Mechanical and optical properties of monolithic CAD-CAM restorative materials

Effect of preparation design on fracture resistance of molars restored with occlusal veneers of different CAD-CAM materials: an in vitro study

BACKGROUND

Occlusal veneer had been evaluated for mechanical properties using lithium disillicate. However, studies evaluating the mechanical properties of occlusal veneer with different preparation designs and ceramic materials are lacking. So, this in vitro study aimed to evaluate the fracture resistance of occlusal veneers with two designs fabricated from two different ceramic materials.

MATERIAL AND METHODS

Fourty mandibular third molars were distributed to 2 groups (n = 20) according to preparation design: group (O) anatomical occlusal reduction and group (OA) anatomical occlusal and 1 mm axial reduction. Each group was additionally subdivided into two subgroups (n = 10) according to ceramic materials; in subgroup X, lithium disilicate (e.max CAD, Ivoclar AG, Schaan, Liechtenstein) was used, and in subgroup S, zirconia-reinforced lithium silicate (ZLS) (Vita Suprinity, VitaZahnfabrik, Bad Säckingen, Germany) was used. All specimens were cemented with a light-cure resin cement (Choice 2, Bisco, Schaumburg, USA). 5000 thermocycles were applied to all specimens with both temperatures of 5 °C and 55 °C in two water baths; the dwell time was 30s at each bath, and the transfer time was 10s. Then all specimens were subjected to a fatigue simulation under dynamic loading of 200 N for 250,000 cycles. A universal testing machine (5500R/1123, Instron, Norwood, USA) was used to evaluate the fracture strength with a crosshead speed of 1 mm/min. All data were analyzed statistically by using a two-way ANOVA, and for some violations of assumptions, these results were compared with those obtained by the nonparametric test (Scheirer Ray Hare) (α = 0.05).

RESULTS

A statistically significantly higher fracture resistance in the 'OA' (3389 N) compared to the 'O' (2787 N) group regardless of the ceramic material (P < .001) and a statistically significantly higher fracture resistance in the 'X' (3295 N) compared to the 'S' (2881 N) regardless of the preparation design (P = .015).

CONCLUSIONS

For occlusal veneers, all preparation designs and materials (such as Vita Suprinity and e.max CAD) had clinically acceptable fracture resistance values that were greater than the maximal biting forces. On the other hand, the e.max CAD with occlusal veneer, including axial reduction design, demonstrated the maximum fracture resistance value. Finally, no relationship between fracture strength and mode of failure was found.

Exploring the optical behavior and relative translucency parameter of CAD-CAM resin-based composites, polymer-infiltrated ceramic network, and feldspar porcelain

OBJECTIVES

To evaluate and compare the optical properties and relative translucency parameter of CAD-CAM restorative materials.

METHODS

Four CAD-CAM materials were evaluated: Lava Ultimate (LU), Grandio Blocs (GB), VITA Enamic (VE), and VITA Mark II (VM). Disk-shaped samples in shade A2-HT were prepared (n = 10) and polished to 1.00 ± 0.01 mm of thickness. Scattering (S), absorption (K), albedo (a) coefficient, transmittance (T%), light reflectivity (RI), infinite optical thickness (X∞), and radiative transfer coefficients (μa, and μ'S) were calculated using Kubelka-Munk method and Thennadil's semi-empirical approach. Root Mean Square Error (RMSE) and Goodness of Fit (GFC) were used as performance optical behavior. Translucency differences were evaluated using the relative translucency parameter (RTP00) and 50:50 % translucency perceptibility and acceptability thresholds (TPT00 and TAT00).

RESULTS

The spectral distribution of S, K, T%, RI, and X∞ was wavelength-dependent. GFC and RMSE values indicated good spectral behavior matches and good comparative spectral values for RI in LU-GB, LU-VE, and GB-VE, and for K in VE-VM. VM displayed the highest scattering values across the wavelengths, while VE and VM showed lower absorption at shorter wavelengths. LU and GB had the highest transmittance. The X∞ values indicated that all 1.0 mm thick materials could be influenced by the background. No good spectral match and no good comparative spectral values were found between CAD-CAM materials and anterior bovine maxillary specimens. VM had the lowest RTP00 values with perceptible and unacceptable differences compared to CAD-CAM materials evaluated.

SIGNIFICANCE

Understanding the optical behavior of different CAD-CAM materials was essential for guiding clinicians in material selection and optimizing their clinical performance. The findings confirm that the different compositions and microstructure impact the optical properties and translucency of CAD-CAM restorative materials.

Optimizing restorative procedure and material selection for pulpotomized primary molars: Mechanical characterization by 3D finite element analysis

Purpose

This study aimed to assess the stress distribution in pulpotomized primary molars with different types of restorative materials using 3D-finite element analysis (FEA), and provide valuable insights into the selection and application of restorative materials, with the ultimate goal of reducing the risk of pulpotomy failure and protecting residual dental tissue.

Methods

Four 3D models of pulpotomized primary molars with different restorative materials according to the material and its elastic modulus were analysed: resin composite, stainless steel crowns (SSCs), prefabricated zirconia crowns and endocrowns. The food layer was also designed before vertical and bucco-lingual forces were applied to simulate physiological masticatory conditions. The results were obtained by colorimetric graphs of the von Mises stresses (VMS) in the restoration and tooth remnant. The maximum shear stress on the bonding interfaces and pressure stress on the Mineral trioxide aggregate (MTA)-pulp interfaces were recorded.

Results

The results of the 3D-FEA showed that all restorative materials generated stresses and strains on the tooth structure after pulpotomy. In the resin composite group, the marginal enamel exhibited the highest stress peaks. In the zirconia crown and SSC groups, there was a concentration of stress at the dentin-restoration margin. The shear stress concentrations were mainly at the adhesive margins, with lower levels around endocrowns compared to other groups. MTA in the resin composite group experienced more VMS than in the other group. The resin composite group also generated relatively higher pressure stress values at the MTA-pulp interface compared to the other groups.

Significance

In the model of primary teeth following pulpotomy, the three types of restorations covering the occlusal surface can effectively reduce the stress on pulp capping materials under occlusal loads, thereby potentially decreasing the risk of pulpotomy failure. In addition, the group of endocrowns demonstrated reduced stress at the bonding interface and in the stress concentration zone near the dentist-restoration edge, making them more effective at protecting residual dental tissue.

Surface Modification of Feldspathic Ceramic Used for Minimally Invasive Restorations: Effect of Airborne Particle Type on the Surface Properties and Biaxial Flexural Strength

This study aimed to evaluate the effect of airborne particle abrasion with different particles on the surface free energy, roughness, and biaxial flexural strength of a feldspathic ceramic by comparing it with hydrofluoric acid etching, the standard surface treatment, and polishing. Square-shaped feldspathic ceramic specimens (12 mm × 12 mm × 1.2 mm) were divided into subgroups as airborne particles abraded with alumina (AO3a, AO3b, AO25, AO50a, AO50b, AO90, AO110a, AO110b, AO120a, and AO120b), silica (SO50a, SO50b, SO100, and SO100/200), or nutshell granule (NS100/200), hydrofluoric acid etched, and polished (n = 12). Surface free energy (n = 5), roughness (n = 5), biaxial flexural strength (n = 12), and Weibull moduli (n = 12) were investigated. Data were evaluated with 1-way ANOVA and Tukey HSD tests, and possible correlations were investigated with Pearson's correlation (α = 0.05). SO100/200 mostly had lower surface free energy (p ≤ 0.011), and polishing and etching led to higher surface free energy than AO3a, AO3b, and AO120a (p ≤ 0.031). Polished, SO100, and SO50b specimens mostly had lower roughness and AO125 had the highest roughness (p ≤ 0.029). SO100/200 mostly had lower biaxial flexural strength (p ≤ 0.041), and etched specimens had higher biaxial flexural strength than AO120a, AO120b, and SO50b (p ≤ 0.043). AO3b had the highest (33.56) and AO120b had the lowest (11.8) Weibull modulus. There was a weak positive correlation between the surface free energy and the biaxial flexural strength (r = 0.267, p = 0.011). A larger particle size mostly resulted in higher roughness, which was also affected by the particle shape. Most of the test groups had similar biaxial flexural strength to that of the hydrofluoric acid-etched group. Therefore, for tested feldspathic ceramic, airborne particle abrasion with tested parameters may be a suitable alternative without causing any further damage.

Effect of Coffee Thermocycling on Color Stability and Translucency of CAD-CAM Polychromatic High Translucent Zirconia Compared With Lithium Disilicate Glass Ceramic

AIMS AND OBJECTIVES

To evaluate the effect of coffee thermocycling on color stability and translucency of CAD-CAM polychromatic high translucent zirconia compared with lithium disilicate glass ceramic.

METHODS

Sixteen rectangular plates (14 × 16 × 1.0 mm) of two ceramic materials (IPS E.max CAD (IEC), IPS E.max ZirCAD Prime [IZP]) were prepared. Each specimen was measured for color coordinates using a spectrophotometer following 30,000 cycles of coffee thermocycling. CIELAB formula was used to determine color and translucency differences (ΔE and ΔTP). The means of ΔE and ΔTP were compared using independent samples t-test and were evaluated using their respective 50%:50% perceptibility and acceptability thresholds (PT and AT). One-way analysis of variance was performed to evaluate the translucency parameter (TP) and surface roughness (Ra) of each material.

RESULTS

Mean ΔE values of IEC (4.69) and IZP (4.64) were higher than the AT (ΔE ≤ 2.7) with no significant difference found between the two groups (p = 0.202). Considering the TP, only IEC showed a statistically significant increase in TP value (p < 0.001). However, the mean ΔTP of IEC (3.25) remained within the range of acceptability (1.3 < ΔTP ≤ 4.4).

CONCLUSIONS

Within the limitations of this current study, the color stability of all materials was clinically affected by coffee thermocycling. In terms of translucency, only lithium disilicate glass ceramic was influenced by coffee thermocycling. High translucent zirconia had superior translucency stability compared to lithium disilicate glass ceramic.

In silico nonlinear dynamic finite-element analysis for biaxial flexural strength testing of CAD/CAM materials

PURPOSE

The aim of this study was to establish and assess the validity of in silico models of biaxial flexural strength (BFS) tests to reflect in vitro physical properties obtained from two commercially available computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic blocks and one CAD/CAM resin composite block.

