Fracture, roughness and phase transformation in CAD/CAM milling and subsequent surface treatments of lithium metasilicate/disilicate glass-ceramics

Brittle-Ductile Threshold in Lithium Disilicate under Sharp Sliding Contact

Computer-aided design (CAD)/computer-aided manufacturing (CAM) milling and handpiece grinding are critical procedures in the fabrication and adjustment of ceramic dental restorations. However, due to the formation of microfractures, these procedures are detrimental to the strength of ceramics. This study analyzes the damage associated with current brittle-regime grinding and presents a potential remedy in the application of a safer yet still efficient grinding regime known as "ductile-regime grinding." Disc-shaped specimens of a lithium disilicate glass-ceramic material (IPS e.max CAD) were obtained by cutting and crystallizing the lithium metasilicate CAD/CAM blanks (the so-called blue blocks) following the manufacturer's instructions. The discs were then polished to a 1 µm diamond suspension finish. Single-particle micro-scratch tests (n = 10) with a conical diamond indenter were conducted to reproduce basic modes of deformation and fracture. Key parameters such as coefficient of friction and penetration depth were recorded as a function of scratch load. Further, biaxial flexure strength tests (n = 6) were performed after applying various scratch loads to analyze their effects on ceramic strength. Scanning electron microscopy (SEM) and focused ion beam (FIB) were used to characterize surface and subsurface damage. Statistical analysis was performed using one-way analysis of variance and Tukey tests. While the SEM surface analysis of scratch tracks revealed the occurrence of both ductile and brittle removal modes, it failed to accurately determine the threshold load for the brittle-ductile transition. The threshold load for brittle-ductile transition was determined to be 70 mN based on FIB subsurface damage analyses in conjunction with strength degradation studies. Below 70 mN, the specimens exhibited neither strength degradation nor the formation of subsurface cracks. Determination of the brittle-ductile thresholds is significant because it sets a foundation for future research on the feasibility of implementing ductile-regime milling/grinding protocols for fabricating damage-free ceramic dental restorations.

Effect of glazing and thermocycling on the fracture toughness and hardness of a New fully crystallized aluminosilicate CAD/CAM ceramic material

BACKGROUND

The mechanical properties of fully crystallized lithium aluminosilicate ceramics may be influenced by intraoral temperature variations and postmilling surface treatment. The purpose of this study is to explore the interplay among glazing, thermocycling, and the mechanical characteristics (namely, fracture toughness and hardness) of fully crystallized lithium aluminosilicate ceramics.

METHODS

Bending bars (n = 40) cut from LisiCAD blocks (GC, Japan) were randomly assigned to glazed or unglazed groups (n = 20) and subjected to the single edge v-notch beam method to create notches. A glazing firing cycle was applied to the glazed group, while the unglazed group was not subjected to glazing. Half of the specimens (n = 10) from both groups underwent thermocycling before fracture toughness testing. The fracture toughness (KIC) was evaluated at 23 ± 1 °C using a universal testing machine configured for three-point bending, and the crack length was measured via light microscopy. Seven specimens per group were selected for the hardness test. Hardness was assessed using a Vickers microhardness tester with a 1 kg load for 20 s, and each specimen underwent five indentations following ISO 14705:2016. The Shapiro-Wilk and Kolmogorov-Smirnov tests were used to evaluate the normality of the data and a two-way ANOVA was utilized for statistical analysis. The significance level was set at (α = 0.05).

RESULTS

Regardless of the thermocycling conditions, the glazed specimens exhibited significantly greater fracture toughness than did their unglazed counterparts (P < 0.001). Thermocycling had no significant impact on the fracture toughness of either the glazed or unglazed specimens. Furthermore, statistical analysis revealed no significant effects on hardness with thermocycling in either group, and glazing alone did not substantially affect hardness.

CONCLUSIONS

The impact of glazing on the fracture toughness of LiSiCAD restorations is noteworthy, but it has no significant influence on their hardness. Furthermore, within the parameters of this study, thermocycling was found to exert negligible effects on both fracture toughness and hardness.

Wear characteristics of esthetic resin matrix and zirconia reinforced lithium disilicate CAD/CAM materials: two-body wear and surface topography analysis

BACKGROUND

This in vitro study assessed the wear behavior of different CAD-CAM blocks and the abrasion of the enamel antagonist against these materials.

METHODS

64 disk-shaped specimens were prepared from 8 different CAD/CAM blocks as follow: one lithium disilicate glass ceramics block "IPS Emax CAD" as control group, two zirconia reinforced lithium silicate "Vita Suprinity & Celtra DUO," one interpenetrating network ceramic block "Vita Enamic," Three resin-based block composites "Lava Ultimate, Cerasmart & Brilliant-crios" as well as one hybrid nanoceramic "Shofu block HC". All specimens were mounted against canine and tested for two body wear analysis using a chewing simulating loading machine (100,000 cycles, 50 N, 5/55 °C). The amount of wear loss was measured for each specimen using a digital precise scale. Wear area before and after the chewing simulation were evaluated using an optical profilometer. Data analysed using one-way ANOVA test followed by Tukey's post hoc.

RESULTS

The results showed a significantly higher wear loss in resin matrix ceramics in comparison to glass ceramics. However, for tooth wear glass ceramics had significantly higher value than hybrid ceramics.

