Fracture Load of Different Zirconia Types: A Mastication Simulation Study

Effect of low-temperature degradation and sintering protocols on the color of monolithic zirconia crowns with different yttria contents

This study investigated the effects of low-temperature degradation (LTD) on the L*, a*, and b* values of highly translucent zirconia crowns. Four types of zirconia disks with different yttria contents (IPS e.max ZirCAD LT, IPS e.max ZirCAD MT, IPS e.max ZirCAD MT Multi, IPS e.max ZirCAD Prime, Ivoclar) and two shades (A2 and BL) were used. A crown was manufactured using four types of zirconia and LTD treated. Color measurements were performed, and the color difference (ΔE00) before and after LTD was calculated. The microstructure was determined through X-ray fluorescence and X-ray diffractometry. Highly translucent zirconia crowns showed greater changes in the a* and b* values than in the L* value after LTD, regardless of the shade. The Multi2 crowns exhibited a discernible color change due to the LTD treatment. The X-ray fluorescence results did not reveal any apparent change in the microstructure between sintering programs for all zirconia specimens.

Translucency of chairside monolithic zirconias using different sintering ovens: An in vitro investigation

OBJECTIVE

To evaluate the translucency of several monolithic zirconias (MZ) processed in various sintering ovens designed for single-visit, chairside use.

METHODS

Discs (n = 40) from zirconia blocks were fabricated for each MZ at manufacturer-recommended minimal thicknesses, as provided in each material's instructions for use: IPS e.max ZirCAD LT (ZLT); CEREC Zirconia+ (CZ+); 3M Chairside (3M); KATANA Zirconia (KT). Groups (n = 10) were sintered following manufacturer instructions for each oven: CEREC SpeedFire, Ivoclar CS4, Ivoclar CS6, and Ivoclar S2 (laboratory furnace control). Specimens were highly polished on one side and glazed on the other. Each side was measured with a spectrophotometer against white and black backgrounds to determine translucency parameter (TP) and contrast ratio (CR) values. Results for TP and CR for each material and oven combination were compared with a linear mixed model. Oven precision was evaluated using the Kruskall-Wallis test.

RESULTS

Glazed specimens were more translucent than polished ones (p < 0.001). ZLT and CZ+ were more translucent than 3M and KT regardless of the sintering oven (p < 0.01). Several oven/material combinations reached or exceeded the S2 oven TP: CS4 with CZ+ and 3M; CS6 with ZLT and KT (p < 0.01). SpeedFire was significantly less precise (p < 0.05) and produced lower TP values for ZLT, CZ+, and KT (p < 0.01). Results for TP and CR were highly correlated.

CONCLUSIONS

MZ surface finish, material thickness, and oven used all had a significant effect on translucency. Some chairside-oriented solutions produced results with translucency equal to conventionally processed zirconia.

CLINICAL SIGNIFICANCE

The translucency of a ceramic restoration is an important factor in determining its esthetics. Clinicians desiring the most esthetic outcomes with monolithic zirconia should be aware of the significant effects that surface finishing, material thickness, and the sintering oven used can have on restoration translucency.

Zirconia restoration types, properties, tooth preparation design, and bonding. A narrative review

OBJECTIVE

The purpose of this review was to provide dental professionals with information regarding the various types of zirconia restorations, their mechanical and optical properties, tooth preparation design, and bonding protocol in an effort to enhance the longevity and durability of zirconia restorations.

OVERVIEW

The yttria content of zirconia ceramics determines their classification. The mechanical and optical properties of each type are discussed, with an emphasis on the effect of yttria concentration on the properties of zirconia. The processing and sintering methods are also discussed as they have a direct impact on the properties of zirconia. The design of tooth preparation, specifically occlusal reduction, varies depending on the type of zirconia used in each case. Finally, a protocol for zirconia restoration bonding is described to ensure optimal bonding to the tooth structure.

CONCLUSION

Not all zirconia restorations are the same. The selection of zirconia type based on yttria concentration, processing and sintering methods, tooth preparation design, and adherence to the bonding protocol are all critical to the success and longevity of zirconia restorations.

CLINICAL SIGNIFICANCE

Zirconia restorations are the most commonly used indirect restorative material. The selection of the most appropriate zirconia type based on its yttria content, which determines its strength and translucency, is critical to the success and the longevity of the restoration. Tooth preparation design also influences the strength and translucency of the zirconia. Air-borne particle abrasion, followed by a ceramic primer and resin cement, can ensure a durable bond to the tooth structure.