METHODS

In vitro three-point bending and BFS tests were conducted for three CAD/CAM materials (n = 10): Katana Zirconia ST10 (raw material: super-translucent multilayered zirconia, ST10; Kuraray Noritake Dental, Niigata, Japan), Katana Zirconia HT10 (raw material: highly translucent multilayered zirconia, HT10; Kuraray Noritake Dental), and Katana Avencia N (AN; Kuraray Noritake Dental). Densities, flexural moduli, and fracture strains were obtained from the in vitro three-point bending test and used as an input for an in silico nonlinear finite element analysis. The maximum principal stress (MPS) distribution was obtained from an in silico BFS analysis.

RESULTS

The elastic moduli of AN, HT10, and ST10 were 6.513, 40.039, and 32.600 GPa, respectively. The in silico fracture pattern of ST10 observed after the in silico evaluation was similar to the fracture pattern observed after the in vitro testing. The MPS was registered in the center of the tensile surface for all three specimens. The projections of the supporting balls were in the form of a triple asymmetry.

CONCLUSIONS

The in silico approach established in this study provided an acceptable reflection of in vitro physical properties, and will be useful to assess biaxial flexural properties of CAD/CAM materials without wastage of materials.

Influence of additives and binder on the physical properties of dental silicate glass-ceramic feedstock for additive manufacturing

OBJECTIVES

The aim of the study was to investigate the impact of organic additives (binder, plasticizer, and the cross-linking ink) in the formulation of water-based feedstocks on the properties of a dental feldspathic glass-ceramic material developed for the slurry-based additive manufacturing technology "LSD-print."

MATERIAL AND METHODS

Three water-based feldspathic feedstocks were produced to study the effects of polyvinyl alcohol (AC1) and poly (sodium 4-styrenesulfonate) (AC2) as binder systems. A feedstock without organic additives was tested as the control group (CG). Disc-shaped (n = 15) and bar (n = 7) specimens were slip-cast and characterized in the green and fired states. In the green state, density and flexural strength were measured. In the fired state, density, shrinkage, flexural strength (FS), Weibull modulus, fracture toughness (KIC), Martens parameters, and microstructure were analyzed. Disc-shaped and bar specimens were also cut from commercially available CAD/CAM blocks and used as a target reference (TR) for the fired state.

RESULTS

In the green state, CG showed the highest bulk density but the lowest FS, while the highest FS in the green state was achieved with the addition of a cross-linking ink. After firing, no significant differences in density and a similar microstructure were observed for all slip-cast groups, indicating that almost complete densification could be achieved. The CAD/CAM specimens showed the highest mean FS, Weibull modulus, and KIC, with significant differences between some of the slip-cast groups.

SIGNIFICANCE

These results suggest that the investigated feedstocks are promising candidates for the slurry-based additive manufacturing of restorations meeting the class 1a requirements according to DIN EN ISO 6871:2019-01.

Optical properties of recycled zirconia for dental applications

STATEMENT OF PROBLEM

While waste zirconia can be recycled, whether the optical properties of recycled zirconia match those of commercially available zirconia is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the optical properties of recycled zirconia by assessing its color, translucency, and opalescence across different thicknesses and shades.

MATERIAL AND METHODS

Sixty specimens were prepared from 3 mol% yttria-stabilized tetragonal zirconia polycrystal blocks (Lava Plus; 3M ESPE) (group C); 60 other specimens were prepared from waste blocks of the same zirconia (group R). The specimens were further categorized into 4 subgroups (n=15) based on their thicknesses (1.0 mm or 1.5 mm) and shades (A1 or A3). Specimen color was measured with a spectrophotometer (Easyshade Advance 4.0; Vita ZahnFabrik). The parameters of color difference (ΔE00), translucency (TP), contrast ratio (CR), and opalescence (OP) were calculated. Grain size analysis was performed using scanning electron microscopy. Data were analyzed with analysis of variance (ANOVA) (α=.05).

RESULTS

Significant differences in translucency and opalescence were observed between groups C and R in all specimens (P<.001). Group R exhibited a range of TP (4.89 to 11.27), CR (0.74 to 0.91), and OP (3.36 to 8.65) values. The ΔE00 values between groups C and R ranged from 13.99 to 21.31. Both thickness and shade significantly affected the ΔE00 values (P<.001). The grain size in group C was not significantly different from that in group R (F=0.364, df=1, P=.555). The TP and OP values of group R decreased with increasing thickness (P<.001).

CONCLUSIONS

Recycled zirconia was less translucent and opalescent than commercially available zirconia. The color difference between commercially available and recycled zirconia exceeded the acceptable threshold, even when using the same staining procedure. Recycled zirconia exhibited reduced translucency and opalescence with increasing thickness.

Flexural Strength of Different Monolithic Computer-Assisted Design and Computer-Assisted Manufacturing Ceramic Materials Upon Accelerated Aging

OBJECTIVES

 The durability of ceramic is crucial, which is probably influenced by aging. This study evaluated the effect of aging on flexural strength of different ceramics.

MATERIALS AND METHODS

 One-hundred twenty ceramic discs (Ø 12 mm, 1.5 mm thickness) were prepared from zirconia-reinforced lithium silicate (ZLS, C), lithium disilicate (LS2, E), precolored yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP, Ip), and customized color Y-TZP (Ic). Samples were randomly divided into two groups for accelerated aging (A) between 5 and 55°C water baths, 30-second immersing time each, for 10,000 cycles, and nonaged group (N), serving as control. Biaxial flexural strength (σ) was evaluated utilizing the piston-on-three-balls at 0.5 mm/min speed. Analysis of variance and Tukey comparisons were determined for significant differences (α = 0.05). Weibull analysis was applied for survival probability, Weibull modulus (m), and characteristic strength (σo). Microstructures were evaluated with scanning electron microscopy and X-ray diffraction (XRD).

RESULTS

 The highest σ and σo were seen for IcN, followed by IcA, IpN, IpA, EN, CA, CN, and EA, respectively. CN showed the highest m, while EA showed the lowest m. Significant differences of σ for each ceramic were indicated (p < 0.05). Aging caused a significant difference in σ (p < 0.05). XRD showed t→m phase transformation of Ip and Ic after aging.

CONCLUSION

 Aging affected strength of ceramics. Comparable strength between LS2 and ZLS was evidenced, but both were less strength than Y-TZP either aging or non-aging. Comparable strength between precolored Y-TZP and customized color Y-TZP was indicated. Better resisting aging deterioration of Y-TZP than LS2 and ZLS is suggested for fabrication restorative reconstruction.

A Bilayer Method for Measuring Toughness and Strength of Dental Ceramics

The ever-increasing usage of ceramic materials in restorative dentistry necessitates a simple and effective method to evaluate flexural strength σF and fracture toughness KC. We propose a novel method to determine these quantities using a bilayer specimen composed of a brittle plate adhesively bonded onto a transparent polycarbonate substrate. When this bilayer structure is placed under spherical indentation, tunneling radial cracks initiate and propagate in the lower surface of the brittle layer. The failure analysis is based on previous theoretical relationships, which correlate σF with the indentation force P and layer thickness d, and KC with P and mean length of radial cracks. This work examines the accuracy and limitations of this approach using a wide range of contemporary dental ceramic materials. The effect of layer thickness, indenter radius, load level, and length and number of radial cracks are carefully examined. The accuracy of the predicted σF and KC is similar to those obtained with other concurrent test methods, such as biaxial flexure and 3-point bending (σF), and bending specimens with crack-initiation flaws (KC). The benefits of the present approach include treatment for small and thin plates, elimination of the need to introduce a precrack, and avoidance of dealing with local material nonlinearity effects for the KC measurements. Finally, the bilayer configuration resembles occlusal loading of a ceramic restoration (brittle layer) bonded to a posterior tooth (compliant substrate).

Repair bond strength of a new self-adhesive composite resin to three different resin-matrix ceramic CAD-CAM materials

This study aimed to evaluate the shear bond strength of two flowable composite resins to resin-matrix ceramic CAD-CAM materials.Fifty-four plates obtained from Lava Ultimate (LU), Cerasmart (CS), and Vita Enamic (VE) CAD-CAM blocks were assigned to nine groups: N0: Nova Compo SF (NCSF), N1: Silane/Single Bond Universal (SBU)/NCSF, N2: SBU/NCSF, N3: Silane/G-Premio Bond (GPB)/NCSF, N4: GPB/NCSF, G1: Silane/SBU/G-aenial Universal Injectable Composite (GUIC), G2: SBU/GUIC, G3: Silane/GPB/GUIC, G4: GPB/GUIC. After the repair procedures, shear bond strength values were analyzed. Silane pre-application decreased bond strength in most LU and CS groups but increased it in VE. NCSF performed better than GUIC in all CAD-CAM's with similar adhesive protocols. SBU in combination with NSCF had the highest bond strength among all repair procedures in LU and CS. Silane-containing universal adhesives in combination with self-adhesive resin composites should be used to repair resin-matrix ceramic materials.

Effect of thermocycling on the mechanical properties of permanent composite-based CAD-CAM restorative materials produced by additive and subtractive manufacturing techniques

BACKGROUND

The aim of the study was to determine and compare the biaxial flexural strength (BFS) and Vickers hardness (VHN) of additive and subtractive manufactured permanent composite-based restorative materials, before and after thermal aging.

METHODS

A total of 200 specimens were prepared; 100 disc-shaped specimens (diameter 13 × 1.2 mm) for the BFS test and 100 square specimens (14 × 14 × 2 mm) for the VHN test. The specimens were made from various materials: two subtractive composite-based blocks (Cerasmart 270 [CS], Vita Enamic [VE]), two additive composite-based resins used for two different vat polymerization methods (digital light processing [DLP]; Saremco Print Crowntec [SC] and stereolithography [SLA]; Formlabs Permanent Crown Resin [FP]), and one feldspathic glass-matrix ceramic block (Vita Mark II [VM]) as the control group. Specimens of each material were divided into two subgroups: thermal cycled or non-thermal cycled (n = 10). BFS and VHN tests were performed on all groups. Data were analyzed with two-way ANOVA and post hoc Tukey test (α = 0.05).

