress distribution to cement layer and root dentin for post and cores made of CAD/CAM materials with different elasticity modulus in the absence of ferrule

Background

To evaluate the stress distribution in a maxillary central incisor with different post and cores made of six CAD/CAM materials with different elastic modulus in the absence of ferrule using the finite element analysis.

Material and Methods

A three-dimensional endodontically treated maxillary central incisor restored with an all-ceramic crown was modelled in Rhinoceros (5.0 SR8, McNeel). The geometries were analyzed in ANSYS 17.2 (ANSYS Inc.) considering isotropic, homogeneous, linearly elastic materials with perfectly bonded contacts. The elastic moduli (E) of the post-and-cores defined the groups to be compared: nanoceramic resin (E=12.8GPa); composite resin (E=16GPa); hybrid ceramic (E=34.7GPa); lithium disilicate (E=95GPa); titanium (Ti-Al6-V4) (E=112GPa); and Y-TZP material (E=209.3GPa). The set was constrained in the cortical bone and loaded (45°/100 N) on the incisor palatine face. Stress distribution was analyzed by Maximum Principal Stress criteria for the crown-core cement line, Post-and-core's cement line, Post-and-core system and Dentin.

Results

The stress distribution at the crown-core cement line (11.4 - 13.2 MPa) was inversely proportional to the increase of the elastic modulus of the post-core approaches, while it was direct proportional on the post-and-core (4.7 - 40 MPa) and cement line (4.1 - 6.2 MPa). Stress distribution on the dentin was similar for all groups (24.7 - 25.3).

Conclusions

Post-and-core made by CAD/CAM seems to be an efficient treatment alternative, since it is a conservative approach, promotes better aesthetic quality and it allows the control of the cement line thickness. Key words:Endodontically treated teeth, Post-and-core technique, Ceramic crown, Finite element analysis, Biomimetics.

Evaluating dental zirconia

OBJECTIVES

To survey simple contact testing protocols for evaluating the mechanical integrity of zirconia dental ceramics. Specifically, to map vital material property variations and to quantify competing damage modes.

METHODS

Exploratory contact tests are conducted on layer structures representative of zirconia crowns on dentin.

RESULTS

Sharp-tip micro- and nano-indentations were used to investigate the roles of weak interfaces and residual stresses in veneered zirconia, and to map property variations in graded structures. Tests with blunt sphere indenters on flat specimens were used to identify and quantify various critical damage modes in simulated occlusal loading in veneered and monolithic zirconia.

SIGNIFICANCE

Contact testing is a powerful tool for elucidating the fracture and deformation modes that control the lifetimes of zirconia dental ceramics. The advocated tests are simple, and provide a sound physical basis for analyzing damage resistance of anatomically-correct crowns and other complex dental prostheses.

Load-bearing capacity of lithium disilicate and ultra-translucent zirconias

OBJECTIVE

The aim of this study was to evaluate the load-bearing capacity of monolithic lithium disilicate (LiDi - IPS e.max CAD) and novel ultra-translucent zirconia restorative systems of various compositions: 5Y-PSZ (5 mol% yttria-partially-stabilized zirconia) and 4Y-PSZ (4 mol% yttria-partially-stabilized zirconia); relative to a 3Y-TZP (3 mol% yttria-stabilized zirconia) control.

MATERIALS AND METHODS

Experiments were carried out with 10 disc specimens (Ø12 ×1 mm) per ceramic material. The zirconia intaglio surface (as machined) was sandblasted (50 µm Al₂O₃ at 2 bar), while LiDi was etched with 5% HF for 20 s. The ceramic discs were then adhesively bonded onto a dentin-like substrate (G10, a high-pressure fiberglass material) using Multilink Automix cement and Monobond Plus primer, producing a ceramic/cement/dentin-like substrate trilayer structure. The bonded specimens were stored in water for 3 days at 37 °C prior to a Hertzian indentation flexural radial fracture test. The plate-on-foundation theory was used to validate the load-bearing capacity of the trilayer systems based on the flexural tensile stress at the ceramic intaglio (cementation) surface-a cause for bulk fracture of ceramic onlays.

RESULTS

The experiment data showed that, when bonded to and supported by a dentin-like substrate, the load-bearing capacity of LiDi (872 N) is superior to the 5Y-PSZ (715 N) and can even reach that of 4Y-PSZ (864 N), while 3Y-TZP still holds the highest load-bearing capacity (1195 N). Theoretical analyses agree with experimental observations. The translucency of 5Y-PSZ approaches that of LiDi, which are superior to both 4Y-PSZ and 3Y-TZP.

CONCLUSIONS

When adhesively bonded to and supported by dentin, lithium disilicate exhibits similar load-bearing properties to 4Y-PSZ but much better than 5Y-PSZ.

Complications and survival rates of inlays and onlays vs complete coverage restorations: A systematic review and analysis of studies

OBJECTIVE

The aim of this study was to identify if different types of indirect restorations used for single teeth had different biological and technical complications, as well as survival rates.

METHOD

An electronic search was performed in various electronic databases to identify articles, published between 1980 and 2017. The search terms were categorised into 4 groups: inlay, onlay, inlay/onlay and crown. Manual searches of published full-text articles and related reviews were also performed.

RESULTS

A total number of 2849 papers were retrieved initially. After a detailed assessment for eligibility, 9 studies were selected for inclusion. The heterogeneity of the studies did allow neither a meta-analysis nor any meaningful comparison between types of restorations or materials. Only some pooling was performed for representative reasons. The mean survival rate of inlays was 90.89%, while for onlays and crowns it was 93.50% and 95.38%, respectively. For the fourth study group, consisting of both inlays and onlays, the survival rate was found to be 99.43%. Statistical analysis demonstrated caries to be the main biological complication for all types of restorations, followed by a root and/or tooth fracture incidence (11.34%) and endodontic incidence. Ceramic fractures represented the most common technical complication, followed by loss of retention and porcelain chipping.

CONCLUSION

The 5-year survival rate for crowns and inlays/onlays is very high, exceeding 90%. An association between the kind of complications and different types of restorations could not be established. Nevertheless, a relatively high failure rate due to caries and ceramic fractures was noted.

Analysis of flexural strength and contact pressure after simulated chairside adjustment of pressed lithium disilicate glass-ceramic

STATEMENT OF PROBLEM

Research evaluating load-to-failure of pressed lithium disilicate glass-ceramic (LDGC) with a clinically validated test after adjustment and repair procedures is scarce.

