Effects of alumina-blasting pressure on the bonding to super/ultra-translucent zirconia

Different surface treatments and adhesive monomers for zirconia-resin bonds: A systematic review and network meta-analysis

This review examined the efficacy of surface treatments and adhesive monomers for enhancing zirconia-resin bond strength. A comprehensive literature search in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library yielded relevant in vitro studies. Employing pairwise and Bayesian network meta-analyses, 77 articles meeting inclusion criteria were analyzed. Gas plasma was found to be ineffective, while treatments including air abrasion, silica coating, laser, selective infiltration etching, hot etching showed varied effectiveness. Air abrasion with finer particles (25-53 µm) showed higher immediate bond strength than larger particles (110-150 µm), with no significant difference post-aging. The Rocatec silica coating system outperformed the CoJet system in both immediate and long-term bond strength. Adhesives containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) were superior to other acidic monomers. The application of 2-hydroxyethyl methacrylate and silane did not improve bonding performance. Notably, 91.2 % of bonds weakened after aging, but this effect was less pronounced with air abrasion or silica coating. The findings highlight the effectiveness of air abrasion, silica coating, selective infiltration etching, hot etching, and laser treatment in improving bond strength, with 10-MDP in bonding agents enhancing zirconia bonding efficacy.

Randomized clinical trial of zirconia laminate veneers sintered by using conventional versus speed process: 1-year follow-up

STATEMENT OF PROBLEM

The application of highly translucent multilayered zirconia ceramic in minimally invasive esthetic dentistry allows the achievement of both esthetics and strength with minimal thickness. Clinical studies that have assessed the performance of zirconia ultrathin veneers sintered with the conventional and speed procedure are lacking.

PURPOSE

The purpose of this clinical study was to evaluate the effect of speed sintering processes on the translucency and clinical performance of zirconia laminate veneers.

MATERIAL AND METHODS

Four participants had their teeth restored with 32 ultratranslucent zirconia laminate veneers. Based on the zirconia sintering procedure, the participants were randomly allocated into 2 groups. The teeth were prepared by selective reduction over trial restorations. Zirconia veneers were milled from multilayer zirconia blanks and sintered either by speed sintering or conventional sintering as specified by the manufacturer's recommendations. The intaglio surface of the veneers were airborne-particle abraded with 50-μm aluminum-oxide, and the veneers were then adhesively bonded to the teeth with translucent light-polymerizing resin cement. The modified California Dental Association (CDA)/Ryge criteria were used to assess participants at baseline and every 3 months for 12 months. The translucency and the color difference of the tooth before and after veneer restoration were evaluated. For statistical analysis, the Pearson chi squared test, independent t test, and paired t test were used (α=.05).

RESULTS

Translucency and color differences were significantly higher in the conventionally sintered group (P<.05). No restorations were lost. No significant differences were found between the 2 groups in the CDA/Ryge criteria or color parameter after follow-up intervals (P>.05). The primary qualitative changes observed at the final recall were marginal integrity and marginal discoloration. The color match and zirconia surface were rated Alfa.

CONCLUSIONS

After 1 year of follow-up, both conventional and speed sintered ultrathin zirconia laminates showed satisfactory functional, esthetic, and color stability outcomes.

Topographical and crystalline change on surface by sandblasting improve flexural and shear bond strength of niobia-modified yttria-stabilized tetragonal zirconia polycrystal

This study aimed to investigate the effects of sandblasting on the physical properties and bond strength of two types of translucent zirconia: niobium-oxide-containing yttria-stabilized tetragonal zirconia polycrystals ((Y, Nb)-TZP) and 5 mol% yttria-partially stabilized zirconia (5Y-PSZ). Fully sintered disc specimens were either sandblasted with 125 µm alumina particles or left as-sintered. Surface roughness, crystal phase compositions, and surface morphology were explored. Biaxial flexural strength (n=10) and shear bond strength (SBS) (n=12) were evaluated, including thermocycling conditions. Results indicated a decrease in flexural strength of 5Y-PSZ from 601 to 303 MPa upon sandblasting, while (Y, Nb)-TZP improved from 458 to 544 MPa. Both materials significantly increased SBS after sandblasting (p<0.001). After thermocycling, (Y, Nb)-TZP maintained superior SBS (14.3 MPa) compared to 5Y-PSZ (11.3 MPa) (p<0.001). The study concludes that (Y, Nb)-TZP is preferable for sandblasting applications, particularly for achieving durable bonding without compromising flexural strength.

Optimization of surface roughness, phase transformation and shear bond strength in sandblasting process of YTZP using statistical machine learning

