Effects of accelerated artificial aging on the translucency and color stability of monolithic ceramics with different surface treatments

The effect of aging on the translucency of contemporary zirconia generations: in-vitro study

BACKGROUND

The translucency of different zirconia generations at each time point after thermocycling aging is still lacking.

METHODS

Four zirconia materials were used with a total of 60 samples produced from monolithic third generation (5Y) 5 mol% yttria-stabilized zirconia polycrystalline ceramic and fourth generation zirconia (4Y) 4 mol% yttria-stabilized zirconia polycrystalline ceramic, represented by [group1:[CM-5Y] Ceramill Zolid fx (3rd generation zirconia) (Amann Girrbach, Koblach, Austria), group 2:[CM-4Y] Ceramill Zolid HT + (4th generation zirconia) (Amann Girrbach, Koblach, Austria), group 3:[CC-5Y] Cercon XT/ML (Dentsply Sirona, Germany) (3rd generation), and group 4:[CC-4Y] Cercon HT/ML (Dentsply Sirona, Germany) (4th generation)]. The L*a*b* figures were measured by using a spectrophotometer at baseline and after 10,000, 30,000, and 50,000 cycles of thermocycling. At each interval, the translucency of the samples was estimated by using the translucency formula CIEDE2000. The Scheffe post-hoc compared differences among each of the four materials. The Repeated measures ANOVA tested the differences between the materials at each of the different thermocycling intervals (p < .001). Data analyses were evaluated at a significance level of p < .05 (CI 95%).

RESULTS

Two-way ANOVA revealed that at baseline the third and fourth generation's zirconia showed statistically significant differences in translucency (P < .001). Translucency values at baseline and after thermocycling exhibited statistically significant changes (p = .003). At each of the time interval; CM-4Y had the highest translucency values followed by CM-5Y, CC-4Y and CC-5Y had the least translucency values.

CONCLUSIONS

The third and fourth generations of zirconia displayed different translucencies. Thermocycling affected the translucency of both third and fourth generations of zirconia. At each of the time intervals group 2:[CM-4Y] had the highest TP followed by group1:[CM-5Y], while, group 3:[CC-5Y] and group 4:[CC-4Y] had the least TP.

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.

Effect of low-temperature degradation and sintering protocols on the color of monolithic zirconia crowns with different yttria contents

This study investigated the effects of low-temperature degradation (LTD) on the L*, a*, and b* values of highly translucent zirconia crowns. Four types of zirconia disks with different yttria contents (IPS e.max ZirCAD LT, IPS e.max ZirCAD MT, IPS e.max ZirCAD MT Multi, IPS e.max ZirCAD Prime, Ivoclar) and two shades (A2 and BL) were used. A crown was manufactured using four types of zirconia and LTD treated. Color measurements were performed, and the color difference (ΔE00) before and after LTD was calculated. The microstructure was determined through X-ray fluorescence and X-ray diffractometry. Highly translucent zirconia crowns showed greater changes in the a* and b* values than in the L* value after LTD, regardless of the shade. The Multi2 crowns exhibited a discernible color change due to the LTD treatment. The X-ray fluorescence results did not reveal any apparent change in the microstructure between sintering programs for all zirconia specimens.

Microshear bond strength of resin cement to glass-ceramics after intaglio surface staining

STATEMENT OF PROBLEM

Applying stains to the intaglio surface of computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic ceramic restorations has been proposed as an option to help mask darkened substrates. However, little is known about the effects of this procedure on the adhesion between the resin cement and the ceramic.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of intaglio surface staining on the microshear bond strength between 2 CAD-CAM ceramics and a resin cement.

MATERIAL AND METHODS

Lithium disilicate (Gmax) and leucite-reinforced (Gpress) ceramic blocks were sectioned, crystalized when indicated, and polished. They received either none, 1, or 2 layers of ceramic stains and a glaze liquid mixture followed by a firing cycle. The surfaces of groups Gmax0, Gmax1, and Gmax2 were etched with 9% hydrofluoric acid etching (HF) for 20 seconds, and those of groups Gpress0 and Gpress1 were etched for 60 seconds. After rinsing and drying, a ceramic primer was applied and air-dried. Resin cement rods (n=24 per group) were built from a silicone mold. Specimens were stored in distilled water for 24 hours before microshear bond testing. Failure mode was observed under a digital microscope. Data were analyzed by using the Kruskal-Wallis and Mann-Whitney nonparametric tests (α=.05).

RESULTS

Intaglio staining negatively affected the microshear bond strength for both ceramics. A significant difference was observed between Gmax1 (3.5 ±1.73 MPa) and Gmax2 (3.7 ±2.1 MPa) when compared with Gmax0 (14.2 ±4.4 MPa) and also between GPress0 (25.7 ±5.1 MPa) and Gpress1 (1.8 ±2.7 MPa). No difference was observed between 1 and 2 stain layers for Gmax. Most failures were adhesive for Gmax0, mixed for Gpress, and cohesive within the stain layer for experimental groups.

CONCLUSIONS

Intaglio surface staining with a stain and glaze mixture caused a significant reduction in bond strength between resin cement and both ceramics tested.

Effect of mouth rinses on the stainability of monolithic lithium disilicate glass-ceramics with different surface treatments: An in vitro study

STATEMENT OF PROBLEM

Mouth rinses have been reported to cause tooth surface discoloration. However, information regarding their effect on the stainability of monolithic glass-ceramics with different surface treatments is lacking.

