Three-body wear effect on different CAD/CAM ceramics staining durability

A step-by-step technique to create an ideal color match, form, and surface texture to all-ceramic restorations

OBJECTIVES

Although the presence of a chairside CAD/CAM system in the dental office saves time and cost, it deprives the dentist from the dental technologist' skills and experience. The dentist now has to gain and acquire knowledge and skills about how to finish, characterize, stain, and glaze ceramic restorations. The main objectives of this article is to teach novel and reproducible techniques for surface color, texture, glaze and polish for either the chairside or laboratory fabricated indirect ceramic restoration.

CLINICAL CONSIDERATIONS

A protocol for intraoral characterization of monolithic ceramics; the "Triple R" protocol for tooth color mimicking was followed. It consist of three steps: (1) "Recognize" tooth color shapes, (2) "Record" the present color shapes in the patient dentition by drawing a color map for the color shapes extension and determine which luster paste stain to be used for replicating them, and (3) "Replicate" intraorally the recorded color shapes guided by the adjacent natural teeth using low fusing ceramic pastes (shades and stains) for color shape replication. Also, the final touch technique was followed to shape, texture and final surface finish of dental restorations. It is composed of 5 basic levels which we call dental "micro-esthetics that define shape, texture, and surface luster.

CONCLUSIONS

Following the steps of both; the "Triple R" protocol and the "FINAL TOUCH" technique will help to reproduce the final shade of the restoration to create the illusion of a natural tooth to the observer.

CLINICAL SIGNIFICANCE

This article shows how combining two practical methodologies to record and replicate both color shapes and surface texture of natural teeth may extend mimicking, that is, step by step natural tooth shade beyond the limitations of the available commercial shade guides.

Longevity of extrinsic stains on monolithic zirconia restorations: An in vitro study

STATEMENT OF PROBLEM

Three-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) has been commonly used for fixed prosthodontic restorations. The opacity of 3Y-TZP may be masked with external staining, although the longevity of extrinsic stains applied to monolithic zirconia is unclear.

PURPOSE

The purpose of this in vitro study was to analyze the color and surface roughness of extrinsically stained zirconia specimens after thermocycling and toothbrushing.

MATERIAL AND METHODS

Monolithic Ø12.5×1.25-mm zirconia disks were milled from 3Y-TZP blocks, sintered according to manufacturer instructions, and then divided into 3 groups (C, J, and O; n=16) for application of stain and glaze. All specimens underwent 10 000 thermocycles in distilled water before being further divided into 2 dentifrice groups (n=8): normal grit, low relative dentin abrasivity (RDA) (Subgroup N) and abrasive grit, high RDA (Subgroup A). Specimens were brushed in a multistation brushing machine under 1.47 N of force using a 5:8 toothpaste and distilled water slurry for 10 000 cycles with a straight (American Dental Association Standard) toothbrush to simulate 1 year of toothbrushing. Color and surface roughness measurements were obtained at 3 time points: baseline, after thermocycling, and after brushing. A 2-way repeated measures ANOVA was used to independently assess changes in color and surface roughness with respect to thermocycling and brushing (α=.05).

RESULTS

Group J displayed no significant change in color for either dentifrice system (P>.05). However, a significant change in surface roughness was observed for both dentifrice subgroups (P<.001). Group C specimens displayed significant changes in color (P<.001) and surface roughness (P<.001) for both dentifrice systems. Group O specimens displayed significant changes in color (P<.025) for both dentifrice systems and significant changes in surface roughness (P<.004) for subgroup A, but no significant changes for subgroup N (P=.075).

CONCLUSIONS

Artificial aging of monolithic zirconia resulted in changes in color and surface roughness that did not surpass the thresholds for perceptibility and acceptability. This study failed to establish durability limits for extrinsic stains applied to 3Y-TZP.

Translucent Zirconia in Fixed Prosthodontics-An Integrative Overview

Over the past two decades, dental ceramics have experienced rapid advances in science and technology, becoming the fastest-growing field of dental materials. This review emphasizes the significant impact of translucent zirconia in fixed prosthodontics, merging aesthetics with strength, and highlights its versatility from single crowns to complex bridgework facilitated by digital manufacturing advancements. The unique light-conducting properties of translucent zirconia offer a natural dental appearance, though with considerations regarding strength trade-offs compared to its traditional, opaque counterpart. The analysis extends to the mechanical attributes of the material, noting its commendable fracture resistance and durability, even under simulated physiological conditions. Various zirconia types (3Y-TZP, 4Y-TZP, 5Y-TZP) display a range of strengths influenced by factors like yttria content and manufacturing processes. The study also explores adhesive strategies, underlining the importance of surface treatments and modern adhesives in achieving long-lasting bonds. In the realm of implant-supported restorations, translucent zirconia stands out for its precision, reliability, and aesthetic adaptability, proving suitable for comprehensive dental restorations. Despite its established benefits, the review calls for ongoing research to further refine the material's properties and adhesive protocols and to solidify its applicability through long-term clinical evaluations, ensuring its sustainable future in dental restorative applications.

