Impact of oral fluids on dental ceramics: What is the clinical relevance?

Staining and bleaching susceptibility of zirconia-reinforced lithium silicate glass-ceramics with different thicknesses, translucencies, and fabrication methods

STATEMENT OF PROBLEM

The influence of different thicknesses, translucencies, and fabrication methods on the spectrophotometric and topographical properties of zirconia-reinforced lithium silicate glass-ceramics (ZLSs) for dental restorations remains unclear.

PURPOSE

The purpose of this in vitro study was to investigate the effect of thicknesses, translucencies, and fabrication methods on the color stability, translucency parameter, opalescence parameter, whiteness stability, transmitted irradiance, light transmittance, opacity, gloss, and roughness of ZLSs exposed to coffee staining and bleaching treatments.

MATERIAL AND METHODS

Two pressable ZLSs (VITA AMBRIA, VA and Celtra Press, CP) and 2 machinable ZLSs (VITA Suprinity, VS and Celtra Duo, CD) were examined at high translucency (HT) and low translucency (LT) levels in 2 thicknesses (n=160). The specimens were evaluated at baseline, after coffee staining, and after bleaching. The color stability (ΔE2000), translucency parameter (TP), opalescence parameter (OP), whiteness index (WID), and whiteness stability (ΔWID) were measured with a spectrophotometer. Transmitted irradiance (It), light transmission (T), and opacity (O) were obtained from a light-polymerizing unit and a polymerization light collection device. Roughness stability (ΔSa%) was determined with an optical profilometer, and gloss stability (ΔGU%) was recorded with a gloss meter. Data of ΔCIE2000, ΔWID, ΔSa%, and ΔGU% were analyzed by 4-way ANOVA, and data of the TP, OP, WID, It, T, and O were analyzed by repeated 4-way ANOVA (α=.05).

RESULTS

VS-HT exceeded the ΔCIE2000 acceptability threshold after coffee staining and bleaching protocols. Pressable ZLSs exhibited greater color stability than machinable ZLSs. The 1-mm-thick VA, CP, and CD materials exceeded the ΔWID perceptibility threshold after bleaching. The highest TP and OP was displayed by the 1-mm-thick CP after bleaching. ΔGU increased after water storage and decreased after coffee staining and bleaching. ΔSa% significantly increased after bleaching (P<.05).

CONCLUSIONS

The color stability and other spectrophotometric properties of ZLSs depended on material thickness. The effects of ZLS fabrication methods and translucency levels on their measured properties were inconsistent. Subjecting 1-mm-thick ZLS materials to acidic media adversely impacted their stainability and surface texture.

Effect of surface pretreatment and artificial aging on the retention of lithium disilicate crowns cemented to zirconia implant abutments

STATEMENT OF PROBLEM

Recent advancements in restorative dentistry have seen an increase in the use of ceramic restorations and zirconia implant abutments. However, how the pretreatment of a zirconia abutment and different artificial aging protocols affect the bond strength of a cemented, monolithic lithium disilicate crown is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of surface pretreatment on the retentive strength of milled lithium disilicate crowns bonded to custom zirconia implant abutments with different resin cements after thermocycling and long-term aging.

MATERIAL AND METHODS

A total of 144 crowns (n=8) were milled and bonded to 144 abutments. In the experimental groups, 72 abutments were airborne-particle abraded with 50-μm aluminum oxide before bonding. All specimens were stored at 37 °C in 100% humidity for 24 hours. Forty-eight specimens were subjected to thermocycling, and another 48 were subjected to aging for 6 months. Retentive strength was measured by using a pull-off test with a universal testing machine. Retentive strength values were calculated and compared with 3-way analysis of variance and a Tukey-Kramer post hoc test (α=.05).

RESULTS

In the 24-hour aging group, retention for all experimental groups was significantly higher (P<.05) than for the control group, except for Panavia 21 with Clearfil Ceramic Primer. In the thermocycling and long-term aging groups, all cements in the experimental group displayed significantly higher retention than the control. The airborne-particle abrasion of custom zirconia implant abutments with 50-μm aluminum oxide before bonding to lithium disilicate crowns significantly increased the bond strength of the Multilink Hybrid Abutment with Monobond Plus and RelyX Ultimate with Scotchbond Universal cements after 24-hour aging, but not of Panavia 21 with Clearfil Ceramic Primer.

CONCLUSIONS

Airborne-particle abrasion significantly increased the bond strength of all 3 cements after thermocycling and long-term aging.

Bio-inspired nacre-like zirconia/PMMA composites for chairside CAD/CAM dental restorations

OBJECTIVES

To introduce a versatile fabrication process to fabricate zirconia/PMMA composites for chairside CAD/CAM dental restorations. These zirconia composites have nacre-like lamellar microstructures, competent and tooth-matched mechanical properties, as well as crack resistance behaviours.

METHODS

Bi-directional freeze casting was used to fabricate ceramic green bodies with highly aligned lamellar structure. Pressure was then applied to control the ceramic volume fraction. PMMA was infiltrated into the ceramic scaffold. Mechanical tests including 3-point bending, Vickers hardness, and fracture toughness were performed on the composites. The machinability of the composites was also characterised.

RESULTS

Two types of nacre-like zirconia/PMMA composites, i.e., 3Y-YZP/PMMA and 5Y-PSZ/PMMA composites were fabricated. The microstructure created was similar to the 'brick and mortar' structure of nacre. Excellent flexural strength (up to 400 MPa and 290 MPa for 3Y-TZP/PMMA and 5Y-PSZ/PMMA composite, respectively), tuneable hardness and elastic modulus within the range similar to enamel, along with improved crack-resistance behaviour were demonstrated on both zirconia composites. In addition, both zirconia/PMMA composites showed acceptable machinability, being easy to mill, as would be required to produce a dental crown.

SIGNIFICANCE

Nacre-like zirconia/PMMA composites therefore exhibit the potential for use in the production of chairside CAD/CAM dental restorations.

Cerium Oxide Polishes Lithium Disilicate Glass Ceramic via a Chemical-Mechanical Process

OBJECTIVE

 The aim of the present study was to evaluate the chemical-mechanical polishing (CMP) effect of cerium oxide (ceria [CeO2]) as an abrasive to polish lithium disilicate glass ceramic.

MATERIALS AND METHODS

 For the polishing experiment, 22 lithium disilicate glass ceramic samples were prepared, polished with sandpaper using a polishing machine, their surface roughness (Ra) was measured using a profilometer, and they were randomly divided into two groups (n = 10). The samples were polished for 30 seconds with ceria paste with different ratios of deionized water:ceria by weight: 1:0.5 (C0.5) and 1:1 (C1) according to their group and the Ra values were determined. The Ra measurement was repeated after an additional 30 seconds of polishing until 120 seconds of polishing had been performed. The surface images of the postpolishing (120 seconds) samples were obtained using scanning electron microscopy (SEM) to evaluate the surface morphology. For the adsorption experiment, 10 lithium disilicate glass ceramic specimens were prepared and soaked in 50-mL deionized water. After 24 hours, the specimens were removed. Each liquid sample was divided in two halves. The first half was stored and ceria particles were added into the second half. After 24 hours, the solutions were filtered. The silicon concentration in the liquid samples was analyzed using inductively coupled plasma-optical emission spectrometry.

STATISTICAL ANALYSIS

 The difference in mean Ra value between groups was analyzed using two-way repeated analysis of variance (ANOVA) and the difference in mean silica concentrations before and after adding ceria particles was analyzed using the paired t-test. A p-value of <0.05 was considered statistically significant.

