Performance of dental ceramics: challenges for improvements

Fracture Load and Phase Transformation of Monolithic Zirconia Crowns Submitted to Different Aging Protocols

Monolithic zirconia crowns have many favorable properties and may potentially be used to solve dental problems such as chipping. However, monolithic zirconia crown resistance can be affected by its phase transformation when subjected to low temperatures, humidity, and stress. This study evaluated the fracture load and phase transformation of monolithic zirconia crowns submitted to different thermal and mechanical aging tests. Seventy monolithic zirconia crowns were randomly divided into the following five groups: control, no treatment; hydrothermal aging at 122°C, two bar for one hour; thermal fatigue, 10⁴ cycles between 5°C and 55°C, dwell time, 30 seconds; and mechanical fatigue, 10⁶ cycles with a load of 70 N, sliding of 1.5 mm at 1.4 Hz; and combination of mechanical plus thermal fatigue. Fracture load was measured with a universal testing machine. Surface changes and fracture mode and origin were examined with a scanning electron microscope. Monoclinic phase content was evaluated by x-ray diffraction. The fracture load was analyzed using one-way analysis of variance at a level of 5%, and Weibull distribution was performed. No statistically significant differences were observed in the mean fracture load and characteristic fracture load among the groups (p>0.05). The Weibull modulus ranged from 6.2 to 16.6. The failure mode was similar for all groups with the crack origin located at the contact point of the indenter. Phase transformation was shown at different surfaces of the crown in all groups (1.9% to 8.9%). In conclusion, monolithic zirconia crowns possess high fracture load, structural reliability, and low phase transformation.

Influence of core design, production technique, and material selection on fracture behavior of yttria-stabilized tetragonal zirconia polycrystal fixed dental prostheses produced using different multilayer techniques: split-file, over-pressing, and manually built-up veneers

AIM

To investigate and compare the fracture strength and fracture mode in eleven groups of currently, the most commonly used multilayer three-unit all-ceramic yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) fixed dental prostheses (FDPs) with respect to the choice of core material, veneering material area, manufacturing technique, design of connectors, and radii of curvature of FDP cores.

MATERIALS AND METHODS

A total of 110 three-unit Y-TZP FDP cores with one intermediate pontic were made. The FDP cores in groups 1-7 were made with a split-file design, veneered with manually built-up porcelain, computer-aided design-on veneers, and over-pressed veneers. Groups 8-11 consisted of FDPs with a state-of-the-art design, veneered with manually built-up porcelain. All the FDP cores were subjected to simulated aging and finally loaded to fracture.

RESULTS

There was a significant difference (P<0.05) between the core designs, but not between the different types of Y-TZP materials. The split-file designs with VITABLOCS(®) (1,806±165 N) and e.max(®) ZirPress (1,854±115 N) and the state-of-the-art design with VITA VM(®) 9 (1,849±150 N) demonstrated the highest mean fracture values.

CONCLUSION

The shape of a split-file designed all-ceramic reconstruction calls for a different dimension protocol, compared to traditionally shaped ones, as the split-file design leads to sharp approximal indentations acting as fractural impressions, thus decreasing the overall strength. The design of a framework is a crucial factor for the load bearing capacity of an all-ceramic FDP. The state-of-the-art design is preferable since the split-file designed cores call for a cross-sectional connector area at least 42% larger, to have the same load bearing capacity as the state-of-the-art designed cores. All veneering materials and techniques tested in the study, split-file, over-press, built-up porcelains, and glass-ceramics are, with a great safety margin, sufficient for clinical use both anteriorly and posteriorly. Analysis of the fracture pattern shows differences between the milled veneers and over-pressed or built-up veneers, where the milled ones show numerically more veneer cracks and the other groups only show complete connector fractures.

Dental prostheses mimic the natural enamel behavior under functional loading: A review article

Alumina- and zirconia-based ceramic dental restorations are designed to repair functionality as well as esthetics of the failed teeth. However, these materials exhibited several performance deficiencies such as fracture, poor esthetic properties of ceramic cores (particularly zirconia cores), and difficulty in accomplishing a strong ceramic–resin-based cement bond. Therefore, improving the mechanical properties of these ceramic materials is of great interest in a wide range of disciplines. Consequently, spatial gradients in surface composition and structure can improve the mechanical integrity of ceramic dental restorations. Thus, this article reviews the current status of the functionally graded dental prostheses inspired by the dentino-enamel junction (DEJ) structures and the linear gradation in Young's modulus of the DEJ, as a new material design approach, to improve the performance compared to traditional dental prostheses. This is a remarkable example of nature's ability to engineer functionally graded dental prostheses. The current article opens a new avenue for recent researches aimed at the further development of new ceramic dental restorations for improving their clinical durability.

Mono or polycrystalline alumina-modified hybrid ceramics

OBJECTIVES

This study evaluated the effect of addition of alumina particles (polycrystalline or monocrystalline), with or without silica coating, on the optical and mechanical properties of a porcelain.