RESULTS

The type of restorative material used for the specimen had a statistically significant influence on both BFS and VHN values. However, thermal cycling did not affect the BFS and VHN values. After thermal cycling, the results of the BFS test were ranked from best to worst as follows: CS, FP, SC, VE, then VM. For the VHN values, the order from best to worst was as follows: VM, VE, CS, FP, then SC.

CONCLUSIONS

3D printed and milled composite groups showed higher BFS than feldspathic ceramics. When the VHN results were examined, it was seen that the 3D resin groups had the lowest VHN values. Furthermore, it was observed that the thermal cycle had no effect on BFS or VHN.

Finishing technique effect on strength of zirconia-reinforced lithium silicate ceramic

The aim of this study was to evaluate the effect of two finishing techniques, glazing or polishing, in comparison with the as-cut condition, on the biaxial-flexural-strength (BFS) of a zirconia-reinforced lithium silicate ceramic (ZLS). Cylinders were milled from CAD/CAM blocks and sliced to obtain disc-shaped specimens (ISO6872:2015). Polished and glazed specimens were processed following the manufacturer's instructions. Thirty-three specimens were obtained for each condition and microstructural and BFS/fractographic characterizations were performed. BFS and roughness data were analyzed using Weibull statistics and ANOVA one-way with Tukey post-hoc test, respectively. While a rougher surface was observed for as-cut specimens, smoother surfaces were observed for polished and glazed ZLS at microscopical evaluation and confirmed through surface-roughness evaluation. X-ray spectra depicted a glass phase for all groups and characteristic metasilicate, lithium disilicate, and lithium phosphate peaks for the as-cut and polished specimens. Glazed specimens showed higher characteristic strength than polished and as-cut specimens, which did not differ significantly. While higher Weibull-modulus was observed for the polished than for the as-cut specimens, no statistically significant differences were noted between glazed and polished, and between glazed and as-cut specimens. ZLS presents higher strength when glazed, and polishing increases the structural reliability of the material relative to the as-cut condition. Both finishing techniques reduced surface roughness similarly.

Quantitative analysis of the color in six CAD-CAM dental materials of varied thickness and surface roughness: An in vitro study

STATEMENT OF PROBLEM

Computer-aided design and computer-aided manufacturing (CAD-CAM) monochromatic restorative materials are gaining popularity because of their convenience and efficiency. However, studies that quantitatively analyzed color change associated with thickness and surface roughness are sparse.

PURPOSE

The purpose of this in vitro study was to quantitatively evaluate the color of 6 CAD-CAM monochromatic materials of different thickness and surface roughness using the CIELab color system.

MATERIAL AND METHODS

A total of 150 12×12-mm square specimens of 6 different CAD-CAM monochromatic materials (VITA Enamic HT [VE], IPS e.max CAD HT [LS], LAVA Ultimate HT [LU], Telio CAD HT [TE], VITA Suprinity HT [VS], and Celtra Duo HT [CD]) in shade A2 and 5 different thicknesses (from 0.5 mm to 2.5 mm, with 0.5-mm increments) were fabricated (n=5). After 3 different surface treatments (polished, roughened by SiC P800-grit, and P300-grit), CIELab color parameters (L*, a* and b*) were measured using a spectrophotometer (VITA Easyshade V), and surface roughness was measured with a profilometer (VK-X200). Color variation was quantified by ΔE00 and 50:50% acceptability and perceptibly thresholds. Data analyses were performed using MANOVA, 2-way ANOVA, post hoc Tukey-Kramer test, and the 1-sample t test (α=.05).

RESULTS

The L*, a*, and b* of the monochromatic specimens were significantly influenced by material type, thickness, and surface roughness (P<.001). An overall increase in the L* (from 61.90 to 82.2), a* (from -4.22 to 1.16), and b* (from 5.48 to 43.22) of the specimens was observed with increased thickness. The roughened specimens exhibited lower L* and higher a* and b* than the polished ones (P<.001). The use of P300-grit for roughening resulted in greater ΔE00 compared with P800-grit (P<.001). As thickness decreased or surface roughness increased, the ΔE00 increased and exceeded the acceptability and perceptibly thresholds for color difference.

CONCLUSIONS

Material type, thickness, and surface roughness were major factors affecting the color of CAD-CAM monochromatic materials. Variations in thickness of 0.5 mm or more, as well as roughening treatments, may lead to clinically unacceptable color changes.

Zirconia-Reinforced Lithium Silicate Ceramic in Digital Dentistry: A Comprehensive Literature Review of Our Current Understanding

Zirconia-reinforced lithium silicate (ZLS) ceramic is a new innovative dental material with unique a chemical composition that is designed to combine harmoniously with the appropriate optical properties of lithium disilicate and the enhanced mechanical strength of zirconia. A thorough understanding of ZLS materials is essential for both clinicians and dental technicians. At present, the mechanical behavior and optical properties of the ZLS ceramic system have not been extensively researched, and there is still a lack of consensus regarding the fabrication process and clinical behavior of ZLS all-ceramic restorations. The aim of the present study was to present a selection of comprehensive information concerning zirconia-reinforced lithium silicate ceramics and their optical and mechanical properties, as well as to assess data regarding cementation procedures and clinical outcomes for ZLS all-ceramic restorations. Three electronic databases (PubMed, Web of Science, and the Cochrane Library) were used for the research by two independent reviewers. The search was limited to articles published in the English language, as well as clinical and in vitro studies of color and studies on mechanical behavior and the cementation procedures of ZLS restorations. The exclusion criteria comprised abstracts, questionnaire-based studies, case reports, literature reviews, and studies that were not available in English. Zirconia-reinforced lithium-silicate-based ceramic presents a unique and complex microstructure that increases mechanical resistance but decreases aesthetic appearance, especially its translucency, due to tetragonal zirconia content. A material's thickness, the color of the underlying tooth structure, and the resin cement shade are important factors that influence the final shade and aesthetic appearance of ZLS restorations. Mechanical properties, which are defined by the fracture toughness, flexural strength, elastic modulus, and hardness of ZLS ceramic are higher compared to feldspathic, lithium disilicate, and hybrid ceramics, as well as resin nanoceramics; however, they are lower than translucent or high-translucency zirconia. Acid etching, sandblasting, and laser etching represent the most used methods to prepare the ZLS restoration surfaces for proper bonding procedures.

Advanced lithium disilicate: A comparative evaluation of translucency and fatigue failure load to other ceramics for monolithic restorations

The aim of this in vitro study was to evaluate the surface roughness, translucency, fatigue failure load (FFL), and number of cycles for fatigue failure (CFF) of a recently released lithia-based material called advanced lithium disilicate and three other ceramics indicated for monolithic restorations. First, ALD (advanced lithium disilicate, CEREC Tessera, Dentsply Sirona), LD (lithium disilicate, IPS e. max CAD, Ivoclar), LS (lithium silicate-disilicate, Suprinity, Vita Zahnfabrik), and 4Y-PSZ (Yttria-stabilized zirconia, IPS e.max ZirCAD MT, Ivoclar) discs (n = 15, Ø = 10 mm and thickness = 1.0 mm) were fabricated from CAD/CAM blocks/discs, A2 shade. The discs were sintered/crystallized and subsequently analyzed by a rugosimeter (Mitutoyo SJ-410) to determine Ra and Rz surface roughness parameters. Next, they were evaluated to determine the translucency parameter (TP) using a bench-top spectrophotometer (SP60, EX-Rite). The discs were subsequently cemented to glass fiber epoxy resin discs, and the specimens were tested under cyclic loading (Step-test), immersed in distilled water at a frequency of 20 Hz, with an initial cyclic load of 200 N for 5,000 cycles and increments of 50 N every 10,000 cycles until failure. Fatigue failure load (FFL) and number of cycles for fatigue failure (CFF) were recorded for subsequent Kaplan Meier analysis, with post-hoc Mantel-Cox and Weibull analysis (α = 0.05). Complementary fractographic, topographic and energy dispersive spectroscopy analyses (EDS) were performed. 4Y-PSZ showed higher survival (p < 0.05), with higher FFL and CFF (1077 N; 180,333 cycles), followed by LD (980 N; 161,000 cycles), LS (937 N; 152,333 cycles) and ALD (910 N; 147,000 cycles). No differences were observed between the tested groups regarding Weibull modulus. ALD presented TP (28.14) equal to DL (28.27) and higher than LS (25.51). All lithia-based materials had higher translucency than 4Y-PSZ (TP = 8.62) (p < 0.05). ALD appears to have a similar elemental composition to LD and LSD for oxygen and silicon. ALD and LSD have a similar zirconium content. Fractures originated on the cemented surface of the ceramic discs. Lithia-based ceramics showed lower surface roughness, with ALD (Ra = 0.04 μm; Rz = 0.66 μm) showing the lowest values (p < 0.05). Despite showing lower FFL when compared to LD and 4Y-PSZ, ALD has compatible translucency and mechanical fatigue performance with its indication for fabricating monolithic, anterior and posterior adhesively cemented single-unit restorations. However, further studies are needed to substantiate its clinical performance.

Optical properties, biaxial flexural strength, and reliability of new-generation lithium disilicate glass-ceramics after thermal cycling

PURPOSE

To investigate the color stability, translucency, biaxial flexural strength (BFS), and reliability of nano-lithium disilicate and fully crystallized lithium disilicate after thermal cycling and to compare with those of a commonly used lithium disilicate.

MATERIALS AND METHODS

Three lithium disilicate glass-ceramics were used to prepare disk-shaped specimens (ø:12 mm, thickness: 1.2 mm) from A2 shaded HT blocks (Amber Mill, AM; Initial LiSi Block, IN; IPS e.max CAD, EX). AM and EX specimens were crystallized, and all specimens were polished with a polishing paste (Diamond Polish Mint). A spectrophotometer (CM-26d) was used to measure color coordinates before and after thermal cycling. BFS test was performed after thermal cycling. Color differences (ΔE00 ) and relative translucency parameter (RTP) values were calculated. One-way analysis of variance (ANOVA) (ΔE00 and BFS), two-way ANOVA followed by Tukey's HSD tests (RTP), and chi-square tests (Weibull modulus and characteristic strength) were used for the statistical analyses (α = 0.05).

