Comparative Effectiveness of Multiple Laser Scanning and Conventional Techniques on Zirconia Shear Bond Strength

This study aimed to compare the impact of different laser scanning with that of conventional methods on zirconia surface treatment through evaluation of shear bond strength (SBS) values. One hundred and thirty-two sintered zirconia cubic-samples were prepared and randomly divided into six study groups: milling control (without surface treatment); grinding; sandblasting; and three-times, four-times, and five-times laser scanning groups. The treatment process for the first three groups was performed before the zirconia coating, while the last three groups were treated after zirconia coating with veneer slurry through a spraying technique. In the current study, the surface roughness Ra, contact angle measurement, phase transformation, topography and interfaces, SBS in unaged and aged conditions, and fracture mode patterns of zirconia cores were investigated. The results were analyzed using laser confocal scanning microscopy, drop analyzer, X-ray diffractometry (XRD), scanning electron microscope (SEM) equipped with energy dispersive spectroscopy (EDS), universal testing machine and stereomicroscope. The results indicated that three-times laser scanned specimens presented higher Ra values than the other studied groups. The minimum contact angle value was detected in the mentioned group, while the control group presented the highest value. The XRD showed phase transformation from tetragonal to monoclinic t–m following grinding and sandblasting. However, the laser scanned specimens and the control group preserved the structural integrity of the zirconia core, presenting the tetragonal phase only. The highest SBS values were recorded in specimens treated with three-times laser scanning in the unaged and aged conditions. A mixed fracture was a common fracture pattern among the studied groups. The results confirmed that SBS could be optimized through three-times laser scanning and it provided better adhesion between zirconia and the veneer ceramic material. Multiple scanning processes of more than three times are not recommended for zirconia surface treatment.

Collective substitutions of selective rare earths (Yb3+, Dy3+, Tb3+, Gd3+, Eu3+, Nd3+) in ZrO2: an exciting prospect for biomedical applications

The study aims to understand the significance of collective rare earth (RE3+) substitutions in ZrO2 structures for biomedical applications. The RE3+ ions namely Yb3+, Dy3+, Tb3+, Gd3+, Eu3+, and Nd3+ were selected and their concentrations were adjusted to obtain three different combinations. The influence of RE3+ on the crystal structure of ZrO2 alongside the absorption, luminescence, mechanical, magnetic, computed tomography (CT), magnetic resonance imaging (MRI) properties was explored. The concomitant effect of the average ionic size and RE3+ concentration determines the crystallization behavior of ZrO2 at elevated temperatures. The collective RE3+ substitutions exhibit both up-conversion and down-conversion emissions with their respective excitation at 793 and 350 nm. Nevertheless, increment in the concentration of RE3+ is found to be detrimental to the mechanical stability of ZrO2. The collective characteristics of multiple RE3+ demonstrate the potential of the investigated system in multimodal imaging applications. The unique luminescence characteristics of Eu3+ and Tb3+ are promising for fluorescence imaging while the presence of Dy3+, Tb3+, Gd3+ and Nd3+ unveils a paramagnetic response required for MRI. In addition, Dy3+ and Yb3+ contribute to the high X-ray absorption coefficient values suitable for X-ray CT imaging.

Additive manufacturing of ceramics for dental applications: A review

OBJECTIVE

The main goal of this review is to provide a detailed and comprehensive description of the published work from the past decade regarding AM of ceramic materials with possible applications in dentistry. The main printable materials and most common technologies are also addressed, underlining their advantages and main drawbacks.

METHODS

Online databases (Web of knowledge, Science Direct, PubMed) were consulted on this topic. Published work from 2008 to 2018 was collected, analyzed and the relevant papers were selected for inclusion on this review.

RESULTS

Ceramic materials are broadly used in dentistry to restore/replace damaged or missing teeth, due to their biocompatibility, chemical stability and mechanical and aesthetic properties. However, there are several unmet challenges regarding their processing and performance. Due to their brittleness nature, a very tight control of the manufacturing process is needed to obtain dental pieces with adequate mechanical properties. Additive manufacturing (AM) is an emerging technology that constitutes an interesting and viable manufacturing alternative to the conventional subtractive methods. AM enables the production of customized complex 3D parts in a more sustainable and less expensive way. AM of ceramics can be achieved with an extensive variety of methods.