PURPOSE

The purpose of this in vitro study was to investigate the effect of the simulated chairside adjustment of the intaglio surface of monolithic pressed LDGC and procedures intended to repair damage.

MATERIAL AND METHODS

A total of 423 IPS e.max Press (Ivoclar Vivadent AG) disks (15 mm diameter, 1 mm height) were used in the study. The material was tested by using an equibiaxial loading arrangement (n≥30/group) and a contact pressure test (n≥20/group). Specimens were assigned to 1 of 14 groups. One-half was assigned to the equibiaxial load test and the other half underwent contact pressure testing. Testing was performed in 2 parts, before glazing and after glazing. Before-glazing specimens were devested and entered in the test protocol, while after-glazing specimens were devested and glazed before entering the test protocol. Equibiaxial flexure test specimens were placed on a ring-on-ring apparatus and loaded until failure. Contact pressure specimens were cemented to epoxy resin blocks with a resin cement and loaded with a 50-mm diameter hemisphere until failure. Tests were performed on a universal testing machine with a crosshead speed of 0.5 mm/min. Weibull statistics and likelihood ratio contour plots determined intergroup differences (95% confidence bounds).

RESULTS

Before glazing, the equibiaxial flexural strength test and the Weibull and likelihood ratio contour plots demonstrated a significantly higher failure strength for 1EC (188 MPa) than that of the damaged and/or repaired groups. Glazing following diamond-adjustment (1EGG) was the most beneficial post-damage procedure (176 MPa). Regarding the contact pressure test, the Weibull and likelihood ratio contour plots revealed no significant difference between the 1PC (98 MPa) and 1PGG (98 MPa) groups. Diamond-adjustment, without glazing (1EG and 1PG), resulted in the next-to-lowest equibiaxial flexure strength and the lowest contact pressure. After glazing, the strength of all the groups, when subjected to glazing following devesting, increased in comparison with corresponding groups in the before-glazing part of the study.

CONCLUSIONS

A glazing treatment improved the mechanical properties of diamond-adjusted IPS e.max Press disks when evaluated by equibiaxial flexure and contact pressure tests.

Fracture load of colored and non-colored high translucent zirconia three-unit fixed dental prosthesis frameworks

Aim: The use of colored translucent zirconia may enable restorations of a more natural tooth-like appearance than previous opaque white zirconia. The shift from non-colored to colored zirconia may however entail a risk of reduced strength. The aim of the present study was to compare fracture load and fracture mode of fixed dental prostheses frameworks made of colored translucent zirconia to that of non-colored controls.

Methods: A total of forty three-unit FDP frameworks were manufactured from two different high translucent zirconia materials (Zenostar, Wieland Dental, and DD cubeX2, Dental Direkt). Each group contained two subgroups, one colored and one non-colored. Coloring was performed before final sintering using two different infiltration techniques. All FDPs underwent an artificial aging process in the form of heat treatment, thermocycling and preloading whereafter the specimens were subjected to load until fracture. Fracture load and mode was registered.

Results: For one of the zirconia materials, Zenostar, the non-colored frameworks showed significantly higher fracture loads (p < .0001) compared to its colored counterpart. No significant difference (p > .05) was found between colored and non-colored frameworks in the other zirconia material, DD cubeX2. All FDPs fractured through the connector. Some fractures ran through the mesial and some through the distal side of the connector but there were no significant differences in fracture mode between groups.

Conclusion: Coloring before sintering of high-translucent zirconia may decrease the fracture load of FDP frameworks for certain materials and techniques. Fracture mode however, does not appear to be affected.

Comparative Evaluation of Marginal Adaptation and Fracture Strength of Different Ceramic Inlays Produced by CEREC Omnicam and Heat-Pressed Technique

Objective

The aim of this in vitro study was to evaluate marginal adaptation and fracture strength of inlays produced by CEREC Omnicam using different types of blocs and heat-pressed technique. Methods: Seventy-five extracted human mandibular molars were divided randomly into 5 groups (n=15). 60 molars in four groups received MOD inlay preparations. Experimental groups were CO: Intact teeth, EC: IPS e.max CAD and CEREC, LU: Lava Ultimate and CEREC, EL: IPS Empress CAD and CEREC, EP: IPS Empress Esthetic ingots and heat-pressed technique. Marginal gap measurements were taken with a stereomicroscope. Restorations were cemented with Variolink N and stored in distilled water at 37°C for 24 hours. All samples were subjected to thermocycling. The fracture strength of specimens was determined at a 0.5 mm/min crosshead speed until fracture. Fracture modes were determined. Statistical analyses were performed using one-way analysis of variance for fracture strength data and Kruskal–Wallis for marginal gap data (p=0.05).

Results

The mean marginal gap size of EC, LU, EL, and EP were 33.54 µm, 33.77 µm, 34.23 µm, and 85.34 µm, respectively. EP had statistically higher values than other groups. The fracture strength values were significantly higher in the intact teeth group (3959,00 ± 1279,79 N) than those of restored groups EC (2408,00 ± 607,97 N), LU (2206,73 ± 675,16), EL (2573.27 ± 644,73) ve EP (2879,53 ± 897,30).

Conclusion

Inlays fabricated using CEREC Omnicam demonstrated better marginal adaptation than inlays produced with heat-pressed technique, whereas fracture strength values of inlays fabricated with different type of blocks using CEREC Omnicam exhibited similarity to those fabricated with heat-pressed technique.

Numerical fatigue analysis of premolars restored by CAD/CAM ceramic crowns

OBJECTIVES

The purpose of this study was to estimate the fatigue life of premolars restored with two dental ceramics, lithium disilicate (LD) and polymer infiltrated ceramic (PIC) using the numerical method and compare it with the published in vitro data.

METHODS

A premolar restored with full-coverage crown was digitized. The volumetric shape of tooth tissues and crowns were created in Mimics^®. They were transferred to IA-FEMesh for mesh generation and the model was analyzed with Abaqus. By combining the stress distribution results with fatigue stress-life (S-N) approach, the lifetime of restored premolars was predicted.

RESULTS

The predicted lifetime was 1,231,318 cycles for LD with fatigue load of 1400N, while the one for PIC was 475,063 cycles with the load of 870N. The peak value of maximum principal stress occurred at the contact area (LD: 172MPa and PIC: 96MPa) and central fossa (LD: 100MPa and PIC: 64MPa) for both ceramics which were the most seen failure areas in the experiment. In the adhesive layer, the maximum shear stress was observed at the shoulder area (LD: 53.6MPa and PIC: 29MPa).

