Current status of zirconia restoration

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

OBJECTIVE

The aim was to evaluate the optical properties, mechanical properties and aging stability of yttria-stabilized zirconia with different compositions, highlighting the influence of the alumina addition, Y₂O₃ content and La₂O₃ doping on the translucency.

METHODS

Five different Y-TZP zirconia powders (3 commercially available and 2 experimentally modified) were sintered under the same conditions and characterized by X-ray diffraction with Rietveld analysis and scanning electron microscopy (SEM). Translucency (n=6/group) was measured with a color meter, allowing to calculate the translucency parameter (TP) and the contrast ratio (CR). Mechanical properties were appraised with four-point bending strength (n=10), single edge V-notched beam (SEVNB) fracture toughness (n=8) and Vickers hardness (n=10). The aging stability was evaluated by measuring the tetragonal to monoclinic transformation (n=3) after accelerated hydrothermal aging in steam at 134°C, and the transformation curves were fitted by the Mehl-Avrami-Johnson (MAJ) equation. Data were analyzed by one-way ANOVA, followed by Tukey's HSD test (α=0.05).

RESULTS

Lowering the alumina content below 0.25wt.% avoided the formation of alumina particles and therefore increased the translucency of 3Y-TZP ceramics, but the hydrothermal aging stability was reduced. A higher yttria content (5mol%) introduced about 50% cubic zirconia phase and gave rise to the most translucent and aging-resistant Y-TZP ceramics, but the fracture toughness and strength were considerably sacrificed. 0.2mol% La₂O₃ doping of 3Y-TZP tailored the grain boundary chemistry and significantly improved the aging resistance and translucency. Although the translucency improvement by La₂O₃ doping was less effective than for introducing a substantial amount of cubic zirconia, this strategy was able to maintain the mechanical properties of typical 3Y-TZP ceramics.

SIGNIFICANCE

Three different approaches were compared to improve the translucency of 3Y-TZP ceramics.

Effect of thione primers on adhesive bonding between an indirect composite material and Ag-Pd-Cu-Au alloy

The current study evaluated the effect of primers on the shear bond strength of an indirect composite material joined to a silverpalladium-copper-gold (Ag-Pd-Cu-Au) alloy (Castwell). Disk specimens were cast from the alloy and were air-abraded with alumina. Eight metal primers were applied to the alloy surface. A light-polymerized indirect composite material (Solidex) was bonded to the alloy. Shear bond strength was determined both before and after the application of thermocycling. Two groups primed with Metaltite (thione) and M. L. Primer (sulfide) showed the greatest post-thermocycling bond strength (8.8 and 6.5 MPa). The results of the X-ray photoelectron spectroscopic (XPS) analysis suggested that the thione monomer (MTU-6) in the Metaltite primer was strongly adsorbed onto the Ag-Pd-Cu-Au alloy surface even after repeated cleaning with acetone. The application of either the thione (MTU-6) or sulfide primer is effective for enhancing the bonding between a composite material and Ag-Pd-Cu-Au alloy.

Influence of the Conditioning Method for Pre-Sintered Zirconia on the Shear Bond Strength of Bilayered Porcelain/Zirconia

This study evaluated the bond strength of veneering porcelain with an experimental conditioner-coated zirconia. Pre-sintered Y-TZP specimens (n = 44) were divided in two groups based on conditioning type. After sintering, all sample surfaces were sandblasted and layered with veneering porcelain. Additionally, half of the specimens in each group underwent thermal cycling (10,000 cycles, 5–55 °C), and all shear bond strengths were measured. After testing, the failure mode of each fractured specimen was determined. Differences were tested by parametric and Fisher’s exact tests (α = 0.05). The differences in bond strength were not statistically significant. Adhesive fractures were dominantly observed for the non-thermal cycled specimens. After thermal cycling, the conditioner-coated group showed cohesive and mixed fractures (p = 0.0021), whereas the uncoated group showed more adhesive fractures (p = 0.0021). Conditioning of the pre-sintered Y-TZP did not change the shear bond strength of the veneering porcelain, but did improve the failure mode after thermal cycling.

