Influence of substructure design, veneer application technique, and firing regime on the in vitro performance of molar zirconia crowns

Mechanical Properties of High- and Low-Fusing Zirconia Veneering Ceramics Fired on Different Trays and Substrates

This study aimed to evaluate the effect of ceramic type, firing tray, and firing substrate on the density, shrinkage, biaxial flexural strength, Martens' hardness, and elastic indentation modulus of zirconia veneering ceramics. Disk-shaped specimens were fabricated from a high-fusing (HFZ) and a low-fusing (STR) zirconia veneering ceramic. These specimens were then divided into 10 groups according to firing trays (round, small honeycomb-shaped, cordierite [RSC]; round, large honeycomb-shaped, aluminum oxide [RLA]; rectangular, plane, silicon nitride [RCPS]; round, plane, silicon nitride [RPS]; and rectangular, plane, calcium silicate [RCPC]) and firing substrates (firing cotton and platinum foil) used (n = 12). The density, shrinkage, biaxial flexural strength, Martens' hardness, and indentation modulus were measured, and analyzed with generalized linear model analysis (α = 0.05). The interaction between the ceramic type and firing substrate affected density (p < 0.001), and the other outcomes were affected by the interaction among all main factors (p ≤ 0.045). Higher density was observed with HFZ or platinum foil (p ≤ 0.007). RSC and RLA led to a higher density than RCPS within HFZ and led to the lowest density within STR (p ≤ 0.046). STR had a higher shrinkage (p < 0.001). RSC mostly led to a lower shrinkage of HFZ (p ≤ 0.045). The effect of ceramic type and firing substrates on the biaxial flexural strength, Martens' hardness, and indentation modulus was minimal while there was no clear trend on the effect of firing tray on these properties. Ceramic type, firing tray, and firing substrate affected the mechanical properties of the tested zirconia veneering ceramics. Firing the tested zirconia veneering ceramics over a round and small honeycomb-shaped cordierite firing tray with firing cotton mostly led to improved mechanical properties.

The Effect of Different Ageing Protocols on the Shear Bond Strength of the Ceromer Indirect Composite on Two Different Substructure Materials

BACKROUND

The evolution of restorative materials in prosthodontics has led to the emergence of indirect composite resins, including ceromers, as alternatives to traditional metal-ceramic restorations. However, research gaps exist regarding the impact of ageing protocols on the bond strength of ceromer composites to different metal substructures, necessitating further investigation in this area.

AIM

This study aimed to determine the effect of five different ageing protocols on the shear bond strength (SBS) of ceromer indirect composites on two different substructures.

METHODS

In this in vitro study, 120 metallic discs (10 × 2 mm) were cast from cobalt-chromium (Co-Cr) alloy (n = 60) and spark erosion treated from grade V titanium (n = 60). Each sample was sandblasted. The M.L. primer (Shofu, Germany) and layers of opaque were applied to the surface following the manufacturer's instructions. A special jig (6 × 2 mm) was placed on each disc. The ceromer was condensed in it and light-cured separately for 90 s. Following polishing, specimens were separated into five ageing groups: distilled water (as a control), thermal cycling, tea, coffee, and gastric acid immersion. All samples were placed in 37°C incubation for 28 days for distilled water, coffee, and tea, and 7 days for gastric acid immersion and thermal cycling for 5000 cycles (5-55°C). A universal test machine was used to measure the SBS. The samples were evaluated for failure modes using stereomicroscopy. Data were analyzed using one-way analysis of variance (ANOVA) (P < 0.05).

RESULTS

According to one-way ANOVA, the mean SBS (MPa) between the two groups was compared in each ageing protocol, and there were no significant differences between the Co-Cr-C and Ti-C groups (P > 0.05). The most frequent mode of failure in all groups was mixed.

CONCLUSIONS

Applying the ageing protocols, the type of substructure material had no significant effect on the SBS of the ceromer indirect composite except for tea immersion.

Effect of final temperature and heating rate on the mechanical and optical properties of a zirconia veneering ceramic

PURPOSE

To evaluate the effect of firing temperature and heating rate on the volumetric shrinkage, translucency, flexural strength, hardness, and fracture toughness of a zirconia veneering ceramic.

MATERIAL AND METHODS

Zirconia veneering ceramic specimens (N = 45) with varying final temperatures (730 °C, 750 °C, and 770 °C) and heating rates (70 °C/min, 55 °C/min, and 40 °C/min) were fabricated (n = 5). Each specimen's shrinkage, translucency, flexural strength, hardness, and fracture toughness were determined. Two-way analysis of variance, Scheffé test, and Pearson's correlation analysis were used to evaluate data (α = 0.05).

