Current status of zirconia restoration

Effect of Simplified Bonding on Shear Bond Strength between Ceramic Brackets and Dental Zirconia

The aim of this study was to evaluate the long term stability of shear bond strength (SBS) when 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) containing universal adhesive was used in the ceramic bracket bonding on dental zirconia. Twenty human maxillary incisors were collected. The ceramic bracket was bonded on the buccal enamel surface after the acid-etching and orthodontic primer application (Group CON). Sixty zirconia specimens were sintered, sandblasted and divided into three experimental groups; group CP—ceramic primer followed by an orthodontic primer; group U—universal adhesive; group CU—ceramic primer followed by a universal adhesive. For each specimen, the bracket was bonded onto the treated surface with composite resin (Transbond XT, 3M ESPE). The SBS tested before (CON0, CP0, U0, CU0) and after the artificial aging (CON1, CP1, U1, CU1). The data were statistically analyzed with the Kruskal–Wallis test at a significance level of 0.05. The mean SBS of CON0, CP0, U0 and CU0 were within the clinically acceptable range without significant differences. After the aging process, SBS decreased in all groups. Among the aged groups, CP1 showed the highest SBS. Based on the results, when bonding ceramic brackets to a dental zirconia surface, we can conclude that ceramic primer used with an orthodontic primer, rather than using a universal adhesive, is recommended.

Adhesion behavior of conventional and high-translucent zirconia: Effect of surface conditioning methods and aging using an experimental methodology

OBJECTIVE

Evaluate the adhesive behavior of conventional and high-translucent zirconia after surface conditioning and hydrothermal aging.

MATERIALS AND METHODS

Conventional (ZrC) and high-translucent zirconia (ZrT) specimens were divided into six groups: without surface treatment (ZrC and ZrT), air-borne particle abrasion with 50-μm Al₂ O₃ sized particles (ZrC-AO and ZrT-AO), and tribochemical treatment with 30-μm silica modified Al₂ O₃ sized particles (ZrC-T and ZrT-T). Zirconia specimens were treated using an MDP-containing universal adhesive and bonded to two resins blocks with an adhesive luting cement. Microbar specimens with cross-sectioned areas of 1 mm² were achieved. Half of the microbars were subjected to hydrothermal aging. Bond strength was evaluated by microtensile bond strength test and statistically evaluated by the Weibull analysis.

RESULTS

Roughness of the ZrC-AO and ZrT-AO groups were statistically higher. Bond strength analysis revealed higher bond strength for ZrC-AO and ZrC-T groups compared to ZrT-AO and ZrT-T, respectively. Mixed failure was the most frequent for the mechanically treated groups, while no cohesive failures were obtained.

CONCLUSION

Lower values of bond strength were obtained for the mechanically treated high-translucent zirconia groups when compared to their conventional zirconia counterparts. Mechanical surface treatment significantly improved the bond strength to conventional and high-translucent zirconia.

CLINICAL SIGNIFICANCE

Mechanical surface treatment (air-borne particle abrasion or tribochemical treatment) associated with the use of universal adhesives containing MDP could provide a durable bonding to conventional and high-translucent zirconia.

Surface Roughness of Monolithic and Layered Zirconia Restorations at Different Stages of Finishing and Polishing: An In Vitro Study

PURPOSE

To evaluate surface roughness and topography of different zirconia-based restorations at various steps of finishing and polishing.

MATERIALS AND METHODS

Seventy-five zirconia discs were fabricated and divided into 3 layered and 2 monolithic groups: layered conventional (VM9; Vita), layered pressed (PM9; Vita), layered digital (TriLuxe Forte; Vita), opaque monolithic (Ceramill Zi; Amann Girrbach), and translucent monolithic (Zolid FX; Amann Girrbach). Surface roughness testing (Ra, Rz) and scanning electron microscopy were performed at the glazed, unglazed, finished, polished, super-polished, and super-polished with diamond paste steps. One-way ANOVA and Tukey tests were used for statistical analysis.

RESULTS

There were significant differences in all groups among the different steps (p < 0.001, F = 77.67 for layered conventional; p < 0.001, F = 133.90 for layered pressed; p < 0.001, F = 47.94 for layered digital; p < 0.001, F = 48.05 for zirconia opaque; p < 0.001, F = 43.91 for zirconia translucent). For the layered groups, glazed stage was significantly different from all other steps (p < 0.001). For the layered conventional and digital groups, polishing using diamond paste was not significantly different from the polished and super-polished steps (p = 0.448, p = 0.153), while for the layered pressed group, polishing using diamond paste was not significantly different from the super polished step (p = 0.815). For monolithic groups, there were no significant differences between the polished and super-polished steps (p = 0.957 for zirconia opaque, p = 1.00 for zirconia translucent). Both the diamond paste and super-polished steps showed no significant differences (p = 0.620, p = 0.550) from the glazed surface in the opaque zirconia group.

CONCLUSIONS

Surface roughness of monolithic and layered zirconia was improved by polishing; however, only opaque zirconia reached the level of surface roughness of the glazed stage. Type of buildup affected the surface roughness of adjusted ceramics, with monolithic zirconia showing lower surface roughness than layered zirconia. Polishing with diamond paste provided no significant improvement in the surface roughness of monolithic or layered zirconia.

Effects of different finishing/polishing protocols and systems for monolithic zirconia on surface topography, phase transformation, and biofilm formation

PURPOSE

The purpose of this study was to evaluate the effects of various protocols and systems for finishing and polishing monolithic zirconia on surface topography, phase transformation, and bacterial adhesion.

MATERIALS AND METHODS

Three hundred monolithic zirconia specimens were fabricated and then treated with three finishing and polishing systems (Jota [JO], Meisinger [ME], and Edenta [ED]) using four surface treatment protocols: coarse finishing alone (C); coarse finishing and medium polishing (CM); coarse finishing and fine polishing (CF); and coarse finishing, medium polishing, and fine polishing (CMF). Surface roughness, crystal phase transformation, and bacterial adhesion were evaluated using atomic force microscopy, X-ray diffraction, and streptococcal biofilm formation assay, respectively. One-way and two-way analysis of variance with Tukey post hoc tests were used to analyze the results (α=.05).

RESULTS

In this study, the surface treatment protocols and systems had significant effects on the resulting roughness. The CMF protocol produced the lowest roughness values, followed by CM and CF. Use of the JO system produced the lowest roughness values and the smallest biofilm mass, while the ME system produced the smallest partial transformation ratio. The ED group exhibited the highest roughness values, biofilm mass, and partial transformation ratio.

CONCLUSION

Stepwise surface treatment of monolithic zirconia, combined with careful polishing system selection, is essential to obtaining optimal microstructural and biological surface results.

Improvement of mechanical properties of Y-TZP by thermal annealing with monoclinic zirconia nanoparticle coating

OBJECTIVE

To assess whether a thermal annealing with a monoclinic zirconia (mZrO₂) nanoparticle coating can improve the reliability of sandblasted yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) and maintain its mechanical strength.

METHODS

Commercially available Y-TZP (Lava Frame, 3M Dental Products) disks were sintered and surface-treated as follows: AS (as sintered, with no treatment); SB (sandblasting); SB-TA (sandblasting followed by thermal annealing at 1000 °C); and SB-mZr-TA (sandblasting followed by thermal annealing at 1000 °C with the mZrO₂ nanoparticle coating). The mZrO₂ nanoparticles of 21 nm in size were prepared by a hydrothermal method, and coated onto Y-TZP sintered disks as a 5 g/L ethanol dispersion. Biaxial flexural strength (S) was measured using the piston-on-three-ball test, and reliability was evaluated by the Weibull modulus (m).

