Should finishing, polishing or glazing be performed after grinding YSZ ceramics? A systematic review and meta-analysis

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives. (J Prosthet Dent 2024;132:■■■-■■■).

Polishing systems for modern aesthetic dental materials: a narrative review

Objectives To review the current literature surrounding chairside polishing systems for resin composites, zirconia and lithium disilicate restorations.Methods A literature search was undertaken and databases were hand-searched for the most relevant articles.Discussion The current marketplace contains a wide variety of polishing systems, each with different abrasive compounds and number of steps. Current efforts are aimed at reducing the number of steps required for polishing to improve clinical effectiveness. Reduced step systems showed some comparable results to the more traditional multi-step protocols, but the most effective results were achieved with the use of polishing paste as an additional step.Conclusions Based on the current available literature, the use of material-specific polishing systems is effective for chairside polishing of direct and indirect restorative materials. However, it is important to emphasise that, for optimum outcomes, it is essential to follow manufacturers' recommendations for each step, with particular considerations of the handpiece speed, time spent per step and use of adjunct water coolant.

Effect of simulated intraoral adjustment on the color and translucency of gradient multilayered monolithic zirconia

STATEMENT OF PROBLEM

The use of multilayered monolithic zirconia ceramics is becoming popular because it simplifies the production of esthetic restorations. The effect of clinical adjustment on the optical properties of these ceramics, especially strength-gradient zirconia, remains unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the color and translucency of gradient multilayered zirconia brands after grinding and polishing.

MATERIAL AND METHODS

Sixty 10×10×1-mm monolithic zirconia specimens were milled from 6 zirconia brands (Ceramill Zolid HT White, Ceramill Zolid HT Preshade, Ceramill Zolid FX Multicolor, VITA YZ XT Multicolor, IPS e.max ZirCAD Prime, and KATANA YML). The zirconia specimens were milled to include all layers of A2 preshaded multilayered zirconia blanks (A2 shade) except Ceramill Zolid HT White and Ceramill Zolid HT Preshade. Ceramill Zolid HT White specimens were milled from a white zirconia blank with subsequent shading. The color coordinates and the relative translucency parameter after glazing and after grinding and polishing were determined with a reflectance spectrophotometer, and the relative translucency parameter and contrast ratio were measured. The differences in color and translucency were calculated. The data were analyzed using 2-way ANOVA and 1-way ANOVA tests followed by the post hoc Tukey test (α=.05).

RESULTS

Statistically significant changes (P<.001) in the color coordinates measured before and after grinding and polishing were detected for each zirconia brand except for the KATANA YML that showed no significant difference (P=.686) in lightness. The highest color difference after grinding and polishing was detected in group KATANA YML. The 2-way ANOVA test showed a statistically significant interaction (P<.001) between the zirconia brand and the grinding and polishing regarding the relative translucency parameter. The zirconia brand had a significant impact on the relative translucency parameter before and after grinding and polishing (both P<.001).

CONCLUSIONS

Except for KATANA YML, the color change in multilayered zirconia after clinical adjustment with polishing was not beyond the clinically acceptable limit of the color difference. Although clinical adjustment with polishing reduced the translucency of gradient zirconia, the change in translucency was below the clinically detectable threshold value of the translucency difference.

A Comprehensive Review of the Surface and Chromatic Properties of Monolithic Zirconia: Evaluating the Impact of Polishing and Finishing Methods on Aesthetics and Performance

Monolithic zirconia is widely used in dentistry due to its outstanding mechanical properties, biocompatibility, and aesthetic qualities. This review examines how different polishing and finishing methods impact the performance and appearance of monolithic zirconia restorations. Derived from zirconium, zirconia is a robust ceramic that exists in monoclinic, tetragonal, and cubic forms, with properties that prevent crack propagation. Monolithic zirconia, preferred over porcelain-fused-to-metal (PFM) crowns, offers better aesthetics and avoids chipping. Various surface treatments, such as polishing and glazing, enhance zirconia's smoothness and wear characteristics. Polished zirconia is less abrasive to enamel than glazed zirconia, making it more suitable for opposing teeth. Research indicates that polished zirconia has a smoother surface and higher fracture resistance compared to other dental ceramics. Surface roughness, which is influenced by the treatment method, is crucial in minimizing wear on opposing teeth. Polished monolithic zirconia also shows high flexural strength, chipping resistance, and translucency. While both polishing and glazing reduce brightness, polishing better preserves translucency. The literature identifies polishing as the best post-processing method for enhancing zirconia's surface quality and mechanical properties without compromising its load-bearing capacity. In conclusion, polishing and finishing significantly improve the aesthetic and clinical performance of monolithic zirconia, confirming its effectiveness for durable and visually appealing dental restorations.

Effect of zirconia surface conditioning before glazing on the wear of opposing enamel: an in vitro study

OBJECTIVES

This in vitro study aimed to evaluate the wear of natural teeth opposing 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) with different surface conditions.

MATERIALS AND METHODS

Sixty 3Y-TZP specimens were randomly assigned to six groups (n = 10), differing in surface condition. In three groups, the samples underwent glazing-with the glaze applied to roughened (i.e., 106-µm-grit diamond-finished), as-sintered, and polished zirconia. The three remaining groups consisted of unglazed specimens: solely polished samples and diamond-finished samples (106-µm-grit and 46-µm-grit) without further conditioning. Two-body wear was evaluated at extracted, non-carious molars (n = 60), which served as antagonists in chewing simulation (10,000 masticatory cycles, 49N load). As a control, natural teeth with intact enamel surfaces were tested against natural molars (n = 10). All samples were 3D-scanned before and after the chewing simulation (7 Series, Straumann). Volume loss was calculated (Inspect Software, GOM), and statistically analyzed (SPSS Statistics 24, IBM).

RESULTS

Volume loss of the natural antagonists decreased in the following order: 106-µm-grit diamond-finished zirconia (4.6 ± 2.5 mm3), glazed 106-µm-grit diamond-finished zirconia (3.8 ± 1.1 mm3), glazed as-sintered zirconia (3.5 ± 0.9 mm3), 46-µm-grit diamond-finished zirconia (1.7 ± 0.6 mm3), control (1.6 ± 0.7 mm3), glazed polished zirconia (1.4 ± 0.5 mm3), and solely polishing (0.4 ± 0.2 mm3). Even when polishing the surfaces before glazing, volume loss was not mitigated to the same extent as after polishing alone.

CONCLUSIONS

The zirconia surface condition beneath the glazing influences antagonist wear. Although polishing before glazing resulted in acceptable levels of antagonist wear, this approach did not yield as favorable results as polishing alone.

CLINICAL RELEVANCE

For operators favoring glazing, pre-polishing the zirconia surface could be advantageous to reduce wear.

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.