Factors affecting enamel and ceramic wear: a literature review

Effects of simulated gastric juice on color stability, surface roughness and microhardness of laboratory-processed composites

Medical problems such as gastroesophageal reflux disease can cause considerable damage to restorations in the oral environment. This study evaluated the effects of gastric juice on the surface characteristics of different types of laboratory-processed indirect composites with different filler particles and polymerization modes. Specimens were prepared from Tescera (TES; Bisco), Sinfony (SIN; 3M ESPE), Solidex (SOL; Shofu), and Adoro (AD; Ivoclar Vivadent). Before exposing the specimens to simulated gastric juice for 24 h, color, surface roughness, and microhardness were measured on one half of the polished flat surface of each specimen. After exposure to the simulated gastric juice, the same tests were repeated on the other half of specimen surface. Results indicated that gastric juice had a significant impact on color change (p<0.001). AD showed the largest surface roughness change among the resins (p<0.001). Gastric juice also significantly affected the microhardness of the materials, and AD and TES showed statistically similar change in microhardness (p>0.05).

Wear of primary teeth caused by opposed all-ceramic or stainless steel crowns

PURPOSE

This study was conducted to evaluate the effects of full-coverage all-ceramic zirconia, lithium disilicate glass-ceramic, leucite glass-ceramic, or stainless steel crowns on antagonistic primary tooth wear.

MATERIALS AND METHODS

There were four study groups: the stainless steel (Steel) group, the leucite glass-ceramic (Leucite) group, the lithium disilicate glass-ceramic (Lithium) group, and the monolithic zirconia (Zirconia) group. Ten flat crown specimens were prepared per group; opposing teeth were prepared using primary canines. A wear test was conducted over 100,000 chewing cycles using a dual-axis chewing simulator and a 50 N masticating force, and wear losses of antagonistic teeth and restorative materials were calculated using a three-dimensional profiling system and an electronic scale, respectively. Statistical significance was determined using One-way ANOVA and Tukey's test (P<.05).

RESULTS

The Leucite group (2.670±1.471 mm³) showed the greatest amount of antagonist tooth wear, followed by in decreasing order by the Lithium (2.042±0.696 mm³), Zirconia (1.426±0.477 mm³), and Steel groups (0.397±0.192 mm³). Mean volume losses in the Leucite and Lithium groups were significantly greater than in the Steel group (P<.05). No significant difference was observed between mean volume losses in the Zirconia and Steel groups (P>.05).

CONCLUSION

Leucite glass-ceramic and lithium disilicate glass-ceramic cause more primary tooth wear than stainless steel or zirconia.

Influence of the preparation design and artificial aging on the fracture resistance of monolithic zirconia crowns

PURPOSE

The aim of this study was to evaluate the fracture resistance and fracture behavior of monolithic zirconia crowns in accordance with the preparation design and aging simulation method.

MATERIALS AND METHODS

An upper first molar was prepared sequentially with three different preparation designs: shoulderless preparation, 0.4 mm chamfer and 0.8 mm chamfer preparation. For each preparation design, 30 monolithic zirconia crowns were fabricated. After cementation on Cr-Co alloy dies, the following artificial aging procedures were performed: (1) thermal cycling and mechanical loading (TCML): 5000 cycles of thermal cycling 5℃-55℃ and chewing simulation (1,200,000 cycles, 50 N); (2) Low Temperature Degradation simulation (LTD): autoclave treatment at 137℃, 2 bar for 3 hours and chewing simulation; and (3) no pre-treatment (control group). After artificial aging, the crowns were loaded until fracture.

RESULTS

The mean values of fracture resistance varied between 3414 N (LTD; 0.8 mm chamfer preparation) and 5712 N (control group; shoulderless preparation). Two-way ANOVA analysis showed a significantly higher fracture loads for the shoulderless preparation, whereas no difference was found between the chamfer preparations. In contrast to TCML, after LTD simulation the fracture strength of monolithic zirconia crowns decreased significantly.

CONCLUSION

The monolithic crowns tested in this study showed generally high fracture load values. Preparation design and LTD simulation had a significant influence on the fracture strength of monolithic zirconia crowns.

