1
|
Huang B, Chen M, Wang J, Zhang X. Advances in zirconia-based dental materials: Properties, classification, applications, and future prospects. J Dent 2024; 147:105111. [PMID: 38866229 DOI: 10.1016/j.jdent.2024.105111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES Zirconia (ZrO2) ceramics are widely used in dental restorations due to their superior mechanical properties, durability, and ever-improving translucency. This review aims to explore the properties, classification, applications, and recent advancements of zirconia-based dental materials, highlighting their potential to revolutionize dental restoration techniques. STUDY SELECTION, DATA AND SOURCES The most recent literature available in scientific databases (PubMed and Web of Science) reporting advances of zirconia-based materials within the dental field is thoroughly examined and summarized, covering the major keywords "dental zirconia, classification, aesthetic, LTD, applications, manufacturing, surface treatments". CONCLUSIONS An exhaustive overview of the properties, classifications, and applications of dental zirconia was presented, alongside an exploration of future prospects and potential advances. This review highlighted the importance of addressing challenges such as low-temperature degradation resistance and optimizing the balance between mechanical strength and translucency. Also, innovative approaches to improve the performances of zirconia as dental material was discussed. CLINICAL SIGNIFICANCE This review provides a better understanding of zirconia-based dental biomaterials for dentists, helping them to make better choice when choosing a specific material to fabricate the restorations or to place the implant. Moreover, new generations of zirconia are still expected to make progress on key issues such as the long-term applications in dental materials while maintaining both damage resistance and aesthetic appeal, defining the directions for future research.
Collapse
Affiliation(s)
- Bo Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Mengbing Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| |
Collapse
|
2
|
AboElhassan RG, Watts DC, Alamoush RA, Elraggal A. Biomechanical behavior and Weibull survival of CAD-CAM endocrowns with different marginal designs: A 3D finite element analysis. Dent Mater 2024; 40:227-235. [PMID: 37977990 DOI: 10.1016/j.dental.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To evaluate and compare the effect of tooth preparation designs and different CADCAM. materials on stress distribution and Weibull survival probability of endocrowns. applied to root canal-treated lower first permanent molar using the 3D finite element. analysis method. METHODS A root canal-treated lower first permanent molar was prepared for endocrowns with a. butt joint or with a ferrule design by placing, circumferentially, a 1-mm wide shoulder. finish line. The prepared molar was scanned for the two designs and modeled on a 3D. Finite element model. Monolithic zirconia (IPS e.max ZirCAD MT, FCZ), lithium. disilicate (IPS e.max CAD, EX), and nano-ceramic resin composite (Lava Ultimate, LU). CAD-CAM materials were used for each preparation to design the virtual endocrown. A. total of six models were built according to the different tooth preparation designs and. endocrown materials. An occlusal load of 600 N and a transverse load of 20 N in. magnitude that simulates the average occlusal load was directed toward the occlusal. surfaces. von Mises and maximum principle values were evaluated Weibull risk-ofrupture. analysis was used to analyze the survival probability of the restorations and. tooth in the different models. RESULTS The highest von Mises were found in the butt joint design for FCZ, EX, and LU (45.3. MPa, 35.2 MPa, and 24.2 MPa, respectively) compared to the ferrule design for the. same materials (42.6 MPa, 31.2 MPa, and 23.6 MPa, respectively). For von Mises. stress distribution in the remaining part of tooth structure (dentin), the highest stresses. were found in LUFerrule which was closely similar to LUButt joint (135.4 MPa and. 134.7 MPa, respectively), followed by EXFerrule and FCZFerrule (132.2 MPa and. 131.7 MPa, respectively), while the lowest stresses were found in EXButt joint and. FCZButt joint (129.0 MPa and 128.4 MPa, respectively). Shear stresses within the. resin cement were the highest in FCZ and EX compared to LU. EX was found to be the. most reliable material with the highest survival probability, while FCZ showed the. lowest survival probability according to the Weibull risk-of-fracture results. SIGNIFICANCE Materials with high elastic modulus transfer more stresses to the endocrown and less. to the remaining tooth structure. Endocrown tooth preparation with ferrule design has. better stress distribution and magnitude compared to the butt joint design.
