Survival probability of zirconia-reinforced lithium silicate ceramic: Effect of surface condition and fatigue test load profile

Can the Remaining Coronal Tooth Structure Influence the Mechanical Behavior of Nonpost Full Crowns?

OBJECTIVES

 This study investigated the impact of the remaining coronal tooth structure on the mechanical behavior of nonpost (NP) full crowns on endodontically treated maxillary central incisors.

MATERIALS AND METHODS

 Forty bovine incisors with NP and 2-mm of ferrule were divided into four groups based on the remaining structure: complete 2-mm ferrule (NP-2), absence of mesial and distal ferrule effect (NP-BL), absence of buccal and lingual ferrule effect (NP-MD), and no ferrule (NP-0). The specimens underwent a stepwise stress fatigue test until fracture occurred, and stress distribution was analyzed using in silico finite element analysis (FEA). Additionally, groups with endodontic posts (P) were simulated in the FEA.

RESULTS

 The results showed that the survival rates varied among the different groups under oblique loading. The NP-2 group exhibited the highest survival rate, with all samples enduring loads up to 200 N and some surviving up to 520 N. The NP-MD and NP-BL groups had lower survival rates, while the NP-0 group had the poorest survival rate. The predominant failure mode was a nonrepairable root fracture. FEA results indicated no significant difference between groups with and without posts. NP intraradicular restorations on nonweakened roots with a minimum height of 2mm and partial or total ferrule thickness of 1mm offer a promising treatment option.

CONCLUSION

 A complete 2-mm ferrule was found to be the most favorable configuration for NP full crowns. However, maintaining the remaining tissue is crucial, as both combinations with preserved ferrule effect exhibited superior behavior in terms of fatigue and fracture load compared to the group with no ferrule. These findings contribute to understanding the mechanical considerations for NP full crowns and provide insights into treatment planning and design choices in restorative dentistry.

Effect of printing layer orientation and polishing on the fatigue strength of 3D-printed dental zirconia

OBJECTIVE

The aim of the study was to evaluate the influence of surface polishing and printing layer orientation on the fatigue behaviour of 3 mol% yttria-stabilized zirconia (3Y-TZP) by stereolithography (SLA) in comparison with subtractive manufacturing.

MATERIALS AND METHODS

60 experimental zirconia bar-shaped specimens were 3D-printed (P) via SLA, and 30 specimens were milled (M) from commercial zirconia block (Lava™ Frame, 3 M ESPE AG). All specimens had the same dimensions (1 mm × 1 mm x 12 mm) after sintering. The 3D-printed specimens were randomly divided according to printing orientations: parallel or perpendicular to the tensile surface in the fatigue test. The specimens were subsequently submitted to two surface finishing protocols (n = 15/gr): unpolished or polished. Their phase compositions were analysed by X-ray diffraction. The fatigue behaviour was evaluated by a stepwise approach.

RESULTS

The milled and both 3D-printed groups showed similar phase compositions for the as-sintered condition. Considerable amounts of rhombohedral phase were detected after polishing. Milled unpolished samples presented significantly higher fatigue strength than 3D-printed unpolished samples. Polishing did not improve the fatigue strength for milled zirconia but was advantageous for the 3D-printed specimens. 3D-printed specimens with parallel printing-layer orientation were significantly stronger than specimens with perpendicular layers regardless of surface finishing.

CONCLUSION

The manufacturing techniques had a significant influence on the fatigue strength of 3Y-TZP, but not on the phase compositions of the surface. The polishing protocol showed different effects on 3Y-TZP fatigue strength and induced phase transition of the 3Y-TZP from Tetragonal to Rhombohedral. The best fatigue strength was achieved through milling using an unpolished surface and SLA-printed layers that were parallel to the tensile surface, followed by polishing.

Does glaze firing affect the strength of advanced lithium disilicate after simulated defects?

OBJECTIVE

To study the influence of glazing on strength repair of lithium disilicate glass-ceramics after defect incorporation in different production processing phases.