RESULTS

 Ra decreased as the ratio of ceria and polishing time increased. The surface morphology of the samples analyzed by SEM corresponded with their Ra values. The mean silicon concentration after adding ceria particles was significantly decreased (p < 0.05).

CONCLUSION

 Using a ceria-polishing paste to polish lithium disilicate glass ceramic generates a significantly smoother surface compared with baseline roughness. Moreover, CeO2 has a mechanical action and chemical reaction with lithium disilicate glass ceramic. Therefore, it can be used as a CMP paste to create a smooth surface.

Chemical and mechanical stability of an ion-exchanged lithium disilicate glass in artificial saliva

Multi-component lithium disilicate (LD) glasses were ion-exchanged in a pure or mixed nitrate salt bath. The surface morphologies, mechanical properties, chemical stability and ion leaching of ion-exchanged LD glasses before and after storage in artificial saliva for 21 days were investigated. It can be found that chemical stability of ion-exchanged LD glass was temperature-dependent. The residual compressive stress induced by ion-exchange increased the chemical potential of alkali ions in glass, and the ion-exchanged LD glass, especially 235 °C/64 h group, chemical stability in artificial saliva for 21 days were deteriorated. Back-exchange treatment could relax the stress on the outermost layer of the ion-exchanged LD glass without deteriorating its strengthening effect, and back-exchanged LD glass presented good chemical and mechanical stability in artificial saliva. The results might help to enhance the service stability of ion-exchanged LD glass-ceramics in the oral condition.

Effect of acidic media on flexural strength and fatigue of CAD-CAM dental materials

OBJECTIVE

To investigate the effect of acidic media, including beverages and gastric fluids on flexural strength and fatigue of CAD-CAM materials.

METHODS

Four CAD-CAM materials (high-translucency zirconia (Ceramill Zolid HT+), lithium disilicate (IPS e-max CAD), hybrid ceramic (Vita Enamic), and nanohybrid resin composite (Grandio Blocs) were prepared and immersed in one of five media (gastric HCl, white wine, Coca-Cola, orange juice, and artificial saliva) in an incubator (37 ℃, 24 h). Surface topography and roughness were obtained using a scanning electron microscope (SEM) and a stylus contact profilometer, respectively. Initial 3-point flexural strength was measured for half of the bars (n = 20/gp) using a universal testing machine (0.5 mm/min). The other bars underwent 10⁶ cyclic fatigue loadings before measurement of residual 3-point flexural strength. Data were statistically analyzed (two-way and three-way ANOVA, Tukey's post-hoc, p < 0.05). Weibull distributions were plotted for reliability analysis.

RESULTS

Zirconia bars has the highest initial flexural strengths followed by lithium disilicate, while resin composite and hybrid ceramic groups had the lowest strength regardless of the erosive medium. Cyclic fatigue significantly reduced initial flexural strengths for all materials except for hybrid ceramic and resin composite. Weibull moduli were the highest for zirconia, lithium disilicate and resin composite and lowest for hybrid ceramic.

SIGNIFICANCE

Erosive media significantly changed surface roughness of CAD-CAM materials except for zirconia and resin composite without jeopardizing the flexural strength of the CAD-CAM materials. Despite the higher flexural strengths for zirconia and lithium disilicate, resin composite and hybrid ceramic were more resistant to cyclic fatigue.

Silica infiltration on translucent zirconia restorations: Effects on the antagonist wear and survivability

OBJECTIVE

To assess potential antagonist wear and survival probability of silica-infiltrated zirconia compared to glass-graded, glazed, and polished zirconia.

METHODS

Table top restorations made of 3Y-TZP (3Y), 5Y-PSZ (5Y), and lithium disilicate (LD) were bonded onto epoxy resin preparations. Each zirconia was divided into five groups according to the surface treatment: polishing; glaze; polishing-glaze; glass infiltration; and silica infiltration. The LD restorations received a glaze layer. Specimens were subjected to sliding fatigue wear using a steatite antagonist (1.25 ×106 cycles, 200 N). The presence of cracks, fractures, and/or debonding was checked every one/third of the total number of cycles was completed. Roughness, microstructural, Scanning electron microscopy, wear and residual stress analyses were conducted. Kaplan-Meier, Mantel-Cox (log-rank) and ANOVA tests were performed for statistical analyses.

RESULTS

The survival probability was different among the groups. Silica infiltration and polishing-glaze led to lower volume loss than glaze and glass-infiltration. Difference was observed for roughness among the zirconia and surface treatment, while lithium disilicate presented similar roughness compared to both glazed zirconia. Scanning electron microscopy revealed the removal of the surface treatment after sliding fatigue wear in all groups. Compressive stress was detected on 3Y surfaces, while tensile stress was observed on 5Y.

SIGNIFICANCE

3Y and 5Y zirconia behaved similarly regarding antagonist wear, presenting higher antagonist wear than the glass ceramic. Silica-infiltrated and polished-glazed zirconia produced lower antagonist volume loss than glazed and glass-infiltrated zirconia. Silica-infiltrated 3Y and lithium disilicate restorations were the only groups to show survival probabilities lower than 85%.

Effect of Corrosive Media on the Chemical and Mechanical Resistance of IPS e.max® CAD Based Li2Si2O5 Glass-Ceramics

The influence of 4% acetic acid (pH~2.4) and an alkaline solution of NaOH (pH~10) on the corrosion resistance and micromechanical properties of disilicate crystals containing glass-ceramics (LS2-GC's) is studied. Partially crystallized lithium metasilicate crystal containing glass-ceramics (LS-GC's) are annealed to fully LS2-GC's using a one stage and a two-stage heating to induce nucleation. Materials with various chemical and wear resistance are prepared. The content of the crystalline phase in the material annealed in the two-stage process A is 60.0% and increases to 72.2% for the material heated in the one-stage process B. The main elements leached in the acidic medium are lithium and phosphorus, while lithium, silicon, and phosphorus leached into the alkaline environment. Material B exhibits better chemical resistance to the corrosive influence of 4% acetic acid under quasi-dynamic conditions. In the alkaline corrosion medium, silicon is leached from material A faster compared to the material B. After prolonged exposure to acidic or basic environments, both materials show evidence of surface structural changes. A decrease of the sliding wear resistance is observed after corrosion in the acidic environment under dynamic conditions. In both materials, the wear rate increases after corrosion.

Aging resistance of infiltrated monolithic zirconia compared to noninfiltrated monolithic zirconia: A systematic review of in vitro studies

Aim

The aim of the study is to systematically assess the impact of low-temperature degradation (LTD) simulation in an autoclave on mechanical and microstructural properties of infiltrated monolithic zirconia compared to the noninfiltrated zirconia.

Settings and Design

Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines.

Materials and Methods

An electronic search was done within these databases: PubMed, Scopus, and Web of Science, Science Direct, Embase, Wiley, Google Scholar for articles published between 2000 and March 2021. Search results that met eligibility criteria were categorized into two groups based on properties assessed of infiltrated monolithic zirconia exposed to LTD (also called aging simulation) - (a) mechanical (flexural strength and fracture toughness) and (b) microstructural properties (phase transformation rate and m content).

Statistical Analysis Used

Qualitative analysis.

Results

The search identified 272 preliminary results. After discarding duplicates, and screening of titles, abstracts, and full texts, 10 articles finally met inclusion criteria. Data were collected on author's details and their countries, journal and year of publication, type and percentage of infiltration, aging protocol (duration and temperature), mechanical, and microstructural properties. All the included studies invariably revealed better aging resistance without a change in mechanical properties for infiltrated monolithic zirconia as compared to noninfiltrated species.