Clinical Performance of Minimally Invasive Monolithic Ultratranslucent Zirconia Veneers: A Case Series up to Five Years of Follow-up

There is a lack of reports in the literature on the long-term clinical performance of ultratranslucent zirconia, especially considering its use in manufacturing monolithic veneers. The purpose of this case series is to describe the aesthetic treatment steps of three patients with minimally invasive ultratranslucent zirconia veneers and to report the clinical findings up to five years. Three patients (woman: 2, man: 1; mean age: 30 years) unsatisfied with their dental aesthetics sought dental treatment. The treatment plan involved cementing ultratranslucent zirconia veneers. Air-abrasion was performed on the internal surface of zirconia with alumina particles coated by silica (silicatization), followed by silane and adhesive applications for the adhesive cementation. All veneers were adhesively cemented to enamel with resin cement (Variolink Esthetic, Ivoclar). The patients were clinically evaluated annually considering the Ryge modified/ California Dental Association criteria. After a mean follow-up of 4.33 years (4-5 years), a survival rate of 100% was detected for the 28 minimally invasive ultratranslucent zirconia veneers cemented in the 3 patients. There were no absolute failures such as debonding, veneer fracture, or secondary caries. Superficial marginal discoloration was observed in one element (maxillary left lateral incisor) of one patient. Ultratranslucent zirconia is a viable option for manufacturing veneers due to its excellent clinical performance and longevity. However, further long-term clinical studies are essential to consolidate this material as an option for esthetic 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.

Clinical evaluation of cemented and adhesively resin-bonded monolithic and partially layered zirconia and lithium disilicate crowns

Purpose

Zirconia and lithium disilicate crowns are very popular dental restorations. The cement type and layering technique used can profoundly affect the clinical performance of these crowns.This retrospective study is designed to investigate the success rate of cemented and adhesively bonded monolithic and partially layered zirconia and lithium disilicate crowns placed in faculty practice settings.

Materials and Methods

Patients who had received zirconia or lithium disilicate crowns at the faculty practice were invited for clinical examination. The examiner used the modified United States Public Health Service (MUSPHS) evaluation criteria to evaluate the crowns. The crowns were either glass ionomer cemented zirconia (GIC-Zr), resin-bonded zirconia (Adh-Zr), or resin-bonded lithium disilicate (Adh-LD). The crowns were also divided into monolithic and layered groups. Inferential analysis was used to examine the differences through bivariate analysis using t-testing and one-way ANOVA.

Results

Thirty-five patients, with a combined total of 218 single crowns, agreed to participate in the study. No statistically significant differences in the quality outcome variables considered were found between the groups, except for marginal adaptation, where Adh-Zr achieved significantly higher scores compared to GIC-Zr and Adh-LD. Layered zirconia and lithium disilicate crowns have significantly higher quality outcomes in terms of anatomic form, marginal adaptation, and color match compared to monolithic zirconia and lithium disilicate crowns.

Conclusions

Conventionally cemented zirconia and adhesively bonded zirconia and lithium disilicate crowns are reliable treatment options with high short-term success rates. Clinical studies with longer follow-up times are needed to investigate their long-term success rates.

Indirect restorative systems-A narrative review

OBJECTIVE

The background and clinical understanding of the properties of currently available indirect restorative systems and fabrication methods is, along with manufacturer and evidence-based literature, an important starting point to guide the clinical selection of materials for tooth and/or implant supported reconstructions. Therefore, this review explores most indirect restorative systems available in the market, especially all-ceramic, along with aspects of manufacturing process, clinical survival rates, and esthetic outcomes.

OVERVIEW

Progressive incorporation of new technologies in the dental field and advancements in materials science have enabled the development/improvement of indirect restorative systems and treatment concepts in oral rehabilitation, resulting in reliable and predictable workflows and successful esthetic and functional outcomes. Indirect restorative systems have evolved from metal ceramics and polymers to glass ceramics, polycrystalline ceramics, and resin-matrix ceramics, aiming to improve not only biological and mechanical properties, but especially the optical properties and esthetic quality of the reconstructions, in attempt to mimic natural teeth.

