Size or hierarchical dependence of the elastic modulus of three ceramic-composite CAD/CAM materials

In vitro evaluation of CAD/CAM composite materials

OBJECTIVES

The purpose of this in vitro study was to evaluate the microstructural, elemental and mechanical properties of contemporary computer-aided-design/computer-aided manufacturing (CAD/CAM) resin based composite (RBC) materials.

METHODS

Six CAD/CAM RBC materials [Brilliant CRIOS (Coltene Whaledent AG), Cerasmart (GC), Lava Ultimate (3M ESPE), Tetric CAD (Ivoclar Vivadent), Shofu Block HC (Shofu), Grandio Blocs (VOCO GmbH)] were tested. Ten rectangular blocks (14 Χ 12 Χ 18 mm) for each material, after metallographic grinding and polishing, were subjected to Instrumented Indentation Testing (ΙIT). Martens Hardness (HM), Indentation Elastic Modulus (EIT), Elastic (ηIT) and Creep indices (CIT) were determined according to formulas provided by ISO 14577. The diagonal length of each indentation was measured and HV was determined. The results of HM, EIT, ηΙΤ, HV, and CIT were statistically analyzed by one-way ANOVA and Tukey post hoc test employing the material as a discriminating variable (a = 0.05), while the possible correlations were determined by Spearman's correlation test. One specimen from each group was examined by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX).

RESULTS

Backscattered Electron images and EDX analysis demonstrated differences in size, shape and type of fillers along with elemental composition among materials tested. Statistical significant differences were identified for all mechanical properties tested. Grandio Blocs had the significantly higher HM (953±7 N/mm2), HV (136±1) and EIT (23±1 GPa) followed by Lava Ultimate (ΗM=674±25 N/mm2, HV=105±2, EIT=15±1 GPa). Elastic index ranged from 41% to 52%, with Shofu Block demonstrating the significantly highest ηIT (52 ± 1%) values. Cerasmart had significantly higher CIT value (8.4 ± 0.1%) than all other materials tested, while Grandio Blocs and Lava Ultimate had the lowest ones. Spearman's correlation revealed that all mechanical properties tested exhibited correlations with each other, apart from ηΙΤ.

CONCLUSIONS

The results showed that the CAD/CAM materials tested have differences in their microstructure, elemental composition and mechanical properties.

CLINICAL SIGNIFICANCE

The RBCs tested showed significant differences in mechanical properties and thus differences in clinical performance are anticipated. RBCs with increased filler loading had the most favorable combination of hardness, elastic modulus and creep index indicating that these materials may have better clinical performance under intraoral loading conditions.

Surface characterization of indirect restorative materials submitted to different etching protocols

OBJECTIVES

This in vitro study aimed to evaluate the effect of different times and concentrations of hydrofluoric acid etching on the surface of indirect restorative materials obtained from blocks used in CAD-CAM technology.

METHODS

Specimens (4 mm × 4 mm × 0.8 mm) were obtained for each indirect restorative material: zirconia-reinforced lithium monosilicate ceramic (Celtra Duo), nanoceramic resin (Lava Ultimate), and polymer-infiltrated ceramic network material (Vita Enamic). The materials were submitted to etching with 5% or 10% hydrofluoric acid for 20, 40, 60, or 90 s. A control group for each material was evaluated without any surface treatment, totaling nine experimental groups for each material (n = 10). The specimens were evaluated for surface roughness (R_a and R_z), confocal optical microscopy, the contact angle (θ), surface free energy (γs), total free interaction energy (∆G) using a goniometer, and microshear bond strength to resin cement. Specimen images were obtained using scanning electron microscopy, confocal optical microscopy, and atomic force microscopy. Data on the surface roughness, the contact angle, surface free energy, total free interaction energy, and bond strength were subjected to two-way ANOVA and Tukey´s test (α=0.05).

RESULTS

In general, Celtra Duo showed better results after etching with 10% hydrofluoric acid for 40 or 60 s. Lava Ultimate showed better performance after etching with 10% hydrofluoric acid for 20 or 40 s, whereas Vita Enamic showed better results after etching with 5% hydrofluoric acid for 90 s.

CONCLUSION

Each material showed different characteristics after etching with hydrofluoric acid. Knowledge of the proper protocol for each material is essential to ensure improvements in the adhesion process and durability of indirect restorations. In general, Celtra Duo presented mechanical properties superior to those of Lava Ultimate and Vita Enamic.