RESULTS

The shrinkage (44.9 ± 3.1-47.5 ± 1.6 vol%) and flexural strength (74.1 ± 17.4-107.0 ± 27.1 MPa) were not affected by tested parameters (P ≥ 0.288). The interaction between the main factors affected the translucency, hardness, and fracture toughness of the specimens (P ≤ 0.007). Specimens with 770 °C final temperature and 70 °C/min heating rate had the lowest (21.8 ± 3.2 %) translucency (P ≤ 0.039). The hardness ranged between 4.98 ± 0.51 GPa (730 °C; 70 °C/min) and 5.60 ± 0.37 GPa (770 °C; 70 °C/min). Fracture toughness ranged between 0.54 ± 0.04 MPa√m and 0.67 ± 0.08 MPa√m with the highest values for specimens fired at 730 °C with 70 °C/min (P ≤ 0.001). There was a positive correlation between translucency and hardness (r = 0.335, P = 0.012), and a negative correlation between fracture toughness and all parameters other than shrinkage (translucency: r = -0.693/P < 0.001, flexural strength: r = -0.258/P = 0.046, hardness: r = -0.457/P < 0.001).

CONCLUSIONS

Heating rate and final temperature should be considered while fabricating veneered zirconia restorations with tested ceramic as they affected the translucency, hardness, and fracture toughness.

Mechanical Stability of Screw-Retained Monolithic and Bi-layer Posterior Hybrid Abutment Crowns after Thermomechanical Loading: An In Vitro Study

To evaluate the failure-load and survival-rate of screw-retained monolithic and bi-layered crowns bonded to titanium-bases before and after mouth-motion fatigue, 72 titanium-implants (SICvantage-max, SIC-invent-AG) were restored with three groups (n = 24) of screw-retained CAD/CAM implant-supported-single-crowns (ISSC) bonded to titanium-bases: porcelain-fused-to-metal (PFM-control), porcelain-fused-to-zirconia (PFZ-test) and monolithic LDS (LDS-test). Half of the specimens (n = 12/group) were subjected to fatigue in a chewing-simulator (1.2 million cycles, 198 N, 1.67 Hz, thermocycling 5–55 °C). All samples were exposed to single-load-to-failure without (PFM0, PFZ0, LDS0) or with fatigue (PFM1, PFZ1, LDS1). Comparisons were statistically analyzed with t-tests and regression-models and corrected for multiple-testing using the Student–Neuman–Keuls method. All PFM and LDS crowns survived fatigue exposure, whereas 16.7% of PFZ showed chipping failures. The mean failure-loads (±SD) were: PFM0: 2633 ± 389 N, PFM1: 2349 ± 578 N, PFZ0: 2152 ± 572 N, PFZ1: 1686 ± 691 N, LDS0: 2981 ± 798 N, LDS1: 2722 ± 497 N. Fatigue did not influence load to failure of any group. PFZ ISSC showed significantly lower failure-loads than monolithic-LDS regardless of artificial aging (p < 0.05). PFM ISSC showed significantly higher failure loads after fatigue than PFZ (p = 0.032). All ISSC failed in a range above physiological chewing forces. Premature chipping fractures might occur in PFZ ISSC. Monolithic-LDS ISSC showed high reliability as an all-ceramic material for screw-retained posterior hybrid-abutment-crowns.

Effect of processing methods on the chipping resistance of veneered zirconia

OBJECTIVES

To evaluate the edge chipping resistance (R_eA) and the fracture toughness (K_C) of 3Y-TZP bilayers produced with the following materials/processing combinations: fluorapatite glass-ceramic applied on zirconia using the traditional layering and hot-pressing (press-on) techniques; feldspathic porcelain using rapid layer technology (RLT); and lithium disilicate glass-ceramic using CAD-on method. The influence of the cooling rate (slow and fast) was analyzed for layering and hot-pressing.

METHODS

Bilayer bars (25x4x2 mm) were made following manufacturers' instructions. The edge chipping test was performed in an universal testing machine, using a coupled Vickers indenter. R_eA was calculated dividing the critical load at fracture by the edge distance. Fracture toughness was calculated by a regression fit with a fixed slope of 1.5 correlating the critical chipping load regarding edge distance and also with indentation fracture (IF) method. Data were statistically analyzed using ANOVA and Tukey's test (α = 5%).

RESULTS

R_eA and K_C was significantly higher for the CAD-on bilayers. RLT showed intermediate R_eA means, and layering and hot-pressing techniques showed the lowest R_eA values. For both processing methods there was no effect of the cooling protocol on the R_eA and fracture toughness.

CONCLUSIONS

There is a significant effect of the material/processing association on the edge chipping resistance and fracture toughness of the bilayers. There was no effect of the cooling protocol on the edge chipping resistance and fracture toughness for the specimens processed by both the layering and hot-pressing techniques.

Residual stresses explaining clinical fractures of bilayer zirconia and lithium disilicate crowns: A VFEM study

OBJECTIVE

To understand the stress development in porcelain-veneered zirconia (PVZ) and porcelain-veneered lithium disilicate (PVLD) crowns with different veneer/core thickness ratios and cooling rates. To provide design guidelines for better performing bilayer restorations with the aid of Viscoelastic Finite Element Method (VFEM).

