Performance of dental ceramics: challenges for improvements

Effect of different preparations and restorative materials on partial posterior restorations: A 3D FEA study using μCT data

STATEMENT OF PROBLEM

Three-dimensional finite element analysis (3D FEA) allows for the accurate simulation of stress distribution and identification of potential failures in posterior indirect restorations. By combining microcomputed tomography (μCT) with FEA, more realistic and reliable models can be created, improving the accuracy of predictions.

PURPOSE

The purpose of this 3D FEA study using μCT data was to assess the effect of different restorative materials on stress distribution in partial posterior restorations and the resin cement layer.

MATERIAL AND METHODS

Four replicas of a mandibular first molar were prepared for different partial posterior preparations: inlay, onlay, 1-piece endodontic crown, and occlusal veneer. For each model, monolithic posterior restorations were simulated with 4 different restorative materials: composite resin, lithium disilicate glass-ceramic, polymer-infiltrated ceramic, and zirconia. After the fabrication and luting of the restorations, μCT images of the specimens were obtained and 3D finite element models built. An evenly distributed load of 500 N was applied, simulating 3 occlusal contacts. The maximum value of maximum principal stress and stress distribution on the restorations, cement layers, and tooth structure was calculated and analyzed.

RESULTS

One-piece endodontic crowns had lower stress, whereas inlays showed higher stress. Of the restorative materials, zirconia and glass-ceramic had the highest stress on the restorations, followed by polymer-infiltrated ceramic and composite resin. This difference between the restorative materials was larger for inlays and 1-piece endodontic crowns than for onlays and occlusal veneers. Cuspal coverage in the onlay preparation had lower and more evenly distributed stress than the intracoronal inlay preparation.

CONCLUSIONS

The different tooth preparations for single-unit posterior partial restorations influenced the stress distribution on the restoration, resin cement layer, and remaining tooth structure.

Principles guiding the restoration of the root-filled tooth

Endodontic treatment is usually required because of significant coronal disease or traumatic tissue loss. The restoration of the subsequently endodontically treated tooth is also complicated by the reduction in its structural strength consequent to accessing the pulp chamber and the removal of radicular dentine during root canal instrumentation, alongside some alteration of dentinal properties during disinfection by chemical agents, prior to obturation. A loss of proprioceptive feedback, which may lead to increased loading, can place further stress on the already very compromised structure. This article considers the principles of restoring endodontically treated teeth: assessing restorability, providing a coronal seal to prevent reinfection, and gaining retention for a core where necessary, to restore aesthetics and function. Consideration is given to the patient and material factors that influence the decision to restore the treated tooth using direct or indirect restorations. Specific attention is given to anterior or posterior teeth and the various materials which may be used in their overall restoration with their associated, probable, longevity.

Comparison of Vertical Marginal Discrepancy in High and Low Translucent Monolithic Zirconia Crowns in Repeated Firing Cycles

OBJECTIVE

 Increase in vertical marginal discrepancy (VMD) during repeated firing cycles and its clinical outcomes is a major concern for high and low translucent monolithic zirconia crowns. The purpose of this in vitro study was to evaluate and compare VMD in high and low translucent monolithic zirconia crowns in repeated firing cycles.

MATERIAL AND METHODS

 To perform this study, 10 monolithic zirconia crowns made by computer-aided design and computer-aided manufacturing method were used in two groups of five with high and low translucency, which were designed on Zimmer tissue-level implant abutment. The crowns in each group were randomly numbered from 1 to 5 and each underwent 1, 3, and 5 firing cycles. After completing each mentioned cycle, the VMD was measured at eight predetermined points on abutment by optical microscope and their average was recorded for each sample. Data analysis was done by SPSS 22 software through repeated-measure analysis of variance, paired t-test, and t-test with a 5% significance threshold.

RESULTS

 A total of 240 measurements were made for the VMD, which, due to the presence of five samples in each translucency group and eight examined points in each sample, was finally summed up to six averages for each translucency group in the mentioned three stages of firing cycles. The averages for the low-translucency group after 1, 3, and 5 firing cycles were 76.86, 85.02, and 90.55 μm, respectively, and for the high-translucency group after 1, 3, and 5 firing cycles were 80.38, 87.33, and 97.78 μm, respectively. The average VMD of the samples regardless of the translucency level after 1, 3 and 5 firing cycles was calculated as 78.62, 86.18, and 94.16 μm, respectively.

CONCLUSION

 This study found that VMD increased with repeated firing cycles, with no significant difference between high- and low-translucency zirconia crowns. Repeated firings significantly raised VMD, but all values remained within clinically acceptable limits, supporting the suitability of both translucency types for clinical use.

Effects of home bleaching agents on hybrid ceramics: mechanical properties and color change

BACKGROUND

Home bleaching is a promising option for addressing discolored teeth conservatively. However, its impact on the physical and mechanical properties of indirect restorations remains unknown. This study provides comparative insights into the material responses to aesthetic treatments by assessing the effects of home bleaching agents on two hybrid ceramics: VITA ENAMIC® and Grandio Blocs. The focus is on evaluating color stability and biaxial flexural strength.

METHODS

60 discs (12 × 1 mm) were prepared from hybrid ceramics. Specimens were divided into two groups according to type of hybrid ceramic (30 specimens in each group); group A: VITA ENAMIC®, group B: Grandio Blocs. Each group was further subdivided into 3 subgroups according to the concentration of home bleaching agents used (10 specimens in each subgroup); subgroup C: unbleached control group, subgroup C10%: carbamide peroxide 10% bleaching agent, and subgroup C35%: carbamide peroxide 35% bleaching agent. Samples of subgroup C10% were bleached with Home Bleaching Opalescence PF (10%) for 8 h per day for 14 days, as directed by the manufacturer. Samples of subgroup C35% were bleached using WHITEsmile Carbamide Peroxide (35%), following the manufacturer's directions for 30 min every day for 14 days. Color change (ΔE) was assessed using of the CIE L*a*b* system. Then, the biaxial flexural strength test was done. The data were analyzed using two-way ANOVA tests and Weibull analysis.

RESULTS

VITA ENAMIC samples exhibited significantly higher color change than Grandio Blocs (p < 0.001), while Grandio Blocs showed significantly higher biaxial flexural strength (p < 0.001). The concentration of the bleaching agent had no significant effect on color change (p = 0.086). However, regardless of its concentration, bleaching significantly reduced biaxial flexural strength in both materials (p < 0.001). Weibull analysis showed that Grandio Blocs had higher characteristic strength, while VITA ENAMIC demonstrated more reliable failure behavior.

CONCLUSIONS

Compared to Grandio Blocs, VITA ENAMIC® exhibited a greater color change with both 10% and 35% carbamide peroxide home bleaching agents. Additionally, both concentrations of carbamide peroxide reduced the biaxial flexural strength of hybrid ceramics. These findings can guide clinicians in selecting hybrid ceramics based on clinical demands for aesthetics and durability. VITA ENAMIC® offers greater structural reliability and predictability for aesthetic restorations, while Grandio Blocs provide superior durability and stress resistance for high-stress clinical applications.

Fracture resistance and mode of failure of modified Polyether-ether-ketone versus lithium disilicate endocrowns

PURPOSE

The current study aimed to compare modified Polyether-ether-ketone's fracture resistance and failure mode versus lithium disilicate glass-ceramic endocrowns.

MATERIALS AND METHODS

A total of 16 butt-joint endocrown specimens on mandibular second molar teeth were fabricated and divided into two equivalent groups; Pressable modified Polyether-ether-ketone (PEEK) (BioHPP®) and Pressable lithium disilicate glass ceramic (IPS e.max® Press). A computer-aided design/computer-aided manufacturing system was used to digitally create and milled wax patterns. Final restorations were cemented each to its corresponding prepared tooth. Thermomechanical cycling loading representing one year of clinical service was done in a chewing simulator. Fracture resistance was evaluated utilizing a universal testing machine. The failure mode was evaluated by inspecting fractured surfaces using a Stereomicroscope and further examined by a Scanning Electron Microscope (SEM) amongst both groups.

RESULTS

A statistically significant variation in fracture resistance was recorded with a mean load of (2762.96 ± 216.15 N) for modified PEEK and (2175.91 ± 267.72 N) for lithium disilicate glass-ceramic endocrowns.

CONCLUSION

Modified PEEK endocrowns have higher fracture resistance than lithium disilicate glass-ceramic endocrowns. Moreover, the likeliness of catastrophic fracture in molars receiving endodontic treatment restored by modified PEEK is less than teeth restored with lithium disilicate glass ceramics.