PURPOSE

The purpose of this in vitro study was to assess the effect of mouth rinses on the color change of milled and pressed monolithic lithium disilicate glass-ceramics with different surface treatments.

MATERIAL AND METHODS

Fifty-six Ø12×1.5-mm disk specimens were fabricated using 2 different processing techniques: milling and pressing. Each group was subdivided into 2 subgroups according to surface treatments: glazed and polished. Specimens were then immersed in 2 different types of mouth rinse (n=7): chlorhexidine (CHX) and Listerine (LST). Color parameters were assessed using a digital spectrophotometer. Color difference (ΔE00) was calculated and compared with perceptibility (ΔE00=0.8) and acceptability (ΔE00=1.8) thresholds. The data were analyzed using ANOVA and Tukey post hoc tests (α=.05).

RESULTS

The color difference (ΔE00) was significantly affected by the type of processing technique, surface treatment, and mouth rinse (P<.001) and their interaction (P=.008). All ΔE00 values were below the selected clinical acceptability threshold (ΔE00=1.8). Milled groups (ΔE00=1.13) showed greater discoloration than pressed groups (ΔE00=0.86). Glazed specimens (ΔE00=0.70) were more resistant to discoloration than polished specimens (ΔE00=1.28) and immersion in CHX (ΔE00=1.09) led to more discoloration than immersion in LST (ΔE00=0.89).

CONCLUSIONS

The color of milled and pressed monolithic lithium disilicate glass-ceramics with different surface treatments was affected by using CHX and LST mouth rinses. Glazed lithium disilicate glass-ceramics showed less staining compared with those that were polished. Specimens immersed in CHX showed more discoloration than those immersed in LST.

A 3-year controlled clinical trial comparing high-translucency zirconia (cubic zirconia) with lithium disilicate glass ceramic (e.max)

INTRODUCTION

The rate of clinical success in veneers, under esthetics, has achieved a range of 18 months to 20 years. In a plethora of studies, it registers a success rate reaching 75% and even 100%. The most common type of glass ceramics used in ceramics is the vitreous lithium disilicate crystal-reinforced material, e.max®. Recent studies focus on "polycrystalline ceramic use" in manufacturing veneers, as it possesses a stronger structure and different enabling manufacturing schemes.

OBJECTIVES

This research aims at comparing e.max and the high-translucent Cubic Zirconia. Such comparison is administered to veneers manufacturing: esthetic (surface and edge, and staining and color matching), functional (crack and fracture, contact point, and patient satisfaction), and biological (posttreatment vitality and hypersensitivity, and periodontal response).

MATERIALS AND METHODS

The research sample consisted of 60 veneers, divided into two groups: cubic zirconia and e.max. The sample included 2 males (16.6%) and 10 females (83.3%), with age ranging from 25 to 37 years. Patients were thoroughly diagnosed and treated and included in this study based on certain inclusion-exclusion criteria. Hickel's 2010 criteria were utilized to examine and observe the clinical aspect of veneers during intervals of 1 week, 3 months, 1 year, and 3 years.

RESULTS

No significant differences were traced across the groups for all the variables, with a p-value being greater than 0.05. The e.max group revealed better clinical results compared to the cubic zirconia one regarding esthetics and tooth translucency. Nonetheless, the results showed a merely slight increase in hypersensitivity in the e.max group.

CONCLUSION

Within the limitation of an extensive follow-up period, we can conclude that there is no difference between cubic zirconia and e.max (p > 0.05), where e.max and cubic zirconia veneers have the same characteristics in terms of the following. The characteristics of the aspects examined were esthetic, functional, and biological.

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.

An investigation on fatigue, fracture resistance, and color properties of aesthetic CAD/CAM monolithic ceramics

OBJECTIVES

To evaluate and compare fracture resistance, translucency, and color reproducibility, as well as the effect of aging on the fracture load and color stability of novel monolithic CAD/CAM ceramics.

MATERIALS AND METHODS

One hundred crowns of uniform thickness were milled from five ceramic blocks (n = 20): partially crystallized lithium disilicate (PLD) and fully crystallized lithium disilicate (FLD), lithium metasilicate (LMS), 4Y-TZP (SMZ), and 5Y-TZP (UMZ) monolithic zirconia. PLD crowns were glazed, LMS was fired, and FLD was polished. SMZ and UMZ crowns were sintered and polished. Crowns were adhesively cemented to epoxy dies. Half of the crowns (n = 10) were subjected to 1.200.000 load cycles with thermal cycling. Color space values L, a, b defined by the Commission Internationale de l´Eclairage (CIELAB) were measured before and after aging, and (∆E) was calculated. Both aged and non-aged specimens were loaded until fracture in a universal testing machine and the fracture load was recorded. X-ray diffraction (XRD) and scanning electron microscope (SEM) fractographic analysis were carried out on fractured fragments of representative samples. For translucency and color reproducibility, 50 rectangular-shaped specimens were fabricated and processed as described previously. Color values were measured over black and white backgrounds, and the translucency parameter (TP) was computed. Using the shade verification mode, (∆E) to shade A3 was calculated. Data were statistically analyzed using one-way and two-way ANOVA, and t-test.

RESULTS

Aging did not affect fracture resistance significantly (p > 0.05). The highest mean fracture load was obtained for the SMZ and UMZ. A significant color change was observed after aging in all groups. The highest TP was noted for FLD. SMZ and UMZ had the best shade match.

CONCLUSIONS

Zirconia showed higher fracture resistance and color stability than lithium silicate ceramics. Lithium silicate ceramics were more translucent. The experimental FLD demonstrated high translucency.