SIGNIFICANCE

The fatigue life and failure modes of all-ceramic crown determined by the numerical method seem to correlate well with the previous experimental study.

Does veneering technique affect the flexural strength or load-to-failure of bilayer Y-TZP? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Causes of failures of bilayer yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) restorations include the processing technique and the properties of the veneer ceramic. The effect of the veneering method on the mechanical behavior of veneered Y-TZP remains unclear.

PURPOSE

The purpose of this systematic review was to assess the effect of the veneering method on the flexural strength and failure load of bilayer Y-TZP.

MATERIAL AND METHODS

This study followed the Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were performed through August 2017 in PubMed/MEDLINE, Web of Science (Core Collection), Scopus, and Embase, with no year or language limit, targeting in vitro studies evaluating the effect of the veneering technique on the flexural strength and load-to-failure of bilayer Y-TZP immediately or after aging. Statistical analyses were conducted using an appropriate software. Comparisons were drawn with random effect models (α=.05).

RESULTS

From 3242 identified studies, 241 were selected for full-text analysis; from these, 33 studies were included. Manual searching yielded no additional papers. The meta-analysis consisted of 32 studies. Meta-analysis was performed separately for flexural strength and failure load data to compare the hand-layered method (control) with pressed, fused, and cemented veneering techniques. The cemented and fused methods were analyzed using subgroups depending on the veneering material being examined (predominantly glass-ceramics and particle-filled glass-ceramics), and the results were compared with those of the hand-layered method. The pressed group presented flexural strength (7 studies) (P=.150) and failure load (19 studies) (P=.140) values that were similar to those of the hand-layered group. Subgroup analysis revealed that the fused group with particle-filled glass-ceramics (7 studies) produced higher load-to-failure (P=.006) values than the hand-layered group. Subgroup analyses showed a statistical difference that favored the hand-layered over the cemented method, with predominantly glass-ceramic materials (5 studies) (P=.002).

CONCLUSIONS

The fused technique with particle-filled glass-ceramics seems more appropriate for the veneering of Y-TZP, with improved failure load, than the hand-layered method with predominantly glass-ceramic materials. The use of predominantly glass-ceramics for the cemented method is not recommended as failure load was lower than for the hand-layered group. Pressed veneers showed failure load and flexural strength values similar to those of the the hand-layered technique.

Mechanical properties of provisional dental materials: A systematic review and meta-analysis

Provisional restorations represent an important phase during the rehabilitation process, knowledge of the mechanical properties of the available materials allows us to predict their clinical performance. At present, there is no systematic review, which supports the clinicians' criteria, in the selection of a specific material over another for a particular clinical situation. The purpose of this systematic review and meta-analysis was to assess and compare the mechanical properties of dimethacrylates and monomethacrylates used in fabricating direct provisional restorations, in terms of flexural strength, fracture toughness and hardness. This review followed the PRISMA guidelines. The searches were conducted in PubMed, Embase, Web of Science, Scopus, the New York Academy of Medicine Grey Literature Report and were complemented by hand-searching, with no limitation of time or language up to January 10, 2017. Studies that assess and compare the mechanical properties of dimethacrylate- and monomethacrylate-based provisional restoration materials were selected. A quality assessment of full-text articles were performed according to modified ARRIVE and CONSORT criteria and modified Cochrane Collaboration's tool for in vitro studies. Initially, 256 articles were identified. After removing the duplicates and applying the selection criteria, 24 articles were included in the qualitative synthesis and 7 were included in the quantitative synthesis (meta-analysis). It may be concluded that dimethacrylate-based provisional restorations presented better mechanical behavior than monomethacrylate-based ones in terms of flexural strength and hardness. Fracture toughness showed no significant differences. Within the monomethacrylate group, polymethylmethacrylate showed greater flexural strength than polyethylmethacrylate.

Fracture-free surfaces of CAD/CAM lithium metasilicate glass-ceramic using micro-slurry jet erosion

This paper reports the use of micro-slurry jet erosion (MSJE) on CAD/CAM lithium mesilicate glass ceramic (LMGC) that is capable of achieving the fracture-free surface quality. A computer-controlled MSJE process using a low-pressure and low-concentration alumina slurry was applied to diamond-ground LMGC surfaces with surface and subsurface damage. The MSJE processed and diamond-ground LMGC surfaces were examined using scanning electron microscopy (SEM) to examine surface morphology, fractures, and residual defects. 3D confocal laser microscopy (CLM) was used to quantitatively characterize all machined surface textures as a function of processing conditions. Our results show that surface and subsurface damage induced in diamond-ground surfaces were significantly diminished after 50-cycle MSJE processing. Fracture-free surfaces were obtained after 100 MSJE cycles. Our measured parameters of the 3D surface topography included the average surface roughness, maximum peak-valley height, highest peak height, lowest valley height, and kurtosis and absolute skewness of height distributions. All these parameters were significantly reduced with the increase of MSJE cycles. This work implies that MSJE promises to be an effective manufacturing technique for the generation of fracture-free LMGC surfaces which are crucial for high-quality monolithic restorations made from the material.

Stress distribution in endodontically treated abfracted mandibular premolar restored with different cements and crowns: A three-dimensional finite element analysis

Context

Noncarious cervical lesions may penetrate the pulp and require root canal treatment followed by crown placement. Such teeth may be susceptible to fracture, especially at the cervical area.

Aims

To estimate which combination of restorative material and crown resulted in homogenous stress-strain distribution of endodontically treated abfracted mandibular premolar using three-dimensional finite element model (FEM).

Settings and Design

A three-dimensional model of mandibular single-rooted premolar along with alveolar bone was created in finite element analysis (FEA) software preprocessor ANSYS rel 14.5 FEM software (ANSYS Inc., Houston, USA, 1994). Cervical lesion was created in the model with specific dimensions, 3 mm mesiodistally and 2 mm gingivoocclusally with enamel occlusal margin and dentin gingival margin.

Materials and Methods

Tooth was simulated to be root canal treated and restored with different types of cements and crowns followed by placing a static load of 300 N at an angle of 135°. Analysis was run and stress distribution pattern was studied.

Results

Cervical region of an endodontically treated tooth is subjected to stresses, irrespective of restorative material used. Porcelain fused to metal (PFM) crowns showed least strain values with different postendodontic, restorative materials.

Conclusions

FEA is a predictable and reproducible model to predict stress-strain behavior. PFM crowns with different postendodontic restorative materials showed least strain values in the cervical area of abfracted, endodontically treated premolars.