CONCLUSIONS

Based on several clinical research, materials, and patient-related parameters, a decision tree for the selection of indirect restorative materials was suggested to guide clinicians in the rehabilitation process.

CLINICAL SIGNIFICANCE

The pace of materials development is faster than that of clinical research aimed to support their use. Since no single material provides an ideal solution to every case, professionals must continuously seek information from well designed, long-term clinical trials in order to incorporate or not new materials and technological advancements.

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

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

Translucency and mechanical behavior of partially stabilized monolithic zirconia after staining, finishing procedures and artificial aging

Partially stabilized zirconia (5Y-PSZ) has been widely used to manufacture indirect monolithic restorations, and the effect of finishing procedures on the optical and mechanical properties of these materials are still unclear. The purpose of this study was to evaluate the effect of staining, polishing and glazing on surface roughness, crystalline phase content, microhardness, fracture toughness, dynamic elastic modulus, three-point flexural strength, strain distribution, color (∆E₀₀/∆L/∆a/∆b), and translucency before and after artificial accelerated aging (water spray and ultraviolet) of 5Y-PSZ. Bar-shaped and rectangle-shaped specimens of the 5Y-PSZ were prepared and divided into six groups, according to finishing procedure: GC (control), GS (staining), GG (glazing), GSG (staining and glazing), GP (polishing), GSP (staining and polishing). There was a significant difference between groups for surface roughness (p < 0.05), dynamic elastic modulus (p = 0.007), microhardness (p =  < 0.05), ∆E₀₀ (p = 0.010), and ∆a (p = 0.008). GC presented higher cubic phase content, and the stained groups (GS, GSG and GSP) presented higher monoclinic content. The different finishing procedures affected roughness, dynamic elastic modulus, microhardness, and color of 5Y-PSZ; polishing being the finish that provides minors changes to the 5Y- PSZ. Accelerated artificial aging caused color change, regardless of finishing procedure used.

3-D Surface Morphological Characterization of CAD/CAM Milled Dental Zirconia: An In Vitro Study of the Effect of Post-Fabrication Processes

Objective: To investigate the effect on zirconia surface of the post-fabrication surface treatments on the morphological characteristics and mechanical properties of CAD/CAM milled dental zirconia specimens as well as to identify the critical parameters in the measurement of oral retention under in vitro circumstances. Method: The zirconia specimens (N = 20, n = 4) were subjected to CAD/CAM milling and divided into five groups. The specifications were: Group G1—sintered; Group G2—sintered followed by a polishing process; Group G3—sintered followed by polishing and sandblasting with alumina particles Al2O3 (110 µm); Group G4—sintered followed by sandblasting; Group G5—sintered followed by sandblasting with polishing as the end process. All the groups were subjected to Fretting wear tests, 3-D surface roughness measurements, and Vickers’s Micro hardness tests. Investigation of the phase transformation using XRD, and surface feature examination using SEM were also carried out. Additionally, one-way ANOVA, Tukey, and Pearson correlations were statistically analysed. Results: The fabrication processes had a significant effect on the performance of zirconia specimens in all the groups (p > 0.05). Specimens that underwent polishing as the last process exhibited lower surface roughness. The monoclinic phase of zirconia was observed in all the specimens before and after wear except for those in the G2 and G5 groups, where polishing was the end process. In G5, the post-wear surface properties revealed lower surface roughness and hardness. Further, the SEM and 3-D topography show grooves as seen by the dale void volume (Vvv) values; shallow valley depth (Svk); micro craters; and wear track. Conclusion: Specimens in G5 that were subjected to multistep post-fabrication process, namely sandblasting followed by polishing, yielded better results when compared to those in the other groups (G1, G2, G3, and G4). G5 with an interlayer of alumina is recommended for clinical applications due to its enhanced surface properties, mechanical properties, and low wear.