RESULTS

Biaxial flexural tests showed a significant increase in the strength of Group SB (S_SB = 1445 ± 191 MPa) compared with Group AS (S_AS = 1071 ± 112 MPa). The thermal annealing improved the reliabilities of the sandblasted Y-TZP (m_SB-TA = 20.14 and m_SB-mZr-TA = 21.33), as compared with Group SB (m_SB = 7.77). However, the conventional thermal annealing without the mZrO₂ coating caused a significant decrease in the strength of sandblasted Y-TZP (S_SB-TA = 1273 ± 65 MPa). Importantly, the mZrO₂ coating prevented the decrease in the strength caused by conventional thermal annealing (S_SB-mZr-TA = 1379 ± 65 MPa).

SIGNIFICANCE

The thermal annealing with the mZrO₂ nanoparticle coating can improve the reliability of sandblasted Y-TZP and maintain its mechanical strength, which would otherwise be decreased by the conventional annealing process.

Fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal clasps for removable partial dentures

With the rapid development of computer-aided design/computer-aided manufacturing (CAD/CAM) systems, the application of zirconia in removable partial dentures is expected to expand. Clasps composed of zirconia should improve esthetics without inducing the risk of metal allergy. The aim of this study was to examine the fatigue resistance of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) clasps for removable partial dentures. Yttria-stabilized tetragonal zirconia polycrystal and cobalt-chromium (Co-Cr) alloy were prepared using CAD/CAM systems. Specimens were either of the semicircular type or of the flat type, with cross-sectional areas of taper ratios of 0.50, 0.75, and 1.00. All specimens were tested using the cantilever test and the constant displacement fatigue test, and data were analyzed using ANOVA. During the cantilever test, the maximum displacement prior to fracture was greater than the required undercut, and the semicircular-type specimen exhibited a higher fracture load than the flat type. None of the specimens displayed permanent deformation and showed almost the same degree of deformation after fatigue testing. A lower taper ratio was associated with lower average load values and greater displacement. Within the limitations of this study, it was possible to conclude that Y-TZP provides the required undercut and adequate retentive force for removable partial denture clasps. Additionally, Y-TZP and Co-Cr alloy had almost the same degree of deformation even after the simulated lifespan of removable partial dentures.

Load-bearing capacities of ultra-thin occlusal veneers bonded to dentin

OBJECTIVES

To test whether the load-bearing capacity of occlusal veneers made of ceramic or hybrid materials bonded to dentin does differ from those of porcelain-fused-to metal or lithium disilicate glass ceramic crowns.

MATERIAL AND METHODS

In 80 human molars, occlusal tooth substance was removed so that the defects extended into dentin, simulating defects caused by attrition/erosion. Restorations at a standardized thickness of either 0.5 mm or 1.0 mm were digitally designed. For both thicknesses, 4 test groups (n = 10 per group) were defined, each including a different restorative material: "0.5-ZIR": 0.5 mm thick zirconia (Vita YZ HT); "1.0-ZIR": 1.0 mm thick zirconia (Vita YZ HT); "0.5-LDC": 0.5 mm thick lithium disilicate ceramic (IPS e.max Press); "1.0-LDC": 1.0 mm thick lithium disilicate ceramic (IPS e.max Press); "0.5-HYC": 0.5 mm thick PICN (Vita Enamic); "1.0-HYC": 1.0 mm thick PICN (Vita Enamic); "0.5-COC": 0.5 mm thick tooth shaded resin composite (Lava Ultimate) and "1.0-COC": 1.0 mm thick tooth shaded resin composite (Lava Ultimate). Consecutively, the specimens were thermo-mechanically aged and then loaded until fracture. The load-bearing capacities (F_max) between the groups were statistically compared using the Kruskal-Wallis test (p < 0.05) and pairwise group comparison applying the Dunn's method. In addition, the results were compared to those of conventional lithium-disilicate ceramic crowns ("CLD") and to porcelain-fused to metal crowns ("PFM").

RESULTS

The median F_initial values for the 0.5 mm thin restorations were 1'350 N for 0.5-ZIR, 850 N for 0.5-LDC, 1'100 N for 0.5-HYC and 1'950 N for 0.5-COC. With CLD as the control, a significant difference was found between the groups 0.5-COC and 0.5-LDC (KW: p = 0.0124). With PFM as the control, the comparisons between PFM and 0.5-LDC as well as between 0.5-COC and 0.5-LDC were significant (KW: p = 0.0026). Median F_max values of 2'493 N in the group 0.5-ZIR, 1'165 in the group 0.5-LDC, 2'275 N in the group 0.5-HYC and 2'265 N in the group 0.5-COC were found. The medians of the F_initial values for the 1.0 thick restorations amounted of 2'100 N in 1.0-ZIR, 1'750 N in 1.0-LDC, 2'000 N in 1.0-HYC and 2'300 N in 1.0-COC. Testing the multiple comparisons with Dunn's method no significant differences were found (p > 0.05). The median F_max values of the 1.0 mm thick restorations were: 2'489 N in the group 1.0-ZIR, 1'864 N in the group 1.0-LDC, 2'485 N in the group 1.0-HYC and 2'479 N in the group 1.0-COC. With CLD as the control group, a significant difference between zirconia and lithium-disilicate was found for the 0.5 (p = 0.0017) and 1.0 mm (p = 0.0320) thick specimens. Comparing the 0.5 mm thick specimens with CLD as the control, a significant difference was found between 0.5-HYC and 0.5-LDC (p = 0.0017). With PFM as the control, the comparison of lithium disilicate and zirconia was statistically significant for both thicknesses (p = 0.0009 for the 0.5 mm thick specimens; p = 0.0074 for the 1.0 mm thick specimens). In addition, with PFM as control group, significant differences were seen between 0.5-LDC and all other groups with restorations in 0.5 mm thickness (p = 0.0017).

CONCLUSIONS

Regarding their maximum load-bearing capacity, minimally invasive occlusal veneers made of ceramic, hybrid materials or polymeric materials can be applied to correct occlusal tooth wear with exposed dentin and thus replace conventional crown restorations in cases of normally expected intraoral bite forces.

Zirconia Use in Dentistry - Manufacturing and Properties

Several types of metal-free ceramics have been developed to meet the patients demand for natural looking appearance restorations. Owing to their biocompatibility and good mechanical properties zirconia has been successfully used in recent years as a dental biomaterial. Due to its high opacity zirconia cores are generally covered with ceramic veneers that provide a more natural appearance but have frequent incidence of chipping. As an alternative to veneered zirconia full-contour zirconia restorations become more widely used nowadays. The paper reviews the current knowledge and scientific data of the zirconia use in dentistry in order to compare the zirconia based dental restorations with the metal-ceramic ones and also the two types of dental restoration based on zirconia, veneered or monolithic zirconia.

Bond strength of heat-pressed veneer ceramics to zirconia with various blasting conditions

Background/purpose

With the technology of dental prostheses and materials progress, the bond durability of the all-ceramic restoration system plays an important role in the oral environment. The purpose of this study was to evaluate the influence of the parameters of blasting on the shear bond strength between zirconia and pressed veneer ceramics.

Materials and methods

Zirconia was blasted with different alumina particle size subjected to two types of applied pressures. Heat-pressed and layered veneer ceramic blocks were served as an experimental group and control group, respectively. The shear strength of specimens after thermocycling for 20,000 times was also investigated to simulate oral environment.

Results

The results indicated that the surface roughness was increased significantly (P < 0.05) with increasing particle size of alumina and blasting pressure. The alumina particle size had statistically significant influence (P < 0.05) on shear strength of heat-pressed groups. Among heat-pressed ceramic specimens, the highest and lowest shear strength could be obtained when 50 μm of alumina was used at pressure of 0.3 MPa and 110 μm of alumina was used at 0.5 MPa, respectively. The negligible effect of thermal cycle on shear strength of heat-pressed groups can be seen.