CLINICAL RELEVANCE

Tested ceramics showed sufficient stability to withstand masticatory forces. Characterization of final restorations might be mandatory for better color match.

Effect of Simulated Mastication on Structural Stability of Prosthetic Zirconia Material after Thermocycling Aging

Recent trends to improve the aesthetic properties-tooth-like color and translucency-of ceramic dental crowns have led to the development of yttria-stabilized zirconia (Y-TZP) materials with higher stabilizer content. These 5Y-TZP materials contain more cubic or t' phase, which boosts translucency. The tradeoff as a consequence of a less transformable tetragonal phase is a significant reduction of strength and toughness compared to the standard 3Y-TZP composition. This study aims at determining the durability of such 5Y-TZP crowns under lab conditions simulating the conditions in the oral cavity during mastication and consumption of different nutrients. The test included up to 10,000 thermal cycles from 5 °C to 55 °C "from ice cream to coffee" and a chewing simulation representing 5 years of use applying typical loads. The investigation of the stress-affected zone at the surface indicates only a very moderate phase transformation from tetragonal to monoclinic after different varieties of testing cycles. The surface showed no indication of crack formation after testing. It can, therefore, be assumed that over the simulated period, dental crowns of 5Y-TZP are not prone to fatigue failure.

Effect of thickness of externally characterized stains on optical properties of high-translucency zirconia

OBJECTIVES

There is insufficient information about the effects of the thickness of externally characterized stains or glazes on CIELAB color parameters and the translucency parameter (TP) of 5 mol% yttria partially stabilized zirconia (5Y-PSZ). The present study evaluated the effect of a thickness reduction of the externally characterized or glazed layer on its CIE2000 color parameters and TP₀₀ of 5Y-PSZ.

MATERIALS AND METHODS

Twenty-eight specimens were sectioned from 5Y-PSZ blanks. Three brands of powdered stains (namely VI, SH, and IV) and a glaze (GL) were used to extrinsically stain the specimen surfaces (n = 7 per group). After measuring the final thickness and color, specimens of each group were carefully ground and finally polished. The reduced thickness was carefully controlled in decrements of 0.02 mm on the characterized stains or glazed layers at each reduction cycle until the surface of the un-stained zirconia was exposed. The CIELAB color parameters of specimens were measured using a spectrophotometer. Subsequently, differences in lightness (∆L'), chroma (∆C'), and hue (∆H'), and TP₀₀ values and color differences (ΔE₀₀) were calculated using the CIEDE2000 formula to determine differences between the specimen and the un-stained zirconia at each reduction cycle. A paired-samples t-test, two-way mixed-design analysis of variance, and Pearson correlation coefficient were used to analyze the data (α = 0.05).

RESULTS

There were no significant differences in lightness, chroma, hue, or TP₀₀ values before or after glazing or after each reduction cycle of the glazed layer. Mean ΔE₀₀ values ranged between 20.94 and 33.55 after applying the externally characterized stains. With a decreased thickness of the characterized stain layer, there were observed that significant decreases in ∆L', ∆H', ∆C', and ΔE₀₀, and significant increases in TP₀₀.

CONCLUSIONS

Increasing the thickness of externally characterized stains decreased the lightness and caused the alternation of chroma and hue, whereas these phenomena were not observed in the glazed group. There was a slight change of CIE2000 color parameters and TP₀₀ when the thickness of the characterized layer exceeded 0.06 mm.

CLINICAL RELEVANCE

The application and thickness of externally characterized stains can sensitively affect CIE2000 color parameters and translucency of 5Y-PSZ.

Using artificial intelligence to predict the final color of leucite-reinforced ceramic restorations

OBJECTIVES

The aim of this study was to evaluate the accuracy of machine learning regression models in predicting the final color of leucite-reinforced glass CAD/CAM ceramic veneer restorations based on substrate shade, ceramic shade, thickness and translucency.

METHODS

Leucite-reinforced glass ceramics in four different shades were sectioned in thicknesses of 0.3, 0.5, 0.7, and 1.2 mm. The CIELab coordinates of each specimen were obtained over four different backgrounds (black, white, A1, and A3) interposed with an experimental translucent resin cement using a calibrated spectrophotometer. The color change (CIEDE2000) values, as well as all the CIELab values for each one of the experimental groups, were submitted to 28 different regression models. Each regression model was adjusted according to the weights of each dependent variable to achieve the best-fitting model.

RESULTS

Different substrates, ceramic shades, and thicknesses influenced the L, a, and b of the final restoration. Of all variables, the substrate influenced the final ceramic shade most, followed by the ceramic thickness and the L, a, and b of the ceramic. The decision tree regression model had the lowest mean absolute error and highest accuracy to predict the shade of the ceramic restoration according to the substrate shade, ceramic shade and thickness.

CLINICAL SIGNIFICANCE

The machine learning regression model developed in the study can help clinicians predict the final color of the ceramic veneers made with leucite-reinforced glass CAD/CAM ceramic HT and LT when cemented with translucent cements, based on the color of the substrate and ceramic thicknesses.

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.

Flexural strengths, failure load, and hardness of glass-ceramics for dental applications

STATEMENT OF PROBLEM

Glass-ceramics are often selected for use in dental restorations based upon advertised flexural strengths obtained from standardized tests on prefabricated specimens (bars and disks); these may not accurately reflect their performance in dental applications.