Crystallization by microwave energy: Effects on the survival probability of lithia-based glass ceramics

This study evaluated the survival probabilities of two lithia-based glass-ceramics after final crystallization in a microwave furnace using conventional crystallization as a reference. Disc-shaped samples of a lithium silicate (LS, Celtra Duo) and a lithium disilicate (LD, e.max CAD) were prepared and divided into two groups according to the crystallization method (n = 30): microwave (M) or conventional furnaces (C). The biaxial flexural strength test was used to determine the fatigue test profile and its parameters. Then, specimens were submitted to an accelerated life test (step stress) using three profile levels - mild, moderate, and aggressive - varying the load increments and the number of cycles until fracture (4 Hz). Survival data were used to calculate Weibull's beta (β) value and reliability of the assigned missions. Scanning electron microscopy was employed to analyze surface morphology, fracture characteristics, and failure patterns. Beta (β) values for the LS-C, LS-M, LD-C, and LD-M groups were 2.65, 0.25, 0.62, and 0.3, respectively. Similar reliability was observed in all groups after 50,000 cycles at 100 and 150 Mpa. At 200 Mpa, the crystallization method did not affect the reliability within LS or LD. However, LD showed greater reliability than LS when crystallized by microwave energy. Thus, microwave energy can be suggested as an alternative to the process of conventional lithia-based glass-ceramics crystallization without damaging their survival probabilities.

Exploring physical and mechanical properties of hydrothermally processed recycled non-sintered dental zirconia wastes

BACKGROUND AND AIM

The present investigation explored the potential for recycling residual blocks obtained from the machining processes under hydrothermal conditions. Furthermore, the study examined the recycled samples' various physical and mechanical properties to assess their viability for further use.

MATERIALS AND METHODS

In this in vitro study, Aman Girbach blocks were collected, half of which underwent a hydrothermal process, while the other half did not. The blocks were then subjected to ball milling. Uniaxial and isostatic pressed blocks were prepared, and 10 samples were obtained from each type of recycled block. These samples were compared to a commercial material, and four groups were formed based on the powder type and pressing method used. The quality control analysis of the recycled samples included assessing particle size distribution, identifying crystalline phases, analyzing color differences, examining microstructure, and evaluating mechanical properties. Statistical tests such as normal distribution calculations (k-s test), one-way ANOVA, Brown-Forsythe, Tukey HSD, and Games-Howell tests were used to compare the four groups and perform pairwise comparisons.

RESULTS

The flexural strength and density of the control commercial group were significantly higher than the other experimental groups (P = 0.000). Linear shrinkage of recycled isostatic pressed experimental bodies was significantly lower than that of others (P = 0.000). Qualitative evaluation of microstructure and crystalline phase by FESEM and XRD showed no significant difference in grain size and crystalline phase between different groups.

CONCLUSION

The hydrothermal process is a promising way to recycle zirconia ceramic with lower energy consumption. Recycled waste demonstrates potential as a cost-effective and viable option for ceramic prostheses in situations with low to medium stress levels.

The effect of two preparation designs on the fracture resistance and marginal adaptation of two types of ceramic crowns using CAD/CAM technology (In vitro study)

BACKGROUND

Recently, prosthodontic approaches involve more conservative procedures that include less invasive finish line preparations that use less ceramic thickness.

AIM OF THE STUDY

This in vitro study aimed to evaluate the effect of vertical preparation and modified vertical preparation designs on the marginal adaptation and fracture resistance of two types of ceramic crowns using CAD/CAM technology.

MATERIALS AND METHODS

Two typodont maxillary first premolars were embedded in acrylic resin. Forty positive replicas of epoxy resin dies were used that were divided into two groups depending on the preparation design (n = 20); Group V (Vertical): dies with feather edge finish line and Group MV (Modified vertical): dies with feather edge finish line, where a reverse shoulder of 1 mm depth was placed on the buccal surface 1.5 mm from the occlusal surface. Each group was further subdivided into two subgroups according to the type of ceramic material (n = 10): Subgroup Va and subgroup MVa for lithium disilicate (e.max CAD) and subgroup Vb and subgroup MVb for zirconia (zolid ht+). Crown restorations were made with CAD-CAM technology. The marginal adaptation was assessed using a stereomicroscope both prior to cementation and after cementation and aging. Fracture resistance was tested with a universal testing machine, and the data were statistically analyzed.

RESULTS

Marginal adaptation showed no significant differences between subgroups before or after cementation and aging. Three-way ANOVA indicated that preparation design (p = 0.516) and material (p = 0.269) had no significant effect, but cementation had a significant effect (p < 0.0001) on the marginal adaptation. According to two-way ANOVA test, Subgroup (MVb) showed the highest result followed by subgroup (Vb) and subgroub (MVa) and the least was subgroub (Va). Fracture modes showed no significant differences among the subgroups (p = 0.982).

CONCLUSIONS

Marginal adaptation of lithium disilicate and zirconia crowns remained clinically acceptable regardless of preparation design. While the modified vertical preparation with a reverse shoulder notably enhanced the fracture resistance of both materials, with zirconia demonstrating superior fracture resistance compared to lithium disilicate with average values exceeding premolar biting force.

Shear Bond Strength of Simulated Single-Retainer Resin-Bonded Bridges Made of Four CAD/CAM Materials for Maxillary Lateral Incisor Agenesis Rehabilitation

OBJECTIVES

 Maxillary lateral incisor agenesis (MLIA), treated orthodontically by space opening, requires complimentary aesthetic rehabilitation. Resin-bonded bridges (RBBs) can be equated as interim rehabilitation until skeletal maturity is achieved to place an implant-supported crown or as definitive rehabilitation in case of financial restrictions or implant contraindications. Scientific evidence of the best material must be confirmed in specific clinical situations. Computer-aided design and computer-aided manufacturing (CAD/CAM) materials are promising versatile restorative options. This study aimed to identify a straightforward material to deliver interim or definitive RBBs for nonprepared tooth replacement in MLIA.

MATERIALS AND METHODS

 Single-retainer RBB made from CAD/CAM ceramic blocks (Vita Enamic [ENA], Suprinity [SUP], and zirconia [Y-ZPT]) and a three-dimensional (3D) printed material (acrylonitrile butadiene styrene [ABS]) were evaluated by shear bond strength (SBS) and mode of failure, after adherence to an artificial tooth with RelyX Ultimate used in a three-step adhesive strategy.

STATISTICAL ANALYSIS

 The load to fracture (N) was recorded, and the mean shear stress (MPa) was calculated with standard deviations (SD) for each group and compared between materials using boxplot graphics. One-way analysis of variance (ANOVA) followed by the Tukey-Kramer post hoc test was used to compare the differences (α = 0.05). A meta-analysis focusing on CAD/CAM materials evaluated the magnitude of the difference between groups based on differences in means and effect sizes (α = 0.05; 95% confidence interval [CI]; Z-value = 1.96). Failure mode was determined by microscopic observation and correlated with the maximum load to fracture of the specimen.

RESULTS

 The mean ± SD SBS values were ENA (24.24 ± 9.05 MPa) < ABS (24.01 ± 1.94 MPa) < SUP (29.17 ± 4.78 MPa) < Y-ZPT (37.43 ± 12.20 MPa). The failure modes were mainly adhesive for Y-ZPT, cohesive for SUP and ENA, and cohesive with plastic deformation for ABS.

CONCLUSION

 Vita Enamic, Suprinity, Y-ZPT zirconia, and 3D-printed ABS RBBs are optional materials for rehabilitating MLIA. The option for each material is conditioned to estimate the time of use and necessity of removal for orthodontic or surgical techniques.

Performance of Bonded Lithium Disilicate Partial-coverage Crowns in the Restoration of Endodontically Treated Posterior Teeth: An Up to Seven-Year Retrospective Study

OBJECTIVES

To evaluate the clinical performance of adhesively bonded lithium disilicate glass-ceramic (LDG) partial-coverage crowns in restoring posterior endodontically treated teeth (ETT).

METHODS AND MATERIALS

A total of 121 morphologically compromised posterior ETT were restored with LDG partial-coverage crowns between October 2015 and January 2018. The restorations were fabricated in the laboratory or at the chairside. Two adhesive systems and resin cements were used to cement the restorations. Tooth and restoration survival rates were calculated. The restorations were evaluated clinically using the modified United States Public Health Service (USPHS) criteria for an observation period of 5-7 years. The Cox proportional hazards model was used to estimate relative failure risks such as tooth type, resin cements, gender, and sleep bruxism. The standard chi-squared test was used to compare the survival of different tooth types for significant differences (α=0.05). In addition, survival probability was calculated using the Kaplan-Meier algorithm.