METHODS

Groups tested were: control (C), polycrystalline alumina (PA), polycrystalline alumina-silica (PAS), monocrystalline alumina (MA), monocrystalline alumina-silica (MAS). Polycrystalline alumina powder was synthesized using a polymeric precursor method; a commercially available monocrystalline alumina powder (sapphire) was acquired. Silica coating was obtained by immersing alumina powders in a tetraethylorthosilicate solution, followed by heat-treatment. Electrostatic stable suspension method was used to ensure homogenous dispersion of the alumina particles within the porcelain powder. The ceramic specimens were obtained by heat-pressing. Microstructure, translucency parameter, contrast ratio, opalescence index, porosity, biaxial flexural strength, roughness, and elastic constants were characterized.

RESULTS

A better interaction between glass matrix and silica coated crystalline particles is suggested in some analyses, yet further investigation is needed to confirm it. The materials did not present significant differences in biaxial flexural strength, due to the presence of higher porosity in the groups with alumina addition. Elastic modulus was higher for MA and MAS groups. Also, these were the groups with optical qualities and roughness closer to control. The PA and PAS groups were considerably more opaque as well as rougher.

SIGNIFICANCE

Porcelains with addition of monocrystalline particles presented superior esthetic qualities compared to those with polycrystalline particles. In order to eliminate the porosity in the ceramic materials investigated herein, processing parameters need to be optimized as well as different glass frites should be tested.

Fracture of porcelain-veneered gold-alloy and zirconia molar crowns using a modified test set-up

Objective: The main aim of this study was to compare fracture load and fracture mode of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) and metal-ceramic (MC) molar crowns using a modified test set-up to produce fractures similar to those seen in vivo, i.e. fractures of the veneering material rather than complete fractures.

Materials and methods: 13 high-noble-alloy MC and 13 Y-TZP molar crowns veneered with porcelain were manufactured. The crowns were artificially aged before final load to fracture. Load was applied using a 7 mm diameter steel ball exerting force on the cusps with stresses directed toward the core-veneer interface. Fracture surface analysis was performed using light- and scanning electron microscopy.

Results: The test design produced fractures of the veneering material rather than complete fractures. MC crowns withstood significantly (p > 0.001) higher loads (mean 2155 N) than Y-TZP (mean 1505 N) crowns, yet both endure loads sufficient for predictable clinical use. Fracture mode differed between MC and Y-TZP. MC crowns exhibited fractures involving the core-veneer interface but without core exposure. One Y-TZP crown suffered a complete fracture, all others except one displayed fractures of the veneering material involving the core-veneer interface with core exposure.

Conclusions: The test set-up produces fractures similar to those found in vivo and may be useful to evaluate the core-veneer interface of different material systems, both metals and ceramics. The study confirms suggestions from previous studies of a weaker core-veneer bond for Y-TZP compared to MC crowns.

Wear behavior of pressable lithium disilicate glass ceramic

This article reports effects of surface preparation and contact loads on abrasive wear properties of highly aesthetic and high-strength pressable lithium disilicate glass-ceramics (LDGC). Abrasive wear testing was performed using a pin-on-disk device in which LDGC disks prepared with different surface finishes were against alumina pins at different contact loads. Coefficients of friction and wear volumes were measured as functions of initial surface finishes and contact loads. Wear-induced surface morphology changes in both LDGC disks and alumina pins were characterized using three-dimensional laser scanning microscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy. The results show that initial surface finishes of LDGC specimens and contact loads significantly affected the friction coefficients, wear volumes and wear-induced surface roughness changes of the material. Both wear volumes and friction coefficients of LDGC increased as the load increased while surface roughness effects were complicated. For rough LDGC surfaces, three-body wear was dominant while for fine LDGC surfaces, two-body abrasive wear played a key role. Delamination, plastic deformation, and brittle fracture were observed on worn LDGC surfaces. The adhesion of LDGC matrix materials to alumina pins was also discovered. This research has advanced our understanding of the abrasive wear behavior of LDGC and will provide guidelines for better utilization and preparation of the material for long-term success in dental restorations. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 968-978, 2016.

Surface treatments for repair of feldspathic, leucite - and lithium disilicate-reinforced glass ceramics using composite resin

The aim of this study was to evaluate the efficacy of different surface conditioning methods on the microtensile bond strength of a restorative composite repair in three types of dental ceramics: lithium disilicate-reinforced, leucite-reinforced and feldspathic. Twelve blocks were sintered for each type of ceramic (n=3) and stored for 3 months in distilled water at 37 °C. The bonding surface of ceramics was abraded with 600-grit SiC paper. Surface treatments for each ceramic were: GC (control) - none; GDB - diamond bur #30 µm; GHF - hydrofluoric acid (10%); GT- tribochemical silica coating (45-μm size particles). Treatments were followed by cleaning with phosphoric acid 37% for 20 s + silane + adhesive. The composite resin was used as restorative material. After repair, samples were subjected to thermocycled ageing (10,000 cycles between 5 °C and 55 °C for 30 s). Thereafter, the samples were sectioned into 1.0 mm2 sticks and tested for microtensile bond strength with 0.5 mm/min crosshead speed. Data were compared by two-way ANOVA and Tukey's test (α=0.05). The superficial wear with diamond bur proved to be suitable for feldspathic porcelain and for leucite-reinforced glass ceramic while hydrofluoric acid-etching is indicated for repairs in lithium disilicate-reinforced ceramic; tribochemical silica coating is applicable to leucite-reinforced ceramic. Predominance of adhesive failures was observed (>85% in all groups). In conclusion, the success of surface treatments depends on the type of ceramic to be repaired.