Fracture load and survival of anatomically representative monolithic lithium disilicate crowns with reduced tooth preparation and ceramic thickness

PURPOSE

To investigate the effect of reducing tooth preparation and ceramic thickness on fracture resistance of lithium disilicate crowns.

MATERIALS AND METHODS

Specimen preparation included a standard complete crown preparation of a typodont mandibular left first molar with an occlusal reduction of 2 mm, proximal/axial wall reduction of 1.5 mm, and 1.0 mm deep chamfer (Group A). Another typodont mandibular first molar was prepared with less tooth reduction: 1 mm occlusal and proximal/axial wall reduction and 0.8 mm chamfer (Group B). Twenty crowns were milled from each preparation corresponding to control group (n=5) and conditioned group of simultaneous thermal and mechanical loading in aqueous environment (n=15). All crowns were then loaded until fracture to determine the fracture load.

RESULTS

The mean (SD) fracture load values (in Newton) for Group A were 2340 (83) and 2149 (649), and for Group B, 1752 (134) and 1054 (249) without and with fatigue, respectively. Reducing tooth preparation thickness significantly decreased fracture load of the crowns at baseline and after fatigue application. After fatigue, the mean fracture load statistically significantly decreased (P<.001) in Group B; however, it was not affected (P>.05) in Group A.

CONCLUSION

Reducing the amount of tooth preparation by 0.5 mm on the occlusal and proximal/axial wall with a 0.8 mm chamfer significantly reduced fracture load of the restoration. Tooth reduction required for lithium disilicate crowns is a crucial factor for a long-term successful application of this all-ceramic system.

Fracture Resistance of Zirconia Restorations with a Modified Framework Design

OBJECTIVES

Chipping is one of the concerns related to zirconia crowns. The reasons of chipping have not been completely understood. This in-vitro study aimed to assess the effect of coping design on the fracture resistance of all-ceramic single crowns with zirconia frameworks.

MATERIALS AND METHODS

Two types of zirconia copings were designed (n=12): (1) a standard coping (SC) with a 0.5mm uniform thickness and (2) a modified coping (MC) consisted of a lingual margin of 1mm thickness and 2mm height connected to a proximal strut of 4mm height and a 0.3mm-wide facial collar. After veneer porcelain firing, the crowns were cemented to metal dies. Afterwards, a static vertical load was applied until failure. The modes of failure were determined. Data were calculated and statistically analyzed by independent samples T-test. P<0.05 was considered statistically significant.

RESULTS

The mean and standard deviation (SD) of the final fracture resistance equaled to 3519.42±1154.96 N and 3570.01±1224.33 N in SC and MC groups, respectively; the difference was not statistically significant (P=0.9). Also, the mean and SD of the initial fracture resistance equaled to 3345.34±1190.93 N and 3471.52±1228.93 N in SC and MC groups, respectively (P=0.8). Most of the specimens in both groups showed the mixed failure mode.

CONCLUSIONS

Based on the results, the modified core design may not significantly improve the fracture resistance.

Novel Zirconia Materials in Dentistry

Zirconias, the strongest of the dental ceramics, are increasingly being fabricated in monolithic form for a range of clinical applications. Y-TZP (yttria-stabilized tetragonal zirconia polycrystal) is the most widely used variant. However, current Y-TZP ceramics on the market lack the aesthetics of competitive glass-ceramics and are therefore somewhat restricted in the anterior region. This article reviews the progressive development of currently available and next-generation zirconias, representing a concerted drive toward greater translucency while preserving adequate strength and toughness. Limitations of efforts directed toward this end are examined, such as reducing the content of light-scattering alumina sintering aid or incorporating a component of optically isotropic cubic phase into the tetragonal structure. The latest fabrication routes based on refined starting powders and dopants, with innovative sintering protocols and associated surface treatments, are described. The need to understand the several, often complex, mechanisms of long-term failure in relation to routine laboratory test data is presented as a vital step in bridging the gaps among material scientist, dental manufacturer, and clinical provider.

Effect of thickness and surface modifications on flexural strength of monolithic zirconia

STATEMENT OF PROBLEM

A recommended minimum thickness for monolithic zirconia restorations has not been reported. Assessing a proper thickness that has the necessary load-bearing capacity but also conserves dental hard tissues is essential.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of thickness and surface modifications on monolithic zirconia after simulated masticatory stresses.

MATERIAL AND METHODS

Monolithic zirconia disks (10 mm in diameter) were fabricated with 1.3 mm and 0.8 mm thicknesses. For each thickness, 21 disks were fabricated. The specimens of each group were further divided into 3 subgroups (n=7) according to the surface treatments applied: untreated (control), airborne-particle abrasion with 50-μm Al₂O₃ particles at a pressure of 400 kPa at 10 mm, and grinding with a diamond rotary instrument followed by polishing. The biaxial flexure strength was determined by using a piston-on-3-balls technique in a universal testing machine. Flexural loading was applied with a 1.4-mm diameter steel cylinder, centered on the disk, at a crosshead speed of 0.5 mm/min until fracture occurred. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed. The data were statistically analyzed with 2-way ANOVA, Tamhane T2, 1-way ANOVA, and Student t tests (α=.05).

RESULTS

The 1.3-mm specimens had significantly higher flexural strength than the 0.8-mm specimens (P<.05). Airborne-particle abrasion significantly increased the flexural strength (P<.05). Grinding and polishing did not affect the flexural strength of the specimens (P>.05).

CONCLUSIONS

The mean flexural strength of 0.8-mm and 1.3-mm thick monolithic zirconia was greater than reported masticatory forces. Airborne-particle abrasion increased the flexural strength of monolithic zirconia. Grinding did not affect flexural strength if subsequently polished.

In vitro study of the fracture resistance of monolithic lithium disilicate, monolithic zirconia, and lithium disilicate pressed on zirconia for three-unit fixed dental prostheses

PURPOSE

The purpose of this study was to determine fracture resistance and failure modes of three-unit fixed dental prostheses (FDPs) made of lithium disilicate pressed on zirconia (LZ), monolithic lithium disilicate (ML), and monolithic zirconia (MZ).

MATERIALS AND METHODS

Co-Cr alloy three-unit metal FDPs model with maxillary first premolar and first molar abutments was fabricated. Three different FDPs groups, LZ, ML, and MZ, were prepared (n = 5 per group). The three-unit FDPs designs were identical for all specimens and cemented with resin cement on the prepared metal model. The region of pontic in FDPs was given 50,000 times of cyclic preloading at 2 Hz via dental chewing simulator and received a static load until fracture with universal testing machine fixed at 10°. The fracture resistance and mode of failure were recorded. Statistical analyses were performed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni's correction (α=0.05/3=0.017).