Intraoral Repair of Direct and Indirect Restorations: Procedures and Guidelines

The service life of defective direct or indirect restorations could be prolonged by repair or relayering actions where durable adhesion of resin-based composite materials is established for longevity of repairs. The advances in adhesive technologies have introduced several surface conditioning concepts to adhere resin composites onto different restorative materials. The purpose of this report is to summarize reasons for failure, survival of repaired reconstructions, elaborate upon types and mechanisms of available surface conditioning methods, and present operative dentists with practical guidelines for intraoral repair procedures.

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

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

Influence of Pre-Sintered Zirconia Surface Conditioning on Shear Bond Strength to Resin Cement

This study analyzed the shear bond strength (SBS) of resin composite on zirconia surface to which a specific conditioner was applied before sintering. After sintering of either conditioner-coated or uncoated specimens, both groups were divided into three subgroups by their respective surface modifications (n = 10 per group): no further treatment; etched with hydrofluoric acid; and sandblasted with 50 µm Al₂O₃ particles. Surfaces were characterized by measuring different surface roughness parameters (e.g., R_a and R_max) and water contact angles. Half of the specimens underwent thermocycling (10,000 cycles, 5–55 °C) after self-adhesive resin cement build-up. The SBSs were measured using a universal testing machine, and the failure modes were analyzed by microscopy. Data were analyzed by nonparametric and parametric tests followed by post-hoc comparisons (α = 0.05). Conditioner-coated specimens increased both surface roughness and hydrophilicity (p < 0.01). In the non-thermocycled condition, sandblasted surfaces showed higher SBSs than other modifications, irrespective of conditioner application (p < 0.05). Adhesive fractures were commonly observed in the specimens. Thermocycling favored debonding and decreased SBSs. However, conditioner-coated specimens upon sandblasting showed the highest SBS (p < 0.05) and mixed fractures were partially observed. The combination of conditioner application before sintering and sandblasting after sintering showed the highest shear bond strength and indicated improvements concerning the failure mode.

Influence of Different Framework Designs on the Fracture Properties of Ceria-Stabilized Tetragonal Zirconia/Alumina-Based All-Ceramic Crowns

The aim of this study was to evaluate the fracture load and failure mode of all-ceramic crowns with different ceria-stabilized tetragonal zirconia/alumina nanocomposite (Ce-TZP/A) framework designs. Four frameworks (anatomical shape: AS, with a buccal or lingual supporting structure: BS and LS, or buccal and lingual supporting structures: BLS) were fabricated. All frameworks were veneered with porcelain to fabricate all-ceramic crowns followed by cementation to tooth analogs. The fracture load of each crown either without or with pre-loading (1.2 million cycles, 49 N) was measured. The failure mode was classified into partial or complete fracture. Differences were tested for significance (p < 0.05) by a two-way Analysis of Variance (ANOVA), followed by Tukey’s test and by Fisher’s exact test, respectively. Without pre-loading, supporting structures did not influence the fracture load or failure mode. Partial fractures were the most common failure mode. Pre-loading promoted the severity of the failure mode, although the fracture load among the framework designs was not influenced. In the AS group, prefailures were observed during pre-loading, and complete fractures were significantly increased after pre-loading. In contrast, the failure mode of the BLS group remained unchanged, showing only partial fracture even after pre-loading. This Ce-TZP/A framework design, comprised of an anatomical shape with additional buccal and lingual structures, has the potential to reduce the chipping of the veneering porcelain.

Fracture toughness of chairside CAD/CAM materials - Alternative loading approach for compact tension test

OBJECTIVE

This in-vitro study determined plane-strain fracture toughness (KIC) of five different chairside CAD/CAM materials used for crown fabrication, following alternative innovative loading approach of compact tension test specimens.

METHODS

Rectangular-shaped specimens were cut from CAD/CAM blocks (n=10): Vita Mark II (Vident) (VMII); Lava-Ultimate (3M/ESPE) (LU); Vita Enamic (Vident) (VE); IPS e.max CAD (Ivoclar Vivadent); crystallized and un-crystallized (E-max and E-max-U, respectively); and Celtra Duo (Dentsply) fired and unfired (CD and CD-U, respectively). Specimens were notched with thin diamond disk prior to testing. Instead of applying tensile loading through drilled holes, a specially-made wedge-shaped steel loading-bar was used to apply compressive load at the notch area in Instron universal testing machine. The bar engaged the top ¼ of the notch before compressive load was applied at a cross-head speed of 0.5mm/min. Fracture load was recorded and KIC calculated. Data was statistically-analyzed with one-way ANOVA at 95% confidence level and Tukey's tests.

