The adverse effects of tungsten carbide grinding on the strength of dental zirconia

Posterior two-unit cantilevered zirconia resin-bonded fixed partial dentures: A 3-year prospective single-arm clinical trial

OBJECTIVES

To evaluate the longevity of cantilevered zirconia-based resin-bonded fixed partial dentures (RBFPDs) in replacing missing posterior teeth, as well as the quality of life and patient satisfaction experienced by those receiving zirconia RBFPDs.

METHODS

A prospective single-arm uncontrolled clinical trial was conducted to replace one or more missing premolars or molars with a span of 5 to 8 mm using cantilevered zirconia RBFPDs. Thirty-six participants with 40 prostheses were recruited and underwent a 3-year clinical evaluation. The retainer designs included a minimum thickness of 0.8 mm, a minimum of 200° circumferential wraparound with an occlusal bar, and a connector dimension of 3 × 3 mm. Patient-reported outcomes, including patient satisfaction and Oral Health Impact Profile (OHIP), were assessed.

RESULTS

The average age of participants was 45.8 years, and 72.5 % were women. The success rate of the posterior zirconia RBFPDs was 76.2 %, with an estimated mean success duration of 46.1 months. The survival rate was 88.1 %, with an estimated mean survival duration of 49.4 months. Participants were highly satisfied with the treatment, achieving an average satisfaction score of 80.8 ± 11.9. Participants' total OHIP scores decreased from 52.3 to 39.6 after 3 years, indicating a significant improvement in oral health-related quality of life (P = 0.009).

CONCLUSIONS

After 3 years, a moderately high survival rate and favourable patient-reported outcomes of posterior cantilevered zirconia RBFPDs were achieved. Therefore, it can be recommended as a conservative treatment option to replace missing posterior teeth, provided that retainer design considerations are taken into account.

CLINICAL SIGNIFICANCE

Cantilevered zirconia RBFPDs for posterior teeth can serve as a conservative treatment option that is both aesthetically pleasing and biocompatible. It offers a more cost-effective alternative compared to dental implants, which are often prohibitively expensive for the majority of patients. This approach has the potential to greatly improve patient-reported outcomes.

Effect of different surface treatments on the bonding potential and physical and mechanical properties of ultratranslucent zirconia

STATEMENT OF PROBLEM

Studies to determine a suitable surface treatment that improves bonding without compromising the strength or translucency of ultratranslucent zirconia are scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of different surface treatments on translucency, surface topography, phase transformation, biaxial flexural strength, bond strength, and durability.

MATERIAL AND METHODS

A total of 169 ultratranslucent zirconia disks were randomly divided into 4 groups according to the surface treatment applied: airborne-particle abrasion (APA) (n=46), tribochemical silica airborne-particle abrasion (TS) (n=46), nonthermal oxygen plasma (NTP) (n=46), and no treatment, control (C) (n=31). The translucency parameter (ΔTP00) was evaluated with a spectrophotometer (n=15), phase transformation was assessed with an X-ray diffractometer (n=5), surface topography was evaluated with a scanning electron microscope (SEM) (n=3), and biaxial flexural strength (BFS) was tested with a universal testing machine (n=15). For the microshear bond strength (μSBS) test, 40 composite resin specimens were attached to 8 disks and tested with a universal testing machine; 20 specimens were tested after 24 hours, and 20 specimens after hydrothermal aging in a thermocycler (TC). The data were analyzed with ANOVA followed by the Tukey post hoc test (α=.05). Weibull analysis was performed for the flexural strength and μSBS results.

RESULTS

Significant ΔTP00 differences were found among all groups and were highest for the APA group (7.33) and lowest for the NTP group (4.79). The NTP group had a significantly higher monoclinic weight fraction value (4.54%) than other groups. The NTP group had significantly higher BFS (581.31) than other groups, while the APA group showed significantly lower values than other groups (340.43). The APA group had significantly higher μSBS values after 24 hours (13.51 MPa) and after TC (13.68 MPa) than the other groups (P<.05).

CONCLUSIONS

Although APA and TS are effective techniques for improving resin-zirconia bonding, they result in significantly higher deterioration of translucency and strength. NTP significantly improved the BFS of zirconia; however, it showed lower bond strength values than other methods.

A Comparative Study on Simulated Chairside Grinding and Polishing of Monolithic Zirconia

This study evaluated the effects of different simulated chairside grinding and polishing protocols on the physical and mechanical properties of surface roughness, hardness, and flexural strength of monolithic zirconia. Sintered monolithic zirconia specimens (15 mm × 3 mm × 3 mm) were abraded using three different burs: diamond bur, modified diamond bur (zirconia specified), and tungsten carbide bur, along with a group of unprepared specimens that served as a control group. The study was divided into two phases, Phase 1 and Phase 2. Surface roughness, surface hardness, and flexural strength were assessed before and after the grinding procedure to determine the ‘best test group’ in Phase 1. The best abrasive agent was selected for Phase 2 of the study. The specimens in Phase 2 underwent grinding with the best abrasive agent selected. Following the grinding, the specimens were then polished using commercially available diamond polishing paste, a porcelain polishing kit, and an indigenously developed low-temperature sintered zirconia slurry. The physical and mechanical properties were again assessed. Results were analyzed using one-way ANOVA test. Specimens were observed under scanning electron microscopy (SEM) and X-ray diffraction (XRD) for their microstructure and crystalline phases, respectively. Grinding with diamond burs did not weaken zirconia (p > 0.05) but produced rougher surfaces than the control group (p < 0.05). Tungsten carbide burs did not significantly roughen the zirconia surface. However, specimens ground by tungsten carbide burs had a significantly reduced mean flexural strength (p < 0.05) and SEM revealed fine surface cracks. Phase transformation was not detected by XRD. Polishing with commercially available polishing agents, however, restored the surface roughness levels to the control group. Dental monolithic zirconia ground with tungsten carbide burs had a significantly reduced flexural strength and a smooth but defective surface. However, grinding with diamond burs roughened the zirconia surface. These defects may be reduced by polishing with commercially available polishing agents. The use of tungsten carbide burs for grinding dental zirconia should not be advocated. Grinding with diamond abrasives does not weaken zirconia but requires further polishing with commercially available polishing agents.