CONCLUSIONS

Resin based CAD/CAM Blocks gives a superior result when evaluating the wear behavior and its effect on the opposing tooth surface.

Impact of glazing on wear, fracture load, and optical properties of a new fully crystallized lithium disilicate ceramic material

OBJECTIVES

Lithium disilicate (LDS) based glass ceramics are indispensable materials in the field of prosthetic dentistry due to their strength and excellent esthetics. Recently, novel fully crystallized LDS for the milling process have been introduced to the market, requiring only chairside polishing before delivery. Since limited data is available about subjecting this material to glazing, this study aimed to evaluate the wear properties, fracture resistance, and optical properties of the newly introduced fully crystallized LDS after glazing.

METHODS

Lithium disilicate glass-ceramics (fully crystallized (LiSiCAD) and partially crystallized types (EmaxCAD), of shade A3, were used in the present study. The fully crystallized specimens were subjected to a glazing firing cycle in a furnace (LiSiCAD-G) and compared to a polished fully crystallized counterpart (LiSiCAD-P, negative control) and a glazed partially crystallized LDS (EmaxCAD, positive control). Rectangular-shaped ceramic specimens (n = 10, 12 × 6.5 × 1.5 mm) and enamel antagonists were used to test the wear resistance in a specially designed wear machine built at the Department of Oral Technology, University of Bonn, Germany. The volumetric enamel loss of antagonists was measured by means of overlapping virtual 3D models derived from micro-CT scans for the teeth before and after the wear test. The weight loss of ceramic specimens in milligrams was measured after 100,000 and 200,000 wear cycles. A spectrophotometer was used to calculate the CIELAB color parameters of the ceramic specimens against black and white backgrounds to measure the translucency. Fracture resistance was also assessed after thermodynamic fatigue using a universal testing machine until fracture at a 1 mm/min crosshead speed. Statistical analysis was performed using one-way ANOVA and the significance level was set at α = 0.05.

RESULTS

EmaxCAD and LisiCAD-G groups showed significantly higher mean ceramic weight loss after 100,000 cycles (2 ± 0.3 mg and 1.93 ± 0.2 mg, respectively) than LisiCAD-P group (0.78 ± 0.19 mg). Glazed LiSiCAD specimens demonstrated significantly higher ΔE values from shade A3 compared to polished LiSiCAD. There was no significant difference in ΔE between LiSiCAD-G and EmaxCAD. For fracture resistance, no significant difference was observed between LiSiCAD-G and LiSiCAD-P before or after aging.

CONCLUSIONS

The glazed fully crystallized LDS was superior to the partially crystallized one with regard to wear resistance but showed more color changes than the polished fully crystallized one. Furthermore, polishing of fully crystallized LDS could still be considered a better option than glazing when aesthetics is a primary prerequisite.

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.

A Critical Review of Dental Lithia-Based Glass-Ceramics

The purpose of this article is to review current understanding of lithia-based glass-ceramics and to identify future research needs for this class of dental materials in relation to novel compositions and fabrication methods. With rapid advances in material development and digital technology, time efficiency of dental workflow and fit accuracy of ceramic restorations are ever improving. Lithia-based glass-ceramics are at the forefront of this advance-new variants with more efficient fabrication routes are continually being introduced into the marketplace. Base glass composition, crystallization heat treatment, nucleant and coloration additives, and property gradation are some pertinent variables. The trend in fabrication is to move from CAD/CAM grinding of partially crystallized glass-ceramics to fully crystallized materials, thereby circumventing the need for postmachining firing altogether. In these endeavors, a better understanding of mechanical properties and evolving shaping technologies, such as ductile grinding, is paramount. Additive manufacturing and 3-dimensional printing methodologies offer a promising alternative to current CAD/CAM subtractive manufacturing routes. Challenges to the implementation of new technologies in efficient development and production of high-quality dental glass-ceramic prostheses are addressed.

Analysis of surface characteristics of (Y, Nb)-TZP after finishing and polishing

PURPOSE

This in vitro study aimed to evaluate the surface characteristics of a full veneer crown fabricated chairside (CS) from a (Y, Nb)-TZP zirconia block in response to conventional zirconia grinding and polishing.

MATERIALS AND METHODS

Zirconia crowns (n = 40) were first prepared and divided into two groups of materials: Labside (LS) and CS, after which each specimen went through a five-step grinding and polishing procedure. Following each surface treatment, surface characteristics were analyzed using confocal laser microscopy (CLSM), average surface roughness (Ra) values were processed from the profile data through Gaussian filtering, and X-ray diffraction pattern analysis was performed to evaluate the monoclinic (M) phase content. Then, a representative specimen was selected for field-emission scanning electron microscopy (FE-SEM), followed by a final analysis of the roughness and X-ray diffraction of the specimens using the independent t-test and repeated measures analysis of variance (RM-ANOVA).

RESULTS

In every group, polishing significantly reduced the Ra values (P < .001). There was no significant difference in Ra between the polished state CS and LS. Furthermore, CLSM and FE-SEM investigations revealed that even though grain exposure was visible in CS specimens throughout the as-delivered and ground states, the exposure was reduced after polishing. Moreover, while no phase transformation was visible in the LS, phase transformation was visible in CS after every surface treatment, with the M phase content of the CS group showing a significant reduction after polishing (P < .001).