RESULTS

Means and SDs of KIC in MPam(1/2) for VMII, LU, VE, E-max, E-max-U, CD and CD-U were: 0.73 (0.13), 0.85 (0.21), 1.02 (0.19), 1.88 (0.62), 0.81 (0.25), 2.65 (0.32) and 1.01 (0.15), respectively. ANOVA revealed significant difference among the groups (p<0.001). CD and E-max had significantly highest mean KIC values.

SIGNIFICANCE

Mean KIC values of the tested materials varied considerably, however, none of them reached mean KIC of dentin (3.08MPam(1/2)) previously reported. For E-max and CD, specimens firing significantly increased mean KIC. The modified test arrangement was found to be easy to follow and simplified specimen preparation process.

Clinical prospective evaluation of zirconia-based three-unit posterior fixed dental prostheses: Up-to ten-year results

OBJECTIVES

Only a few studies exist, which assess the clinical long-term behavior of all-ceramic FDPs in the posterior region. The aim of the present prospective clinical study was to evaluate the clinical performance of posterior three-unit FDPs manufactured from Y-TZP after a service period up to 10 years.

METHODS

55 patients received 59 three-unit FDPs in the posterior region of the maxilla or mandible. Abutment teeth were prepared and full-arch impressions were taken. Definitive casts were fabricated and optically scanned. Frameworks were fabricated with computer-aided design (CAD) and manufacturing (CAM) technology. Y-TZP frameworks were veneered and adhesively luted to the abutment teeth. Baseline and follow-up examinations (service time: ≥ 48 months) were recorded by applying modified United States Public Health Services (USPHS) rating criteria. Cumulative survival rate was analyzed with Kaplan-Meier. Percentage of biological and technical complication was calculated.

RESULTS

Fifty-three patients with 57 FDPs attended the last follow-up visit and a mean observation period of the remaining was 6.3 ± 1.9 years was calculated. Biological complications occurred in 17.5%, technical complications in 28% of the FDPs. The 10-year cumulative survival rate amounted 85.0%. Three FDPs failed to survive, two due to a root fracture of the abutment tooth and one due to secondary caries.

CONCLUSIONS

Three-unit FDPs made from Y-TZP, veneered with ceramic offer a treatment option with a high rate of chipping. However, the manufacturing processes nowadays are modified in order to avoid this complication.

CLINICAL SIGNIFICANCE

The results of the present investigation suggest that three-unit Y-TZP posterior FDPs may are a possible treatment option. However, a high rate of chipping can be expected.

Zirconia based dental ceramics: structure, mechanical properties, biocompatibility and applications

Zirconia (ZrO₂) based dental ceramics have been considered to be advantageous materials with adequate mechanical properties for the manufacturing of medical devices.

Effect of Polishing Systems on Surface Roughness and Topography of Monolithic Zirconia

This study evaluated the effect of different chairside polishing systems on the surface roughness and topography of monolithic zirconia. Thirty-five monolithic zirconia specimens (Lava PLUS, 3M ESPE) were fabricated and divided into five groups of seven and polished with the following: Group 1 (WZ)-Dura white stone followed by Shofu zirconia polishing kit; Group 2 (SZ)-Shofu zirconia polishing kit; Group 3 (CE)-Ceramiste porcelain polishers; Group 4 (CM)-Ceramaster porcelain polishers; and Group 5 (KZ)-Komet ZR zirconia polishers. All specimens were ground with a fine-grit diamond bur prior to polishing procedures to simulate clinical finishing. Baseline and post-polishing profilometric readings were recorded and delta Ra values (difference in mean surface roughness before and after polishing) were computed and analyzed using one-way analysis of variance and Scheffe post hoc test (p<0.05). Representative scanning electron microscopy (SEM) images of the ground but unpolished and polished specimens were acquired. Delta Ra values ranged from 0.146 for CE to 0.400 for KZ. Delta Ra values for KZ, WZ, and SZ were significantly greater than for CE. Significant differences in delta Ra values were also observed between KZ and CM. The SEM images obtained were consistent with the profilometric findings. Diamond-impregnated polishing systems were more effective than silica carbide-impregnated ones in reducing the surface roughness of ground monolithic zirconia.

