Ceramics in dentistry: historical roots and current perspectives

Assessing degradation of composite resin cements during artificial aging by Martens hardness

BACKGROUND

Aim of the study was to verify the efficiency of Martens hardness measurements in detecting the degradation of composite resin cements during artificial aging.

METHODS

Four cements were used: Variolink II (VL2), RelyX Unicem 2 Automix (RUN), PermaFlo DC (PDC), and DuoCem (DCM). Specimens for Martens hardness measurements were light-cured and stored in water at 37 °C for 1 day to allow complete polymerization (baseline). Subsequently the specimens were artificially aged by water storage at 37 °C or thermal cycling (n = 6). Hardness was measured at baseline as well as after 1, 4, 9 and 16 days of aging. Specimens for indirect tensile strength measurements were produced in a similar manner. Indirect tensile strength was measured at baseline and after 16 days of aging (n = 10). The results were statistically analyzed using one-way ANOVA (α = 0.05).

RESULTS

After water storage for 16 days hardness was significantly reduced for VL2, RUN and DCM while hardness of PDC as well as indirect tensile strength of all cements were not significantly affected. Thermal cycling significantly reduced both, hardness and indirect tensile strength for all cements. No general correlation was found between Martens hardness and indirect tensile strength. However, when each material was analyzed separately, relative change of hardness and of indirect tensile strength revealed a strong linear correlation.

CONCLUSIONS

Martens hardness is a sensible test method to assess aging of resin composite cements during thermal cycling that is easy to perform.

Influence of nano-structured alumina coating on shear bond strength between Y-TZP ceramic and various dual-cured resin cements

PURPOSE

The purpose of this study was to evaluate the effect of nano-structured alumina surface coating on shear bond strength between Y-TZP ceramic and various dual-cured resin cements.

MATERIALS AND METHODS

A total of 90 disk-shaped zirconia specimens (HASS CO., Gangneung, Korea) were divided into three groups by surface treatment method: (1) airborne particle abrasion, (2) tribochemicalsilica coating, and (3) nano-structured alumina coating. Each group was categorized into three subgroups of ten specimens and bonded with three different types of dual-cured resin cements. After thermocycling, shear bond strength was measured and failure modes were observed through FE-SEM. Two-way ANOVA and the Tukey's HSD test were performed to determine the effects of surface treatment method and type of cement on bond strength (P<.05). To confirm the correlation of surface treatment and failure mode, the Chi-square test was used.

RESULTS

Groups treated with the nanostructured alumina coating showed significantly higher shear bond strength compared to other groups treated with airborne particle abrasion or tribochemical silica coating. Clearfil SA Luting showed a significantly higher shear bond strength compared to RelyX ARC and RelyX Unicem. The cohesive failure mode was observed to be dominant in the groups treated with nano-structured alumina coating, while the adhesive failure mode was prevalent in the groups treated with either airborne particle abrasion or tribochemical silica coating.

CONCLUSION

Nano-structured alumina coating is an effective zirconia surface treatment method for enhancing the bond strength between Y-TZP ceramic and various dual-cured resin cements.

Translucent zirconia in the ceramic scenario for monolithic restorations: A flexural strength and translucency comparison test

OBJECTIVE

To compare three different compositions of Yttria-Tetragonal Zirconia Polycrystal (Y-TZP) ceramic and a lithium disilicate ceramic in terms of flexural strength and translucency.

METHODS

Three zirconia materials of different composition and translucency, Aadva ST [ST], Aadva EI [EI] and Aadva NT [NT](GC Tech, Leuven, Belgium) were cut with a slow speed diamond saw into beams and tabs in order to obtain, after sintering, dimensions of 1.2×4.0×15.0mm and 15.0×15.0×1.0mm respectively. Blocks of IPS e.max CAD LT were cut and crystallized in the same shapes and dimensions and used as a reference group [LD]. Beams (n=15) were tested in a universal testing machine for three-point bending strength. Critical fracture load was recorded in N, flexural strength (σ in MPa), Weibull modulus (m) and Weibull characteristic strength (σ⁰ in MPa) were then calculated. Tabs (n=10) were measured with a spectrophotometer equipped with an integrating sphere. Contrast Ratios were calculated as CR=Yb/Yw. SEM of thermally etched samples coupled with lineal line analysis (n=6) was used to measure the tested zirconia grain size. Data were statistically analyzed.

RESULTS

Differences in translucency, flexural strength and grain size were found to be statistically significant. CR increased and flexural strength decreased in the following order ST(σ 1215±190MPa, CR 0.74±0.01)>EI(σ 983±182MPa, CR 0.69±0.01)>NT(σ 539±66MPa, CR 0.65±0.01)>LD (σ 377±39Mpa, CR 0.56±0.02). The average grain size was different for the three zirconia samples with NT(558±38nm)>ST(445±34nm)>EI(284±11nm).

CONCLUSIONS

The zirconia composition heavily influenced both the flexural strength and the translucency. Different percentages of Yittria and Alumina result in new materials with intermediate properties in between the conventional zirconia and lithium disilicate. Clinical indications for Zirconia Aadva NT should be limited up to three-unit span bridges.

Influence of resin cement shade on the color and translucency of ceramic veneers

Objective

This in vitro study evaluated the effect of two different shades of resin cement (RC- A1 and A3) layer on color change, translucency parameter (TP), and chroma of low (LT) and high (HT) translucent reinforced lithium disilicate ceramic laminates.