CONCLUSION

Within the limits of this study, clinically acceptable level of surface finishing of (Y, Nb)-TZP can be achieved after conventional zirconia polishing sequence.

Simulation of CAD/CAM milling on lithium disilicate: Mechanical and topographic analyses of surface grinding different protocols

The aim of this study was to evaluate the topography and the fatigue performance of lithium disilicate glass-ceramic after surface grinding through different laboratory protocols used to simulate the Computer-aided design/Computer-aided manufacturing (CAD/CAM) milling. Ceramic discs (IPS e.max CAD, Ø = 13.5 mm × 1.2 mm of thickness) were produced through different methodologies: milling in CAD/CAM system (CAD/CAM group); produced in-lab with a polished surface (POL group); or produced through in-lab methods and randomly distributed into five groups according to different grinding protocols to simulate the CAD/CAM milling [grinding with a CAD/CAM bur coupled to a mandrel (CAD/CAM Bur group); fine diamond bur using oscillatory movements (DBO group); fine diamond bur in x and y axes of the disc (DBXY group); #60-grit silicon carbide sandpaper (SiC group); and #60-grit wood sandpaper (WS group)]. The specimens were fatigue tested (n = 15) according to the step-stress method (initial load: 60 N; step-size: 20 N; 10,000 cycles/step; 20 Hz frequency). A roughness analysis was performed on all specimens, while fractal dimension (FD) and fractography were performed on representative samples. The Kaplan-Meier analysis showed that the POL (293.3 N) group presented better fatigue performance (higher load and number of cycles for failure) (p < 0.05) than the other groups (CAD/CAM = 222.7 N; CAD/CAM Bur = 181.3 N; DBO = 184.0 N; DBXY = 192.0 N; SiC = 182.6 N; WS = 182.6 N). For roughness, only the SiC (Ra = 1.616; Rz = 10.465) and WS (Ra = 1.673; Rz = 10.655) groups produced statistically similar Ra (μm) and Rz (μm) values to the CAD/CAM (Ra = 1.628; Rz = 9.571) group (p > 0.05). The surface created by CAD/CAM milling and POL group exhibited more complexity (FD) higher values than the experimental groups. For the ceramic surface topography images, the CAD/CAM milling visibly produced a uniform surface compared to the other groups; however, the POL group was the smoothest. The DBO, DBXY, SiC, and WS groups resulted in similar characteristics of surface topography. Therefore, although the SiC and WS groups showed similar roughness to the control group (CAD/CAM), no in-lab simulation method was fully capable to mimic the mechanical performance of the CAD/CAM-milled lithium disilicate glass-ceramic.

Bonding of Clear Aligner Composite Attachments to Ceramic Materials: An In Vitro Study

Background: We aim to evaluate the effect of surface conditioning, bonding agents and composite types on surface roughness (SR) and shear bond strength (SBS) of clear aligner composite attachments bonded to ceramics. Methods: One hundred and eighty IPS e.max CAD specimens were prepared. For SR, 60 specimens were divided according to surface conditioning (n = 15) into four groups: control, 9.6% hydrofluoric acid (HFA), 37% phosphoric acid (PhA), air abrasion (AA). SR was measured using a Profilometer and Atomic Force Microscopy. For SBS, 120 specimens were divided according to conditioning methods (n = 40) (9.6% HFA and 37% PhA or AA), then according to bonding agents (n = 20) (Assure universal bond (AUB) or Single bond universal (SBU)) and then according to composite type (n = 10): Filtek™ Z350 and Filtek™ Z350 XT flowable composite. SBS was measured using Instron testing machine. Descriptive and group comparison were calculated (p < 0.05). Results: AA had the highest SR, while the control had the lowest SR (p < 0.05). HFA had the highest, but insignificant SBS, followed by AA (p > 0.05). AUB had higher SBS than SBU (p < 0.001). Filtek™ Z350 produced higher SBS than Filtek™ Z350 XT flowable composite (p < 0.01). Conclusion: The combination of AA, AUB, and Filtek Z350 produced the highest SBS, followed by HFA, AUB, and Filtek Z350.

Effect of repeated millings on the surface integrity of diamond burs and roughness of different CAD/CAM materials

OBJECTIVES

This study evaluated the surface integrity of two types of diamond burs and their effect on the roughness of different CAD/CAM materials.

MATERIALS AND METHODS

CAD/CAM materials, Vita Mark II (VM), IPS e.max CAD (EM), Celtra Duo (CD), G-Ceram (GC), and Lava Ultimate (LU) blocks were milled with CEREC MCXL. Five pairs of pointed cylinder burs (CB) and step burs (SB) were used repeatedly. The wear rate of burs was analyzed before and after milling with a scanning electron microscope (SEM) and weighing the burs. The milling time of the blocks at different milling stages was recorded from 2 (M2) to 8 times (M8) of use. The surface roughness (Ra) of blocks was measured with a profilometer. Data from the differences in surface roughness were analyzed using univariate analyses of variance and Kruskal-Wallis tests (alpha = 0.05).