Resin bonding of metal brackets to glazed zirconia with a porcelain primer

Objective

The aims of this study were to compare the shear bond strength between orthodontic metal brackets and glazed zirconia using different types of primer before applying resin cement and to determine which primer was more effective.

Methods

Zirconia blocks were milled and embedded in acrylic resin and randomly assigned to one of four groups: nonglazed zirconia with sandblasting and zirconia primer (NZ); glazed zirconia with sandblasting, etching, and zirconia primer (GZ); glazed zirconia with sandblasting, etching, and porcelain primer (GP); and glazed zirconia with sandblasting, etching, zirconia primer, and porcelain primer (GZP). A stainless steel metal bracket was bonded to each target surface with resin cement, and all specimens underwent thermal cycling. The shear bond strength of the specimens was measured by a universal testing machine. A scanning electron microscope, three-dimensional optical surface-profiler, and stereoscopic microscope were used to image the zirconia surfaces. The data were analyzed with one-way analyses of variance and the Fisher exact test.

Results

Group GZ showed significantly lower shear bond strength than did the other groups. No statistically significant differences were found among groups NZ, GP, and GZP. All specimens in group GZ showed adhesive failure between the zirconia and resin cement. In groups NZ and GP, bonding failed at the interface between the resin cement and bracket base or showed complex adhesive and cohesive failure.

Conclusions

Porcelain primer is the more appropriate choice for bonding a metal bracket to the surface of a full-contour glazed zirconia crown with resin cement.

Biaxial flexural strength of bilayered zirconia using various veneering ceramics

PURPOSE

The aim of this study was to evaluate the biaxial flexural strength (BFS) of one zirconia-based ceramic used with various veneering ceramics.

MATERIALS AND METHODS

Zirconia core material (Katana) and five veneering ceramics (Cerabien ZR; CZR, Lava Ceram; LV, Cercon Ceram Kiss; CC, IPS e.max Ceram; EM and VITA VM9; VT) were selected. Using the powder/liquid layering technique, bilayered disk specimens (diameter: 12.50 mm, thickness: 1.50 mm) were prepared to follow ISO standard 6872:2008 into five groups according to veneering ceramics as follows; Katana zirconia veneering with CZR (K/CZR), Katana zirconia veneering with LV (K/LV), Katana zirconia veneering with CC (K/CC), Katana zirconia veneering with EM (K/EM) and Katana zirconia veneering with VT (K/VT). After 20,000 thermocycling, load tests were conducted using a universal testing machine (Instron). The BFS were calculated and analyzed with one-way ANOVA and Tukey HSD (α=0.05). The Weibull analysis was performed for reliability of strength. The mode of fracture and fractured surface were observed by SEM.

RESULTS

It showed that K/CC had significantly the highest BFS, followed by K/LV. BFS of K/CZR, K/EM and K/VT were not significantly different from each other, but were significantly lower than the other two groups. Weibull distribution reported the same trend of reliability as the BFS results.

CONCLUSION

From the result of this study, the BFS of the bilayered zirconia/veneer composite did not only depend on the Young's modulus value of the materials. Further studies regarding interfacial strength and sintering factors are necessary to achieve the optimal strength.

Restoring Congenitally Missing Maxillary Lateral Incisors Using Zirconia-Based Resin Bonded Prostheses

OBJECTIVE

This clinical report describes an alternative treatment modality for the replacement of congenitally missing maxillary lateral incisors in a 17-year-old patient.

CLINICAL CONSIDERATIONS

Zirconia-based resin-bonded fixed partial dentures (RBFPDs) were selected as a viable and conservative treatment option in a young individual with highly aesthetic expectations. Fabrication of all-ceramic RBFPDs followed specific preparation design and features to accommodate two retainers. The zirconia frameworks with bilateral wings were digitally designed and then milled by a computer-aided design and computer-aided manufacturing (CAD/CAM)-controlled milling machine. Zirconia surface was treated with a two-step chairside tribochemical silica-coating/silane coupling surface treatment protocol, and adhesive resin luting cement was used to achieve micromechanical and chemical bonding. Completion of the treatment resulted in a functional and aesthetic successful outcome and a 17-month follow-up presented uneventful.