RESULTS

No significant differences were observed among the ΔE00 values of tested materials (df = 2, F = 2.933, p = 0.070). RTP values were only affected by material type (p < 0.001) as AM had the highest RTP (p < 0.001), whereas IN and EX had similar values (p ≥ 0.165). BFS values varied among tested materials (df = 2, F = 21.341, p < 0.001). AM and EX had similar BFS values (p = 0.067) that were higher than that of IN (p ≤ 0.001). Weibull moduli of the materials were similar (p = 0.305), whereas EX had the highest and IN had the lowest characteristic strength values (p < 0.001) CONCLUSIONS: Although nano-lithium disilicate had the highest translucency, all materials had imperceptible color and translucency changes after thermal cycling when reported threshold values were considered. Newly introduced lithium disilicate glass-ceramics had adequate flexural strength as compared to the precursor material.

Surface fractures in pre-crystallized and crystallized zirconia-containing lithium silicate glass-ceramics generated in ultrasonic vibration-assisted machining

Machining-induced surface fractures in ceramic restorations is a long-standing problem in dentistry, affecting the restorations' functionality and reliability. This study approached a novel ultrasonic vibration-assisted machining technique to zirconia-containing lithium silicate glass-ceramics (ZLS) and characterized its induced surface fracture topographies and morphologies to understand the microstructure-property-processing relations. The materials were processed using a digitally controlled ultrasonic milling machine at a harmonic vibration frequency with different amplitudes. Machining-induced surface fracture topographies were measured with a 3D white light optical profilometer using the arithmetic mean, peak and valley, and maximum heights, as well as the kurtosis and skewness height distributions, and the texture aspect ratios. Fracture morphologies were analysed using scanning electron microscopy (SEM). The surface fracture topographies were significantly dependent on the material microstructure, the mechanical properties, and the ultrasonic machining vibration amplitudes. Larger scale fractures with higher arithmetic mean, peak and valley heights, and kurtosis and skewness height distributions were induced in higher brittleness indexed pre-crystallized ZLS than lower indexed crystallized ZLS by conventional machining. Conchoidal fractures occurred in pre-crystallized ZLS while microcracks were found in crystallized state although brittle fractures mixed with localized ductile flow deformations dominated all machined ZLS surfaces. Ultrasonic machining at an ideal vibration amplitude resulted in more ductile removal, reducing fractured-induced peaks and valleys for both materials than conventional processing. This research demonstrates the microstructure-property-processing interdependence for ZLS materials and the novel machining technique to be superior to current processing, reducing fractures in the materials and potentially advancing dental CAD/CAM techniques.

Biaxial flexural strength and Weibull characteristics of a resin ceramic material after thermal-cycling

PURPOSE

The purpose of this in vitro study was to compare the flexural strength and Weibull characteristics of 3 different resin-ceramic materials with a zirconia-reinforced lithium silicate material after thermal-cycling.

MATERIAL AND METHODS

Four different computer-aided design and computer-aided manufacturing restorative materials (Vita Enamic, Lava Ultimate, Crystal Ultra, and Vita Suprinity) were tested. A total of 40 Ø12×1.2-mm disks were prepared and divided into 4 groups (n = 10). Their flexural strength was evaluated after 5000 thermal-cycles with a 4-point biaxial flexure test using a universal testing machine. The Weibull modulus and probability of failure were also determined from the biaxial flexural strength data. Data were analyzed with one-way ANOVA and the Tukey pairwise comparison test (α = 0.05).

RESULTS

Significant differences were found among the materials in terms of biaxial flexural strength (p < 0.05). Vita Suprinity had the highest mean ±standard deviation flexural strength (289.1 ± 15.1 MPa), and Vita Enamic had the lowest (100.0 ± 3.2 MPa). The highest Weibull modulus was calculated for Crystal Ultra, followed by Vita Enamic, Lava Ultimate, and Vita Suprinity.

CONCLUSION

Vita Suprinity had the highest flexural strength when compared with the other materials tested. Crystal Ultra had the highest flexural strength among the resin-ceramic materials. The highest Weibull modulus was calculated for Crystal Ultra and the lowest for Vita Suprinity.

Effect of simulated gastric acid on aesthetical restorative CAD-CAM materials' microhardness and flexural strength

Background

Gastric acid, which is among erosive substances, gradually rises to the mouth in individuals with reflux and bulimia nervosa disorders, and this causes various effects on dental restorations.

Aim

The objective of this study is in vitro investigation of gastric acid's effect on flexural strength and hardness on aesthetic restorative computer-aided design and computer-aided manufacturing (CAD-CAM) materials.

Materials and Methods

For this study, four materials have been used, namely Enamic (Vita), Superfect Zir (Aidite) Zirconia, IPS e.max CAD (Ivoclar Vivadent), and Mark II (Vita). From these four different materials, 24 samples with 14 × 4 × 1 dimensions in rectangular prism form are used, which makes a total of 96 samples. One group was separated as the control group, while the rest was allowed to wait at 37°C, 5 ml gastric acid for 96 hours. Hardness value and flexural strengths were measured as pre-exposure and post-exposure to gastric acid.

Results

There is a statistically significant difference between the groups in terms of the amount of decrease in the mean hardness after exposure to gastric acid compared to pre-exposure values (p: 0,000; P < 0,05). There was no statistically significant difference between the groups in terms of the amount of decrease in the post-exposure average flexural strength compared to the pre-exposure value (p: 0.063; P > 0.05). There is a statistically significant difference between the groups in terms of the average flexural strength after exposure to the acid.

Conclusions

According to the data obtained, it was concluded that exposure to gastric acid affects the hardness and flexural strength properties of dental restorative ceramic materials.

Translucency of Lithium-Based Silicate Glass-Ceramics Blocks for CAD/CAM Procedures: A Narrative Review

Amid chairside CAD/CAM materials, the use of lithium-based silicate glass-ceramics (LSGC) has been steadily increasing. This review aims to report on the translucency of these materials and the variables used to measure it. An electronic search was performed within the PubMed database within the period between 2 June 2011 and 11 September 2022. English-language papers investigating the translucency of IPS e.max CAD, Celtra Duo, Suprinity PC, Initial LiSi Block, Amber Mill, N!ce, and CEREC Tessera LSGC CAD/blocks were included in the search strategy. After an initial retrieval of 160 papers, the application of exclusion criteria, and the screening of abstracts and then of full texts, 33 papers were included in the study. The retrieved materials, with different degrees of translucency (LT, HT), were IPS e.max CAD (n = 33), Suprinity PC (n = 8), and Celtra Duo (n = 1). Concerning the examined colors, the most used was A2 (n = 20), followed by A1 (n = 8) and A3 (n = 2). The translucency parameter (TP) was the most used method (n = 30) with respect to the contrast ratio (CR) (n = 11) to assess translucency. Five papers measured both. Several specimens' thicknesses (0.5-4 mm) were investigated, with 1 mm (n = 23) being the most frequently analyzed. While a general tendency could be identified, conflicting results among different papers were reported.

Color stability of two different resin matrix ceramics: randomized clinical trial

BACKGROUND

One of the most common causes of aesthetic failure and restoration replacement is the tooth restorations color mismatch specifically after aging.

METHODS

One hundred and two participants with endodontically treated first molar were selected clinically. The patients were randomly splited into two groups and restored either with Cerasmart hybrid ceramic or Vita Enamic polymer infiltrated ceramic network (PICN) crowns and cemented using dual cure adhesive cement. The color difference (ΔE) values after cementation at 0 (Baseline), 6, and 12 months of use were obtained by quantification of L*, a*, and b* values with a digital spectrophotometer. Mann-Whitney test used to compare between tested groups at each time point and between (α = 0.05).

RESULTS

At 6 months follow-up intervals, Vita Enamic group showed the highest significant ∆L* (p = 0.035) and ∆a* (p < 0.001) compared to Cerasmart group. ∆b* and ∆E showed no significant difference between both groups (p > 0.05). Furthermore, all color parameters of both groups showed statistically significant difference at 12 months follow-up intervals. After 12 months, Vita Enamic restorations presented higher color change compared to Cerasmart restorations with a (p-value of 0.0120). When comparing the total color difference ∆Et through-out the follow-up intervals of Vita Enamic & Cerasmart groups, there were insignificant difference (p = 0.263).

CONCLUSION

Both hybrid materials demonstrated comparable color stability after 1 year of clinical service within clinical acceptance range. However, Cerasmart demonstrated a better colour stability after 1 year.

TRIAL REGISTRATION

ClinicalTrials.gov (ID: NCT05501808) 15/8/ 2022- 'retrospectively registered'.

Effect of staining layer on roughness after progressive wear of monolithic ceramics

PURPOSE

The aim of this study was to evaluate staining layer behavior applied to high-translucency zirconia (YZHT), feldspathic ceramics (FD), and zirconia-reinforced lithium silicate (ZLS) surfaces against different antagonists.

METHODS AND MATERIALS

Monolithic ceramic discs (n = 120) (ø 12 mm; thickness, 1.2 mm; ISO 6872) were obtained, 30 from YZHT and FD, and 60 from ZLS CAD/CAM blocks (staining layer applied before or after the crystallization procedure). The specimens were divided into 12 subgroups (n = 10) according to the antagonists: steatite, polymer-infiltrated ceramic, or zirconia. Mechanical cycling (1.5 × 104  cycles; 15 N; horizontal displacement, 6 mm; 1.7 Hz) and flexural strength tests (1 mm/min-1000 kg cell) were performed. The differences between final and initial roughnesses (Ra, Rz, and Rsm), the mass loss, and the flexural strength data were individually analyzed by two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

The roughnesses of all ceramics did not present a statistically significant difference before wear simulation: Ra (p = 0.3348), Rz (p = 0.5590), and Rsm (p = 0.5330). After the wear simulation, the Ra parameter was not affected by an interaction between ceramic and antagonist (p = 0.595). The Rz and Rsm parameters were affected only by the antagonist pistons (both, p = 0.000). The ceramics used in this study showed statistically significant differences in mass loss after the wear test (p < 0.0001). The additional firing (2 steps) of the ZLS2 led to a higher lost mass quantity.