Sandblasting process is often applied to roughen the intaglio of yttria tetragonal zirconia polycrystals (YTZP) surfaces for easy and quality adhesion and micro-shear retention with dentine/resin cements. Sandblasting process parameters have shown to influence, at different scales, surface roughness, phase transformation and shear bond strength, all of which are referred, herein, as performance characteristics. This study aimed to find the parametric settings of sandblasting parameters that could simultaneously optimize these performance characteristics, hypothetically testing the probability. YTZP surfaces were sandblasted at different levels of incidence angle (IA), abrasive particle size (AP), pressure(P) and sandblasting time (ST) following the Taguchi method based on the two-level parametric process settings (L8(27)). Surface morphologies, roughness (SR), monoclinic content (MC), and shear bond strength (SS) were characterized by the SEM, average surface roughness, XRD, and shear bond strength tests, respectively. Rough surfaces containing scratches, plastic deformation streaks, micro cracks and pitting were observed. According to the Taguchi method, the same optimum sandblasting parametric setting maximized SR and MC but failed to maximize SS. Subsequently, the principal component analysis embedded in statistical machine learning was applied to find the optimum sandblasting parametric setting that maximized all the performance characteristics. The optimum sandblasting setting of IA = 45°, AP = 110 μm, ST = 20 s and P = 400 kPa predicted the maximum values of SR = 0.773 μm, MC = 36% and SS = 16.6 MPa. Analysis of variance confirmed AP and P as the most influencing parameters affecting all performance characteristics. Finally, these results provide a systematic and comprehensive route for optimizing sandblasting roughening of YTZP surfaces which can be adopted in adhesive dental and orthodontic industry.

Translucent multi-layered zirconia: Sandblasting effect on optical and mechanical properties

OBJECTIVE

The aim of this study was to evaluate the influence of the sandblasting treatment on the microstructure, optical and mechanical properties of multi-layered translucent zirconia.

METHODS

Samples of yttria-stabilized zirconia were prepared by stratifying four layers (L1, L2, L3 and L4) of ML-type KATANA multi-layered monolithic discs, whose surfaces were then sandblasted with alumina particles (110 µm and 0.2 MPa) in order to evaluate its effect on the presence of different crystalline phases as well as on the optical and mechanical properties of each of the four layers. The optical characterization was carried out by measuring the reflectance spectrum and colorimetric parameters by UV-Vis spectrophotometric analysis and the transmittance curves were indirectly obtained using the Kubelka-Munk model (KM). Microstructural, structural, mechanical and roughness characterizations were also performed using SEM, XRD, biaxial flexural strength B3B, and light interferometry, respectively RESULTS: According to the KM model there are different degrees of translucency between the upper and lower layers of the monolithic discs, but there was no influence of the Al2O3-sandblasting treatment on this optical property. The disk pigmentation causes greater absorption of light below 600 nm, decreasing the transmittance rate to values below 25% in this region of the spectrum. The yellowing index presented higher values for inner disk layers L3 and L4, in agreement with the highest values of the light absorption coefficient K observed for these layers. The roughness of the samples did not change significantly with the surface treatment performed and the sandblasting did not result in new crystalline phases. SEM analysis showed the presence of different grain sizes in all layers analyzed, being related to the co-occurring presence of cubic (c-ZrO2) and tetragonal (t-ZrO2) phases in similar contents (∼ 50 wt%). The Weibull statistical analysis, in turn, showed an increase in the Weibull characteristic stress value (σ0) for most layers subjected to sandblasting, except for the second layer (central region of the disk). It was also verified an increase in the value of the structural reliability of the material (m), referring to the samples of the central region of the disc (L2 and L3 layers) after sandblasting.

SIGNIFICANCE

The pigmentation in the disk causes a decrease of the transmittance rate to values well below 25% in the region of the spectrum 400-600 nm and the inner layers (L3 and L4) have even lower transmittance than the outer layers in this spectrum range. Although the CR index indicates variation related to the Al2O3-sandblasting treatment, the transmittance spectra of KM model show that the sandblasting did not cause a significant change in the transmittance rate of the four analyzed layers. Also, there is no significant difference in the light scattering of the different layers of the disc, either before or after Al2O3-sandblasting treatment.

Current classification of zirconia in dentistry: an updated review

Zirconia, a crystalline oxide of zirconium, holds good mechanical, optical, and biological properties. The metal-free restorations, mostly consisting of all-ceramic/zirconia restorations, are becoming popular restorative materials in restorative and prosthetic dentistry choices for aesthetic and biological reasons. Dental zirconia has increased over the past years producing wide varieties of zirconia for prosthetic restorations in dentistry. At present, literature is lacking on the recent zirconia biomaterials in dentistry. Currently, no article has the latest information on the various zirconia biomaterials in dentistry. Hence, the aim of this article is to present an overview of recent dental zirconia biomaterials and tends to classify the recent zirconia biomaterials in dentistry. This article is useful for dentists, dental technicians, prosthodontists, academicians, and researchers in the field of dental zirconia.

Effect of Multiple Firings on the Microshear Bond Strength Between a Translucent Zirconia and a Resin Cement

PURPOSE

This study investigated the microshear bond strength between a resin cement and a translucent zirconia subjected to multiple characterization firings.

METHODS AND MATERIALS

5Y-PSZ zirconia blocks (Katana UTML) were sliced, sintered (1550°C, 2 h), and randomly divided into six groups (n=10) according to the number of characterization firings (0, 1, 2, 3, 5, or 10) and aging (baseline or after thermocycling). Each characterization firing was performed at 750°C for 1 minute. The ceramic surfaces were all sandblasted with 50 μm Al2O3 and silanized. Then, cylinders of resin cement (0.96 mm diameter × 2 mm height) were bonded onto their surfaces. The baseline samples were immersed in distilled water for 24 hours before the microshear bond strength (μSBS) tests. The aged samples were tested after 5000 thermocycles in water (5°C-55°C). The failure modes were classified as adhesive, predominantly adhesive, or cohesive. Scanning electron microscope images of the failure modes and the ceramic surfaces after the firings were taken. The μSBS data were analyzed by two-way ANOVA and Tukey's test.