Material and Methods

One dual-cured RC (Variolink II, A1- and A3-shade, Ivoclar Vivadent) was applied to 1-mm thick ceramic discs to create thin RC films (100 µm thick) under the ceramics. The RC was exposed to light from a LED curing unit. Color change (ΔE) of ceramic discs was measured according to CIEL*a*b* system with a standard illuminant D65 in reflectance mode in a spectrophotometer, operating in the light range of 360-740 nm, equipped with an integrating sphere. The color difference between black (B) and white (W) background readings was used for TP analysis, while chroma was calculated by the formula C^*_ab=(a^*2+b^*2)^½. ΔE of 3.3 was set as the threshold of clinically unacceptable. The results were evaluated by two-way ANOVA followed by Tukey's post hoc test.

Results

HT ceramics showed higher ΔE and higher TP than LT ceramics. A3-shade RC promoted higher ΔE than A1-shade cement, regardless of the ceramic translucency. No significant difference in TP was noted between ceramic discs with A1- and those with A3-shade cement. Ceramic with underlying RC showed lower TP than discs without RC. HT ceramics showed lower chroma than LT ceramics, regardless of the resin cement shade. The presence of A3-shade RC resulted in higher chroma than the presence of A1-shade RC.

Conclusions

Darker underlying RC layer promoted more pronounced changes in ceramic translucency, chroma, and shade of high translucent ceramic veneers. These differences may not be clinically differentiable.

The Strengthening Mechanism of Resin Cements on Porcelain Surfaces

All-ceramic crowns bonded with resin cements have increased performance, and two theories have been proposed. Marquis (1992) suggested that the resin modified defects by crack healing, while Nathanson (1993) proposed that resin polymerization shrinkage strengthened porcelains. Both theories imply a sensitivity of strengthening to defect size. The hypothesis tested was that resin strength enhancement is independent of defect severity. We ground 200 porcelain discs to remove imperfections and indented 120 to create a large defect. Discs were tested dry, wet, and after being coated with 75–100 μm of resin cement in bi-axial flexure. Disc strength with and without indentations was increased significantly when coated with 2 resin cements. Both cements significantly increased the strength independent of defect population, and the hypothesis was accepted. It is proposed that the combination of surface pre-treatment and cement moved the fracture origin from the porcelain/cement interface to the cement surface, consistent with resin strength enhancement independent of defect severity.

Resin Elasticity and the Strengthening of All-ceramic Restorations

Resin luting of all-ceramic restorations results in increased performance; however, the strengthening mechanism and the role of the mechanical properties of the resin are not fully understood. The hypothesis tested is that ceramic strength enhancement is dependent on the elastic modulus of the resin. Three-point flexural moduli of a flowable, luting, and hybrid composite resin were characterized. Two hundred forty porcelain discs were air-abraded. One group acted as a control, and 3 additional groups were coated with 120 ± 20 μm of each resin prior to bi-axial flexure testing. All resins significantly increased in mean strength, and the associated strength increase was related to the elastic modulus of the resin (R2 = 0.9885), so the hypothesis was accepted. The combination of Poisson constraint and the creation of a resin-inter-penetrating layer sensitive to the elastic modulus of the resin may provide an explanation of the strengthening mechanism.

In Vitro Evaluation and Comparison of the Translucency of Two Different All-Ceramic Systems

OBJECTIVES

The aim of this study was to evaluate and compare the translucency of two different all-ceramic systems using Vita Easyshade digital shade matching device in an in vitro model.

MATERIALS AND METHODS

Translucency of lithium disilicate glass-ceramic (IPS e.max Press) and zirconia all-ceramic system (Ceramill ZI) were evaluated and compared. A total of 5 square-shaped specimens with 0.5 mm thickness were fabricated from each ceramic system in A1 shade according to Vitapan Classical shade tab. Specimens were then veneered and glazed with corresponding veneer ceramics recommended by each system manufacturer and the total thickness was set to 1.5 mm. Translucency was evaluated using VITA Easyshade in two stages: before and after veneering and glazing on black and white background. Translucency parameter (TP) was calculated. A one-way ANOVA and Bonferonni tests were used when appropriate (α=0.05).

RESULTS

Lithium disilicate glass-ceramic was significantly more translucent than the zirconia system in both stages (P<0.05). Translucency of all specimens was significantly decreased after veneering and glazing in both all-ceramic systems (P<0.05).

CONCLUSION

The translucency of two different dental ceramics was significantly influenced by both material and stages of preparation. Within the limitations of the experiment, these results can be valuable and help the clinician to make appropriate esthetic decisions.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

SIGNIFICANCE

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

A Preliminary Research into Clinical Semi-permeability Tolerance in the Field of Dental Rehabilitation

Objective

To study clinical semi-permeability tolerance level in the field of dental restoration.

Method

Vita 95 enamel porcelain powder was adopted and 6.0% used as the control transmissivity. Discoid porcelain plates with different transmissivity, namely increasing transmissivity (0.25%, 0.5%, 1.0%, 1.5%, 2%, 2.5%, 3%, 3.5%, 4% and 4.5%) and decreasing transmissivity (-0.25%, -0.5%, -1.0%, -1.5%, -2%, -2.5%, -3% and -3.5%) were made. Forty observers judged these according to six grades: same, similar, slightly different, visibly different, recognizable and significantly different, and under the observation conditions of a neutral grey background and 45^°/0^° lighting. The judgment results were analysed statistically.

Results

When the transmissivity of the control porcelain plates was 6.032%, and the transmissivity of test porcelain plates decreased by 1% or increased by 3%, observers could find slight differences between the test samples and the control samples. When transmissivity of test samples decreased by 2.5% or increased by 4.5%, observers thought that the two porcelain plates belonged to different orders of magnitude.

Conclusions

Under the experimental conditions, the upper and lower limits of clinical semi-permeability tolerance were 3% and 1%, respectively.