METHODS

The VFEM was validated by comparing the predicted residual stresses with experimental measurements. Then, the model was used to predict transient and residual stresses in the two bilayer systems. Models with two different veneer/core thickness ratios were prepared (2:1 and 1:1) and two cooling protocols were simulated (Fast: ∼300 °C/min, Slow: ∼30 °C/min) using the heat transfer module, followed by stress analysis in ABAQUS. The physical properties of zirconia, lithium disilicate, and the porcelains used for the simulations were determined as a function of temperature.

RESULTS

PVLD showed lower residual stresses than PVZ. The maximum tensile stresses in PVZ were observed in the cusp area, whereas those in PVLD were located in the central fossa. The 1:1 thickness ratio decreased stresses in both layers of PVZ. Slow cooling slightly decreased residual stresses in both systems. However, the cooling rate effect was more evident in transient stresses.

SIGNIFICANCE

Slow cooling is preferable for both systems. A thinner porcelain layer over zirconia lowers stresses throughout the restoration. The different stress distributions between PVZ and PVLD may affect their failure modes. Smaller mismatches in modulus, CTE, and specific heat between the constituents, and the use of low T_g porcelains can effectively reduce the deleterious transient and residual tensile stresses in bilayer restorations.

Effect of different ceramic materials and substructure designs on fracture resistance in anterior restorations

STATEMENT OF PROBLEM

Materials have been developed to reduce the chipping of ceramic veneer and improve the esthetics of anterior ceramic veneered restorations. However, studies of the effects of material and substructure design on fracture resistance are sparse.

PURPOSE

The purpose of this in vitro study was to investigate the fracture resistance of metal-ceramic (MC), zirconia-feldspathic porcelain (ZC), and zirconia-lithium disilicate (ZL) anterior restorations and evaluate the effect of material and substructure design.

MATERIAL AND METHODS

After preparing and scanning artificial maxillary central incisor teeth, titanium abutments and restoration specimens (n=90) were fabricated. MC, ZC, and ZL materials were prepared with substructure designs A (two-third coverage of the palatal surface) and B (one-third coverage of the palatal surface). After cementation, the specimens were thermocycled (10 000 cycles, 5 and 55 °C). Fracture load measurements, failure mode analysis, energy dispersive X-ray spectroscopy (EDS), line scan analysis, fractography, finite element analysis (FEA), and Weibull analysis were performed. Two-way ANOVA was used to identify the effects of material and substructure design on fracture load. One-way ANOVA was used to identify significant differences of fracture load (α=.05).

RESULTS

MC and ZL showed significantly higher fracture load than ZC (P<.05). MC_A showed a significantly higher fracture load than MC_B (P<.05). ZC_A exhibited the lowest Weibull modulus. FEA revealed that the maximum principal stress occurred near the loading area of the veneer. ZL displayed the lowest maximum principal stress among all the materials.

CONCLUSIONS

ZL and MC_A exhibited more favorable fracture resistance. The substructure design of MC, with increased metal coverage of the palatal surface, improved fracture resistance significantly.

Does veneering technique affect the bond strength of bilayer Y-TZP? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Reasons for failures of bilayer yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) restorations include the core-veneer interface bond strength. The influence of the veneering method on the bond strength of veneered Y-TZP is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effect of the veneering method on the bond strength of bilayer Y-TZP.

MATERIAL AND METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were performed on PubMed/MEDLINE, Web of Science (Core Collection), and Scopus for in vitro studies evaluating the effect of the veneering technique on the bond strength of bilayer Y-TZP. Statistical analyses were performed with random-effect models (α=.05).

RESULTS

From 619 identified studies, 140 were selected for full-text analysis and 16 were included. Manual searching yielded no additional articles. The meta-analyses comprised 15 studies, and 1 study was included only in the descriptive analysis. Meta-analyses compared the hand-layered method (control) with pressed, fused, and cemented veneering methods. The fused and cemented techniques were analyzed by using subgroups assessing the veneering ceramic type (predominantly glass-ceramics and particle-filled glass-ceramics). Similar bond strength results (P=.540) were found for pressed and hand-layered veneered Y-TZP specimens. Fused veneers achieved higher bond strength values (P<.001) than the hand-layered veneers on Y-TZP frameworks, irrespective of the veneering ceramic type (predominantly glass-ceramics: P=.002; particle-filled glass-ceramics: P<.001). Global and subgroup analyses indicated that lower core-veneer bond strength values (P<.001) were found for cemented in relation to hand-layered veneers.

CONCLUSIONS

Core-veneer interfacial adhesion was equivalent for pressed and hand-layered veneering techniques. Improved bond strength, regardless of the veneer ceramic material type, was achieved by the fused veneering method, which seems to be a promising choice for the veneering of Y-TZP. In contrast, the cemented method may be unsuitable for veneering Y-TZP structures because of its lower bond strength than the hand-layered veneering technique.

Do thermal treatments affect the mechanical behavior of porcelain-veneered zirconia? A systematic review and meta-analysis

OBJECTIVES

A systematic review of in vitro studies was conducted to assess the effect of thermal treatments on flexural strength or critical load to failure of porcelain-veneered zirconia (PVZ).

SOURCES

Literature searches were performed up to June 2018 in PubMed/MEDLINE, Scopus and Web of Science databases, with no publication year or language limits.