Artificial Intelligence in Biomedical Applications of Zirconia

Artificial intelligence (AI) is rapidly developed based on computer technology, which can perform tasks that customarily require human intelligence by building intelligent software or machines. As a subfield of AI, machine learning (ML) can learn from the intrinsic statistical patterns and structures in data through algorithms to predict invisible data. With the increasing interest in aesthetics in dentistry, zirconia has drawn lots of attention due to its superior biocompatibility, aesthetically pleasing, high corrosion resistance, good mechanical properties, and absence of reported allergic reactions. The evolution of AI and ML led to the development of novel approaches for the biomedical applications of zirconia in dental devices. AI techniques in zirconia-related research and clinical applications have attracted much attention due to their ability to analyze data and reveal correlations between complex phenomena. The AI applications in the field of zirconia science change according to the application direction of zirconia. Therefore, in this article, we focused on AI in biomedical applications of zirconia in dental devices and AI in zirconia-related applications in dentistry.

Increasing dental zirconia micro-retentive aspect through ultra-short pulsed laser microstructuring: study on flexural strength and crystal phase characterization

Objectives

Although ultra-short pulsed laser (USPL) microstructuring has previously improved zirconia bond-strength, it is yet unclear how different laser-machined surface microstructures and patterns may influence the material’s mechanical properties. Therefore, the aim of this study was to assess the flexural strength of zirconia after different USPL settings creating three different geometrical patterns with structures in micrometer scale.

Methods

One hundred sixty zirconia bars (3Y-TZP, 21 × 4 × 2.1 mm) were prepared and randomly divided into five groups (n = 32): no surface treatment (negative control-NC); sandblasting with Al₂O₃ (SB); and three laser groups irradiated with USPL (Nd:YVO₄/1064 nm/2-34 J/cm²/12 ps): crossed-lines (LC), random-hatching (LR), and parallel-waves (LW). Bars were subjected to a four-point flexural test (1 mm/min) and crystal phase content changes were identified by X-ray diffraction. Surface roughness and topography were analyzed through 3D-laser-profilometry and SEM. Data were analyzed with parametric tests for roughness and Weibull for flexural strength (α = 5%).

Results

LR (Mean[95%CI]: 852.0 MPa, [809.2–894.7]) was the only group that did not show a significantly different flexural strength than NC (819.8 MPa, [796.6–842.9]), (p > 0.05). All laser groups exhibited higher Weibull moduli than NC and SB, indicating higher reliability and homogeneity of the strength data. An increase of monoclinic phase peak was only observed for SB.

Conclusion

In conclusion, USPL created predictable, homogeneous, highly reproducible, and accurate surface microstructures on zirconia ceramic. The laser-settings of random-hatching (12 ps pulses) increased 3Y-TZP average surface roughness similarly to SB, while not causing deleterious crystal phase transformation or loss of flexural strength of the material. Furthermore, it has increased the Weibull modulus and consequently material’s reliability.

Clinical significance

Picosecond laser microstructuring (LR conditions) of 3Y-TZP ceramic does not decrease its flexural strength, while increasing materials realiability and creating highly reproducible and accurate microstructures. These features may be of interest both for improving clinical survival of zirconia restorations as well as enhancing longevity of zirconia implants.

Evaluation of Changes in Temperature of Zirconia Frameworks During Grinding Under Different Chair-Side Conditions: An In Vitro Study

Aim:

To evaluate the changes in the temperature of zirconia during grinding under different clinical conditions.

Materials and Methods:

A total of 60 zirconia framework specimens were fabricated and divided into groups of 10 specimens each. Two different handpieces, namely, a high-speed handpiece (HSH) and a low-speed handpiece (LSH), were used for grinding with and without water cooling. Fine- and coarse-grit diamond burrs were used with the HSH, separately. The following six groups were created: (a) HSH fine-grit with water cooling, (b) HSH coarse grit with water cooling, (c) HSH fine grit without water cooling, (d) HSH coarse grit without water cooling, (e) LSH with water cooling, and (f) LSH without water cooling. Each zirconia framework was ground until 1 mm3 of the material was removed. Temperature values corresponding to the grinding techniques were compared and statistically analyzed. One-way analysis of variance was used to compare the group parameters, while the Tukey honest significant difference test was used to detect significant differences between the groups. The significance level was set at P <.05.

Results:

The highest mean temperature was measured in the case of grinding with the LSH without water cooling (54.7 °C ± 11.6 °C), while the lowest mean temperature was observed in the case of grinding with the HSH using the coarse-grit diamond rotary instrument under water cooling (22.6 °C ± 0.6 °C).

Conclusions:

The grinding of zirconia must be performed with an HSH under water cooling. Further, when water cooling is used, neither the type of handpiece nor the grain type of the rotary instrument used as it has a significant effect on the temperature.