RESULTS

For M2, the highest roughness (2.12 ± 0.1 μm) was observed with the VM block. EM blocks presented the highest roughness values (1.82 ± 0.3 μm, 1.85 ± 0.1 μm, and 1.86 ± 0.04 μm) at M4, M6, and M8, respectively. While the highest Ra values were observed for VM (2.12 to 1.43 µm), LU provided the lowest mean Ra (1.62 to 1.33 µm) among the tested materials. After the repeated use of burs up to 8 times, the surface roughness of all the tested materials decreased. Milling of LU resulted in chip deposits on the CB surface in SEM images. The duration of cutting was higher for CD and EM materials than those of other materials, but the milling duration for VM, GC, and LU blocks was similar. SB burs exhibited more wear than CB after repeated milling.

CONCLUSIONS

A repeated number of millings more than 4 times decreased the surface integrity of the milling burs, increased the surface roughness of CAD/CAM blocks except for LU, and increased the milling duration. Increased material hardness was more detrimental on bur surface integrity.

CLINICAL RELEVANCE

During milling CAD/CAM blocks, clinicians should note that the surface integrity of milling burs decreases after 4 times of use as a function of material hardness where step burs wear quicker than pointed cylinder burs.

Microstructural considerations for novel lithium disilicate glass ceramics: A review

OBJECTIVE

To review the ultrastructural characteristics of novel lithium disilicate based glass ceramics (LDC), how their manufacturing process influences their structure and their clinical use.

OVERVIEW

Lithium disilicate based glass ceramic has been successfully used for indirect restorations ranging from partial tooth coverage up to tooth replacement for over 20 years. It combines esthetic and mechanical properties, unlike any other indirect material which makes it an indispensable part of esthetic and restorative dentistry. Recently, novel LDCs have been introduced to the market. Parameters for their use and their microstructure are still not been widely known. This article will review these materials and highlight with high-resolution scanning electron microscopic images their structural aspects and their resulting clinical relevance.

CONCLUSION

Restorations made from LDCs are reliable and can be predictably used only when proper guidelines and protocols during manufacturing and clinical use are followed. For novel LDCs manufacturing and long-term bonding protocols still must be established. Moreover, novel LDCs machinable blocks should be crystallized or heat-treated after milling for superior performance.

CLINICAL SIGNIFICANCE

With more and newer etchable LDC materials entering the market, clinicians and technicians need to be aware of the differences in manufacturing and the resulting microstructure to ensure a successful treatment outcome that will last.

Investigation of indentation size effect and R-curve behaviour of Li2O-SiO2 and Li2O-2SiO2 glass ceramics

Indentation size effect (ISE) and R-curve behaviour of Li₂O-SiO₂ and Li₂O-2SiO₂ glass ceramics are investigated using micro-indentation and indentation-strength (IS) techniques, respectively. Vickers micro-indentations were applied on both materials at the load of 0.10-19.6 N to determine the load influence on the measured hardness. For the IS-measured fracture toughness, the load ranged from 1.96 to 19.6 N. The hardness decreased with increasing load by 20% and 18% on Li₂O-SiO₂ and Li₂O-2SiO₂ glass ceramics, respectively, indicating the ISE behaviour on both materials. The fracture toughness increased with the load by 27% and 59% on Li₂O-SiO₂ and Li₂O-2SiO₂ glass ceramics, respectively, signifying the R-curve behaviour. The ISE behaviour of both materials was analysed using the Meyer's, Hays-Kendall (HK), proportional specimen resistance (PSR), Nix-Gao (NG), modified PSR (MPSR) and elastic plastic deformation (EPD) models while the R-curve behaviour was analysed by the fractional power law. The Meyer's index of both materials was less than 2, strongly confirming the ISE existence. The HK, PSR and NG models were only suitable to determine intrinsic Vickers hardness for Li₂O-2SiO₂ glass ceramic while the MPSR and EPD models were successful for both materials. The fractional power law gave higher R-curve steepness for Li₂O-2SiO₂ than Li₂O-SiO₂ glass ceramics. Also, material and brittleness indices predicted, respectively, higher quasi-plasticity and better machinability for Li₂O-2SiO₂ than Li₂O-SiO₂ glass ceramics indicating superior performance in the former to the latter. Finally, this study presents a new significant insight into the micro-mechanisms of fracture tolerance behaviour of these glass ceramics which is critical to their functional performance as structural ceramics.

Resistance to Fracture of Lithium Disilicate Feldspathic Restorations Manufactured Using a CAD/CAM System and Crystallized with Different Thermal Units and Programs

The aim of this study was to determine the resistance to fracture of feldspathic restorations with lithium disilicate and crystallized with different ovens and programs. Methods: Sixty monolithic restorations (LD) (EMAX CAD™ LT, Ivoclar-Vivadent™) were designed with the same parameters and milled with a CAD/CAM system (CEREC SW 5.1, CEREC MCXL, Dentsply-Sirona™, Bensheim). Each restoration was randomly assigned by randomization software (RANDNUM) to one of the three groups: (a) (NF) Oven P310 (Ivoclar, Vivadent) normal crystallization program, (b) (FF) Ivoclar P310 oven (Ivoclar-Vivadent™) rapid crystallization program, or (c) (SF) SpeedFire oven (Dentsply-Sirona™). Results: There were statistically significant differences between the groups (ANOVA, p < 0.05). The NF and FF groups showed the highest values of resistance to fracture, with statistically significant differences with the SF group. Conclusions: Using a furnace from the same dental company with predetermined programs from the material manufacturer, as well as using a predetermined program for rapid crystallization, has no effect on fracture resistance, and would save clinical time when performing ceramic restorations with lithium disilicate, while keeping their mechanical properties.