Ceramic Inlays: Effect of Mechanical Cycling and Ceramic Type on Restoration-dentin Bond Strength

This study aimed to evaluate the bond strength between dentin and five different ceramic inlays in permanent maxillary premolars, with and without mechanical cycling. One hundred permanent maxillary premolars were prepared and divided into 10 groups (n=10) according to the ceramic system (IPS e.Max Press; IPS e.Max CAD; Vita PM9; Vita Mark II; and Vita VM7) and the mechanical cycling factor (with and without [100 N, 2 Hz, 1.2×106 cycles]). The inlays were adhesively cemented, and all of the specimens were cut into microbars (1×1 mm, nontrimming method), which were tested under microtensile loading. The failure mode was classified and contact angle, roughness, and microtopographic analyses were performed on each ceramic surface. The mechanical cycling had a significant effect (p=0.0087) on the bond strength between dentin and IPS e.max Press. The Vita Mark II group had the highest bond strength values under both conditions, with mechanical cycling (9.7±1.8 MPa) and without (8.2±1.9 MPa), while IPS e.Max CAD had the lowest values (2.6±1.6 and 2.2±1.4, respectively). The adhesive failure mode at the ceramic/cement interface was the most frequent. Vita Mark II showed the highest value of average roughness. IPS e.max Press and Vita Mark II ceramics presented the lowest contact angles. In conclusion, the composition and manufacturing process of ceramics seem to have an influence on the ceramic surface and resin cement bond strength. Mechanical cycling did not cause significant degradation on the dentin and ceramic bond strength under the configuration used.

Evaluation of translucency of monolithic zirconia and framework zirconia materials

PURPOSE

The opacity of zirconia is an esthetic disadvantage that hinders achieving natural and shade-matched restorations. The aim of this study was to evaluate the translucency of non-colored and colored framework zirconia and monolithic zirconia.

MATERIALS AND METHODS

The three groups tested were: non-colored framework zirconia, colored framework zirconia with the A3 shade according to Vita Classic Scale, and monolithic zirconia (n=5). The specimens were fabricated in the dimensions of 15×12×0.5 mm. A spectrophotometer was used to measure the contrast ratio, which is indicative of translucency. Three measurements were made to obtain the contrast ratios of the materials over a white background (L^*w) and a black background (L^*b). The data were analyzed using the one-way analysis of variance and Tukey HSD tests. One specimen from each group was chosen for scanning electron microscope analysis. The determined areas of the SEM images were divided by the number of grains in order to calculate the mean grain size.

RESULTS

Statistically significant differences were observed among all groups (P<.05). Non-colored zirconia had the highest translucency with a contrast ratio of 0.75, while monolithic zirconia had the lowest translucency with a contrast ratio of 0.8. The mean grain sizes of the non-colored, colored, and monolithic zirconia were 233, 256, and 361 nm, respectively.

CONCLUSION

The translucency of the zirconia was affected by the coloring procedure and the grain size. Although monolithic zirconia may not be the best esthetic material for the anterior region, it may serve as an alternative in the posterior region for the bilayered zirconia restorations.

An evaluation of wear of human enamel opposed by ceramics of different surface finishes

Statement of Problem:

Surface of porcelain restoration is a matter of clinical concern because of its abrasive action on the opposing enamel.

Purpose:

This study comparatively evaluated wear of enamel when opposed by three different surface finishes of ceramic.

Materials and Methods:

A total of 60 metal-ceramic discs (10 mm × 2 mm) with different surface finishes were fabricated. They were divided into four groups of autoglazed ceramic surface, over glazed ceramic surface, ceramic surface polished with Shofu polishing kit and ceramic surface polished with DFS polishing wheels and paste. Each group comprised of 15 discs. Sixty human teeth samples were prepared from freshly extracted, unrestored, caries free, nonattrited maxillary first premolars. Each tooth sample was weighed before wear testing using AT200 Mettler Toledo electronic analytical balance of 0.0001 g accuracy. Occlusal surfaces of these teeth were then abraded against the substrates in a wear machine for a total of 10,000 cycles. Each tooth sample was weighed after 5000 cycles and after the total of 10,000 cycles, respectively, using the same balance. Differences in weight of tooth samples before and after wear testing were evaluated statistically using one-way analysis of variance and Bonferroni's correction for multiple group comparisons.

Results:

The values obtained for percentage weight loss after 10,000 cycles for over glazed ceramic surface were marginally higher than values obtained for autoglazed surface. It was observed that values obtained for percentage weight loss by polished ceramic after 10,000 cycles were statistically less as compared to the values obtained with autoglazed and over glazed ceramic surface (P < 0.001). There was no statistically significant difference between the values obtained by polished ceramic surfaces of two different groups.

Conclusion:

Enamel wear produced by polished porcelain is substantially less than autoglazed and over glazed porcelain. No significant difference was found in enamel wear when opposed by ceramic surfaces polished by two different methods. This study indicates the potential damage porcelain can inflict upon enamel and suggests that porcelain should be polished instead of over glazed.

Comparison of Contrast Ratio, Translucency Parameter, and Flexural Strength of Traditional and "Augmented Translucency" Zirconia for CEREC CAD/CAM System

PURPOSE

Tetragonal zirconia polycrystals (TZP) can be used via CAD/CAM technique as metal replacement for fixed partial dentures. However, its intense white color and high opacity may represent an aesthetic limit. New TZPs with a claimed higher degree of translucency were recently marketed. The aim of the study was to investigate contrast ratio (CR), translucency parameter (TP), flexural strength (σ), Weibull characteristic strength (σ0 ), and Weibull modulus (m) of three "traditional" (IPS e.max Zir-CAD, inCoris ZI, VITA In-Ceram YZ) and two "increased translucency" (inCoris TZI, VITA In-Ceram YZ HT) Y-TZPs.