SIGNIFICANCE

There is no perfect technology for all materials/applications, capable alone of fulfilling all the specificities and necessities of every patient. Although very promising, AM of ceramic dental materials remains understudied and further work is required to make it a widespread technology in dentistry.

Structure, luminescence, mechanical and in vitro behavior of zirconia toughened alumina due to terbium substitutions

The significance of Tb³⁺ inclusions at the zirconia toughened alumina (ZTA) structure was explored. The influence of Tb³⁺ content at the crystal structures of ZrO₂ and Al₂O₃ and the resultant optical, mechanical, magnetic and cytotoxicity properties were deliberated. The critical role of Tb³⁺ to attain a structurally stable ZTA until 1500 °C is ensured. Depending on the Tb³⁺ content, either tetragonal zirconia (t-ZrO₂) or cubic zirconia (c-ZrO₂) structures were stabilized while the propensity of Tb³⁺ reaction with Al₂O₃ to yield TbAlO₃ is transpired only after exceeding the occupancy limit in ZrO₂. The green emission and paramagnetic features are imparted by the Tb³⁺ inclusions at the ZTA structure. Dense and pore free microstructures with a direct impact on the improved mechanical features of ZTA is empowered by the presence of Tb³⁺. Further, the results from MTT assay and live/dead cell staining ensured the negligence of Tb³⁺ contained ZTA systems to induce toxicity.

Enhanced Cell Response to Zirconia Surface Immobilized with Type I Collagen

Zirconia (ZrO₂) dental implants provide good biocompatibility, have good corrosion resistance, and have a color that is similar to that of natural teeth. Unfortunately, ZrO₂ is a bioinert material and therefore achieves osseointegration difficultly. In this study, we sought to enhance osseointegration by producing rough ZrO₂ surfaces that contain hydroxyl groups (designated ZSA) through the use of sandblasting in conjunction with alkaline treatment. We immobilized type I collagen on ZSA surfaces using the natural cross-linker, procyanidin. Our results further showed that surfaces produced in ZSA-P/C featured more and steadier type I collagen than surfaces produced in ZSA-C. The ZSA-P/C also presented superior cell responses in terms of adhesion, proliferation, and mineralization of human bone marrow mesenchymal stem cells. The enhanced cell responses in the ZSA-P/C were induced through the prolonged activation of focal adhesion kinase, AKT (the phosphoinositide 3-kinase pathway), and p38 (the mitogen-activated protein kinase pathway). The simple and novel approach to immobilize type I collagen on roughened ZrO₂ surfaces presented in this article can likely benefit dental implant applications.

Response of pre-crystallized CAD/CAM zirconia-reinforced lithium silicate glass ceramic to cyclic nanoindentation

This paper reports on a cyclic nanoindentation approach of a pre-crystallized zirconia-reinforced lithium silicate glass ceramic (ZLS) to understand its material behavior associated with its machinability in dental CAD/CAM diamond abrasive milling. The material response to the cyclic nanoindentation using a Berkovich diamond tip was quantitatively determined in terms of the indentation contact hardness, elastic modulus, elasticity and plasticity for each loading cycle at peak loads of 2.5-10 mN. The cyclic load-displacement curves at different load levels indicate discrete discontinuities and hysteresis loops, which might have arisen from viscoelasticity behavior. Material properties degraded with an increasing number of loading cycles due to the mechanical softening which may facilitate machining in dental CAD/CAM milling. Elastic and plastic displacements and indentation energies revealed the pre-crystallized ZLS experiences predominantly elastic deformation and thus has a high capacity to retain its structure and shape. Furthermore, elastic energy dominated cyclic loading led to pseudoelasticity due to plastic strain accumulation. In situ scanning probe microscopy (SPM) images of cyclic indentation imprints reveal the fracture-free plastic deformation of the pre-crystallized ZLS under cyclic nanoindentation conditions. The outcomes of this study provide the mechanics model of diamond milling of the pre-crystallized ZLS due to the cyclic loading nature of dental CAD/CAM abrasive processing.