In-lab simulation of CAD/CAM milling of lithium disilicate glass-ceramic specimens: Effect on the fatigue behavior of the bonded ceramic

The aim of this study was to evaluate the effect of in-lab simulation procedures performed on a lithium disilicate ceramic luted to a dentin-analogue material regarding the fatigue performance and topographic changes. Lithium disilicate ceramic (IPS e.max CAD) discs (Ø = 13.5 mm and 1.5 mm of thickness) were produced in different ways: milled in a CAD/CAM system (CAD/CAM - control group); mirror-polished (POL group); produced in-lab and ground with #60 silicon carbide paper (SiC group); with #60 wood sandpaper (WS group); with a fine diamond bur (DB group); or with a CAD/CAM bur adapted in a handpiece with a custom mandrel (MANDREL group). The ceramic discs were adhesively luted (Multilink N) onto dentin analogue discs (Ø = 12 mm and 2 mm of thickness) and fatigue testing (n = 19 discs) was performed by step-stress methodology (initial load of 200 N; step-size of 50 N; 10,000 cycles per step; 20 Hz). Surface roughness and contact angle analysis were also performed. According to Kaplan-Meier and post-hoc Mantel-Cox (log-rank), distinct fabrication methods affected the fatigue performance of bonded glass-ceramic discs (p< 0.001). The CAD/CAM group presented the lowest fatigue failure loads (1250 N) and number of cycles for failure (185,000), while the POL groups obtained the highest results (1752 N; 284,444 cycles). The in-lab groups had intermediate values (1355 - 1526 N; 206,052 - 238,684 cycles). Polished specimens presented the lowest roughness values (Ra = 0.041 μm), while the SiC (1.604 μm), WS (1.701 μm), and MANDREL (1.867 μm) groups showed statistically similar roughness values to the CAD/CAM group (1.738 μm). Despite differences before etching, the contact angle was similar among the milled and simulated groups after etching, except for the polished group. Even with some topographic similarities, the tested in-lab simulation methods were not able to mimic the milled specimens in terms of fatigue findings, leading to distinct magnitude of overestimations of the results.

Effect of milling, fitting adjustments, and hydrofluoric acid etching on the strength and roughness of CAD-CAM glass-ceramics: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Whether procedures performed before the cementation of computer-aided design and computer-aided manufacturing (CAD-CAM) glass-ceramic restorations, including milling, fitting adjustment, and hydrofluoric acid etching introduce defects on the ceramic surface that affect the mechanical and surface properties is unclear.

PURPOSE

A systematic review and meta-analysis were conducted to assess the effect of milling, fitting adjustments, and hydrofluoric acid etching (HF) on the flexural strength and roughness (Ra) of CAD-CAM glass-ceramics.

MATERIAL AND METHODS

Literature searches were performed up to June 2020 in the PubMed/MEDLINE, Web of Science, and Scopus databases, with no publication year or language limits. The focused question was "Do milling, fitting adjustments, and hydrofluoric acid etching affect the flexural strength and roughness of CAD-CAM glass-ceramics?" For the meta-analysis, flexural strength and Ra data on milling, fitting adjustment, and HF etching versus control (polishing) were analyzed globally. A subgroup analysis assessed the effect of etching parameters (HF concentration and time) on the flexural strength and roughness of CAD-CAM glass-ceramics with different microstructures. Comparisons were performed with random-effect models at 5% significance.

RESULTS

Fourteen studies from 2764 potentially relevant records were included in the qualitative syntheses, and 12 in the meta-analysis. Milling and fitting adjustments increased roughness and reduced the flexural strength of CAD-CAM glass-ceramics. The effect of HF etching was dependent on the glass-ceramic microstructure, HF concentration, and etching time. For feldspathic- and leucite-reinforced ceramics, HF 5% applied for between 30 and 120 seconds increased roughness without affecting flexural strength. For lithium disilicate glass-ceramics, HF concentrations greater than 4.9% used for 20 seconds or more reduced the strength without affecting the surface roughness.

CONCLUSIONS

The flexural strength of CAD-CAM glass-ceramic is reduced by grinding procedures such as milling and fitting adjustment. Ceramic microstructure, HF concentration, and etching time determined the effect of hydrofluoric acid etching on the flexural strength and surface roughness of glass-ceramic materials.