METHODS

For flexural strength, ISO 6872:2008 was followed. Bars (N = 40) were cut from pre-sintered blocks. Dense-sintering, finishing, and polishing were performed in order to obtain specimens of 15 × 4 × 1.2 mm. Samples were tested with three-point bending setup in a universal testing machine. For CR and TP, specimens (N = 10) were cut perpendicularly to the long axis from pre-sintered blocks. After the dense-sintering, specimens were finished and polished in order to obtain tiles of 12 × 15 × 1 mm. CR and TP were measured with a spectrophotometer equipped with an integrating sphere.

RESULTS

No significant difference was found regarding flexural strength. A significant difference was found both for CR and TP among tested groups. VITA In-Ceram YZ HT and inCoris TZI showed the higher translucency. The difference was not statistically significant when compared with VITA In-Ceram YZ, and statistically significant when compared with IPS e.max Zir-CAD and inCoris ZI.

CONCLUSION

The new "augmented translucency" TZPs showed higher translucency and similar flexural strength than "traditional" TZPs.

CLINICAL SIGNIFICANCE

Monolithic zirconia use is partially restricted due to the zirconia low translucency. The new "augmented translucency" zirconia showed a modest but perceptible increase in translucency and a similar flexural resistance, thus increasing the clinically suitable thickness range with optimized aesthetic and resistance. (J Esthet RestorDent 28:S32-S39, 2016).

Translucency of monolithic and core zirconia after hydrothermal aging

Objective: To evaluate the hydrothermal aging effect on the translucency of partially stabilized tetragonal zirconia with yttria (Y-TZP) used as monolithic or fully milled zirconia and of core type.

Methods: Twenty disc-shaped specimens (1 and 10 mm) for each type of monolithic and core Y-TZP materials were milled and sintered according to the manufacturer’s instruction. The final specimens were divided into two groups according to the type of Y-TZP used. Translucency parameter (TP) was measured over white and black backgrounds with the diffuse reflectance method; X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to analyze the microstructure of both Y-TZP types before and after aging. Data for TP values was statistically analyzed using Student’s t-test.

Results: Monolithic Y-TZP showed the highest TP mean value (16.4 ± 0.316) before aging while core Y-TZP showed the lowest TP mean value (7.05 ± 0.261) after aging. There was a significant difference between the two Y-TZP types before and after hydrothermal aging. XRD analysis showed increases in monoclinic content in both Y-TZP surfaces after aging.

Conclusion: Monolithic Y-TZP has a higher chance to low-temperature degradation than core type, which may significantly affect the esthetic appearance and translucency hence durability of translucent Y-TZP.

Effect of abutment shade, ceramic thickness, and coping type on the final shade of zirconia all-ceramic restorations: in vitro study of color masking ability

PURPOSE

The aim of the study was to evaluate the effect of abutment shade, ceramic thickness, and coping type on the final shade of zirconia all-ceramic restorations.

MATERIALS AND METHODS

Three different types of disk-shaped zirconia coping specimens (Lava, Cercon, Zirkonzahn: ø10 mm × 0.4 mm) were fabricated and veneered with IPS e.max Press Ceram (shade A2), for total thicknesses of 1 and 1.5 mm. A total of sixty zirconia restoration specimens were divided into six groups based on their coping types and thicknesses. The abutment specimens (ø10 mm × 7 mm) were prepared with gold alloy, base metal (nickel-chromium) alloy, and four different shades (A1, A2, A3, A4) of composite resins. The average L*, a*, b* values of the zirconia specimens on the six abutment specimens were measured with a dental colorimeter, and the statistical significance in the effects of three variables was analyzed by using repeated measures analysis of variance (α=.05).The average shade difference (ΔE) values of the zirconia specimens between the A2 composite resin abutment and other abutments were also evaluated.

RESULTS

The effects of zirconia specimen thickness (P<.001), abutment shade (P<.001), and type of zirconia copings (P<.003) on the final shade of the zirconia restorations were significant. The average ΔE value of Lava specimens (1 mm) between the A2 composite resin and gold alloy abutments was higher (close to the acceptability threshold of 5.5 ΔE) than th ose between the A2 composite resin and other abutments.

CONCLUSION

This in-vitro study demonstrated that abutment shade, ceramic thickness, and coping type affected the resulting shade of zirconia restorations.

The effects of sintering temperature and duration on the flexural strength and grain size of zirconia

Objective: This study investigated the effect of different sintering temperatures and times on the flexural strength and grain size of zirconia.

Material and methods: Zirconia specimens (In-Coris ZI, In-Coris TZI, 120 samples) were prepared in a partially sintered state. Subsequently, the specimens were randomly divided into three groups and sintered at different final sintering temperatures and for various durations: 1510 °C for 120 min, 1540 °C for 25 min and 1580 °C for 10 min. Three-point flexural strength (for 120 samples, 20 samples per group) was measured according to the ISO 6872: 2008 standards. The grain sizes were imaged by scanning electron microscopy (SEM) and the phase transitions were determined by X-ray diffraction (XRD). The data were analyzed using one-way ANOVA and Duncan tests (p < 0.05).

Results: The highest flexural strength was observed in ZI and TZI samples sintered at 1580 °C for 10 min. The differences between the ZI samples sintered at 1510 °C for 120 min and those sintered at 1540 °C for 25 min were statistically insignificant. Also, TZI samples sintered at 1510 °C for 120 min and those sintered at 1540 °C for 25 min also did not show any statistically significant differences. There were no visible differences in the grain sizes between the ZI and TZI specimens. The XRD patterns indicated similar crystalline structure for both materials subjected to the three different procedures.