MATERIALS AND METHODS

Bar-shaped specimens (1 × 1 × 12 mm, n = 280; 20/group) made from different lithium disilicate ceramics (IPS e.max CAD, Ivoclar, "LD" or advanced lithium disilicate CEREC Tessera, Dentsply Sirona, "ALD") were exposed to 7 different protocols: crystallized without (c) and with glaze layer (cg), with a defect incorporated before crystallization without (ic) and with glaze layer (icg), with a defect after crystallization without (ci) or with glaze layer (cig), and defect incorporated after the glaze layer (cgi). The flexural strength was determined using the three-point bending test. Analysis of indented areas and fractured specimens was performed by scanning electron microscopy. Flexural strength data were evaluated by two-way ANOVA followed by Tukey tests (α = 5%).

RESULTS

Two-way ANOVA revealed a significant influence of ceramic (p < 0.001; F = 55.45), protocol (p < 0.001; F = 56.94), and the interaction protocol*ceramic (p < 0.001; F = 13.86). Regardless of ceramics, defect incorporation as final step resulted in the worst strength, while defects introduced before crystallization did not reduce strength. Glaze firing after defect incorporation led to strength repair for ALD, whereas such an effect was not evident for LD.

CONCLUSIONS

The advanced lithium disilicate must receive a glaze layer to achieve its highest strength. Defects incorporated in the pre-crystallized stage can be healed during crystallization. Defects should not be incorporated after glazing.

CLINICAL RELEVANCE

Clinical adjustments should be performed on pre-crystallized or crystalized restorations that receive a glazer layer afterwards.

Thickness and Substrate Effect on the Mechanical Behaviour of Direct Occlusal Veneers

PURPOSE

This study aimed to evaluate the fracture resistance and stress magnitude of occlusal veneers made of conventional or flowable resin composites at different minimal thicknesses bonded on enamel or dentin.

MATERIAL AND METHODS

A total of 120 sound bovine incisors were flattened and used as substrates (enamel or dentin) for the restorations. The teeth were embedded into polymethyl methacrylate and allocated into 4 groups according to the resin composite (Clearfil AP-X PLT and Clearfil Majesty Flow, Kuraray Dental) and substrate. Further, the substrates were randomly subdivided in 12 groups (N = 120, n = 10) according to the occlusal veneer minimal thickness: 0.5, 1.0, or 2.0 mm. The teeth were directly restored with a standardised procedure. Then, the specimens were loaded until fracture in a universal testing machine (Instron 6022, Instron Corp.). A 3-way and a 1-way analysis of variance were used to determine significant differences for each factor. Three-dimensional finite element analysis was carried out following the in vitro boundary conditions to assess the stress magnitude in the restoration during compressive loading.

RESULTS

The fracture loads were recorded into initial load to failure (ILF) and fatal load to failure (FLF). Differences were found in material for ILF and FLF, leading to an overall equal good performance in fracture load and stress distribution for both materials, regardless of the substrate. Differences in thickness were apparent in both ILF and FLF.

CONCLUSIONS

Direct conventional and flow resin composite occlusal veneers present a promising mechanical behaviour when bonded on enamel or dentin. However, caution is advised when preparing 0.5-mm minimal thickness restorations.

Effect of Finishing Protocols on the Surface Roughness and Fatigue Strength of a High-Translucent Zirconia

Purpose

In case of need for esthetical improvement of zirconia restorations, an individualization using extrinsic staining can be applied. This study aimed to evaluate the surface roughness and fatigue strength (survival) of high-translucency zirconia (3Y-TZP, YZ®HT, Vita Zanhfabrik) with extrinsic characterization and/or glaze.