A Narrative Review on Polycrystalline Ceramics for Dental Applications and Proposed Update of a Classification System

Dental zirconias have been broadly utilized in dentistry due to their high mechanical properties and biocompatibility. Although initially introduced in dentistry as an infrastructure material, the high rate of technical complications related to veneered porcelain has led to significant efforts to improve the optical properties of dental zirconias, allowing for its monolithic indication. Modifications in the composition, processing methods/parameters, and the increase in the yttrium content and cubic phase have been presented as viable options to improve zirconias' translucency. However, concerns regarding the hydrothermal stability of partially stabilized zirconia and the trade-off observed between optical and mechanical properties resulting from the increased cubic content remain issues of concern. While the significant developments in polycrystalline ceramics have led to a wide diversity of zirconia materials with different compositions, properties, and clinical indications, the implementation of strong, esthetic, and sufficiently stable materials for long-span fixed dental prostheses has not been completely achieved. Alternatives, including advanced polycrystalline composites, functionally graded structures, and nanosized zirconia, have been proposed as promising pathways to obtain high-strength, hydrothermally stable biomaterials. Considering the evolution of zirconia ceramics in dentistry, this manuscript aims to present a critical perspective as well as an update to previous classifications of dental restorative ceramics, focusing on polycrystalline ceramics, their properties, indications, and performance.

A Comparison of Failure Loads for Polycrystalline Zirconia Ceramics with Varying Amounts of Yttria, Glass-Ceramics and Polymers in Two Different Test Conditions

It is unclear how zirconia dental crowns with different yttria compositions will perform clinically, and how they will compare with crowns made of glass-ceramics and polymers. The present objective was to determine failure loads of crowns and discs made of glass ceramics or polymers as compared to yttria-partially stabilized zirconia (Y-PSZ) crowns and discs with varying yttria concentrations. Crowns of zirconia (Cercon XT, Katana UTML, BruxZir Anterior), glass ceramic (Celtra press, IPS e.max press, Lisi press), and polymeric materials (Trilor, Juvora, Pekkton) were fabricated and cemented to epoxy abutments. The total number of specimens was 135 for crowns and 135 for discs (n = 15 specimens per material type and design). A universal testing machine was used to perform compressive loading of crowns/discs to failure with a steel piston along the longitudinal axis of the abutments. Energy dispersive spectroscopy (EDS) was used to identify the yttria concentration for each zirconia brand. The data were analyzed using generalized linear models and regression analyses. The results revealed significant differences (p < 0.05) in mean failure loads for different crown materials: Trilor (6811 ± 960 N) > Juvora (5215 ± 151 N) > Cercon (4260 ± 520 N) = BruxZir (4186 ± 269 N) = e.max (3981 ± 384 N) > Katana (3195 ± 350 N) = Lisi (3173 ± 234 N) = Pekkton (3105 ± 398 N) > Celtra (2696 ± 393 N). The general linear model revealed significant differences (p < 0.05) in mean failure loads when comparing the different materials for the discs, i.e., Trilor (5456 ± 1748 N) > Juvora (4274 ± 869 N) > Pekkton (3771 ± 294 N) > Katana (2859 ± 527 N) > Cercon (2319 ± 342 N) = BuxZir (2250 ± 515 N) = e.max (2303 ± 721 N) = Lisi (2333 ± 535 N) > Celtra (1965 ± 659 N). EDS showed that the zirconia materials contained yttria at different concentrations (BruxZir = 5Y-PSZ, Cercon = 4Y-PSZ, Katana = 3Y-PSZ). The yttria concentration had a significant effect on the failure load of the Katana (3Y-PSZ) crowns, which revealed lower failure loads than the Cercon (4Y-PSZ) and BruxZir (5Y-PSZ) crowns, whose failure loads were comparable or higher than e.max glass ceramic. The failure load of the trilayer disc specimens did not correlate with the failure load of the respective crown specimens for the zirconia, glass-ceramic and polymeric materials.

Translucent Zirconia in Fixed Prosthodontics-An Integrative Overview

Over the past two decades, dental ceramics have experienced rapid advances in science and technology, becoming the fastest-growing field of dental materials. This review emphasizes the significant impact of translucent zirconia in fixed prosthodontics, merging aesthetics with strength, and highlights its versatility from single crowns to complex bridgework facilitated by digital manufacturing advancements. The unique light-conducting properties of translucent zirconia offer a natural dental appearance, though with considerations regarding strength trade-offs compared to its traditional, opaque counterpart. The analysis extends to the mechanical attributes of the material, noting its commendable fracture resistance and durability, even under simulated physiological conditions. Various zirconia types (3Y-TZP, 4Y-TZP, 5Y-TZP) display a range of strengths influenced by factors like yttria content and manufacturing processes. The study also explores adhesive strategies, underlining the importance of surface treatments and modern adhesives in achieving long-lasting bonds. In the realm of implant-supported restorations, translucent zirconia stands out for its precision, reliability, and aesthetic adaptability, proving suitable for comprehensive dental restorations. Despite its established benefits, the review calls for ongoing research to further refine the material's properties and adhesive protocols and to solidify its applicability through long-term clinical evaluations, ensuring its sustainable future in dental restorative applications.