RESULTS

A significant difference in fracture resistance was found between LZ (4943.87 ± 1243.70 N) and ML (2872.61 ± 658.78 N) groups, as well as between ML and MZ (4948.02 ± 974.51 N) groups (P<.05), but no significant difference was found between LZ and MZ groups (P>.05). With regard to fracture pattern, there were three cases of veneer chipping and two interfacial fractures in LZ group, and complete fracture was observed in all the specimens of ML and MZ groups.

CONCLUSION

Compared to monolithic lithium disilicate FDPs, monolithic zirconia FDPs and lithium disilicate glass ceramics pressed on zirconia-based FDPs showed superior fracture resistance while they manifested comparable fracture resistances.

Influence of various bonding techniques on the fracture strength of thin CAD/CAM-fabricated occlusal glass-ceramic veneers

OBJECTIVES

To evaluate the efficiency of immediate dentin sealing and the effects of different bonding protocols on the fracture strength of CAD/CAM occlusal veneers bonded to exposed dentin.

METHODS

Ninety-six extracted maxillary premolars were initially divided into three main groups with 32 specimens each: without immediate dentin sealing, immediate dentin sealing/total etching and immediate dentin sealing/selective etching. Teeth were identically prepared in the dentin to receive occlusal veneers of 0.8mm thickness, milled from lithium disilicate ceramic blocks (IPS e.max CAD). Each main group was later subdivided, according to the pre-cementation surface etching protocol (total/selective), into two subgroups with 16 specimens each. All restorations were adhesively bonded using a resin cement (Variolink Esthetic). Half of the specimens of each subgroup were subjected to thermo-dynamic loading in a chewing simulator with 1,200,000 cycles at 10kg load. The other half and the surviving specimens were subjected to quasi-static loading until failure. Statistical analysis was performed using three-way ANOVA and Tukey's post-hoc tests.

RESULTS

All specimens except one survived the artificial aging. A significantly higher fracture strength of restorations (p ≤ 0.001) was obtained when immediate dentin sealing was followed regardless of the etching method with values ranging from a minimum of 1122 ± 336N to a maximum of 1853 ± 333N. Neither the pre-cementation treatment nor the artificial aging had a statistical significant effect on the fracture strength.

SIGNIFICANCE

Immediate dentin sealing protocol is recommended whenever dentin is exposed during the preparation for thin glass-ceramic occlusal veneers.

A review of engineered zirconia surfaces in biomedical applications

Zirconia is widely used for load-bearing functional structures in medicine and dentistry. The quality of engineered zirconia surfaces determines not only the fracture and fatigue behaviour but also the low temperature degradation (ageing sensitivity), bacterial colonization and bonding strength of zirconia devices. This paper reviews the current manufacturing techniques for fabrication of zirconia surfaces in biomedical applications, particularly, in tooth and joint replacements, and influences of the zirconia surface quality on their functional behaviours. It discusses emerging manufacturing techniques and challenges for fabrication of zirconia surfaces in biomedical applications.

Monolithic zirconia dental crowns. Internal fit, margin quality, fracture mode and load at fracture

OBJECTIVE

Dental all-ceramic restorations of zirconia, with and without an aesthetic veneering layer, have become a viable alternative to conventional metal-ceramic restorations. The aim of this study was to evaluate whether factors of the production methods or the material compositions affect load at fracture, fracture modes, internal fit or crown margins of monolithic zirconia crowns.

METHODS

Sixty crowns made from six different commercially available dental zirconias were produced to a model tooth with a shallow circumferential chamfer preparation. Internal fit was assessed by the replica method. The crown margin quality was assessed by light microscopy on an ordinal scale. The cemented crowns were loaded centrally in the occlusal fossa with a horizontal steel cylinder with a diameter of 13mm at 0.5mm/min until fracture. Fractographic analysis was performed on the fractured crowns.

RESULTS

There were statistically significant differences among the groups regarding crown margins, internal fit and load at fracture (p<0.05, Kruskall Wallis). Fracture analyses revealed that all fractures started cervically and propagated to the occlusal surface similar to clinically observed fractures. There was statistically significant correlation between margin quality and load at fracture (Spearman's rank correlation, p<0,05).

SIGNIFICANCE

Production method and material composition of monolithic zirconia crowns affect internal fit, crown margin quality and the load at fracture. The hard-machined Y-TZP zirconia crowns had the best margin quality and the highest load at fracture. Reduction of margin flaws will improve fracture strength of monolithic zirconia crowns and thereby increase clinical success.

Fracture, roughness and phase transformation in CAD/CAM milling and subsequent surface treatments of lithium metasilicate/disilicate glass-ceramics

This paper studied surface fracture, roughness and morphology, phase transformations, and material removal mechanisms of lithium metasilicate/disilicate glass ceramics (LMGC/LDGC) in CAD/CAM-milling and subsequent surface treatments. LMGC (IPS e.max CAD) blocks were milled using a chairside dental CAD/CAM milling unit and then treated in sintering, polishing and glazing processes. X-ray diffraction was performed on all processed surfaces. Scanning electron microscopy (SEM) was applied to analyse surface fracture and morphology. Surface roughness was quantitatively characterized by the arithmetic average surface roughness R_a and the maximum roughness R_z using desktop SEM-assisted morphology analytical software. The CAD/CAM milling induced extensive brittle cracks and crystal pulverization on LMGC surfaces, which indicate that the dominant removal mechanism was the fracture mode. Polishing and sintering of the milled LMGC lowered the surface roughness (ANOVA, p < 0.05), respectively, while sintering also fully transformed the weak LMGC to the strong LDGC. However, polishing and glazing of LDGC did not significantly improve the roughness (ANOVA, p > 0.05). In comparison of all applied fabrication process routes, it is found that CAD/CAM milling followed by polishing and sintering produced the smoothest surface with R_a = 0.12 ± 0.08µm and R_z = 0.89 ± 0.26µm. Thus_, it is proposed as the optimized process route for LMGC/LDGC in dental restorations. This route enables to manufacture LMGC/LDGC restorations with cost effectiveness, time efficiency, and improved surface quality for better occlusal functions and reduced bacterial plaque accumulation.