RESULTS

Among seven failed cases, one was a tooth fracture, and six were restoration fractures. According to the Kaplan-Meier analysis, the estimated survival rate of the teeth was 99% for seven years, while the estimated survival rate of the restorations was 94.8% for 5 years and 92.8% for 7 years. Tooth type and resin cements did not influence restoration survival rates (p>0.05), while sleep bruxism and male patients might increase the risk of failure (p<0.05).

CONCLUSIONS

The indirect adhesively bonded LDG partial-coverage crowns of posterior ETT exhibited favorable clinical outcomes. Ceramic fracture was the most common failure pattern.

Recent advances in dental zirconia: 15 years of material and processing evolution

OBJECTIVES

The objective was to discuss the research on zirconia published in the past 15 years to help the dental materials community understand the key properties of the types of zirconia and their clinical applications.

METHODS

A literature search was performed in May/2023 using Web of Science Core Collection with the term "dental zirconia". The search returned 5102 articles, which were categorized into 31 groups according to the research topic.

RESULTS

The current approach to improving the translucency of zirconia is to decrease the alumina content while increasing the yttria content. The resulting materials (4Y-, 5Y-, and above 5 mol% PSZs) may contain more than 50% of cubic phase, with a decrease in mechanical properties. The market trend for zirconia is the production of CAD/CAM disks containing more fracture resistant 3Y-TZP at the bottom layers and more translucent 5Y-PSZ at the top. Although flaws located between layers in multilayered blocks might represent a problem, newer generations of zirconia layered blocks appear to have solved this problem with novel powder compaction technology. Significant advancements in zirconia processing technologies have been made, but there is still plenty of room for improvement, especially in the fields of high-speed sintering and additive manufacturing.

SIGNIFICANCE

The wide range of zirconia materials currently available in the market may cause confusion in materials selection. It is therefore imperative for dental clinicians and laboratory technicians to get the needed knowledge on zirconia material science, to follow manufacturers' instructions, and to optimize the design of the prosthetic restoration with a good understanding where to reinforce the structure with a tough and strong zirconia.

Biological Properties of 3D-Printed Zirconia Implants with p-Cell Structures

Research on 3-dimensional (3D) printed porous zirconia-based dental implants is still in its infancy. This study aimed to evaluate the biological responses of novel zirconia implants with p-cell structures fabricated by 3D printing. The solid zirconia samples exhibited comparable density, 3-point flexural strength, and accelerated aging properties compared to specimens prepared previously by conventional methods. Cell-based experiments showed that the p-cell structure promoted cell proliferation, adhesion, and osteogenesis-related protein expression. Mechanical tests showed that both p-cell and control implants could withstand a torque of 35 Ncm without breaking. The mean maximum breaking loads of p-cell and control implants were 1,222.429 ± 115.591 N and 1,903.857 ± 250.673 N, respectively, which were much higher than the human physiological chewing force and human mean maximum occlusal force. An animal experiment showed that the bone trabeculae around the implants were significantly thicker, more numerous, and denser in the p-cell group than in the control group. This work could provide promising guidance for further exploring 3D printing techniques for porous zirconia bionic implants in dentistry.

Comparing Zirconium Crown Marginal Adaptation in Preparations with Two Different Occlusal Reductions

This study aimed to assess and contrast the effects on the vertical marginal fit of full contour CAD/CAM-generated monolithic zirconia crowns at pre- and post-cementation levels with various occlusal reduction schemes (planar and flat) and cements. Forty sound human maxillary first premolars were sampled for this study. The samples were divided into two main groups with twenty samples in each group according to the occlusal reduction scheme as follows: Group A included a chamfer finishing line design with a planar occlusal reduction scheme and Group B included a chamfer finishing line design with a flat occlusal reduction scheme. Each group was sampled into two subgroups (n = 10) based on the type of cement as follows: resin-modified glass ionomer cement (Fuji Plus) for subgroups A1 and B1, and a universal adhesive system (Duo Estecem II) for subgroups A2 and B2. Marginal gaps were tested in four indentations using a Dino light stereomicroscope (230×). Paired T-tests and Student's t-tests were used to analyze the data. Before cementation, subgroup A1 scored the lowest mean of vertical marginal gap values, while subgroup B2 scored the highest mean; following cementation, subgroup A1 scored the lowest mean of vertical marginal gap values, and subgroup B2 scored the highest mean of vertical marginal gap values. A chamfer finishing line design with a planar occlusal reduction scheme could be a preferable occlusal reduction scheme.

Effect of incisal preparation design on the fracture strength of monolithic zirconia-reinforced lithium silicate laminate veneers

PURPOSE

This study aimed to assess the fracture resistance of monolithic zirconia-reinforced lithium silicate laminate veneers (LVs) fabricated on various incisal preparation designs.

MATERIALS AND METHODS

Sixty maxillary central incisors with various preparation designs were 3D-printed, 15 each, including preparation for: (1) LV with feathered-edge design; (2) LV with butt-joint design; (3) LV with palatal chamfer; and (4) full-coverage crown. Restorations were then designed and manufactured from zirconia-reinforced lithium silicate (ZLS) following the contour of a pre-operation scan. Restorations were bonded to the assigned preparation using resin cement and following the manufacturer's instructions. Specimens were then subjected to 10,000 thermocycles at 5 to 55°C with a dwell time of 30 s. The fracture strength of specimens was then assessed using a universal testing machine at a crosshead speed of 1.0 mm/min. One-way ANOVA and Bonferroni correction multiple comparisons were used to assess the fracture strength differences between the test groups (α = 0.001). Descriptive fractographic analysis of specimens was carried out with scanning electron microscopy images.

RESULTS

Complete coverage crown and LV with palatal chamfer design had the highest fracture resistance values (781.4 ± 151.4 and 618.2 ± 112.6 N, respectively). Single crown and LV with palatal chamfer had no significant difference in fracture strength (p > 05). LV with feathered-edge and butt-joint designs provided significantly (p < 05) lower fracture resistance than complete coverage crown and LV with palatal chamfer design.

CONCLUSION

The fracture resistance of chairside milled ZLS veneers was significantly influenced by the incisal preparation designs tested. Within the limitation of this study, when excessive occlusal forces are expected, LV with palatal chamfer display is the most conservative method of fabricating an indirect restoration.

Ultrathin lithium disilicate and translucent zirconia crowns for posterior teeth: Survival and failure modes

PURPOSE

To evaluate the reliability and failure modes of ultrathin (0.5 mm) lithium disilicate, translucent and ultra-translucent zirconia crowns for posterior teeth restorations.

MATERIALS AND METHODS

Fifty-four mandibular first molar crowns of three ceramic materials: (1) Lithium disilicate (e.max CAD, Ivoclar Vivadent), (2) 3Y-TZP (Zirconn Translucent, Vipi), and (3) 5Y-PSZ (Cercon XT, Dentsply Sirona), with 0.5 mm of thickness were milled and cemented onto composite resin abutments. Eighteen samples of each group were tested under mouth-motion step-stress accelerated life testing in a humid environment using mild, moderate, and aggressive profiles. Data was subjected to Weibull statistics. Use level curves were plotted and reliability was calculated for a given mission of 100,000 cycles at 100, 200, and 300 N. Fractographic analyses of representative samples were performed in scanning electron microscope.

RESULTS

Beta (β) values suggest that failures were dictated by material's strength for lithium disilicate and by fatigue damage accumulation for both zirconias. No significant differences were detected in Weibull modulus and characteristic strength among groups. At a given mission of 100,000 cycles at 100 N, lithium disilicate presented higher reliability (98% CB: 95-99) regarding 3Y-TZP and 5Y-PSZ groups (84% CB: 65%-93% and 79% CB: 37&-94%, respectively). At 200 N, lithium disilicate reliability (82% CB: 66%-91%) was higher than 5Y-PSZ (20% CB: 4%-44%) and not significantly different from 3Y-TZP (54% CB: 32%-72%). Furthermore, at 300 N no significant differences in reliability were detected among groups, with a notable reduction in the reliability of all materials. Fractographic analyses showed that crack initiated at the interface between the composite core and the ceramic crowns due to tensile stress generated at the intaglio surface.

CONCLUSIONS

Ultrathin lithium disilicate crowns demonstrated higher reliability relative to zirconia crowns at functional loads. Lithium disilicate and zirconia crown's reliability decreased significantly for missions at higher loads and similar failure modes were observed regardless of crown material. The indication of 0.5 mm thickness crowns in high-load bearing regions must be carefully evaluated.