Esthetic Prosthetic Restorations: Reliability and Effects on Antagonist Dentition

Recent advances in ceramics have greatly improved the functional and esthetic properties of restorative materials. New materials offer an esthetic and functional oral rehabilitation, however their impact on opposing teeth is not welldocumented. Peer-reviewed articles published till December 2014 were identified through Pubmed (Medline and Elsevier). Scientifically, there are several methods of measuring the wear process of natural dentition which enhances the comparison of the complicated results. This paper presents an overview of the newly used prosthetic materials and their implication on antagonist teeth or prostheses, especially emphasizing the behavior of zirconia restorations.

Intraoral pH and temperature during sleep with and without mouth breathing

To measure and compare the intraoral pH and temperature of individuals during sleep with and without mouth breathing. Ten healthy participants [mean age = 25·8 (± 4·3)] wore a custom-made appliance fitted with a pH probe and thermocouple for two sets of 48 h. Continuous pH and temperature measurements were taken from the palatal aspect of the upper central incisors. To simulate mouth breathing during sleep, participants wore a nose clip for two nights of the four, with the first group (n = 5) wearing the nose clip during the first night and the rest (n = 5) wearing the nose clip during the second night of sleep to balance any potential bias from the wearing sequence. Both qualitative and quantitative analyses were conducted. The mean intraoral pH during daytime was 7·3 (± 0·4) and during sleep was 7·0 (± 0·5). The mean intraoral pH during sleep with mouth breathing was 6·6 (± 0·5), which was statistically significant compared with the normal sleep condition (P < 0·01). The intraoral pH decreased slowly over the hours of sleep in all participants. When sleeping with forced mouth breathing, intraoral pH showed a greater fall over a longer period of time. The mean intraoral temperature was 33·1 °C (± 5·2) during daytime and 33·3 °C (± 6·1) during sleep, with no statistical significance between sleep with and without mouth breathing (P > 0·05). The results suggest that mouth breathing during sleep is related to a decrease in intraoral pH compared with normal breathing during sleep, and this has been proposed as a causal factor for dental erosion and caries.

Effect of Polishing Systems on Surface Roughness and Topography of Monolithic Zirconia

This study evaluated the effect of different chairside polishing systems on the surface roughness and topography of monolithic zirconia. Thirty-five monolithic zirconia specimens (Lava PLUS, 3M ESPE) were fabricated and divided into five groups of seven and polished with the following: Group 1 (WZ)-Dura white stone followed by Shofu zirconia polishing kit; Group 2 (SZ)-Shofu zirconia polishing kit; Group 3 (CE)-Ceramiste porcelain polishers; Group 4 (CM)-Ceramaster porcelain polishers; and Group 5 (KZ)-Komet ZR zirconia polishers. All specimens were ground with a fine-grit diamond bur prior to polishing procedures to simulate clinical finishing. Baseline and post-polishing profilometric readings were recorded and delta Ra values (difference in mean surface roughness before and after polishing) were computed and analyzed using one-way analysis of variance and Scheffe post hoc test (p<0.05). Representative scanning electron microscopy (SEM) images of the ground but unpolished and polished specimens were acquired. Delta Ra values ranged from 0.146 for CE to 0.400 for KZ. Delta Ra values for KZ, WZ, and SZ were significantly greater than for CE. Significant differences in delta Ra values were also observed between KZ and CM. The SEM images obtained were consistent with the profilometric findings. Diamond-impregnated polishing systems were more effective than silica carbide-impregnated ones in reducing the surface roughness of ground monolithic zirconia.

Full-Arch, Implant-Supported Monolithic Zirconia Rehabilitations: Pilot Clinical Evaluation of Wear Against Natural or Composite Teeth

PURPOSE

To clinically evaluate the amount of contact wear generated between full-arch monolithic zirconia implant-supported restorations and natural or composite antagonists, over a 1-year period.

MATERIALS AND METHODS

Forty-seven teeth from clinically functional, full-arch monolithic zirconia screw-retained implant prostheses (FDPs) and their antagonists were investigated. The first group ("Zirconia-E") was opposed to natural teeth ("Enamel"), whereas the other one ("Zirconia-CR") was opposed to nano-hybrid composite teeth ("Composite Resin"). Replicas of the restorations and their antagonists were obtained immediately after delivery (T₀ ) and after 1 year of clinical service (T₁ ). Each tooth surface was individually evaluated three-dimensionally by software to quantify the vertical distance between the two scans (Hausdorff distance), which was considered as contact wear. Data obtained for each arch were subjected to one-way ANOVA test and a post hoc analysis (Tukey's test) at a 5% level of significance. Furthermore, the influence of the location of the teeth (anterior or posterior) was analyzed. Minimum post hoc statistical power between statistically different groups was 99.6%.

