Contemporary all-ceramic fixed partial dentures: a review

Customized-3D zirconia barriers for guided bone regeneration (GBR): clinical and histological findings from a proof-of-concept case series

OBJECTIVES

The aim of this case series was to evaluate, clinically and histologically, customized-3D zirconia barriers manufactured for guided bone regeneration (GBR) procedures.

METHODS

Seven healthy consecutive patients with severe bone atrophy (two of them with a bilateral atrophy) were selected for a GBR procedure with a zirconia barrier. In a 3D software (DentalCad, Exocad GmbH, Germany), a virtual bone graft was designed and a shell was designed covering the graft; a standard tessellation language (.STL) file was obtained and milled (M1, Zirkonzahn, Italy) using a 1200 MPa zirconia (Prettau, Zirkonzahn, Italy). Nine GBR surgeries (8 upper-posterior jaw, 1 lower-posterior jaw) were performed using autogenous bone chips mixed with xenograft (SmartBone, IBI-SA, Switzerland / BioOss, Geistlich, Switzerland) covered with a zirconia barrier, fixed by means of screws. After healing, implant sites were prepared with a trephine bur, collecting a bone biopsy, and dental implants were inserted (Neodent, Straumann Group, Switzerland). Specimens were histologically analyzed.

RESULTS

Eight successful surgeries were recorded; one zirconia barrier got exposed after one month of healing but no signs of infection were present till the barrier was removed. In all cases it was possible to insert implants with no additional bone augmentation procedures. Histological evaluations showed the presence of intense deposition of new bone.

CONCLUSIONS

Within the limitations of the present case series, the tested customized-3D zirconia barriers confirmed good clinical and histological performances, and, even in case of premature exposure, did not show signs of infection. Preliminary results suggest they are effective for GBR procedures. Further research is necessary with a larger sample size.

CLINICAL SIGNIFICANCE

The presented barriers could be a viable alternative to titanium-reinforced polytetrafluoroethylene membranes and customized meshes.

Optimized Zirconia 3D Printing Using Digital Light Processing with Continuous Film Supply and Recyclable Slurry System

Stereolithography (SL) can fabricate complex ceramic parts layer by layer using computer-aided design (CAD) models. The traditional SL system utilizes a vat filled with ceramic slurry with a high solid content, which for ceramics contributes to several limitations and operational difficulties, and further renders it nonrecyclable mainly due to the presence of printed residue and its high viscosity. In this study, we utilized a continuous film supply (CFS) system integrated with a tape-casting type digital light processing (DLP) printer to fabricate zirconia prototypes with a solid content of 45 volume percent (vol.%). Various printing and postprocessing parameters were studied for optimization, to achieve a relative density of 99.02% ± 0.08% with a microhardness of 12.59 ± 0.47 GPa. Slurry reusability was also demonstrated by printing with recycled slurry to produce consistent relative density values in the range of 98.86% ± 0.02% to 98.94% ± 0.03%. This method provides new opportunities for material recycling and the fabrication of dense complex ceramic products, reducing the consumption of the material.

Clinical acceptability of PEEK fixed dental prosthesis in partially edentulous patient - A one year single arm pilot study

Purpose

The study evaluated the clinical efficacy of Polyether ether ketone (PEEK) fixed dental prosthesis (FDP) over a period of one year using modified Ryges criteria and California Dental Assessment system.

Methods

The group consisted of 20 patients restored with posterior three-unit PEEK FDP. Patient recall and clinical examination of the restorations were done at interval of 0, 3, 6, 9 and 12 months. Clinical examination for evaluation of longevity of restorations was done using modified Ryges criteria and California dental assessment system on chipping of the veneered composite, discoloration at the marginal areas, and marginal adaptation, retention, periodontal health and hygiene of PEEK FDP. Radiographic assessment was done after 12 months. Statistical analysis were done using Friedman test.

Results

95% of the patients had maintained the restoration of PEEK FDP without fracture during the study period. 5% patient reported with de-cementation of fixed dental prosthesis. 10% of the PEEK FDP shows marginal discoloration. However, no significant changes were observed during the periodic time interval evaluation in marginal adaptation, oral hygiene status and periodontal health. (p < 0.5).