Collapse
Affiliation(s)
- Rewaa G AboElhassan
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - David C Watts
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rasha A Alamoush
- Department of Fixed and Removable Prosthodontics, School of Dentistry, the University of Jordan, Amman, Jordan
| | - Alaaeldin Elraggal
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| |
Collapse
|
3
|
The Effect of Surface Treatments on Zirconia Bond Strength and Durability. J Funct Biomater 2023; 14:jfb14020089. [PMID: 36826888 PMCID: PMC9968119 DOI: 10.3390/jfb14020089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
To evaluate the effects of airborne particle abrasion (APA) combined with MDP-containing resin cement, a glass-ceramic spray deposition (GCSD) method on the shear bond strengths (SBSs) and durability of 3 mol% yttrium oxide-stabilized zirconia ceramic (3Y-TZP) compared with lithium disilicate glass ceramics (LDGC). 3Y-TZP disks were randomly treated as follows: for Group APA+MDP, 3Y-TZP was abrased using 50 μm Al2O3 particles under 0.1 Mpa and bonded with MDP-containing resin cement; for Group GCSD, 3Y-TZP was treated with the GCSD method, etched by 5% HF for 90 s, silanized and bonded with resin cement without MDP. Group LDGC was bonded as the Group GCSD. X-ray diffraction (XRD), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and energy dispersive X-ray detector (EDX) were used to analyze the surface chemical and micro-morphological changes of the ceramics before bonding. The bonded ceramic specimens were randomly divided into subgroups, and the SBSs were determined before and after 10,000 thermocycling. The SBSs were analyzed with a one-way ANOVA analysis. Failure modes were determined with optical microscopy and SEM. The XRD, ATR-FTIR and XPS results identified the formation of lithium disilicate and zirconium silicate on 3Y-TZP after GCSD. The SEM micrographs revealed that 3Y-TZP surfaces were roughened by APA, while 3Y-TZP with GCSD and LDGC surfaces could be etched by HF to be porous. The APA treatment combined with MDP-containing resin cement produced the high immediate zirconia shear bond strengths (SBSs: 37.41 ± 13.51 Mpa) that was similar to the SBSs of the LDGC (34.87 ± 11.02 Mpa, p > 0.05), but, after thermocycling, the former dramatically decreased (24.00 ± 6.86 Mpa, maximum reduction by 35.85%) and the latter exhibited the highest SBSs (30.72 ± 7.97 Mpa, minimum reduction by 11.9%). The 3Y-TZP with GCSD treatment displayed the lower zirconia SBSs before thermocycling (27.03 ± 9.76 Mpa, p < 0.05), but it was similar to the 3Y-TZP treated with APA and MDP containing resin cement after thermocycling (21.84 ± 7.03 vs. 24.00 ± 6.86 Mpa, p > 0.05). The APA combined with MDP-containing resin cement could achieve the high immediate zirconia SBSs of those of the LDGC, but it decreased significantly after thermocycling. The GCSD technique could yield the immediate zirconia SBSs similar to those of LDGC before thermocycling, and long-term zirconia SBSs were similar to those of 3Y-TZP treated with APA followed by MDP-containing resin cement after thermocycling. Hence, the GCSD technique could enrich zirconia surface treatments and is an alternative to zirconia surface pretreatment for 3Y-TZP bond durability.
Collapse
|
4
|
Aboushelib MN, Elraggal A. Fractographic analysis of fractured fixation screws in implant-supported restorations. Dent Mater 2023; 39:123-131. [PMID: 36577562 DOI: 10.1016/j.dental.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/19/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study was to fractographically examine clinically fractured fixation screws used to fix implant supported restorations and to estimate stress at failure. METHODS 20 clinically fractured titanium implant fixation screws were collected and analyzed under scanning electron microscope in order to locate critical crack origin and calculate stress at fracture. Principles of fractographic analysis were applied using relative equations and cause and conditions of screw fracture were calculated. X-rays and patients' records were collected after approval of necessary consent forms. RESULTS Fractographic analysis revealed location and dimensions of critical crack size for every fractured screw examined. Two patterns of screw fracture were identified; the first was related to improper seating of fixation screw leading to damage at screw threads and eventual fracture of screw body. The second was related to slow crack growth propagation causing final fracture of screw body. The calculated stress at failure ranged from 755 to 804 MPa. Patients' records revealed that 75% of fractured screws were related to single unit screw retained restorations. SIGNIFICANCE Single unit screw retained restorations and improperly seated implant abutments impose high stress concentration on fixation screw which may result in fixation screw fracture.