Effect of Cleansing Methods on Saliva-Contaminated Zirconia—An Evaluation of Resin Bond Durability

The aims of this study were to investigate 1) the influence of cleansing methods after saliva contamination and 2) aging conditions (thermocycling and water storage) on zirconia shear bond strength (SBS) with a resin cement. One hundred and eighty zirconia specimens were sandblasted with 50 μm aluminum oxide particles, immersed in saliva for one minute (with the exception of the control group, [C]), and divided into groups according to the cleansing method, as follows: water rinse (W); 37% phosphoric acid gel (PA); cleaning paste (ie, Ivoclean®) containing mainly zirconium oxide (IC); and 70% isopropanol (AL). Scanning electron microscopy was done to qualitatively evaluate the zirconia surface after each cleansing method. For the SBS test, resin cement buttons were bonded to the specimens using a dedicated jig. SBS was evaluated according to standard protocols after 24 hours, 5000 thermal cycles (TC), or 150 days of water storage. Statistical analysis was performed using two-way analysis of variance and Tukey test (p&lt;0.05). Data showed a significant effect for the 150 days of water storage, TC, and 24 hours of water storage (150 days &lt; TC &lt; 24 hours). Group comparisons showed that PA &lt; AL and W &lt; IC and C. SBS ranged from 10.4 to 21.9 MPa (24 hours), from 6.4 to 14.8 MPa (TC), and from 2.9 to 7.0 MPa (150 days). Failure analysis revealed a greater percentage of mixed failures for the majority of the specimens and a smaller percentage of adhesive failures at the ceramic-resin cement interface. Our findings suggest that Ivoclean® was able to maintain adequate SBS values after TC and 150 days of storage, comparable to the uncontaminated zirconia.

Influence of preparation design and ceramic thicknesses on fracture resistance and failure modes of premolar partial coverage restorations

STATEMENT OF PROBLEM

Preparation designs and ceramic thicknesses are key factors for the long-term success of minimally invasive premolar partial coverage restorations. However, only limited information is presently available on this topic.

PURPOSE

The purpose of this in vitro study was to evaluate the fracture resistance and failure modes of ceramic premolar partial coverage restorations with different preparation designs and ceramic thicknesses.

MATERIAL AND METHODS

Caries-free human premolars (n=144) were divided into 9 groups. Palatal onlay preparation comprised reduction of the palatal cusp by 2 mm (Palatal Onlay Standard), 1 mm (Palatal-Onlay-Thin), or 0.5 mm (Palatal Onlay Ultrathin). Complete-coverage onlay preparation additionally included the buccal cusp (Occlusal Onlay Standard; Occlusal Onlay Thin; Occlusal Onlay Ultrathin). Labial surface preparations with chamfer reductions of 0.8 mm (Complete-Veneer-Standard), 0.6 mm (Complete-Veneer-Thin), and 0.4 mm (Complete Veneer Ultrathin) were implemented for complete veneer restorations. Restorations were fabricated from a pressable lithium disilicate ceramic (IPS-e.max-Press) and cemented adhesively (Syntac-Classic/Variolink-II). All specimens were subjected to cyclic mechanical loading (F=49 N, 1.2 million cycles) and simultaneous thermocycling (5°C to 55°C) in a mouth-motion simulator. After fatigue, restorations were exposed to single-load-to-failure. Two-way ANOVA was used to identify statistical differences. Pair-wise differences were calculated and P-values were adjusted by the Tukey-Kramer method (α=.05).

RESULTS

All specimens survived fatigue. Mean (SD) load to failure values (N) were as follows: 837 (320/Palatal-Onlay-Standard), 1055 (369/Palatal-Onlay-Thin), 1192 (342/Palatal-Onlay-Ultrathin), 963 (405/Occlusal-Onlay-Standard), 1108 (340/Occlusal-Onlay-Thin), 997 (331/Occlusal-Onlay-Ultrathin), 1361 (333/Complete-Veneer-Standard), 1087 (251/Complete-Veneer-Thin), 883 (311/Complete-Veneer-Ultrathin). Palatal-onlay restorations revealed a significantly higher fracture resistance with ultrathin thicknesses than with standard thicknesses (P=.015). Onlay restorations were not affected by thickness variations. Fracture loads of standard complete veneers were significantly higher than thin (P=.03) and ultrathin (P<.001) restorations.

CONCLUSIONS

In this in vitro study, the reduction of preparation depth to 1.00 and 0.5 mm did not impair fracture resistance of pressable lithium-disilicate ceramic onlay restorations but resulted in lower failure loads in complete veneer restorations on premolars.

Evaluation of removal forces of implant-supported zirconia copings depending on abutment geometry, luting agent and cleaning method during re-cementation

PURPOSE

To evaluate the effects of different abutment geometries in combination with varying luting agents and the effectiveness of different cleaning methods (prior to re-cementation) regarding the retentiveness of zirconia copings on implants.