CONCLUSION

All ceramics presented similar initial roughnesses and similar roughnesses after the wear simulation. The zirconia antagonist showed better performance against ceramics with high crystalline content.

CLINICAL SIGNIFICANCE

It is clear that restorative materials must be carefully selected by dental practitioners according to indications, properties, and antagonists. The steatite antagonist, that is, an enamel analog, showed better performance against vitreous ceramics, while the zirconia antagonist showed better performance against ceramics with high crystalline content. Wear affects the surface roughnesses of the ceramics. Additional firing for the staining of the zirconia-reinforced lithium silicate ceramic led to a greater loss of mass.

Effects of thickness and polishing treatment on the translucency and opalescence of six dental CAD-CAM monolithic restorative materials: an in vitro study

BACKGROUND

Computer-aided design and computer-aided manufacturing (CAD-CAM) materials for prosthetic is gaining popularity in dentistry. However, limited information exists regarding the impact of thickness and roughening treatment on the optical properties of contemporary CAD-CAM restorative materials. This study aimed to quantitatively evaluate the translucency and opalescence of six dental CAD-CAM materials in response to different thicknesses and roughening treatments.

METHODS

Six dental CAD-CAM materials, lithium disilicate glass-ceramic (IPS e.max CAD, LS), polymer-infiltrated ceramic (VITA Enamic, VE), resin-nano ceramic glass-ceramic (LAVA Ultimate, LU), polymethyl methacrylate (Telio CAD, TE), and two zirconia reinforced lithium silicate (VITA Suprinity, VS, and Celtra Duo, CD), in shade A2 were prepared as 12 × 12mm2 specimens of four thicknesses (0.5mm, 1.0mm, 1.5mm, and 2.0mm) (N = 240, n = 10). After three different treatments (polished, roughened by SiC P800-grit, and SiC P300-grit), the translucency parameter (TP00) and opalescence parameter (OP) were measured with a spectrophotometer (VITA Easyshade V). The surface roughness was analyzed with a shape measurement laser microscope. The data were analyzed using a MANOVA, post hoc Tukey-Kramer test, the t test, and regression analysis (α = .05).

RESULTS

The TP00 and OP were significantly influenced by material type, thickness and roughening treatment (P < .05). TP00 showed a continues decline with increasing thicknesses, while the variations of OP were material-dependent. TP00 ranged from 37.80 (LS in 0.5mm) to 5.66 (VS in 2.0mm), and OP ranged from 5.66 (LU in 0.5mm) to 9.55 (VS in 0.5mm). The variations in TP00 of all materials between adjacent thicknesses ranged from 2.10 to 15.29, exceeding the acceptable translucency threshold except for LU. Quadratic and logarithmic regression curves exhibited the best fit for TP00 among the materials. Compared to polished specimens, rougher specimens exhibited lower TP00 and higher OP in all materials except for LS (P < 0.05). Roughening with P300-grit decreased TP00 and OP by an average of 2.59 and 0.43 for 0.5mm specimens, and 1.26 and 0.25 for 2.0mm specimens, respectively.

CONCLUSIONS

Variations in translucency caused by thickness and roughening treatment were perceptible and may be clinically unacceptable. Careful consideration should be given to the selection of CAD-CAM materials based on their distinct optical properties.

Risk Factors with Porcelain Laminate Veneers Experienced during Cementation: A Review

The clinical success of porcelain laminate veneers (PLVs) depends on many clinical and technical factors, from planning to execution, among which adhesive cementation is of significant importance. This procedure carries many risk factors if not optimally executed. The objective of this study was to document the clinical parameters affecting successful cementation procedures with a focus on the adhesive strength, integrity, and esthetics of the PLVs. A literature search was conducted through MEDLINE, complemented by a hand search using predefined keywords. Articles published in English between 1995 and 2023 were selected. According to this review, the success and longevity of PLVs rely in great part on the implementation of a precise cementation technique, starting from field isolation, adequate materials selection for adhesion, proper manipulation of the materials, the seating of the veneers, polymerization, and elimination of the excess cement. Several clinical steps performed before cementation, including treatment planning, preparation, impression, and adequate choice of the restorative material, could affect the quality of cementation. Scientific evidence suggests careful implementation of this process to achieve predictable outcomes with PLVs. The short- and long-term clinical success of adhesively luted PLVs is tributary to a deep understanding of the materials used and the implementation of clinical protocols. It is also contingent upon all the previous steps from case selection, treatment planning, and execution until and after the cementation.

Edge chipping damage in lithium silicate glass-ceramics induced by conventional and ultrasonic vibration-assisted diamond machining

OBJECTIVES

Diamond machining of lithium silicate glass-ceramics (LS) induces extensive edge chipping damage, detrimentally affecting LS restoration functionality and long-term performance. This study approached novel ultrasonic vibration-assisted machining of pre-crystallized and crystallized LS materials to investigate induced edge chipping damage in comparison with conventional machining.

METHODS

The vibration-assisted diamond machining was conducted using a five-axis ultrasonic high-speed grinding/machining machine at different vibration amplitudes while conventional machining was performed using the same machine without vibration assistance. LS microstructural characterization and phase development were performed using scanning electron microscopy (SEM) and x-ray diffraction (XRD) techniques. Machining-induced edge chipping depths, areas and morphology were also characterized using the SEM and Java-based imaging software.

RESULTS

All machining-induced edge chipping damages resulted from brittle fractures. The damage scales, however, depended on the material microstructures; mechanical properties associated with the fracture toughness, critical strain energy release rates, brittleness indices, and machinability indices; and ultrasonic vibration amplitudes. Pre-crystallized LS with more glass matrix and lithium metasilicate crystals yielded respective 1.8 and 1.6 times greater damage depths and specific damage areas than crystallized LS with less glass matrix and tri-crystal phases in conventional machining. Ultrasonic machining at optimized amplitudes diminished such damages by over 50 % in pre-crystallized LS and up to 13 % in crystallized LS.

SIGNIFICANCE

This research highlights that ultrasonic vibration assistance at optimized conditions may advance current dental CAD/CAM machining techniques by significant suppression of edge chipping damage in pre-crystallized LS.

Effect of Different Scaling Methods on the Surface Topography of Different CAD/CAM Ceramic Compositions

This study evaluated the effect of ultrasonic and manual scaling using different scaler materials on the surface topography of computer-aided designing and computer-aided manufacturing (CAD/CAM) ceramic compositions. After scaling with manual and ultrasonic scalers, the surface properties of four classes of CAD/CAM ceramic discs: lithium disilicate (IPE), leucite-reinforced (IPS), advanced lithium disilicate (CT), and zirconia-reinforced lithium silicate (CD) of 1.5 mm thickness were evaluated. Surface roughness was measured before and after treatment, and scanning electron microscopy was used to evaluate the surface topography following the performed scaling procedures. Two-way ANOVA was conducted to assess the association of the ceramic material and scaling method with the surface roughness. There was a significant difference in the surface roughness between the ceramic materials subjected to different scaling methods (p < 0.001). Post-hoc analyses revealed significant differences between all groups except for IPE and IPS where no significant differences were detected between them. CD showed the highest surface roughness values, while CT showed the lowest surface roughness values for the control specimens and after exposure to different scaling methods. Moreover, the specimens subjected to ultrasonic scaling displayed the highest roughness values, while the least surface roughness was noted with the plastic scaling method.

Translucency, color stability, and biaxial flexural strength of advanced lithium disilicate ceramic after coffee thermocycling

OBJECTIVE

To compare the color stability, translucency, and biaxial flexural strength (BFS) of differently glazed advanced lithium disilicate (ALDS) with those of lithium disilicate (LDS) and zirconia-reinforced lithium silicate (ZLS) after coffee thermocycling.

MATERIALS AND METHODS

Forty disk-shaped specimens were prepared from three lithium silicate based materials (CEREC Tessera, ALDS; IPS e.max CAD, LDS; Vita Suprinity, ZLS). ALDS specimens were divided into two subgroups according to glazing procedures (reduced glaze duration, ALDS-S and normal glaze duration, ALDS-N), while LDS and ZLS specimens were crystallized and glazed. Color coordinate measurements were performed before and after coffee thermocycling. Color differences (ΔE₀₀ ) and relative translucency parameters (RTP) were calculated. Specimens were then subjected to BFS test. Statistical analysis was performed by using 1- (ΔE₀₀ and BFS) and 2-way (RTP) ANOVA tests (α = 0.05).

RESULTS

ΔE₀₀ values of tested materials were similar (df = 3, F = 0.150, p = 0.929). Two-way ANOVA showed the significant effect of material type, coffee thermocycling, and the interaction between these parameters on RTP values (p < 0.001). Both before and after thermocycling, LDS had the highest (p ≤ 0.001) and ZLS had the lowest (p < 0.001) RTP values, while ALDS-N had higher RTP than ALDS-S (p ≤ 0.001). Among tested materials, only LDS had similar RTP values before and after thermocycling (p = 0.865) as the other materials had lower RTP values after thermocycling (p < 0.001). ALDS-N had higher BFS values than ALDS-S (p = 0.005), while LDS had similar values to ALDS specimens (p ≥ 0.201). ZLS had the highest BFS (p ≤ 0.007).

CONCLUSIONS

ALDS had comparable values to those of other materials. However, reduced glazing duration resulted in decreased translucency and BFS of ALDS.

CLINICAL SIGNIFICANCE

ALDS may be an appropriate restorative material for those patients with increased coffee consumption considering its color stability and ability to maintain translucency, particularly when glazed by using a conventional porcelain furnace.

Comparison of the Color Change of Porcelain Laminate Veneers Produced by Different Materials After Luting with Three Resin Cements

OBJECTIVES

This study aimed to compare color change of porcelain laminate veneers fabricated with two lithium disilicate ceramics and a zirconia-reinforced lithium silicate ceramic material after luting with conventional dual-cure, amine-free dual-cure, or light-cure resin cements using artificial accelerated aging (AAA).