DATA

From 393 relevant studies, 21 were selected for full-text analysis, from which 7 failed to meet the inclusion criteria. The 14 remaining papers were included in the systematic review: 8 for meta-analysis and 6 restricted to descriptive analyses. Hand searching of reference lists resulted in no additional papers.

STUDY SELECTION

In vitro studies using PVZ specimens testing the influence of thermal treatments on the fracture resistance to monotonic or cyclic loading. Papers evaluating cooling rate were divided into those applying fast cooling from above the porcelain glass transition temperature (T_g), or from below it. Meta-analyses were performed separately for flexural strength and critical load to failure, using random effects at a 5% significance level.

CONCLUSIONS

Delaying furnace opening at a temperature below the porcelain T_g is advised for PVZ restorations, in order to improve their fracture resistance. Additional information is required to confirm the apparent beneficial effect of self-glaze and repeated veneer firings on the mechanical properties of these restorations. Finally, in order to obtain conclusive and relevant evidence regarding thermal treatments and the fracture resistance of PVZs, future studies should concentrate on anatomically-correct crown specimens.

Effect of screw access hole design on the fracture resistance of implant-supported zirconia-based restorations

OBJECTIVE

To evaluate the effect of screw access hole design on the fracture resistance of cement-retained implant-supported zirconia-based restorations with screw access holes.

MATERIALS AND METHODS

Thirty cement-retained implant-supported zirconia-based molar crown specimens were fabricated. The specimens were divided into 3 groups of 10: without access holes (C), with screw access holes (S), and with screw access holes accompanied with a surrounding zirconia wall (W). The veneering ceramic thickness was 0.8 mm in all groups. Implants were vertically mounted in a metal block. Abutments were screwed on the implants and the specimens were cemented to the abutments. A universal testing machine applied compressive forces to the specimens until fracture. Fracture resistance values of the specimens were measured. One-way analysis of variance (ANOVA) and Tukey HSD tests were used to analyze data (P < .05).

RESULTS

The mean fracture resistance values were 5794.85 N for C, 2691.48 N for S, and 3878.06 N for W. The screw access hole design significantly affected the fracture resistance (P < .0001). Significant differences were found between C and S (P < .001), C and W (P < .001), and S and W (P = .026).

CONCLUSIONS

The screw access hole decreased the fracture resistance. A surrounding zirconia wall for the screw access hole increased the fracture resistance.

CLINICAL SIGNIFICANCE

Screw access hole design may affect the fracture resistance of cement-retained implant-supported zirconia-based restorations with screw access holes. This study introduced a screw access hole design to improve the fracture resistance of these restorations.

In-vitro performance and fracture strength of thin monolithic zirconia crowns

PURPOSE

All-ceramic restorations required extensive tooth preparation. The purpose of this in vitro study was to investigate a minimally invasive preparation and thickness of monolithic zirconia crowns, which would provide sufficient mechanical endurance and strength.

MATERIALS AND METHODS

Crowns with thickness of 0.2 mm (group 0.2, n=32) or of 0.5 mm (group 0.5, n=32) were milled from zirconia and fixed with resin-based adhesives (groups 0.2A, 0.5A) or zinc phosphate cements (groups 0.2C, 0.5C). Half of the samples in each subgroup (n=8) underwent thermal cycling and mechanical loading (TCML)(TC: 5℃ and 55℃, 2×3,000 cycles, 2 min/cycle; ML: 50 N, 1.2×10⁶ cycles), while the other samples were stored in water (37℃/24 h). Survival rates were compared (Kaplan-Maier). The specimens surviving TCML were loaded to fracture and the maximal fracture force was determined (ANOVA; Bonferroni; α=.05). The fracture mode was analyzed.

RESULTS

In both 0.5 groups, all crowns survived TCML, and the comparison of fracture strength among crowns with and without TCML showed no significant difference (P=.628). Four crowns in group 0.2A and all of the crowns in group 0.2C failed during TCML. The fracture strength after 24 hours of the cemented 0.2 mm-thick crowns was significantly lower than that of adhesive bonded crowns. All cemented crowns provided fracture in the crown, while about 80% of the adhesively bonded crowns fractured through crown and die.

CONCLUSION

0.5 mm thick monolithic crowns possessed sufficient strength to endure physiologic performance, regardless of the type of cementation. Fracture strength of the 0.2 mm cemented crowns was too low for clinical application.

Does veneering technique affect the flexural strength or load-to-failure of bilayer Y-TZP? A systematic review and meta-analysis

STATEMENT OF PROBLEM

Causes of failures of bilayer yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) restorations include the processing technique and the properties of the veneer ceramic. The effect of the veneering method on the mechanical behavior of veneered Y-TZP remains unclear.

PURPOSE

The purpose of this systematic review was to assess the effect of the veneering method on the flexural strength and failure load of bilayer Y-TZP.

MATERIAL AND METHODS

This study followed the Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) statement. Searches were performed through August 2017 in PubMed/MEDLINE, Web of Science (Core Collection), Scopus, and Embase, with no year or language limit, targeting in vitro studies evaluating the effect of the veneering technique on the flexural strength and load-to-failure of bilayer Y-TZP immediately or after aging. Statistical analyses were conducted using an appropriate software. Comparisons were drawn with random effect models (α=.05).