MATERIALS AND METHODS

Implants were embedded in resin blocks. Three groups of titanium abutments (pre-fabricated, height: 7.5 mm, taper: 5.7°; customized-long, height: 6.79 mm, taper: 4.8°; customized-short, height: 4.31 mm, taper: 4.8°) were used for luting of CAD/CAM-fabricated zirconia copings with a semi-permanent (Telio CS) and a provisional cement (TempBond NE). Retention forces were evaluated using a universal testing machine. Furthermore, the influence of cleaning methods (manually, manually in combination with ultrasonic bath or sandblasting) prior to re-cementation with a provisional cement (TempBond NE) was investigated with the pre-fabricated titanium abutments (height: 7.5 mm, taper: 5.7°) and SEM-analysis of inner surfaces of the copings was performed. Significant differences were determined via two-way ANOVA.

RESULTS

Significant interactions between abutment geometry and luting agent were observed. TempBond NE showed the highest level of retentiveness on customized-long abutments, but was negatively affected by other abutment geometries. In contrast, luting with Telio CS demonstrated consistent results irrespective of the varying abutment geometries. Manual cleaning in combination with an ultrasonic bath was the only cleaning method tested prior to re-cementation that revealed retentiveness levels not inferior to primary cementation.

CONCLUSION

No superiority for one of the two cements could be demonstrated because their influences on retentive strength are also depending on abutment geometry. Only manual cleaning in combination with an ultrasonic bath offers retentiveness levels after re-cementation comparable to those of primary luting.

Fracture Strength of Zirconia and Alumina Ceramic Crowns Supported by Implants

Due to the brittleness and limited tensile strength of the veneering glass-ceramic materials, the methods that combine strong core material (as zirconia or alumina) are still under debate. The present study aims to evaluate the fracture strength and the mechanism of failure through fractographic analysis of single all-ceramic crowns supported by implants. Forty premolar cores were fabricated with CAD/CAM technology using alumina (n = 20) and zirconia (n = 20). The specimens were veneered with glass-ceramic, cemented on titanium abutments, and subjected to loading test until fracture. SEM fractographic analysis was also performed. The fracture load was 1165 (±509) N for alumina and 1638 (±662) N for zirconia with a statistically significant difference between the two groups (P = 0.026). Fractographic analysis of alumina-glass-ceramic crowns, showed the presence of catastrophic cracks through the entire thickness of the alumina core; for the zirconia-glass-ceramic crowns, the cracks involved mainly the thickness of the ceramic veneering layer. The sandblast procedure of the zirconia core influenced crack path deflection. Few samples (n = 3) showed limited microcracks of the zirconia core. Zirconia showed a significantly higher fracture strength value in implant-supported restorations, indicating the role played by the high resistant cores for premolar crowns.

Trends in computer-aided manufacturing in prosthodontics: a review of the available streams

In prosthodontics, conventional methods of fabrication of oral and facial prostheses have been considered the gold standard for many years. The development of computer-aided manufacturing and the medical application of this industrial technology have provided an alternative way of fabricating oral and facial prostheses. This narrative review aims to evaluate the different streams of computer-aided manufacturing in prosthodontics. To date, there are two streams: the subtractive and the additive approaches. The differences reside in the processing protocols, materials used, and their respective accuracy. In general, there is a tendency for the subtractive method to provide more homogeneous objects with acceptable accuracy that may be more suitable for the production of intraoral prostheses where high occlusal forces are anticipated. Additive manufacturing methods have the ability to produce large workpieces with significant surface variation and competitive accuracy. Such advantages make them ideal for the fabrication of facial prostheses.

Coordinate geometry method for capturing and evaluating crown preparation geometry

STATEMENT OF PROBLEM

A validated universal method requiring no human input is needed to capture and evaluate preparation geometries in a manner that can be used to see the correlation of different parameters.

PURPOSE

The purpose of this study was to present a method of capturing and evaluating crown preparation geometry.

MATERIAL AND METHODS

One manually machined acrylic resin block and 9 randomly selected preparations for ceramic complete crowns prepared by general dentists were selected and prepared. The specimens were scanned (3D scanner; Nobel Biocare), and buccolingual and mesiodistal cross section images were collected. The images were imported into digitizing software (Engauge Digitizer 4.1) to convert the outlines into x and y coordinates. Six points were chosen by using a set of algorithms, and the resulting parameters were calculated.

RESULTS

The acrylic resin block was milled with a 12 degree total occlusal convergence (TOC) instrument producing a 12.83 degree TOC. For the other specimens, average TOC values ranged from 18 degrees to 52 degrees. The mean average margin width was 0.70 mm, and the mean average base dimension was 6.23 mm. The surface area/volume ratio, resistance length, and limiting taper were also calculated.

CONCLUSIONS

The method described provides a basis for accurately evaluating preparation geometry without human input.

Influence of Abutment Design on Stiffness, Strength, and Failure of Implant-Supported Monolithic Resin Nano Ceramic (RNC) Crowns

BACKGROUND

Recent technical development allows the digital manufacturing of monolithic reconstructions with high-performance materials. For implant-supported crowns, the fixation requires an abutment design onto which the reconstruction can be bonded.

PURPOSE

The aim of this laboratory investigation was to analyze stiffness, strength, and failure modes of implant-supported, computer-assisted design and computer-aided manufacturing (CAD/CAM)-generated resin nano ceramic (RNC) crowns bonded to three different titanium abutments.