Conclusion

Blasting with 50 μm of alumina at 0.3 MPa could enhance the bond strength between zirconia and veneer ceramics.

Clinical performance of tooth- or implant-supported veneered zirconia single crowns: 42-month results

OBJECTIVES

The objective of this clinical study was to compare and assess the clinical performance of tooth-supported and implant-supported zirconia single crowns with sintered veneering caps.

METHODS

In this prospective study, 118 patients with a total of 220 single crowns placed on 106 teeth (69 vital teeth, 37 endodontically treated teeth) and 114 implants in molar and premolar regions were examined during a mean observation period of 42 months. The restorations were evaluated for technical failures such as veneering porcelain fractures (chipping), surface quality, marginal fit, and the interface quality of the coping and sintered veneering. The soft tissue status was assessed using the modified Silness and Löe's plaque and gingival index (mPI) and the modified Muhlemann sulcus bleeding index (mSBI). Tooth-supported crowns were checked for secondary caries and hypersensitivity during the follow-up period. Recalls were performed every 6 months.

RESULTS

The 3-year Kaplan-Meier success probability was 98.2% and 100% for implant- and tooth-supported crowns, respectively. A significant difference could be detected between the implant-supported and tooth-supported zirconia single crowns, in terms of their chipping rate (p = 0.039). Veneering material fractures were recorded on two implant-supported restorations (1.8%). No veneering fractures occurred on tooth-supported single crowns. The plaque and gingival index and sulcus bleeding index showed stable and healthy soft peri-implant and periodontal tissues. Neither loss of vitality nor secondary caries occurred on tooth-supported crowns.

CONCLUSIONS

Zirconia-based single crowns with a sintered veneering cap showed promising clinical results on both tooth and implant abutments; however, the dental implants were more prone to complications. In terms of clinical significance, high-strength ceramic with a sintered veneering cap can be recommended for prosthetic treatment of both tooth- and implant-supported single crowns in molar regions.

CLINICAL RELEVANCE

This study provides valuable information for further application of all-ceramic restorations.

Effects of different surface treatments on the shear bond strength of veneering ceramic materials to zirconia

PURPOSE

To evaluate and compare the effect of different materials and techniques on the shear bond strength of veneering ceramic materials to zirconia.

MATERIALS AND METHODS

136 sintered zirconia cubes were prepared and randomly divided into four study groups according to corresponding methods of surface treatment and materials: GLN (grinding followed by laser scanning using Noritake Cerabien ZR), SLN (sandblasting followed by laser scanning using Noritake Cerabien ZR), GLV (grinding followed by laser scanning using VITA VM 9), and SLV (sandblasting followed by laser scanning using VITA VM 9). Spraying technique was performed to coat the core. Profilometer, SEM, XRD, EDS, universal testing machine, and stereomicroscope were used to record surface roughness Ra, surface morphology, phase transformation, elemental compositions, shear bond strength SBS values, and failure types, respectively. Specimens were investigated in unaged (not immersed in artificial saliva) and aged (stored in artificial saliva for a month) conditions to evaluate SBS values.

RESULTS

Grinding and GLN as first and second surface treatments provided satisfactory Ra values in both conditions (1.05 ± 0.24 µm, 1.30 ± 0.21 µm) compared to sandblasting and other groups (P<.05). The group GLN showed the highest SBS values in both conditions (30.97 ± 3.12 MPa, 29.09 ± 4.17 MPa), while group SLV recorded the lowest (23.96 ± 3.60 MPa, 22.95 ± 3.68 Mpa) (P<.05). Sandblasting showed phase transformation from t-m. Mixed failure type was the commonest among all groups.

CONCLUSION

GLN showed to be a reliable method which provided satisfactory bond strength between the veneer ceramic and zirconia. This method might preserve the integrity of fixed dental crowns.

Effects of different surface finishing protocols for zirconia on surface roughness and bacterial biofilm formation

PURPOSE

Surface finishing of a zirconia restoration is essential after clinical adjustment. Herein, we investigated the effects of a surface finishing protocol for monolithic zirconia on final roughness and bacterial adherence.

MATERIALS AND METHODS

Forty-eight disk-shaped monolithic zirconia specimens were fabricated and divided into four groups (n = 12) based on initial surface treatment, finishing, and polishing protocols: diamond bur+polishing bur (DP group), diamond bur+stone grinding bur+polishing bur (DSP group), no diamond bur+polishing bur (NP group), and no diamond bur+stone grinding bur+polishing bur (NSP group). Initial and final surface roughness was measured with a profilometer, and shown using scanning electron microscope. Bacterial adhesion was evaluated by quantifying Streptococcus mutans in the biofilm. Kruskal-Wallis and Mann-Whitney U tests were used to compare results among groups, and two-way analysis of variance was used to evaluate the effects of grinding burs on final roughness (α=.05).

RESULTS

The DP group had the highest final Ra value, followed by the DSP, NP, and NSP groups. Use of the stone grinding bur as a coarse-finishing step significantly decreased final Ra values when a diamond bur was used (P<.001). Omission of the stone grinding bur increased biofilm formation on specimen surfaces. Combining a stone grinding bur with silicone polishing burs produced the smallest final biofilm values, regardless of the use of a diamond bur in initial surface treatment.

CONCLUSION

Coarse finishing of monolithic zirconia with a stone grinding bur significantly decreased final Ra values and bacterial biofilm formation when surfaces had been roughened by a diamond bur.

Response of pre-crystallized CAD/CAM zirconia-reinforced lithium silicate glass ceramic to cyclic nanoindentation

This paper reports on a cyclic nanoindentation approach of a pre-crystallized zirconia-reinforced lithium silicate glass ceramic (ZLS) to understand its material behavior associated with its machinability in dental CAD/CAM diamond abrasive milling. The material response to the cyclic nanoindentation using a Berkovich diamond tip was quantitatively determined in terms of the indentation contact hardness, elastic modulus, elasticity and plasticity for each loading cycle at peak loads of 2.5-10 mN. The cyclic load-displacement curves at different load levels indicate discrete discontinuities and hysteresis loops, which might have arisen from viscoelasticity behavior. Material properties degraded with an increasing number of loading cycles due to the mechanical softening which may facilitate machining in dental CAD/CAM milling. Elastic and plastic displacements and indentation energies revealed the pre-crystallized ZLS experiences predominantly elastic deformation and thus has a high capacity to retain its structure and shape. Furthermore, elastic energy dominated cyclic loading led to pseudoelasticity due to plastic strain accumulation. In situ scanning probe microscopy (SPM) images of cyclic indentation imprints reveal the fracture-free plastic deformation of the pre-crystallized ZLS under cyclic nanoindentation conditions. The outcomes of this study provide the mechanics model of diamond milling of the pre-crystallized ZLS due to the cyclic loading nature of dental CAD/CAM abrasive processing.

Comparative evaluation of the mechanical properties of CAD/CAM dental blocks

This study compares the mechanical properties of commercially available CAD/CAM (Computer-Aided Design/Computer-Aided Manufacturing) millable dental blocks including Vita Enamic, Lava Ultimate, and MAZIC Duro. All the discs were cut in dimension of 1.2 mm in thickness and 12 mm in diameter, ground up to #1200 Sic papers and polished. The biaxial flexure strength of the ceramic discs was measured after thermocycling treatment and the broken surfaces were observed using scanning electron microscopy (SEM). The discs were brushed using a toothbrush testing machine under a 150 g load. Surface roughness and morphology were determined after toothbrushing cycles. Finally, the friction and wear behavior of the materials against an opposing tooth were studied using a reciprocating pin-on-plate test configuration. The vertical loss of dental cusp was measured, and the surface image was examined using field emission scanning electron microscopy (FE-SEM). The biaxial flexural strength data were subjected to Weibull analysis. To compare the significance between the groups, all data were analyzed by one-way analysis (ANOVA). The biaxial flexural strength of the Lava Ultimate and MAZIC Duro materials is significantly higher than that of Vita Enamic. In addition, Lava Ultimate and MAZIC Duro exhibited significantly smoother surfaces than that of Vita Enamic after toothbrushing. Lava Ultimate and MAZIC Duro also showed less wear to the opposing tooth than that of Vita Enamic. In addition, Lava Ultimate possesses more suitable mechanical properties than the Vita Enamic and Mazic Duro for use in oral clinical prosthesis.