CLINICAL SIGNIFICANCE

Specific etching protocols must be recommended for each indirect material because longer exposure to hydrofluoric acid can jeopardize the surface, thus affecting the mechanical and bond strength properties.

Effect of Surface-Etching Treatment, Glaze, and the Antagonist on Roughness of a Hybrid Ceramic after Two-Body Wear

Stains and glaze are effective procedures for achieving an aesthetic smoothness on indirect restorations. Thus, the effect of surface-etching treatments previous to the stain layer and the glaze application on the occlusal and antagonist wear of a hybrid ceramic were evaluated against different antagonists. Disc-shaped samples were prepared from polymer-infiltrated ceramic network (PICN) blocks. The specimens were divided into eight groups, according to the surface-etching treatment and glaze application: P (polished specimens); PG (polishing plus glaze); E (hydrofluoric acid etching plus stain); EG (acid etching plus stain plus glaze); A (aluminum oxide sandblasting plus stain); AG (sandblasting plus stain plus glaze); S (self-etching primer plus stain); SG (self-etching primer plus stain plus glaze). Half of the samples were subjected to a wear simulation with a steatite antagonist, and the other half was tested using a PICN antagonist. The test parameters were: 15 N, 1.7 Hz, 6 mm of horizontal sliding, 5000 cycles. The discs and the antagonists' masses were measured before and after the wear tests. The average roughness and spacing defects were evaluated. The etching treatment affected the surface and antagonist mass loss when tested against steatite. AG showed the highest mass loss. This influence was not detected when using the PICN antagonist. The glaze application after staining ensures a smoother surface and avoids antagonist wear.

Applications of scanning electron microscopy and focused ion beam milling in dental research

The abilities of scanning electron microscopy (SEM) and focused ion beam (FIB) milling for obtaining high-resolution images from top surfaces, cross-sectional surfaces, and even in three dimensions, are becoming increasingly important for imaging and analyzing tooth structures such as enamel and dentin. FIB was originally developed for material research in the semiconductor industry. However, use of SEM/FIB has been growing recently in dental research due to the versatility of dual platform instruments that can be used as a milling device to obtain low-artifact cross-sections of samples combined with high-resolution images. The advent of the SEM/FIB system and accessories may offer access to previously inaccessible length scales for characterizing tooth structures for dental research, opening exciting opportunities to address many central questions in dental research. New discoveries and fundamental breakthroughs in understanding are likely to follow. This review covers the applications, key findings, and future direction of SEM/FIB in dental research in morphology imaging, specimen preparation for transmission electron microscopy (TEM) analysis, and three-dimensional volume imaging using SEM/FIB tomography.

Evaluation of the damping capacity of common CAD/CAM restorative materials

OBJECTIVES

To evaluate and quantify the damping capacities of common CAD/CAM restorative materials (CRMs) and to assess their energy dissipation abilities by comparing loss tangent and Leeb hardness data.

METHODS

Leeb hardness (HLD), together with its deduced energy dissipation data (HLD_dis), and loss tangent values recorded via dynamic mechanical analysis (DMA) were determined for 4 ceramic, 13 composite, and 2 polymer-based CRMs as well as 1 metal. For Leeb hardness, ten indentations per material were performed on two separate specimens (12.0 × 12.0 × 3.5 mm³) after water storage (24 h; 37.0 ± 1.0 °C). For DMA, ten specimens (16.00 × 4.00 × 1.00 mm³ ± 0.05 mm) per material were investigated in distilled water (37.0 ± 0.5 °C) with a dynamic force of 1 N at 1.5 Hz. Each data set was analyzed using two-way analysis of variance (ANOVA) with material type and material nested in material type as factors. Post-ANOVA contrasts were performed using a Bonferroni adjustment for multiple comparisons (α = 0.05). Correlations between different parameters were tested (Pearson, α = 0.05).

RESULTS

HLD_dis data revealed the significantly highest damping capacity for metal and the lowest values for ceramics with composites and polymers in between. However, for loss tangent, the metal together with lithium disilicate glass-ceramics exhibited the lowest damping effects and polymer materials the highest results with composites likewise in between. A strong dependency of the loss tangent results on the filler content of the investigated CRMs was indicated (r = - 0.822, p < 0.001), while a positive and only moderate correlation between loss tangent and HLD_dis was observed (r = 0.565, p < 0.001), which conversely revealed a very strong correlation (r = 0.911, p < 0.001) if the metal was excluded from the calculation.