MATERIALS AND METHODS

Eighteen monolithic RNC crowns were produced and loaded in a universal testing machine under quasi-static condition according to DIN ISO 14801. With regard to the type of titanium abutment, three groups were defined: (1) prefabricated cementable standard; (2) CAD/CAM-constructed individualized; and (3) novel prefabricated bonding base. Stiffness and strength were measured and analyzed statistically with Wilcoxon rank sum test. Sections of the specimens were examined microscopically.

RESULTS

Stiffness demonstrated high stability for all specimens loaded in the physiological loading range with means and standard deviations of 1,579 ± 120 N/mm (group A), 1,733 ± 89 N/mm (group B), and 1,704 ± 162 N/mm (group C). Mean strength of the novel prefabricated bonding base (group C) was 17% lower than of the two other groups. Plastic deformations were detectable for all implant-abutment crown connections.

CONCLUSIONS

Monolithic implant crowns made of RNC seem to represent a feasible and stable prosthetic construction under laboratory testing conditions with strength higher than the average occlusal force, independent of the different abutment designs used in this investigation.

Fracture strength of monolithic all-ceramic crowns made of high translucent yttrium oxide-stabilized zirconium dioxide compared to porcelain-veneered crowns and lithium disilicate crowns

OBJECTIVE

The aim of the study was to provide data on the fracture strength of monolithic high translucent Y-TZP crowns and porcelain-veneered high translucent Y-TZP crown cores and to compare that data with the fracture strength of porcelain-veneered Y-TZP crown cores and monolithic lithium disilicate glass-ceramic crowns.

MATERIALS AND METHODS

Sixty standardized crowns divided into six groups (n = 10) were fabricated: monolithic high translucent Y-TZP crowns, brand A, monolithic high translucent Y-TZP crowns, brand B, veneered high translucent Y-TZP crown cores, brand A, veneered high translucent Y-TZP crown cores, brand B, heat-pressed monolithic lithium disilicate crowns and veneered Y-TZP crown cores. All crowns were thermocycled, cemented onto dies, cyclically pre-loaded and finally loaded to fracture.

RESULTS

The monolithic Y-TZP groups showed significantly higher fracture strength (2795 N and 3038 N) compared to all other groups. The fracture strength in the veneered Y-TZP group (2229 N) was significantly higher than the monolithic lithium disilicate group (1856 N) and the veneered high translucent Y-TZP groups (1480 N and 1808 N).

CONCLUSIONS

The fracture strength of monolithic high translucent Y-TZP crowns is considerably higher than that of porcelain-veneered Y-TZP crown cores, porcelain-veneered high translucent Y-TZP crown cores and monolithic lithium disilicate crowns. The fracture strength of a crown made of monolithic high translucent Y-TZP is, with a large safety margin, sufficient for clinical use for the majority of patients. Porcelain-veneered Y-TZP crown cores show higher fracture resistance than monolithic lithium disilicate crowns.

Effect of various veneering techniques on mechanical strength of computer-controlled zirconia framework designs

PURPOSE

The objectives of this study were to evaluate the fracture resistance (FR), flexural strength (FS), and shear bond strength (SBS) of zirconia framework material veneered with different methods and to assess the stress distributions using finite element analysis (FEA).

MATERIALS AND METHODS

Zirconia frameworks fabricated in the forms of crowns for FR, bars for FS, and disks for SBS (N = 90, n = 10) were veneered with either (a) file splitting (CAD-on) (CD), (b) layering (L), or (c) overpressing (P) methods. For crown specimens, stainless steel dies (N = 30; 1 mm chamfer) were scanned using the labside contrast spray. A bilayered design was produced for CD, whereas a reduced design (1 mm) was used for L and P to support the veneer by computer-aided design and manufacturing. For bar (1.5 × 5 × 25 mm(3) ) and disk (2.5 mm diameter, 2.5 mm height) specimens, zirconia blocks were sectioned under water cooling with a low-speed diamond saw and sintered. To prepare the suprastructures in the appropriate shapes for the three mechanical tests, nano-fluorapatite ceramic was layered and fired for L, fluorapatite-ceramic was pressed for P, and the milled lithium-disilicate ceramics were fused with zirconia by a thixotropic glass ceramic for CD and then sintered for crystallization of veneering ceramic. Crowns were then cemented to the metal dies. All specimens were stored at 37°C, 100% humidity for 48 hours. Mechanical tests were performed, and data were statistically analyzed (ANOVA, Tukey's, α = 0.05). Stereomicroscopy and scanning electron microscopy (SEM) were used to evaluate the failure modes and surface structure. FEA modeling of the crowns was obtained.

RESULTS

Mean FR values (N ± SD) of CD (4408 ± 608) and L (4323 ± 462) were higher than P (2507 ± 594) (p < 0.05). Mean FS values (MPa ± SD) of CD (583 ± 63) and P (566 ± 54) were higher than L (428 ± 41) (p < 0.05). Mean SBS values (MPa ± SD) of CD (49 ± 6) (p < 0.05) were higher than L (28 ± 5) and P (30 ± 8). For crown restorations, while cohesive failures within ceramic and zirconia were seen in CD, cohesive failures within ceramic were found in both L and P. Results were verified by FEA.

CONCLUSION

The file splitting technique showed higher bonding values in all mechanical tests, whereas a layering technique increased the FR when an anatomical core design was employed.