PURPOSE

The purpose of this in vitro study was to determine and compare 4-point flexural strength, biaxial flexural strength, hardness, and crown failure loads for 3 commercially available glass-ceramics.

MATERIAL AND METHODS

Specimens were pressed and prepared from 3 brands of glass-ceramics: Celtra (CEL), IPS e.max (EMA), and Lisi (LIS). Rectangular bars, circular disks, and fully contoured crowns were created (n=15 specimens per glass-ceramic, 45 specimens per geometry, totaling 135 specimens). Disks were tested for biaxial flexural strength by using a piston-on-3-ball (POB) test, while bars were tested for 4-point flexural strength by using 4-point bending (4PB) and Vickers hardness (VH) tests. Crown failure loads were assessed in "crunch-the-crown" (CTC) tests. The results were analyzed by using general linear modeling, the Pearson correlation coefficient, and Weibull analysis.

RESULTS

The general linear modeling revealed significant differences (P<.05) in the failure load for crown specimens (EMA>LIS>CEL), the 4-point flexural strength (EMA>LIS>CEL), and the biaxial flexural strength (EMA>LIS=CEL). The disk specimens had higher flexural strengths than the bar specimens for CEL and EMA materials. LIS had a higher Weibull modulus than EMA and CEL for bar and crown specimens. CEL had a higher Weibull modulus than LIS and EMA for disk specimens. There was no correlation among the VH (R²=0.86 and P=.24), biaxial flexural strength (R²=0.84 and P=.26), and crown failure load. However, there was a high correlation between the failure load (crown specimens) and 4-point flexural strength (bar specimens) (R²=0.99 and P=.03).

CONCLUSIONS

The 4-point flexural strength correlated significantly with crown failure load.

Color change of glass ceramic restorations cemented by four types of dual-cured resin luting agents with different initiator systems

This study aimed to comprehensively evaluate the effect of dual-cured resin luting agents with different initiator systems on the color stability of glass ceramic restorations by simulating various clinical glass ceramic restorations. Three commonly used shades from each of the two dual-cured resin luting agents with an amine-initiation system or without it were studied. The individual specimens had different translucency and thickness and were artificially aged using a xenon light aging machine. The color was measured before and after aging using a digital spectrophotometer with the difference calculated and analyzed statistically. As results, the amine-free dual-cured resin luting agents were more color stable than those using amine-initiation systems for both uncovered and bonding groups. The translucency and thickness of the ceramic, and shade and type of the resin luting agent significantly affected the color stability of glass ceramic restorations.

Effects of surface treatment and shade on the color, translucency, and surface roughness of high-translucency self-glazed zirconia materials

STATEMENT OF PROBLEM

The impact of different surface treatments and shades on the color, translucency, and surface roughness of high-translucency self-glazed zirconia materials is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the effects of different external surface treatments (self-glazed, milled, polished, and glazed), intaglio surface treatments (milled and airborne-particle abraded), and shades (A1 and A3 shades) on the color, translucency, and surface roughness of high-translucency self-glazed zirconia materials, as well as the correlations among optical parameters, translucency, and surface roughness.

MATERIAL AND METHODS

Eighty shade A1 and 80 shade A3 disks were fabricated with a thickness of 0.80 ±0.02 mm and divided into 16 groups (n=10). Different external and intaglio surface treatments were applied to the specimens. CIELab values were measured with a spectrophotometer, and color differences (ΔE₀₀) and relative translucency parameter (RTP) were calculated. Total transmittance (Tt%) and reflectance (R%) were tested with a spectrophotometer equipped with an integrating sphere. Surface roughness (Ra and Rz) (μm) was measured with a noncontact 3-dimensional laser scanning microscope. One specimen from each group was subjected to scanning electron microscope (SEM) examination. Data were analyzed with ANOVA and the Tukey post hoc test. The correlation among optical parameters, translucency, and surface roughness was investigated by using Pearson correlation analysis (α=.05).

RESULTS

The effects of external surface treatments, intaglio airborne-particle abrasion, and shades on ΔE₀₀, RTP, and Ra values of the disks were significantly different (P<.001). The smoothest external polishing surface had the greatest RTP and color difference (P<.001). Shade A3 disks had lower RTP and Tt% values than shade A1 disks (P<.001). ΔE₀₀ had a highly positive relationship with the RTP (A1: r=0.884, P<.001; A3: r=0.859, P<.001). SEM images demonstrated that surface treatments affected the surface texture of monolithic zirconia ceramics.

CONCLUSIONS

Different surface treatments affected the surface roughness, translucency, and final color of zirconia materials. The smoothest external polishing surface had the greatest RTP and color difference. Different shades influenced the translucency, as the darker the disk shade, the lower the translucency. The RTP was appropriate as an auxiliary indicator for evaluating the color of a dental ceramic.

Effect of artificial aging on the translucency of monolithic zirconia materials sintered at different temperatures

STATEMENT OF PROBLEM

Translucent zirconia materials were developed as an alternative to lithium disilicate materials. However, the effect of sintering temperature and artificial aging on the translucency of zirconia materials is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the translucency of recently developed zirconia materials after different sintering temperatures and the effect of artificial aging.

MATERIAL AND METHODS

Disk-shaped specimens (Ø15×1 mm) of 3 different monolithic zirconias (Katana UTML, Prettau Anterior, VITA YZ XT) and a control lithium disilicate reinforced glass ceramic (IPS e.max CAD LT) were evaluated. The zirconia specimens were divided into 2 subgroups with different sintering temperatures (1450 °C, 1550 °C) (n=5, N=35). The specimens were artificially aged in a thermocycle tester and a mastication simulator. The translucency parameter (TP) was calculated by measuring with a spectrophotometer. Kruskal-Wallis and Wilcoxon signed-rank tests were used to analyze the data (α=.05).