RESULTS

From 3242 identified studies, 241 were selected for full-text analysis; from these, 33 studies were included. Manual searching yielded no additional papers. The meta-analysis consisted of 32 studies. Meta-analysis was performed separately for flexural strength and failure load data to compare the hand-layered method (control) with pressed, fused, and cemented veneering techniques. The cemented and fused methods were analyzed using subgroups depending on the veneering material being examined (predominantly glass-ceramics and particle-filled glass-ceramics), and the results were compared with those of the hand-layered method. The pressed group presented flexural strength (7 studies) (P=.150) and failure load (19 studies) (P=.140) values that were similar to those of the hand-layered group. Subgroup analysis revealed that the fused group with particle-filled glass-ceramics (7 studies) produced higher load-to-failure (P=.006) values than the hand-layered group. Subgroup analyses showed a statistical difference that favored the hand-layered over the cemented method, with predominantly glass-ceramic materials (5 studies) (P=.002).

CONCLUSIONS

The fused technique with particle-filled glass-ceramics seems more appropriate for the veneering of Y-TZP, with improved failure load, than the hand-layered method with predominantly glass-ceramic materials. The use of predominantly glass-ceramics for the cemented method is not recommended as failure load was lower than for the hand-layered group. Pressed veneers showed failure load and flexural strength values similar to those of the the hand-layered technique.

Three-dimensional characterization and distribution of fabrication defects in bilayered lithium disilicate glass-ceramic molar crowns

OBJECTIVE

To investigate and characterize the distribution of fabrication defects in bilayered lithium disilicate glass-ceramic (LDG) crowns using micro-CT and 3D reconstruction.

METHODS

Ten standardized molar crowns (IPS e.max Press; Ivoclar Vivadent) were fabricated by heat-pressing on a core and subsequent manual veneering. All crowns were scanned by micro-CT and 3D reconstructed. Volume, position and sphericity of each defect was measured in every crown. Each crown was divided into four regions-central fossa (CF), occlusal fossa (OF), cusp (C) and axial wall (AW). Porosity and number density of each region were calculated. Statistical analyses were performed using Welch two sample t-test, Friedman one-way rank sum test and Nemenyi post-hoc test. The defect volume distribution type was determined based on Akaike information criterion (AIC).

RESULTS

The core ceramic contained fewer defects (p<0.001) than the veneer layer. The size of smaller defects, which were 95% of the total, obeyed a logarithmic normal distribution. Region CF showed higher porosity (p<0.001) than the other regions. Defect number density of region CF was higher than region C (p<0.001) and region AW (p=0.029), but no difference was found between region CF and OF (p>0.05). Four of ten specimens contained the largest pores in region CF, while for the remaining six specimens the largest pore was in region OF.

SIGNIFICANCE

LDG core ceramic contained fewer defects than the veneer ceramic. LDG strength estimated from pore size was comparable to literature values. Large defects were more likely to appear at the core-veneer interface of occlusal fossa, while small defects also distributed in every region of the crowns but tended to aggregate in the central fossa region. Size distribution of small defects in veneer obeyed a logarithmic normal distribution.

Prospective cohort clinical study assessing the 5-year survival and success of anterior maxillary zirconia-based crowns with customized zirconia copings

STATEMENT OF PROBLEM

Studies evaluating anterior zirconia-based crowns are limited.

PURPOSE

The purpose of this prospective cohort clinical study was to assess the efficacy of zirconia-based anterior maxillary crowns with 0.3-mm customized copings at the cervical third and anatomical design elsewhere for up to 5 years of service.

MATERIAL AND METHODS

Eighteen participants who required an anterior maxillary crown (n=20) and who had signed a consent form approved by the University of Washington Health Sciences Center Human Subjects Division were enrolled. All preparations were standardized and prepared with an occlusal reduction of 1.5 to 2 mm and an axial reduction of 1 to 1.5 mm with 10 degrees of convergence angle. All finish lines were located on the sound tooth structure. Zirconia copings (Lava; 3M ESPE) were custom designed and milled to a 0.3-mm thickness at the cervical third and with selective thickness elsewhere to support the veneering porcelain. All restorations were luted with self-etching self-adhesive composite resin cement. Recall appointments were at 2 weeks, 6 months, and 12 months, and annually thereafter for 5 years. Modified Ryge criteria were used to assess the clinical fracture measurements, esthetics, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses. Descriptive statistics and 95% confidence intervals were used to describe the number and rate of complications and self-reported satisfaction with the crowns.