CLINICAL SIGNIFICANCE

File splitting (CAD-on) or layering veneering ceramic on zirconia with a reduced framework design may reduce ceramic chipping.

Digital imaging and fabrication

Bioceramics have been adopted in dental restorations for implants, bridges, inlays, onlays, and all-ceramic crowns. Dental bioceramics include glass ceramics, reinforced porcelains, zirconias, aluminas, fiber-reinforced ceramic composites, and multilayered ceramic structures. The process of additive manufacturing is ideally suited to dentistry. Models are designed using data from a computed tomography scan or magnetic resonance imaging. Since its development in 2001, direct ceramic machining of presintered yttria tetragonal zirconia polycrystal has become increasingly popular in dentistry. There are wide variety commercially available cements for luting all-ceramic restorations. However, resin cements have lower solubility and better aesthetic characteristics.

Marginal and internal fit of heat pressed versus CAD/CAM fabricated all-ceramic onlays after exposure to thermo-mechanical fatigue

OBJECTIVES

The aim of the study was to evaluate the marginal and internal fit of heat-pressed and CAD/CAM fabricated all-ceramic onlays before and after luting as well as after thermo-mechanical fatigue.

MATERIALS AND METHODS

Seventy-two caries-free, extracted human mandibular molars were randomly divided into three groups (n=24/group). All teeth received an onlay preparation with a mesio-occlusal-distal inlay cavity and an occlusal reduction of all cusps. Teeth were restored with heat-pressed IPS-e.max-Press* (IP, *Ivoclar-Vivadent) and Vita-PM9 (VP, Vita-Zahnfabrik) as well as CAD/CAM fabricated IPS-e.max-CAD* (IC, Cerec 3D/InLab/Sirona) all-ceramic materials. After cementation with a dual-polymerising resin cement (VariolinkII*), all restorations were subjected to mouth-motion fatigue (98 N, 1.2 million cycles; 5°C/55°C). Marginal fit discrepancies were examined on epoxy replicas before and after luting as well as after fatigue at 200× magnification. Internal fit was evaluated by multiple sectioning technique. For the statistical analysis, a linear model was fitted with accounting for repeated measurements.

RESULTS

Adhesive cementation of onlays resulted in significantly increased marginal gap values in all groups, whereas thermo-mechanical fatigue had no effect. Marginal gap values of all test groups were equal after fatigue exposure. Internal discrepancies of CAD/CAM fabricated restorations were significantly higher than both press manufactured onlays.

CONCLUSIONS

Mean marginal gap values of the investigated onlays before and after luting as well as after fatigue were within the clinically acceptable range. Marginal fit was not affected by the investigated heat-press versus CAD/CAM fabrication technique. Press fabrication resulted in a superior internal fit of onlays as compared to the CAD/CAM technique.

CLINICAL RELEVANCE

Clinical requirements of 100 μm for marginal fit were fulfilled by the heat-press as well as by the CAD/CAM fabricated all-ceramic onlays. Superior internal fit was observed with the heat-press manufacturing method. The impact of present findings on the clinical long-term behaviour of differently fabricated all-ceramic onlays warrants further investigation.

Evidence of yttrium silicate inclusions in YSZ-porcelain veneers

This report introduces the discovery of crystalline defects that can form in the porcelain veneering layer when in contact with yttria-stabilized zirconia (YSZ). The focus was on dental prostheses and understanding the defects that form in the YSZ/porcelain system; however the data reported herein may have broader implications toward the use and stability of YSZ-based ceramics in general. Specimens were cut from fully sintered YSZ plates and veneering porcelain was applied (<1 mm thick) to one surface and fired under manufacturer's recommended protocol. Scanning electron microscopy (SEM) with integrated electron dispersive X-ray (EDAX) was used for microstructural and elemental analysis. EDAX, for chemical analysis and transmission electron diffraction (TED) for structural analysis were both performed in the transmission electron microscope (TEM). Additionally, in order to spatially resolve Y-rich precipitates, micro-CT scans were conducted at varying depths within the porcelain veneer. Local EDAX (SEM) was performed in the regions of visible inclusions and showed significant increases in yttrium concentration. TEM specimens also showed apparent inclusions in the porcelain and selected area electron diffraction was performed on these regions and found the inclusions to be crystalline and identified as either yttrium-silicate (Y2 SiO5 ) or yttrium-disilicate (Y2 Si2 O7 ). Micro-CT data showed that yttrium-silicate precipitates were distributed throughout the thickness of the porcelain veneer. Future studies are needed to determine whether many of the premature failures associated with this materials system may be the result of crystalline flaws that form as a result of high temperature yttrium diffusion near the surfaces of YSZ.

Implant-supported full-arch zirconia-based mandibular fixed dental prostheses. Eight-year results from a clinical pilot study

OBJECTIVE

The purpose of this pilot study was to evaluate the long-term clinical performance of implant-supported full-arch zirconia-based fixed dental prostheses (FDPs).

MATERIALS AND METHODS

Ten patients received full-arch zirconia-based (Cercon) mandibular FDPs supported by four implants (Astra Tech). Nine patients received 10-unit FDPs and one patient received a 9-unit FDP. The FDPs were cemented onto individually prepared titanium abutments and were evaluated at baseline and after 12, 24, 36 and 96 months.