Structural, charge density and bond length variations in c-Y2O3 influenced by progressive cerium additions

Cerium occupancy induces expansion of the cubic Y₂O₃ unit cell and yields a dense microstructure alongside enhanced mechanical properties.

A low cost minimally invasive adhesive alternative for maxillary central incisor replacement

OBJECTIVE

The beneficial mechanical properties of zirconia, together with the adhesive techniques, provide a wide range of clinical applications, including the construction of thin structures and minimally invasive adhesive restorations.

CLINICAL CONSIDERATIONS

A periodontal disease-related missing maxillary central incisor, in a pregnant patient with chronic periodontal disease in the first trimester of pregnancy, and with type II diabetes treated with resin-bonded fixed partial denture using the missing tooth cemented to a zirconia framework and then bonded to the abutment teeth.

CONCLUSIONS

According to the systemic conditions presented in this case report, using a low-cost technology and the missing tooth it was possible to obtain an easier and satisfactory esthetic and functional result.

CLINICAL SIGNIFICANCE

The mechanical properties of zirconia made it possible to treat a pregnant patient with chronic periodontal disease in the first trimester of pregnancy, and with type II diabetes with a thin zirconia framework and minimally invasive adhesive restorations.

Comparison of Cytomorphometry and Early Cell Response of Human Gingival Fibroblast (HGFs) between Zirconium and New Zirconia-Reinforced Lithium Silicate Ceramics (ZLS)

New zirconia-reinforced lithium silicate ceramics (ZLS) could be a viable alternative to zirconium (Y-TZP) in the manufacture of implantological abutments-especially in aesthetic cases-due to its good mechanical, optical, and biocompatibility properties. Although there are several studies on the ZLS mechanical properties, there are no studies regarding proliferation, spreading, or cytomorphometry. We designed the present study which compares the surface, cellular proliferation, and cellular morphology between Y-TZP (Vita YZ® T [Vita Zahnfabrik (Postfach, Germany)]) and ZLS (Celtra® Duo [Degudent (Hanau-Wolfgang, Germany)]). The surface characterization was performed with energy dispersive spectroscopy (EDS), scanning electron microscopy (SEM), and optical profilometry. Human gingival fibroblasts (HGFs) were subsequently cultured on both materials and early cellular response and cell morphology were compared through nuclear and cytoskeletal measurement parameters using confocal microscopy. The results showed greater proliferation and spreading on the surface of Y-TZP. This could indicate that Y-TZP continues to be a gold standard in terms of transgingival implant material: Nevertheless, more in vitro and in vivo research is necessary to confirm the results obtained in this study.

Electrospun ZrO2 nanofibers: precursor controlled mesopore ordering and evolution of garland-like nanocrystal arrays

We observed that the hydrolysis-condensation reaction of precursors makes a significant difference in constructing ordered mesopores in electrospun ZrO2 nanofibers. Transmission-SAXS studies confirm the generation of uniform clusters of size ∼1.44 nm in the ZrOCl2·8H2O (inorganic salt) derived sol due to its relatively slow hydrolysis-condensation process. These initial -Zr-O-Zr- clusters acted as building blocks to form uniform 3D ordered cubic (Pm3[combining macron]m) mesopores in the presence of Pluronic F127 surfactant. In contrast, the commonly used Zr-alkoxide (zirconium n-propoxide) precursor, which is highly hydrolysable even after the use of a controlling agent, generates larger clusters with broad size distributions due to the uncontrolled hydrolysis-condensation of alkoxy groups. Accordingly, in the presence of F127, the alkoxide derived sol yielded disordered mesopores in the resultant fibers. XRD under dynamic heating conditions (up to 900 °C) and the corresponding TEM studies of the ZrOCl2·8H2O derived nanofibers confirmed the retention of mesopores even in the extremely thin nanofibers (diameter ∼15-25 nm) after the amorphous to crystal phase transformation (cubic/tetragonal). An interesting morphological transformation has been observed in the nanofibers at 900 °C where the fibers have been uniformly segmented by distinct single nanocrystals (width ∼15-65 nm) with mesopores. Further heat-treatment at 1100 °C made these segmented nanofibers nonporous, and a garland-like appearance with monoclinic nanocrystal arrays was formed.