CLINICAL SIGNIFICANCE

Ultraconservative lithium disilicate and zirconia crowns of 0.5 mm thickness may be indicated in anterior restorations and pre-molars. Their clinical indication in high-load requirement regions must be carefully evaluated.

Minimally processed recycled yttria-stabilized tetragonal zirconia for dental applications: Effect of sintering temperature on glass infiltration

This study aimed to develop a recycling process for the remnants of milled 3Y-TZP and enhance their properties using glass infiltration. 3Y-TZP powder was gathered from the vacuum system of CAD-CAM milling equipment, calcined and sieved (x < 75 μm). One hundred twenty discs were fabricated and pre-sintered at 1000 °C/h. These specimens were then divided into four groups, categorized by glass infiltration (non-infiltrated [Zr] or glass-infiltrated [Zr-G]) and sintering temperature (1450 °C [Zr-1450] or 1550 °C [Zr-1550]/2h). After sintering, the specimens were characterized by X-Ray Diffraction (XRD), relative density measurement, and scanning electron microscopy and energy dispersive spectroscopy (SEM-EDS). The biaxial flexural strength test was performed according to the ISO 6872 and followed by fractographic analysis. Subsequent results were analyzed using Weibull statistics. Relative density values of the sintered specimens from Zr-1450 and Zr-1550 groups were 86.7 ± 1.5% and 92.2 ± 1.7%, respectively. Particle size distribution revealed particles within the range of 0.1-100 μm. XRD analysis highlighted the presence of the ZrO2-tetragonal in both the Zr-1450 and Zr-1550 groups. Glass infiltration, however, led to the formation of the ZrO2-monoclinic of 9.84% (Zr-1450-G) and 18.34% (Zr-1550-G). SEM micrographs demonstrated similar microstructural characteristics for Zr-1450 and Zr-1550, whereas the glass-infiltrated groups exhibited comparable infiltration patterns. The highest characteristic strength was observed in the glass-infiltrated groups. Fractographic analyses suggested that fracture origins were related to defects on the tensile side, which propagated to the compression side of the samples. Both the sintering temperature and glass infiltration significantly influenced the mechanical properties of the 3Y-TZP recycled.

Development, characterization, and biological study of bioglass coatings 45S5 and BioK on zirconia implant surfaces

Zirconia implants are gaining attention as a viable alternative to titanium implants due to their comparable osseointegration development, improved soft tissue adaptation, and enhanced aesthetics. An encouraging avenue for improving zirconia implant properties involves the potential application of bioactive coatings to their surfaces. These coatings have shown potential for inducing hydroxyapatite formation, crucial for bone proliferation, and improving implant mechanical properties. This study aimed to evaluate the effect of coating zirconia implants with two bioactive glasses, 45S5 and BioK, on osteogenesis in vitro and osseointegration in vivo. Zirconia samples and implants were prepared using Zpex zirconia powder and blocks, respectively. The samples were divided into three groups: polished zirconia (ZRC), zirconia coated with 45S5 bioglass (Z + 45S5), and zirconia coated with BioK glass (Z + BK). Coatings were applied using a brush and sintered at 1200°C. Chemical analysis of the coatings was carried out using x-ray diffraction and Fourier Transform Infrared Spectroscopy. Surface topography and roughness were characterized using scanning electron microscopy and a roughness meter. In vitro experiments used mesenchymal cells from Wistar rat femurs, and the coated zirconia implants were found to promote cell viability, protein synthesis, alkaline phosphatase activity, and mineralization, indicating enhanced osteogenesis. In vivo experiments with 18 rats showed positive results for bone formation and osseointegration through histological and histomorphometric analysis and a push-out test. The findings indicate that bioactive glass coatings have the potential to improve cell differentiation, bone formation, and osseointegration in zirconia implants.

Bio-inspired nacre-like zirconia/PMMA composites for chairside CAD/CAM dental restorations

OBJECTIVES

To introduce a versatile fabrication process to fabricate zirconia/PMMA composites for chairside CAD/CAM dental restorations. These zirconia composites have nacre-like lamellar microstructures, competent and tooth-matched mechanical properties, as well as crack resistance behaviours.

METHODS

Bi-directional freeze casting was used to fabricate ceramic green bodies with highly aligned lamellar structure. Pressure was then applied to control the ceramic volume fraction. PMMA was infiltrated into the ceramic scaffold. Mechanical tests including 3-point bending, Vickers hardness, and fracture toughness were performed on the composites. The machinability of the composites was also characterised.

RESULTS

Two types of nacre-like zirconia/PMMA composites, i.e., 3Y-YZP/PMMA and 5Y-PSZ/PMMA composites were fabricated. The microstructure created was similar to the 'brick and mortar' structure of nacre. Excellent flexural strength (up to 400 MPa and 290 MPa for 3Y-TZP/PMMA and 5Y-PSZ/PMMA composite, respectively), tuneable hardness and elastic modulus within the range similar to enamel, along with improved crack-resistance behaviour were demonstrated on both zirconia composites. In addition, both zirconia/PMMA composites showed acceptable machinability, being easy to mill, as would be required to produce a dental crown.

SIGNIFICANCE

Nacre-like zirconia/PMMA composites therefore exhibit the potential for use in the production of chairside CAD/CAM dental restorations.

Evaluation of the Color Stability of Three Resin-Ceramic Materials Using a Spectrophotometer and a Digital Photography Software

Background

Computer-aided design/computer-aided manufacturing (CAD/CAM) resin ceramics allow easier milling than glass ceramics but are suspected to be more stainable. Although Photoshop® is widely used for picture analysis, its potential for shade selection has not been properly assessed.

Aim

Purpose primary: To evaluate the color stability of three CAD/CAM resin ceramics and Lithium Disilicate. Secondary: to compare the color evaluation between a spectrophotometer (Vita Easyshade compact) and Photoshop software.

Materials and Methods

Three CAD/CAM resin ceramic materials (n = 10) and a fourth group of lithium disilicate were used. Half of each group were thermocycled (5°C and 55°C; 3000 cycles). All samples were immersed in colored beverages (coffee, tea and red wine) for 30 days. Values were obtained by spectrophotometry and photographs analyzed using Photoshop software. The parameters measured were CIEL*a*b, and the color difference (ΔE) was analyzed. A mixed model test was used to compare the results through time and materials (α = 0.05). The comparison between the spectrophotometer and Photoshop results was performed using the bivariate Pearson's correlation test.

Results

Lithium disilicate glass ceramic exhibited less color change (ΔE = 14) than resin ceramics (15.7 < ΔE < 18.7). The least change was noted with GC Cerasmart (ΔE = 15.7) followed by Vita Enamic (ΔE = 17*) and Brilliant Crios (ΔE = 18.7*). Spectrophotometer and Photoshop values showed low correlations.

Conclusions

Resin ceramics may suffer from color change in clinical use. Photoshop is technique sensitive; pictures are easily affected by the light conditions and camera settings.

Surface fractures in pre-crystallized and crystallized zirconia-containing lithium silicate glass-ceramics generated in ultrasonic vibration-assisted machining

Machining-induced surface fractures in ceramic restorations is a long-standing problem in dentistry, affecting the restorations' functionality and reliability. This study approached a novel ultrasonic vibration-assisted machining technique to zirconia-containing lithium silicate glass-ceramics (ZLS) and characterized its induced surface fracture topographies and morphologies to understand the microstructure-property-processing relations. The materials were processed using a digitally controlled ultrasonic milling machine at a harmonic vibration frequency with different amplitudes. Machining-induced surface fracture topographies were measured with a 3D white light optical profilometer using the arithmetic mean, peak and valley, and maximum heights, as well as the kurtosis and skewness height distributions, and the texture aspect ratios. Fracture morphologies were analysed using scanning electron microscopy (SEM). The surface fracture topographies were significantly dependent on the material microstructure, the mechanical properties, and the ultrasonic machining vibration amplitudes. Larger scale fractures with higher arithmetic mean, peak and valley heights, and kurtosis and skewness height distributions were induced in higher brittleness indexed pre-crystallized ZLS than lower indexed crystallized ZLS by conventional machining. Conchoidal fractures occurred in pre-crystallized ZLS while microcracks were found in crystallized state although brittle fractures mixed with localized ductile flow deformations dominated all machined ZLS surfaces. Ultrasonic machining at an ideal vibration amplitude resulted in more ductile removal, reducing fractured-induced peaks and valleys for both materials than conventional processing. This research demonstrates the microstructure-property-processing interdependence for ZLS materials and the novel machining technique to be superior to current processing, reducing fractures in the materials and potentially advancing dental CAD/CAM techniques.