RESULTS

Nine patients attended the 8-year follow-up. None of the restorations showed bulk fracture, all FDPs were in use. Fractures of the veneering porcelain were, however, observed in eight patients. A total of 36 out of 89 units (40%) showed such fractures. Patient satisfaction was excellent despite the veneering material fractures.

CONCLUSION

Results from this 8-year pilot study suggest that implant-supported full-arch zirconia-based FDPs can be an acceptable treatment alternative.

Load-bearing properties of minimal-invasive monolithic lithium disilicate and zirconia occlusal onlays: finite element and theoretical analyses

OBJECTIVE

The aim of this study was to test the hypothesis that monolithic lithium disilicate glass-ceramic occlusal onlay can exhibit a load-bearing capacity that approaches monolithic zirconia, due to a smaller elastic modulus mismatch between the lithium disilicate and its supporting tooth structure relative to zirconia.

METHODS

Ceramic occlusal onlays of various thicknesses cemented to either enamel or dentin were considered. Occlusal load was applied through an enamel-like deformable indenter or a control rigid indenter. Flexural tensile stress at the ceramic intaglio (cementation) surface-a cause for bulk fracture of occlusal onlays-was rigorously analyzed using finite element analysis and classical plate-on-foundation theory.

RESULTS

When bonded to enamel (supported by dentin), the load-bearing capacity of lithium disilicate can approach 75% of that of zirconia, despite the flexural strength of lithium disilicate (400MPa) being merely 40% of zirconia (1000MPa). When bonded to dentin (with the enamel completely removed), the load-bearing capacity of lithium disilicate is about 57% of zirconia, still significantly higher than the anticipated value based on its strength. Both ceramics show slightly higher load-bearing capacity when loaded with a deformable indenter (enamel, glass-ceramic, or porcelain) rather than a rigid indenter.

SIGNIFICANCE

When supported by enamel, the load-bearing property of minimally invasive lithium disilicate occlusal onlays (0.6-1.4mm thick) can exceed 70% of that of zirconia. Additionally, a relatively weak dependence of fracture load on restoration thickness indicates that a 1.2mm thin lithium disilicate onlay can be as fracture resistant as its 1.6mm counterpart.

Fracture toughness improvements of dental ceramic through use of yttria-stabilized zirconia (YSZ) thin-film coatings

OBJECTIVES

The aim of this study was to evaluate strengthening mechanisms of yttria-stabilized zirconia (YSZ) thin film coatings as a viable method for improving fracture toughness of all-ceramic dental restorations.

METHODS

Bars (2mm×2mm×15mm, n=12) were cut from porcelain (ProCAD, Ivoclar-Vivadent) blocks and wet-polished through 1200-grit using SiC abrasive. A Vickers indenter was used to induce flaws with controlled size and geometry. Depositions were performed via radio frequency magnetron sputtering (5mT, 25°C, 30:1 Ar/O2 gas ratio) with varying powers of substrate bias. Film and flaw properties were characterized by optical microscopy, scanning electron microscopy (SEM), and X-ray diffraction (XRD). Flexural strength was determined by three-point bending. Fracture toughness values were calculated from flaw size and fracture strength.

RESULTS

Data show improvements in fracture strength of up to 57% over unmodified specimens. XRD analysis shows that films deposited with higher substrate bias displayed a high %monoclinic volume fraction (19%) compared to non-biased deposited films (87%), and resulted in increased film stresses and modified YSZ microstructures. SEM analysis shows critical flaw sizes of 67±1μm leading to fracture toughness improvements of 55% over unmodified specimens.

SIGNIFICANCE

Data support surface modification of dental ceramics with YSZ thin film coatings to improve fracture toughness. Increase in construct strength was attributed to increase in compressive film stresses and modified YSZ thin film microstructures. It is believed that this surface modification may lead to significant improvements and overall reliability of all-ceramic dental restorations.

The wear of polished and glazed zirconia against enamel

STATEMENT OF PROBLEM

The wear of tooth structure opposing anatomically contoured zirconia crowns requires further investigation.

PURPOSE

The purpose of this in vitro study was to measure the roughness and wear of polished, glazed, and polished then reglazed zirconia against human enamel antagonists and compare the measurements to those of veneering porcelain and natural enamel.

MATERIAL AND METHODS

Zirconia specimens were divided into polished, glazed, and polished then reglazed groups (n=8). A veneering porcelain (Ceramco3) and enamel were used as controls. The surface roughness of all pretest specimens was measured. Wear testing was performed in the newly designed Alabama wear testing device. The mesiobuccal cusps of extracted molars were standardized and used as antagonists. Three-dimensional (3D) scans of the specimens and antagonists were obtained at baseline and after 200 000 and 400 000 cycles with a profilometer. The baseline scans were superimposed on the posttesting scans to determine volumetric wear. Data were analyzed with a 1-way ANOVA and Tukey Honestly Significant Difference (HSD) post hoc tests (α=.05)

RESULTS

Surface roughness ranked in order of least rough to roughest was: polished zirconia, glazed zirconia, polished then reglazed zirconia, veneering porcelain, and enamel. For ceramic, there was no measureable loss on polished zirconia, moderate loss on the surface of enamel, and significant loss on glazed and polished then reglazed zirconia. The highest ceramic wear was exhibited by the veneering ceramic. For enamel antagonists, polished zirconia caused the least wear, and enamel caused moderate wear. Glazed and polished then reglazed zirconia showed significant opposing enamel wear, and veneering porcelain demonstrated the most.