Collapse
Affiliation(s)
- Moustafa N Aboushelib
- Dental Biomaterials Department, Faculty of Dentistry, Alexandria University, Champollion st, Azarita, Alexandria, Egypt.
| | - Alaaeldin Elraggal
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion st, Azarita, Alexandria, Egypt.
| |
Collapse
|
5
|
Elraggal A, R Afifi R, Alamoush RA, Raheem IA, Watts DC. Effect of acidic media on flexural strength and fatigue of CAD-CAM dental materials. Dent Mater 2023; 39:57-69. [PMID: 36496258 DOI: 10.1016/j.dental.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the effect of acidic media, including beverages and gastric fluids on flexural strength and fatigue of CAD-CAM materials. METHODS Four CAD-CAM materials (high-translucency zirconia (Ceramill Zolid HT+), lithium disilicate (IPS e-max CAD), hybrid ceramic (Vita Enamic), and nanohybrid resin composite (Grandio Blocs) were prepared and immersed in one of five media (gastric HCl, white wine, Coca-Cola, orange juice, and artificial saliva) in an incubator (37 ℃, 24 h). Surface topography and roughness were obtained using a scanning electron microscope (SEM) and a stylus contact profilometer, respectively. Initial 3-point flexural strength was measured for half of the bars (n = 20/gp) using a universal testing machine (0.5 mm/min). The other bars underwent 106 cyclic fatigue loadings before measurement of residual 3-point flexural strength. Data were statistically analyzed (two-way and three-way ANOVA, Tukey's post-hoc, p < 0.05). Weibull distributions were plotted for reliability analysis. RESULTS Zirconia bars has the highest initial flexural strengths followed by lithium disilicate, while resin composite and hybrid ceramic groups had the lowest strength regardless of the erosive medium. Cyclic fatigue significantly reduced initial flexural strengths for all materials except for hybrid ceramic and resin composite. Weibull moduli were the highest for zirconia, lithium disilicate and resin composite and lowest for hybrid ceramic. SIGNIFICANCE Erosive media significantly changed surface roughness of CAD-CAM materials except for zirconia and resin composite without jeopardizing the flexural strength of the CAD-CAM materials. Despite the higher flexural strengths for zirconia and lithium disilicate, resin composite and hybrid ceramic were more resistant to cyclic fatigue.
Collapse
Affiliation(s)
- Alaaeldin Elraggal
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Rania R Afifi
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rasha A Alamoush
- Department of Prosthodontics, School of Dentistry, The University of Jordan, Amman, Jordan
| | - Islam Abdel Raheem
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - David C Watts
- School of Medical Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
6
|
Mezarina-Kanashiro FN, Bronze-Uhle ES, Rizzante FAP, Lisboa-Filho PN, Borges AFS, Furuse AY. A new technique for incorporation of TiO 2 nanotubes on a pre-sintered Y-TZP and its effect on bond strength as compared to conventional air-borne particle abrasion and silicatization TiO 2 nanotubes application on pre-sintered Y-TZP. Dent Mater 2022; 38:e220-e230. [PMID: 35750506 DOI: 10.1016/j.dental.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/01/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study evaluated the microshear bond strength of a resin cement to Y-TZP after different methods of TiO2 nanotubes (nTiO2) incorporation on pre-sintered Y-TZP surfaces. METHODS nTiO2 were synthesized and incorporated on Y-TZP slices as follows (n = 15): 1) nTiO2 mixed with isopropyl alcohol/manual application (MAl); 2) nTiO2 mixed with acetone/manual application (MAc); 3) nTiO2 mixed with isopropyl alcohol/high-pressure vacuum application (HPVAl); 4) nTiO2 mixed with acetone/high-pressure vacuum application (HPVAc). As controls, surfaces were sandblasted with Al2O3 (OX) or Rocatec silicatization (ROC). All ceramics were sintered after nTiO2 incorporation. Surface treatments of OX and ROC were made after sintering. Surfaces were characterized by confocal laser microscopy, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Resin composite cylinders (1.40 mm diameter and 1 mm height) were cemented with a resin cement, stored in water at 37 °C for 24 h and thermocycled for 10 000 cycles before microshear bond strength evaluation. Data were analyzed with one-way ANOVA and Games-Howell (α = 0.05), and fracture analysis was performed using a stereomicroscope. RESULTS EDS confirmed the presence of TiO2 on treated Y-TZP. The confocal analysis showed higher roughness for HPVAc and OX. There were significant differences between surface treatments (p < 0.001). HPVAl (22.96 ± 10.3), OX (34.16 ± 7.9) and ROC (27.71 ± 9.4) showed higher microshear bond strengths and were statistically similar (p > 0.05). MAC showed intermediary values, and HPVAc and MAl presented decreased bond strength, with a high percentage of premature debonding. CONCLUSION High-pressure vacuum application of nTiO2 mixed with isopropyl alcohol was able to produce bond strength values compared to conventional air abrasion and Rocatec silicatization. SIGNIFICANCE The infiltration of TiO2 nanostructures on the pre-sintered Y-TZP is an interesting approach that can improve bond strength without the need of sandblasting methods.