Conclusion

Infiltration within monolithic zirconia can reduce degradation and simultaneously maintain their mechanical properties by preventing water entry into grain contours. The final m content was less for infiltrated Zirconium, indicating a lesser phase transformation and better aging resistance.

Other Information

Systematic review protocol registered at PROSPERO CRD42021248153.

A REVIEW OF MECHANICAL BEHAVIOR OF DENTAL CERAMIC RESTORATIONS

Dental ceramics are well known for restoring the function and aesthetic of lost or damaged teeth. Understanding these materials’ mechanical and aesthetic properties can make a suitable choice for those materials. The longevity of dental ceramics depends on several factors, including manufacturing method, clinical process, and the oral cavity’s aqueous environment. Failure mechanisms in restorative ceramics are complex and a combination of several factors. Different microstructures in the crystalline phase will involve the propagation of cracks and eventually the fatigue of ceramic materials. Large grains reduce mechanical performance compared to small grain sizes. Aesthetic materials used for veneering are weaker than the core materials and fail when even subjected to small loads. The soft bonding in the core–veneer interface and possible residual stresses created during the veneering method are drawbacks of these systems. Studies on the mechanical behavior of these materials have grown significantly in recent years and provide helpful information about static and fatigue experimentation and the failure behavior of various materials used in dental crowns.

Impact of varying step-stress protocols on the fatigue behavior of 3Y-TZP, 4Y-TZP and 5Y-TZP ceramic

OBJECTIVE

To test the impact of three varying step-stress protocols on the fatigue behavior of two 3Y-TZP, one 4Y-TZP and one 5Y-TZP zirconia materials.

METHODS

Eight specimens per zirconia material (N = 32) were selected for static testing to determine the start load for dynamic tests (30% of the mean value of static fracture load). 45 specimens per material (N = 180) were used for dynamic load tests using three step-stress protocols: 1. 50 N/5000 cycles; 2. 5% of static load/5000 cycles, and 3. 10 N/1000 cycles. Following materials were tested: 3Y-TZP_{(<0.25 Al2O3)} (O: opaque) 3Y-TZP_{(<0.05 Al2O3)} (T: translucent), 4Y-TZP_{(<0.01 Al2O3)} (ET: extra translucent) and 5Y-TZP_{(<0.01 Al2O3)} (HT: high translucent). The specimens (4 ± 0.02 × 3 ± 0.02 × 45 mm) were placed centrally on the support rolls and the load was applied perpendicularly over the 4 mm specimen side (∼4-point flexural strength according to the DIN 6872:2019). Data was analyzed with Kolmogorov-Smirnov-test, t-test, one-way ANOVA with post-hoc Scheffé-test, Chi-square-test, Kaplan-Meier with Log-Rank-test and two-parametric Weibull analysis (p < 0.05).

RESULTS

The step-stress protocols showed no impact on the fracture load or Weibull modulus within one zirconia material. However, the zirconia materials T, ET and HT showed differences in cycle number to fracture between the step-stress protocols (T: 3 > 2 > 1; ET: 2 > 3 > 1; HT: 2, 3 > 1) with lowest cycle number to fracture for protocol 1. Within one step-stress protocol, the cycle number to fracture varied according to the zirconia material as follows: 1: T, O ≥ O, ET > HT; 2: ET > O, T, HT; 3: O, T, ET > HT. Cracking started at the tensile side of the specimens at all times. All specimens showed typical compression curls (single or double). Fragmentation patterns were similar for all materials with a lot of crack branching and fragmentation due to secondary cracks indicating high energy fractures.

SIGNIFICANCE

Dynamic fatigue tests seem to provide important information on the long-term stability of zirconia materials. Zirconia materials with higher opacity seem to be more robust towards varying step-stress protocols than translucent zirconia materials. Regarding expenditure of time, a step-stress protocol with a load increase of 50 N every 5000 cycles seems favorable to gain information on the long-term stability of zirconia materials.

Intraoral low-temperature degradation of monolithic zirconia dental prostheses: Results of a prospective clinical study with ex vivo monitoring

OBJECTIVE

To investigate the intraoral development and kinetics of low-temperature degradation (LTD) in second-generation 3 mol.% yttria-doped tetragonal zirconia polycrystal (3Y-TZP) monolithic prostheses, as well as the influence of masticatory mechanical stress and glaze layer on it.

METHODS

A total of 101 posterior tooth elements were included in a prospective clinical study, which included ex vivo LTD monitoring (at baseline, 6 months, 1 year, and 2 years) using Raman spectroscopy (n = 2640 monoclinic phase measurement points per evaluation time) and SEM. Four types of areas (1-2 mm² surface, 6 on molars, and 4 on premolars) were analyzed on each element surface: occlusal, axial, glazed, or unglazed. Raman depth mapping and high-resolution SEM were performed on the selected samples.

RESULTS

LTD developed in 3Y-TZP monolithic restorations 6 months after intraoral placement and progressed with time. After two years, the tetragonal-to-monoclinic transformation was non-uniform, with the presence of localized clusters of transformed grains. In axial areas, the grain aspect was typical of the classical nucleation-growth process reported for LTD, which progresses from the surface to a depth of several tens of microns. However, in occlusal areas, tribological stress generated surface crushing and grain pull-out from the clusters, which induced an underestimation of the aging process when the evaluation was limited to monoclinic phase quantification. Glazing cannot be considered a protection against LTD.

SIGNIFICANCE

If LTD occurs in dental prostheses in the same way as in orthopedic prostheses, its clinical impact is unknown and needs to be further studied.

Effect of mouth rinses on optical properties of CAD-CAM materials used for laminate veneers and crowns

OBJECTIVE

The purpose of this study was to investigate the effect of mouth rinses on the color and translucency of three computer-aided design and computer-aided manufacturing (CAD-CAM) restorative materials in laminate veneer and crown thicknesses.

METHODS

Specimens from two different 5Y-TZP zirconia (InCoris TZI (IT), and Zirkonzahn (ZH)) and lithium disilicate (IPS e.max CAD [IC]) in two different thicknesses (0.7 mm for laminate veneer, and 1.5 mm for crown) were sectioned. All specimens were colored with an A2-shade liquid, and the baseline color values were recorded according to the CIELab system with a spectrophotometer. Each group was divided into two subgroups (n = 15) according to the immersion solution: two different mouth rinses, KL (Klorhex), and LI (Listerine, cool mint) for 180 hours. The color coordinates (L*, a*, b*) of the specimens were measured before and after immersion in a mouth rinse, and TP and ΔE₀₀ color differences were calculated by using the CIEDE2000 color difference formula. A 3-way ANOVA, Bonferroni test, and 1-sample t tests were used to analyze the data (α = 0.05).

RESULTS

The 3-way ANOVA revealed a significant interaction of material, thickness, and mouth rinse for translucency parameter and color difference (ΔE₀₀ ) data (p < 0.001). TP decreased for both zirconia materials in laminate veneer thickness when immersed in LI mouth rinse (p < 0.05). No difference was found among the TP mean values of three materials in crown thickness after immersed in mouth rinses (p > 0.826). Both zirconia materials immersed in LI showed greater discoloration than after immersed in KL (p < 0.05). A significant difference was found in color change values among three materials for the laminate veneer thickness after immersed in LI (p < 0.001). However, all color difference values were within the clinical acceptability threshold, except for when ZH in laminate veneer thickness was immersed in LI.