Conclusion

PEEK FDP had satisfactory clinical efficacy and acceptable clinical outcome during the observation period of 12 months. No significant radiological changes were observed at the end of 12 months.

Effect of grinding and aging on subcritical crack growth of a Y-TZP ceramic

This study aimed to investigate slow crack growth (SCG) behavior of a zirconia ceramic after grinding and simulated aging with low-temperature degradation (LTD). Complementary analysis of hardness, surface topography, crystalline phase transformation, and roughness were also measured. Disc-shaped specimens (15 mm Ø × 1.2 mm thick, n = 42) of a full-contour Y-TZP ceramic (Zirlux FC, Amherst) were manufactured according to ISO:6872-2008, and then divided into: Ctrl - as-sintered condition; Ctrl LTD - as-sintered after aging in autoclave (134°C, 2 bar, 20 h); G - ground with coarse diamond bur (grit size 181 μm); G LTD - ground and aged. The SCG parameters were measured by a dynamic biaxial flexural test, which determines the tensile stress versus stress rate under four different rates: 100, 10, 1 and 0.1 MPa/s. LTD led to m-phase content increase, as well as grinding (m-phase content: Ctrl - 0%; G - 12.3%; G LTD - 59.9%; Ctrl LTD - 81%). Surface topography and roughness analyses showed that grinding created an irregular surface (increased roughness) and aging did not promote any relevant surface change. There was no statistical difference on surface hardness among different conditions. The control group presented the lowest strength values in all tested rates. Regarding SCG, ground conditions were less susceptible to SCG, delaying its occurrence. Aging (LTD) caused an increase in SCG susceptibility for the as-sintered condition (i.e. G < G LTD < Ctrl < Ctrl LTD).

Effect of framework design on fracture load after thermal cycling and mechanical loading of implant-supported zirconia-based prostheses

This study evaluated the effect of zirconia framework design on fracture load of implant-supported zirconia-based prostheses after thermal cycling and mechanical loading. Three different zirconia framework designs were investigated: uniform-thickness (UNI), anatomic (ANA), and supported anatomic (SUP) designs. Each framework was layered with feldspathic porcelain (ZAC group) or indirect composite material (ZIC group). The specimens then underwent fracture load testing after thermal cycling and cyclic loading. In the ZAC group, mean fracture load was significantly lower for UNI design specimens than for the other framework designs. In the ZIC group, there was no significant difference in mean fracture load between ANA design specimens and either UNI or SUP design specimens. To improve fracture resistance of implant-supported zirconia-based prostheses after artificial aging, uniformly thick layering material and appropriate lingual support with zirconia frameworks should be provided.

An In vitro Comparative Evaluation of Flexural Strength of Monolithic Zirconia after Surface Alteration Utilising Two Different Techniques

INTRODUCTION

Chairside surface alteration like grinding is often done by clinicians for adjustment of zirconia restorations. To restore the surface of the prostheses, either polishing or glazing is done. However, there is a controversy which of the surface restoration technique helps regain strength of the restoration.

AIM

This study was conducted to evaluate the effects of chairside surface alteration on flexural strength of Monolithic zirconia.

MATERIALS AND METHODS

Rectangular zirconia samples (n=30) were prepared by CAD-CAM and divided into three groups. One was control group with no alteration (n=10), second was ground and polished (n=10) and third was ground and reglazed (n=10). Flexural strength testing was performed with a three-point bend test on a universal testing machine. The collected data was statistically analysed for normal distribution using D'Agostino and Pearson omnibus normality test, one-way ANOVA and Tukeys multiple comparison test (p<0.05).

RESULTS

The mean flexural strength of the reglazed group was significantly higher (648.7 MPa) as compared to the control (507 MPa) or the polished groups (588.5 MPa).

CONCLUSION

Statistically, reglazing increased the flexural strength as compared to polishing.