RESULTS

The number of characterization firings and aging affected the bond strength. The highest bond strength values were observed from the 2-firing group at baseline. The μSBS results after 1, 2, or 3 characterization firings were similar at baseline and after aging. On the other hand, 0, 5, and 10 firings revealed the lowest bond strengths. The most frequent failures were adhesive and predominantly adhesive. Zirconia grains were not affected by the multiple firings.

CONCLUSION

One to three characterization firings after sintering improve the bond strength of 5Y-PSZ to the resin cement when compared to none or several (five or ten) firing cycles.

Effects of Particle Abrasion Media and Pressure on Flexural Strength and Bond Strength of Zirconia

OBJECTIVES

To compare the effects of particle abrasion medium and pressure on shear bond strength and biaxial flexural strength of three generations of zirconia (Lava Frame, Lava Plus, and Lava Esthetic) with the goal of optimizing the bond to zirconia.

METHODS

280 discs (14 mm diameter; 1 mm thickness) of each zirconia were milled and sintered. Specimens of each material were randomly distributed into 14 groups (n=20); half were tested for shear bond strength and half were tested for biaxial flexural strength. The specimens were particle abraded on one surface by 2 different media (50 μm alumina particles or 50 μm glass beads) for 10 seconds at three different pressures (15, 30, and 45 psi or 0.1, 0.2, 0.3 MPa). Untreated specimens served as positive control. A tube (1.50 mm diameter) filled with dual cured resin cement (Panavia SA) was placed onto the surface and light cured. Specimens were stored in water (37°C for 24 hours) and shear bond strength was measured in a universal testing machine (Instron). Biaxial flexural strength of each specimen was measured according to ISO 6872. Shear bond strength and biaxial flexural strength were compared individually with a 2-way analysis of variance (ANOVA) for factors surface treatment and zirconia composition.

RESULTS

Significant differences were seen between surface treatments (p<0.01), zirconia composition (p<0.01) and their interaction (p<0.01) for both bond strength and flexural strength. With alumina particle abrasion, higher pressure produced higher bonds for Lava Frame and Lava Plus zirconia while the bond of Lava Esthetic declined with increased pressure. Higher pressure (>0.2 MPa or 30 psi) with alumina decreased biaxial flexural strength with Lava Esthetic zirconia.

CONCLUSIONS

Particle abrasion with alumina produced a significantly better combination of bond strength while maintaining biaxial strength of three zirconia materials than particle abrasion with glass beads. The bond strength also depended upon the pressure of particle abrasion and the generation of zirconia used.

Effect of surface treatments on biaxial flexural strength, fatigue resistance, and fracture toughness of high versus low translucency zirconia

BACKGROUND

Mechanical surface treatments can deteriorate the mechanical properties of zirconia. This study evaluated and compared the biaxial flexural strength, fracture toughness, and fatigue resistance of high translucency (HT) to low translucency (LT) zirconia after various mechanical surface treatments.

METHODS

Four hundred eighty zirconia discs were prepared by milling and sintering two HT (Katana and BruxZir) and LT (Cercon and Lava) zirconia blocks at targeted dimensions of 12 mm diameter × 1.2 mm thickness. Sintered zirconia discs received one of the following surface treatments: low-pressure airborne particle abrasion (APA) using 50 µm alumina particles, grinding using 400 grit silicon carbide paper, while as-sintered specimens served as control. Internal structure and surface roughness were evaluated by scanning electron microscope (SEM) and a non-contact laser profilometer, respectively. Half of the discs were tested for initial biaxial flexural strength, while the rest was subjected to 10⁶ cyclic fatigue loadings, followed by measuring the residual biaxial flexural strength. Fractured surfaces were examined for critical size defects (c) using SEM to calculate the fracture toughness (K_IC). The effect of surface treatments, zirconia type, and cyclic fatigue on the biaxial flexural strength was statistically analyzed using three-way analysis of variance (ANOVA) and Tukey HSD post hoc tests (α = 0.05). Weibull analysis was done to evaluate the reliability of the flexural strength for different materials.

RESULTS

The initial biaxial flexural strength of LT zirconia was significantly higher (p < 0.001) than that of HT zirconia in all groups. While low APA significantly increased the biaxial flexural strength of LT zirconia, no significant change was observed for HT zirconia except for Katana. Surface grinding and cyclic fatigue significantly reduced the flexural strength of all groups. High translucency zirconia reported higher fracture toughness, yet with lower Weibull moduli, compared to LT zirconia.

CONCLUSION

LT zirconia has higher biaxial flexural strength, yet with lower fracture toughness and fatigue resistance, compared to HT zirconia. Low-pressure APA has significantly increased the biaxial flexural strength in all zirconia groups except BruxZir. Grinding was deteriorating to biaxial flexural strength and fracture toughness in all zirconia types. Cyclic fatigue has significantly decreased the biaxial flexural strength and reliability of HT and LT zirconia.