Influence of CAD/CAM milling, sintering and surface treatments on the fatigue behavior of lithium disilicate glass ceramic

This paper reports on the process-fatigue relation of lithium disilicate glass ceramic (LDGC) using low-cycle, high-load Hertzian indentations with a rigid indenter to simulate teeth grinding/clenching of LDGC restorations with different surface asperities obtained in CAD/CAM milling, sintering, polishing and glazing. The maximum contact stresses were evaluated as functions of the number of load cycles and surface treatments using the Hertzian model. Indentation-induced surface damage was viewed using scanning electron microscopy (SEM) to understand the relationships among microstructures, surface asperities, crack morphology and propagation. Different processes and surface treatments significantly affected the maximum contact stresses of indented LDGC surfaces (ANOVA, p < 0.05), which were all significantly reduced with the number of cycles (ANOVA, p < 0.05). Quasi-plastic deformation was dominant in single-cycle indentation of all processed and treated surfaces. In higher cycle indentations, inner cone cracks were formed on all surfaces; median and transverse cracks were formed on the roughest surfaces processed by CAD/CAM milling and sintering. Ring cracks, fretting, pulverization, micro-bridges, surface smearing and wedging, and edge chippings were also propagated on all surfaces. The process-fatigue relation provides an understanding of the mechanical functions of surface asperities produced in different processes and treatments. It indicates that the mechanically assisted growth of surface asperities with different roughness strongly affected the indentation-induced surface damage. Finally, the smoothest surfaces produced by CAD/CAM milling, polishing and sintering sustained the highest contact stresses and the least fatigue damage at higher cycles, ensuring their superior fatigue performance compared to other processed LDGC surfaces.

Color matching of full ceramic versus metal-ceramic crowns - a spectrophotometric study

Background and aims

To verify the color match of metal-ceramic and full ceramic crowns, using instrumental methods.

Methods

A number of 153 teeth (anterior and posterior teeth), in 62 patients, were restored with metal ceramic (MC, n=119), pressed-ceramic (PC, n=28), and zirconia-ceramic (ZC, n=6) full coverage crowns. The shade of a reference natural tooth was recorded instrumentally with a dental spectrophotometer (Vitaeasyshade Advance 4.0) in “single tooth measurement”, which provided the base color in Vita Classic (VC) and Vita 3D Master shades (3D).

For verifying the outcome of the restoration “verify restoration” mode was used, and ΔE values were recorded for both VC and 3D Master shade guides. Moreover, matching symbols were also recorded (***=good, **=fair, *=poor). Descriptive statistics was performed and data were analyzed (One-sample z-Test, α=0.05) for comparison with visual thresholds in dentistry (Perceptibility Threshold – PT=1.2 and Acceptability Threshold – AT=2.7).

Results

The data did not follow a normal distribution (Kolmogorov-Smirnov test, p<0.05). Recorded color difference was significantly higher than PT and AT, for all types of restorations, regardless of the coding system (p<0.05). For MC crowns in 2.52% (4.20% for 3D) of the cases the color difference was smaller than PT, in 19.32% (the same for 3D) of cases was between PT and AT, and in 78.15% (76.47% for 3D) of cases was higher than the AT. For PC crowns in 3.57% (0% for 3D) of the cases the color difference was smaller than PT, in 25% (32.14% for 3D) of cases was between PT and AT, and in 71.42% (67.85% for 3D) of cases was higher than the AT. In the case of ZC crowns none of the restorations had color difference smaller than PT, but in 16.66% of cases was between PT and AT, and in 83.33% of cases was higher than the AT, for both VC and 3D.

Conclusion

Within the limitations of the study, a better color match was achieved in the case of pressed ceramic crowns, made of lithium disilicate. In most of the situations the color difference between the restoration and the reference tooth exceeded the perceptibility thresholds, but the matching was recorded as “fair” by the spectrophotometer.

Effect of nanomaterial incorporation on the mechanical and microbiological properties of dental porcelain

STATEMENT OF PROBLEM

Dental porcelain restorations are subject to biological failures related to secondary caries and periodontal disease leading to prosthesis replacement.

PURPOSE

The purpose of this in vitro study was to explore the microbiological and mechanical properties of dental porcelain incorporated with different percentages of silver vanadate (β-AgVO₃) through microbiological analysis, roughness tests, and the Vickers microhardness test.

MATERIAL AND METHODS

IPS InLine porcelain specimens were made by using a cylindrical Teflon matrix in the dimensions of 8×2 mm. For the control group, the porcelain was manipulated according to the manufacturer's instructions. The groups incorporating the nanomaterial were prepared with 2.5%, 5%, and 10% of β-AgVO_3, which was added proportionally by mass to the porcelain powder. In vitro microbiologic analysis, roughness tests, and the Vickers microhardness test were performed.

RESULTS

Against Streptococcus mutans, the control group showed no inhibition halo (0 mm). All groups with AgVO₃ showed a zone of inhibition, the highest for the group with 10% (30 mm) and then the groups with 2.5% (9 mm) and 5% (17 mm). For Vickers microhardness, no statistically significant difference (P<.05) was observed between the evaluated groups. The group with 10% of AgVO₃ had the highest mean roughness and was statistically different (P<.001) from the other groups.

CONCLUSIONS

Adding β-AgVO₃ to dental porcelain demonstrated antimicrobial effectiveness at all concentrations (2.5%, 5%, and 10%), with no effect on Vickers microhardness. The 10% group had higher roughness than the other groups.

Effect of staining and repeated firing on the surface and optical properties of lithium disilicate

OBJECTIVE

Evaluate the effect of staining and repeated firings on color, translucency and surface proprieties of CAD/CAM lithium disilicate (LD).