Contemporary All-ceramic Materials – Part 1

Over the past 35 years, multiple types of all-ceramic materials have been introduced as an ideal alternative for metal-fused to ceramic. This review covers state-of-the-art development of all-ceramic systems in terms of history, material composition, fabrication technologies, and structural and strength properties. These materials are proved to be ideal in terms of mechanical properties and biocompatibility, making metal-free ceramic restorations a realistic clinical alternative for conventional metal-fused-to ceramic.

Near-surface damage - a persistent problem in crowns obtained by computer-aided design and manufacturing

Robust dental systems obtained by computer-aided design and manufacture (CAD/CAM) have been introduced and, in parallel, the strength of the ceramic materials used in fabricating dental crowns has improved. Yet all-ceramic crowns suffer from near-surface damage, limiting their clinical success, especially on posterior teeth. Factors directly associated with CAD/CAM fabrication that contribute to the degree of damage include material selection and machining parameters and strategies. However, a number of additional factors also either create new damage modes or exacerbate subcritical damage, potentially leading to catastrophic failure of the crown. Such factors include post-fabrication manipulations in the laboratory or by the clinician, fatigue associated with natural occlusal function, and stress fields created by compliance or distortion within the supporting tooth structure and/or adhesive material holding the crown to the tooth. Any damage reduces the strength of a crown, increasing the probability of catastrophic failure. The challenge is to understand and manage the combination of competing damage initiation sites and mechanisms, limitations imposed by the demand for aesthetics, and biologically related constraints.

Effect of air-abrasion regimens and fine diamond bur grinding on flexural strength, Weibull modulus and phase transformation of zirconium dioxide

PURPOSE

This study evaluated the effect of air abrasion and polishing regimens on the flexural strength of yttrium stabilized polycrystalline tetragonal zirconia (Y-TZP).

METHODS

From Y-TZP blocks (InCeram 2000 YZ Cubes; Vita Zahnfabrik, Bad Säckingen, Germany) 120 bars (25 mm × 4 mm × 1.2 mm) were obtained according to ISO 6872:2008 and randomly divided into 4 groups: Group C: (control) without surface treatment (n = 30); Group APA: Air abrasion with aluminum oxide (44 µm) (n = 30); Group SC: Silica-coating (CoJet, 30 µm) (n = 30); Group FD: Fine diamond bur (n = 30). Subsequently, all specimens were subjected to 4-point bending test (in distilled water at 37 °C) in a universal testing machine (EMIC DL 1000; São José dos Pinhais, Paraná, Brazil); cross-head speed: 0.5 mm/min). The characteristic strength (σ0) of each specimen was obtained from the flexural strength test and evaluated using Weibull analysis. X-ray diffraction analysis was utilized to quantity the monoclinic phase. The surface topography of specimens was analyzed using 3D optical profilometer and scanning electron microscopy (SEM) after surface conditioning methods. The flexural strength data (σ4p) were statistically analyzed by 1-way ANOVA, Tukey test (α = 0.05) and Weibull (m = modulus, σ0 = characteristic strength) were calculated.

RESULTS

The mean ± standard deviations (MPa) of the groups were as follows: C: 1196.2 ± 284.2a; APA: 1369.7 ± 272.3a; SC: 1207.1 ± 229.7a and FD: 874.4 ± 365.4b. The values (m) and (σ0) were as follows: C: 4.5 and 1308.12; APA: 5.9 and 1477.88; SC: 6.0 and 1300.28; and FD: 2.6 and 985.901, respectively.

CONCLUSIONS

Air particle abrasion with neither silica nor alumina showed significant difference compared to the control group but grinding with fine diamond bur impaired the flexural strength of the zirconia tested.