RESULTS

While the overall TP of monolithic zirconia increased after artificial aging, the lithium disilicate specimens did not show a statistically significant difference (P=.35). The Prettau Anterior and VITA YZ XT specimens had a statistically significant higher TP than Katana UTML (P=.009). Sintering temperature did not have a statistically significant effect on the TP value of monolithic zirconia materials (P>.05).

CONCLUSIONS

Artificial aging increased the TP, and the sintering temperature did not affect the TP of monolithic zirconia. The use of fully stabilized zirconia may be an alternative to lithium disilicate in esthetic restorations in clinical practice.

Effect of toothbrushing on the optical properties and surface roughness of extrinsically stained high-translucency zirconia

OBJECTIVES

The effect of toothbrushing on the color, relative translucency, and surface roughness of extrinsically stained zirconia dental restorations is still unclear. The purpose of the present study was to evaluate the optical properties and surface textures of extrinsically stained or glazed partially stabilized zirconia with 5 mol% yttria (5Y-PSZ) after toothbrushing by determining changes in the color, translucency parameter (TP), and surface roughness.

MATERIALS AND METHODS

Specimens (2 mm thick; n = 50) were sectioned from 5Y-PSZ blanks. Three brands of powdered stains (namely VI, SH, IV) and a glaze (GL) were used to extrinsically stain the specimen surfaces (n = 10 per group). The specimens were subjected to 10,000-50,000 simulated toothbrushing strokes using a toothpaste slurry (Ora2 PREMIUM Stain clear paste). The color parameters were measured before staining or glazing and before and after simulated brushing. The color changes and TP values can be calculated before and after simulated brushing. The surface roughness was also evaluated.

RESULTS

Significant changes were found in the shade and TP values of 5Y-PSZ after extrinsic staining, but no significant changes were found after toothbrushing, irrespective of the staining brand (p > 0.05). The surface roughness of the characterized 5Y-PSZ specimens decreased after toothbrushing, whereas that of the non-characterized 5Y-PSZ group increased.

CONCLUSIONS

Toothbrushing markedly affects the surface roughness of extrinsically stained or glazed 5Y-PSZ specimens, whereas no impacts on the color or translucency were observed.

CLINICAL RELEVANCE

For esthetic reasons, clinicians and dental technicians prefer to apply extrinsic stains to zirconia restorations, which profoundly affects its appearance. The limited influence of toothbrushing on color and translucency of 5Y-PSZ is promising for clinical applications.

The Effect of Translucency and Surface Treatment on the Flexural Strength of Aged Monolithic Zirconia

Aims

This in vitro study aimed to evaluate the effect of the degrees of translucency in different types of monolithic zirconia as well as the aging and surface treatment with airborne particle abrasion on the flexural strength of monolithic zirconia.

Materials and Methods

Sixty bar-shaped specimens were fabricated from three different types of presintered monolithic zirconia (n = 20 per group) including low translucent (LT) (DD Bio ZW iso, high strength zirconia, Dental Direkt, Germany), high translucent (HT) (DD Bio ZX² 98, high translucent zirconia, Dental Direkt, Germany), and multilayered system (ML) (DD cubeX2®ML, multilayer, cubic zirconia system, Dental Direkt, Germany). Each monolithic zirconia group was equally subdivided according to be either air-abraded with 110 µm aluminium oxide particles or left untreated (control). After thermocycling, the flexural strength was measured by using a universal testing machine. Two-way ANOVA followed by Tukey's post hoc and independent samples t-test were used for the statistical analyses (P < 0.05).

Results

Surface treatment and types of zirconia were found to have a significant interaction (P = 0.010). Having controlled the effect of surface treatment, the flexural strength of HT and LT zirconia was found to be significantly higher than the ML zirconia system (P ≤ 0.001). Airborne particle abrasion could significantly decrease the flexural strength of monolithic zirconia only in ML zirconia (P = 0.002).

Conclusions

Multilayered zirconia system had the lowest flexural strength among all groups. Moreover, the flexural strength of this system was attenuated by surface treatment with airborne particles abrasion.

The effect of thermocyclic aging on color stability of high translucency monolithic lithium disilicate and zirconia ceramics luted with different resin cements: an in vitro study

Background

High-translucency monolithic zirconia were developed to combine the esthetics of all ceramic restorations with the strength properties of zirconia. The purpose of this study was to compare the color stability of high-translucency monolithic zirconia ceramics with lithium disilicate luted using light-cure versus dual-cure resin cements following thermocyclic aging.

Methods

Forty specimens, each composed of 10 × 10 × 1 mm ceramic slice luted to dentin surface of an extracted tooth, were prepared and assigned into four groups (n = 10) as follows; LiDi/LC: lithium disilicate luted by light-cure resin cement; LiDi/DC: lithium disilicate luted by dual-cure resin cement; Zr/LC: zirconia luted by light-cure resin cement; and Zr/DC: zirconia luted by dual-cure resin cement. Color analysis of the specimens was performed before and after 3000 thermal cycles by means of spectrophotometry. The CIE L*a*b* values of the specimens were measured, and data were analyzed statistically at a significance value of p < 0.05.