MATERIAL AND METHODS

One hundred eighty LD discs were made (ISO 6872) and distributed in different groups (n = 20): control (CO)-no treatment; single-step characterization (SC)-crystallization and staining fired together; and double step characterization (DC)-crystallization and then staining. The samples were submitted to two, four, or six firings, resulting in nine groups: COII, COIV, COVI, SCII, SCIV, SCVI, DCII, DCIV, and DCVI. The color and translucency were measured by a reflectance spectrophotometer. Surface roughness (Ra) and Vickers nano-hardness were also measured. ANOVA and Tukey statistical tests were used (α = .05).

RESULTS

Only CO and DC demonstrated significant color alterations (ΔE₀₀ > 1.8). SC and DC did not show changes in translucency by the number of firings (P > .05); however, for CO (P = .02) these values increased. Nano-hardness was similar in all groups (P > .05). Ra values indicated differences due to the type of characterization (SC presented the highest values) and number of firings (CO and DC groups) (P < .01).

CONCLUSION

SC promoted color, translucency, and roughness stability after repeated firings.

CLINICAL SIGNIFICANCE

The single characterization technic in CAD/CAM lithium disilicate presents good color, translucency, and hardness stability, which promote predictable results to monolithic restoration.

Effect of extrinsic pigmentation and surface treatments on biaxial flexure strength after cyclic loading of a translucent ZrO2 ceramic

OBJECTIVE

To evaluate the influence of extrinsic pigmentation on the biaxial flexural strength and surface topographic of translucent Y-TZP (InCoris TZI - Sirona - USA) subjected to several surface treatments.

METHODS

Sintered zirconia discs-shaped specimens (n=120) (ø:12mm; thickness:1.2mm; ISO 6872) were prepared and divided (n=15) according to various factors: "extrinsic pigmentation" (n: without; p: with) and "surface treatments" (C: control - as sintered; A: abraded with silica-coated alumina particles (30μm); G: glazed with a thin film of low-fusing porcelain glaze; GH: glazed and etched with 10% hydrofluoridric acid for 60s. Mechanical cycling (1.2×106 cycles, 200N, 3.8Hz) and flexural strength test (1mm/min - 1000kg cell) were performed. Two-way ANOVA and Tukey's were used for statistical test (α=0.05). Weibull analysis was used to evaluate the strength reliability. Samples were analyzed via (1) an optical profilometer to determine the surface roughness (Ra); (2) an X-ray diffraction (XRD) to evaluate phase transformations; and (3) a SEM equipped with an energy dispersive X-ray spectroscopy (EDX) to elucidate morphological properties and chemical compositions.

RESULTS

Regardless of the surface treatment (p=0.5459) (Cn: 560.16MPa; Gn: 573.36MPa; An: 643.51MPa; GHn: 542.94MPa; Cp: 628.04MPa; Gp: 641.90MPa; Ap: 554.47MPa; GHp :602.84MPa) and extrinsic pigmentation (p=0.1280) there was no difference in the flexural strength among the experimental groups. According to the XRD analysis, phase transformations occurred in the An group (t→m) and in Ap group (t→c). Surface roughness was affected by surface treatments (An - p=0.001) and extrinsic pigmentation (Gp - p=0.001).

SIGNIFICANCE

The biaxial flexural strength of the tested samples was not affected neither by surface treatments nor by pigmentation, although it can cause phase transformation and promote surface roughness.

Microstructural development during heat treatment of a commercially available dental-grade lithium disilicate glass-ceramic

OBJECTIVE

To elucidate the microstructural evolution of a commercial dental-grade lithium disilicate glass-ceramic using a wide battery of in-situ and ex-situ characterization techniques.

METHODS

In-situ X-ray thermo-diffractometry experiments were conducted on a commercially available dental-grade lithium disilicate glass-ceramic under both non-isothermal and isothermal heat treatments in air. These analyses were complemented by experiments of ex-situ X-ray diffractometry, field-emission scanning electron microscopy, energy-dispersive X-ray spectroscopy, differential scanning calorimetry, and field-emission scanning electron thermo-microscopy.

RESULTS

It was found that the non-fired blue block consists of ∼40 vol % crystals embedded in a glass matrix. The crystals are mainly lithium metasilicate (Li₂SiO₃) along with small amounts of lithium orthophosphate (Li₃PO₄) and lithium disilicate (Li₂Si₂O₅). Upon heating, the glassy matrix in the as-received block first crystallizes partially as SiO₂ (i.e., cristobalite) at ∼660 °C. Then, the SiO₂ crystals react with the original Li₂SiO₃ crystals at ∼735 °C, forming the desired Li₂Si₂O₅ crystals by a solid-state reaction in equimolar concentration (SiO₂ + Li₂SiO₃ → Li₂Si₂O₅). Precipitation of added colourant Ce ions in the form of CeO₂ appears at ∼775 °C. These events result in a glass-ceramic material with the aesthetic quality and mechanical integrity required for dental restorations. It also has a microstructure consisting essentially of elongated Li₂Si₂O₅ grains in a glassy matrix plus small cubic CeO₂ grains at the outermost part of the surface.

SIGNIFICANCE

It was found that by judiciously controlling the heat treatment parameters, it is possible to tailor the microstructure of the resulting glass-ceramics and thus optimizing their performance and lifespan as dental restorations.

Polishing effects and wear performance of chairside CAD/CAM materials

OBJECTIVES

To investigate the surface roughness of CAD/CAM materials immediately after milling and after different chairside and labside polishing procedures. A two-body wear test was performed to compare the different wear characteristics of the materials and the corresponding antagonists.