RESULTS

Mean values were 63 ± 23 μm for Zirconia-E, 76 ± 29 μm for enamel, 70 ± 38 μm for composite resin; Zirconia-CR had a mean value of 19 ± 4 μm and significantly differed from the other groups. Contact wear between anterior and posterior teeth differed significantly only in the composite resin arch, with a mean of 39 ± 22 μm for anterior teeth versus 101 ± 19 μm for posterior ones.

CONCLUSIONS

Within the limitations of this preliminary evaluation, monolithic zirconia full-arch rehabilitations induced a clinically acceptable wear on natural and composite antagonists over a 1-year period; they might be considered a viable solution for implant-supported rehabilitations.

The effects of salivas on occlusal forces

Contacting surfaces of opposing teeth produce friction that, when altered, changes the contact force direction and/or magnitude. As friction can be influenced by several factors, including lubrication and the contacting materials, the aim of this study was to measure the occlusal load alterations experienced by teeth with the introduction of different salivas and dental restorative materials. Pairs of molar teeth were set into occlusion with a weighted maxillary tooth mounted onto a vertical sliding assembly and the mandibular tooth supported by a load cell. The load components on the mandibular tooth were measured with three opposing pairs of dental restorative materials (plastic denture, all-ceramic and stainless steel), four (human and three artificial) salivas and 16 occlusal configurations. All lateral force component measurements were significantly different (P < 0·0001) from the dry (control) surface regardless of the crown material or occlusal configuration, while the effects of the artificial salivas compared to each other and to human saliva depended on the crown material.

The zirconia ceramic: strengths and weaknesses

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

Enamel Wear Opposing Polished and Aged Zirconia

Aging of dental zirconia roughens its surface through low temperature degradation. We hypothesized that age-related roughening of zirconia crowns may cause detrimental wear to the enamel of an opposing tooth. To test our hypothesis, we subjected artificially aged zirconia and reference specimens to simulated mastication in a wear device and measured the wear of an opposing enamel cusp. Additionally, the roughness of the pretest surfaces was measured. The zirconia specimens, artificially aged by autoclave, showed no significant increase in roughness compared to the nonaged specimens. Furthermore, no significant difference in material or opposing enamel wear between the aged and nonaged zirconia was seen. All zirconia specimens showed less material and opposing enamel wear than the enamel to enamel control or veneering porcelain specimens. Scanning electron micrographs showed relatively smooth surfaces of aged and nonaged zirconia following wear testing. The micrographs of the veneering ceramic showed sharp fractured edges and fragments of wear debris. Zirconia may be considered a wear-friendly material for restorations opposing enamel, even after simulated aging.

Tooth wear against ceramic crowns in posterior region: a systematic literature review

The objective of this systematic review was to assess tooth wear against ceramic crowns in posterior region in vitro and in vivo. An electronic PubMed search was conducted to identify studies on tooth wear against ceramic crowns in posterior region. The selected studies were analyzed in regard to type of crowns, natural antagonist, measuring protocol and outcome. From a yield of 1 000 titles, 43 articles were selected for full-text analysis; finally, no in vitro and only five in vivo studies met the inclusion criteria. As there is heterogeneity in design, used measuring method, ceramics and analysis-form, a meta-analysis was not possible. Results of these studies are very controversial which makes a scientifically valid comparison impossible. This review indicated that some all-ceramic crowns are as wear friendly as metal-ceramic crowns. Up to now, it has been impossible to associate tooth wear with any specific causal agent. The role of ceramic surface treatment that might be responsible for the changing in rate of tooth wear seems undetermined as yet through clinical trials. The literature reveals that studies on this topic are subject to a substantial amount of bias. Therefore, additional clinical studies, properly designed to diminish bias, are warranted.

The wear of polished and glazed zirconia against enamel

STATEMENT OF PROBLEM

The wear of tooth structure opposing anatomically contoured zirconia crowns requires further investigation.