METHODS AND MATERIALS

Ninety noncarious human maxillary central incisors were embedded in autopolymerizing acrylic resin blocks to prepare conventional laminate veneers with incisal coverage. Prepared teeth were randomly divided into 3 groups (n=30) to fabricate laminate veneer restorations using: (1) lithium disilicate ceramic, (2) lithium disilicate ceramic with high-density micronization, and (3) zirconia-reinforced lithium silicate ceramic. Impressions of the preparations were taken with a laboratory scanner. Acquired 3D images were processed into a surface tessellation language file. Data were exported for 3D printing on a printer, and laminate veneers were printed in castable wax resin. Ceramic veneers were heat-pressed after investment according to the manufacturer's recommendations and further divided into three groups (n=10) according to luting cement type: (1) light-cure resin cement, (2) amine-free dual-cure resin cement, and (3) conventional dual-cure resin cement. Color measurements were performed from the middle of each specimen with a spectrophotometer before and after AAA for 300 hours with a total energy of 150 kJ/m2. Color changes were calculated with the CIEDE 2000 (ΔE00) formula. Color differences were assessed using two-way analysis of variance (ANOVA) (α=0.05), and the paired t-test was used to compare the L*, a*, and b* parameters in each group before and after aging.

RESULTS

There were no significant differences between the ceramic groups (p>0.05). The color changes of the materials ranged from 2.26 to 3.13. All materials were above the clinically acceptable limit (ΔE00>1.8). The conventional dual-cure resin cement group showed more color change (p>0.05).

CONCLUSIONS

Color changes were observed in all porcelain laminate veneers after artificial accelerated aging. The zirconia-reinforced lithium silicate veneers showed similar color changes as lithium disilicate veneers; the amine-free dual-cure resin cement showed a similar color change as light-cure resin cement after aging.

The Fracture Load as a Function of the Material Thickness: The Key to Computing the Strength of Monolithic All-Ceramic Materials?

The thickness of a material has a significant impact on its fracture load. The aim of the study was to find and describe a mathematical relationship between the material thickness and the fracture load for dental all-ceramics. In total, 180 specimens were prepared from a leucite silicate ceramic (ESS), a lithium disilicate ceramic (EMX), and a 3Y-TZP zirconia ceramic (LP) in five thicknesses (0.4, 0.7, 1.0, 1.3, and 1.6 mm; n = 12). The fracture load of all specimens was determined using the biaxial bending test according to the DIN EN ISO 6872. The regression analyses for the linear, quadratic, and cubic curve characteristics of the materials were conducted, and the cubic regression curves showed the best correlation (coefficients of determination (R²): ESS R² = 0.974, EMX R² = 0.947, LP R² = 0.969) for the fracture load values as a function of the material thickness. A cubic relationship could be described for the materials investigated. Applying the cubic function and material-specific fracture-load coefficients, the respective fracture load values can be calculated for the individual material thicknesses. These results help to improve and objectify the estimation of the fracture loads of restorations, to enable a more patient- and indication-centered situation-dependent material choice.

An engineering perspective of ceramics applied in dental reconstructions

The demands for dental materials continue to grow, driven by the desire to reach a better performance than currently achieved by the available materials. In the dental restorative ceramic field, the structures evolved from the metal-ceramic systems to highly translucent multilayered zirconia, aiming not only for tailored mechanical properties but also for the aesthetics to mimic natural teeth. Ceramics are widely used in prosthetic dentistry due to their attractive clinical properties, including high strength, biocompatibility, chemical stability, and a good combination of optical properties. Metal-ceramics type has always been the golden standard of dental reconstruction. However, this system lacks aesthetic aspects. For this reason, efforts are made to develop materials that met both the mechanical features necessary for the safe performance of the restoration as well as the aesthetic aspects, aiming for a beautiful smile. In this field, glass and high-strength core ceramics have been highly investigated for applications in dental restoration due to their excellent combination of mechanical properties and translucency. However, since these are recent materials when compared with the metal-ceramic system, many studies are still required to guarantee the quality and longevity of these systems. Therefore, a background on available dental materials properties is a starting point to provoke a discussion on the development of potential alternatives to rehabilitate lost hard and soft tissue structures with ceramic-based tooth and implant-supported reconstructions. This review aims to bring the most recent materials research of the two major categories of ceramic restorations: ceramic-metal system and all-ceramic restorations. The practical aspects are herein presented regarding the evolution and development of materials, technologies applications, strength, color, and aesthetics. A trend was observed to use high-strength core ceramics type due to their ability to be manufactured by CAD/CAM technology. In addition, the impacts of COVID-19 on the market of dental restorative ceramics are presented.

Effect of thickness on the translucency of resin-based composites and glass-ceramics

This study was aimed to evaluate the effect of thickness (1, 2, 3, and 4 mm) on the translucency of resin-based composites (RBCs) and glass-ceramics, and compare the influence of the thickness of those materials on the translucency parameter (TP) value. The materials were divided into two groups, eight RBCs in Group 1 and five glass-ceramics in Group 2 and TP, ΔL*, Δa*, and Δb* were compared. Statistically significant differences were present in the 2, 3, and 4 mm in the TP, in the 2 and 4 mm in ΔL*, and in all thicknesses in Δa* and Δb* betweent the two groups. The TP of RBCs and glass-ceramics decreased as thickness increased, especially from 1 mm to 2 mm. The TP values of the RBCs were more significantly decreased as the thickness of the material increased from 2 mm to 4 mm than those of the glass-ceramics.

Influences of Different CAD/CAM Ceramic Compositions and Thicknesses on the Mechanical Properties of Ceramic Restorations: An In Vitro Study

The aim of this study was to assess the influences of different CAD/CAM ceramic compositions and thicknesses on the surface roughness and hardness of ceramic restorations. Four different ceramics were used in the current study: lithium disilicate (LD), leucite reinforced (LE), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS). Each group included 30 specimens subdivided into three different ceramic thicknesses (0.5, 1 and 1.5 mm thicknesses). The microhardness was measured for all the specimens using a microhardness testing machine, while the surface roughness was measured using a non-contact optical profilometer at three intervals (before toothbrushing and after toothbrushing, with and without toothpaste). Three-way and two-way ANOVA were used to determine the factors influencing the surface roughness and microhardness. There was a significant difference in the surface roughness between the studied groups for all the thicknesses. The findings showed that ALD had the lowest surface roughness, while ZLS showed the highest surface roughness. Moreover, ALD, followed by ZLS, had the highest hardness, while LD and LE had the lowest hardness values. Regarding the thicknesses, both the 0.5 and 1 mm ceramic thicknesses showed a significantly lower surface roughness than the 1.5 mm thickness, while the 1.5 mm thickness showed a significantly higher microhardness than the 0.5 mm thickness. The surface roughness and hardness were significantly affected by the ceramic composition and type of filler. It is recommended to use 1.5 mm-thick ceramic materials for the fabrication of definitive full-coverage ceramic restorations, while veneers require 0.5 mm-thick materials. ALD is a promising CAD/CAM material that can be used for the fabrication of restorations with a proper strength in both anterior and posterior regions.

Effect of Successive In-office Bleaching Sessions on the Surface Properties, Substance Loss, Biaxial Flexural Strength, and Reliability of CAD-CAM Monolithic Materials

Little is known about the effects of in-office bleaching on the surface properties and on other aspects of CAD-CAM monolithic materials, especially when successive bleaching sessions are conducted. This study evaluated the effect of up to three successive in-office bleaching sessions on the microhardness, roughness, topography, substance loss, biaxial flexural strength (BFS), and reliability of CAD-CAM monolithic materials. Disks from Lava Ultimate (LU), Vita Enamic (VE), and IPS Empress CAD (EMP) were fabricated and submitted to one, two, and three bleaching sessions. In-office bleaching was performed with 40% hydrogen peroxide and each session consisted of three applications of 20 minutes each. The analyses regarding the aforementioned parameters were assessed before and after the first, second, and third bleaching sessions, except for BFS, which was evaluated at the baseline and after the third session. Weibull modulus was calculated from the BFS data. Bleaching decreased the microhardness of LU and VE from the third and second sessions, respectively, and affected neither the roughness nor the BFS of the three materials. However, in LU, it decreased the reliability and caused topographic changes, which were accentuated by the increase in the number of sessions. In general, LU and EMP showed, respectively, the highest and the lowest substance losses. Successive in-office bleaching sessions with the use of the protocol of the present study should be avoided in LU and VE.

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.

Triple scan evaluation of internal and marginal adaptation of overlays using different restorative materials

OBJECTIVE

Problems in the confection of indirect restorations may increase the marginal and internal gap. This study aimed to quantify the marginal and the internal fit of overlays fabricated with three different materials.

MATERIALS AND METHODS

Standardized cavities were prepared on endodontically treated human third molars and digital impressions were done using an intraoral camera (Trios 3). Restorations were designed (n = 15) and fabricated with three materials: Hybrid ceramic (Cerasmart; GC Corp, EUROPE), high-strength lithium disilicate (GC Initial® LiSi Press; GC Corp, Tokyo, Japan), and zirconia reinforced Lithium Silicate Glass Ceramic (Vita Suprinity; Vita, Germany). Axial, marginal, pulpal, and gingival gaps were calculated by measuring the distance between the restoration and the tooth at several reference points. Two-Way analysis of variance was used for statistical analysis. The significance level was set at α = 0.05.

RESULTS

Mean gap was significantly influenced by the material (p < 0.001), gap localization (p < 0.001), and interaction between the factors (p = 0.002). For all materials, the highest gap was observed at gingival and pulpal surfaces (p ≤ 0.015). LiSi Press achieved the overall lowest values at axial values measurements (p ≤ 0.003).

CONCLUSIONS

The performance of a CAD/CAM system relative to marginal adaptation is influenced by the restorative material used. High-strength lithium disilicate seems to be showed the best marginal adaptation.

CLINICAL SIGNIFICANCE

Marginal and internal adaptation of CAD/CAM restorations could be influenced by the type of material chosen.

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.

Effects of background color and thickness on the optical properties of CAD-CAM resin-matrix ceramics

STATEMENT OF PROBLEM

Information regarding the masking ability of computer-aided design and computer-aided manufacture (CAD-CAM) resin-matrix ceramic materials with different compositions is scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of background color and thickness on the optical properties (color and translucency) of CAD-CAM resin-matrix ceramics.