Full-mouth rehabilitation in a completely digital workflow using partially adhesive monolithic zirconia restorations

OBJECTIVE

This clinical case describes a completely digital workflow using current digital technologies for a full-mouth adhesive rehabilitation with ultra-translucent multilayer zirconia restorations.

CLINICAL CONSIDERATIONS

A healthy 60-year-old man with abfractions on all upper and lower molars and severe tooth wear underwent a full-mouth rehabilitation with laminate veneers and partial adhesive restorations. A proper zirconia bonding protocol was realized to provide a durable bond between the ultra-translucent zirconia and the resin cement. Furthermore, the implementation of a digital workflow enables the clinician to have an effective communication during treatment planning and simplify the clinical and laboratory procedures, providing the patient with long-term esthetic treatment and functional results.

CONCLUSION

The implementation of a completely digital workflow and the use of ultra-translucent multilayer zirconia for indirect adhesive restorations can be an alternative with simplified and predictable procedures for patients with dental wear and teeth discolorations.

CLINICAL SIGNIFICANCE

The digital workflow described is intended to facilitate the planning and execution of a full-mouth adhesive rehabilitation and demonstrates to clinicians a reliable zirconia bonding concept for minimally invasive anterior and posterior restorations.

Effect of dynamic loading on fracture resistance of gradient zirconia fixed partial denture frameworks

STATEMENT OF PROBLEM

The new strength-gradient zirconia composed of 3-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) and 5-mol% yttria-stabilized tetragonal zirconia polycrystal (5Y-TZP) has been claimed to have superior mechanical properties. However, data on the fracture resistance of 3-unit gradient 5Y-TZP and 3Y-TZP fixed partial denture frameworks are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of dynamic loading on the fracture resistance of gradient zirconia fixed partial denture frameworks.

MATERIAL AND METHODS

Two standardized stainless-steel master dies were designed to simulate a mandibular left second premolar and second molar prepared to receive zirconia frameworks. The frameworks were designed with a 0.6-mm uniform wall thickness. The mesiodistal width of the connectors was 3 ±0.02 mm, and the occlusogingival height was 3 ±0.02 mm. Forty zirconia frameworks were fabricated and divided into 2 groups according to the tested materials (n=20): 3Y-TZP and gradient 5Y-TZP and 3Y-TZP. The frameworks were cemented onto their corresponding dies with a conventional glass ionomer cement. Half of the cemented frameworks in each group underwent 600 000 cycles of dynamic loading in a mastication simulator (n=10). The other half was fractured without dynamic loading (n=10). Fracture resistance measurements (N) for each framework were recorded by using a universal testing machine at a crosshead speed of 1 mm/min. A fractured framework from each group was examined by using a scanning electron microscope (SEM) at ×100 magnification. The data obtained were statistically analyzed by using 2-way ANOVA, the pairwise Tukey honestly significant difference (HSD), and simple main effect tests to detect the difference between group mean values (α=.05).

RESULTS

The mean ±standard deviation of fracture load value before dynamic loading was 1919 ±193 N for the 3Y-TZP group and 908 ±99 N for the gradient 5Y-TZP and 3Y-TZP group. In addition, the mean fracture load value after dynamic loading was 1418 ±163 N for the 3Y-TZP group and 716 ±85 N for the gradient 5Y-TZP and 3Y-TZP group. The interaction between the effects of the zirconia material and dynamic loading on the fracture resistance was statistically significant (P=.002). The 3Y-TZP group had a statistically significant, higher fracture load mean value the gradient 5Y-TZP and 3Y-TZP group before and after dynamic loading (P<.001).

CONCLUSIONS

The fracture resistance of 3Y-TZP frameworks was significantly higher than that of gradient 5Y-TZP and 3Y-TZP frameworks before and after dynamic loading. Dynamic loading significantly reduced the fracture resistance of 3Y-TZP and gradient 5Y-TZP and 3Y-TZP frameworks.

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.