Impact Behavior of Three Notched All-Ceramic Restorations after Soaking in Artificial Saliva

Biomechanics play a critical role in influencing the clinical applications of all-ceramic dental restorations. The restorative biomaterials have to demonstrate mechanical durability in the oral environment because they are always exposed to a variety of oral environments. This study was designed to evaluate the effect of soaking time, notch and saliva pH values on the impact energy of three commonly used all-ceramic materials for CAD/CAM. The leucite-reinforced glass ceramic (ProCAD), lithium disilicate glass ceramic (IPS e.max CAD) and zirconia-based ceramic materials (IPS e.max ZirCAD) were used. The experimental results indicated that the impact energy of ProCAD decreased with an increase in soaking time, but not for IPS e.max CAD and IPS e.max ZirCAD. The impact energy of the zirconia system was higher than leucite-reinforced and lithium disilicate-based ceramic systems. When subjected to preformed 0.5 mm U-shape notch on the bar specimen of 3 mm thick, the impact energy of the all-ceramic restorations revealed a markedly reduction of about 80%–90%, almost irrespective of dental compositions, which indicated the effect of flaw to a great degree. No statistically significant influence (p > 0.05) of pH values (4, 7 and 9) on impact energy was found for each group. It is concluded that the no matter which all-ceramic materials were used, it was appreciably sensitive to the presence of notches. The ceramic composition and microstructure have been shown to affect mechanical durability.

Effect of Splinting in Accuracy of Two Implant Impression Techniques

Because there is no consensus in the literature about the need for a splint between copings, the aim of this study was to evaluate, in vitro, the accuracy of 2 impression techniques for implant-supported prostheses. A master cast was fabricated with four parallel implant abutment analogs and a passive framework. Two groups with 5 casts each were formed: Group 1 (squared impression copings with no splint: S) and Group 2 (splinted squared impression copings, using metal drill burs and Pattern resin: SS). The impression material used was polyvinyl siloxane with open trays for standard preparation of the casts. For each cast, the framework was positioned, and a titanium screw was tightened with 10 N·cm torque in analog A, after which measurements of the abutment-framework interface gaps were performed at analogs C and D. This process was repeated for analog D. These measurements were analyzed using software. A one-way analysis of variance (ANOVA) with a confidence interval of 95% was used to analyze the data. Significant differences were detected between S and SS in relation to the master cast (P ≤ 0.05). The median values of the abutment-framework interface gaps were as follows: master cast: 39.64 μm; squared impression copings with no splint: 205.86 μm; splinted squared impression copings: 99.19 μm. Under the limitations of this study, the technique presented for Group 2 produces better results compared with the technique used for Group 1.

Using zirconia-based prosthesis in a complete-mouth reconstruction treatment for worn dentition with the altered vertical dimension of occlusion

This clinical report describes the complete mouth reconstruction of a patient with a worn dentition. Computer-aided design and computer-aided manufacturing processed porcelain fused-to-zirconia prostheses were used to achieve good esthetics, function, and biomechanics.

Gap comparison between single crown and three-unit bridge zirconia substructures

PURPOSE

To compare marginal and internal gaps of zirconia substructure of single crowns with those of three-unit fixed dental prostheses.

MATERIALS AND METHODS

Standardized Co-Cr alloy simulated second premolar and second molar abutments were fabricated and subsequently duplicated into type-III dental stone for working casts. After that, all zirconia substructures were made using Lava™ system. Marginal and internal gaps were measured in 2 planes (mesial-distal plane and buccal-palatal plane) at 5 locations: marginal opening (MO), chamfer area (CA), axial wall (AW), cusp tip (CT) and mid-occlusal (OA) using Replica technique.

RESULTS

There were significant differences between gaps at all locations. The mean ± SD of marginal gap in premolar was 43.6 ± 0.4 µm and 46.5 ± 0.5 µm for single crown and 3-unit bridge substructure respectively. For molar substructure the mean ± SD of marginal gap was 48.5 ± 0.4 µm and 52.6 ± 0.4 µm for single crown and 3-unit bridge respectively. The largest gaps were found at the occlusal area, which was 150.5 ± 0.5 µm and 154.5 ± 0.4 µm for single and 3-unit bridge premolar substructures respectively and 146.5 ± 0.4 µm and 211.5 ± 0.4 µm for single and 3-unit bridge molar substructure respectively.