MATERIAL AND METHODS

Twelve rectangular specimens were fabricated at a different thickness (1, 1.5, and 2 mm) (n=12) from each of the resin-matrix ceramic materials: Shofu block (SB), Lava Ultimate (LU), CERASMART (CS), VITA ENAMIC (VE), Crystal Ultra (CU), and the VITABLOCS Mark II feldspathic ceramic (VB). The color of the specimens over amalgam, titanium, enamel, and dentin backgrounds was measured with a spectrophotometer, and the color differences (ΔE∗ab) were calculated by using the Commission Internationale de l'Eclairage (CIE) 76 formula. The difference in color of the specimen over the black and white backgrounds was used to calculate the translucency parameter (TP). ANOVA was used to statistically test whether material, background, and thicknesses influenced ΔE∗ab and TP values. Post hoc comparisons were performed to determine the significant difference among the groups (α=.05).

RESULTS

The interaction with 2 between factors demonstrated that the material was a factor that significantly influenced ΔE∗ab (P<.001). The highest mean ±standard deviation of ΔE∗ab was recorded in the combination of VB material and 2-mm thickness (1.84 ±0.37), and the lowest with CS material with 1.5-mm thickness (0.47 ±0.24). The type of material and specimen thickness significantly influenced TP (P<.001). The highest and lowest mean ±standard deviation of TP were recorded for the 1-mm-thick CS (14.20 ±0.90) and 2-mm-thick SB (4.91 ±0.42) specimens, respectively.

CONCLUSIONS

CERASMART resin-matrix ceramic and VITABLOCS Mark II feldspathic ceramic exhibited high and low masking abilities over the investigated background substrates, respectively. However, irrespective of the thickness, all study materials exhibited acceptable masking abilities.

Effect of the thickness of CAD-CAM materials on the shear bond strength of light-polymerized resin cement

This study aimed to investigate the effect of the thickness of computer aided design-computer aided manufacturing (CAD-CAM) restorative materials on the bond strength of light-polymerized resin cement. Ninety specimens were prepared from three different CAD-CAM materials (a leucite-based glass-ceramic [Empress CAD], a polymer-infiltrated ceramic network [Vita Enamic], and a zirconia-reinforced lithium silicate glass-ceramic [Vita Suprinity]) in different thicknesses (1, 2, and 3 mm). One surface of each specimen was treated by using a single-step self-etching ceramic primer (Monobond Etch & Prime). Light-polymerized resin cement was bonded to treated surfaces by exposure to a light-emitting diode curing unit from the untreated side of the samples. Shear bond strength (SBS) between the ceramic and the resin cement was measured by using a universal testing machine. The leucite-based glass-ceramic had higher SBS values than the other materials at each thickness. For each material, 1 mm-thick specimens had the highest SBS values. The difference between the SBS values of 2 mm- and 3 mm-thick polymer-infiltrated ceramic network was nonsignificant, whereas the SBS values of 2 mm-thick leucite-based glass-ceramic and the zirconia-reinforced lithium silicate glass-ceramic were significantly higher than those of the corresponding 3 mm-thick specimens. The choice of the material and its thickness may be highly important for clinical success when light-polymerized resin cements are used for cementation.

Engineering DNA-Guided Hydroxyapatite Bulk Materials with High Stiffness and Outstanding Antimicrobial Ability for Dental Inlay Applications

Programmable base pair interactions at the nanoscale make DNA an attractive scaffold for forming hydroxyapatite (HAP) nanostructures. However, engineering macroscale HAP mineralization guided by DNA molecules remains challenging. To overcome this issue, a facile strategy is developed for the fabrication of ultrastiff DNA-HAP bulk composites. The electrostatic complexation of DNA and a surfactant with a quaternary ammonium salt group enables the formation of long-range ordered scaffolds using electrospinning. The growth of 1D and 2D HAP minerals is thus realized by this DNA template at a macroscale. Remarkably, the as-prepared DNA-HAP composites exhibit an ultrahigh Young's modulus of ≈25 GPa, which is comparable to natural HAP and superior to most artificial mineralized composites. Furthermore, a new type of dental inlay with outstanding antibacterial properties is developed using the stiff DNA-HAP. The encapsulated quaternary ammonium group within the dense HAP endows the composite with long-lasting and local antibacterial activity. Therefore, this new type of super-stiff biomaterial holds great potential for oral prosthetic applications.

Load-to-Failure Resistance and Optical Characteristics of Nano-Lithium Disilicate Ceramic after Different Aging Processes

The aim of this study was to compare the load-to-failure resistance and optical properties of nano-lithium disilicate (NLD) with lithium disilicate (LDS) and zirconia-reinforced lithium silicate (ZLS) in different aging processes. Thirty crowns were milled from NLD, LDS, and ZLS (n = 10). All crowns were subjected to thermomechanical aging and loaded until catastrophic failure. Ten specimens from each material were prepared in two different thicknesses (0.7 mm and 1.5 mm, n = 5), and color coordinates were measured before and after coffee thermocycling. Color differences (ΔE00) and relative translucency parameter (RTP) were calculated. Data were analyzed by using ANOVA and Bonferroni-corrected t-tests (α = 0.05). ZLS had the highest load-to-failure resistance (p ≤ 0.002), while the difference between LDS and NLD was nonsignificant (p = 0.776). The interaction between material type and thickness affected ΔE00 (p < 0.001). Among the 0.7 mm thick specimens, ZLS had the lowest ΔE00 (p < 0.001). Furthermore, 1.5 mm thick ZLS had lower ΔE00 than that of 1.5 mm thick LDS (p = 0.036). Other than ZLS (p = 0.078), 0.7 mm thick specimens had higher ΔE00 (p < 0.001). The interaction between material type, thickness, and thermocycling affected RTP (p < 0.001). Thinner specimens presented higher RTP (p < 0.001). NLD and LDS had higher RTP than ZLS (p ≤ 0.036). However, 0.7 mm thick specimens had similar RTP after coffee thermocycling (p ≥ 0.265). Coffee thermocycling reduced the RTP values of 0.7 mm thick NLD (p = 0.032) and LDS (p = 0.008). NLD may endure the occlusal forces present in the posterior region. However, long-term coffee consumption may impair the esthetics of restorations particularly when thin NLD is used.

Evaluation of surface characterization and mechanical features of resin-matrix ceramics before and after different surface treatments

STATEMENT OF PROBLEM

Surface treatments (STs) required for micromechanical interlocking can lead to alterations in the surface characterization and mechanical features of the resin-matrix ceramics (RMCs), which may jeopardize the long-term outcome of an indirect restoration. However, evidence on this issue is lacking.

PURPOSE

The purpose of this in vitro study was to assess the influence of different STs on the surface roughness (SR), water contact angle (WCA), and flexural strength (FS) of RMCs.

MATERIAL AND METHODS

Two hundred rectangular plates (12×14×1 mm) were prepared from 5 different RMC ingots, including a polymer-infiltrated ceramic network (Vita Enamic [VE]), 2 resin nanoceramics (Lava Ultimate [LU], Grandio Blocks [GB]), a flexible nanoparticle-filled resin (GC Cerasmart [GC]), and a reinforced composite resin (Brilliant Crios [BC]). Plates of each RMC group were further divided into 4 subgroups according to the ST applied: Control, no treatment (C); airborne-particle abrasion with aluminum oxide particles (APA); 2W- and 3W-Er,Cr:YSGG laser irradiations (LI^2W, LI^3W) (n=10 per ST). The SR (Ra) of each plate was recorded with a contact profilometer. WCAs (θ) of distilled water on the plates were determined by using the sessile-drop method. The FS (MPa) of each plate was measured with a universal testing machine. Data acquired for SR, WCA, and FS were statistically analyzed (α=.05). Weibull statistics were also conducted to determine the reliability of each material.

RESULTS

The 2-way ANOVA showed that SR, WCA, and FS values were significantly influenced not only by all tested variables but also by their interaction terms (P<.001). All STs significantly increased the SR values (P<.05). Maximum and minimum SR values were recorded in GC-LI^3W (7.06 ±0.16) and GC-C (0.07 ±0.02) groups. After STs, WCA values significantly diminished (P<.05). Maximum and minimum WCA values were recorded in LU-C (61.74 ±2.45) and VE-APA (40.38 ±1.56) groups. All STs significantly reduced the FS values (P<.05). The upper and lower FS bounds were 140.7 ±17.07 and 60.66 ±6.31, respectively, set by VG-C and GC-APA. Weibull distribution indicated that the untreated groups presented the highest m values. Among the treated groups, BC-LI^3W demonstrated superior reliability (m=14.04).

CONCLUSIONS

APA for LU, LI^2W for VG and BC, and LI^3W for GC and VE can be preferred. Although APA increased the SR and provided more wettable surfaces, it caused considerable loss of FS. Therefore, LI can be recommended as a safer ST for RMCs.

Long-term effects of simulated gastric juice alternated with brushing on hardness, substance loss, flexural strength and reliability of CAD-CAM monolithic materials

OBJECTIVES

The purpose of this study is to evaluate, over a simulated 5-year period, the effect of simulated gastric juice alternated with brushing on CAD-CAM monolithic materials considering microhardness, substance loss, flexural strength, and reliability of the materials.

METHODOLOGY

Blocks from Lava Ultimate (LU), Vita Enamic (VE), IPS Empress CAD (EMP), IPS e.max CAD (EMAX), and Vita Suprinity (VS) were milled into cylinders and sliced into disks. The EMAX and VS were crystallized, and all specimens were polished with silicon carbide papers and allocated as follows: 1) artificial saliva + brushing or 2) simulated gastric juice (0.113% hydrochloric acid (HCl) solution in deionized water, pH 1.2) + brushing, simulating 1, 3, and 5 years of clinical function. Each year of clinical function was simulated by three repetitions of immersion for 3 hours in artificial saliva or simulated gastric juice followed by 1,217 brushing cycles. The microhardness and substance loss were evaluated at baseline (T0) and at each year by using a Vickers hardness tester and an analytical balance. The biaxial flexural strength (BFS) test was performed in a mechanical testing machine at the end of the 5th year. Weibull modulus was calculated from the BFS data.