Methods

Sixty (60) zirconia discs (12 × 1.2 mm) were obtained, sintered, and randomly distributed among three groups (n = 20) according to the surface finishing protocol: C (control), C + G (extrinsic characterization followed by a glaze layer), and G (glaze layer). The surface roughness (Ra) was analyzed with a contact profilometer. Subsequently, the specimens were subjected to a fatigue load profile starting at 120 N during 20,000 cycles at 4 Hz frequency, with a 5% increase at each step until failure. The failed specimens were evaluated under a stereomicroscope. Surface roughness analysis was evaluated by using one-way ANOVA and post hoc Tukey tests (95%); while fatigue survival probability was analyzed with Kaplan-Meier and Mantel-Cox (log- rank, 95%).

Results

One-way ANOVA revealed that surface roughness was affected by the finishing protocol, where C + G showed the highest mean value (0.46 ± 0.18 µm)A followed by G (0.30 ± 0.10 µm)B, and C (0.19 ± 0.02 µm)C. While for fatigue strength, the G protocol presented a higher mean value (243.00, and 222.36-263.63)A, followed by C + G (192.75 and 186.61-198.88)B and C (172.50 and 159.43-185.56)C.

Conclusion

Surface finishing protocols modify the surface roughness and fatigue strength of high-translucent zirconia. Regardless of the surface roughness, both glazing protocols improved the ceramic fatigue strength, favoring the restoration's long-term survival.

The Correlation of Surface Roughness Parameters of Zirconia and Lithium Disilicate with Steatite Wear

PURPOSE

Various surface roughness parameters are utilized to describe the surface in the tooth to ceramics abrasion and to assess the resulting wear. The use of three-dimensional parameters may offer a better estimation for wear and an improved deduced clinical surface treatment. The aim of this study was to determine the influence of various surface roughness parameters of zirconia and lithium disilicate ceramics on the wear of steatite antagonists.

MATERIAL AND METHODS

Forty zirconia specimens with a diameter of 7 mm and a thickness of 3 mm and 40 lithium disilicate specimens with the dimensions 10×10×4 mm were each divided into five subgroups. Two subgroups were treated with different clinically established diamond burs; a third subgroup was treated with a silicone polishing set. Two additional subgroups were produced by glazing the surfaces after treatment. Surface roughness parameters were determined by laser scanning microscopy. All specimens underwent 1.2 million loading cycles using steatite antagonists. After regular intervals of cycles, precision impressions were made to assess the wear. The correlation between wear and different roughness parameters was evaluated using the Spearman correlation test.

RESULTS

For the glazed zirconia, unglazed zirconia, and glazed lithium disilicate specimens no significant correlations (p > 0.05) between the investigated roughness parameters and antagonist wear could be found. In the unglazed lithium disilicate groups, significant (p ≤ 0.05) correlations with steatite substance loss could be found for several roughness parameters after 1.2 million cycles.

CONCLUSIONS

For lithium disilicate, it seems not sufficient to use only one roughness parameter to indicate the wear behavior of the surface. There was no correlation between wear and the tested roughness parameters of zirconia surfaces.

Effect of Different Ceramic Materials on Fatigue Resistance and Stress Distribution in Upper Canines with Palatal Veneers

OBJECTIVE

 The aim of this study was to evaluate, by means of a fatigue life test, different ceramic materials used in palatal veneers to restore the canine guidance.

MATERIALS AND METHODS

 Forty-five standardized anatomical preparations were made in extracted healthy human canines with 1.2 uniform thickness. Samples were scanned, restorations were designed and milled in polymer-infiltrated ceramic network (PICN, Vita Enamic), zirconia-reinforced lithium silicate (ZLS, Vita Suprinity), and high translucent yttrium oxide-stabilized tetragonal zirconia (YZHT, Vita YZHT). Dental preparations were etched, restorations were processed according to the manufacturers' recommendations, and adhesively cemented. Then, three samples of each group were tested with load-to-fracture to determine the fatigue parameters. In addition, the palatal veneers stresses were evaluated using numerical models through finite element analysis.