Comparative Analysis of the Structural Weights of Fixed Prostheses of Zirconium Dioxide, Metal Ceramic, PMMA and 3DPP Printing Resin-Mechanical Implications

The aim of this study was to determine the mechanical implications of four-unit fixed dental prostheses (FDPs) made of (1) monolithic zirconium dioxide (ZR O2), (2) polymethylmethacrylate (PMMA), (3) metal ceramic (PFM) and (4) impression resin (3DPP).

METHODS

Four groups were studied with eight samples for each material (n: 32). Each structure was weighed, subjected to compressive tests and analyzed using 3D FEA.

RESULTS

PMMA presented the lowest structural weight (1.33 g), followed by 3DPP (1.98 g), ZR O2 (6.34 g) and PFM (6.44 g). In fracture tests, PMMA presented a compressive strength of 2104.73 N and a tension of 351.752 MPa; followed by PFM, with a strength of 1361.48 N and a tension of 227.521 MPa; ZR O2, with a strength of 1107.63 N and a tension of 185.098 MPa; and 3DPP, with a strength of 1000.88 N and a tension of 143.916 MPa. According to 3D FEA, 3DPP presented the lowest degree of deformation (0.001 mm), followed by PFM (0.011 mm), ZR O2 (0.168 mm) and PMMA (1.035 mm).

CONCLUSIONS

The weights of the materials did not have a direct influence on the mean values obtained for strength, stress or strain. Since the performance was related to the tension and forces supported by the structures in critical zones, the importance of considering design factors is clear. In vitro and 3D FEA assays allowed us to simulate different scenarios for the mechanical properties of certain materials before evaluating them clinically. Thus, they can generate predictions that would allow for the design of a better research methodology in future clinical trials.

Effect of Various Beverages on Adhesion of Repaired CAD/CAM Restorative Materials

(1) Background: The purpose of this study was to determine the effect of commonly consumed beverages on the bond strength of three different computer-aided design-computer-aided manufacturing (CAD/CAM) resin-ceramic hybrid materials repaired with resin-based composite (RBC) materials. (2) Materials and Methods: Rectangular prism specimens (N = 138) measuring 6 mm × 5 mm × 2 mm were obtained from GC Cerasmart (GC), Lava Ultimate (LU), and Vita Enamic (VE) blocks. These blocks were polished and then subjected to thermal cycling (10,000 cycles, 5 °C to 55 °C). After the surface treatment was applied, the average surface roughness value was measured. All the surfaces were repaired with RBC. Thermal cycling was performed for the second time. Each group was then distributed into three subgroups according to the beverage used: tea (t), cola (c), and distilled water (0) (n = 15). The specimens were stored in these solutions for 28 days and then subjected to the shear bond strength (SBS) test. Statistical analysis was performed using a two-way ANOVA test with Bonferroni adjustment. (3) Results: The surface roughness of the materials presented no significant difference after different surface treatments (p > 0.05). No significant difference was observed among the materials (p > 0.05). Tea and cola presented similar SBS values (p > 0.05). Both were significantly lower than distilled water (p < 0.001, p < 0.001, respectively). (4) Conclusions: Consumption of beverages reduces the bond strength in surfaces repaired with RBC to CAD/CAM resin-ceramic hybrid materials. (5) Clinical Significance: Repairing damaged resin matrix dental restorations with RBC is advantageous in terms of time and cost by achieving adequate bond strengths. Frequently consumed beverages reduce the bond strength of repaired CAD/CAM resin-ceramic hybrid materials.

Current classification of zirconia in dentistry: an updated review

Zirconia, a crystalline oxide of zirconium, holds good mechanical, optical, and biological properties. The metal-free restorations, mostly consisting of all-ceramic/zirconia restorations, are becoming popular restorative materials in restorative and prosthetic dentistry choices for aesthetic and biological reasons. Dental zirconia has increased over the past years producing wide varieties of zirconia for prosthetic restorations in dentistry. At present, literature is lacking on the recent zirconia biomaterials in dentistry. Currently, no article has the latest information on the various zirconia biomaterials in dentistry. Hence, the aim of this article is to present an overview of recent dental zirconia biomaterials and tends to classify the recent zirconia biomaterials in dentistry. This article is useful for dentists, dental technicians, prosthodontists, academicians, and researchers in the field of dental zirconia.

Clinical Outcomes of CAD/CAM (Lithium disilicate and Zirconia) Based and Conventional Full Crowns and Fixed Partial Dentures: A Systematic Review and Meta-Analysis

Although CAD/CAM (computer-aided design/computer-aided manufacturing) restorations act as a favorable alternative to conventional metal-ceramic restorations for fixed dental prostheses, little is known about their intermediate and persistent clinical performance. This systematic review and meta-analysis aimed to assess the clinical performance in terms of biological, technical, and esthetic aspects and the survival and success ratios for single full crowns (SFCs) and fixed partial dentures (FPDs) fabricated by CAD/CAM and conventional techniques and according to the materials used (zirconia {ZC} and lithium disilicate {LD}). The population, intervention, control, outcome, and study design (PICOS) strategy was used to electronically search key terms in the PubMed, Cochrane Library, Embase, and Wiley Online databases for randomized control trials (RCTs) and cohort studies. The bias risks for RCTs and cohort studies were assessed using the Cochrane collaboration tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using Rev5 from Cochrane. A total of 13 studies reporting on 1598 restorations in 1161 patients with a mean observation period of 3.6 years (minimum-maximum: 1-9.3 years) met the inclusion criteria. Meta-analysis of the included studies indicated that CAD/CAM manufacturing resulted in 1.17, 1.14, and 16.88 (95% CI: 0.64-2.17, 0.86-1.52, 7.59-37.56) higher biological, technical, and esthetic complications than conventional manufacturing of restorations. However, the difference was significant for esthetic complications only (p<0.00001). A significant difference was observed for all biological, technical, and aesthetic aspects between SFCs and FPDs (odds ratio {OR} = 2.61 vs. 1.78, 95% CI: 1.92-3.56 vs. 1.33-2.38; p<0.00001). The survival ratio of SFCs was 2.69 (95% CI: 1.98-3.65), significantly higher compared to the 1.76 (95% CI: 1.31-2.36) of FPDs (p<0.00001). The success ratio of FPDs at 1.18 (95% CI: 0.83-1.69) was significantly lower compared to SFCs at 2.36 (95% CI: 1.68-3.33). The clinical performance of LD with 2.42 (CI: 1.16-5.03) was significantly higher compared to ZC with 2.22 (CI: 1.78-2.77) (p<0.00001). The biological, technical, and aesthetic behaviors showed similar clinical outcomes between the CAD/CAM and conventional groups. LD could be a good alternative to zirconia, but its intermediate or persistent clinical performance needs to be evaluated. Overall, zirconia and CAD/CAM techniques must evolve further to outclass the conventional techniques used in the fabrication of SFCs and FPDs.

Repair Bond Strength to Hybrid CAD/CAM Materials after Silane Heat Treatment with Laser

PURPOSE

This study investigated the effect of different surface treatments and the effect of silane heat treatment with laser on the shear bond strength (SBS) of a nanoceramic composite to repaired hybrid CAD/CAM blocks.

MATERIALS AND METHODS

60 hybrid CAD/CAM specimens (Cerasmart, GC) were prepared and randomly divided into six groups according to the different surface treatments (n = 10): group ER: Er:YAG laser+silane (Monobond Plus, Ivoclar Vivadent); group ER+SHT: Er:YAG laser+silane heat treatment; group B: bur+silane; group B+SHT: bur+silane heat treatment; group HF: hydrofluoric acid+silane; group HF+SHT: hydrofluoric acid+silane heat treatment. Afterwards, a universal adhesive (Universal Bond Quick, Kuraray) was applied, and nanoceramic resin composite (Zenit, President) cylinders were bonded to the Cerasmart specimens. They were thermocycled for 10,000 cycles (5-55°C) and subjected to SBS testing using a universal testing machine. Failure modes were examined with a stereomicroscope (15X). Scanning electron microscopy (SEM) was used to evaluate the surface topography (n = 2). The data were statistically analyzed using the Mann-Whitney U-test and the Kruskal-Wallis test (p < 0.05).

RESULTS

Regarding the surface treatments, group ER showed significantly lower SBS than groups B and HF (p < 0.05). Regarding the presence of silane heat treatment by laser, groups ER+SHT and B+SHT showed significantly lower SBS than group HF+SHT(p < 0.05). In addition, group B+SHT showed significantly lower SBS than did group B (p < 0.05).

CONCLUSION

Er:YAG laser treatment for repairing hybrid CAD/CAM blocks was not as effective as bur roughening or hydrofluoric acid etching. Silane heated by Er:YAG laser was incapable of significantly increasing the bond strength to repaired hybrid CAD/CAM blocks.