Collapse
Affiliation(s)
- Franco Naoki Mezarina-Kanashiro
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Erika Soares Bronze-Uhle
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil; Department of Physics, School of Sciences, São Paulo State University, Bauru, Brazil
| | - Fabio Antonio Piola Rizzante
- Department of Oral Rehabilitation at Medical University of South Carolina, James B. Edwards College of Dental Medicine, Charleston, SC, USA
| | | | - Ana Flavia Sanches Borges
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Adilson Yoshio Furuse
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
| |
Collapse
|
7
|
Elraggal A, Afifi R, Abdelraheem I. Effect of erosive media on microhardness and fracture toughness of CAD-CAM dental materials. BMC Oral Health 2022; 22:191. [PMID: 35590294 PMCID: PMC9118722 DOI: 10.1186/s12903-022-02230-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Erosive acids might create surface flaws and deteriorate the mechanical properties of CAD-CAM materials. This invitro study aimed to investigate the effect of simulated gastric HCl and extrinsic erosive acids on surface microhardness and fracture toughness of CAD-CAM materials. Methods 400 bar-shaped specimens (17×4×2 mm3) were prepared from 4 different CAD-CAM dental materials (n = 100/group); monolithic zirconia (Ceramill Zolid HT+, Amanngirbach, Austria), lithium disilicate ceramic (IPS e.max CAD, Ivoclar Vivadent, Liechtenstein), nanohybrid resin composite (Grandio Blocs, VOCO) and polymer-infiltrated glass network (Vita Enamic, VITA Zahnfabrik). Specimens from each material type were further subdivided into 5 groups (n = 20) according to the erosive media applied (simulated gastric HCl, white wine, Coca-Cola®, orange juice, and artificial saliva that served as a control). Specimens were immersed for 24 h in an incubator at 37 ℃, then ultrasonically cleaned in distilled water and air-dried. Half of the specimens were tested for Vickers microhardness (VHN) at parameters of 500 gf for 10 s, while the rest of the specimens underwent 3-point flexure till fracture. Fractured surfaces were examined under a scanning electron microscope (SEM) for fracture toughness (KIC) calculation using the quantitative fractographic analysis method. Data collected were statistically analyzed using two-way analysis of variance (α = 0.05) after verification of data normality and homogeneity of variances. Results Erosive media created surface flaws that lowered the surface microhardness of the material and initiated the fracture pattern under different loads according to material type. The material type was a more predominant factor than erosive media that affected either the microhardness or the fracture toughness of CAD-CAM dental materials. The highest VHN and KIC values were found among Ceramill Zolid HT+ groups followed by IPS e.max CAD and Grandio Blocs regardless of the erosive media employed. Erosive media significantly reduced the VHN and KIC in Vita Enamic specimens compared to the rest of the material types. Conclusion All CAD-CAM materials used, except Vita Enamic, showed high resistance against the erosive acids indicating higher longevity of the material in patients frequently exposed to either extrinsic or intrinsic acid.
Collapse
Affiliation(s)
- Alaaeldin Elraggal
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion street, Alexandria, Egypt.
| | - Rania Afifi
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion street, Alexandria, Egypt
| | - Islam Abdelraheem
- Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Champollion street, Alexandria, Egypt
| |
Collapse
|