RESULTS

 The mean of the monotonic test for PICN, ZLS, and YZHT was 674.18 N, 560.5 N, and 918.98 N, respectively. The StepWise test was performed until specimen fracture or until suspension of the test after 1.2 × 10⁶ cycles. Regarding survival, using the Kaplan-Meier method, PICN presented results for the mean and median of 245.21 N and 225 N, respectively; ZLS had an average of 175.76 N and a median of 168 N, and YZHT with an average of 383.30 N and a median of 366 N. Regarding the Weibull method, PICN showed results of 5.43 β and 264 η for form and scale, respectively; ZLS had 36.14 β for form and 380.67 η for scale; and YZHT presented 4.95 β for form and 417.38 η for scale. The highest stress value was calculated for YZHT, ZLS, and PICN, respectively.

CONCLUSIONS

 It was possible to conclude that all tested materials have the possibility of being used for rehabilitation of upper canines' palatal surface.

Effect of three different veneering techniques on the stress distribution and in vitro fatigue behavior of core-veneer all-ceramic fixed partial dentures

Background. The present study aimed to evaluate the influence of the veneering technique on the tensile stress distribution and survival of full-ceramic fixed dental prostheses (FDPs). Methods. A three-dimensional model of an FDP was modeled on a second premolar and a second molar with a pontic between them for finite element analysis (FEA). The groups were divided according to the veneering technique: conventional stratification, rapid layer, and CAD-on techniques. A mesh control test determined the number of elements and nodes. The materials' properties were attributed to each solid component with isotropic, homogeneous, and linear elastic behavior. For the in vitro fatigue test (n=30), the FDPs were cemented on dentin analog abutments and submitted to 2×10⁶ mechanical cycles (100 N at 3 Hz). Results. Maximum principal stress showed that the connector between the pontic and the second molar concentrated higher stresses, regardless of the techniques: Rapid layer (6 MPa) > CAD-on (5.5 MPa) > conventional stratification (4 MPa). The conventional stratification technique concentrated high stresses at the interface between the framework and veneering ceramic (2 MPa), followed by the rapid layer (1.8 MPa) and CAD-on (1.5 MPa) techniques. The crowns fabricated using the rapid layer and CAD-on techniques exhibited a 100% survival rate, while the conventional stratification group had 0% survival. Conclusion. Even with similar stress distribution between the veneering techniques, the conventional stratification technique was more prone to failure under fatigue due to higher defects incorporated than CAD-on and rapid layer techniques.

Zirconia-reinforced lithium silicate (ZLS) mechanical and biological properties: A literature review

OBJECTIVES

This paper aimed to provide a literature review of the mechanical and biological properties of zirconia-reinforced lithium silicate glass-ceramics (ZLS) in Computer-aided design / Computer-aided manufacturing (CAD/CAM) systems.

DATA/SOURCES

An extensive search of the literature for papers related to ZLS was made on the databases of PubMed/Medline, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The papers were selected by 3 independent calibrated reviewers.

STUDY SELECTION

The search strategy produced 937 records. After the removal of duplicates and the exclusion of papers that did not meet the inclusion criteria, 71 papers were included.

CONCLUSIONS

After reviewing the included records, it was found that two types of ZLS (Vita Suprinity PC; Vita Zahnfabrik and Celtra Duo; Dentsply Sirona) are nowadays available on the market for CAD/CAM systems, similar in their chemical composition, microstructure, and biological-mechanical properties. ZLS is reported to be a biocompatible material, whose fracture resistance can withstand physiological chewing loads. The firing process influences the improvements of strength and fatigue failure load, with a volumetric shrinkage. To date, ZLS can be considered a viable alternative to other glass-ceramics for fixed single restorations.

CLINICAL SIGNIFICANCE

. As to biocompatibility and mechanical properties of ZLS, data are still scarce, often controversial and limited to short-term observational periods. These promising ceramics require further in vitro/in vivo studies to accurately define mechanical and biological properties, mainly in the long-term performance of restorations produced with such materials.

Dental Materials Coatings: Effect on the Clinical Behavior

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