The effect of surface treatments on the adhesive bond in all-ceramic dental crowns using four-point bending and dynamic loading tests

The aim of this study was to determine the effect of sandblasting, grinding and plasma treatment on the adhesive bond strength between framework ceramic (Y-TZP) and veneering ceramic (feldspar ceramic). Therefore, four-point bending specimens (n = 180) were cut from densely sintered 3Y-TZP blanks. Subsequently, 80 of these samples received surface treatment by sandblasting and 80 samples by grinding. A reference group (20 samples) was not processed. Half of the specimens that received a surface treatment were additionally exposed to an oxygen plasma treatment. After processing, all specimens were manually veneered with feldspar ceramic and examined with a four-point bending test to evaluate the strain energy release rate G. The surface treatment parameters that achieved the highest and lowest G were transferred to real geometries of a posterior crown (n = 45). The crowns' ceramic framework was sandblasted and veneered by hand. The all-ceramic crowns were tested in a dynamic loading test and Wöhler curves were evaluated. Four-point bending samples blasted at an angle of 90° at 6 bar and a working distance of 1.5 cm without plasma treatment achieved the highest energy release rate. Samples blasted at an angle of 90° at 2 bar and a working distance of 1 cm with plasma treatment achieved the lowest energy release rate. Overall, plasma treatment did not improve bond strength. In the dynamic loading test, the group blasted with 2 bar showed the best results.

Fixed prosthetic rehabilitation of a patient with Papillon-Lefevre syndrome supported by a Quad Zygoma Approach: A clinical report

Papillon-Lefevere syndrome (PLS) is a rare disorder with severe oral manifestations resulting in premature tooth loss at an early stage of life. As a result, extensive bone resorption pattern in the maxilla negates conventional implant treatment in the majority of cases. This clinical report describes a prosthetic rehabilitation revision of a 26-year-old female diagnosed with PLS using an implant supported fixed complete denture with a quad zygoma approach. A 1 year follow-up is also presented.

A Critical Review of Dental Lithia-Based Glass-Ceramics

The purpose of this article is to review current understanding of lithia-based glass-ceramics and to identify future research needs for this class of dental materials in relation to novel compositions and fabrication methods. With rapid advances in material development and digital technology, time efficiency of dental workflow and fit accuracy of ceramic restorations are ever improving. Lithia-based glass-ceramics are at the forefront of this advance-new variants with more efficient fabrication routes are continually being introduced into the marketplace. Base glass composition, crystallization heat treatment, nucleant and coloration additives, and property gradation are some pertinent variables. The trend in fabrication is to move from CAD/CAM grinding of partially crystallized glass-ceramics to fully crystallized materials, thereby circumventing the need for postmachining firing altogether. In these endeavors, a better understanding of mechanical properties and evolving shaping technologies, such as ductile grinding, is paramount. Additive manufacturing and 3-dimensional printing methodologies offer a promising alternative to current CAD/CAM subtractive manufacturing routes. Challenges to the implementation of new technologies in efficient development and production of high-quality dental glass-ceramic prostheses are addressed.

Surface Characteristics and Adhesion of Veneering Composite Resin to PAEK-Based Substructure Restorative Materials

PURPOSE

To evaluate and compare the shear bond strength (SBS) of composite veneering material to polyetherketoneketone (PEKK), polyetheretherketone (PEEK), zirconia (YZ), and nickel-chromium alloy (NiCr) substructure restorative materials.

MATERIALS AND METHODS

Forty samples (12 × 2 mm) were prepared from four materials: PEKK, PEEK, zirconia, and NiCr alloy (n = 10). The Vickers hardness was evaluated before preparing the surface for bonding by shot-blasting using 110 μm Al₂ O₃ particles. The surface roughness (Ra) of each sample was determined using a noncontact optical profilometer. The veneering resin was bonded onto each sample following primer application. The prepared samples were then subjected to an SBS test using a universal testing machine at 0.5 mm/min crosshead speed. Failure modes and surface topography following debonding were assessed. The data were statistically analyzed using ANOVA and Tukey's post-hoc comparison test (p < 0.05).  RESULTS: The highest and lowest mean surface roughness was observed in PEEK (3.45 ±0.13 μm) and NiCr (1.87 ±0.07 μm) materials, respectively. A significant difference in roughness values was observed between the materials except for NiCr and YZ (p = 0.547). Concerning SBS, PEEK and NiCr exhibited the highest (16.23 ±0.96 MPa) and lowest (10.1 ±0.63 MPa) values. The mean difference in SBS indicated a statistically significant difference between the material groups (p < 0.01).

CONCLUSIONS

PEKK materials demonstrated significantly lower SBS than PEEK and significantly higher SBS values than conventional zirconia and alloy materials. A positive and significant correlation between mean roughness and SBS was observed, but the causality could be either intrinsic to the material or the roughness.

Exploring Ductility in Dental Ceramics

Two damage regimes-"brittle" and "ductile"-have been identified in the literature on ceramic grinding, machining, grit blasting, and wear. In the brittle regime, the damage mechanism is essentially crack formation, while in the ductile region, it is quasiplasticity. Onset of the brittle mode poses the greater threat to strength, so it becomes important to understand the mechanics of ductile-brittle thresholds in these materials. Controlled microcontact tests with a sharp indenter are employed to establish such thresholds for a suite of contemporary computer-aided design/computer-aided manufacturing dental ceramics. Plots of flexural strength S versus indentation load P show a steep decline beyond the threshold, consistent with well-established contact mechanics relations. Threshold dimensions occur on a scale of order 1 µm and contact load of order 1 N, values pertinent to practical grit finishing protocols. The ductile side of ceramic shaping is accessed by reducing grit sizes, applied loads, and depths of cut below critical levels. It is advocated that critical conditions for ductile shaping may be most readily quantified on analogous S(P) plots, but with appropriate machining variable (grit size, depths of cut, infeed rate) replacing load P. Working in the ductile region offers the promise of compelling time and cost economies in prosthesis fabrication and preparation.

Current Protocols for Resin-Bonded Dental Ceramics

Resin-bonded ceramic restorations are common treatment options. Clinical longevity of resin-bonded ceramic restorations depends on the quality and durability of the resin-ceramic bond. The type and composition of the specific ceramic determines the selection of the most effective bonding protocol. Such protocol typically includes a surface pretreatment step followed by application of a priming agent. Understanding of fundamental ceramic properties and chemical compositions enables the clinician to make proper material selection decisions for clinically successful and long-lasting restorations. Based on research accrued over the past decades, this article reviews and discusses current resin-bonding protocols to most commonly used dental ceramics.

Effect of Speed Sintering on Low Temperature Degradation and Biaxial Flexural Strength of 5Y-TZP Zirconia

Translucent zirconia is becoming the material of choice for the esthetic restorative material. We aimed to evaluate the surface structure, phase determination, translucency, and flexural strength of 5Y-TZP Zirconia (Katana STML Block and Disc) between the regular sintering and the speed sintering with and without low-temperature degradation (LTD). A total of 60 zirconia discs (30 per group; regular sintering and speed sintering) were used in this study. A CAM machine was used to mill cylinders out of the zirconia blanks and then cut into smaller discs. For the speed sintering, the zirconia blocks were milled into smaller discs. The zirconia discs were subjected to regular and speed sintering with and without LTD. Scanning electron microscopy was used to characterize the zirconia specimens and the zirconia grain size. Furthermore, the zirconia specimens were analyzed for elemental analysis using energy dispersive spectroscopy and phase identification using X-ray diffraction. The zirconia specimens were subjected to translucency measurements and biaxial flexural strength testing. The results of the zirconia specimens were compared among the groups. Statistical analysis was completed using SPSS version 20.0 to detect the statistically significant differences (p value = 0.05). A one-way ANOVA with multiple comparisons was performed using Scheffe analysis among the groups. The speed sintering presented smaller grain sizes. The zirconia specimens with and without LTD in regular and speed sintering presented a similar surface structure. Regular sintering showed more translucency compared to speed sintering. Multiple comparisons of the translucency parameter were a significant difference (p value < 0.05) between the various groups except for the comparison between speed sintering and speed sintering LTD. The regular sintering showed bigger gain sizes and slightly more translucency compared to speed sintering. The speed sintering showed higher biaxial flexural strengths compared to regular sintering. This shows that speed sintering can be considered a suitable method of sintering zirconia.