CONCLUSION

Independent-samples t-test showed significant differences of gap in zirconia substructure between single crowns and three-unit bridge (P<.001). Therefore, the span length has the effect on the fit of zirconia substructure that is fabricated using CAD/CAM technique especially at the occlusal area.

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.

The zirconia ceramic: strengths and weaknesses

Metal ceramic restorations were considered the gold standard as reliable materials. Increasing demand for esthetics supported the commercialization of new metal free restorations. A growing demand is rising for zirconia prostheses. Peer-reviewed articles published till July 2013 were identified through a Medline (Pubmed and Elsevier). Emphasizing was made on zirconia properties and applications. Zirconia materials are able to withstand posterior physiologic loads. Although zirconia cores are considered as reliable materials, these restorations are not problem free.

Marginal Fit of Implant-Supported All-Ceramic Zirconia Frameworks

This study evaluated the effect of fabrication techniques and cyclic loading on the vertical marginal fit of implant-supported fixed partial denture (FPD) frameworks. Thirty implant-supported 3-unit FPD frameworks were fabricated on a model system, divided into 3 equal groups (n = 10). The first group (control) was constructed from base metal alloy; the other 2 test groups were constructed from all-ceramic zirconia using a computer-aided design/computer-aided manufacturing (CAD/CAM) Cerec 3 system and a copy milling (Zirkonzahn) system. A cyclic load of 200 N was applied to each framework for up to 50,000 cycles. Linear measurements were made in micrometers of the vertical gap between the framework and the implant-supported abutment at 16 predetermined points before and after cyclic loading. The frameworks were viewed using scanning electron microscopy to inspect any fractographic features. One-way analysis of variance was performed to compare the marginal discrepancy values of the control and the 2 test groups and for each group; a t test was applied to determine whether significant changes in the fit were observed after cyclic loading (α = 0.05). The CAD/CAM group showed significantly higher marginal gap mean values (80.58 μm) than the Zirkonzahn and control groups (50.33 μm and 42.27 μm, respectively) with no significant difference. After cyclic loading, the CAD/CAM group recorded the highest marginal gap mean value (91.50 ± 4.260 μm) followed by control group (72.00 ± 2.795 μm); the Zirkonzahn group recorded the lowest marginal gap (65.37 ± 6.138 μm). Cyclic loading significantly increased the marginal gap mean values in the control group only. A marginal chip was observed in one of the CAD/CAM ceramic frameworks. Within the limitations of this study, the fabrication technique influenced the marginal fit of the implant-supported 3-unit FPD frameworks. Cyclic loading failed to change the fit of all-ceramic zirconia frameworks, whereas significant changes were found in the metal frameworks.

Evaluation of shear bond strength of zirconia bonded to dentin after various surface treatments of zirconia

Establishing a reliable bond of resin cement to zirconia based materials has been a major limitation against zirconia restoration.

PURPOSE OF STUDY

This study evaluated the shear bond strength of zirconia bonded to dentin specimens using a self etch dual cure resin cement after various surface treatments of zirconia. Twenty zirconia rods (3 × 2.5 mm) were prepared from zirconia blocks and assigned into 5 groups for the following surface treatments. (1) Group I: Control (C) no treatment (2) Group II: airborne-particle abrasion (APA), (3) Group III: hydrofluoric acid etching (HF), (4) Group IV: hydrofluoric acid etching followed by silanation (HF/S), and (5) Group V: application of zirconia primer (Z). Dentin Specimens were prepared from extracted molars stored in 0.5% chloramine-T. Zirconia rods were bonded to dentin using resin cement (Multilink Speed), then light polymerized. The specimens tested for failure were tested using the notched shear bond test method in a universal loading apparatus. One way ANOVA followed by Tukey HSD for cell means were used to analyze the data (=0.05). The highest values were obtained with group V (Z) (8.66 MPa) followed by group II (APA) (6.71 MPa), and group IV (HF/S) (4.41 MPa). The least values were obtained for group III (HF) (3.88 MPa) with no significant difference (P value 0.53) between group III (HF) (3.88 MPa) and group I (C) (3.70 MPa). Among the surface treatments employed in this study zirconia primer application is a practical procedure to improved bond strength of zirconia to resin cement followed by Airborne Particle Abrasion with 50 μm Al2O3 particles.