Effect of slow-cooling protocol on biaxial flexural strengths of bilayered porcelain-ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/A) disks

OBJECTIVE

The present study investigated the biaxial flexural strengths of bilayered ceria-stabilized zirconia/alumina nanocomposite (Ce-TZP/A) disks with various layering porcelains veneered using a slow-cooling protocol.

METHODS

Five porcelain materials (VITA VM9, Cercon Ceram Kiss, and Vintage ZR with experimental coefficient of thermal expansions; CTEs of 8.45, 9.04, and 9.61ppm/°C) were veneered on Ce-TZP/A disks and slow-cooled after firing to fabricate bilayered specimens (core-to-porcelain thickness: 0.8mm/1.5mm). Biaxial flexural strengths of the specimens with the porcelain layer in tension were tested based on the piston-on-three-ball method (ISO 6872:2008). The data were statistically analyzed using Weibull distribution and Fisher's exact test.

RESULTS

Tensile stresses were observed in the entire porcelain layer while compressive stress at the surface of the Ce-TZP/A layer shifted to tensile stress at the interface between the materials. The cases of small CTE mismatches between the materials showed high Weibull characteristic strengths at the internal and external surfaces of the specimens, except the VM9 group (CTE: 9.0-9.2ppm/°C). The maximum tensile stress was observed on the surface of the porcelain layer, where cracks originated and continuously propagated into the Ce-TZP layer. The Ce-TZP/A fractured into two pieces for large CTE mismatches between the materials, resulting in significantly lower flexural strengths than those fracturing into three pieces for small CTE mismatches.

SIGNIFICANCE

Flexural strengths and fracture behaviors of bilayered porcelain-Ce-TZP/A disks were influenced by the CTE mismatches, and a small CTE mismatch between the materials was preferred when using a slow-cooling protocol.

Evaluation of the Microshear Bond Strength of MDP-containing and Non-MDP-containing Self-adhesive Resin Cement on Zirconia Restoration

OBJECTIVES

The purpose of this study was to measure the microshear bond strength (μSBS) of four different self-adhesive resin cements with/without 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing primer to zirconium ceramics and to evaluate the effect of zirconia primers on these self-adhesive resin cements (SARCs).

METHODS AND MATERIALS

Zirconia blocks (20 × 20 × 8 mm³) were prepared and divided into eight groups (n=20). They were sandblasted (50 μm Al₂O₃) and treated as follows: no primer or primer (Z-Primer Plus). Four self-adhesive resin cements (MDP-containing: Permacem 2.0 [PC], Clearfil SA luting [CS]; non-MDP-containing: Rely-X U200 [RU], Maxcem Elite [ME]) were bonded to the zirconia surface. After thermocycling, a μSBS test was performed. The failure mode was analyzed using light microscopy. Statistical analysis of μSBS was performed using one-way analysis of variance and two-sample t-test with post hoc Tukey test. The loss rate was evaluated using the Fisher's exact test and χ² test with post hoc Tukey test (p<0.05).

RESULTS

Within the no primer groups, the PC and CS groups showed higher bond strength than the RU and ME groups. Comparing the μSBS of the no primer and primer groups in the same SARCs, the RU/P group was higher than the RU group, and the ME/P group was higher than the ME group. No significant difference was observed between the PC and PC/P groups and between the CS and CS/P groups.

CONCLUSIONS

Non-MDP-containing SARC showed the increased bonding value with MDP-containing primer to zirconia ceramics. The bond strength of MDP-containing SARCs was not affected significantly by the use of zirconia primer.

Effect of different sintering process on flexural strength of translucency monolithic zirconia

Background

Sintering process is responsible for the strength of zirconia restoration. This study evaluated the effect of different sintering temperatures and sintered-holding times on flexural strength of translucency monolithic zirconia.

Material and Methods

One hundred and thirty five zirconia bar specimens (width-length-thickness = 10×20×1.5 mm) were prepared from yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramic and randomly divided into nine groups to be sintered at different temperatures [decreasing- (SD, 1350°C), regular- (SR, 1450°C), and increasing- (SI, 1550°C) sintering temperature] and different sintered-holding times [shortening- (HS, 60 min), regular- (HR, 120 min), and prolonged- (HP, 180 min) sintered-holding time]. Flexural strength was determined using three-point bending test in a universal testing machine at 1 mm/min crosshead speed. An analysis of variance (ANOVA) and Tukey’s multiple comparisons were used to determine for statistically significant difference of flexural strength (α=0.05). Weibull analysis was applied for survival probability, Weibull modulus (m), and characteristics strength (σo) of the flexural strength. The crystal sizes were microscopically examined using scanning electron microscope (SEM). The phase composition of zirconia was determined using X-ray diffraction (XRD).

Results

The mean±sd (MPa), m, and σo of flexural strength were 1080.25±217.19, 5.54, and 1167.53 for SDHS, 1243.41±233.17, 5.19, and 1352.30 for SDHR, 1298.92±235.68, 6.24, and 1394.79 for SDHP, 1303.34±171.87, 8.40, and 1377.90 for SRHS, 1331.73±278.84, 5.31, and 1444.50 for SRHR, 1348.13±283.35, 5.32, and 1460.68 for SRHP, 1458.45±289.19, 4.51, and 1604.41 for SIHS 1581.34±190.56, 8.20, and 1675.21 for SIHR and, 1604.10±139.52, 12.57, and 1667.90 for SIHP. The flexural strength was significantly affected by altering sintering temperatures and holding times (p<0.05). Enlarging grain size and increasing t→m phase shifting related with raising temperatures and times.

Conclusions

Increasing sintering temperature and prolonged sintered-holding time lead to enhancing flexural strength of translucency monolithic zirconia, and are suggested for sintering process to achieve durable restoration.

Key words:Flexural strength, monolithic zirconia, sintering temperature, sintered-holding time.

Retentive force of PEEK secondary crowns on zirconia primary crowns over time

OBJECTIVES

The purpose of the present study was to evaluate the retentive forces of CAD/CAM-fabricated polyetheretherketone (PEEK) secondary crowns on zirconia primary crowns over an artificial aging period representing 10 years of clinical service and compare them to electroformed secondary crowns made from pure gold.

MATERIAL AND METHODS

Implant-supported zirconia primary crowns (N = 20) were CAD/CAM milled and provided either with electroformed secondary crowns (group ZE; N = 10) or CAD/CAM-fabricated PEEK secondary crowns (group ZP; N = 10). All secondary crowns were attached to a casted tertiary structure to ensure adequate stability. A universal testing machine was used to determine the retentive force values at baseline and after 1, 3, 5, and 10 years of simulated aging in the presence of artificial saliva. Data were analyzed applying Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U test. Level of significance was set at p < 0.05.