On the Mechanical Properties of Hybrid Dental Materials for CAD/CAM Restorations

Two hybrid dental materials available for computer-aided design and manufacturing (CAD/CAM) dental restorations have been selected to explore their potential. On the one hand, the scarcely investigated polymer-based material Vita Enamic^® (VE) and, on the other hand, the leucite-based material IPS Empress^® CAD (EC). Their micro-structure and mechanical performance were analyzed in two environments: directly as received by the manufacturer (AR), and after immersion and storage in artificial saliva (AS) for 30 days to determine the influence of the saliva effect. To avoid an inappropriate selection of materials for clinical use, a full understanding of their mechanical behavior is essential. Therefore, this investigation aims to determine the micro-structural and chemical composition by field emission scanning electron microscopy (FE-SEM) and X-ray fluorescence analysis, establishing the density, micro- and nano-hardness, the nano-elastic modulus, and the flexural strength and fracture toughness (by introducing a femto-laser notch to replicate a real crack). In addition, fracture surfaces of the broken samples were analyzed to correlate the failure micro-mechanisms with their mechanical properties. Results indicate that while the crystalline phase of the materials is very similar (composed of SiO₂ and Al₂O₃), the micro-structure and mechanical behavior is not. The material EC, with finer micro-structure, exhibits a higher mechanical performance but with greater variability of results. Furthermore, the material VE, with a 25 vol.% polymer phase, shows a mechanical performance similar to enamel and dentin and therefore more similar to human behavior.

MicroCT evaluation for CAD/CAM occlusal veneer fit using two materials and three cement space settings

This study was aimed to evaluate the fit of occlusal veneer restoration for two CAD/CAM materials with different cement space settings, using microCT scans. Sixty resin dies were made and divided into two groups (n=30) according to the materials, (I): Hybrid all-ceramic, and (II): zirconia-reinforced lithium silicate glass-ceramic. Each group was subdivided into three subgroups (n=10) according to the cement space parameters (30, 40, and 50 µm). Occlusal veneers for the six subgroups were milled. A circle with 20 different sections was placed at the center of every scanned specimen to measure four different locations (Occlusal, Axial, Marginal, and Absolute marginal discrepancy). Data were analyzed using two-way ANOVA at a 0.05 level of significance. There was no statistically significant effect of material type on the mean values of internal and marginal gaps for the three cement space parameters (P>0.05). There were no statistically significant differences in the occlusal and axial gap between the cement space parameters, furthermore, there were statistically significant differences in marginal gap distances and absolute marginal discrepancies (P>0.05). Hybrid all-ceramic showed smaller marginal and internal discrepancies than zirconia-reinforced lithium silicate glass-ceramic without statistically significant differences, and, for both materials, 50 µm cement space significantly improved the marginal fit and absolute marginal discrepancy.

In Vivo Evaluation of the Effects of Sintering Temperature on the Optical Properties of Dental Glass-Ceramics

In prosthodontics, the ability of glass-ceramics to express the optical properties of natural teeth is an important goal of esthetic restorations. Dental restorations do not merely need to be similar in color to natural teeth; proper optical properties, such as opalescence, transparency, etc., must be combined in order to achieve excellent esthetic effects. The optical properties of ceramic materials are mainly distinguished by different hues (e.g., A, B, C, and D) combined with translucency (e.g., high translucency (HT), medium translucency (MT), low translucency (LT), and medium opacity (MO)). However, there are many varieties of tooth color. Therefore, it is expected that glass-ceramics can change their nanocrystal size and porosity through different heat-treatment temperatures and times and, thereby, present different transparency effects. This study mainly analyzed the influence of changes in sintering temperature on the optical properties of glass-ceramics. The optical properties of glass-ceramics in the oral cavity were evaluated with human trials. We hypothesized that (1) the transparency of glass-ceramics can be changed by controlling the sintering temperature and (2) glass-ceramics modified by the sintering temperature can be suitable for clinical applications. Results showed that the transparency decreased, the nanoparticle size increased, the crystallinity increased, and the surface hardness decreased as the sintering temperature increased. High-brightness glass-ceramics have more-sensitive optical properties. Results of clinical trials showed that glass-ceramics whose transparency was changed by controlling the sintering temperature can be candidates for clinical applications. Based on the above results, the hypotheses of this study were supported. In the future, we will continue to explore the esthetic field of dental restorations.

Fractographic and Microhardness Evaluation of All-Ceramic Hot-Pressed and CAD/CAM Restorations after Hydrothermal Aging

All-ceramic dental restorations have great advantages, such as highly esthetical properties, a less complex fabrication, and a similar abrasion resistance to enamel. Despite these advantages, ceramic materials are more prone to fracture due to their brittle microstructure. The main aim of this in vitro study was to determine the difference in hot-pressed and milled glass-ceramic mechanical properties such as fracture resistance and microhardness (VHN). Four types of ceramics, two hot-pressed and two milled, feldspathic glass-ceramics and zirconia-reinforced glass-ceramics were selected in this study and tested using the static loading test and Vicker’s testing. Hydrothermal aging, consisting of different baths with temperatures between 5 degrees Celsius and 55 degrees Celsius, was chosen as the in vitro aging method. Statistical analyses are performed using SPSS Statistics software at a significance level of p < 0.05. Micro-hardness values decrease after hydrothermal aging. The static loading test reveals a significant difference between the feldspathic hot-pressed glass-ceramic, which fractures at lower forces, and milled zirconia-reinforced lithium silicate glass-ceramic, which fractures at greater forces (N). Fractographic analysis of the fractured fragments resulted in the static loading test revealing different surface features about the crack origins and propagations under a stereomicroscope.

Effect of Different Surface Treatments on the Micro-Shear Bond Strength and Surface Characteristics of Zirconia: An In Vitro Study

Purpose

To study the effect of different surface treatments on the micro-shear bond strength and surface characteristics of zirconia.

Methods

Two types of zirconia ceramics were tested: opaque (O) and translucent (T). Each type of zirconia was further allotted into four groups based on the type of surface treatment method. The four groups were: control (C), air abrasion with 110 µm Al₂O₃ particles (A), etching with Zircos–E Etching solution for 2 hours (E), and a combination of air abrasion and etching (AE). After the surface treatment, all specimens were ultrasonically cleaned and 10 resin cement cylinders were attached to the zirconia discs in each group. A micro-shear bond strength test was performed in a universal testing machine at a crosshead speed of 0.5 mm/min. The fracture surfaces were assessed under a compound microscope. SEM, EDAX, and AFM analyses were done for the zirconia specimens after being subjected to surface treatment. Statistical analysis for the bond strength test was done using the Shapiro–Wilk test, one-way analysis of variance (ANOVA), and Post hoc Tukey test.

Results

The micro-shear bond strength values for the groups were as follows in megapascals (MPa): OC 18.96 (5.54), OA 22.66 (2.51), OE 28.48 (4.50), OAE 28.63 (4.53), TC 22.82 (5.46), TA 25.36 (5.17), TE 28.12 (4.76), and TAE 32.00 (3.47). The one-way analysis of variance (ANOVA) and post hoc Tukey HSD tests were done which showed significant results in the groups. In opaque zirconia, significant differences were seen in the etching and air abrasion with etching groups when compared with the control and air abrasion groups. There was no difference between the etching and air abrasion with etching groups. For translucent zirconia, the only significant difference was seen in the air abrasion with etching group in comparison with the control and air abrasion groups. The mode of failure was majorly adhesive. The surface topography and surface roughness showed significant differences between the groups. The EDAX results showed material loss that occurred due to sandblasting in the air abrasion groups.

Conclusions

Etching with Zircos–E Etching solution significantly increased the bond strength of zirconia to resin cement when compared with other surface treatment methods. In translucent zirconia, the best results can be achieved by combining etching with air abrasion.

Consensus on the preparation margin and restoration margin in ceramic esthetic rehabilitation

In esthetic rehabilitation, methods used to enhance the margin quality have always been the focus and difficulty of improving the level of diagnosis and treatment, prevention and treatment of complications, and collaboration between clinicians and technicians. However, it is impeded by the ambiguous definition and classification of margin, unstandardized tooth preparation, manufacturing process of restoration, and lack of reliable means of checking the quantitative requirements of preparation or restoration. The digital technologies that are increasingly applied, such as intra-oral scanner, impression scanner, and computerized numerical control cutting machine, have strict requirements about margin quality. Failure of recognizing margins by these scanners will hinder the digital process of diagnosis and treatment. Even if these sharp and narrow margins are successfully scanned, they cannot be milled accurately. To overcome these problems, this article demonstrated the clear and complete definition of preparation margin and restoration margin, as well as their subclassifications, by analyzing the target restoration space from a geometric perspective. Practical approaches to measuring the margin width and inspecting the margin quality were proposed. The new and full understanding and proposal about preparation margin and restoration margin characterized by measurements will effectively support the thoroughly digitalized process of esthetic rehabilitation using porcelain in fixed prosthodontics, which is based on the guidance of values.