Zirconia stimulates ECM-remodeling as a prerequisite to pre-osteoblast adhesion/proliferation by possible interference with cellular anchorage

The biological response to zirconia (ZrO₂) is not completely understood, which prompted us to address its effect on pre-osteoblastic cells in both direct and indirect manner. Our results showed that zirconia triggers important intracellular signaling mainly by governing survival signals which leads to cell adhesion and proliferation by modulating signaling cascade responsible for dynamic cytoskeleton rearrangement, as observed by fluorescence microscopy. The phosphorylations of Focal Adhesion Kinase (FAK) and Rac1 decreased in response to ZrO₂ enriched medium. This corroborates the result of the crystal violet assay, which indicated a significant decrease of pre-osteoblast adhesion in responding to ZrO₂ enriched medium. However, we credit this decrease on pre-osteoblast adhesion to the need to govern intracellular repertory of intracellular pathways involved with cell cycle progression, because we found a significant up-phosphorylation of Mitogen-Activated Protein Kinase (MAPK)-p38 and Cyclin-dependent kinase 2 (CDK2), while p15 (a cell cycle suppressor) decreased. Importantly, Protein phosphatase 2 A (PP2A) activity decreased, guaranteeing the significant up-phosphorylation of MAPK -p38 in response to ZrO₂ enriched medium. Complementarily, there was a regulation of Matrix Metalloproteinases (MMPs) in response to Zirconia and this remodeling could affect cell phenotype by interfering on cell anchorage. Altogether, our results show a repertory of signaling molecules, which suggests that ECM remodel as a pre-requisite to pre-osteoblast phenotype by affecting their anchoring in responding to zirconia.

The Role of Nanomechanics in Healthcare

Nanomechanics has played a vital role in pushing our capability to detect, probe, and manipulate the biological species, such as proteins, cells, and tissues, paving way to a deeper knowledge and superior strategies for healthcare. Nanomechanical characterization techniques, such as atomic force microscopy, nanoindentation, nanotribology, optical tweezers, and other hybrid techniques have been utilized to understand the mechanics and kinetics of biospecies. Investigation of the mechanics of cells and tissues has provided critical information about mechanical characteristics of host body environments. This information has been utilized for developing biomimetic materials and structures for tissue engineering and artificial implants. This review summarizes nanomechanical characterization techniques and their potential applications in healthcare research. The principles and examples of label-free detection of cancers and myocardial infarction by nanomechanical cantilevers are discussed. The vital importance of nanomechanics in regenerative medicine is highlighted from the perspective of material selection and design for developing biocompatible scaffolds. This review interconnects the advancements made in fundamental materials science research and biomedical technology, and therefore provides scientific insight that is of common interest to the researchers working in different disciplines of healthcare science and technology.

Probing the combined additions of Ca2+ and PO43− in the stabilized ZrO2 polymorph: structural, morphological and mechanical analysis

Selective uptake of Ca²⁺ at c-ZrO₂ lattice: additions beyond critical limit lead to β-Ca₃(PO₄)₂ crystallization in the presence of PO₄³⁻.

Fracture Resistance of Monolithic Glass-Ceramics Versus Bilayered Zirconia-Based Restorations

PURPOSE

To compare the fracture resistance of monolithic reinforced glass-ceramic restorations with bilayer zirconia-based restorations.