RESULTS

Retentive forces were not different for the groups ZE and ZP at baseline (median ZE 2.85 N; ZP 2.8 N; p ≤ 0.218). Because retentive force values changed significantly over simulation time for group ZE (Kruskal-Wallis; p ≤ 0.028), the values between the test groups ZE and ZP differed significantly (Mann-Whitney U) at 5 years (ZE 3.03 N; ZP 2.76 N; p ≤ 0.003) and 10 years (ZE 3.1 N; ZP 2.78 N; p ≤ 0.011).

CONCLUSIONS

PEEK secondary crowns exhibit stable retentive force values over 10 years of simulated aging showing no signs of deterioration while the retentive force values of electroformed secondary crowns increase over time.

CLINICAL RELEVANCE

PEEK might be a suitable alternative to proven metallic materials for the fabrication of secondary crowns.

Effect of occlusal groove on abutment, crown thickness, and cement-type on fracture load of monolithic zirconia crowns

The aim of this study was to investigate the effects of occlusal form of abutment, occlusal thickness of monolithic zirconia crowns (MZC), and cement type on the fracture load of MZC. Abutments were prepared with 2 types of occlusal forms: groove-type and flat-type. These were designed so that thickness at the central fissure region of MZC was 0.3, 0.5, or 0.7 mm. Glass ionomer cement and resin cement were used to lute MZC to their corresponding abutment. Fracture load was determined using a universal testing machine. As a result, groove-type abutment had lower fracture load compared to flat-type abutment; however, the decline in strength was smaller when resin cement was used. Additionally, specimens with larger occlusal thickness had greater fracture load regardless of groove or cement-type. The fracture of MZC occurred on the central fissure region of MZC except for 0.7 mm groove-type MZC luted with resin cement.

Ultra-thin occlusal veneers bonded to enamel and made of ceramic or hybrid materials exhibit load-bearing capacities not different from conventional restorations

OBJECTIVES

The objective of this study was to test whether or not the load-bearing capacity of occlusal veneers bonded to enamel and made of ceramic or hybrid materials does differ from those of porcelain-fused-to-metal or lithium disilicate glass ceramic crowns.

MATERIAL AND METHODS

In 80 human molars occlusal enamel was removed without extending into the dentin in order to mimic substance defects caused by attrition. The restorations were digitally designed at a standardized thickness of either 0.5 mm or 1.0 mm. For each thickness, 4 test groups were formed each including a different restorative material: "0.5-ZIR": 0.5 mm thick zirconia (Vita YZ HT); "1.0-ZIR": 1.0 mm thick zirconia (Vita YZ HT); "0.5-LDC": 0.5 mm thick lithium disilicate ceramic (IPS e.max Press); "1.0-LDC": 1.0 mm thick lithium disilicate ceramic (IPS e.max Press); "0.5-HYC": 0.5 mm thick PICN (Vita Enamic); "1.0-HYC": 1.0 mm thick PICN (Vita Enamic); "0.5-COC": 0.5 mm thick tooth shaded resin composite (Lava Ultimate) and "1.0-COC": 1.0 mm thick tooth shaded resin composite (Lava ultimate). Each group consists of 10 specimens. Two additional groups of 10 specimens each were used as controls and exhibited conventional crown preparations. In one group the crowns were made of lithium-disilicate ceramic ("CLD": IPS e.max CAD) and the other group consisted of porcelain-fused to metal crowns ("PFM"). All restorations were cemented onto the prepared teeth following the manufacturer's instruction of the corresponding luting cement. Subsequently, they were thermo-mechanically aged and then loaded until fracture. Load-bearing capacities (F_max) between the groups were compared applying the Kruskal-Wallis test (p < 0.05) and pairwise group comparisons using the Dunn's method.

RESULTS

Median values (and quartiles) for the load-bearing capacity amounted to (F_max) 2'407 (1'670; 2'490) N for the CLD group and to 2'033 (1'869; 2'445) N for the PFM group. For the 0.5 mm thick restorations F_max reached the highest median value in group 0.5-HYC 2'390 (1'355; 2'490) N, followed by 0.5-COC 2'200 (1'217; 2'492) N and 0.5-LDC 1'692 (1'324; 2'355) N. No results were obtained for group 0.5-ZIR due to the impracticability to fabricate ultra-thin specimens. The distribution of the values for the 1.0 mm thick restorations was 2'489 (2'426; 2'491) N for 1.0-COC, 2'299 (2'156; 2'490) N for 1.0-ZIR, 2'124 (1'245; 2'491) N for 1.0-HYC, and 1'537 (1'245; 1'783) N for 1.0-LDC. The differences of the medians between the test and the control groups did not reach statistical significance for the 0.5 mm thick specimens (KW: p = 0.6952 and p = 0.6986). Within the groups exhibiting 1.0 mm thickness, however, significant different medians were found: 1.0-LDC < 1.0-ZIR and 1.0-LDC < 1.0-COC (KW: p < 0.0209).

CONCLUSIONS

Regarding their maximum load-bearing capacity, minimally invasive occlusal veneers made of ceramic and hybrid materials can be applied to correct occlusal tooth wear and thus replace conventional crown restorations.

Five-axis laser milling system that realizes more accurate zirconia CAD/CAM crowns by direct milling from fully sintered blocks

Directly milling zirconia computer-aided design (CAD)/computer-aided manufacturing (CAM) crowns from fully sintered zirconia blocks using a five-axis laser milling system, compared with three-axis milling and full sintering by heating milled semi-sintered crowns, was investigated. The mechanical characteristics of zirconia specimens were similar across groups. The order of the marginal gap was three-axis>conventional (lingual thickness of 1.5 mm>0.5 mm)>five-axis group (close to zero). The marginal shape was almost perfectly circular in all groups. The internal corner shape and gap were almost perfect for the five-axis milled crown but not for conventional and three-axis crowns. The roundness of the marginal and internal shapes was almost perfect in the five-axis milling group but not for the three-axis and conventional groups. These small distortions result in large marginal gaps. Results of the present study suggest the superiority of the five-axis milling system in creating a zirconia prosthesis.

Surface properties of dental zirconia ceramics affected by ultrasonic scaling and low-temperature degradation

Zirconia (3Y-TZP) dental prostheses are widely used in clinical dentistry. However, the effect of ultrasonic scaling performed as a part of professional tooth cleaning on 3Y-TZP dental prostheses, especially in conjunction with low-temperature degradation (LTD), has not been fully investigated. The present study aimed to evaluate the influence of ultrasonic scaling and LTD on the surface properties of 3Y-TZP in relation to bacterial adhesion on the treated surface. 3Y-TZP specimens (4 × 4 × 2 mm) were polished and then subjected to autoclaving at 134°C for 100 h to induce LTD, followed by 10 rounds of ultrasonic scaling using a steel scaler tip for 1 min each. Surface roughness, crystalline structure, wettability, and hardness were analyzed by optical interferometry, X-ray diffraction analysis, contact angle measurement, and nano-indentation technique, respectively. Subsequently, bacterial adhesion onto the treated 3Y-TZP surface was evaluated using Streptococcus mitis and S. oralis. The results demonstrated that the combination of ultrasonic scaling and LTD significantly increased the Sa value (surface roughness parameter) of the polished 3Y-TZP surface from 1.6 nm to 117 nm. LTD affected the crystalline structure, causing phase transformation from the tetragonal to the monoclinic phase, and decreased both the contact angle and surface hardness. However, bacterial adhesion was not influenced by these changes in surface properties. The present study suggests that ultrasonic scaling may be acceptable for debridement of 3Y-TZP dental prostheses because it did not facilitate bacterial adhesion even in the combination with LTD, although it did cause slight roughening of the surface.