RESULTS

Twenty crowns with a mean follow-up of 58.7 months were evaluated. All crowns were rated as Alfa for fracture measurements (smooth surface, no fracture/chipping). Twelve crowns were rated esthetically as Romeo (no mismatch in color and shade) and 8 as Sierra (mismatch in color and shade within normal range). Twelve crowns were rated as Alfa (no visible evidence of crevice) and 8 as Bravo (visible evidence of crevice, no penetration of explorer) for marginal integrity. Nineteen were rated as Alfa (no discoloration) and 1 as Bravo (superficial discoloration) for marginal discoloration. No proximal caries or periapical pathoses were detected in 5 years. Participants were highly satisfied with their crowns after 5 years (mean ±SD: 9.8 ±0.4 on 0 to 10 scale).

CONCLUSIONS

Zirconia-based anterior maxillary crowns with customized copings with 0.3-mm thickness at the cervical third and zirconia margins performed well after 5 years of service.

Leucite and cooling rate effect on porcelain-zirconia mechanical behavior

OBJECTIVE

This study investigated the influence of the cooling protocol on the mechanical behavior of Y-TZP veneered with porcelain with different compositions. The tested hypotheses were: (1) Y-TZP infrastructures veneered with porcelain containing leucite in its composition presents higher flexural strength (σ) and reliability (m), and (2) slow cooling protocol results in greater σ and m.

METHODS

A total of 120 bilayer porcelain-Y-TZP bar-shaped specimens were prepared with the dimensions of 1.8mm (0.8mm Y-TZP±1.0mm porcelain)×4.0mm×16.0mm. Specimens were divided into four groups (n=30) according to the porcelain composition (containing or not leucite) and cooling protocol. Fast cooling was performed by opening the furnace chamber at sintering temperature. For the slow cooling, the chamber was maintained closed until it reached the room temperature. Specimens were tested in three-point bending with the porcelain surface under tension using a universal testing machine, in 37°C water, at 0.5mm/min crosshead speed. Data were analyzed by two-way ANOVA, Tukey post-hoc test (α=0.05) and Weibull.

RESULTS

Y-TZP veneered with porcelains with different microstructural composition presented similar σ and m values (p=0.718). The cooling protocol had no influence on the σ and m values of the experimental groups (p=0.718). Cracking represented 95% of failures, whereas the initial flaw propagated from the porcelain surface towards the interface.

SIGNIFICANCE

Y-TZP veneered with porcelain containing or not leucite present similar mechanical behavior and, at 1-mm thickness, is not sensitive to the cooling protocol.

Influence of aging on flexural strength of translucent zirconia for monolithic restorations

STATEMENT OF PROBLEM

Concern has been raised with regard to the low-temperature degradation (LTD) of translucent yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) for monolithic zirconia restorations.

PURPOSE

The purpose of this in vitro study was to assess the LTD behavior of 4 commercially available translucent Y-TZP materials by accelerated aging specimens in steam at 134°C, 0.2 MPa.

MATERIAL AND METHODS

Thin bars (22×3×0.2 mm) of Y-TZP, including Katana ML (Kuraray Noritake Dental Inc), Katana HT13 (Kuraray Noritake Dental Inc), Prettau (Zirkonzahn), and BruxZir (Glidewell Laboratories) (n=30 for each group), were machined from sintered blocks. Control specimens were assessed in the nonaged condition. Artificially ageing (n=5 per group at 5, 50, 100, 150, and 200 hours) was conducted in steam at 134°C at 0.2 MPa. The specimens were characterized, tested in 4-point flexure, and the fracture surfaces were analyzed. The monoclinic-to-tetragonal (m/t) peak intensity ratio measured by x-ray diffraction was used to calculate the monoclinic phase fraction and monitor LTD. Linear regression with heteroscedasticity-consistent robust standard errors was used to test for the effect of LTD (aging time) on (σ_f) and m/t. The Spearman rank correlation coefficient was used to assess the relationship between σ_f and monoclinic phase fraction (α=.05).

RESULTS

Artificial aging resulted in LTD as shown by an increase in the monoclinic phase fraction for all specimens. After aging for 200 hours, the mean ±SD monoclinic phase fraction increased from 2.90 ±0.34% to 76.1 ±0.64% for Prettau, 2.69 ±0.18% to 76.0 ±0.26% for BruxZir, 4.6 ±0.19% to 35.8 ±0.80% for Katana HT13, and 3.57 ±0.35% to 33.2 ±1.1% for Katana ML (all P<.001). Flexural strength changed from a mean ±SD of 1612 ±197 MPa to all fractured during aging for Prettau (P<.001); 1248 ±73.5 MPa to all fractured during aging for BruxZir (P<.001); 1052 ±84.2 to 1099 ±70 MPa ±130 for Katana HT13 (P=.45); and from 875 ±130 to 909 ±70 MPa (P=.82) for Katana ML. The mean flexural strength values of Prettau and BruxZir decreased with an increase in the monoclinic phase with Spearman rank correlation coefficients of -0.80 (P=.001) for Prettau and -0.63 (P=.022) for BruxZir. No significant changes in flexural strength were measured for Katana ML or Katana HT13 (P>.05).

CONCLUSIONS

The LTD of Y-TZP resulted in a significant decrease in flexural strength of Prettau and BruxZir, whereas Katana ML and Katana HT13 exhibited less LTD and no significant decrease in flexural strength.