CONCLUSIONS

Although HLD_dis and loss tangent values both allowed a distinct differentiation of the damping capabilities of various CRMs and the respective material types, HLD_dis data appeared to more accurately describe the damping capacity of CRMs as the energy dissipation mechanism of permanent plastic material deformation, that is commonly observed for metals and some composite-based CRMs, is equally captured. This finding could be particularly interesting for the future development of new CRMs with improved mechanical properties as HLD_dis data determination in principle is a very efficient and simple technique to entirely specify unknown damping capacities of materials.

New method to differentiate surface damping behavior and stress absorption capacities of common CAD/CAM restorative materials

OBJECTIVES

To assess energy dissipation capacities and surface damping abilities of different CAD/CAM restorative materials (CRMs) to characterize stress resistance during load peaks.

METHODS

Using instrumented indentation testing (IIT), Martens hardness (HM) together with its elastic (η_IT) and plastic index (η_ITdis) and Leeb hardness (HLD) together with its deduced energy dissipation (HLD_dis) were determined for eight ceramic, eight composite, and four polymer-based materials as well as three metals. The results were compared to those of bovine enamel. Ten indentations per material were performed at room temperature (23 ± 1 °C) on two separate specimens (12.0 × 12.0 × 3.5 mm³) after water storage (24 h; 37.0 ± 1.0 °C). Hardness parameters were recorded, and data were analyzed with one-way MANOVA (Games-Howell post hoc tests, α = 0.05). Correlations between different parameters were tested (Pearson, α = 0.05).

RESULTS

Independently determined HLD_dis, and η_ITdis values substantiated different energy dissipation characteristics of CRM, whereby a strong correlation was observed for the two datasets (r = 0.956, p = 0.011). Ceramics had the significantly lowest values (p < 0.001) while both parameters revealed the highest surface damping effects for metals (p < 0.001), followed in both cases by bovine enamel. Energy dissipation of polymer and composite CRM was in between ceramics and bovine enamel (p < 0.001), whereas only for HLD_dis did both show no significant difference (p > 0.05).

SIGNIFICANCE

Promising new HLD_dis and η_ITdis data allow a reliable differentiation of energy dissipation and surface damping capacities of CRMs. Previously published rankings of edge chipping and loss tangent results were perfectly reproduced, especially by HLD_dis.

Influence of polymerization pressure and post-cure treatment on conversion degree and viscoelastic properties of polymer infiltrated ceramic network

This study aimed at determining an optimum polymerization pressure for Polymer Infiltrated Ceramic Network (PICN) blocks by characterizing the conversion degree (DC) and the viscoelastic properties of experimental PICN blocks polymerized at 90 °C under various high pressures followed or not by post-cure treatment (PC). Near infrared analysis and dynamic mechanical analysis were used to characterize DC and viscoelastic properties of sixteen PICN: one control (thermo-cured) and fifteen experimental groups (one thermo-cured followed by PC and fourteen high pressure polymerized PICN, in the range of 50-350 MPa without and with PC). Conversion degree of high pressure polymerized PICN blocks without post curing displays an optimum between 100 and 150 MPa resulting in an improved E' and T_g. Post curing induces a higher DC with a controversial effect on thermomechanical properties. The results suggested that 100-150 MPa without PC is an optimum polymerization parameter, resulting in PICN blocks with significantly better DC, T_g, E'.

Resin-matrix ceramics for occlusal veneers: Effect of thickness on reliability and stress distribution

OBJECTIVE

To evaluate the influence of resin-matrix ceramic material and thickness on reliability and stress distribution of occlusal veneers (OV).

METHODS

One hundred and twenty-six OV of a mandibular first molar were milled using a CAD/CAM system and allocated according to materials (resin nanoceramic (RNC) or polymer-infiltrated ceramic network (PICN)) and thicknesses (0.5, 1.0 and 1.5 mm), totaling six groups (RNC0.5, RNC1, RNC1.5, PICN0.5, PICN1, and PICN1.5). Step-stress accelerated-life testing was performed (n = 21/group) with the load applied at the distobuccal cusp tip of the occlusal veneer until failure or suspension. The use level probability Weibull curves and reliability were calculated and plotted (90% CI). Finite element analysis evaluated the stress distribution according to maximum principal stress (σ_max) on the restoration and maximum shear stress (τ_max) on the cement layer.