Comparison of Cytomorphometry and Early Cell Response of Human Gingival Fibroblast (HGFs) between Zirconium and New Zirconia-Reinforced Lithium Silicate Ceramics (ZLS)

New zirconia-reinforced lithium silicate ceramics (ZLS) could be a viable alternative to zirconium (Y-TZP) in the manufacture of implantological abutments-especially in aesthetic cases-due to its good mechanical, optical, and biocompatibility properties. Although there are several studies on the ZLS mechanical properties, there are no studies regarding proliferation, spreading, or cytomorphometry. We designed the present study which compares the surface, cellular proliferation, and cellular morphology between Y-TZP (Vita YZ® T [Vita Zahnfabrik (Postfach, Germany)]) and ZLS (Celtra® Duo [Degudent (Hanau-Wolfgang, Germany)]). The surface characterization was performed with energy dispersive spectroscopy (EDS), scanning electron microscopy (SEM), and optical profilometry. Human gingival fibroblasts (HGFs) were subsequently cultured on both materials and early cellular response and cell morphology were compared through nuclear and cytoskeletal measurement parameters using confocal microscopy. The results showed greater proliferation and spreading on the surface of Y-TZP. This could indicate that Y-TZP continues to be a gold standard in terms of transgingival implant material: Nevertheless, more in vitro and in vivo research is necessary to confirm the results obtained in this study.

Micro-CT Analysis of Y-TZP Copings Made by Different CAD/CAM Systems: Marginal and Internal Fit

Purpose

The aim of the study was to measure the marginal and internal adaptation (MIA) of zirconia copings, made of 4 ceramic systems for CAD/CAM, using microcomputed tomography (micro-CT) technology.

Material and Methods

Two identical stainless steel models were used, representing a preparation for full ceramic crown on a lower molar. The master models were then scanned for the production of copings from specific yttrium oxide partially stabilized tetragonal zirconia polycrystal ceramic blocks of each system (n=10): Cerec/inCoris Zi, Sirona; Cercon/Cercon base, Dentsply; Ceramill/Ceramill Zi, Amann Girrbach; and Lava/Lava Frame Zirconia, 3M ESPE. MIA was evaluated measuring 4 points as follows: marginal gap (MG), axial wall gap (AW), axio-occlusal angle gap (AO), and central occlusal area gap (CO). The data were statistically analyzed by ANOVA and Tukey's test (α = 0.05).

Results

The ceramic system Lava showed greater internal desadaptation (80.75 ± 22.69 µm) while CEREC presented the lowest values (49.92 ± 11.77 µm). There were significant differences between the measurement points evaluated. CO demonstrated the greater values (77.03 ± 22.61 µm). All marginal and internal adaptation values were considered clinically acceptable.

Conclusion

It was concluded that there was an influence of the type of ceramic system in marginal and internal adaptation of copings in zirconia.

Effect of Simulated Mastication on the Surface Roughness and Wear of Machinable Ceramics and Opposing Dental Enamel

OBJECTIVE:

Computer aided design-computer aided machining (CAD-CAM) ceramic crowns are replacing ceramo-metal ones due to newly developed mechanical properties and esthetics. To obtain knowledge about their interactions due to polishing and occlusal contacts with the opposing dental enamel specimen, including surface roughness and wear, the three-body wear simulation was investigated.

METHODS AND MATERIALS:

The surface roughness (RA) and wear rate (mm) of four CAD-CAM blocks with different compositions including Vita Mark II, e.max, Suprinity, and Enamic, after two surface treatments of glazing and polishing, and their opposing enamel specimens, were investigated using a mastication simulator and atomic force microscope.

RESULTS:

The roughness of all ceramic and to a greater extent enamel samples, with the exception of enamel opposing polished Enamic samples, was decreased after wear. No significant difference in wear was evident for the ceramic samples between the glazed and polished treatments. Lower wear rates were recorded only for polished Vita Mark II and polished Enamic in comparison to the glazed ones.

CONCLUSION:

The newly developed polishing systems for CAD-CAM ceramics can be good alternatives to reglazing, because the roughness and wear rate of both the ceramic and the opposing enamel will either not change or decrease.

Light transmittance of CAD/CAM ceramics with different shades and thicknesses and microhardness of the underlying light-cured resin cement

Objectives

The aim of this in vitro study was to evaluate the effects of the thickness and shade of 3 types of computer-aided design/computer-aided manufacturing (CAD/CAM) materials.

Materials and Methods

A total of 120 specimens of 2 shades (A1 and A3) and 2 thicknesses (1 and 2 mm) were fabricated using VITA Mark II (VM; VITA Zahnfabrik), IPS e.max CAD (IE; IvoclarVivadent), and VITA Suprinity (VS; VITA Zahnfabrik) (n = 10 per subgroup). The amount of light transmission through the ceramic specimens was measured by a radiometer (Optilux, Kerr). Light-cured resin cement samples (Choice 2, Bisco) were fabricated in a Teflon mold and activated through the various ceramics with different shades and thicknesses using an LED unit (Bluephase, IvoclarVivadent). In the control group, the resin cement sample was directly light-cured without any ceramic. Vickers microhardness indentations were made on the resin surfaces (KoopaPazhoohesh) after 24 hours of dark storage in a 37°C incubator. Data were analyzed using analysis of variance followed by the Tukey post hoc test (α = 0.05).

Results

Ceramic thickness and shade had significant effects on light transmission and the microhardness of all specimens (p < 0.05). The mean values of light transmittance and microhardness of the resin cement in the VM group were significantly higher than those observed in the IE and VS groups. The lowest microhardness was observed in the VS group, due to the lowest level of light transmission (p < 0.05).

Conclusion

Greater thickness and darker shades of the 3 types of CAD/CAM ceramics significantly decreased the microhardness of the underlying resin cement.

Recent advances in understanding the fatigue and wear behavior of dental composites and ceramics

Dental composite and ceramic restorative materials are designed to closely mimic the aesthetics and function of natural tooth tissue, and their longevity in the oral environment depends to a large degree on their fatigue and wear properties. The purpose of this review is to highlight some recent advances in our understanding of fatigue and wear mechanisms, and how they contribute to restoration failures in the complex oral environment. Overall, fatigue and wear processes are found to be closely related, with wear of dental ceramic occlusal surfaces providing initiation sites for fatigue failures, and subsurface fatigue crack propagation driving key wear mechanisms for composites, ceramics, and enamel. Furthermore, both fatigue and wear of composite restorations may be important in enabling secondary caries formation, which is the leading cause of composite restoration failures. Overall, developing a mechanistic description of fatigue, wear, and secondary caries formation, along with understanding the interconnectivity of all three processes, are together seen as essential keys to successfully using in vitro studies to predict in vivo outcomes and develop improved dental restorative materials.

Internal accuracy of digitally fabricated cross-arch yttria-stabilized tetragonal zirconia polycrystalline prosthesis

Objective

This investigation determined the internal precision of one-piece cross-arch yttria partially stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramic fabricated from two digital systems (Trios-3 and CS-3500) compared to traditional metal alloy casting.

Materials and methods

A metal model consisting of four abutments (two canine and two molar) was used for one-piece cross-arch reconstruction. The metal abutments were computerized, prepared in a cylinder form possessing 5° taper and chamfer margin. Two digital approaches of computer-aided design and computer-aided manufacturing were used to fabricate one-piece cross-arch Y-TZP prostheses. The traditional lost wax technique was used to fabricate conventional cast prostheses with nonnoble metal alloys. Ten prostheses were constructed from each system. The preciseness of the prosthesis was evaluated at 22 positions for each abutment using a digital stereomicroscope. Analysis of variance (ANOVA) and Tukey’s method were determined for all pairwise differences at the 95% CI.