Adhesive Cementation of Zirconia Based Ceramics-Surface Modification Methods Literature Review

Introduction: The conditioning procedures for glass-based ceramic restorations before adhesive cementation are generally recognized. In the case of polycrystalline ceramics, which include zirconium oxide, there is still no standardized protocol. The aim of this work was to present conditioning methods of the cementation surface of zirconium oxide fixed dentures. The new generation high translucency zirconia has been also considered. Material and method: The following keywords for the PUBMED and EMBASE databases were used: zirconium oxide, zirconium oxide with increased translucency, bond strength, bending strength, surface treatment. The inclusion criteria were original papers in English published between 2015–2021. Results: Out of 1537 publications, 53 articles were selected for the study, covering methods of conditioning zirconium ceramics, including new materials with increased translucency. These procedures were divided into 5 main groups. Summary: Due to the widespread use of zirconia ceramics and the introduction of new zirconia-based materials, the use of a predictable and standardized cementation protocol is one of the most important factors contributing to the long-term clinical success of prosthetic restorations. Therefore, the research showed differences in the properties of the covered materials after conditioning. It suggests the need to create separate conditioning protocols for highly translucent and traditional zirconia.

Overview of Several Typical Ceramic Materials for Restorative Dentistry

With the development of ceramic technology, prosthodontic ceramics are becoming a useful option for improving esthetic outcomes in dentistry. In this paper, various ceramic materials were reviewed and evaluated, and their advantages and disadvantages and indications in oral prosthodontics were analyzed objectively. The properties of resin-based ceramics, polycrystalline ceramics, and silicate ceramics were compared and analyzed. Resin-based ceramics may replace other ceramic materials in the CAD/CAM field.

Effect of abutment neck taper and cement types on the amount of remnant cement in cement-retained implant restorations: an in vitro study

PURPOSE

The present study aims to analyze the effect of abutment neck taper and types of cement on the amount of undetected remnant cement of cement-retained implant prostheses.

MATERIALS AND METHODS

Three neck taper angles (53°, 65°, 77°) and three types of cement (RMGI: resin-modified glass ionomer, ZPC: zinc phosphate cement, ZOE: zinc oxide eugenol cement) were used. For each group, the surface percentage was measured using digital image and graphic editing software. The weight of before and after removing remnant cement from the abutment-crown assembly was measured using an electronic scale. Two-way ANOVA and Duncan & Scheffe’s test were used to compare the calculated surface percentage and weight of remnant cement (α = .05).

RESULTS

There were significant differences in remnant cement surface percentage and weight according to neck taper angles (P < .05). However, there were no significant differences in remnant cement surface percentage and weight on types of cement. No interaction was found between neck taper angles and types of luting cement (P > .05). The wide abutment with a small neck taper angle showed the most significant amount of remnant cement. And the types of luting cement did not influence the amount of residual cement.

CONCLUSION

To remove excess cement better, the emergence profile of the crown should be straight to the neck taper of the abutment in cement-retained implant restoration.

Retention strength of monolithic zirconia crowns cemented with different primer-cement systems

BACKGROUND

The purpose of this in vitro study was to assess the influence of different cement systems with different ceramic primers on the retention strength of zirconia crowns.

METHODS

Thirty extracted molars were prepared with flat occlusal surfaces, 20 degrees taper, and 3 mm axial wall height. A zirconia crown with an occlusal bar was fabricated for each tooth. All specimens were divided (n = 10) into; Group M: Multilink Speed/Monobond N, Group P: Panavia V5/Clearfil Ceramic Primer Plus, Group D: Duo-Link universal/Z-Prime Plus. The intaglio surfaces of crowns were air-abraded using 50 µm alumina at 2.5 bar for 10 s. Then each crown was cemented onto its corresponding tooth. All specimens were thermocycled for 10,000 cycles between 5 and 55 °C. Each crown was subjected to gradually increasing vertical load along the path of insertion through hooks engaging the occlusal bar using a universal testing machine until failure. The force at dislodgment was recorded and retention strength was calculated for each specimen. The failure modes were recorded for each specimen. The data were statistically analyzed using one way ANOVA test followed by Tukey HSD test (α = .05).

RESULTS

Group D showed lowest strength (1.42 ± 0.23 MPa) and differed significantly (P < .001) from Group M (2.71 ± 0.45 MPa) and Group P (2.47 ± 0.41 MPa). There was no significant difference (P = .34) between Group M and Group P. The failure modes for Groups M and Group P were mainly cohesive, while Group D showed adhesive failure.

CONCLUSIONS

The retention strength of zirconia crowns was improved with Multilink Speed and Panavia V5 cement systems, while the use of the Duo-Link Universal cement system only showed half of those retention strength values.

Effects of Different Air Particle Abrasion Protocols on the Biaxial Flexural Strength and Fractography of High/Ultra-Translucent Zirconia

In this study, the biaxial flexural strength (BFS) and fractography of high/ultra-translucent monolithic zirconia ceramics subjected to different mechanical surface pretreatments were evaluated. A total of 108 disc-shaped samples (12 mm diameter, 1.2 mm thickness) of three zirconia materials (5Y-ZP KATANA Zirconia UTML (ML), 3Y-TZP DD Bio ZX2 (DB), and 5Y-ZP DD cube X2 (DC)) were used. The BFS was investigated after subjecting the samples to surface treatment using air abrasion particles of two types (aluminum oxide or glass microbeads). The data were analyzed using two-way analysis of variance, followed by Scheffe's post hoc test for multiple comparisons. The mean ± standard deviation BFS for DB was highest after treatment with 50 µm Al₂O₃ (1626.05 ± 31.9 MPa), with lower values being observed following treatment with 50 µm glass microbeads (1399.53 ± 24.2 MPa) and in the control sample (1198.51 ± 21.1 MPa). The mean ± standard deviation (SD) BFSs for DC and ML were the highest in the control groups. Surface air abrasion with 50 µm Al₂O₃ particles and 2 bar pressure is recommended for 3Y-TZP translucent zirconia, while no abrasion of 5Y-ZP translucent zirconia ceramic.