Marginal, Internal Fit and Microleakage of Zirconia Infrastructures: An In-Vitro Study

Fitting accuracy and microleakage dominate prognostic covariates for the long-term durability of crown restorations. The fitting accuracy and microleakage potential of zirconia infrastructures might be influenced by manufacturing technology.

Zirconia in fixed implant prosthodontics

BACKGROUND

CAD/CAM technology in combination with zirconia ceramic has increasingly gained popularity in implant dentistry.

PURPOSE

This narrative review presents the current knowledge on zirconia utilized as framework material for implant-borne restorations and implant abutments, laboratory tests and developments, clinical performance, and possible future trends for implant dentistry are addressed.

MATERIAL AND METHODS

A review of available literature from 1990 through 2010 was conducted with search terms zirconia,""implants,""abutment,""crown," and "fixed dental prosthesis" using electronic databases (PubMed) and manual searching.

RESULTS

Latest applications of zirconia in implant dentistry include implant abutments, multiple unit and full-arch frameworks as well as custom-made bars to support fixed and removable prostheses. High biocompatibility, low bacterial surface adhesion as well as favorable chemical properties of zirconia ceramics are reported. Zirconia stabilized with yttrium oxide exhibits high flexural strength and fracture toughness due to a transformation toughening mechanism. Preliminary clinical data confirmed the high stability of zirconia for abutments and as a framework material for implant borne crowns and fixed dental prostheses. Zirconia abutment or framework damage has rarely been encountered. However, veneering porcelain fractures are the most common technical complication in implant-supported zirconia restorations. These porcelain veneer failures have led to concerns regarding differences in coefficient of thermal expansions between core and veneering porcelain and their respective processing techniques.

CONCLUSION

As presently evidence of clinical long-term data is missing, caution with regard to especially extensive implant-borne zirconia frameworks is recommended.

Reliability of metalloceramic and zirconia-based ceramic crowns

Despite the increasing utilization of all-ceramic crown systems, their mechanical performance relative to that of metal ceramic restorations (MCR) has yet to be determined. This investigation tested the hypothesis that MCR present higher reliability over two Y-TZP all-ceramic crown systems under mouth-motion fatigue conditions. A CAD-based tooth preparation with the average dimensions of a mandibular first molar was used as a master die to fabricate all restorations. One 0.5-mm Pd-Ag and two Y-TZP system cores were veneered with 1.5 mm porcelain. Crowns were cemented onto aged (60 days in water) composite (Z100, 3M/ESPE) reproductions of the die. Mouth-motion fatigue was performed, and use level probability Weibull curves were determined. Failure modes of all systems included chipping or fracture of the porcelain veneer initiating at the indentation site. Fatigue was an acceleration factor for all-ceramic systems, but not for the MCR system. The latter presented significantly higher reliability under mouth-motion cyclic mechanical testing.

The effect of zirconia surface treatment on flexural strength and shear bond strength to a resin cement

STATEMENT OF PROBLEM

Despite the expanded applications for zirconia in restorative dentistry, there is no clear recommendation in the literature regarding surface treatment before bonding.

PURPOSE

The purpose of this study was to evaluate the effect of mechanical surface treatment of yttria-partially stabilized zirconia on its flexural strength and the effect of mechanical and chemical surface treatments on its bond strength to a resin cement.