CONCLUSIONS

The color change of ZH zirconia with LI mouth rinse in laminate veneer thickness was high. For both zirconia ceramics, translucency decreased and the color was less stable in laminate veneer thickness after immersed in LI compared to the crown thickness.

CLINICAL SIGNIFICANCE

The results of this in vitro study suggest that long-term use of alcohol-containing mouth rinse may alter the optical properties of tested CAD-CAM materials in tested laminate veneer thickness. For color stability with the long term use of tested mouth rinses, lithium disilicate may be preferred for both types of restorations.

Effect of in vitro aging and acidic storage on color, translucency, and contrast ratio of monolithic zirconia and lithium disilicate ceramics

STATEMENT OF PROBLEM

How the translucency and color of ceramic restorations are affected by surface changes from the corrosive environment in the oral cavity and aging of materials is unclear.

PURPOSE

The purpose of this in vitro study was to compare the impact of acidic exposure and aging on the color and translucency of monolithic zirconia and lithium disilicate ceramics.

MATERIAL AND METHODS

Twenty computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic zirconia specimens and 20 pressed lithium disilicate specimens were fabricated. Half of the specimens of each group were aged in an autoclave (7.5 hours, 134 °C, 0.2 MPa), and the rest were immersed in hydrochloric acid to simulate the acidic conditions in the oral cavity from gastric reflux. The color coordinates L∗, a∗, and b∗ were measured with an ultraviolet spectrophotometer before and after aging or acidic storage. The translucency parameters and contrast ratios were calculated, and the CIEDE2000 color difference formula was used to determine color differences before and after each treatment. ANOVA and ANCOVA test models were used for data analysis (α=.05), while differences of color parameters in respect to acceptability and perceptibility thresholds were evaluated with the 1-sample t test (α=.05).

RESULTS

Lithium disilicate presented a significantly higher translucency parameter and lower contrast ratio at baseline compared with monolithic zirconia specimens (P<.001). Acidic storage significantly impacted all parameters compared with aging, especially for the lithium disilicate group. Color differences were above the acceptability ΔΕ₀₀ threshold for lithium disilicate after acidic storage (P=.001) and below for monolithic zirconia after acidic storage (P=.003).

CONCLUSIONS

The performance of lithium disilicate was slightly inferior compared with that of monolithic zirconia specimens, as they presented significant and clinically observable differences for the translucency parameter and ΔΕ₀₀ after acidic storage and aging.

In vivo ageing of zirconia dental ceramics - Part II: Highly-translucent and rapid-sintered 3Y-TZP

OBJECTIVE

3Y-TZP ceramics with reduced alumina content have improved translucency and are used in monolithic dental restorations without porcelain-based veneers. The workflow can be further streamlined with rapid sintering. This study was designed to assess how these approaches affect ageing when the materials are exposed to the oral environment in vivo.

METHODS

43 discs were fabricated from 3Y-TZP powder with 0.05% Al₂O₃ and sintered with conventional or rapid regimens (1450 °C 2 h, 1530 °C 2 h, or 1530 °C 25 min). Their surfaces were polished or airborne-particle abraded with 50 μm Al₂O₃. The discs were incorporated in complete dentures of 16 volunteers and worn continuously for up to 48 months. Ageing changes on disc surfaces were monitored every 6 months by X-ray diffraction, scanning electron microscopy and atomic force microscopy. Data was statistically analysed with linear models.

RESULTS

The amount of monoclinic phase on polished surfaces increased linearly, reaching up to 40% after 48 months in vivo. The ageing process observed for rapid sintering was 1.6 times faster compared to conventional sintering. A nano-scale increase in roughness with microcracking was also detected on polished surfaces. Airborne-particle abraded surfaces did not exhibit clear signs of ageing during the course of the study.

SIGNIFICANCE

Highly-translucent 3Y-TZP ceramics are more susceptible to ageing than classic 3Y-TZP. After 4 years in vivo, the extent of degradation did not yet constitute grounds for clinical concern, but was more pronounced in materials prepared with rapid sintering.

In vivo aging of zirconia dental ceramics - Part I: Biomedical grade 3Y-TZP

OBJECTIVE

In vivo aging of biomedical grade 3Y-TZP ceramics in the oral environment was assessed and compared to artificially accelerated in vitro hydrothermal aging extrapolations at 37°C.

METHODS

88 discs were pressed and sintered (1450-1500°C) from two commercial 3Y-TZP compositions containing 0.25% Al₂O₃ to generate finer- and coarser-grained specimens. As-sintered (AS) and airborne-particle abraded (APA; 50μm Al₂O₃) surfaces were investigated. In vivo aging was performed by incorporating specimens in lingual flanges of complete dentures of 12 edentulous volunteers who wore them continuously for up to 24 months. For comparison, in vitro hydrothermal aging at 134°C was also performed and analysed by XRD and (FIB)-SEM. Data was statistically analysed with linear regression models.

RESULTS

Finer and coarser-grained specimens exhibited statistically insignificant differences in aging in vivo. The monoclinic fraction (X_m) on AS surfaces abruptly increased to ∼8% after 6 months. The aging process then proceeded with slower linear kinetics (∼0.24%/month). After 24 months, X_m reached ∼12%. The calculated maximum transformed layer was 0.385μm representing one layer of transformed grains. APA surfaces were highly aging resistant. The initial X_m of ∼4.0% linearly increased by 0.03%/month in vivo. In vitro aging exhibited an initial induction period, followed by linear aging kinetics. Coarser-grained AS surfaces aged significantly faster than fine-grained (2.41%/h compared to 2.16%/h). APA discs aged at a rate of 0.3%/h in vitro. Microcracking within a single grain and pull-out of grain clusters were observed on aged AS surfaces.

SIGNIFICANCE

Biomedical grade 3Y-TZP was susceptible to in vivo aging. After 2 years in vivo, the aging kinetics were almost 3-times faster than the generally accepted in vitro-in vivo extrapolation.

Surface Characterization and Conductivity of Two Types of Lithium-Based Glass Ceramics after Accelerating Ageing

In this study, two different dental ceramics, based on zirconia-reinforced lithium-silicate (LS1) glass-ceramics (Celtra Duo, Dentsply Sirona, Bensheim, Germany) and lithium disilicate (LS2) ceramics (IPS e.max CAD, Ivoclar, Vivadent, Schaan, Liechtenstein) were examined. They were tested prior to and after the crystallization by sintering in the dental furnace. Additionally, the impact of ageing on ceramic degradability was investigated by immersing it in 4% acetic acid at 80 °C for 16 h. The degradability of the materials was monitored by Impedance Spectroscopy (IS), X-Ray Powder Diffraction (XRPD), and Field Emission Scanning Electron Microscope (FE-SEM) techniques. It was detected that LS2 (vs. LS1) samples had a lower conductivity, which can be explained by reduced portions of structural defects. XRPD analyses also showed that the ageing increased the portion of defects in ceramics, which facilitated the ion diffusion and degradation of samples. To summarize, this study suggests that the non-destructive IS technique can be employed to probe the ageing properties of the investigated LS1 and LS2 ceramics materials.

Wear of feldspathic-ceramic-veneered zirconia posterior FPDs after 10 years

Background

The abrasion behavior of various ceramics is rarely investigated, though it is relevant for the clinical success of such restorations. The aim of this in vivo study was to evaluate the wear of feldspathic-ceramic-veneered zirconium oxide frameworks over a period of at least 10 years.