Results

The means and SDs of internal accuracy of prostheses constructed from the traditional cast technique, Trios-3, and CS-3500 were 75.15±13.46 μm, 78.55±14.30 μm, and 82.43±16.32 μm, respectively. ANOVA revealed statistical significance for the internal accuracy of prostheses between the different techniques at different positions of each abutment. Preciseness of the Y-TZP prosthesis constructed from Trios-3 illustrated significantly better internal fit than that constructed from CS-3500 (p<0.05). Tukey multiple comparisons revealed that the Y-TZP prosthesis constructed from both digital systems displayed significantly less internal fit than the traditionally fabricated prosthesis (p<0.05).

Conclusion

The one-piece cross-arch Y-TZP prosthesis constructed from Trios-3 demonstrated superior internal accuracy than that from CS-3500, but both slightly lower in accuracy than the traditional cast metal prosthesis. Nevertheless, the internal discrepancies of the Y-TZP prosthesis fabricated by both digital techniques were not beyond the range of clinical prestige and were convincingly precise to be recommended for one-piece cross-arch extensive reconstruction.

Trueness analysis of zirconia crowns fabricated with 3-dimensional printing

STATEMENT OF PROBLEM

The primary manufacturing method of zirconia ceramic crowns is computer-aided design and computer-aided manufacture (CAD-CAM), but a disadvantage of this technique is material waste. Three-dimensional (3D) printing, which has been recently introduced into dentistry, has improved the processing of polymers and metals, but not yet of ceramic crowns.

PURPOSE

The purpose of this in vitro study was to evaluate the 3D trueness of zirconia crowns fabricated by 3D printing to investigate the potential application of this technology in dental ceramic restorations.

MATERIAL AND METHODS

A typodont tooth was prepared for a ceramic crown, and a digital crown was designed using the CAD software. The digital crown was processed either with a 3D-printing system or with a dental milling system. The crowns were scanned using a dental laboratory scanner, and the data collected for each crown were divided into 4 parts (the external surface, intaglio surface, marginal area, and intaglio occlusal surface). Finally, the trueness of each part was determined using the 3D inspection software. The 3D trueness of the crowns fabricated by either 3D printing or milling was compared by a 1-sided test (α=.05).

RESULTS

The trueness of the external surface, intaglio surface, marginal area, and intaglio occlusal surface of the 3D-printed crowns was no worse than the corresponding trueness of the CAD-CAM crowns (P<.05).

CONCLUSIONS

Zirconia crowns produced by 3D printing meet the trueness requirements, and 3D printing may be suitable for fabricating zirconia crowns.

Effect of Surface Modification on In-Depth Transformations and Flexural Strength of Zirconia Ceramics

PURPOSE

Chairside surface adjustments of zirconia dental restorations enhance the toughening stress-induced tetragonal-to-monoclinic phase transformation and domain reorientation by ferro-elastic domain switching (FDS), but also trigger subsurface damage, which could compromise long-term clinical performance. The purpose of this study was to assess the depth of phase transformation, associated FDS, and flexural strength of dental zirconia (BruxZir HT 2.0), after chairside surface treatments.

MATERIALS AND METHODS

Square specimens were sectioned from CAD/CAM blocks and sintered according to manufacturer's recommendations (n = 30). They were left as-sintered (AS; control), air abraded with fine (AAF) or coarse (AAC) alumina particles, ground (G) or ground and polished (GP). Roughness was measured by profilometry. Crystalline phases were investigated by grazing incidence X-ray diffraction (GIXRD) (n = 3). GIXRD data were fit using semi-log regression protocols to assess transformation depth and extent of FDS. The mean biaxial flexural strength was measured according to ISO 6872. Subsurface damage was assessed from SEM images using a bonded polished interface configuration. Flaw distribution was assessed by Weibull analysis. Results were analyzed by Kruskal-Wallis with Tukey's adjustment for multiple comparisons (p < 0.05).

RESULTS

Air-abraded and ground groups exhibited higher mean surface roughness than control. AAF group exhibited the highest flexural strength (1662.6 ± 202.6 MPa) with flaw size (5.9 ± 1.8 μm) smaller than transformation (14.5 ± 1.2 μm) or FDS depth (19.3 ± 1.1 μm), followed by GP group (1567.2 ± 209.7 MPa) with smallest FDS depth (9.3 ± 2.0 μm) and flaw size (2.6 ± 1.8 μm), but without m-phase. AAC group (1371.4 ± 147.6 MPa) had the largest flaw size (40.3 ± 20.3 μm), transformation depth (47.2 ± 3.0 μm) and FDS depth (41.2 ± 2.2 μm). G group (1357.0 ± 196.7 MPa) had the smallest transformation depth (8.6 ± 1.5 μm), and mean FDS depth (19.8 ± 3.7 μm) and flaw size (18.6 ± 3.1 μm). AAC and AAF exhibited the highest Weibull modulus (11.2 ± 0.4 and 9.8 ± 0.3 μm, respectively).

CONCLUSIONS

Variations in mean biaxial flexural strength were explained by the balance between the depth of toughening mechanisms (phase transformation and FDS) and subsurface damage. AAF and GP groups were the most efficient surface adjustments in promoting the highest mean biaxial flexural strength.

Role of coefficient of thermal expansion on bond strength of ceramic veneered yttrium-stabilized zirconia

Background

Incompatible coefficient of thermal expansion (CTE) is supposed to be a reason for chipping of ceramic veneered zirconia. This study evaluates the effect of veneering ceramic at varied CTE on bond strength to zirconia.

Material and Methods

Zirconia disks (Z, Ø 10 mm, 1.0 mm thickness) were prepared from Y-TZP (Cercon®) and sintered at 1350°C for 6 hours. All zirconia disks were veneered with ceramics ((Ø 7.0 mm, 1.5 mm thickness) with varied CTE including VITADur® alpha (VDα), VITAVM®7 (VM7), VITAVM®9 (VM9), Cercon® ceramkiss (CCK), IPSe.max® ceram (IeC), and IPS dSIGN® (IdS) (n=15). The specimens were thermo-cycled (5-55 °C, 500 cycles) prior to determine the shear bond strength on a universal testing machine. The veneering ceramic and zirconia rods (Ø 4 mm, 30 mm length) were prepared for CTE evaluation. ANOVA and Tukey's multiple comparisons were used to determine the statistically significant difference (α=0.05). Weibull analysis was applied for survival probability, Weibull modulus (m), and characteristics strength (σo) of the shear bond. The interfaces were microscopically examined. The phase transformation of zirconia was determined using X ray diffraction.

Results

The mean±sd (MPa), m, and σo of bond strength were 20.45±2.32, 9.25, and 21.53 for Z-VDα, 19.47±4.53, 4.66, and 20.31 for Z-VM7, 21.05±3.96, 5.61, and 21.88 for Z-IeC, 25.85±2.74, 9.93, and 27.15 for Z-VM9, 25.82±4.39, 6.27, and 27.06 for Z-CCK, and 2.96±0.73, 4.11, and 3.28 for Z-IdS. The CTE (×10-6/°C) were 10.80, 7.83, 7.87, 9.86, 9.93, 10.03, and 12.95 for Z, VDα, VM7, IeC, VM9, CCK, and IdS. The bond strength was significantly affected by the CTE difference (p<0.05). The t→m phase transformation related with the CTE difference.

Conclusions

The CTE's differences induced stress that affected the bond strength. CTE's compatibility of veneering ceramic to zirconia is crucial for enhancing the bond strength. The CTE difference approximately 0.77-0.87×10-6/°C was recommended. Key words:Bond strength, coefficient of thermal expansion, zirconia.