MATERIAL AND METHODS

For flexural strength evaluation, zirconia bars (4 x 5 x 40 mm) were prepared from zirconia blocks, finished using a diamond rotary cutting instrument, sintered, then assigned into 4 groups: (1) control (no treatment), (2) airborne-particle abrasion, (3) silicoating, and (4) wet hand grinding. After storage for 24 hours at 37 degrees C, flexural strength was determined using a 3-point bending test, and the results were analyzed using 1-way ANOVA (alpha=.05). For shear bond strength evaluation, zirconia rods (2.5 x 3 mm) were prepared from zirconia blocks, sintered, and assigned into 16 groups. Each group underwent a combination of the following mechanical and chemical treatments. Mechanical treatment included: (1) control (no treatment), (2) airborne-particle abrasion, (3) silicoating, or (4) wet hand grinding. Chemical treatment included: (1) control (no treatment), (2) acid etching followed by silanation, (3) silanation only, or (4) application of zirconia primer. Dentin specimens were prepared from extracted molars stored in 0.5% chloramine-T. Zirconia rods were bonded to dentin using a resin cement (Multilink Automix), then light polymerized. After storage, the specimens were loaded to failure with the notched shear bond test method in a universal loading apparatus. For artificial aging analysis, the groups that achieved the highest bond strength values were duplicated, stored at 37 degrees C and 100% humidity for 90 days, and thermal cycled before being loaded to failure. Results were analyzed using 2-way ANOVA (alpha=.05).

RESULTS

Airborne-particle abrasion and hand grinding significantly increased flexural strength. The highest shear bond strength values were achieved for the following groups: silicoated + silanated > hand ground + zirconia primer > airborne-particle abraded + silanated > zirconia primer > airborne-particle abraded + zirconia primer. Artificial aging resulted in significantly lower shear bond strength for the silicoated/silanated and the zirconia primer groups.

CONCLUSIONS

Mechanical modification of the surface increased the flexural strength of Y-TZP. The resin bond to Y-TZP was improved by surface treatment. A combination of mechanical and chemical conditioning of the zirconia surface was essential to develop a durable resin bond to zirconia.

Clinical trials in zirconia: a systematic review

Zirconia is unique in its polymorphic crystalline makeup, reported to be sensitive to manufacturing and handling processes, and there is debate about which processing method is least harmful to the final product. Currently, zirconia restorations are manufactured by either soft or hard-milling processes, with the manufacturer of each claiming advantages over the other. Chipping of the veneering porcelain is reported as a common problem and has been labelled as its main clinical setback. The objective of this systematic review is to report on the clinical success of zirconia-based restorations fabricated by both milling processes, in regard to framework fractures and veneering porcelain chipping. A comprehensive review of the literature was completed for in vivo trials on zirconia restorations in MEDLINE and PubMed between 1950 and 2009. A manual hand search of relevant dental journals was also completed. Seventeen clinical trials involving zirconia-based restorations were found, 13 were conducted on fixed partial dentures, two on single crowns and two on zirconia implant abutments, of which 11 were based on soft-milled zirconia and six on hard-milled zirconia. Chipping of the veneering porcelain was a common occurrence, and framework fracture was only observed in soft-milled zirconia. Based on the limited number of short-term in vivo studies, zirconia appears to be suitable for the fabrication of single crowns, and fixed partial dentures and implant abutments providing strict protocols during the manufacturing and delivery process are adhered to. Further long-term prospective studies are necessary to establish the best manufacturing process for zirconia-based restorations.

Concerns of hydrothermal degradation in CAD/CAM zirconia

Zirconia-based restorations are widely used in prosthetic dentistry; however, their susceptibility to hydrothermal degradation remains elusive. We hypothesized that CAD/CAM machining and subsequent surface treatments, i.e., grinding and/or grit-blasting, have marked effects on the hydrothermal degradation behavior of Y-TZP. CAD/CAM-machined Y-TZP plates (0.5 mm thick), both with and without subsequent grinding with various grit sizes or grit-blasting with airborne alumina particles, were subjected to accelerated aging tests in a steam autoclave. Results showed that the CAD/CAM-machined surfaces initially exhibited superior hydrothermal degradation resistance, but deteriorated at a faster rate upon prolonged autoclave treatment compared with ground and grit-blasted surfaces. The accelerated hydrothermal degradation of CAD/CAM surfaces is attributed to the CAD/CAM machining damage and the absence of surface compressive stresses in the fully sintered material. Clinical relevance for surface treatments of zirconia frameworks in terms of hydrothermal and structural stabilities is addressed.