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 stain brand and shade on color stability of stains applied on a CAD-CAM feldspathic ceramic

The aim of this study was to investigate the effect of stain brand and color on color stability of stains on a CAD-CAM ceramic after aging. Specimens (15 × 8 × 1.5 mm) were fabricated from A2-shade ceramic blocks (Mark II; Vita Zahnfabrik) (N = 120). Specimens were divided into two groups (n = 10) to be stained with six different stains (yellow, orange, blue, gray, violet, and brown) from two manufacturers (GC initial spectrum (GC) and IPS e.max Ceram (IPS)). Aging was performed for 5 h at 134 °C. Color coordinates before and after aging were measured to calculate color differences (ΔE₀₀). Kubelka-Munk absorption (K) and scattering coefficients (S) of stains were compared with those of A2 shade tab. Two-way ANOVA was used to analyze the ΔE₀₀ values and Tamhane T2 was used to analyze the K and S coefficients (alpha = 0.05). A significant interaction was found between stain color and brand (p < 0.001). Color changes with IPS stains were higher than those with GC stains except for brown. The highest color difference was with orange stain of IPS (p < 0.001). Absorption and scattering coefficients of different stains on CAD-CAM ceramic were different from those of A2 shade tab except for brown stain (p < 0.001). Tested stains on CAD-CAM ceramic had varying color changes after aging. Color of gray, violet and brown of both stains was stable. Yellow, orange, and blue GC stains were more color stable compared with IPS. Absorption and scattering coefficients of stains in different colors varied.

Effect of Two Brands of Glaze Material on the Flexural Strength and Probability of Failure of High Translucent Monolithic Zirconia

(1) Background: The effect of glazing on the mechanical properties of monolithic high translucent zirconia is not well reported. Therefore, the purpose of this study was to evaluate the effect of glazing on the flexural strength of high translucent zirconia; (2) Methods: Ninety specimens were prepared from second-generation 3Y-TZP high translucent blocks and divided into three groups. Glaze materials were applied on one surface of the specimen and subjected to a four-point bending test and flexural stress and flexural displacement values were derived. Descriptive fractographic analysis of surfaces was conducted to observe the point of failure and fracture pattern.; (3) Results: Control-nonglazed (647.17, 1σ = 74.71 MPa) presented higher flexural strength values compared to glaze I (541.20, 1σ = 82.91 MPa) and glaze II (581.10, 1σ = 59.41 MPa). Characteristic strength (σ_Ɵ) from Weibull analysis also observed higher (660.67 MPa) values for the control specimens. Confocal microscopy revealed that glazed surfaces were much rougher than control surfaces. Descriptive fractographic analysis revealed that there was no correlation between the point of failure initiation and flexural strength; (4) Conclusions: The test results demonstrated that glazing significantly decreased the flexural strength and flexural displacement of the zirconia specimens.

Wear behavior of current computer-aided design and computer-aided manufacturing composites and reinforced high performance polymers: An in vitro study

OBJECTIVE

To analyze the wear rate of computer-aided design and computer-aided manufacturing (CAD/CAM) composites, polyetheretherketones and glass ceramics.

MATERIAL AND METHODS

Our study groups were prepared from two different resin-based composites (Brillant Crios, Cerasmart), a glass ceramic (IPS Emax CAD) and reinforced polyetheretherketone (BioHPP) material (n = 10). Premolar teeth were used as antagonists. The specimens, which were subjected to two body wear tests (240,000 cycles, 1.2 Hz, 50N) in the chewing simulator, were scanned with a 3D laser scanner both before and after the wear test. Volume loss and wear depth were determined by means of the obtained images software program. The wear pattern was examined by scanning electron microscopy. Kruskal Wallis test served for analyzing.

RESULTS

The least volume loss and wear depth were seen in the polyetheretherketone material (0.06 ± 0.04 mm³ , 0.02 ± 0.01 mm), while the maximum volume loss was seen in the groups containing resin-based composite. (p = 0.05). The volume loss value in glass ceramics is between CAD/CAM composites and polyetheretherketone.

CONCLUSION

The behavior of polyetheretherketone against enamel was different from glass ceramics and composite materials in terms of the amount of wear.

CLINICAL SIGNIFICANCE

Polyetheretheketone can be considered as an alternative to other chairside materials in terms of wear resistance.

Feldspathic and Lithium Disilicate Onlays with a 2-Year Follow-Up: Split-Mouth Randomized Clinical Trial

The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance.

Optical behaviors, surface treatment, adhesion, and clinical indications of zirconia-reinforced lithium silicate (ZLS): A narrative review

OBJECTIVES

The present narrative review was focused on the optical properties, surface treatment, adhesion, and clinical indications of zirconia-reinforced lithium silicate ceramics (ZLS) for Computer-aided design / Computer-aided manufacturing (CAD/CAM) technologies.

DATA/SOURCES

A literature search was performed by 3 calibrated independent researchers on PubMed, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The criteria for inclusion were: 1) papers addressing at least one of the following variables about ZLS: optical properties, surface treatment, adhesion, and clinical indications; 2) in vitro, in silico, or in vivo studies; 3) case reports; 4) systematic reviews. The exclusion criteria were: 1) animal studies; 2) non-dental studies; 3) studies only focusing on ZLS used in the heat-pressed process.