Shear bond strength of indirect composite material to monolithic zirconia

PURPOSE

This study aimed to evaluate the effect of surface treatments on bond strength of indirect composite material (Tescera Indirect Composite System) to monolithic zirconia (inCoris TZI).

MATERIALS AND METHODS

Partially stabilized monolithic zirconia blocks were cut into with 2.0 mm thickness. Sintered zirconia specimens were divided into different surface treatment groups: no treatment (control), sandblasting, glaze layer & hydrofluoric acid application, and sandblasting + glaze layer & hydrofluoric acid application. The indirect composite material was applied to the surface of the monolithic zirconia specimens. Shear bond strength value of each specimen was evaluated after thermocycling. The fractured surface of each specimen was examined with a stereomicroscope and a scanning electron microscope to assess the failure types. The data were analyzed using one-way analysis of variance (ANOVA) and Tukey LSD tests (α=.05).

RESULTS

Bond strength was significantly lower in untreated specimens than in sandblasted specimens (P<.05). No difference between the glaze layer and hydrofluoric acid application treated groups were observed. However, bond strength for these groups were significantly higher as compared with the other two groups (P<.05).

CONCLUSION

Combined use of glaze layer & hydrofluoric acid application and silanization are reliable for strong and durable bonding between indirect composite material and monolithic zirconia.

Shear Bond Strengths between Three Different Yttria-Stabilized Zirconia Dental Materials and Veneering Ceramic and Their Susceptibility to Autoclave Induced Low-Temperature Degradation

A study was undertaken to evaluate the effect of artificial aging through steam and thermal treatment as influencing the shear bond strength between three different commercially available zirconia core materials, namely, Upcera, Ziecon, and Cercon, layered with VITA VM9 veneering ceramic using Universal Testing Machine. The mode of failure between zirconia and ceramic was further analyzed as adhesive, cohesive, or mixed using stereomicroscope. X-ray diffraction and SEM (scanning electron microscope) analysis were done to estimate the phase transformation (m-phase fraction) and surface grain size of zirconia particles, respectively. The purpose of this study was to simulate the clinical environment by artificial aging through steam and thermal treatment so as the clinical function and nature of the bond between zirconia and veneering material as in a clinical trial of 15 years could be evaluated.

Veneered Zirconia-Based Restorations Fracture Resistance Analysis

PURPOSE

To examine the effects of the veneering technique on the fracture resistance of zirconia-based crowns.

MATERIALS AND METHODS

An artificial tooth was prepared with a 1.2 mm heavy chamfer finish line and 8° taper. The prepared tooth was scanned using CAD/CAM technology to fabricate 45 cobalt chromium (CoCr) testing dies. One CoCr die was scanned, and 45 zirconia copings were milled and divided according to the veneering technique into three groups of 15 specimens each: layering veneering (LV) using Vita Vm9, overpressing veneering (OV) using Vita Pm9, and digital veneering (DV) using Vita Triluxe forte. The crowns were cemented onto the testing dies using glass ionomer cement. The specimens were thermocycled (3000 cycles, 5° to 55°) then statically loaded (3.7 mm ball, 0.5 mm/min crosshead speed) until failure. Failed crowns were inspected using a magnifier, and failure patterns were identified. One-way ANOVA and multiple comparison Bonferroni tests were applied for statistical analysis of the results.

RESULTS

Means and standard deviations of failure loads were 1200 ± 306 N for the LV group, 857 ± 188 N for the OV group, and 638 ± 194 N for the DV group. The differences in failure loads were statistically significant between all groups (p < 0.05). Failure mode was predominantly cohesive for LV and OV groups, whereas it was predominantly adhesive for the DV group.

CONCLUSIONS

The LV group was superior to other groups in terms of fracture resistance, while the DV group was inferior to the other groups in the same aspect.

Effect of Different Surface Treatments on the Bond Strength of Lithium Disilicate Ceramic to the Zirconia Core

OBJECTIVE

The aim of this study was to evaluate the effect of different surface treatments [sandblasting, Erbium:Yttrium-Aluminium-Garnet (Er:YAG), and femtosecond lasers] on the shear bond strength (SBS) of the CAD-on technique.

BACKGROUND DATA

Although demand for all-ceramic restorations has increased, chipping remains one of the major problems for zirconia-based restorations.

MATERIALS AND METHODS

Forty yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) zirconia plates (IPS e.max ZirCAD, Ivoclar Vivadent) were cut, sintered (12.4 × 11.4 × 3 mm) and divided into four groups according to the surface treatments (n = 10): a control group with no surface treatment (Group C), sandblasting with 50 μm Al2O3 (Group S), Er:YAG laser irradiation (Group E), and femtosecond laser irradiation (Group F). Also, 40 cylindrical (5 mm diameter, 2 mm height) lithium disilicate (IPS e.max CAD) veneer ceramics were cut and fused to all zirconia cores by a glass-fusion ceramic and crystallized according to the CAD-on technique. Specimens were subjected to shear force using a universal testing machine. The load was applied at a crosshead speed of 0.5 mm/min until failure. Mean SBS (MPa) were analyzed with one way ANOVA (p < 0.05). The failed specimens were examined under a stereomicroscope at ×20 to classify the mode of failure.