Survey on the use of CAD-CAM technology by UK and Irish dental technicians

Statement of the problem Digital workflows (CAD/CAM) have been introduced in dentistry during recent years. No published information exists on dental technicians' use and reporting of this technology.Purpose The aim of this cross sectional survey was to identify the extent digital technology has infiltrated the workplace and to investigate the factors affecting the use of CAD-CAM technology by dental laboratory technicians within Ireland and the UK.Materials and methods A web-based questionnaire was composed (Opinio, Object Planet Inc. Oslo, Norway) and distributed to UK and Irish dental technicians. Answers to all questions were anonymous and grouped such that general information was gathered initially, followed by branching of the survey into two sections depending on whether or not the respondent worked with CAD-CAM technology. Results were compiled and statistical analysis (Fisher's Exact test, SPSS, IBM, Armonk, New York, USA) was performed in order to investigate any correlation between various demographic variables and the answers provided.Results The survey was distributed to 760 UK technicians and 77 Irish technicians. The total number of completed surveys was 105, which yielded a total response rate of 14%. Most technicians reported using some form of CAD/CAM aspect in the workflow, and this was more significant for technicians working in large laboratories. Most training received was company-led. Large laboratories were also significantly correlated with less outsourcing of CAD/CAM work and a change in dental material use leading to the increase of zirconia and the decrease of noble alloys. Dental technicians did not report any significant change in working relationships and staffing as a result of CAD/CAM incorporation. High initial investment cost was the most common reason quoted from non-users, along with the lack of such technology in their working environment.

Rehabilitation of edentulous jaws with zirconia complete-arch fixed implant-supported prostheses: An up to 4-year retrospective clinical study

STATEMENT OF PROBLEM

Limited data are available on the clinical outcomes of patients with edentulism treated with zirconia complete-arch fixed implant-supported prostheses (CAFIPs).

PURPOSE

The primary purpose of this retrospective clinical study was to study the failure rate of dental implants as well as the fracture rate of zirconia CAFIPs. The secondary purpose was to study the survival outcomes of patients with edentulism treated with zirconia CAFIPs as well as the rate of technical complications.

MATERIAL AND METHODS

This retrospective clinical study from private practice included 128 patients rehabilitated between January 1, 2013, and December 31, 2016, with 1072 implants supporting 191 zirconia CAFIPs for single-jaw as well as double-jaw rehabilitations. All zirconia prostheses were of 1-piece design and were veneered with feldspathic porcelain only at the gingival region and therefore considered as predominantly monolithic. Additionally, all prostheses were bonded to implant manufacturer's titanium cylinders that provided an intimate contact with the implants. The primary outcome measures were implant failure rate and prosthesis fracture rate. The secondary outcome measures were prosthodontic treatment survival rate and the incidence of technical complications with respect to monolithic zirconia CAFIPs. Cumulative survival rate (CSR) for implants and prostheses was calculated after a life-table survival analysis.

RESULTS

Of the analyzed samples over a 4-year period, at least 288 implants and 49 prostheses had a minimum of 4 years of follow-up. A total of 18 implant failures were noted (13 in maxilla, 5 in mandible), yielding a CSR of 97.6% for implants. One fracture of the zirconia prosthesis was recorded, yielding a CSR of 99.4% for the prostheses over the 4-year period. Another 3 prostheses required remaking because the supporting implants failed, and 1 prosthesis was remade because the lack of passive fit resulted in a CSR of 96.8% for the prosthodontic treatment itself. During the 4-year period, 1 zirconia prosthesis had a technical complication related to the debonding of titanium cylinders, and 2 prostheses had fractured screws, which were resolved successfully. No zirconia prostheses had chipping of the veneered gingival porcelain.

CONCLUSIONS

Findings from this retrospective clinical study from private practice showed that prosthodontic treatment of edentulous patients with a 1-piece, complete-arch fixed implant-supported zirconia prosthesis with veneered porcelain restricted to the gingival region had high survival rates for implants and prostheses. Minimal technical complications related to this type of treatment for edentulous jaws and no chipping of the veneered gingival porcelain were encountered.

Impact of laboratory treatment with coloring and fluorescent liquids on the optical properties of zirconia before and after accelerated aging

STATEMENT OF PROBLEM

Laboratory procedures, such as dipping in coloring and fluorescent liquids, can be used to improve the optical properties of zirconia. However, information is lacking on the effect of these liquids.

PURPOSE

The purpose of this in vitro study was to evaluate the color differences and degree of fluorescence of zirconia (3Y-TZP) treated with coloring and fluorescent liquids before and after an accelerated aging protocol.

MATERIAL AND METHODS

Forty disk-shaped specimens of 3Y-TZP were fabricated by milling and separated according to the laboratory treatment performed: white zirconia (control group); zirconia treated with coloring liquid (A2 group); zirconia treated with fluorescent liquid (fluorescent group); and zirconia treated with both liquids (A2 fluorescent group). The L*a*b* coordinates before aging (T₀) were obtained with a spectrophotometer, and the degree of fluorescence was measured. The disks were subjected to accelerated aging for 1 hour (T₁) and 5 hours (T₂). Measurements were made before and after each time interval. Color differences (ΔE₀₀) were calculated using the CIEDE2000 formula and analyzed by 2-way ANOVA. Lightness (ΔL'), chroma (ΔC'), and hue differences (ΔH') were analyzed by multivariate ANOVA. Degrees of fluorescence were obtained as percentages and were analyzed by 2-way ANOVA. Multiple comparisons were performed by the Tukey HSD test (α=.05).

RESULTS

Color differences were observed when 3Y-TZP disks were treated with coloring (7.91 ΔE₀₀), with fluorescent liquid (5.81 ΔE₀₀), and with both liquids (5.52 ΔE₀₀). Accelerated aging resulted in color differences in the T₂ A2 group (6.74 ΔE₀₀) and at both times evaluated in the fluorescent group (T₁=8.59 ΔE₀₀ and T₂=8.47 ΔE₀₀) (P<.001). In the A2 fluorescent group, the degree of fluorescence was not influenced significantly (P>.05). The use of fluorescent liquid influenced the degree of fluorescence in the fluorescent group (T₀=20%).

CONCLUSIONS

Significant differences in color, lightness, chroma, and hue were achieved in all tested groups before and after aging. The degree of fluorescence was statistically different only in the fluorescent group and was not influenced by accelerated aging.

Survey of UK dentists regarding the use of CAD/CAM technology

Statement of the problem Digital workflows (CAD/CAM) have been introduced in dentistry during recent years. No published information exists on dentists' use and reporting of this technology.Purpose The purpose of this survey was to identify the infiltration of CAD/CAM technology in UK dental practices and to investigate the relationship of various demographic factors to the answers regarding use or non-use of this technology.Materials and methods One thousand and thirty-one online surveys were sent to a sample of UK dentists composing of both users and non-users of CAD/CAM. It aimed to reveal information regarding type of usage, materials, perceived benefits, barriers to access, and disadvantages of CAD/CAM dentistry. Statistical analysis was undertaken to test the influence of various demographic variables such as country of work, dentist experience, level of training and type of work (NHS or private).Results The number of completed responses totalled 385. Most of the respondents did not use any part of a digital workflow, and the main barriers to CAD/CAM use were initial costs and a lack of perceived benefit over conventional methods. Dentists delivering mostly private work were most likely to have adopted CAD/CAM technology (P <0.001). Further training also correlated with a greater likelihood of CAD/CAM usage (P <0.001). Most users felt that the technology had led to a change in the use of dental materials, leading to increased use of, for example, zirconia and lithium disilicate. Most users were trained either by companies or self-trained, and a third felt that their training was insufficient. The majority of respondents (89%) felt that CAD/CAM had a big role to play in the future.Conclusion Most of the respondents did not use any part of a digital workflow. However, the majority of surveyed dentists were interested in incorporating CAD/CAM into their workflow, while most believed that it will have a big role in the future. There are still some concerns from dentists about the quality of chairside CAD/CAM restorations while the costs are still in the main hugely prohibitive (especially for NHS dentistry).