STUDY SELECTION

98 records among in vitro studies and case reports were included.

CONCLUSIONS

Despite the promising microstructure characteristics of ZLS, increased translucency compared to lithium disilicate ceramics (LS₂) was not proven, but acceptable color changes and stability were reported. Mechanical polishing was the most effective method to reduce surface roughness. Moreover, machinability and handling of ZLS resulted harder than LS₂. Conventional acid etching procedures seemed effective in conditioning ZLS surface, but no protocol has been established yet. Besides, silane-coupling and dual-curing resin cements were recommended.

CLINICAL SIGNIFICANCE

ZLSs can be used for anterior and posterior fixed single-unit CAD/CAM restorations onto both natural teeth and implants, but do not seem to represent a viable treatment option for endocrowns onto posterior teeth or fixed dental prostheses.

Toothbrushing Wear Resistance of Stained CAD/CAM Ceramics

Aim: To investigate the effect of toothbrushing on different stained Computerd Aided Design/Computer Aided Manufacturing CAD/CAM ceramics. Materials and Methods: Fifty specimens (high translucency zirconia, YZHT; zirconia-reinforced lithium silicate, ZLS; feldspathic, FDL; hybrid ceramic, HC; all from Vita Zahnfabrik) were divided into five groups according to their staining technique. ZLS allowed the composition of two groups: ZLS1 with crystallization and staining together; ZLS2, with the stain firing after the crystallization. YZHT received a stain firing after the sintering process, and FDL received stain firing directly. The HC was stained with acrylic staining, and was light-cured on its surface. The specimens were brushed in total for 150,000 cycles at 2.45 N with 180 strokes/min. Surface measurements to obtain Rz were performed after 50,000, 100,000 and 150,000 cycles, with five evaluation lines (5 mm) per specimen orthogonal to the brushing direction, covering brushed and unbrushed areas. The wear was analyzed using two-way ANOVA and Tukey tests (α = 5%). Scanning electron microscopy (SEM) was performed to access the surface profile. The wear was affected by material (p < 0.001) and time (p = 0.139). Superior wear (µm) was observed for HC (6.6 ± 4.4; 6.8 ± 4.0; 9.2 ± 3.5) compared to ZLS2 (1.0 ± 0.3; 1.2 ± 2.2; 1.3 ± 0.3), YZHT (1.0 ± 0.1; 1.2 ± 0.3; 1.2 ± 0.3), ZLS1 (0.9 ± 0.1; 1.1 ± 0.5; 1.2 ± 0.3) and FDL (0.9 ± 0.1; 0.9 ± 0.1; 1.0 ± 0.2) after 5, 10 and 15 years of simulation, respectively. SEM showed different wear patters for HC with the removal of the glaze layer. HC showed a higher staining wear rate compared to the glass-based and polycrystalline ceramics after 15 years. The extrinsic characterization of feldspathic ceramic showed its superior longevity compared to the evaluated high-translucency zirconia, zirconia-reinforced lithium silicate, and hybrid ceramic.

Durability of staining and glazing on a hybrid ceramics after the three-body wear

Hybrid ceramic is a promising material for monolithic restorations that could require an individualization through the extrinsic staining to improve aesthetics. Due to the possibilities to treat this ceramic prior to staining, this study evaluated the wear resistance of surface treatments prior to staining and glazing a hybrid ceramic. Thirty-two specimens (Vita Enamic) were divided into 8 groups according to the surface treatment prior to the staining (Polishing: Pol, Acid etching: Ac, Sandblasting with Al₂O₃: Sd or Self-etching silane: Ses) and glaze application (with: gl or without: gl). The specimens were submitted to the ACTA wear machine simulating the presence of food bolus and antagonist. The wear rate of the stain was determined after 7 intervals of 20,000 cycles, using a profilometer. The surface before and after staining, and after wear were inspected using Scanning Electron Microscopy (SEM). The rates were analyzed using three-way ANOVA and Tukey test. The wear was affected by surface treatment, glaze application and number of cycles (p < 0.001). 100% of the staining was removed after 20,000 cycles for Pol, 40,000 for Pol + gl, 60,000 for Ses + gl, 80,000 for Ac, 100,000 for Sd and Ses, 120,000 for Ac + gl and 140,000 for Sd + gl. SEM showed similar worn surfaces. Sandblasting followed by glaze application was the most durable treatment to maintain the external staining on the hybrid ceramic surface when subjected to three-body wear.