RESULTS

There was no difference in the probability of survival for the estimated missions among the groups, except at 600 N in which the results were significantly lower to PICN1.5 (6%) compared to RNC1 (55%) and RNC1.5 (60%). The σ_max values were higher for PICN (31.85-48.63 MPa) than RNC (30.78-33.09 MPa) in the same thicknesses. In addition, 0.5 mm groups concentrated more stress in the restoration (33.09-48.63 MPa) than 1.0 mm (31.11-35.36 MPa) and 1.5 mm (30.78-31.85 MPa) groups in the same material.

SIGNIFICANCE

Both resin-matrix ceramic materials seem up-and-coming restorative systems for occlusal veneers irrespective of the thicknesses as a consequence of the high reliability.

Influence of High-Pressure Polymerization on Mechanical Properties of Denture Base Resins

PURPOSE

The purpose of this study was to study the influence of high-pressure (HP) polymerization on the mechanical properties of denture base PMMA resins compared with conventional thermopolymerization and PMMA discs for digital dentures.

MATERIALS AND METHODS

Three groups of blocks were prepared: Probase Hot (Ivoclar Vivadent, Lichtenstein) conventionally heat polymerized at 100°C, Probase Hot heat polymerized at 100°C under HP (200 MPa) and Ivobase CAD (Ivoclar Vivadent, Lichtenstein). Samples for mechanical/physical (n = 30) and samples for viscoelastic (n = 10) characterizations were cut from the blocks. Flexural strength (σ_f ), elastic modulus (E_f ), hardness, density (ρ), flexural deformation at maximal flexural stress, flexural load energy (U_r ) and viscoelastic properties (E', E'', Tanδ, T_g ) were analyzed using one-way ANOVA (α = 0.05), Scheffé multiple means comparisons (α = 0.05) and Weibull statistics (for σ_f ). SEM images of the fractured surfaces were obtained.

RESULTS

E_f , E', E'' and density of HP polymerized Probase hot were significantly higher than conventional heat polymerized Probase Hot, whereas T_g was significantly lower and σ_f , Tanδ, hardness, flexural deformation at maximal flexural stress, U_r were not significantly different. The highest values for σ_f , flexural deformation at maximal flexural stress, U_r and Weibull modulus were obtained with Ivobase CAD.

CONCLUSION

HP polymerization does not significantly increase the mechanical properties of denture base resins.

Fracture force of CAD/CAM resin composite crowns after in vitro aging

OBJECTIVES

The aim of this in vitro study was to investigate the influence of material, preparation, and pre-treatment on the aging and fracture force of CAD/CAM resin composite molar crowns.

MATERIALS AND METHODS

CAD/CAM molar crowns (n = 80) were milled from four resin composites (Block HC, Shofu; Lava Ultimate, 3 M; Grandio Blocs, Voco; and Tetric CAD, Ivoclar Vivadent, with/without sandblasting). Extracted human teeth were prepared with optimal preparation (height 6-8 mm, angle 6-8°) or worst-case preparation (height 3.5-4 mm, angle 10-15°). Both groups were prepared with a 1-mm deep cervical circular shoulder. Crowns were adhesively bonded after corresponding tooth treatment required for the individual adhesive systems (Table 1). Specimens were aged for 90 days in water storage (37 °C) and subsequently subjected to thermal cycling and mechanical loading (TCML 3000 × 5 °C/3000 × 55 °C, 2 min each cycle, H20 distilled; 1.2 × 10⁶ cycles à 50 N, 1.6 Hz). De-bonding and fracture force was determined.

STATISTICS

one-way-ANOVA; post hoc Bonferroni, α = 0.05.

RESULTS

Four crowns of Lava Ultimate with worst-case preparation de-bonded during TCML. Individual crowns without sandblasting treatment (3x Tetric CAD with optimal preparation; 1x Tetric CAD with worst-case preparation) de-bonded during water storage. One crown of Grandio Blocs with optimal preparation showed a small chipping during TCML. All other crowns survived TCML and water storage without failure. Fracture forces differed between 1272 ± 211 N (Lava Ultimate) and 3061 ± 521 N (Tetric CAD). All Grandio Blocs and Tetric CAD crowns revealed significantly (p ≤ 0.023) higher fracture forces than Block HC or Lava Ultimate crowns. No significantly different (p > 0.05) fracture forces were found between optimal or worst-case preparation/fit groups.

CONCLUSIONS

De-bonding during water storage and TCML was dependent on material and crown pre-treatment. Therefore, surface roughening seems strongly required. Fracture forces were not influenced by preparation but by the type of material.

CLINICAL RELEVANCE

Clinical success and de-bonding of CAD/CAM resin composite crowns is strongly influenced by the type of material and its pre-treatment.