CONCLUSION

Contemporary adhesive techniques involving resin-bonded zirconia-based prostheses can be utilized successfully and predictably in young patients with single missing teeth when implant therapy is currently not a treatment of choice and a less invasive approach is desired.

CLINICAL SIGNIFICANCE

The zirconia-based resin-bonded prosthesis constitutes a viable and conservative treatment modality for the replacement of missing teeth either congenitally or from another etiology in young patients in which implant therapy and a fixed partial denture are currently contraindicated.

Adhesion Properties of Human Oral Epithelial-Derived Cells to Zirconia

BACKGROUND

Few studies have examined epithelial attachment to zirconia and the proliferative ability of epithelial cells on zirconia surfaces.

PURPOSE

To evaluate the adhesion properties of zirconia materials for epithelial cell attachment and compare this with titanium and alumina.

MATERIALS AND METHODS

Human oral epithelial cells were cultured on smooth-surfaced specimens of commercially pure titanium (cpTi), ceria-stabilized zirconia/alumina nano-composite (P-NANOZR), yttria-stabilized zirconia (Cercon), and alumina oxide (inCoris AL). The cell morphology, the cell viability and mRNA of integrin β₄ , laminin γ₂ , catenin δ₂ , and E-cadherin were evaluated by SEM, Cell-Counting Kit-8, and real-time PCR, respectively.

RESULTS

Morphology of cells attached to specimens was similar among all groups. The viable cell numbers on Cercon and inCoris AL after 24 hours culture were significantly higher than for cpTi. Integrin β₄ , laminin γ₂ , and catenin δ₂ mRNA expression was not different among all groups. However, at 3 and 24 hours after incubation, E-cadherin mRNA expression in the P-NANOZR group was significantly higher than for cpTi.

CONCLUSION

Zirconia may support binding of epithelial cells through hemidesmosomes comparable with titanium. Furthermore, P-NANOZR may impart resistance to exogenous stimuli through strong intercellular contacts with peri-implant mucosal cells when used as an abutment and implant superstructure.

Comparison of shear bond strength of orthodontic brackets using various zirconia primers

Objective

The aim of this study was to compare the shear bond strength (SBS) of orthodontic brackets bonded to zirconia surfaces using three different zirconia primers and one silane primer, and subjected to thermocycling.

Methods

We designed 10 experimental groups following the surface treatment and thermocycling. The surface was treated with one of the following method: no-primer (NP), Porcelain Conditioner (PC), Z-PRIME Plus (ZP), Monobond Plus (MP) and Zirconia Liner Premium (ZL) (n=20). Then each group was subdivided to non-thermocycled and thermocycled groups (NPT, PC, ZPT, MPT, ZLT) (n=10). Orthodontic brackets were bonded to the specimens using Transbond™ XT Paste and light cured for 15 s at 1,100 mW/cm². The SBS was measured at a 1 mm/min crosshead speed. The failure mode was assessed by examination with a stereomicroscope and the amount of bonding resin remaining on the zirconia surface was scored using the modified adhesive remnant index (ARI).

Results

The SBS of all experimental groups decreased after thermocycling. Before thermocycling, the SBS was ZL, ZP ≥ MP ≥ PC > NP but after thermocycling, the SBS was ZLT ≥ MPT ≥ ZPT > PCT = NPT (p > 0.05). For the ARI score, both of the groups lacking primer (NP and NPT) displayed adhesive failure modes, but the groups with zirconia primers (ZP, ZPT, MP, MPT, ZL, and ZLT) were associated with mixed failure modes.

Conclusions

Surface treatment with a zirconia primer increases the SBS relative to no-primer or silane primer application between orthodontic brackets and zirconia prostheses.