Results

Thermocycling resulted in a significant change in color coordinates of specimens with an overall ΔE = 3.59 ± 1.60, but there was no statistically significant difference in the color change value among all tested groups (P = 0.756).

Conclusions

At 1 mm restoration thickness, the color stability of high-translucency monolithic lithium disilicate and zirconia ceramics were not significantly different irrespective of the cement type used.

Clinical implication Understanding the difference in color stability of dental ceramics may help in determining long-term esthetic result.

Effect of tooth brush abrasion on the color, gloss and surface roughness of internally and externally stained monolithic ceramic materials

PURPOSE

To measure the durability of the color, change in surface roughness and gloss of stained monolithic ceramic materials subjected to artificial tooth brush abrasion.

MATERIALS AND METHODS

Standardized specimens were manufactured from pressable lithium-disilicate glass ceramic (PC; IPS e.max Press), machinable lithium-disilicate glass ceramic (MC; IPS e.max CAD), and zirconia (ZR; Zenostar). Ceramic staining was applied before (internal; in) and after crystallization/sintering (external; ex). Of each ceramic material, specimens without staining were prepared (no staining; no). Porcelain-fused-to-metal specimens served as control (PFM). Each group consisted of 15 specimens. Tooth brushing was simulated with tooth brushing strokes of 21.6 k, 43.2 k, and 64.8 k. Color, gloss and roughness were measured at baseline and after cycle intervals. Kruskal-Wallis and paired Post-hoc Conover tests were applied to detect statistical differences between treatment groups. Differences before and after aging were calculated by Wilcoxon signed rank test (α=0.05).

RESULTS

In all groups, color difference (∆E) was statistically significant after aging: no-PC (P<.001, 95% CI[0.14,0.84]), no-MC (P=.003, 95% CI[0.23,1.12]), no-ZR (P=.003, 95% CI [0.33,0.62]), in-MC (P=.003, 95% CI[0.35,0.73]), in-ZR (P=.003, 95% CI[0.09,0.32]), ex-PC (P=.003, 95% CI[0.54,0.98]), ex-MC (P<.001, 95% CI[0.23,1.26]), ex-ZR (P=.003, 95% CI[0.27,0.55]), and PFM (P=.002, 95% CI[0.22,0.34]). Aging increased surface roughness and decreased the gloss within all subgroups showing statistical significance.

CONCLUSIONS

Color, gloss and roughness of stained monolithic ceramic materials changed significantly by means of tooth brush abrasion in vitro. Color changes were below the threshold value for the detection by the human eye (∆E 1.8).

Effect of Aging on the Microstructure and Optical Properties of Translucent ZrO 2 Ceramics

Objectives

The development and placement of translucent zirconia ceramics on the dental materials market is in full swing. This research aimed to investigate how aging protocols affect the microstructure, color parameters and translucency of a new-generation monolithic zirconia ceramic.

Material and methods

Translucent zirconia ceramics KATANA-Zirconia STML with different surface treatments (as sintered - control, glazed, polished) was tested using two aging protocols (hydrothermal degradation in autoclave at 134 °C and 2 bars for three hours, chemical degradation in four-percent acetic acid at 80 °C for 16 hours) in order to examine phase composition using X-ray diffraction analysis and ΔE, ΔL and ΔC color parameters through spectrophotometry. The translucency parameter (TP) was calculated using parameters L*, a* and b* on a black and white surface.

Results

Regardless of the surface treatment, aging protocols did not cause a tetragonal-to-monoclinic phase transformation, although hydrothermal degradation in the autoclave transformed the hybrid tetragonal-cubic structure of all specimens to a tetragonal one. All polished and glazed specimens during chemical degradation demonstrated a significant color change ΔE. Lightness ΔL significantly changed in polished specimens aged in the autoclave. In all specimens, ΔC underwent a change manifested through statistically insignificant yellowing. None of the aging protocols altered the translucency of specimens.

Conclusions

Aging, regardless of the final surface treatment, did not manifest a monoclinic phase in the specimens. A tetragonal-cubic microstructure dominates. Unlike polishing, glazing the surface of translucent zirconia ceramics contributed to minor changes in color, lightness and chromaticity. The translucency of translucent zirconia ceramics remains stable regardless of aging and surface treatment.

Effect of Staining and Aging on Translucency Parameter of CAD-CAM Materials

Objectives

To evaluate different intervals of exposure to staining solutions and artificial aging on translucency parameter (TP₀₀) of CAD-CAM materials.

Material and Methods

One millimeter thick square-shaped specimens (N = 288) were cut from Cerasmart (CS), IPS e.max (IE), Lava Ultimate (LU), Shofu HC (SH), Vita Enamic (VE), and Vita Suprinity (VS) and were divided into laboratory and chairside polishing. Reflection wavelength spectra, CIE D65 standard illuminant, 2 ° standard observer, SCI, UV included, SAV aperture, 6 mm diameter, were recorded at 10 nm sensitivity against white and black calibration tiles using a benchtop spectrophotometer. Subsequently, they were converted into CIEDE 2000 TP₀₀. After baseline measurements (T0), the specimens were divided as follows (n = 8): staining in coffee (C) and wine (W), for 60 (T1) and 120 hours (T2), and accelerated artificial aging (A). Artificial aging (ISO 4892-2 standard) was performed in two cycles of 150 KJ/m², for T1 and T2, respectively. TP measurements were repeated at T1 and T2. Data of TP₀₀ retention were submitted to analysis of variance and Fisher’s PLSD multiple comparison test (α=0.05).