Bonding properties of third-generation zirconia CAD-CAM blocks for monolithic restorations to composite and resin-modified glass-ionomer cements

PURPOSE

To compare the interfacial fracture toughness (IFT) of two MDP-based composite cements and a resin-modified glass-ionomer cement (RMGIC) with third-generation zirconia CAD-CAM restorations using two different airborne-particle abrasion (AB) pressures.

METHODS

Blocks were cut into prisms (n=60), split and sintered to the desired equilateral half prisms. Half-prisms were divided into two groups for AB at 0.5 or 2.5 bar with 50 µm Al₂O₃ particles. Each group was then further divided into 3 subgroups, and half-prisms were bonded to their counterparts with Panavia V5 (V5), Panavia Self Adhesive Cement Plus (SA), or RMGIC Fuji Plus (n=10/group). The IFT was determined using the Notchless Triangular Prism test in a water bath at 36°C after thermocycling (10,000 cycles). Surface roughness and SEM analyses were performed for representative zirconia samples after AB, and composite cements were tested for flexural strength and wettability.

RESULTS

SA (2.5 bar) showed a significantly higher IFT. The 3 other groups with SA and V5 showed no significant difference in their IFT values regardless of the AB pressure (1-way ANOVA). Weibull analysis of SA was higher than V5. All RMGIC samples debonded while thermocycling, and were, therefore, not included in the statistical analysis. Surface roughness increased with increasing AB pressure, and both cements showed similar flexural strength values and good wettability.

CONCLUSION

Contrary to RMGIC, composite cements show high performance with zirconia after AB. Increasing AB pressure enhances the micromechanical retention of composite cement. Future perspectives should include study of the effect of AB pressure on zirconia surface properties.

Bond durability and surface states of titanium, Ti-6Al-4V alloy, and zirconia for implant materials

PURPOSE

Screw-retained implant crowns used as dental implants comprise a zirconia coping and titanium base bonded using resin cement. These devices are prone to debonding failures. This study investigated the bond characteristics of implant materials based on shear bond strength (SBS) and surface characteristics.

METHODS

Chemically pure (CP) titanium grade-4 (Ti), Ti-6Al-4V alloy (Ti-6Al-4V), and tetragonal polycrystalline zirconia (zirconia) were evaluated as adherent materials. Plates of each material were polished, primed for the respective resin cements, and cemented using either methyl methacrylate-based resin cement (Super-Bond) or composite-based resin cement (Panavia). The cemented samples were subjected to 10,000 thermocycles alternating between 5 and 55 °C, and the SBS were obtained before and after thermocycling. The sample surfaces were characterized based on surface observations, roughness, and free energy (SFE).

RESULTS

The SBSs of all materials bonded using Panavia were significantly compromised during thermocycling and reached zero. Although the SBSs of Ti and Ti-6Al-4V bonded using Super-Bond were not significantly affected by thermocycling, those of zirconia decreased significantly. The bond durability between zirconia and Super-Bond was improved via alumina air-abrasion, which caused no significant loss of SBS after thermocycling. Surface analyses of the air-abraded zirconia validated these results and confirmed that its surface roughness and SFE were significantly increased.

CONCLUSIONS

The bond durability between resin cement and zirconia was lower than that between Ti and Ti-6Al-4V. The alumina air-abrasion pretreatment of zirconia improved the SFE and surface roughness, thereby enhancing bond durability.

Evaluation of the Bonding Strength between Various Dental Zirconia Models and Human Teeth for Dental Posts through In Vitro Aging Tests

In dentistry, root canal treatment reduces support of the tooth, making it necessary to insert a cylindrical body into the treated tooth to strengthen the crown. In the past, metal or fiberglass was often used. However, metal is too different in color from teeth, so the esthetics are poor, and fiberglass is not as strong as metal. Therefore, an alternative is zirconia, which has the characteristics of high light transmittance, esthetics, good biocompatibility, and high breaking strength. The surface morphology and composition of zirconia ceramics are the key to their bond strength with teeth. Therefore, in this study, the surface characteristics of different brands of zirconia commonly used in clinical practice were evaluated in terms of their surface morphology and surface elements. The surface was modified by sandblasting, and its effect on the bonding strength was discussed. Finally, the stability of the material was evaluated through artificial aging. The results showed that the surface roughness of the zirconia specimens increased after sandblasting, whereas the surface microhardness decreased. The shear test results showed that the 3D shape of the zirconia surface could help improve the bonding strength. The bonding strength of DeguDent increased the most after sandblasting. After 20,000 cycles of aging treatment, the shear strength of each specimen decreased. Field emission scanning electron microscopy results showed that the adhesive remained intact on the surface of zirconia, indicating that adhesion failure occurred between the adhesive and the teeth. This confirms that sandblasting can improve the bonding strength of zirconia. Based on the results obtained, it was concluded that the surface roughness of zirconia is the main factor affecting the bond strength.