MATERIALS AND METHODS

Fifteen ceramic crowns were fabricated on epoxy dies duplicated from a stainless steel master die. They were divided into 3 equal groups (n = 5) according to the type of ceramic material used: group I, monolithic lithium disilicate (IPS e.max CAD), group V, monolithic zirconia-reinforced lithium silicate (Vita Suprinity), and group B (bilayered zirconia substructure with veneering ceramic). All specimens were cemented on epoxy dies with a self-adhesive resin cement (Rely X Unicem), subjected to a chewing simulator, and then loaded until fracture in a universal testing machine. The results were tabulated and statistically analyzed using one-way ANOVA to compare among the 3 materials. The Bonferroni post hoc test was used for pairwise comparisons when the ANOVA test was significant.

RESULTS

Zirconia-reinforced lithium silicate (Vita Suprinity) crowns showed the highest statistically significant (p < 0.05) mean fracture resistance values (1742.9 ± 102.7 N), followed by lithium disilicate (IPS e.max CAD) (1565.2 ± 89.7 N). Bilayered zirconia-based crowns showed the lowest statistically significantly mean fracture resistance values (1267.8 ± 86.1 N).

CONCLUSIONS

Monolithic reinforced glass-ceramics (lithium disilicate and zirconia-reinforced lithium silicate) have better fracture resistance than bilayered zirconia-based ceramics.

CLINICAL IMPLICATIONS

The use of monolithic reinforced ceramic restorations (lithium disilicate and zirconia-reinforced lithium silicate) is preferred to bilayered zirconia-based restorations to avoid chipping of the ceramic veneer.

Micro-Raman Vibrational Identification of 10-MDP Bond to Zirconia and Shear Bond Strength Analysis

So far, there is no report regarding the micro-Raman vibrational fingerprint of the bonds between 10-methacryloyloxy-decyl dihydrogen phosphate (10-MDP) and zirconia ceramics. Thus, the aim of this study was to identify the Raman vibrational peaks related to the bonds of 10-MDP with zirconia, as well as the influence on microshear bond strength. Micro-Raman spectroscopy was employed to assess the vibrational peak of 10-MDP binding to zirconia. Microshear bond strength of the dual-cure resin cement to zirconia with the presence of 10-MDP in composition of experimental ceramic primer and self-adhesive resin cement was also surveyed. Statistical analysis was performed by one-way ANOVA and Tukey's test (p < 0.05). Peaks at 1545 cm⁻¹ and 1562 cm⁻¹ were found to refer to zirconia binding with 10-MDP. The presence of 10-MDP in both experimental ceramic primer and self-adhesive resin cement improved microshear bond strength to zirconia ceramic. It can be concluded that the nondestructive method of micro-Raman spectroscopy was able to characterize chemical bonds of 10-MDP with zirconia, which improves the bond strengths of resin cement.

A CAD/CAM Zirconium Bar as a Bonded Mandibular Fixed Retainer: A Novel Approach with Two-Year Follow-Up

Stainless steel alloys containing 8% to 12% nickel and 17% to 22% chromium are generally used in orthodontic appliances. A major concern has been the performance of alloys in the environment in which they are intended to function in the oral cavity. Biodegradation and metal release increase the risk of hypersensitivity and cytotoxicity. This case report describes for the first time a CAD/CAM zirconium bar as a bonded mandibular fixed retainer with 2-year follow-up in a patient who is subjected to long-term treatment with fixed orthodontic appliance and suspected to have metal hypersensitivity as shown by the considerable increase of nickel and chromium concentrations in a sample of patient's unstimulated saliva. The CAD/CAM design included a 1.8 mm thickness bar on the lingual surface of lower teeth from canine to canine with occlusal rests on mesial side of first premolars. For better retention, a thin layer of feldspathic ceramic was added to the inner surface of the bar and cemented with two dual-cured cement types. The patient's complaint subsided 6 weeks after cementation. Clinical evaluation appeared to give good functional value where the marginal fit of digitized CAD/CAM design and glazed surface offered an enhanced approach of fixed retention.

Stabilization of a t-ZrO2 polymorph in a glassy SiO2 matrix at elevated temperatures accomplished by ceria additions

Cerium additions into the SiO₂–ZrO₂ binary system delay SiO₂ crystallization at elevated temperatures with Ce⁴⁺ occupancy at the t-ZrO₂ lattice for minor additions whereas its excess additions crystallize as discrete CeO₂.