Conclusions: The results of this study showed that experimented high sintering temperature and short sintering time combination increases the flexural strength of zirconia.

Fracture resistance of porcelain veneered zirconia crowns with exposed lingual zirconia for anterior teeth after thermal cycling: An in vitro study

Statement of problem

In some clinical conditions minimally invasive complete crown tooth preparations are indicated. This is especially true when gross removal of tooth structure would weaken the remaining tooth or violate the vitality of the dental pulp.

Objective

The purpose of this study was to investigate the influence of (1) exposed lingual zirconia with veneered zirconia crowns, and (2) reduced lingual thickness of monolithic lithium disilicate crowns on the fracture resistance of the crowns after cyclic loading. Metal-ceramic crowns with exposed lingual metal served as controls.

Materials and methods

Twenty-four maxillary central incisor crowns were fabricated in identical shape on metal testing dies in 3 groups: metal-ceramic crowns (MC, n = 8), veneered zirconia crowns (VZ, n = 8), and monolithic lithium disilicate crowns (MO, n = 8). A conservative preparation design with 0.75 mm lingual clearance was used for each crown system. All crowns were cemented to their corresponding crown preparations with self-adhesive resin cement (Multilink Automix). The crowns were subjected to 1000 cycles of thermal cycling, then cyclic loading of 111 N by means of a stainless steel ball, and 50,000 cycles of loading were applied for the fatigue test. Fatigue loading was followed by a continuously increasing compressive load, at a crosshead speed of 1 mm/min until failure. The compressive load (N) required to cause failure was recorded. Means were calculated and analyzed with one-way ANOVA and the Tukey HSD test (α = .05).

Results

There was a significant difference between MO vs. MC (P = .0001), MO vs. VZ (P = .0001), and VZ vs. MC (P = .012).

Conclusions

There was a significant difference in the mean fracture resistance of MC, VZ, and MO crowns in this in vitro study. The MC group recorded the highest mean fracture strength.

Effect of heat-pressing temperature and holding time on the microstructure and flexural strength of lithium disilicate glass-ceramics

The present study aimed to evaluate the influence of various heat-pressing procedures (different holding time and heat pressing temperature) on the microstructure and flexural strength of lithium disilicate glass ceramic. An experimental lithium silicate glass ceramic (ELDC) was prepared from the SiO2-Li2O-K2O-Al2O3-ZrO2-P2O5 system and heat-pressed following different procedures by varying temperature and holding time. The flexural strength was tested and microstructure was analyzed. The relationships between the microstructure, mechanical properties and heat-pressing procedures were discussed in-depth. Results verified the feasibility of the application of dental heat-pressing technique in processing the experimental lithium disilicate glass ceramic. Different heat-pressing procedures showed significant influence on microstructure and flexural strength. ELDC heat-pressed at 950℃ with holding time of 15 min achieved an almost pore-free microstructure and the highest flexural strength, which was suitable for dental restorative application.

Light transmittance by a multi-coloured zirconia material

Full-contour zirconia restorations are gaining in popularity. Highly translucent zirconia materials and multi-coloured zirconia blocks might help to overcome the aesthetic drawbacks of traditional zirconia. This study evaluated the transmittance of visible light (400-700 nm) through the four different layers (Enamel Layer EL, Transition Layer 1 TL1, Transition Layer 2 TL2, Body Layer BL) of a multi-coloured zirconia block (KATANA™ Zirconia Multi-Layered Disc (ML)) using a spectrophotometer. Forty specimens (thickness of 1±0.05 mm) from each layer were examined and statistically evaluated at a confidence-level of 5%. Light transmittance was expressed as a percentage of the through-passing light. The following mean values (SD) were found: EL 32.8% (1.5), TL1 31.2% (1.3), TL2 25.4% (1.3) and BL 21.7% (1.1). Significant differences were found between all groups (ANOVA, Student-Newman-Keuls). This multi-coloured zirconia block showed four layers with different light transmittance capabilities. It might therefore be useful for enhancing the aesthetic appearance of full-contour zirconia restorations made from this material.

The comparative evaluation of the translucency of crowns fabricated with three different all-ceramic materials: an in vitro study

INTRODUCTION

All-ceramic crowns with different core materials of different strength and aesthetics are available in recent years. The aesthetics of the crown depends mainly on the shade and translucency. Clinician should be aware of the quality and characteristics of these materials so that they will be able to opt for good material for successful clinical use.

AIM AND OBJECTIVE

The aim of this study was to evaluate and compare the translucency of crowns fabricated with three different commercially available all-ceramic materials viz. Alumina - CAD-CAM Procera, Lithium disilicate - Pressable IPS e.max Press, Zirconia - CAD-CAM Lava.

MATERIALS AND METHODS

All-ceramic crowns (5 per each group and total of 15 samples) were made of Alumina - CAD-CAM Procera (Group I), Lithium disilicate - Pressable IPS e.max Press (Group II), Zirconia - CAD-CAM Lava (Group III) and veneered with their respective layering ceramic. Evaluation for the Translucency (CR=Yb/Yw) over the White (Yw) and Black (Yb) backgrounds at the Incisal, Middle, Cervical, Mesial and Distal thirds of each crown were done using the Spectrophotometer. The results obtained were statistically analyzed by Paired t-test (p<0.05) and Analysis of Variance (p<0.05) for the test of significance among the groups.

RESULTS

Significant differences in the contrast ratios were obtained among the three Groups (p<0.001). In this study, Group II Lithium disilicate-Pressable IPS e.max Press showed higher translucency (0.54). Group III Zirconia - CAD-CAM Lava showed the least translucency (0.75) and the translucency of Group I Alumina - CAD-CAM Procera (0.7) was in between both the groups.