Pre-cementation procedures' effect on dental zirconias with different yttria content

OBJECTVE

Several pre-cementation procedures have been advocated to enhance adhesion between zirconia and resin-based cement. There is, however, limited documentation on how these pre-treatments affect the strength of zirconia crowns as most tests are performed on discs or bars. The aim was to assess the effect of pre-cementation procedures on fracture mode, fracture strength and cement retention on zirconia.

METHODS

Two dental zirconia materials with different yttria content were assessed (<4 and>5 mol%). Both discs (n = 45) and crown-shaped specimens (n = 30) of the two materials were pretreated with either air-abrasion or hot-etching with KHF₂ and compared with untreated controls with regards to surface roughness, crystallography, wettability, cement adhesion and fracture strength.

RESULTS AND SIGNIFICANCE

Air-abrasion improves adhesion and strength of zirconia with moderate yttria content (<4 mol%). Acid etching with heated KHF₂ showed the best effect on strength and cement retention on zirconia with higher yttria content (>5 mol%). Application of KHF₂ was, however, complicated on crown-shaped specimens. Pre-treatment and cementation protocols should be optimized for different dental zirconias to improve both strength and retention.

Changes in Crystal Phase, Morphology, and Flexural Strength of As-Sintered Translucent Monolithic Zirconia Ceramic Modified by Femtosecond Laser

Conventional bonding technology suitable for silica-based ceramics is not applicable to zirconia, due to its polycrystalline phase composition, chemical stability, and acid corrosion resistance. The development of an effective treatment to improve its surface roughness and mechanical properties remains an unresolved problem. Therefore, to solve this problem, this in vitro study evaluated the changes in surface morphology and flexural strength of translucent monolithic zirconia surfaces treated with femtosecond laser technology. As-sintered translucent zirconia specimens were subjected to airborne particle abrasion and femtosecond laser treatments, while control group specimens received no treatment. After treatment, the roughness and morphology of the treated zirconia surfaces were examined. The flexural strength and X-ray diffraction of the treated specimens were measured and analyzed. Statistical inferential analysis included one-way analysis of variance at a set significance level of 5%. The surface roughness after femtosecond laser treatment was significantly improved when compared with the control group and the group that received the airborne particle abrasion treatment (p < 0.05). In comparison with the airborne particle abrasion group, the flexural strength of the group that received the femtosecond laser treatment was significantly improved (p < 0.05). The femtosecond laser approach using appropriate parameters enhanced the roughness of the zirconia without reducing its flexural strength; therefore, this approach offers potential for the treatment of zirconia surfaces.

Effect of Acid Mixtures on Surface Properties and Biaxial Flexural Strength of As-Sintered and Air-Abraded Zirconia

The aim of this work was to evaluate the effects of application time of an acid mixture solution on the surface roughness, phase transformation, and biaxial flexural strength of 3Y-TZP after sintering or air abrasion. For the biaxial flexural strength measurement, 220 3Y-TZP disk-shaped specimens were prepared after as-sintering or air abrasion. The etching solution comprised a mixture of hydrofluoric acid, sulfuric acid, hydrogen peroxide, methyl alcohol, and purified water. The samples were divided into 11 subgroups according to the etching times (Control, 1, 2, 3, 5, 8, 10, 12, 15, 20, and 30 min). The results showed that acid treatment on both as-sintered and air-abraded 3Y-TZP surfaces increased the surface roughness. However, it had no significant effects on the monoclinic phase or flexural strength of as-sintered zirconia. The monoclinic phase and flexural strength of air-abraded zirconia increased sharply after air abrasion; however, they gradually decreased after acid treatment, to a similar level to the case of the untreated surface. Surface treatment with acid mixture increased the roughness, but the lack of increase of monoclinic phase is thought to be because the loose monoclinic particles remaining on the surface were removed through the etching process.

Effect of Air-Particle Abrasion Protocol and Primer on The Topography and Bond Strength of a High-Translucent Zirconia Ceramic

PURPOSE

To evaluate effect of air-particle abrasion protocol and primer on surface topography and bond strength of resin cement to high-translucent zirconia ceramics.

MATERIALS AND METHODS

Two hundred disk-shaped high-translucent zirconia specimens of 5Y-PSZ were prepared. The specimens were assigned to 5 groups in terms of particle type and air-particle abrasion pressure: (1) control, (2) alumina with 0.2 MPa-air pressure [AB-0.2], (3) alumina with 0.4 MPa-air pressure [AB-0.4], (4) glass beads with 0.2 MPa-air pressure [GB-0.2], and (5) glass beads with 0.4 MPa-air pressure [GB-0.4]. Two different primers 1% MDP (Experimental) and MDP-silane primer (Clearfil Ceramic Primer Plus) was also tested. Stainless steel rods were bonded to the 5Y-PSZ specimens with PANAVIA V5. For each group, the tensile bond strength (TBS) was measured after 24-hour water storage (n = 10) and after 5000 thermal-cycling (n = 10) at crosshead speed of 2 mm/min. The data were statistically analyzed using Weibull analysis. Surface roughness (Sa) was measured using a 3D-Laser Scanning Confocal Microscope (n = 5) and analyzed by t-test with Bonferroni correction. Surface topography using scanning electron microscopy (SEM) and surface elemental analysis using energy dispersion spectroscopy (EDX), and cross-section SEM at the interface with composite cement were also investigated.