Methods

The abrasion behavior of 15 bridge constructions from 15 different participants was examined after a period of 3, 5, and 10 years using plaster models, which were then subjected to a scanning process on the Atos II industrial scanner and digitized for three-dimensional evaluation of the abrasion by the corresponding software (ATOS Professional 7.6). The individual post-examination models were compared to the baseline model and deviations calculated in the sense of the largest, punctual loss of material in millimeters (“minimal distance”), the average abrasion in millimeters (“mean distance”), and the volume decrease in cubic millimeters (“integrated distance”). Statistical analyses were performed using the Wilcoxon sign rank test or mixed regression models. Multiple testing was considered by Benjamini-Hochberg correction. The significance level was set at 0.05.

Results

We found steadily increasing wear of the ceramic. The average volume decrease was significant (P < 0.001) at 3 years and 10 years (− 3.25 mm³ and − 8.11 mm³, respectively).

Conclusions

The results of this study indicate that the rate of volume loss in feldspathic-ceramic-veneered zirconia frameworks in the posterior region increases significantly over time. An increasing frequency of parameters was observed, particularly in the second half of the study period. However, the use of this class of materials can be considered clinically acceptable.

Trial registration This study is registered in DRKS - German Clinical Trials Register with the register number DRKS00021743. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021743

Comparison of mechanical properties of different reinforced glass-ceramics

STATEMENT OF PROBLEM

Data concerning the mechanical properties of the newly developed lithium disilicate ceramic HS10PC are lacking.

PURPOSE

The purpose of this in vitro study was to investigate the flexural strength (FS), Martens hardness (HM), indentation modulus (E_IT), fracture load (FL), and wear resistance (WR) of HS10PC compared with those of the established glass-ceramics IPS e.max Press and IPS Empress Esthetic.

MATERIAL AND METHODS

Four pressable glass-ceramics were examined: HS10PC (estetic ceram ag), IPS e.max Press low translucency (LT) and high translucency (HT; Ivoclar Vivadent AG), and IPS Empress Esthetic (ES; Ivoclar Vivadent AG). For each material, a total of 85 specimens were fabricated. Specimens were subdivided into 4 groups for FS (n=30), HM, E_IT (n=10), and FL measurement according to the Voss test after artificial aging in an autoclave (n=15), artificial aging in a mastication simulator (n=15), and no artificial aging (n=15). In addition, WR (n=10) was measured after 240 000, 600 000, and 1 200 000 masticatory cycles. Data were statistically analyzed using the global univariate ANOVA, the Scheffé post hoc and paired t tests, and Weibull distribution (α=.05).

RESULTS

HT showed the highest FS, while ES presented the lowest FS of all groups (P<.001). ES showed lower values for HM (P<.001), E_IT (P<.001), and FL for specimens treated in an autoclave and mastication simulator (P<.001) compared with all other groups. An increase in the wear of the ceramic and enamel antagonist between 240 000 and 1 200 000 masticatory cycles was observed for all groups (P<.001). After 1 200 000 masticatory cycles, HS10PC presented less wear of the ceramic than the other 3 materials (P=.003).

CONCLUSIONS

The newly developed lithium disilicate ceramic HS10PC showed comparable results with the established IPS e.max Press for FS, HM, E_IT, FL, and WR. Lithium disilicate ceramics presented higher mechanical results than the leucite-reinforced ES, with all the ceramics showing similar results for the WR of the enamel antagonist.

Effect of erosive and abrasive challenges on the glaze layer applied to ceramic materials

PURPOSE

This study aims to evaluate the effect of erosive, abrasive, and erosive/abrasive challenges on the glaze layer of ceramic materials.

METHODS

Ninety-five samples of monolithic zirconia (MZ) (LuxaCam Zircon HT-Plus) and lithium disilicate (LD) (IPS e.max CAD) were divided according to the response variables: Surface roughness and surface loss (n = 10), evaluated with optical profilometry; surface topography, with scanning electron microscopy SEM (n = 3); and biofilm deposition, with microbiological assay (n = 5). The evaluations were performed in three different time evaluations: (a) Sintered, (b) Glaze, and (c) Challenge (Erosion, Abrasion, and Erosion/Abrasion). Erosion consisted in immersing specimens in HCl solution, abrasion was performed with brushing machine, and erosion/abrasion consisted of a combination of the two previous protocols. Data were analyzed with parametric tests (P < 0.05).

RESULTS

MZ glaze layer presented significantly higher surface roughness (P = 0.00), surface loss (P = 0.03), and biofilm deposition (P = 0.00) than LD. Abrasion and erosion/abrasion showed similar outcomes, generating significantly higher surface roughness (P = 0.00), surface loss (P = 0.00), and biofilm deposition (P = 0.01) than erosion.

CONCLUSIONS

Glaze layer properties were altered by the challenges, with abrasion and erosion/abrasion generating higher surface roughness, surface loss, and biofilm deposition than erosion. A significant correlation was found between the surface roughness and biofilm deposition.

CLINICAL SIGNIFICANCE

The glaze layer is susceptible to challenges, especially to abrasion and erosion/abrasion, which generated greater surface roughness and surface loss than erosion. The greater surface roughness lead to a greater biofilm deposition on the glaze layer.

Surface Characterization and Optical Properties of Reinforced Dental Glass-Ceramics Related to Artificial Aging

The development of various dental glass-ceramic materials and the evolution of novel processing technologies lead to an essential change in the clinical and technical workflow. The long-term success of a dental restoration treatment is defined by its durability, which is directly influenced by the oral environment. This study's purpose was to evaluate the artificial aging behavior of nanostructured, respective microstructured ceramics related to surface topography, roughness, and optical properties. Six monolithic restoration materials were selected: milled lithium disilicate glass-ceramic (LDS-M) MT (medium translucency), hot-pressed lithium disilicate glass-ceramic (LDS-P) MT and HT (high translucency), milled zirconia-reinforced lithium silicate ceramic (ZLS-M) MT and hot-pressed zirconia-reinforced lithium silicate ceramic (ZLS-P) MT and HT, resulting n = 96 surfaces. All the samples were artificially aged by thermal cycling, and all investigations were made before and after thermal cycling. In terms of optical properties, differences recorded between ZLS and LDS ceramics are not significant. Thermal cycling increases the translucency of ZLS and LDS glass-ceramic materials significantly, with the most harmful effect on the pressed and polished samples. Micro- and nano roughness are significantly influenced by in vitro aging and a negative correlation was recorded. Glazed samples are characterized by significant rougher surfaces for all types of materials. On nanolevel, ZLS materials are significantly smoothed by thermal cycling.

High-translucent yttria-stabilized zirconia ceramics are wear-resistant and antagonist-friendly

OBJECTIVES

To evaluate two-body wear of three zirconia ceramics stabilized with 3, 4 and 5mol% yttria and to compare their wear behavior with that of a lithium-disilicate glass-ceramic.

METHODS

Sixteen rectangular-shaped specimens made from three grades of zirconia ceramics and a lithium-disilicate glass-ceramic were polished and dynamically loaded in a chewing simulator (2kg vertical load, 2.1Hz) under water at 90°C for 1.2×10⁶ cycles (about 7 days) in the ball-on-plate mode against steatite antagonists. Surface roughness was measured before and after wear testing. Wear tracks were scanned with a non-contact 3D profilometer and super-impositions were used to determine wear loss of the antagonists. Wear surfaces were imaged by SEM. XRD and micro-Raman spectroscopy were used to characterize phase transformation and stress status in the worn and unworn areas of the zirconia ceramics.