Interfacial toughness of bilayer dental ceramics based on a short-bar, chevron-notch test

OBJECTIVE

The objective of this study was to test the null hypothesis that the interfacial toughness of each of two types of bonded core-veneer bilayer ceramics is not significantly different from the apparent fracture toughness of the control monolithic glass veneer.

METHODS

T-shaped short-bars of a lithia-disilicate glass-ceramic core (LC) and yttria-stabilized polycrystalline zirconia core ceramic (ZC) were prepared according to the manufacturer's recommendations. V-shaped notches were prepared by using 25-mum-thick palladium foil, leaving the chevron-notch area exposed, and the bars were veneered with a thermally compatible glass veneer (LC/GV and ZC/GV). Additionally, we also bonded the glass veneer to itself as a control group (GV/GV). Specimens were kept in distilled water for 30 days before testing in tension. Eight glass veneer bars were prepared for the analysis of fracture toughness test using the indentation-strength technique.

RESULTS

The mean interfacial toughness of the LC/GV group was 0.69 MPam(1/2) (0.11), and did not significantly differ from that of the GV/GV control group, 0.74 MPam(1/2) (0.17) (p>0.05). However, the difference between the mean interfacial toughness of the ZC/GV group, 0.13 MPam(1/2) (0.07), and the LC/GV and the GV/GV groups was statistically significant (p<0.05).

SIGNIFICANCE

For bilayer all-ceramic restorations with high-strength core materials, the veneering ceramics are the weakest link in the design of the structure. Since all-ceramic restorations often fail from chipping of veneer layers or crack initiation at the interface, the protective effects of thermal mismatch stresses oral prosthesis design should be investigated.

Marginal Fit of Heat-pressed vs CAD/CAM Processed All-ceramic Onlays Using a Milling Unit Prototype

The marginal fit of all-ceramic restorations has an important influence on the clinical performance and lifetime of adhesively luted restorations. In proximal boxes, an average marginal gap of less than 100 μm is claimed. These clinical requirements are fulfilled by both processing procedures.

Recent advances in materials for all-ceramic restorations

The past 3 years of research on materials for all-ceramic veneers, inlays, onlays, single-unit crowns, and multi-unit restorations are reviewed in this article. The primary changes in the field were the proliferation of zirconia-based frameworks and computer-aided fabrication of prostheses, and a trend toward more clinically relevant in vitro test methods. This article includes an overview of ceramic fabrication methods, suggestions for critical assessment of material property data, and a summary of clinical longevity for prostheses constructed of various materials.

An overview of treatment considerations for esthetic restorations: a review of the literature

Controversy persists regarding the treatment planning criteria for esthetic restorations. This article reviews the literature regarding the biocompatibility, marginal adaptation, color matching, patient selection, technique sensitivity, and mode and rate of failure of tooth-colored restorations. A Medline search was completed for the period from 1986 to 2006, along with a manual search, to identify pertinent English peer-reviewed articles and textbooks. The key words used were amalgam, posterior composite resin, ceramic inlays/onlays, CEREC, porcelain laminate veneers, all-ceramic crowns, and all-ceramic fixed partial dentures.

Contemporary materials and technologies for all-ceramic fixed partial dentures: A review of the literature

High-strength all-ceramic systems for fixed partial dentures (FPDs) are available for replacing a missing tooth. New core/framework materials have been developed and have evolved in the last decade. With the advancement of CAD/CAM technology, various fabrication techniques have been developed for fabricating improved, consistent, and predictable restorations in terms of strength, marginal fit, and esthetics and for managing core/framework materials that could not otherwise be managed. This article reviews the evolution and development of materials and technologies for all-ceramic FPDs through data published between 1966 and 2004 in the English language. Peer-reviewed articles were identified through a MEDLINE search and a hand search of relevant textbooks and annual publications. The available information suggests that clinical data on the success of these restorations are limited, and that the results of long-term clinical studies are critical to the assessment of these restorations to provide more specific guidelines for usage.