CONCLUSION

Translucency of material gives fair idea to clinician for the choice of material in different zones during replacement and suitability for restoration in aesthetic zone. Selection of all ceramic system depends on the translucency needed for successful prosthesis of artificial tooth so that it mimics patient's natural dentition. The qualitative measurement of translucency will give the evidence for the clinicians during selection of high or low value translucent tooth for successful replacement. Lithium disilicate - Pressable IPS e.max Press is having better translucency in comparison with other two materials in our study.

Comparison of Shade of Ceramic with Three Different Zirconia Substructures using Spectrophotometer

OBJECTIVE

This study assessed how changing the Zirconia (Zr) substructure affected the color samples after they have been overlaid by the same shade of veneering ceramic.

MATERIALS AND METHODS

Three commercial Zr materials were tested in this study: Prettau(®) Zirconia (ZirKonZahn, Italy), Cercon (Dentsply, Germany) and InCoris ZI (Sirona, Germany). For each system, 15 disk-shaped specimens (10 × 1 mm) were fabricated. Three shades of A1, A2 and A3.5 of porcelain (IPS e.MaxCeram, IvoclarVivadent, USA) were used for layering the specimens. Five specimens from each type of Zr were layered with same shade of ceramic. Color measurements were recorderd by a spectrophotometer Color-Eye(®) 7000A (X-Rite, Grand Rapids, MI). Mean values of L, a, b color coordinates and ΔE were recorded and comparisons were made.

RESULTS

Differences in the ΔE were recorded for the same porcelain shade with different Zr substructures and affected the color of the specimens (p < 0.01, ANOVA). The maximum difference between the ΔE values for the A1, A2 and A3.5 shades with three types of Zr substructures was found to be 1.59, 1.69 and 1.45 respectively. Multiple comparisons of the ΔE with PostHoc Tukey test revealed a statistically significant difference (p < 0.05) between the three types of Zr, except between Type 2 Zr and Type 3 Zr for the Shade A1. The mean values of L, a, b and ΔE for the Prettau(®) Zirconia substructure were found to be the least among the three types.

CONCLUSIONS

The brand of Zr used influences the final color of the all ceramic Zr based restorations and this has clinical significance.

The importance of the lifelike esthetic appearance of all-ceramic restorations on anterior teeth

The success of rehabilitation will not depend on just clinical procedures. A proper dental technique (ceramist) is required as well as the respect for some biomimetic principles to obtain the desired final result. This study has the purpose of describing a prosthetic rehabilitation with laminate veneers and all-ceramic crowns of a patient unsatisfied with a previous esthetic treatment because of the negligence of some biomimetic principles. A 45-year-old female patient was admitted to the dental clinic complaining about the lifelike appearance of her all-ceramic restorations. Before the fabrication of new restorations, a mock-up was conducted to verify the patient's satisfaction. A ceramist conducted all the fabrication process so that surface characterizations could be visually verified and the lifelike appearance of natural tooth could be reproduced. After the cementation procedure, the patient reported being satisfied with the lifelike appearance of the new restorations. Based on the clinical findings of the present case report, it can be concluded that the reproduction of the lifelike esthetic appearance of natural teeth and the visualization of the final results before definitive procedures are essential to obtain the clinical success.

The effect of repeated firings on the color change of dental ceramics using different glazing methods

PURPOSE

Surface color is one of the main criteria to obtain an ideal esthetic. Many factors such as the type of the material, surface specifications, number of firings, firing temperature and thickness of the porcelain are all important to provide an unchanged surface color in dental ceramics. The aim of this study was to evaluate the color changes in dental ceramics according to the material type and glazing methods, during the multiple firings.

MATERIALS AND METHODS

Three different types of dental ceramics (IPS Classical metal ceramic, Empress Esthetic and Empress 2 ceramics) were used in the study. Porcelains were evaluated under five main groups according to glaze and natural glaze methods. Color changes (ΔE) and changes in color parameters (ΔL, Δa, Δb) were determined using colorimeter during the control, the first, third, fifth, and seventh firings. The statistical analysis of the results was performed using ANOVA and Tukey test.

RESULTS

The color changes which occurred upon material-method-firing interaction were statistically significant (P<.05). ΔE, ΔL, Δa and Δb values also demonstrated a negative trend. The MC-G group was less affected in terms of color changes compared to other groups. In all-ceramic specimens, the surface color was significantly affected by multiple firings.

CONCLUSION

Firing detrimentally affected the structure of the porcelain surface and hence caused fading of the color and prominence of yellow and red characters. Compressible all-ceramics were remarkably affected by repeated firings due to their crystalline structure.

Comparison of the translucency of shaded zirconia all-ceramic systems

PURPOSE

The purpose of this study was to evaluate and compare the translucency of shaded zirconia all-ceramic systems.

MATERIALS AND METHODS

Translucency of 3 different zirconia all-ceramic systems colored by different techniques was compared with a lithium disilicate glass-ceramic (IPS e.max Press). Square-shaped specimens with 0.5 mm thickness were fabricated from In-Ceram YZ, ICE Zirkon and Katana systems in A1, A2 and A3.5 shades according to Vitapan Classical shade tab (n=11). Specimens were then veneered and glazed with corresponding veneer ceramic recommended by each zirconia system manufacturer and the total thickness was set to 1.5 mm. Translucency measurements were performed with VITA Easyshade Compact spectrophotometer after each stage and translucency parameter was calculated. Data were statistically analyzed with repeated measures ANOVA and Tukey multiple comparison test.