RESULTS

Independent of fracture toughness, strength and aging-susceptibility, the three zirconia ceramics showed a similar and limited amount of wear (∼10μm in depth) and were more wear-resistant than the lithium-disilicate glass-ceramic (∼880μm in depth). Abrasive wear without obvious cracks was observed for all investigated zirconias, whereas the glass-ceramic with a lower fatigue threshold and high susceptibility to surface dissolution exhibited significant abrasion, fatigue and corrosion wear. All three zirconia ceramics yielded a lower antagonist wear than the glass-ceramic and no significant differences were found between the zirconia ceramics.

SIGNIFICANCE

In the context of this study, high-translucent zirconia ceramics stabilized with a higher yttria content, recently introduced in the dental field, were as wear-resistant and antagonist-friendly as conventional high-strength zirconia and suitable for monolithic restorations.

Trade-off between fracture resistance and translucency of zirconia and lithium-disilicate glass ceramics for monolithic restorations

High strength and translucency are generally not coincident in one restorative material and there is still a continuous development for a better balance between these two properties. Zirconia and lithium-disilicate glass-ceramics are currently the most popular alternatives for monolithic restorations. In this work, the mechanical properties and more important, the slow crack growth (SCG) resistance, which rules long-term durability, were thoroughly studied for three zirconia ceramics stabilized by 3, 4 and 5 mol% yttria in comparison to lithium-disilicate glass-ceramic. Translucency versus strength maps revealed that the more translucent zirconia compositions (i.e. with higher yttria contents) fill the gap between the standard 3 mol% yttria stabilized zirconia (3Y-TZP) and lithium-disilicate. Moreover, increasing yttria content did not always result in lower strength, as values for 3 mol% and 4 mol% yttria were the same. Independent on the yttria contents, all zirconia showed similar relative susceptibility to SCG under static and cyclic conditions and were significantly more SCG-resistant than lithium-disilicate glass ceramic. A concern with higher yttria contents (5 and 4 mol%) however could lie in the higher sensitivity to defects, resulting in a larger scatter in strength. STATEMENT OF SIGNIFICANCE: In addition to the common investigations on the generally reported strength, toughness and translucency, V-K_I diagrams (crack velocity versus stress-intensity factor) from fast fracture to threshold for three newly developed zirconia were directly measured by double torsion methods under static and cyclic loading conditions. The crack-growth mechanisms were analyzed in depth. Results were compared with another popular dental ceramic, namely lithium-disilicate glass-ceramic, revealing the pros and cons of polycrystalline and glass-ceramics in terms of long-term durability. This is the first time that V-K_I curves are compared for the major ceramic and glass-ceramic used for dental restorations. Strength versus translucency maps for different CAD/CAM dental restorative materials were described, showing the current indication range for zirconia ceramics.

Biomechanical behavior of cavity design on teeth restored using ceramic inlays: An approach based on three-dimensional finite element analysis and ultrahigh-speed camera

Ceramic fracture and debonding are the primary failures that follow ceramic inlay and can lead to stress and tooth fracture. In this study, we examined two designs-concave and flat-of the gingival cavity bottom for tooth cavities restored using ceramic inlays. We investigated the biomechanical behavior of ceramic inlay-restored teeth (concave and flat) through three-dimensional finite element analysis (FEA) and experimentally validated the results using an ultrahigh-speed camera. We conducted in vitro real-time recording of the deformation of a restored tooth during loading using an ultrahigh-speed camera. This technique enables further image registration to observe deformation variation and vector fields. The deformation vector fields revealed that the concave design moved the deformation toward the buccal side of the cavity bottom, whereas the flat design moved it toward the palatal side. These findings correlated with the FEA results, which indicated that the concave design constrained stress in the dentin cavity and relieved palatal stress. Our results suggest that incorporating a concave design in cavity preparation can improve the fracture resistance of ceramic inlay-restored teeth, preventing unrestorable fractures. The current study is the first to utilize an ultrahigh-speed camera in dental biomechanics, and such cameras are useful for nondestructive and dynamic analysis. STATEMENT OF SIGNIFICANCE: First utilize ultrahigh-speed cameras in dental biomechanics analysis. Tooth fracture videos captured by ultrahigh-speed camera helps us learn fracture mechanics in between tooth cavity design and ceramic inlay. Concave design leads to stress in safer areas that causes a less damaging fracture. Minimal invasive preparation by concave design strengthens tooth fracture resistance. Non-destructive data from ultrahigh-speed cameras combined with FEA can get more insight into how the stress and strain derived in biomaterials.

Recent advances in understanding the fatigue and wear behavior of dental composites and ceramics

Dental composite and ceramic restorative materials are designed to closely mimic the aesthetics and function of natural tooth tissue, and their longevity in the oral environment depends to a large degree on their fatigue and wear properties. The purpose of this review is to highlight some recent advances in our understanding of fatigue and wear mechanisms, and how they contribute to restoration failures in the complex oral environment. Overall, fatigue and wear processes are found to be closely related, with wear of dental ceramic occlusal surfaces providing initiation sites for fatigue failures, and subsurface fatigue crack propagation driving key wear mechanisms for composites, ceramics, and enamel. Furthermore, both fatigue and wear of composite restorations may be important in enabling secondary caries formation, which is the leading cause of composite restoration failures. Overall, developing a mechanistic description of fatigue, wear, and secondary caries formation, along with understanding the interconnectivity of all three processes, are together seen as essential keys to successfully using in vitro studies to predict in vivo outcomes and develop improved dental restorative materials.

Clinical and patient-reported outcomes of zirconia-based implant fixed dental prostheses: Results of a prospective case series 5 years after implant placement

OBJECTIVE

To evaluate the clinical and patient-reported outcome of all-ceramic zirconia implant supported fixed dental prostheses (FDPs) 5 years after implant installation.

MATERIALS AND METHODS

Thirteen patients were treated with two terminally placed one-piece zirconia implants for a three-unit FDP each. The FDPs consisted of a CAD/CAM-fabricated zirconia framework over-pressed with a fluor-apatite veneering ceramic and were adhesively cemented. Survival and success were assessed by applying modified US Public Health Service (USPHS) criteria and preparation of Kaplan-Meier (KM) plots. Alpha and Bravo ratings were accepted for success (among others including small area veneer chippings and occlusal roughness), whereas Charlie ratings allowing for intra-oral correction (e.g., polishing) were accepted for survival. Furthermore, patient-reported outcome measures (PROMs) were analyzed with the help of visual analogue scales (VAS). Wilcoxon matched-pairs signed-rank test (USPHS criteria) and linear mixed models (PROMs) were used to evaluate time effects on response variables.

RESULTS

All patients were available 61.8 ± 1.1 months after implant installation (53.6 ± 3.1 months after final prosthesis insertion). FDP survival was 100%. Significant incidence of veneer chipping (p = .0096) and occlusal roughness (p = .0019) was observed. Charlie rated extent of both phenomena resulted in a KM success estimate of 38.5% (95% CI: 14.1%-62.8%; seven FDPs with obvious roughness, three of them with extended veneer chipping). Compared with the pre-treatment assessments (30%-81% of satisfaction), all surveys at prosthetic delivery showed significantly improved VAS scores (66%-93%; p ≤ .038), except for speech (p = .341). Concerning function, esthetics and self-esteem, no decrease in satisfaction could be observed until the end of follow-up (90%-96%; p ≥ .057), whereas perception of sense (92%) and speech (95%) increased over time (p ≤ .030). Occurrence of technical complications did not correlate with patient satisfaction.