Results

Fisher’s PLSD critical differences among materials, time intervals and staining/aging were 0.16, 0.11 and 0.11, respectively. SH showed the highest TP₀₀ followed by LU > CS > IE = VS > VE. For all time intervals, the lowest TP₀₀ retention was observed with C. W, and A presented similar values.

Conclusions

Translucency Parameter was a time and staining/aging-dependent material. In majority of cases, it decreased upon staining/aging.

Effect of surface finishing and polishing procedures on color properties and translucency of monolithic zirconia restorations at varying thickness

OBJECTIVE

This study aimed to assess the impact of monolithic zirconia thickness on its color properties after different surface finishing and polishing procedures, and following aging in coffee solution.

MATERIALS AND METHODS

Two types of monolithic zirconia brands [Prettau Anterior (PA) and DD Cubex2 (DDC)] with three different thicknesses: 0.5, 1, and 1.5, and 10 mm diameter were tested. The color properties were evaluated after various surface finishing procedures (glazing, adjusting with burs + glaze, polishing, adjusting with burs + polishing) and after 5,000 cycles in a coffee solution were evaluated. The differences in color (ΔE) and translucency, were calculated and statistically analyzed by three-way ANOVA and pairwise comparison (α = 0.05).

RESULTS

The brand, material thickness, and surface finishing protocol before and after coffee thermocycling had significant effect on color variations (p < 0.001). For translucency, 3-way ANOVA revealed a significant interaction between the material thickness and surface finishing protocol following aging in coffee solution (p < 0.001), however no significant interaction was observed following the surface finishing protocols (p = 0.247).

CONCLUSIONS

The optical properties of monolithic zirconia ceramics can be influenced by the material brand, material thickness and the procedure of surface finishing and polishing.

CLINICAL SIGNIFICANCE

Clinicians should take into consideration the potential change of the color properties of monolithic zirconia restorations following both contouring and occlusal adjustment procedures and coffee intake.

How will surface conditioning methods influence the translucency and color properties of CAD-CAM resin-matrix ceramics with different thicknesses?

OBJECTIVE

It was aimed to evaluate the effect of various surface-conditioning methods on the translucency and color properties of resin-matrix ceramics (RMCs) with different types and thicknesses.

MATERIALS AND METHODS

Rectangle-shaped RMCs were prepared from Voco Grandio, Brilliant Crios, Lava Ultimate, GC Cerasmart, and Vita Enamic blocks at 0.5 and 1.0 mm thicknesses. Specimens were divided into four groups: control, airborne-particle abrasion (APA), 2 and 3 W Er, Cr:YSGG laser irradiations (L^2W , L^3W ) (n = 15). The color values of specimens were recorded before and after surface-conditioning using a spectrophotometer. The translucency parameter (RTP₀₀ ) and color difference (ΔE₀₀ ) values were calculated. Data were statistically analyzed using three-way ANOVA and Tukey post hoc tests.

RESULTS

The translucencies of RMCs decreased after all surface-conditioning procedures. L caused more decline in translucency of materials than APA. All ΔE₀₀ values were under the acceptability threshold except for APA-applied Voco Grandio at 0.5 mm. Differences in ΔE₀₀ values between APA and L^3W groups were significant (P˂0.05); while differences between L^2W and L^3W groups were insignificant (P > .05). In all experimental groups, ΔE₀₀ values decreased with increasing thickness of RMCs.

CONCLUSIONS

L and APA significantly affected the translucency and color properties of RMCs. APA was found more favorable than L.

CLINICAL SIGNIFICANCE

Clinicians should carefully use surface conditioning methods, considering their impact on the optical characteristics of RMCs, especially when the restoration is thin.

Aging resistant ZTA composite for dental applications: Microstructural, optical and mechanical characterization

OBJECTIVE

To synthesize a zirconia toughened alumina (ZTA) composite with 70% alumina reinforced by 30% zirconia for dental applications and to characterize its microstructure and optical properties for comparison with the isolated counterpart materials and a first-generation 3Y-TZP.

METHODS

Disc-shaped specimens were divided in four groups (n = 70/material): (1) 3YSB-E (first generation 3Y-TZP), (2) Zpex (second generation 3Y-TZP), (3) alumina, and (4) ZTA-Zpex 70/30. After synthesis, ceramic powders were pressed, and green-body samples sintered following a predetermined protocol. Specimens were polished to obtain a mirror surface finish. Apparent density was measured by Archimedes principle. X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to characterize the crystalline content and microstructure. Reflectance tests were performed to determine the contrast-ratio (CR) and translucency-parameter (TP). Mechanical properties were assessed by biaxial flexural strength (BFS) test. All analyses were conducted before and after artificial aging (20 h, 134 °C, 2.2 bar). Optical parameters were evaluated through repeated-measures analysis of variance and Tukey tests (p < 0.05). BFS data were analyzed using Weibull statistics (95% CI).

RESULTS

High density values (95-99%) were found for all ceramic materials and SEM images exhibited a dense microstructure. While XRD patterns revealed the preservation of crystalline content in the ZTA composite, an increase in the monoclinic peak was observed for pure zirconias after aging. Significantly higher CR and lower TP values were observed for the ZTA composite, followed by alumina, 3YSB-E, and Zpex. The highest characteristic stress was recorded for 3YSB-E, followed by intermediate values between ZTA and Zpex, and the lowest for alumina. Aging affected the optical and mechanical properties of both zirconias, while remained stable for ZTA composite and alumina.