Fracture strength of ceramic monolithic crown systems of different thickness

The objective of this study was to evaluate fracture strength of high-translucent (HTZ) and low-translucent (LTZ) zirconia and glass-ceramic (LDS) crowns. HTZ and LTZ crowns were made with thicknesses of; 0.3 mm, 0.5 mm, 0.7 mm, 1.0 mm, and 1.5 mm; and LDS crowns of 1.0 mm and 1.5 mm thicknesses. Each group consisted of 10 crowns. All crowns underwent artificial aging before loading until fracture. Mean fracture strengths varied from 450 N to 3,248 N in the LTZ group, 438 N to 3,487 N in the HTZ group, and 1,030 N to 1,431 N in the LDS group. The load at fracture of HTZ and LTZ crowns was equal. The load at fracture of yttria-stabilized tetragonal zirconia polycrystals crowns was significantly greater than LDS crowns (P = 0.000). Two types of fractures were recorded; complete and partial crack-like fracture. The crack type fracture occurred most frequently in all groups except in the thicker LTZ groups (1.0 mm and 1.5 mm). According to this study, there is no difference in strength between crowns made of high-translucent or low-translucent zirconia. At equal thickness, the strength of zirconia crowns was significantly greater than that of lithium-disilicate glass-ceramic.

Adhesive Cementation Promotes Higher Fatigue Resistance to Zirconia Crowns

Objective: The aim of this study was to investigate the influence of the cementation strategy on the fatigue resistance of zirconia crowns. The null hypothesis was that the cementation strategy would not affect the fatigue resistance of the crowns.

Methods and Materials: Seventy-five simplified molar tooth crown preparations were machined in glass fiber–filled epoxy resin. Zirconia crowns were designed (thickness=0.7 mm), milled by computer-aided design/computer-aided manufacturing, and sintered, as recommended. Crowns were cemented onto the resin preparations using five cementation strategies (n=15): ZP, luting with zinc phosphate cement; PN, luting with Panavia F resin cement; AL, air particle abrasion with alumina particles (125 μm) as the crown inner surface pretreatment + Panavia F; CJ, tribochemical silica coating as crown inner surface pretreatment + Panavia F; and GL, application of a thin layer of porcelain glaze followed by etching with hydrofluoric acid and silanization as crown inner surface pretreatment + Panavia F. Resin cement was activated for 30 seconds for each surface. Specimens were tested until fracture in a stepwise stress fatigue test (10,000 cycles in each step, 600 to 1400 N, frequency of 1.4 Hz). The mode of failure was analyzed by stereomicroscopy and scanning electron microscopy. Data were analyzed by Kaplan-Meier and Mantel-Cox (log rank) tests and a pairwise comparison (p&lt;0.05) and by Weibull analysis.

Results: The CJ group had the highest load mean value for failure (1200 N), followed by the PN (1026 N), AL (1026 N), and GL (1013 N) groups, while the ZP group had the lowest mean value (706 N). Adhesively cemented groups (CJ, AL, PN, and GL) needed a higher number of cycles for failure than the group ZP did. The groups' Weibull moduli (CJ=5.9; AL=4.4; GL=3.9; PN=3.7; ZP=2.1) were different, considering the number of cycles for failure data. The predominant mode of failure was a fracture that initiated in the cement/zirconia layer. Finite element analysis showed the different stress distribution for the two models.

Conclusion: Adhesive cementation of zirconia crowns improves fatigue resistance.

The effect of grinding and/or airborne-particle abrasion on the bond strength between zirconia and veneering porcelain: a systematic review

Objective: The aim of the study was to make an inventory of current literature on the bond strength between zirconia and veneering porcelain after surface treatment of zirconia by grinding with diamond bur and/or with airborne-particle abrasion.

Material and methods: The literature search for the present review was made following recommended guidelines using acknowledged methodology on how to do a systematic review. The electronic databases PubMed, Cochrane Library, and Science Direct were used in the present study.

Results: Twelve studies were selected. Test methods used in the original studies included shear bond strength (SBS) test, tensile bond strength test, and micro-tensile bond strength test. The majority of studies used SBS. Results showed a large variation within each surface treatment of zirconia, using different grain size, blasting time, and pressure.

Conclusions: Airborne-particle abrasion might improve the bond strength and can therefore be considered a feasible surface treatment for zirconia that is to be bonded. Grinding has been recommended as a surface treatment for zirconia to improve the bond strength; however, this recommendation cannot be verified. A standardized test method and surface treatment are required to be able to compare the results from different studies and draw further conclusions.

Microhardness evaluations of CAD/CAM ceramics irradiated with CO2 or Nd:YAP laser

BACKGROUND AND AIMS

The aim of this study was to measure the microhardness values of irradiated computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics surfaces before and after thermal treatment.

MATERIALS AND METHODS

Sixty CAD/CAM ceramic discs were prepared and grouped by material, i.e. lithium disilicate ceramic (Emax CAD) and zirconia ceramic (Emax ZirCAD). Laser irradiation at the material surface was performed with a carbon dioxide laser at 5 Watt (W) or 10 W power in continuous mode (CW mode), or with a neodymium:yttrium aluminum perovskite (Nd:YAP) laser at 10 W on graphite and non-graphite surfaces. Vickers hardness was tested at 0.3 kgf for lithium disilicate and 1 kgf for zirconia.

RESULTS

Emax CAD irradiated with CO₂ at 5 W increased microhardness by 6.32 GPa whereas Emax ZirCAD irradiated with Nd:YAP decreased microhardness by 17.46 GPa.

CONCLUSION

CO₂ laser effectively increases the microhardness of lithium disilicate ceramics (Emax CAD).

Influence of misfit on the occurrence of veneering porcelain fractures (chipping) in implant-supported metal-ceramic fixed dental prostheses: an in vitro pilot trial

OBJECTIVE

Technical complications such as veneer fractures are more common in implant-supported than tooth-supported restorations. The underlying causes have not been fully identified. The aim of this study was to evaluate whether misfit between the restoration and the implant may affect the risk of veneer fractures.

MATERIALS AND METHODS

Twenty standardized five-unit implant-supported metal-ceramic fixed dental prostheses (FDP)s were manufactured and fixed in acrylic blocks. The test group consisted of ten FDPs fixed with a 150-μm misfit at the distal abutment. The remaining ten FDPs were fixed without misfit and acted as a control group. All FDPS underwent cyclic loading for a total of 100,000 cycles at 30-300 N. The FDPs were checked for cracks or chip-off fractures regularly. After cyclic load, the retorque value of all abutment screws was checked.

RESULTS

Cracks within the veneering porcelain were noted in nine FDPs in the test group and one FDP in the control group. This difference was statistically significant (P < 0.001). Fractures of the veneering porcelain occurred in three FDPs in the test group. No fractures occurred in the control group. This difference was not statistically significant. There were no significant differences in retorque values neither between the groups nor between different abutment positions in the FDPs.