RESULTS

The microhardness of the LU was not influenced by the treatment, whereas that of the other materials, in certain years, was significantly lower in the gastric juice + brushing groups in comparison with artificial saliva + brushing groups. In general, the materials did not present a significant change in microhardness over time, for either of the treatments. The LU alone showed greater substance loss in the gastric juice + brushing groups for every year. In both treatments, the LU, VE, and EMP exhibited a significant increase in the substance loss over time. The treatment did not affect the BFS of the materials. The gastric juice + brushing decreased the reliability of the VE.

CONCLUSIONS

All materials were somehow impaired by the gastric juice + brushing in at least one of the evaluated parameters, except for the BFS. However, in a deeper analysis, the LU would be the least indicated materials, followed by VE, for patients with eating disorders.

Comparative Assessment of the Functional Parameters for Metal-Ceramic and All-Ceramic Teeth Restorations in Prosthetic Dentistry-A Literature Review

Simple Summary

In the last decades, the science and technology of all-ceramic teeth restorations witnessed the fastest-growing field of restorative materials in research and development for fixed prosthodontics. Due to their properties, characterized by a high level of biocompatibility, excellent optical properties, and high fracture resistance, all-ceramic material can also be used in the posterior areas of the dental arches. However, metal-ceramic fixed partial dentures are still perceived as the golden standard for those restorations, thanks to the positive clinical outcomes. Irrespective of the materials of which fixed partial dentures are performed, their success rates depend on the expected outcome and on how they perform in the oral environment. Such conditions of failure restorations may include biological factors (i.e., secondary decay, loss of vitality, periodontal disease, or abutment fracture) or technical factors (i.e., chipping, ceramic fracture, framework fracture, or loss of retention). Our aim is to provide the current evidence for the efficacy of metal-ceramics and all-ceramics in the treatment of multiple posterior edentulous spaces. Moreover, we aim to compare the survival rates of metal-ceramic and all-ceramic fixed partial dentures in terms of functionality and biocompatibility in all the aforementioned clinical situations. Our results have shown that all all-ceramic systems, especially densely sintered zirconia and reinforced glass ceramics, have a promising future to satisfy both practitioners and patients. However, technical and biological complications need to be taken into account when planning multi-unit fixed partial dentures for the posterior areas.

Abstract

The metal-ceramic fixed partial prosthesis is the golden standard for posterior tooth restorations. Following the demands of patients and clinicians for metal-free restorations, all-ceramic materials were developed as they offer an adequate alternative with better optical qualities and good mechanical properties. This study aims to carry out a bibliographic review to assess the survival rate and the biological and technical complications of all-ceramic and metal-ceramic fixed partial dentures. An electronic search for articles in the English language literature was performed using PubMed (MEDLINE). This literature review focused on research studies between 2010 and 2020 that performed clinical studies on tooth-supported fixed partial dentures with a mean follow-up of at least 3 years. All the studies, which analyzed the survival and complications of tooth-supported fixed partial dentures, were included. Thus, 14 studies reporting on 756 all-ceramic and 160 metal-ceramic fixed partial dentures met the inclusion criteria. A comparative analysis was carried out based on all the data existing in the studies included in this review. The metal-ceramic fixed partial dentures showed survival rates of 95% to 100% at 3-, 5-, and 10-year follow-up periods. Zirconia fixed partial dentures were reported to have survival rates of 81% to 100% at 3-, 5-, 9-, 10-year follow-up evaluations. The reinforced glass-ceramic fixed partial dentures showed survival rates of 70% to 93.35% at 5 years, while the alumina FPDs showed a survival rate of 68% at 3 years follow-up. The incidence of caries and loss of vitality were reported as higher for all-ceramic prostheses as compared to the metal-ceramic ones. A significant framework fracture was reported for glass-infiltrated alumina fixed partial dentures in comparison to metal-ceramic fixed partial dentures. All-ceramic and metal-ceramic restorations showed similar survival rates after 3 years, although all-ceramic restorations have problems with technical complications such as chipping, which can lead to framework fractures over time.

Masking ability of different ceramics upon various underlying structures

OBJECTIVE

To evaluate masking ability of different types and thicknesses of ceramics upon various substructures.

MATERIALS AND METHODS

Discs (Ø 12 mm, thickness 0.4, 0.6, 0.8, 1.0, 1.2, 1.4, 1.6, 1.8, and 2.0 mm) were prepared from Bruxzir-Anterior® (Bc), Celtra-DUO® (Cc), and Vita-Suprinity® (Vc) (n = 15/group). Substructures (2 mm thickness) were prepared from natural dentine (Ds), tetracycline-stained dentine (Ts), zirconia (Zs), resin composite (Rs), and cast metal (Ms). A spectrophotometer was used to measure the CIE L*a*b* color coordinates of a specimen. Masking ability was determined from the color difference (∆E₀₀ ) of ceramics between before- and after combining with substructure using ANOVA and Bonferroni test (α = 0.05). ∆E₀₀ value was compared with acceptable clinical threshold (∆E₀₀  = 1.8) and an ideal threshold (∆E₀₀  = 0.8).

RESULTS

Type-thickness of ceramics and substructures were significantly affected ∆E₀₀ . Ts significantly influenced ∆E₀₀ more than Rs, Ms, Zs, and Ds. No significant ∆E₀₀ upon Ms and Zs was indicated. Bc completely masked Ts and Rs if thickness was ≥0.6 mm, and Zs, Ms, and Ds if ≥0.4 mm. Cc completely masked Ts and Rs if thickness was >1.6 mm, and Zs, Ms, and Ds if >1.4 mm. Vc completely masked Ts if thickness was >1.4 mm, Rs and Ms if >1.2 mm, and Zs and Ds if >1 mm.

CONCLUSION

Ts is the most influential substructure impact on color appearance, requiring a minimum thickness of 0.6 mm Bc, 1.2 mm Vc, or 1.6 mm Cc to be perfectly masked.

CLINICAL SIGNIFICANCE

Masking ability was significantly influenced by the type and thickness of ceramic material and underlying structure. Monolithic zirconia had a significantly higher masking ability than lithium silicate/phosphate glass ceramic. Ts indicated the most influencial substructure impacting the color appearance of ceramic restoration, which require a minimum thickness of 0.6 mm Bc, 1.2 mm Vc, or 1.6 mm Cc to achieve ideal masking capability.

Mechanical Properties of Bisacryl-, Composite-, and Ceramic-resin Restorative Materials

OBJECTIVE

Resin-based materials used in restorative dentistry are introduced at a fast pace with limited knowledge about their properties. Comparing properties of these materials from different restorative categories is lacking but can help the clinician in material selection. This study aimed to compare mechanical properties and wear resistance of bis-acryl-, composite-, and ceramic-resin restorative materials.

METHODS AND MATERIALS

Bisacryl-resin (Bis-R, LuxaCrown, DMG), composite-resin (Com-R, Filtek Supreme Ultra, 3M Oral Care), and ceramic-resin (Cer-R, Enamic, VITA Zahnfabrik) specimens were prepared for mechanical tests: fracture toughness (FT) with and without initial thermomechanical loading using a mastication simulator, flexural strength (FS), and flexural modulus (FM), compressive strength (CS), and volumetric wear loss measurement. The datasets for FT and wear resistance were each analyzed using two-way ANOVA followed by pairwise comparisons or Tukey testing as appropriate. The datasets for FS, FM, and CS were analyzed using one-way ANOVA followed by the Tukey test.

RESULTS

Analysis of FS, FM, and CS showed significant differences between materials, with all pairwise comparisons between materials showing significance. Analysis of FT resulted in a significant interaction between the material and treatment, with analysis of wear loss showing a significant interaction between the material and the number of cycles.

CONCLUSIONS

Cer-R demonstrated superior FT, CS, and wear resistance compared to Bis-R and Comp-R materials. Fracture toughness of Bis-R increased after thermomechanical loading.

Effects of Different Air Particle Abrasion Protocols on the Biaxial Flexural Strength and Fractography of High/Ultra-Translucent Zirconia

In this study, the biaxial flexural strength (BFS) and fractography of high/ultra-translucent monolithic zirconia ceramics subjected to different mechanical surface pretreatments were evaluated. A total of 108 disc-shaped samples (12 mm diameter, 1.2 mm thickness) of three zirconia materials (5Y-ZP KATANA Zirconia UTML (ML), 3Y-TZP DD Bio ZX2 (DB), and 5Y-ZP DD cube X2 (DC)) were used. The BFS was investigated after subjecting the samples to surface treatment using air abrasion particles of two types (aluminum oxide or glass microbeads). The data were analyzed using two-way analysis of variance, followed by Scheffe's post hoc test for multiple comparisons. The mean ± standard deviation BFS for DB was highest after treatment with 50 µm Al₂O₃ (1626.05 ± 31.9 MPa), with lower values being observed following treatment with 50 µm glass microbeads (1399.53 ± 24.2 MPa) and in the control sample (1198.51 ± 21.1 MPa). The mean ± standard deviation (SD) BFSs for DC and ML were the highest in the control groups. Surface air abrasion with 50 µm Al₂O₃ particles and 2 bar pressure is recommended for 3Y-TZP translucent zirconia, while no abrasion of 5Y-ZP translucent zirconia ceramic.

Effect of Li+/Na+ exchange on mechanical behavior and biological activity of lithium disilicate glass-ceramic

Lithium disilicate (LD) glass-ceramics with a stoichiometric composition were ion-exchanged in pure NaNO₃ or mixed NaNO₃ + KNO₃ molten salt baths below the glass transition temperature (T_g). The microstructures, surface morphologies, mechanical properties and bioactivities of the ion-exchanged glass-ceramics were studied in detail. It was found that the strength and toughness of LD glass-ceramic could be enhanced from 175 MPa to 0.96 MPa m^1/2 before ion-exchange to 546 MPa and 4.31 MPa m^1/2 respectively under a lowered ion-exchange temperature because the less stress relaxation. In addition, a gradient of Na⁺ rich layer in the surface of glass-ceramic was induced by Li⁺/Na⁺ exchange, which could be beneficial to the formation of HA (Hydroxyapatite) with nano-size porous after soaking in SBF (Simulated Body Fluid) solution and exhibited better bioactivity compared with the original LD glass-ceramic. The results might provide a reference for the strengthening and biological activation of LD glass-ceramics in bone restoration applications.