RESULTS

The control group was significantly more translucent than the zirconia systems (P<.05). ICE Zirkon cores showed the least translucency; neither In-Ceram YZ nor Katana systems were superior to each other in terms of translucency. Translucency of all specimens was decreased after veneering, and the translucency rankings were changed.

CONCLUSION

Coloring technique did not have a significant effect on translucency of zirconia cores. Although zirconia systems were less translucent than lithium disilicate glass ceramic, they had partial translucency and there were translucency differences among the zirconia systems. Chroma affected the translucency of precolored zirconia cores.

The effect of translucency of Y-TZP based all-ceramic crowns fabricated with difference substructure designs

PURPOSE

To analyse the effect of translucency of Y-TZP based all-ceramic crowns fabricated with different substructure thicknesses and extensions. The effect of restoration shading is also investigated.

MATERIALS AND METHODS

A maxillary right central incisal typodont tooth was prepared and a die was fabricated with Type IV stone after making impression. Horizontally and vertically reduced substructure extensions were designed at the facial cervical part with 0.3 mm and 0.5mm thick Lava Y-TZP. Each substructure was fabricated with two different shades, FS1 and FS7. A1 shade veneering porcelain was applied on FS1 shade Y-TZP substructures and D3 shade veneering porcelain was applied on FS7 shade Y-TZP substructures with lost wax and press ceramic technique. Ten specimens were fabricated for a total of 8 groups. The cervical and body colour of specimens were analysed with a spectrophotometer, after placing specimens on the two different coloured abutment teeth using translucent try-in cement. The data were obtained in CIELAB colour coordinates L*a*b*, and DE* through the test specimens over ND1 and ND8 shade abutments were calculated.

RESULTS

At the cervical area, there was a significant difference on substructure extension (P < 0.001). At the body area, results were borderline on substructure thickness (P = 0.05) and there was a significant difference on restoration shade (P = 0.001).

CONCLUSIONS

Vertical reduction design of Y-TZP substructure could increase DE* at the cervical area. Decreasing thickness of Y-TZP substructure may increase DE* at the body area. Increasing the value of Y-TZP based-all ceramic crown shade could increase DE* at the body area.

CLINICAL SIGNIFICANCE

The translucency of a Y-TZP based all-ceramic crowns may influence its esthetic outcome when it is used on a discoloured abutment tooth. Clinicians should be aware of the effect of substructure design on the translucency of YTZP based all-ceramic crowns.

Zirconia ceramics, their contrast ratio and grain size depending on sintering parameters

This study investigated the contrast ratio and grain size depending on sintering parameters of twelve different zirconia materials and compared with glass-ceramic (N=156, n=12 per group). Contrast ratio of all ceramics was measured using a spectrophotometer according to ISO 2471: 2008. Grain sizes of zirconia were determined by SEM. Data was analyzed using one-way ANOVA followed by post-hoc Scheffé-test, Kruskal-Wallis-H-test and Spearman correlation (p<0.05). The area under the sintering curve up 25°C (AUC25) and 1200°C (AUC1200) of zirconia was calculated. Glass-ceramic showed significantly lowest contrast ratio compared to zirconia. Final sintering temperature and AUC1200 influenced contrast ratio. Grain size was affected by final sintering temperature, sintering duration and AUC. Contrast ratio and grain size showed an association.

Translucency of ceramic materials for CEREC CAD/CAM system

OBJECTIVES

To compare translucency of the ceramic materials (CEREC CAD/CAM).

MATERIALS AND METHODS

Fifteen ceramic materials for CEREC CAD/CAM system were evaluated: IPS e.max HT/LT/MO, ZirCAD, Empress HT/LT; VITA Mark II, VITA AL; VITA YZ, VITA In-Ceram Spinell/Alumina/Zirconia; and Sirona InCoris AL; Sirona InCoris ZI/TZI. Specimens (0.5-mm and 1.0-mm thick; n = 10 each material) were cut from commercial blocks using a water-cooled diamond saw. Contrast ratio (CR = YB /YW ) was measured using a spectrophotometer with an integrating sphere. Kruskal-Wallis one way analysis of variance was performed followed by Dunn's multiple test for post-hoc.

RESULTS

CR varied from 0.35 to 1.00 and from 0.48 to 1.00 for 0.5 mm and 1.0 mm thicknesses, respectively. CR increased in the following order: IPS e.max HT (most translucent-least opaque), IPS Empress HT, VITA Mark II, IPS Empress LT, IPS e.max LT, In-Ceram Spinell, IPS e.max MO, VITA YZ, InCoris TZI, IPS e.max ZirCAD, InCoris ZI, In-Ceram Alumina, VITA AL, InCoris AL, and In-Ceram Zirconia (least translucent-most opaque).

CONCLUSIONS

The null hypothesis has been rejected because tested materials exhibited a wide range of CR. Translucency needs to be taken into account in different clinical situations, including considerations associated with thickness of restoration and/or particular layers.

CLINICAL SIGNIFICANCE

A wide range of translucency was identified for the ceramic materials tested. This variability has to be taken into account for the selection of the materials in different clinical situations also related to the thickness clinically required.

Ceramic materials for porcelain veneers: part II. Effect of material, shade, and thickness on translucency

STATEMENT OF PROBLEM

Information regarding the differences in translucency among new ceramic systems is lacking.

PURPOSE

The purpose of this study was to compare the relative translucency of the different types of ceramic systems indicated for porcelain veneers and to evaluate the effect of shade and thickness on translucency.