PURPOSE

The purpose of this in vitro study was to measure the roughness and wear of polished, glazed, and polished then reglazed zirconia against human enamel antagonists and compare the measurements to those of veneering porcelain and natural enamel.

MATERIAL AND METHODS

Zirconia specimens were divided into polished, glazed, and polished then reglazed groups (n=8). A veneering porcelain (Ceramco3) and enamel were used as controls. The surface roughness of all pretest specimens was measured. Wear testing was performed in the newly designed Alabama wear testing device. The mesiobuccal cusps of extracted molars were standardized and used as antagonists. Three-dimensional (3D) scans of the specimens and antagonists were obtained at baseline and after 200 000 and 400 000 cycles with a profilometer. The baseline scans were superimposed on the posttesting scans to determine volumetric wear. Data were analyzed with a 1-way ANOVA and Tukey Honestly Significant Difference (HSD) post hoc tests (α=.05)

RESULTS

Surface roughness ranked in order of least rough to roughest was: polished zirconia, glazed zirconia, polished then reglazed zirconia, veneering porcelain, and enamel. For ceramic, there was no measureable loss on polished zirconia, moderate loss on the surface of enamel, and significant loss on glazed and polished then reglazed zirconia. The highest ceramic wear was exhibited by the veneering ceramic. For enamel antagonists, polished zirconia caused the least wear, and enamel caused moderate wear. Glazed and polished then reglazed zirconia showed significant opposing enamel wear, and veneering porcelain demonstrated the most.

CONCLUSIONS

Within the limitations of the study, polished zirconia is wear-friendly to the opposing tooth. Glazed zirconia causes more material and antagonist wear than polished zirconia. The surface roughness of the zirconia aided in predicting the wear of the opposing dentition.

Influence of surface treatment on the wear of solid zirconia

OBJECTIVE

Recently there has been talk of the use of full-contour solid zirconia crowns or bridge restorations with no porcelain overlay. This could be a useful solution for patients with bruxism or limited interocclusal space. However, the hardness of zirconia could affect the opposite natural dentition. The aim of this in-vitro study was to investigate the role of surface treatments on the wear of a zirconia material and its antagonist.

MATERIALS AND METHODS

Fifty plates (10 × 10 × 1 mm) made of zirconia (LavaMulti(™) ZrO2, 3M ESPE), divided into five equal groups, were sandblasted and ground under standardized conditions with a fine-grit diamond bur (Komet Brasseler, Germany) to simulate clinical conditions. Group (a) was only fired, (b) was fired and sandblasted, (c) only ground, (d) was ground and additionally polished (EVE Ceramic Polishing-Set, Pforzheim) and (e) was ground and glazed. Wear behavior was measured with a pin-on-disk apparatus ABREX against 6 mm steatite balls as antagonists (45°, 5 N load, 5000 cycles, water). The amount of wear was determined topographically using a 3-D profilometer (Concept 3D, Mahr, Germany) by measuring the height loss of the antagonist and the depth of wear Pt of the zirconia.

RESULTS

In groups (a), (b), (c) and (d) the wear value Pt could not be determined (<1 μm). Wear values of the antagonists (steatite balls) revealed a similar outcome in contact with (b), (c) and (e) in the range of 81-85 μm, whereas (e) was more abrasive but not significantly. A noticeable difference in the wear of the antagonist showed group (d) to have the smallest value.

CONCLUSION

Polished zirconia seems to have the lowest wear on the antagonists, in contrast with the other kinds of surface treatment.

An in vitro investigation to compare the surface roughness of auto glazed, reglazed and chair side polished surfaces of Ivoclar and Vita feldspathic porcelain