RESULTS

In MDP-silane groups, the highest TBS was observed in AB-0.4 after 24 hours and GB-0.4 after thermal-cycling (p < 0.05). In MDP groups, AB groups resulted in the significantly higher TBS than GB groups (p < 0.05). AB-0.4 group showed the highest Sa value compared to all groups (p < 0.005), meanwhile GB groups did not show different Sa compared to control (p > 0.005).

CONCLUSION

Air-abrasion with different particle and blasting pressure can improve bonding to zirconia with proper primer selection. Particularly, glass beads abrasion followed by MDP-silane primer and alumina abrasion followed by MDP primer alone provided stable bond strength of resin cement to high-translucent zirconia after aging. High-translucent zirconia abraded with glass beads achieves a desirable bonding performance without creating surface microcracks which may hinder zirconia's mechanical properties.

Bonding to zirconia: Effects of translucency and cusp inclinations using an experimental methodology

Purpose To investigate the effects of translucency and cusp inclination on the micro-shear bond strength (µSBS) of zirconia to self-adhesive resin cement (SARC).Methods Sixty U-shaped zirconia specimens with 1.0 mm thickness consisting of three planes (0°, 20°, and 30°) simulating different cusp inclinations were fabricated from zirconia blocks of high, moderate, and low translucency (n=20). SARC was bonded to the specimen and light-cured for 40 s. The µSBS was tested using a universal testing machine with a cross-head at a speed of 0.5 mm/min and fracture mode was observed using a stereomicroscope (×50). Two-way analysis of variance followed by a post hoc Tukey's honest significant difference test was used for the statistical analyses (α=0.05).Results Varied µSBS values were found in the test groups (7.1-14.9 MPa). Within the zirconia of the same translucency, the µSBS value of the plane 0° specimen was significantly higher than that of the 20° and 30° planes (all p<0.05). Within the zirconia of the same cusp inclination, the µSBS value of highly translucent zirconia was significantly higher than that of moderate and low translucent zirconia (all p<0.05). There was no significant interaction between cusp inclination and translucency (p=0.525). Among the fracture modes, 83.33% were adhesive failure, 11.11% mixed failure, and 5.56% were cohesive failure.Conclusions Translucency and cusp inclination significantly affect the µSBS of zirconia to SARC. The higher the translucency, the greater are the µSBS values; the higher the cusp inclination, the lower are the µSBS values.

Strain analysis of anterior resin-bonded fixed dental prostheses with different thicknesses of high translucent zirconia

Background/purpose

High translucent zirconia has been used as a new monolithic zirconia prosthesis, which has the potential to make anterior resin-bonded fixed dental prostheses (RBFDPs) without veneering porcelain. However, it is unclear whether the RBFDPs retainer can be thinned as much as conventional zirconia RBFDPs. The aim of this study was to assess the usability of high translucent zirconia RBFDPs with a thin retainer thickness by evaluating differences in retainer thickness on the surface strain.

Materials and methods

A model with a missing upper lateral incisor was used. The abutment teeth were upper central incisor and canine. Three types of RBFDPs were fabricated as follows: metal RBFDPs with a retainer thickness of 0.8 mm (0.8M), and high translucent zirconia RBFDPs with a retainer thicknesses of 0.8 and 0.5 mm (0.8Z, 0.5Z) (n = 10). The fitness of the margins was evaluated by the silicone replica technique. The surface strain of each retainer under static loading was measured and statistically analyzed using a t-test with Bonferroni correction.

Results

The marginal fitness of all RBFDPs was under 76.1 μm, which was clinically acceptable. Each strain of the 0.8Z and 0.5Z groups was significantly lower than that of the 0.8M (p < 0.05). There was no difference in strain of the zirconia RBFDPs even if the retainer thickness was changed.

Conclusion

Our results suggest that the high translucent zirconia RBFDPs can be manufactured with a retainer thickness of 0.5 mm, which reduces the amount of tooth preparation compared to the metal RBFDPs.

Shear bond strength of glass ionomer and resin-based cements to different types of zirconia

OBJECTIVE

To investigate the shear bond strength (SBS) of a glass ionomer (GI) cement, an 10-methacryloyloxy-decyl dihydrogen phosphate (MDP)-based adhesive resin cement (MDP-based AC), an MDP-based self-adhesive resin cement (MDP-based SAC), an MDP-free self-adhesive resin cement (MDP-free SAC), and a resin-modified GI (RMGI) cement to a 3 mol% yttria-stabilized (3Y-TZP) and a 5 mol% yttria partially stabilized zirconia (5Y-PSZ).

MATERIALS AND METHODS

Fifty blocks were produced using 3Y-TZP and 5Y-PSZ, assigned to subgroups based on the five cements investigated (n = 10) and luted to cylindrical specimens of the same substrate. Each specimen was loaded in a SBS apparatus to failure. Mean SBS (MPa) values and standard deviations were calculated. Data were analyzed using a two-way analysis of variance and Tukey tests (α = .05). Failed specimens were subjected to fractographic analysis.

RESULTS

MDP-based AC and MDP-based SAC cements displayed the highest SBS values with both the substrates; GI cement showed the lowest. RMGI and MDP-free SAC cements performed better with 3Y-TZP than with 5Y-PSZ. Fractographic analysis revealed only adhesive and mixed failures.