MATERIAL AND METHODS

Disk specimens 13 mm in diameter and 0.7-mm thick were fabricated for the following 9 materials (n=5): VITA VM9, IPS Empress Esthetic, VITA PM9, Vitablocks Mark II, Kavo Everest G-Blank, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as the positive control and Lava as the negative control. The disks were fabricated with the shade that corresponds to A1. For IPS e.maxPress, additional disks were made with different shades (BL2, BL4, A1, B1, O1, O2, V1, V2, V3), thickness (0.3 mm), and translucencies (high translucency, low translucency). Color coordinates (CIE L∗ a∗ b∗) were measured with a tristimulus colorimeter. The translucency parameter was calculated from the color difference of the material on a black versus a white background. One-way ANOVA, the post hoc Tukey honestly significant difference, and the Ryan-Einot-Gabriel-Welsch multiple range tests were used to analyze the data (α=.05).

RESULTS

Statistically significant differences in the translucency parameter were found among porcelains (P<.001) according to the following rank: VM9>PM9, Empress Esthetic>Empress CAD>Mark II, Everest, e.max CAD>e.max Press>Lava. Significant differences also were noted when different shades and thickness were compared (P<.001).

CONCLUSIONS

Different ceramic systems designed for porcelain veneers present varying degrees of translucency. The thickness and shade of lithium disilicate ceramic affect its translucency. Shade affects translucency parameter less than thickness.

Fracture Strength of Zirconia and Alumina Ceramic Crowns Supported by Implants

Due to the brittleness and limited tensile strength of the veneering glass-ceramic materials, the methods that combine strong core material (as zirconia or alumina) are still under debate. The present study aims to evaluate the fracture strength and the mechanism of failure through fractographic analysis of single all-ceramic crowns supported by implants. Forty premolar cores were fabricated with CAD/CAM technology using alumina (n = 20) and zirconia (n = 20). The specimens were veneered with glass-ceramic, cemented on titanium abutments, and subjected to loading test until fracture. SEM fractographic analysis was also performed. The fracture load was 1165 (±509) N for alumina and 1638 (±662) N for zirconia with a statistically significant difference between the two groups (P = 0.026). Fractographic analysis of alumina-glass-ceramic crowns, showed the presence of catastrophic cracks through the entire thickness of the alumina core; for the zirconia-glass-ceramic crowns, the cracks involved mainly the thickness of the ceramic veneering layer. The sandblast procedure of the zirconia core influenced crack path deflection. Few samples (n = 3) showed limited microcracks of the zirconia core. Zirconia showed a significantly higher fracture strength value in implant-supported restorations, indicating the role played by the high resistant cores for premolar crowns.

Evaluation of the color reproducibility of all-ceramic restorations fabricated by the digital veneering method

PURPOSE

The objective of this study was to evaluate the clinical acceptability of all-ceramic crowns fabricated by the digital veneering method vis-à-vis the traditional method.

MATERIALS AND METHODS

Zirconia specimens manufactures by two different manufacturing method, conventional vs digital veneering, with three different thickness (0.3 mm, 0.5 mm, 0.7 mm) were prepared for analysis. Color measurement was performed using a spectrophotometer for the prepared specimens. The differences in shade in relation to the build-up method were calculated by quantifying ΔE(*) (mean color difference), with the use of color difference equations representing the distance from the measured values L(*), a(*), and b(*), to the three-dimensional space of two colors. Two-way analysis of variance (ANOVA) combined with a Tukey multiple-range test was used to analyze the data (α=0.05).

RESULTS

In comparing means and standard deviations of L(*), a(*), and b(*) color values there was no significant difference by the manufacturing method and zirconia core thickness according to a two-way ANOVA. The color differences between two manufacturing methods were in a clinically acceptable range less than or equal to 3.7 in all the specimens.

CONCLUSION

Based on the results of this study, a carefully consideration is necessary while selecting upper porcelain materials, even if it is performed on a small scale. However, because the color reproducibility of the digital veneering system was within the clinically acceptable range when comparing with conventional layering system, it was possible to estimate the possibility of successful aesthetic prostheses in the latest technology.

Translucency of dental ceramics with different thicknesses

STATEMENT OF PROBLEM

The increased use of esthetic restorations requires an improved understanding of the translucent characteristics of ceramic materials. Ceramic translucency has been considered to be dependent on composition and thickness, but less information is available about the translucent characteristics of these materials, especially at different thicknesses.

PURPOSE

The purpose of this study was to investigate the relationship between translucency and the thickness of different dental ceramics.

MATERIAL AND METHODS

Six disk-shaped specimens of 8 glass ceramics (IPS e.max Press HO, MO, LT, HT, IPS e.max CAD LT, MO, AvanteZ Dentin, and Trans) and 5 specimens of 5 zirconia ceramics (Cercon Base, Zenotec Zr Bridge, Lava Standard, Lava Standard FS3, and Lava Plus High Translucency) were prepared following the manufacturers' instructions and ground to a predetermined thickness with a grinding machine. A spectrophotometer was used to measure the translucency parameters (TP) of the glass ceramics, which ranged from 2.0 to 0.6 mm, and of the zirconia ceramics, which ranged from 1.0 to 0.4 mm. The relationship between the thickness and TP of each material was evaluated using a regression analysis (α=.05).

RESULTS

The TP values of the glass ceramics ranged from 2.2 to 25.3 and the zirconia ceramics from 5.5 to 15.1. There was an increase in the TP with a decrease in thickness, but the amount of change was material dependent. An exponential relationship with statistical significance (P<.05) between the TP and thickness was found for both glass ceramics and zirconia ceramics.

CONCLUSIONS

The translucency of dental ceramics was significantly influenced by both material and thickness. The translucency of all materials increased exponentially as the thickness decreased. All of the zirconia ceramics evaluated in the present study showed some degree of translucency, which was less sensitive to thickness compared to that of the glass ceramics.