MATERIALS AND METHODS

Specimens (n = 12 per series) from different CAD/CAM materials (three composites: Lava Ultimate, Cerasmart, BRILLIANT Crios; one hybrid ceramic: VITA Enamic; three ceramics: Celtra Duo, VITA Suprinity, IPS Emax.CAD) were polished according to the manufacturer's instructions. The effect of different polishing procedures was investigated by comparing surface roughness (R_a, R_max) after labside polishing and after chairside polishing. Wear behavior (mean, volume, and maximum wear) of specimens and antagonists as well as changes in surface roughness were determined in a pin-on-block wear test. Statistical analysis was performed with a one-way analysis of variance (ANOVA)/Bonferroni multiple-comparison post hoc test and a multifactorial ANOVA/Tukey's significant difference post hoc test (α = 0.05). SEM micrographs were used for the qualitative evaluation of surfaces and wear traces.

RESULTS

After chairside high-gloss polishing, ceramics and composites exhibited R_a values between 0.08 and 0.10 μm and between 0.11 and 0.13 μm, respectively. After labside high-gloss polishing, values varied between 0.02 and 0.09 μm for ceramics and between 0.06 and 0.16 μm for resin composites. No significant differences were found between labside and chairside pre- and high-gloss polishing. For the ceramics, lower mean wear depths (between - 132.2 ± 19.9 and - 137.0 ± 19.0 μm) were identified compared to the resin composites (which exhibited wear depths between - 159.1 ± 19.4 and - 176.3 ± 23.9 μm). For maximum wear depth and volume, a different ranking of the materials was found. Antagonistic wear varied between 12.0 ± 6.4% and 30.6 ± 9.9% and was higher for the ceramic materials and Lava Ultimate. For all materials, a smoothing between 0.20 and 2.70 μm (R_a) was identified after wear simulation.

CONCLUSIONS

Chairside polishing is as effective as labside polishing, although surfaces were directly adjusted (roughened) only before the chairside polishing. Wear was lowest for ceramics, followed by the resin-infiltrated material and the resin composites.

CLINICAL RELEVANCE

Polishing after milling or adjustment is essential to guaranteeing optimal clinical performance. Chairside polishing after adjustment leads to comparably smooth surfaces as labside polishing after milling and grinding. Ceramics are expected to exhibit lower wear than resin composites under clinical conditions.

The Micromorphological Research of the Internal Structure of Chairside CAD/CAM Materials by the Method of Scanning Impulse Acoustic Microscopy (SIAM)

Aim

The aim of the present work was to compare the elastic properties and internal structure of 4 different CAD/CAM chairside materials, by the method of Scanning Impulse Acoustic Microscopy (SIAM).

Methods

Four chairside CAD/CAM materials with different structures from hybrid ceramic (VITA Enamic, VITA Zahnfabrik), feldspatic ceramic (VITABlocs Mark II, VITA Zahnfabrik), leucite glass-ceramic (IPS Empress CAD, Ivoclar Vivadent) and PMMA (Telio CAD, Ivoclar Vivadent) were examined by Scanning Impulse Acoustic Microscope (SIAM).

Results

The results of micromorphological research of CAD/CAM chairside materials using SIAM method showed differences between the internal structures of these materials. The internal structure of feldspatic and glass-ceramic samples revealed the presence of pores with different sizes, from 10 to 100 microns; the structure of polymer materials rendered some isolated defects, while in the structure of hybrid material, defects were not found.

Conclusion

Based on the results obtained from the present study, in cases of chairside production of dental crowns, it would be advisable to give preference to the blocks of hybrid ceramics. Such ceramics devoid of quite large porosity, glazing for CAD/CAM crowns made from leucite glass-ceramic and feldspatic ceramic may be an option. For these purposes, commercially available special muffle furnace for clinical and laboratory individualization and glazing of ceramic prostheses were provided. Further studies are needed to confirm the evidence emerging from the present research.

Fracture-free surfaces of CAD/CAM lithium metasilicate glass-ceramic using micro-slurry jet erosion

This paper reports the use of micro-slurry jet erosion (MSJE) on CAD/CAM lithium mesilicate glass ceramic (LMGC) that is capable of achieving the fracture-free surface quality. A computer-controlled MSJE process using a low-pressure and low-concentration alumina slurry was applied to diamond-ground LMGC surfaces with surface and subsurface damage. The MSJE processed and diamond-ground LMGC surfaces were examined using scanning electron microscopy (SEM) to examine surface morphology, fractures, and residual defects. 3D confocal laser microscopy (CLM) was used to quantitatively characterize all machined surface textures as a function of processing conditions. Our results show that surface and subsurface damage induced in diamond-ground surfaces were significantly diminished after 50-cycle MSJE processing. Fracture-free surfaces were obtained after 100 MSJE cycles. Our measured parameters of the 3D surface topography included the average surface roughness, maximum peak-valley height, highest peak height, lowest valley height, and kurtosis and absolute skewness of height distributions. All these parameters were significantly reduced with the increase of MSJE cycles. This work implies that MSJE promises to be an effective manufacturing technique for the generation of fracture-free LMGC surfaces which are crucial for high-quality monolithic restorations made from the material.