Effect of surface treatment with laser on repair bond strength of composite resin to ceramic

BACKGROUND

Small chipping or fracture of ceramic restorations may be repaired by composite resin instead of replacing the restoration. This method is faster and cheaper compared to restoration replacement. Several strategies have been suggested to obtain a high repair shear bond strength (SBS). This study aimed to assess the efficacy of some new ceramic surface treatments (laser and universal adhesive) to enhance the repair bond strength of composite resin to ceramic compared to the conventional method.

MATERIALS AND METHODS

This in vitro study evaluated 80 IPS Empress Esthetic ceramic plates in eight groups (n = 10). The ceramic surface was polished with 320-grit silicon carbide paper under running water, rinsed with water spray for 10 s and dried. The samples were then divided into two subgroups for mechanical surface preparation with hydrofluoric (HF) acid and Er: YAG laser (2 W, 200 m J, 10 Hz, 10 s). Each group was divided into two subgroups for use/no use of silane. The conventional or universal adhesive was then applied on the samples in each subgroup. Composite cylinders were bonded to the ceramic surface using plastic tubes. The samples were stored in distilled water at 37°C for 24 h and subjected to an SBS test. Data were analyzed using one-way ANOVA (P < 0.05).

RESULTS

The interaction effect of variables on SBS was significant. Maximum SBS was noted in HF acid + silane + conventional adhesive group (mean: 12.0481 MPa). Minimum SBS was noted in the laser + conventional adhesive group (mean: 2.5766 MPa). Surface treatment with HF acid yielded significantly higher SBS than laser (P < 0.001). The interaction effect of conventional/universal adhesive and use/no use of silane on SBS was statistically significant.

CONCLUSION

The repair SBS was higher in groups treated with HF acid compared to laser. Ceramic surface treatment with HF plus silane plus conventional adhesive yielded a higher SBS as well as HF plus Universal adhesive. Thus, the application of silane as a separate step can be omitted in the repair of ceramic restorations with universal adhesives.

Revolution of Current Dental Zirconia: A Comprehensive Review

The aim of this article is to comprehensively review the revolution of dental zirconia (Zir), including its types, properties, applications, and cementation procedures. A comprehensive search of PubMed and Embase was conducted. The search was limited to manuscripts published in English. The final search was conducted in October 2021. Newly developed monolithic Zir ceramics have substantially enhanced esthetics and translucency. However, this material must be further studied in vitro and in vivo to determine its long-term ability to maintain its exceptional properties. According to the literature, monolithic translucent Zir has had promising results and a high survival rate. Thus, the utilization of this material is indicated when strength and esthetics are needed. Both the materials and methods used for cementation of monolithic Zir have significantly improved, encouraging dentists to use this material, especially when a conservative approach is required. Zir restorations showed promising outcomes, particularly for monolithic Zir crowns supported with implant and fixed dental prostheses.

Effect of Thermocycling on the Bond Strength of Self-Adhesive Resin Cements Used for Luting CAD/CAM Ceramics to Human Dentin

The aim of the study was to evaluate the influence of thermocycling on the shear bond strength of self-adhesive, self-etching resin cements luted to human dentin and computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics. Three modern self-adhesive dental cements (Maxcem Elite, RelyX U200, Panavia SA) were used to lute three CAD/CAM ceramics (IPS Empress CAD, IPS e.max CAD, IPS e.max ZirCAD) onto the dentin. One conventional cement (Panavia V5) served as a control. After preparation, the samples were subjected to thermocycling as a method of artificial aging of dental materials applied to simulate long-term use in oral conditions. Shear bond strength was evaluated according to PN-EN ISO 29022:2013-10 and failure modes were observed under a light microscope. Statistical analysis was performed. The study demonstrated that a combination of ceramics and cements directly impacts the bond strength. The highest bond strength was observed in Panavia V5, lower in Panavia SA and Maxcem Elite and the lowest–in RelyX U200. Adhesive failure between human dentin and cements was the most common failure mode. Moreover, thermocycling highly decreased bond strength of self-adhesive, self-etching cements.

Effect of Preparation Design on Marginal Integrity and Fracture Resistance of Endocrowns: A Systematic Review

Objectives: Endocrown restorations were introduced for endodontically treated teeth as a conservative treatment. However, data about the effect of preparation design on marginal integrity and fracture resistance of endocrowns are lacking. The purpose of this systematic review was to investigate the effect of preparation design of endocrown restorations on marginal integrity and fracture resistance. Materials and Methods: Based on PICO question and the search terms, PubMed, Embase, Scopus, and the Cochrane Library were searched. After including studies matched to predefined inclusion and exclusion criteria, the extracted data were tabulated in a table provided by the authors. Two reviewers assessed the methodological quality of each included study independently. Ten articles were selected for extracting the quantitative data. All included studies were in vitro. The potential risk of bias of the selected studies was assessed using the modified MINORS scale. Results: Four studies assessed the marginal adaptation, five studies evaluated the fracture resistance and just one investigated both the marginal integrity and fatigue resistance of the specimens. The evaluated influencing items in preparation design were as follows: cavity depth, occlusal thickness, ferrule effect, internal divergence angle, type of finish line, and adding vents inside pulp chamber. Meta-analysis could not be done due to heterogeneity of preparation designs and evaluation methods. Conclusion : Marginal discrepancy of endocrowns is intensified with adding preparation features, higher cavity depth and increasing the divergence. Fracture resistance of endocrowns is increased with more occlusal reduction and cavity depth. However, it is still beyond the normal clinical force range.

Influence of resin removal treatments on the surface topography and strength of de-bonded lithium disilicate ceramic

AIM

This study aims to assess the influence of resin removal treatment regimes on the surface topography and compressive strength of de-bonded ceramic surfaces.

MATERIAL AND METHODS

Sixty-five lithium disilicate ceramic (LDC) discs were prepared, cleaned, and polished with carbide paper. All samples were etched using 9.6% hydrofluoric acid (HFA). Fifteen samples were taken as positive controls; the remaining 50 samples were subjected to the process of silanization. Resin build-up using dual-cure cement was performed incrementally and light cured. Based on different methods of resin cleaning from de-bonded LDC, the samples were divided into five groups, n=10 each: group 1 (no treatment), group 2 (slow-speed diamond bur), group 3 (1 min heat treatment), Group 4 (6 min heat treatment), and group 5 (sandblasting with Al₂O₃). Following resin removal, LDC samples were tested under compressive failure load in a universal testing machine. Five disc specimens from each group were sputter coated with gold for scanning electron microscopy (SEM). Analysis of variance (ANOVA) and Tukey's post hoc test was used for descriptive statistics. Level of significance was established at p<0.05.

RESULTS

The highest compressive strength with significant difference among all experimental groups was found in group 5 (321.54 ± 13.25 MPa) (p<0.05). The lowest compressive strength values, presenting significant difference compared with all other groups, were displayed in group 1 (158.57 ± 5.22 MPa) (p<0.05). Compressive strength among group 2 (231.54 ± 15.55 MPa), group 3 (237.81 ± 10.81 MPa), and group 4 (255.53 ± 8.95 MPa) specimens was statistically comparable (p>0.05). On SEM, heat-treated specimens confirmed coarser granules, with mild porosities and roughening, whereas sandblasted specimens exhibited consistent evenness with moderate porosity and loss of glazed surface.

CONCLUSION

De-bonded LDC surface, treated with heat treatment and sandblasting procedures, exhibited removal of residual resin and significantly high compressive strength compared with non-cleansed ceramic surface.

Effect of supporting dies' mechanical properties on fracture behavior of monolithic zirconia molar crowns

The aim of this study was to investigate the effects of supporting dies with different mechanical properties on the fracture strengths and failure modes of monolithic zirconia crowns, and identify a suitable die material for testing high-strength ceramic restorations. Thirty six dies from teeth, porous titanium and composite-resin with 36 zirconia crowns were fabricated based on 3D model. Crowns were cemented, then underwent load-to-fracture testing. Fractographic analysis was performed with scanning electron microscopy, and finite element analysis was made. During loading, a high stress concentration zone formed near the loading point and on surface of die. Cracks generated on failure penetrated the crown and extended to die in 9 teeth group specimens, while composite-resin samples exhibited fracture of both crowns and dies. All dies remained intact in porous titanium group. Fracture mode was undistinguishable in all groups. It was concluded that porous titanium appears suitable as die material for dental restorations with high fracture strength.