CONCLUSIONS

Within the limitations of the study, polished zirconia is wear-friendly to the opposing tooth. Glazed zirconia causes more material and antagonist wear than polished zirconia. The surface roughness of the zirconia aided in predicting the wear of the opposing dentition.

Influence of substructure design, veneer application technique, and firing regime on the in vitro performance of molar zirconia crowns

OBJECTIVES

The aim of this in vitro study was to evaluate the influence of substructure design, veneer application technique, and firing regime on the failure and fracture resistance of molar zirconia crowns.

METHODS

Six groups (n=8/group) of zirconia crowns were fabricated in simple core (SC) or anatomically reduced (AR) design, veneered with different feldspathic or glass ceramic materials, and defined according to the application technique and firing regime (LT: layering technique; LT_L: LT with long-term cooling; PT: press technique; DV: digital veneering technique). The following groups were investigated: SCLT, ARLT, SCLT_L, SCPT, ARPT, ARDV. Crowns were adhesively bonded to polymethylmethacrylate abutment teeth and subjected to thermal cycling (TC: 2×3000×5°/55°) and mechanical loading (ML: 1.2×10(6); 50N; 1.6Hz) in a chewing simulator with metal-ceramic molar crowns as antagonists. Failures were monitored and fracture resistance determined after aging. Data were statistically analyzed (one-way analysis of variance, ANOVA; post hoc Bonferroni, α=0.05). Crowns were subjected to scanning electron microscopy for fractographic failure analysis.

RESULTS

Failures (chipping, cracks) during TCML were observed in groups SCLT (2×), ARDV (2×) and SCLT_L (1×). Defect sizes varied between 3.5mm (SCLT: crack) and 30.0mm(2) (SCLT_L: chipping). Mean (SD) fracture forces ranged between 1529.0 (405.2)N for SCPT and 2372.3 (351.8)N for ARDV.

SIGNIFICANCE

The failure frequency of veneered zirconia crowns could be reduced by using anatomically reduced substructures, the press veneering technique, and an adapted cooling protocol. Fracture resistance increased with use of anatomically reduced substructures and the digital veneering technique.

Enhanced osteoblastic cell response on zirconia by bio-inspired surface modification

Excellent esthetic properties and limited plaque adhesion make zirconia ceramics an ideal material for implants in the fields of dentistry and orthopedics. Unfortunately, the physicochemical stability of zirconia makes it difficult to improve biocompatibility through surface modification. The dopamine-derived residue, 3,4-dihydroxy-L-phenylalanine (L-DOPA), has been identified as an important molecule secreted by marine mussels for the formation of adhesive pads. This study coated zirconia with L-DOPA to improve the biocompatibility of ZrO2. As confirmed by contact angle and X-ray photoelectron spectroscopy (XPS), the formation of L-DOPA film can be controlled by varying the process temperature. Results from scanning electron microscopy (SEM) and atomic force microscopy (AFM) show that the topography of the zirconia substrate was preserved after being coated with a film of L-DOPA. Specifically, the thickness of the coating and initial cell spreading ability were both enhanced by preparing samples at higher temperatures. L-DOPA coated zirconia demonstrated better cyto-compatibility than uncoated specimens, as indicated by cell responses such as cell spreading and proliferation. These preliminary results suggest that L-DOPA film could be used to improve the cyto-compatibility of zirconia and further has the potential to immobilize other biofunctional molecules in biomedical applications.

Practice-based clinical evaluation of metal-ceramic and zirconia molar crowns: 3-year results

This practice-based study evaluates the clinical performance of conventionally luted metal-ceramic and zirconia molar crowns fabricated with pronounced anatomical core design and a prolonged cooling period of the veneering porcelain. Fifty-three patients were treated from 07/2008 until 07/2009 with either metal-ceramic crowns (MCC) (high-noble alloy + low-fusing porcelain) or zirconia crowns (Cercon System, DeguDent, Germany). Forty-nine patients (30 women/19 men) with 100 restorations (metal-ceramic: 48/zirconia: 52, mean observational period: 36·5 ± 6 months) participated in a clinical follow-up examination and were included in the study. Time-dependent survival (in situ criteria), success (event-free restorations) and chipping rates (defects of the veneering ceramics) were calculated according to the Kaplan-Meier method and analysed in relation to the crown fabrication technique, using a Cox regression model (P < 0·05). Three complete failures (metal-ceramic: 1, zirconia: 2) were recorded (survival rate after 3 years: metal-ceramic: 97·6%, zirconia: 95·2%). Of the metal-ceramic restorations, 90·9% remained event-free (two ceramic fractures, one endodontic treatment), whereas the success rate for the zirconia was 86·8% (two ceramic fractures, one endodontic treatment, one secondary caries). No significant differences in survival (P = 0·53), success (P = 0·49) and ceramic fracture rates (P = 0·57) were detected. The combination of a pronounced anatomical core design and a modified firing of the veneering porcelain for the fabrication of zirconia molar crowns resulted in a 3-year survival, success and chipping rate comparable to MCC.