SIGNIFICANCE

The synthesis of experimental 70-30% ZTA composite was successful and its relevance for dental applications relies on its higher masking ability, aging resistance, and strength similar to zirconia.

Translucency of Monolithic Zirconia after Hydrothermal Aging: A Review of In Vitro Studies

PURPOSE

Recent modifications in composition, structure, and fabrication methods have led to monolithic zirconia ceramics of superior translucency. However, during aging, intrinsic microstructural features, such as grain boundaries and pores, may affect light scattering and consequently the translucency of zirconia. The aim of this study was to systematically review if hydrothermal aging affects the translucency of monolithic zirconia.

MATERIALS AND METHODS

An electronic search in Medline and Scopus was conducted to identify the effect of hydrothermal aging on the translucency of zirconia. The search was limited to English-language publications and in vitro studies. The following search terms were used alone or in combination: "monolithic zirconia," "full contour zirconia," "Y-TZP zirconia," "tetragonal zirconia," "cubic zirconia," "aging," "hydrothermal aging," "steam autoclave," "translucency," "translucency parameter," and "contrast ratio." From the titles found after searching the electronic databases, only 10 articles met the inclusion criteria and were included in this review. The translucency parameter or total transmittance was used to extract data from the studies.

RESULTS

Aging reduced the translucency of monolithic zirconia in most of the studies; however, the differences varied according to the brand tested and the microstructure and thickness of the specimens. The thinner specimens presented higher translucency alterations. Although in all studies a change in translucency was recorded, its mean values suggest that the differences are within the acceptability threshold in most cases, independent of the color system used to calculate translucent parameter, so they are clinically undetectable. For longer aging times, beyond the perspective clinical life of the restorations, the change in translucency is higher than the acceptability threshold.

CONCLUSIONS

There is a controversy regarding how aging affects the translucency of monolithic zirconia ceramics; however, this may not be clinically important, as in most cases, changes (either decrease or increase) in translucency were within the acceptability thresholds.

Alqahtani N, Alhassan Mujayri F. Effect of Hydrothermal Aging and Beverages on Color Stability of Lithium Disilicate and Zirconia Based Ceramics

Background and Objectives: All-ceramic prosthesis is widely used in modern dental practice because of its improved physico-mechanical and optical properties. These restorations are exposed to coloring agents from various nutrition and beverages in the oral cavity. Long-term color stability is critical for the success of these restorative materials. The purpose of this in vitro study was to assess the effect of common beverages and mouthwash on the color stability of lithium disilicate (LD), monolithic zirconia (MZ) and bilayer zirconia (BZ) surfaces. Materials and Method: Thirty disc-shaped specimens from each material were fabricated; each group was subdivided (n = 10) according to coffee, green tea and chlorhexidine immersion solutions. The baseline color of ceramic discs was recorded according to the CIE L*a*b* system with a portable spectrophotometer. The second measurement was recorded after 3000 thermocycling and immersion in coloring agents for 7 days. The mean color difference was calculated and data were compared with Kruskal-Wallis and Mann-Whitney post hoc tests (0.05). Results: ΔE values for LD with the immersion of coffee, tea, and Chlorhexidine gluconate (CHG) were 1.78, 2.241 and 1.58, respectively. Corresponding ΔE values for MZ were 5.60, 5.19, and 4.86; marginally higher than the clinically acceptable level of 3.5. Meanwhile, BZ showed better color stability compared to MZ with ΔE values of 4.22, 2.11 and 1.43. Conclusions: Among the ceramics evaluated, LD ceramic was found to be more color stable, while MZ ceramics displayed a higher susceptibility to discoloration. MZ and BZ ceramic colors were significantly altered with coffee immersion, while LD ceramics were more affected by green tea.

In Vitro Simulation and In Vivo Assessment of Tooth Wear: A Meta-Analysis of In Vitro and Clinical Research

Tooth wear may be described as a side-effect of occlusal forces that may be further induced by the common use of contemporary prosthetic materials in practice. The purpose of this systematic review was to appraise existing evidence on enamel wear from both in vitro and clinical research and explore whether evidence from these study designs lies on the same direction. Five databases of published and unpublished research were searched without limitations in August 2019 and study selection criteria included in vitro and clinical research on enamel tooth wear. Study selection, data extraction, and risk of bias assessment were done independently and in duplicate. Random effects meta-analyses of standardized mean differences (SMDs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were conducted while a Monte Carlo permutation test for meta-regression on the exploration of the effect of the study design on the reported outcomes was planned. A total of 27 studies (23 in vitro and 4 clinical) were eligible while 12 contributed to meta-analyses. Overall, some concerns were raised for the quality of the existing evidence and the potential for risk of bias. Enamel wear (mm) of antagonist teeth was more pronounced when opposed to conventional porcelain compared to machinable ceramics (SMD = 2.18; 95%CIs: 1.34, 3.02; p < 0.001). Polished zirconia resulted in decreased volumetric enamel wear (mm³) of opposing teeth compared to pure natural enamel (SMD = –1.06; 95%CIs: –1.73, –0.39; p = 0.002). Monolithic zirconia showed evidence of enhanced potential for antagonist wear (μm) compared to natural teeth (WMD = 107.38; 95%CIs: 30.46, 184.30; p = 0.01). Study design did not reveal an effect on the tooth wear outcome for the latter comparison when both clinical and in vitro studies were considered (three studies; Monte Carlo test, p = 0.66). In conclusion, there is an overriding need for additional evidence from clinical research to substantiate the findings from the already existing laboratory simulation studies.