Numerical simulation of the fracture process in ceramic FPD frameworks caused by oblique loading

Using a newly developed three-dimensional (3D) numerical modeling code, an analysis was performed of the fracture behavior in a three-unit ceramic-based fixed partial denture (FPD) framework subjected to oblique loading. All the materials in the study were treated heterogeneously; Weibull׳s distribution law was applied to the description of the heterogeneity. The Mohr-Coulomb failure criterion with tensile strength cut-off was utilized in judging whether the material was in an elastic or failed state. The simulated loading area was placed either on the buccal or the lingual cusp of a premolar-shaped pontic with the loading direction at 30°, 45°, 60°, 75° or 90° angles to the occlusal surface. The stress distribution, fracture initiation and propagation in the framework during the loading and fracture process were analyzed. This numerical simulation allowed the cause of the framework fracture to be identified as tensile stress failure. The decisive fracture was initiated in the gingival embrasure of the pontic, regardless of whether the buccal or lingual cusp of the pontic was loaded. The stress distribution and fracture propagation process of the framework could be followed step by step from beginning to end. The bearing capacity and the rigidity of the framework vary with the loading position and direction. The framework loaded with 90° towards the occlusal surface has the highest bearing capacity and the greatest rigidity. The framework loaded with 30° towards the occlusal surface has the least rigidity indicating that oblique loading has a major impact on the fracture of ceramic frameworks.

Enhanced reliability of yttria-stabilized zirconia for dental applications

An increasing number of dental applications based on yttria-stabilized zirconia (3 Y-TZP) have been developed in recent years as a result of the advances and versatility of dry-processing and soft machining at the pre-sintered state. Nonetheless, the long-term surface stability of these materials in humid environment is still a matter of concern and may limit its application. In this work, a simple method to prevent hydrothermal degradation on the zirconia surface is studied in detail. This method involves the infiltration of pre-sintered parts with optimized solutions containing Ce salts, leaving unchanged the other processing steps, allowing the diffusion of Ce during conventional sintering. Several pre-sintering conditions, solution concentrations and sintering temperatures were studied and characterized, obtaining working parameters for the production of zirconia parts with mechanical properties similar to standard 3 Y-TZP and high resistance to hydrothermal aging. This optimal combination was obtained with the 1150 °C pre-sintering temperature, 50 wt.% solution and sintering at 1450 °C, leading to a superficial CeO2 content of about 3 mol.%.

Highly-translucent, strong and aging-resistant 3Y-TZP ceramics for dental restoration by grain boundary segregation

Latest trends in dental restorative ceramics involve the development of full-contour 3Y-TZP ceramics which can avoid chipping of veneering porcelains. Among the challenges are the low translucency and the hydrothermal stability of 3Y-TZP ceramics. In this work, different trivalent oxides (Al2O3, Sc2O3, Nd2O3 and La2O3) were selected to dope 3Y-TZP ceramics. Results show that dopant segregation was a key factor to design hydrothermally stable and high-translucent 3Y-TZP ceramics and the cation dopant radius could be used as a controlling parameter. A large trivalent dopant, oversized as compared to Zr(4+), exhibiting strong segregation at the ZrO2 grain boundary was preferred. The introduction of 0.2 mol% La2O3 in conventional 0.1-0.25 wt.% Al2O3-doped 3Y-TZP resulted in an excellent combination of high translucency and superior hydrothermal stability, while retaining excellent mechanical properties.

Effect of sodium sulfite, carboxylic monomer, and phosphoric acid etching on bonding of tri-n-butylborane initiated resin to human enamel

The purpose of the present study is evaluation of bonding durability of tri-n-butylborane (TBB) initiated resin without 4-methacryloyloxyethyl trimellitate anhydride (4-META) joined to human enamel. Ground human enamel was bonded with TBB resin under six surface conditions: 1) as ground, 2) primed with Teeth Primer, 3) sodium sulfite solution, 4) 4-META solution, 5) acetone-water, and 6) phosphoric acid etching. Pre- and post-thermocycling bond strengths and change in strength after thermocycling were compared. Etching enamel with 35-45% phosphoric acid enhanced bonding durability between enamel and TBB-initiated resin. Priming with Teeth Primer or 4-META solution improved bond strength between enamel and TBB-initiated resin. Sodium sulfite had little effect on enamel bonding in the present bonding systems.