RESULTS

The highest SBS was observed in Group F (36 ± 3.31 MPa), followed by Group S (33.03 ± 5.05 MPa), and Group C (32.52 ± 10.15 MPa). The lowest SBS was observed in Group E (31.02 ± 4.96 MPa), but no significant differences were found between the control and surface treated groups (p = 0.377). All the specimens showed a mixed type of failure.

CONCLUSIONS

Femtosecond laser application increased the bond strength between zirconia-veneer specimens. However, the novel CAD-on technique with no surface treatment also showed high bonding strength. Thus, this technique could prevent ceramic chipping without additional surface treatments.

Veneered anatomically designed zirconia FDPs resulting from digital intraoral scans: Preliminary results of a prospective clinical study

OBJECTIVES

The aim of this prospective clinical study was to evaluate the clinical performance of veneered anatomically designed zirconia fixed dental prostheses (FDPs) resulting from intraoral digital impressions.

METHODS

24 patients requiring treatment were provided with all-ceramic FDPs. Intraoral scans (iTero) were performed and veneered anatomically designed CAD/CAM-zirconia FDPs (Zerion/VitaVM9) were fabricated. A feldspar veneering ceramic following a slow cooling firing protocol was applied. A self-curing resin based luting material was used for adhesive cementation. Clinical evaluations were performed at baseline and 6, 12, and 18 months recalls according to the modified USPHS-criteria. Intraoral digital surface scans (iTero) were performed at each recall examination and were digitally superimposed (Geomagic) to evaluate potential veneer cohesive fractures. Kaplan-Meier survival analysis comprised secondary caries, clinically unacceptable fractures, root canal treatment and debonding. Kaplan-Meier success rate included restorations with minimal crevices, tolerable color deviations and clinically acceptable fractures. Data were statistically analyzed.

RESULTS

The Kaplan-Meier survival rate and success rate of the FDPs were 100% and 91.7%, respectively. Clinically acceptable veneer cohesive fractures and crevices at the restoration margin were observed in two patients. These shallow veneer fractures were only detected by overlapping baseline and recall scans. Ceramic surface roughness increased significantly over time (p<0.0001).

CONCLUSIONS

Veneered zirconia FDPs fabricated from digital intraoral scans showed a favorable clinical performance over an observation period of 18 months. Anatomical zirconia core design and slow cooling firing protocol of the veneering ceramic reduced the incidence of chip fractures to a level that could not be detected clinically.

CLINICAL SIGNIFICANCE

The digital workflow on the basis of intraoral digital impressions resulted in clinically satisfying outcomes for veneered zirconia FDPs.

Effect of repeated firings on flexural strength of veneered zirconia

OBJECTIVE

Chipping and/or delamination represent a clinical failure of porcelain fused to zirconia (PFZ) prostheses. Causes and solutions have not been completely clarified. The present study was aimed at evaluating the effects of number of firings on the flexural strength of PFZ specimen.

METHODS

Forty-five zirconia specimens in shape of bars were cut, sintered and divided in 3 groups (n=15). Group 1: veneering ceramic was layered "in bulk" and fired. Group 2: veneering ceramic was layered in three layers, individually fired. Group 3: veneering ceramic was layered in five layers, individually fired. Each layer thickness was controlled by the use of calibrated molds. The total veneering ceramic thickness for all the specimens was 1.2mm, and the total thickness of the specimen of 2.0mm. Three-point bending test was performed. Fracture load was recorded in Newton and MPa value was calculated taking into account the bi-layered nature of the specimen. Data were statistically analyzed.

RESULTS

Specimens obtained with on single firing cycle obtained a statistically significant (p<0.001) lower flexural strength (54.61±8.98MPa) than specimens veneered with 3 or 5 firing cycles. The last two obtained very similar results (77.63±13.17MPa and 73.62±12.38MPa respectively) and the differences was not statistically significant.

SIGNIFICANCE

In bi-layered PFZ specimen, three to five layers and firings determine higher flexural resistance when compared to a single firing. Thus, a 3-layers veneering procedure is recommended to increase flexural resistance. If a 5-layer procedure is necessary to improve esthetics, it does not decrease flexural resistance.

Trends in computer-aided manufacturing in prosthodontics: a review of the available streams

In prosthodontics, conventional methods of fabrication of oral and facial prostheses have been considered the gold standard for many years. The development of computer-aided manufacturing and the medical application of this industrial technology have provided an alternative way of fabricating oral and facial prostheses. This narrative review aims to evaluate the different streams of computer-aided manufacturing in prosthodontics. To date, there are two streams: the subtractive and the additive approaches. The differences reside in the processing protocols, materials used, and their respective accuracy. In general, there is a tendency for the subtractive method to provide more homogeneous objects with acceptable accuracy that may be more suitable for the production of intraoral prostheses where high occlusal forces are anticipated. Additive manufacturing methods have the ability to produce large workpieces with significant surface variation and competitive accuracy. Such advantages make them ideal for the fabrication of facial prostheses.