The change in surface roughness after different surface finishing techniques has attracted the attention of several prosthodontists regarding wear of opposing teeth or restorative material and the strength; plaque retention and appearance of the restoration. However, there is considerable controversy concerning the best methods to achieve the smoothest and strongest porcelain restorations after chair side clinical adjustments. The purpose of this in vitro study was to compare the average surface roughness of a self-glazed surface, a chair side polished surface and a reglazed surface of ceramic. Two feldspathic porcelain, namely VITA VMK94 (Vita Zahnfabrik, Bad Sachingen, Germany) and IVOCLAR CLASSIC (Vivadent AG, FL-9494 Schaan, Liechtenstein) were selected to fabricate 20 specimens of each in the shape of shade guide tabs. A medium-grit diamond rotary cutting instrument was used to remove the glaze layer, and then the surface of half the specimens were re-glazed and the other half were polished using a well-defined sequence of polishing comprising of: Shofu porcelain polishing system, White gloss disc/polishing wheel, Silicone cone with diamond polishing paste and finally with small buff wheel with pumice slurry. The surface roughness (Ra) (μm) of the specimens was evaluated using a profilometer and scanning electron microscope. The data were statistically analyzed by using Student's t test. The results had shown that there is no statistically significant difference both quantitatively and qualitatively, between the surface roughness of reglazed and chair-side polished surface. In addition, both reglazed and chair-side polished surfaces are better than the autoglazed surface. Within all the groups, there is no significant difference between companies. Polishing an adjusted porcelain surface with the suggested sequence of polishing will lead to a finish similar to a re-glazed surface. Therefore chair-side polishing can be a good alternative to reglazing for finishing adjusted porcelain surface.

A comparative evaluation of wear of enamel caused by ceramics with different fusion temperatures

Dental ceramics are the most used esthetic fixed Prosthodontic restorative material today. However, dentists remain suspicious about their potential abrasivity. Lower-fusing ceramic materials developed, are claimed to be wear friendly. This study was conducted to compare the wear of enamel of extracted teeth against one conventionally used ceramic VMK-95 (fusing temperature 930 °C) and two new lower-fusing ceramics-Omega 900 and Finesse with fusing temperatures 900 and 760 °C respectively, used for metal-ceramic restorations. Metal disks were prepared from ceramic alloy and divided into three groups of 10 disks each on which VMK-95, Omega 900 and Finesse ceramics were applied respectively. Ceramic disks and tooth specimen were mounted on custom-made wear simulator and subjected to predefined masticatory test. Each tooth specimen was profiled by laser triangulation sensor before and after masticatory test. Difference in height was calculated. The results showed that mean loss of height of tooth was least against Finesse (0.3431 + 0.0177 mm) followed by Omega 900 (0.4076 + 0.0135 mm) and VMK-95 (0.6177 + 0.014 mm). Statistical analysis revealed statistically significant difference between VMK-95 & Omega 900 and VMK-95 & Finesse. The difference in loss of height of tooth against Finesse & Omega 900 is statistically insignificant (P < 0.001). The results of this study indicate that lower-fusing dental ceramics cause less wear of opposing enamel.

Wear behavior of dental Y-TZP ceramic against natural enamel after different finishing procedures

OBJECTIVE

The aim of this in vitro study was to evaluate the influence of different finishing procedures on the wear behavior of zirconia against natural enamel.

METHODS

64 quadratic specimens (10 mm × 10 mm × 2 mm) were cut from a commercial hipped dental Y-TZP ceramic. Four different groups with 16 specimens each were formed according to the following finishing procedures: PZ (polished), RR (fine-grit diamond), GR (coarse-grit diamond), GZ (glazed). Polished specimens of a leucite-reinforced glass ceramic (Empress CAD) were used as a control (GC). The materials were subjected to the Ivoclar wear method (Willytec chewing simulator, 120,000 cycles, 5kg weight) with 80 natural caries-free cusps of first upper molars as antagonists. Wear was analyzed for both the enamel cusps and test specimens by measurement of the vertical substance loss with a laser scanner. Surface roughness was measured by means of a white-light interferometer.

RESULTS

The surface roughness was significantly different among the polished, diamond-finished, and glazed ceramic specimens (ANOVA, post hoc Bonferroni p<0.05). The results of the one-way ANOVA indicated that the finishing technique significantly affected enamel wear (p<0.05). The post hoc test indicated that the specimens finished with the coarse diamond caused significantly higher antagonist wear than the polished ones. Polished zirconia showed the lowest wear of the antagonist enamel, with a mean value of 171.74 (SD = 121.68), and resulted in enamel wear that was not significantly different from that of the glass ceramic control group. No significant linear correlation could be found between pre-testing surface roughness and abrasive wear.

SIGNIFICANCE

If zirconia is used without veneering material for crowns and fixed dental prostheses (FDPs), the surface must be well-polished if occlusal adjustments with coarse diamonds are performed. The polishing step reduces the wear of the opposing enamel.