Fitting accuracy and fracture resistance of crowns using a hybrid zirconia frame made of both porous and dense zirconia

The purpose of this study is to evaluate the fitting accuracy and fracture resistance of crowns using a hybrid zirconia frame made of both porous and dense zirconia. Commercial semi-sintered zirconia, sintered dense zirconia and sintered hybrid zirconia were used. Sintered zirconia was milled using the CAD/CAM system, and semi-sintered zirconia was milled and sintered to fabricate molar crown frames. Completed frames were veneered with tooth-colored porcelain. The marginal and internal gaps between frames/crowns and abutments were measured. Each crown specimen was subjected to a fracture test. There were no significant differences in marginal and internal gap among all the frames and crowns. The crown with the hybrid zirconia frame had a 31-35% greater fracture load than that with the commercial or dense zirconia frame (p<0.01). This suggests that the all-ceramic crowns with a hybrid zirconia frame have a high fracture resistance.

Outcome of zirconia single crowns made by predoctoral dental students: a clinical retrospective study after 2 to 6 years of clinical service

STATEMENT OF PROBLEM

Zirconia has established its role as a reliable ceramic material for fixed prostheses.

PURPOSE

The purpose of this retrospective study was to evaluate the outcome of zirconia single crowns made by predoctoral students after 2 to 6 years of clinical service.

MATERIAL AND METHODS

A cohort of 88 patients treated with zirconia single crowns (mean 3 crowns per patient, range 1 to 12 crowns) from 2007 to 2010 by predoctoral dental students was identified. The patients were invited to attend a clinical examination.

RESULTS

Sixty-six participants (75%) took part in the clinical follow-up (30 women and 36 men; mean age 60.4 years, range 19 to 81 years). Altogether, 190 teeth with single crowns were examined, and the mean follow-up time was 3.88 years (1.85 to 6.04 years). The most common complications were chipping of veneering porcelain (4%) and loss of cementation (4%). The success rate of the zirconia single crowns after 2 to 6 years was 80% and the survival rate 89%.

CONCLUSIONS

Zirconia crowns can be successfully used in predoctoral dental education. The success rate of zirconia single crowns after 2 to 6 years was 80% and the survival rate was 89%, in accordance with previous studies.

Fracture resistance of computer-aided design/computer-aided manufacturing-generated composite resin-based molar crowns

The aim of this study was to investigate whether different fabrication processes, such as the computer-aided design/computer-aided manufacturing (CAD/CAM) system or the manual build-up technique, affect the fracture resistance of composite resin-based crowns. Lava Ultimate (LU), Estenia C&B (EC&B), and lithium disilicate glass-ceramic IPS e.max press (EMP) were used. Four types of molar crowns were fabricated: CAD/CAM-generated composite resin-based crowns (LU crowns); manually built-up monolayer composite resin-based crowns (EC&B-monolayer crowns); manually built-up layered composite resin-based crowns (EC&B-layered crowns); and EMP crowns. Each type of crown was cemented to dies and the fracture resistance was tested. EC&B-layered crowns showed significantly lower fracture resistance compared with LU and EMP crowns, although there was no significant difference in flexural strength or fracture toughness between LU and EC&B materials. Micro-computed tomography and fractographic analysis showed that decreased strength probably resulted from internal voids in the EC&B-layered crowns introduced by the layering process. There was no significant difference in fracture resistance among LU, EC&B-monolayer, and EMP crowns. Both types of composite resin-based crowns showed fracture loads of >2000 N, which is higher than the molar bite force. Therefore, CAD/CAM-generated crowns, without internal defects, may be applied to molar regions with sufficient fracture resistance.

Influence of surface treatment of contaminated zirconia on surface free energy and resin cement bonding

Influences of contamination and cleaning methods on the bonding of resin cement to zirconia ceramics were examined. Airborne particle-abraded zirconia (IPS e.max ZirCAD) specimens were contaminated with saliva and cleaned with tap water (SC) or by application of 37% phosphoric acid (PA), Ivoclean (IC), or additional airborne particle abrasion (AB). Specimens without contamination served as controls. After application of Monobond Plus to the surface of the specimens, resin cement was mixed and inserted into a mold. Surface free energies of the specimens were determined by measuring contact angles. Surface treatment and storage conditions significantly influenced bond strength, while there was no significant interaction between the two factors. Surface free energies of the SC and IC groups were significantly lower than those of the other groups. Additional AB of saliva-contaminated zirconia increased the strength of bonding with the resin cement as well as increased surface free energy.