CONCLUSIONS

MDP-based AC and MDP-based SAC cements are suitable for both 3Y-TZP and 5Y-PSZ. MDP-free SAC and RMGI cements are adequate choices for 3Y-TZP, but seem less effective with 5Y-PSZ.

CLINICAL SIGNIFICANCE

MDP-based SACs appear to be as reliable as MDP-based ACs for both 3Y-TZP and 5Y-PSZ cementation. Specifically, for 5Y-PSZ cementation, resin-based MDP-free SACs do not seem to guarantee predictable results in terms of SBS.

Effects of air-abrasion pressure on mechanical and bonding properties of translucent zirconia

OBJECTIVES

The purpose of this in vitro study was to investigate the effects of different air-abrasion pressures on flexural strength and shear bond strength of a translucent zirconia.

MATERIALS AND METHODS

The translucent zirconia surface was treated with 50 μm abrasive alumina particles at different pressure: 0.1 MPa; 0.2 MPa; 0.3 MPa; 0.4 MPa; 0.5 MPa; untreated specimens were used as control group (n = 33). For each group, three-point bending test was used to evaluate the flexural strength, and surface characterizations were analyzed. Following adhesive bonding and water storage for 24 h, specimens were subdivided into groups baseline and aged (5000 thermocycles). Then, shear bond strength was measured and failure mode was recorded. Statistical analysis was performed with one-way ANOVA and Tukey test (α = 0.05).

RESULTS

Increasing air-abrasion pressure (0.3 MPa, 0.4 MPa, and 0.5 MPa) decreased the flexural strength. Higher air-abrasion pressure resulted in rougher zirconia surfaces and caused more microcracks. The highest shear bond strength was obtained for zirconia surfaces abraded at 0.2 MPa (15.88 ± 2.70 MPa) and 0.3 MPa (14.32 ± 1.12 MPa). Aging did not decrease the strength for all groups except control group (p < 0.001).

CONCLUSIONS

Air-abrasion with 50 μm abrasive alumina particles at 0.2 MPa could achieve good strength for translucent zirconia ceramics while maintaining adequate and durable bonding with resin cement.

CLINICAL RELEVANCE

A total of 0.2 MPa is recommended for air-abrasion procedure applied before a dental restoration fabricated with translucent zirconia is bonded to resin cement.

Translucency of Monolithic Zirconia after Hydrothermal Aging: A Review of In Vitro Studies

PURPOSE

Recent modifications in composition, structure, and fabrication methods have led to monolithic zirconia ceramics of superior translucency. However, during aging, intrinsic microstructural features, such as grain boundaries and pores, may affect light scattering and consequently the translucency of zirconia. The aim of this study was to systematically review if hydrothermal aging affects the translucency of monolithic zirconia.

MATERIALS AND METHODS

An electronic search in Medline and Scopus was conducted to identify the effect of hydrothermal aging on the translucency of zirconia. The search was limited to English-language publications and in vitro studies. The following search terms were used alone or in combination: "monolithic zirconia," "full contour zirconia," "Y-TZP zirconia," "tetragonal zirconia," "cubic zirconia," "aging," "hydrothermal aging," "steam autoclave," "translucency," "translucency parameter," and "contrast ratio." From the titles found after searching the electronic databases, only 10 articles met the inclusion criteria and were included in this review. The translucency parameter or total transmittance was used to extract data from the studies.

RESULTS

Aging reduced the translucency of monolithic zirconia in most of the studies; however, the differences varied according to the brand tested and the microstructure and thickness of the specimens. The thinner specimens presented higher translucency alterations. Although in all studies a change in translucency was recorded, its mean values suggest that the differences are within the acceptability threshold in most cases, independent of the color system used to calculate translucent parameter, so they are clinically undetectable. For longer aging times, beyond the perspective clinical life of the restorations, the change in translucency is higher than the acceptability threshold.

CONCLUSIONS

There is a controversy regarding how aging affects the translucency of monolithic zirconia ceramics; however, this may not be clinically important, as in most cases, changes (either decrease or increase) in translucency were within the acceptability thresholds.

Strength and aging resistance of monolithic zirconia: an update to current knowledge

New zirconia compositions with optimized esthetic properties have emerged due to the fast-growing technology in zirconia manufacturing. However, the large variety of commercial products and synthesis routes, make impossible to include all of them under the general term of “monolithic zirconia ceramics”. Ultra- or high translucent monolithic formulations contain 3–8 mol% yttria, which results in materials with completely different structure, optical and mechanical properties. The purpose of this study was to provide an update to the current knowledge concerning monolithic zirconia and to review factors related to strength and aging resistance. Factors such as composition, coloring procedures, sintering method and temperature, may affect both strength and aging resistance to a more or less extend. A significant reduction of mechanical properties has been correlated to high translucent zirconia formualtions while regarding aging resistance, the findings are contradictory, necessitating more and thorough investigation. Despite the obvious advantages of contemporary monolithic zirconia ceramics, further scientific evidence is required that will eventually lead to the appropriate laboratory and clinical guidelines for their use. Until then, a safe suggestion should be to utilize high-strength partially-stabilized zirconia for posterior or long span restorations and fully-stabilized ultra-translucent zirconia for anterior single crowns and short span fixed partial dentures.