CONCLUSIONS

Bi-layered FDPs made from zirconia/fluor-apatite highly satisfied patients but showed significant incidence of technical complications.

Effects of small-grit grinding and glazing on mechanical behaviors and ageing resistance of a super-translucent dental zirconia

OBJECTIVES

The purpose of this study is to elucidate the effects of small-grit grinding on the mechanical behaviors and ageing resistance of a super-translucent dental zirconia and to investigate the necessity of glazing for the small-grit ground zirconia.

METHODS

Small-grit grinding was performed using two kinds of silicon carbide abrasive papers. The control group received no grinding. The unground surfaces and the ground surfaces were glazed by an experienced dental technician. Finally, the zirconia materials were thermally aged in water at 134°C for 5h. After aforementioned treatments, we observed the surface topography and the microstructures, and measured the extent of monoclinic phase, the nano-hardness and nano-modulus of the possible transformed zone and the flexural strength.

RESULTS

Small-grit grinding changed the surface topography. The zirconia microstructure did not change obviously after surface treatments and thermal ageing; however, the glaze in contact with zirconia showed cracks after thermal ageing. Small-grit grinding did not induce a phase transformation but improved the flexural strength and ageing resistance. Glazing prevented zirconia from thermal ageing but severely diminished the flexural strength. The nano-hardness and nano-modulus of the surface layer were increased by ultrafine grinding.

CONCLUSIONS

The results suggest that small-grit grinding is beneficial to the strength and ageing resistance of the super-translucent dental zirconia; however, glazing is not necessary and even impairs the strength for the super-translucent dental zirconia.

CLINICAL SIGNIFICANCE

This study is helpful to the researches about dental grinding tools and maybe useful for dentists to choose reasonable zirconia surface treatments.

A review of engineered zirconia surfaces in biomedical applications

Zirconia is widely used for load-bearing functional structures in medicine and dentistry. The quality of engineered zirconia surfaces determines not only the fracture and fatigue behaviour but also the low temperature degradation (ageing sensitivity), bacterial colonization and bonding strength of zirconia devices. This paper reviews the current manufacturing techniques for fabrication of zirconia surfaces in biomedical applications, particularly, in tooth and joint replacements, and influences of the zirconia surface quality on their functional behaviours. It discusses emerging manufacturing techniques and challenges for fabrication of zirconia surfaces in biomedical applications.

Ageing kinetics and strength of airborne-particle abraded 3Y-TZP ceramics

OBJECTIVE

The combined effects of alumina airborne-particle abrasion and prolonged in vitro ageing on the flexural strength of 3Y-TZP ceramic have been studied. The aim was to identify the different effects on the surface and subsurface regions that govern the performance of this popular bioceramic known for its susceptibility to low-temperature degradation (LTD).

METHODS

As-sintered or airborne-particle abraded 3Y-TZP discs were subjected to ageing at 134°C for up to 480h. Biaxial flexural strength was measured and the relative amount of monoclinic phase determined using X-ray diffraction. The transformed zone depth (TZD) was observed on cross-sections with scanning electron microscopy coupled with a focused ion beam. Segmented linear regression was used to analyze the flexural strength and TZD as functions of the ageing time.

RESULTS

A two-step linear ageing kinetics was detected in airborne-particle abraded specimens, reflecting the different microstructures through which the LTD proceeds into the bulk. A 10μm thick altered zone under the abraded surface was involved in both the surface strengthening and the increased ageing resistance. When the zone was annihilated by the LTD, the strength of the ceramic specimens and the speed of LTD returned to the values measured before abrasion. Even at prolonged ageing times, the strength of abraded groups was not lower than that of as-sintered groups.

SIGNIFICANCE

Both the ageing kinetics and the flexural strength were prominently affected by airborne-particle abrasion, which altered the subsurface microstructure and phase composition. Airborne-particle abrasion was not harmful to the 3Y-TZP ceramics' stability.

Grain-Boundary Engineering for Aging and Slow-Crack-Growth Resistant Zirconia

Ceramic materials are prone to slow crack growth, resulting in strength degradation over time. Although yttria-stabilized zirconia (Y-TZP) ceramics have higher crack resistance than other dental ceramics, their aging susceptibility threatens their long-term performance in aqueous environments such as the oral cavity. Unfortunately, increasing the aging resistance of Y-TZP ceramics normally reduces their crack resistance. Our recently conducted systematic study of doping 3Y-TZP with various trivalent cations revealed that lanthanum oxide (La₂O₃) and aluminum oxide (Al₂O₃) have the most potent effect to retard the aging kinetics of 3Y-TZP. In this study, the crack-propagation behavior of La₂O₃ and Al₂O₃ co-doped 3Y-TZP ceramics was investigated by double-torsion methods. The grain boundaries were examined using scanning transmission electron microscopy and energy-dispersive spectroscopy (STEM-EDS). Correlating these analytic data with hydrothermal aging studies using different doping systems, a strategy to strongly bind the segregated dopant cations with the oxygen vacancies at the zirconia-grain boundary was found to improve effectively the aging resistance of Y-TZP ceramics without affecting the resistance to crack propagation.

Wear Behavior of Ceramic CAD/CAM Crowns and Natural Antagonists

OBJECTIVE

Evaluation of wear behavior of computer-aided design/computer-aided manufacturing (CAD/CAM) crowns from various restorative materials and natural antagonists.

METHOD

Full CAD/CAM crowns fabricated with nanoceramic resin (Lava Ultimate (LU)), a glass ceramic in a resin interpenetrating matrix (Vita Enamic (VE)) and a lithium silicate reinforced ceramic enriched with zirconia (Vita Suprinity (VS)) were cemented on human molars. The crown and antagonists were subjected to simulated chewing. 3D data sets, before and after the chewing simulation, were generated and matched. Occlusal surface roughness, vertical and volume loss of the crowns and antagonists were analyzed.

RESULTS

Crown roughness was significantly different between the LU and VE groups after chewing simulation. Crown vertical loss differed in all groups. The highest crown volume loss was found in the LU group, and the lowest in the VE group. Comparisons between the LU and VE groups and the LU and VS groups were significantly different. The highest antagonist volume loss was reached in the VE group, the lowest was in the LU group.

CONCLUSION

Roughness increased after chewing simulation. LU crowns are the most natural antagonist-friendly; these were the most susceptible to vertical and volume loss. Of the tested materials, the VE crowns are the most stable regarding occlusion.

Effect of different acidic solutions on the optical behavior of lithium disilicate ceramics

STATEMENT OF PROBLEM

The stability of the optical characteristics of dental ceramics is essential. Degradation of these materials resulting from pH or temperature alterations in the oral cavity can lead to treatment failure.

PURPOSE

The purpose of this in vitro study was to evaluate the color change (ΔE), the L* coordinate, the translucency parameter, and the contrast ratio of lithium disilicate ceramic exposed to commonly used and potentially colorant solutions.

MATERIAL AND METHODS

Fifty lithium disilicate specimens were prepared and divided into 5 groups according to the immersion solution (artificial saliva, orange juice, cola, coffee, and red wine). Immersions in acidic beverages were alternated in a thermocycler with artificial saliva. The control group was immersed in artificial saliva at 37°C throughout the immersion period. After 168 hours of immersion, the color parameters were assessed with a spectrophotometer and calculated using the because system on 2 backgrounds (black and white) and in 2 time periods, before thermocycling and after thermocycling. Data were submitted to analysis of variance followed by the Tukey honest significant difference test (α=.05).