CONCLUSIONS

Within the limitations of this in vitro pilot trial, it is suggested that misfit between a restoration and the supporting implant may increase the risk of cracking and/or chipping of the veneering porcelain for metal-ceramic FDPs.

Wear Potential of Dental Ceramics and its Relationship with Microhardness and Coefficient of Friction

PURPOSE

To evaluate, by means of pin-on-disk testing, the wear potential of different dental ceramic systems as it relates to friction parameters, surface finish, and microhardness.

MATERIALS AND METHODS

Three groups of different ceramic systems (Noritake EX3, Eris, Empress II) with 20 disks each (10 glazed, 10 polished) were used. Vickers microhardness (Hv) was determined with a 200-g load for 30 seconds. Friction coefficients (μ) were determined by pin-on-disk testing (5 N load, 600 seconds, and 120 rpm). Wear patterns were assessed by scanning electron microscopy (SEM). The results were analyzed using one-way ANOVA and Tukey's test, with the significance level set at α = 0.05.

RESULTS

The coefficients of friction were as follows: Noritake EX3 0.28 ± 0.12 (polished), 0.33 ± 0.08 (glazed); Empress II 0.38 ± 0.08 (polished), 0.45 ± 0.05 (glazed); Eris 0.49 ± 0.05 (polished), 0.49 ± 0.06 (glazed). Microhardness measurements were as follows: Noritake EX3 530.7 ± 8.7 (polished), 525.9 ± 6.2 (glazed); Empress II 534.1 ± 8 (polished), 534.7 ± 4.5 (glazed); Eris, 511.7 ± 6.5 (polished), 519.5 ± 4.1 (glazed). The polished and glazed Noritake EX3 and polished and glazed Eris specimens showed statistically different friction coefficients. SEM image analysis revealed more surface changes, such as small cracks and grains peeling off, in glazed ceramics.

CONCLUSIONS

Wear potential may be related to the coefficient of friction in Noritake ceramics, which had a lower coefficient than Eris ceramics. Within-group analysis showed no differences in polished or glazed specimens. The differences observed were not associated with microhardness.

Effect of geometry on deformation of anterior implant-supported zirconia frameworks: An in vitro study using digital image correlation

PURPOSE

To evaluate the effect of geometry on the displacement and the strain distribution of anterior implant-supported zirconia frameworks under static load using the 3D digital image correlation method.

METHODS

Two groups (n=5) of 4-unit zirconia frameworks were produced by CAD/CAM for the implant-abutment assembly. Group 1 comprised five straight configuration frameworks and group 2 consisted of five curved configuration frameworks. Specimens were cemented and submitted to static load up to 200N. Displacements were captured with two high-speed photographic cameras and analyzed with video correlation system in three spacial axes U, V, W. Statistical analysis was made using the nonparametric Mann-Whitney test.

RESULTS

Up to 150N loads, the vertical displacements (V axis) were statistically higher for curved frameworks (-267.83±23.76μm), when compared to the straight frameworks (-120.73±36.17μm) (p=0.008), as well as anterior displacements in the W transformed axis (589.55±64.51μm vs 224.29±50.38μm for the curved and straight frameworks), respectively (p=0.008). The mean von Mises strains over the surface frameworks were statistically higher for the curved frameworks under any load.

CONCLUSION

Within the limitations of this in vitro study, it is possible to conclude that the geometric configuration influences the deformation of 4-unit anterior frameworks under static load. The higher strain distribution and micro-movements of the curved frameworks reflect less rigidity and increased risk of fractures associated to FPDs.

Surface quality of yttria-stabilized tetragonal zirconia polycrystal in CAD/CAM milling, sintering, polishing and sandblasting processes

This paper studied the surface quality (damage, morphology, and phase transformation) of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) in CAD/CAM milling, and subsequent polishing, sintering and sandblasting processes applied in dental restorations. X-ray diffraction and scanning electron microscopy (SEM) were used to scan all processed surfaces to determine phase transformations and analyse surface damage morphology, respectively. The average surface roughness (R_a) and maximum roughness (R_z) for all processed surfaces were measured using desk-top SEM-assisted morphology analytical software. X-ray diffraction patterns prove the sintering-induced monoclinic-tetragonal phase transformation while the sandblasting-induced phase transformation was not detected. The CAD/CAM milling of pre-sintered Y-TZP produced very rough surfaces with extensive fractures and cracks. Simply polishing or sintering of milled pre-sintered surfaces did not significantly improve their surface roughness (ANOVA, p>0.05). Neither sintering-polishing of the milled surfaces could effectively improve the surface roughness (ANOVA, p>0.05). The best surface morphology was produced in the milling-polishing-sintering process, achieving R_a=0.21±0.03µm and R_z=1.73±0.04µm, which meets the threshold for bacterial retention. Sandblasting of intaglios with smaller abrasives was recommended as larger abrasive produced visible surface defects. This study provides technical insights into process selection for Y-TZP to achieve the improved restorative quality.

The effect of endodontic access on all-ceramic crowns: A systematic review of in vitro studies

OBJECTIVES

The aim of this systematic review was to identify from in vitro studies the effect of endodontic access on the fracture resistance and damage around the access cavity of all-ceramic crowns.

DATA

The articles identified were screened by two reviewers according to inclusion and exclusion criteria. The reference lists of articles advanced to second round screening were hand searched to identify additional potential articles. The risk of bias for the articles was independently performed by two reviewers.

SOURCES

An electronic search was conducted on PubMed/Medline, Web of Science, Scopus and Embase databases with no limitations.

STUDY SELECTION

383 articles were identified, of which, eight met the inclusion criteria and formed the basis of this systematic review. Factors investigated in the selected articles included the, presence of microcracks at the access cavity, repair protocol, ceramic type, crown fabrication method, luting agent and grit size of the diamond bur. The risk of bias was deemed to be high for three, medium for two and low for three of the reviewed studies. The high level of heterogeneity across the studies precluded meta-analyses.

CONCLUSION

Based on the currently available scientific evidence, a 'best practice' protocol with regard to improving the fracture resistance of endodontically accessed and repaired all-ceramic crowns cannot be conclusively identified. However, some key factors which potentially impact on the fracture resistance of endodontically accessed and repaired all-ceramic crowns have been isolated. Cautious clinical interpretation of these factors is concluded for the maintenance of the crown as a permanent restoration.