Wear performance of bovine tooth enamel against translucent tetragonal zirconia polycrystals after different surface treatments

The wear performances of bovine tooth enamel (BTE) against translucent tetragonal zirconia polycrystals (TZP) compared to that of feldspar porcelain and the influence of surface treatments of translucent TZP were investigated by the two-body wear test. Translucent TZP and feldspar porcelain were used as hemisphere abrader specimens with a radius of curvature of 5 mm; flat BTE surfaces were used as substrate specimens. The cross-sectional area of the worn surfaces of the substrates and the wear volume of the antagonist abraders were measured. Surface roughness, hardness and coefficient of friction as well as SEM observations and EPMA analyses were also performed to investigate the underlying mechanism of wear. The results suggested that BTE is less susceptible to wear when translucent TZP is used as the antagonist in contrast to the use of feldspar porcelain, and that surface treatment of the TZP abraders significantly influenced the wear of BTE substrates.

Surface characteristics and castability of Zr-14Nb alloy dental castings

The purpose of this study was to evaluate mechanical properties, surface characteristics and castability of Zr-14Nb dental castings. The mean 0.2% proof and ultimate tensile strengths of Zr-14Nb were approximately 68% and 76% those of Ti-6Al-7Nb, respectively, while they were comparable to Co-29Cr-6Mo. Elongation of Zr-14Nb was the highest of all alloys tested. The hardened reaction layer was formed on the surfaces of the Zr-14Nb castings. The layer consisted of oxygen and aluminum originating form investment. The castability of Zr-14Nb was comparable to that of Ti-6Al-7Nb. Dental castings of Zr-14Nb reveal mechanical properties that were within the range of the other dental alloys. Further improvements in castability and minimization of the surface reaction layer are needed for applications in dental prostheses.

Novel zirconia surface treatments for enhanced osseointegration: laboratory characterization

Purpose. The aim of this study was to evaluate three novel surface treatments intended to improve osseointegration of zirconia implants: selective infiltration etching treatment (SIE), fusion sputtering (FS), and low pressure particle abrasion (LPPA). The effects of surface treatments on roughness, topography, hardness, and porosity of implants were also assessed. Materials and Methods. 45 zirconia discs (19 mm in diameter × 3 mm in thickness) received 3 different surface treatments: selective infiltration etching, low pressure particle abrasion with 30 µm alumina, and fusion sputtering while nontreated surface served as control. Surface roughness was evaluated quantitatively using profilometery, porosity was evaluated using mercury prosimetry, and Vickers microhardness was used to assess surface hardness. Surface topography was analyzed using scanning and atomic force microscopy (α = 0.05). Results. There were significant differences between all groups regarding surface roughness (F = 1678, P < 0.001), porosity (F = 3278, P < 0.001), and hardness (F = 1106.158, P < 0.001). Scanning and atomic force microscopy revealed a nanoporous surface characteristic of SIE, and FS resulted in the creation of surface microbeads, while LPPA resulted in limited abrasion of the surface. Conclusion. Within the limitations of the study, changes in surface characteristics and topography of zirconia implants have been observed after different surface treatment approaches. Thus possibilities for enhanced osseointegration could be additionally offered.

Ceramic dental biomaterials and CAD/CAM technology: state of the art

PURPOSE

Ceramics are widely used as indirect restorative materials in dentistry because of their high biocompatibility and pleasing aesthetics. The objective is to review the state of the arts of CAD/CAM all-ceramic biomaterials.

STUDY SELECTION

CAD/CAM all-ceramic biomaterials are highlighted and a subsequent literature search was conducted for the relevant subjects using PubMed followed by manual search.

RESULTS

Developments in CAD/CAM technology have catalyzed researches in all-ceramic biomaterials and their applications. Feldspathic glass ceramic and glass infiltrated ceramic can be fabricated by traditional laboratory methods or CAD/CAM. The advent of polycrystalline ceramics is a direct result of CAD/CAM technology without which the fabrication would not have been possible.

CONCLUSIONS

The clinical uses of these ceramics have met with variable clinical success. Multiple options are now available to the clinicians for the fabrication of aesthetic all ceramic restorations.