RESULTS

Greater color change (ΔE) and lower L* coordinate values were observed after immersion in orange juice and cola. Regarding the translucency parameter and contrast ratio, the immersion in coffee resulted in greater opacity and lower translucency of the material.

CONCLUSIONS

Alterations in the color stainability, the L* coordinate values, the translucency parameter, and the contrast ratio of the lithium disilicate ceramic were observed, according to the acidic solutions tested.

Effects of two grading techniques of zirconia material on the fatigue limit of full-contour 3-unit fixed dental prostheses

OBJECTIVE

This study evaluated the effects of two grading techniques of zirconia material on the fatigue limit of full-contour 3-unit fixed dental prostheses (FDPs).

METHODS

Presintered blocks of 3Y-TZP were milled to obtain sixty-nine 3-unit FDPs, which were divided into three groups (n=23). The control group (CTL) was sintered and glazed following manufacturer's instructions. In the two experimental groups presintered FDPs received a surface silica/glass infiltration treatment before the sintering process. Silica sol-gel group (SSG) was graded by the sol-gel processing route, while the glass-zirconia-glass group (GZG) was graded by an enameling technique. Graded groups did not receive a glaze layer after sintering. All FDPs were then luted with a dual-curing resin cement on composite abutments, embedded in polyurethane and stored in water for five days. The initial load of the fatigue test was calculated based on the results of the monotonic testing applied on three specimens of each group. To determine the fatigue limit, 20 samples of each group were subjected to staircase testing (100,000 cycles/5Hz).

RESULTS

The fatigue limits (in Newtons) were CTL=1607.27, SSG=1824.31, and GZG=2006.57, and the Dixon and Mood test indicated statistically significant differences among groups (95% confidence interval) (GZG > SSG > CTL).

SIGNIFICANCE

The infiltration of silica and glass on bulk zirconia, by two different grading methods, increased the fatigue limits of monolithic zirconia FDPs.

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.

Impact of gastric acidic challenge on surface topography and optical properties of monolithic zirconia

OBJECTIVE

To evaluate the surface topography and optical properties of monolithic zirconia after immersion in simulated gastric acid.

MATERIALS AND METHODS

Four partially stabilized (PSZ) and one fully stabilized (FSZ) zirconia materials were selected for the study: Prettau (PRT, Zirkonzahn), Zenostar (ZEN, Ivoclar), Bruxzir (BRX, Glidewell), Katana (KAT, Noritake) and FSZ Prettau Anterior (PRTA, Zirkonzahn). IPS e.max (Ivoclar) was used as a control. The specimens (10×10×1.2mm, n=5 per material) were cut, sintered, polished and cleaned before immersed in 5ml of simulated gastric acid solution (Hydrochloric acid (HCl) 0.06M, 0.113% solution in deionized distal water, pH 1.2) for 96h in a 37°C incubator. Specimens were weighed and examined for morphological changes under scanning electron microscope (SEM) coupled with energy dispersive X-ray spectroscopy (EDX). Surface roughness was evaluated by a confocal microscope. Surface gloss and translucency parameter (TP) values were determined by a reflection spectrophotometer before and after acid immersion. The data was analyzed by one-way ANOVA followed by Tukey's HSD post hoc test (p<0.05).

RESULTS

PRTA displayed the most weight loss (1.40%) among the zirconia specimens. IPS e.max showed about three times more weight loss (3.05%) than zirconia specimens as an average. SEM examination indicated areas of degradation, bead-like shapes and smoothening of the polishing scratches after acid immersion. EDX displayed ion interactions and possible ion leaching from all specimens. Sa and Sq values for PRTA, ZEN and IPS e.max were significantly lower (p<0.05) after acid immersion. TP values increased significantly for PRT, ZEN and IPS e.max (p<0.05), while the surface gloss of ZEN, PRTA and IPS e.max increased (p<0.05).

SIGNIFICANCE

Monolithic zirconia materials show some surface alterations in an acidic environment with minimum effect on their optical properties. Whether a smoother surface is in fact a sign of true corrosion resistance or is purely the result of an evenly progressive corrosive process is yet to be confirmed by further research.

All-Ceramic Single Crown Restauration of Zirconia Oral Implants and Its Influence on Fracture Resistance: An Investigation in the Artificial Mouth

The aim of the current investigation was to evaluate the fracture resistance of one-piece zirconia oral implants with and without all-ceramic incisor crowns after long-term thermomechanical cycling. A total of 48 implants were evaluated. The groups with crowns (C, 24 samples) and without crowns (N, 24 samples) were subdivided according to the loading protocol, resulting in three groups of 8 samples each: Group “0” was not exposed to cyclic loading, whereas groups “5” and “10” were loaded with 5 and 10 million chewing cycles, respectively. This resulted in 6 different groups: C0/N0, C5/N5 and C10/N10. Subsequently, all 48 implants were statically loaded to fracture and bending moments were calculated. All implants survived the artificial aging. For the static loading the following average bending moments were calculated: C0: 326 Ncm; C5: 339 Ncm; C10: 369 Ncm; N0: 339 Ncm; N5: 398 Ncm and N10: 355 Ncm. To a certain extent, thermomechanical cycling resulted in an increase of fracture resistance which did not prove to be statistically significant. Regarding its fracture resistance, the evaluated ceramic implant system made of Y-TZP seems to be able to resist physiological chewing forces long-term. Restauration with all-ceramic single crowns showed no negative influence on fracture resistance.

Surface roughness and hardness of yttria stabilized zirconia (Y-TZP) after 10 years of simulated brushing

Introduction: The Y-TZP zirconia used for prosthetic infrastructure, in some clinical situations, can be exposed to the oral environment. In these situations, a polished surface without changes is extremely important. Objective: The aim of this study was to evaluate the mean roughness (Ra) and Vickers hardness of Y-TZP zirconia (Lava™) after simulating ten years of brushing. Material and method: Thirty-six Y-TZP bar-shaped specimens (20mm X 4mm X 1.2mm) were divided into three groups: storage in distilled water (DW, n=12, control); brushing with distilled water (BDW, n=12) and brushing with distilled water and fluoride toothpaste (BFT, n=12). Brushing was performed using a brushing machine with a soft-bristled toothbrush, simulating 10 years of brushing (878.400 cycles, 100gf). The mean roughness (Ra in μm) and Vickers hardness (VHN) of all specimens were measured twice: before and after the experimental treatment, in profilometer and microhardness tester (500gf, 30 seconds), respectively. Data were analyzed using the two-way ANOVA test (α = 0.05). Result: The interaction between groups was not significant for roughness (p = 0.701) nor for hardness (p = 0.928). The final averages for Ra (μm) were equal to: DW - 0.63; BDW - 0.64; and, BFT - 0.68. The final averages for Vickers hardness (VHN) were: DW - 1301.16; BDW - 1316.60; and, BFT - 1299.58. Conclusion: It was concluded that the brushing with distilled or fluoridated toothpaste was not able to change the roughness and hardness of Y-TZP zirconia used in this study.

Emerging ceramic-based materials for dentistry

Our goal is to give an overview of a selection of emerging ceramics and issues for dental or biomedical applications, with emphasis on specific challenges associated with full-contour zirconia ceramics, and a brief synopsis on new machinable glass-ceramics and ceramic-based interpenetrating phase composites. Selected fabrication techniques relevant to dental or biomedical applications such as microwave sintering, spark plasma sintering, and additive manufacturing are also reviewed. Where appropriate, the authors have added their opinions and guidance.