CLINICAL SIGNIFICANCE

Key factors which impact on the fracture resistance of endodontically accessed and repaired all-ceramic crowns have been isolated from in vitro studies. Cautious clinical interpretation of these factors is advised for the maintenance of the crown as a permanent restoration.

Effects of mechanical and chemical surface treatments on the resin-glass ceramic adhesion properties

AIM

Intraoral repair of fractured ceramic restorations using resin composite is practical for dental treatment. In the present study, we investigated whether differences in surface treatments for glass ceramic would affect resin adhesion.

METHODS

Leucite-reinforced glass ceramic plates (IPS Empress Esthetic) were ground with 320-grit silicon carbide paper, cleaned using phosphoric acid, and then etched with hydrofluoric acid (IPS Ceramic Etching Gel) or left unetched, and silanized using silane coupling agent (RelyX Ceramic Primer) or kept unsilanized. Either conventional (Adper Scotchbond Multi-Purpose) or universal (Scotchbond Universal) adhesive was used to bond the resin composite to ceramic surfaces. Specimens were subjected to microshear test after 37°C water storage for 24 h, and fractured surfaces were examined. Ceramic surface hydrophobicity after treatments was verified with contact angle measurements. Data were analyzed using anova and Tukey's tests.

RESULTS

Regardless of the adhesive tested, hydrofluoric acid-etched ceramics showed higher bond strengths. Ceramic primer application improved resin bonding, even in non-etched groups, and also influenced fractography (P < 0.001). Contact angles on ceramics treated with ceramic primer were higher than those treated with silane-containing universal adhesive (P < 0.001).

CONCLUSIONS

Mechanical and chemical retentions contribute to resin adhesion to glass ceramic. Universal adhesive seems to not function in the same manner as a silane coupling agent.

Veneered Zirconia-Based Restorations Fracture Resistance Analysis

PURPOSE

To examine the effects of the veneering technique on the fracture resistance of zirconia-based crowns.

MATERIALS AND METHODS

An artificial tooth was prepared with a 1.2 mm heavy chamfer finish line and 8° taper. The prepared tooth was scanned using CAD/CAM technology to fabricate 45 cobalt chromium (CoCr) testing dies. One CoCr die was scanned, and 45 zirconia copings were milled and divided according to the veneering technique into three groups of 15 specimens each: layering veneering (LV) using Vita Vm9, overpressing veneering (OV) using Vita Pm9, and digital veneering (DV) using Vita Triluxe forte. The crowns were cemented onto the testing dies using glass ionomer cement. The specimens were thermocycled (3000 cycles, 5° to 55°) then statically loaded (3.7 mm ball, 0.5 mm/min crosshead speed) until failure. Failed crowns were inspected using a magnifier, and failure patterns were identified. One-way ANOVA and multiple comparison Bonferroni tests were applied for statistical analysis of the results.

RESULTS

Means and standard deviations of failure loads were 1200 ± 306 N for the LV group, 857 ± 188 N for the OV group, and 638 ± 194 N for the DV group. The differences in failure loads were statistically significant between all groups (p < 0.05). Failure mode was predominantly cohesive for LV and OV groups, whereas it was predominantly adhesive for the DV group.

CONCLUSIONS

The LV group was superior to other groups in terms of fracture resistance, while the DV group was inferior to the other groups in the same aspect.

3D-WOVEN FIBER-REINFORCED COMPOSITE FOR CAD/CAM DENTAL APPLICATION

Three-dimensional (3D)-woven noncrimp fiber-reinforced composite (FRC) was tested for mechanical properties in the two principal directions of the main XY plane and compared to different Computer-Aided-Design/Computer-Aided-Machining (CAD/CAM) Dental Materials. The Dental Materials included ceramic with Vitablock Mark II®, ProCAD®, InCeram® Spinel, InCeram® Alumina and InCeram® Zirconia in addition to a resin-based 3M Corp. Paradigm® particulate-filled composite. Alternate material controls included Coors 300 Alumina Ceramic and a tungsten carbide 22% cobalt cermet. The 3D-woven FRC was vacuum assisted resin transfer molding processed as a one-depth-thickness ~19-mm preform with a vinyl-ester resin and cut into blocks similar to the commercial CAD/CAM Dental Materials. Mechanical test samples prepared for a flexural three-point span length of 10.0 mm were sectioned for minimum-depth cuts to compare machinability and fracture resistance between groups. 3D-woven FRC improved mechanical properties with significant statistical differences over all CAD/CAM Dental Materials and Coors Alumina Ceramic for flexural strength (p<0.001), resilience (p<0.05), work of fracture (p<0.001), strain energy release (p<0.05), critical stress intensity factor (p<0.001) and strain (p<0.001).

In vitro performance of two-piece zirconia implant systems for anterior application

OBJECTIVES

To investigate the influence of the implant-abutment connection on the long-term in vitro performance and fracture resistance of two-piece zirconia implant systems for anterior application.

METHODS

Six groups of two-piece zirconia implant systems (n=10/group) with screw-retained (5×) or bonded (1×) connections were restored with full-contour zirconia crowns. A two-piece screw-retained titanium system served as reference. For simulating anterior loading the specimens (n=8/group) were mounted at an angle of 135° in the chewing simulator, and subjected to thermal cycling (TC: 2×9000×5°/55°C) and mechanical loading (ML: 3.6×10(6)×100N). Failed restorations were examined (scanning electron microscopy). Fracture resistance and maximum bending stress of surviving restorations were determined. 2 specimens per group were loaded to fracture after 24h water storage without TCML. Data were statistically analyzed (ANOVA; Bonferroni; Kaplan-Meier-Log-Rank; α=0.05).

RESULTS

The bonded zirconia system and the titanium reference survived TCML without any failures. Screw-retained zirconia systems showed fractures of abutments and/or implants, partly combined with screw fracture/loosening. Failure frequency (F) varied between the groups (F=8×: 3 groups, F=3×: 1 group, F=1×: 1 group). The Log-Rank-test showed significant (p=0.000) differences. Fracture forces and maximum bending stresses (mean±standard deviation) differed significantly (

ANOVA

p=0.000) between 233.4±31.4N/317.1±42.6N/mm(2) and 404.3±15.1N/549.2±20.5N/mm(2). Fracture forces after TCML were similar to 24h fracture forces.

SIGNIFICANCE

Screw-retained two-piece zirconia implant systems showed higher failure rates and lower fracture resistance than a screw-retained titanium system, and may be appropriate for clinical anterior requirements with limitations. Failures involved the abutment/implant region around the screw, indicating that the connecting design is crucial for clinical success.