Influence of Restorative Material on the Distribution of Loads to the Bone in Hybrid Abutment Crowns-In Vitro Study

Background: The objective of this study was to evaluate the load transmitted to the peri-implant bone by seven different restorative materials in single-unit rehabilitations with morse taper implants using a strain gauge. Materials: In a polyurethane block that simulated type III bone, a morse taper platform implant was installed (3.5 × 11 mm) in the center and 1 mm below the test base surface, and four strain gauges were installed around the implant, simulating the mesial, distal, buccal and lingual positions. Seven similar hybrid abutment crowns were crafted to simulate a lower premolar using different materials: 1-PMMA; 2-glass ceramic over resin matrix; 3-PEEK + lithium disilicate; 4-metal-ceramic; 5-lithium disilicate; 6-zirconia + feldspathic; 7-monolithic zirconia. All groups underwent axial and oblique loads (45 degrees) of 150 N from a universal testing machine. Five measurements (n = 5) were performed with each material and for each load type; the microdeformation data underwent statistical analysis. The data were obtained in microdeformation (με), and the significance level was set at p ≤ 0.05. Results: There was no statistically significant difference in the evaluation among the materials under either the axial load or the oblique load at 45 degrees. In turn, in the comparison between axial load and oblique load, there was a difference in load for all materials. Conclusion: The restorative material did not influence the load transmitted to the bone. Furthermore, the load transmitted to the bone was greater when it occurred obliquely at 45° regardless of the material used. In conclusion, it appeared that the different elastic modulus of each material did not influence the load transmission to the peri-implant bone.

Mechanical Properties of New Generations of Monolithic, Multi-Layered Zirconia

New monolithic multi-layered zirconia restorations are gaining popularity due to their excellent aesthetic properties. However, current knowledge of these newest multi-layer ceramics in terms of mechanical properties is scarce. Three monolithic, multi-layered zirconia materials (Katana, Kuraray Noritake, Japan) were selected for comparison: High Translucent Multi-layered zirconia (HTML), Super Translucent Multi-layered zirconia (STML) and Ultra Translucent Multi-layered zirconia (UTML). Fifteen specimens per group were cut from pre-sintered blocs in each of the four layers (L1, L2, L3, L4) and in different thicknesses (0.4 mm, 0.8 mm and 1.2 mm). Critical fracture load (Fcf) was recorded in 3-point-bending. Flexural strength (σ) in MPa, Vickers hardness (HV) in N/mm2, fracture toughness (KIc) in MPa*m1/2, Weibull Modulus (m) and characteristic Weibull strength (σw) in MPa were assessed. Statistical analysis was performed using ANOVA analysis. FS and KIc were significantly higher (p < 0.05) for Katana™ HTML (652.85 ± 143.76−887.64 ± 118.95/4.25 ± 0.43−5.01 ± 0.81) in comparison to Katana™ STML (280.17 ± 83.41−435.95 ± 73.58/3.06 ± 0.27−3.84 ± 0.47) and UTML (258.25 ± 109.98−331.26 ± 56.86/2.35 ± 0.31−2.94 ± 0.33), with no significant differences between layers and layer thicknesses. The range of indications should be carefully considered when selecting the type of monolithic zirconia for fabrication of dental restorations, as materials widely differ in mechanical properties.

Fracture Load and Fracture Patterns of Monolithic Three-Unit Anterior Fixed Dental Prostheses after In Vitro Artificial Aging-A Comparison between Color-Gradient and Strength-Gradient Multilayer Zirconia Materials with Varying Yttria Content

(1) Background: Due to advantages such as avoidance of chipping, pulp-friendly tooth preparation and cost reduction, zirconia is increasingly being used monolithically without veneering. Nevertheless, to enable good aesthetics, various multilayer systems have been developed. The aim of this study was to investigate the impact of different zirconia multilayer strategies and yttria levels on fracture load, fracture pattern, stress distribution and surface roughness. (2) Methods: Monolithic three-unit anterior FDPs were made from three different color-gradient zirconia multilayer materials with different yttria levels corresponding to varying strength and degrees of translucency grades (Katana HTML, STML, UTML, Kuraray) and one strength-gradient zirconia multilayer material (Katana YML, Kuraray) and artificially aged in a chewing simulator (1.2 × 106 load cycles, 50 N, 2 × 3000 thermocycles, 5−55 °C). Analyses of fracture load, fracture pattern, fracture surfaces, stress distribution and roughness were performed after the fracture load test. Shapiro−Wilk, Kruskal−Wallis, Mann−Whitney U-tests and one-way ANOVA were used (p < 0.05). (3) Results: Fracture loads of the high strength color-gradient material HTML and the strength-gradient material YML were comparable after 5 years of aging (p = 0.645). Increasing yttria levels resulted in a decrease in fracture resistance of 42−57% (p < 0.05). Surface roughness of different zirconia generations is comparable after polishing and aging. (4) Conclusions: Color-gradient multilayer zirconia materials and new strength-gradient zirconia materials with similar yttria levels in the basal layers show comparable mechanical properties and are suitable for anterior FDPs.

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.