Clinical efficacy of veneered zirconium dioxide-based posterior partial fixed dental prostheses: five-year results

Surface strain at the cervical area and fracture strength of flared root canals reinforced using a zirconia tube and glass-fiber post

Background/purpose

Recently, an effective core build-up system for teeth with flared root canals is needed. This research aimed to evaluate the effect of foundation restorations using a composite resin core with a fiber post reinforced with a zirconia tube for the surface strain at the cervical area and the fracture load of teeth with flared root canals.

Materials and methods

Bovine teeth were shaped to mimic human premolars with flared root canals and restored using three types of composite resin foundation restorations with each materials described below: a fiber post (FC), a zirconia tube (ZC), a fiber post and zirconia tube (ZFC). Each specimen was restored with a zirconia crown. The surface strains of the specimens at the cervical area and fracture loads were analyzed using a one-way analysis of variance (ANOVA), followed by Tukey's honest significant difference test.

Results

The surface strains of Groups ZFC and ZC were significantly lower than that of Group FC in the buccal root. The fracture strengths of Groups ZFC and ZC were significantly higher than that of Group FC. The strength of Group ZFC was significantly higher than that of Group ZC.

Conclusion

The use of a composite resin core with a zirconia tube for the simulated premolar with flared root canals reduced surface strain at the cervical area and provided higher fracture strength compared to using a composite resin core with a fiber post. And the zirconia tubes provided even higher fracture strength when used with a fiber post.

Effect of sintering speed, aging processes, and different surface treatments on the optical and surface properties of monolithic zirconia restorations

STATEMENT OF PROBLEM

Advances in dentistry have led to more esthetic and biocompatible restorative materials such as translucent zirconia and to faster and more accurate manufacturing methods. How changes in the surface and optical properties of translucent zirconia affect the esthetics and durability of these restorations under different conditions and manufacturing processes is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of the sintering speed, aging process, and different surface treatments on the translucency and surface structure of monolithic zirconia restorations.

MATERIAL AND METHODS

Prepared typodont teeth were scanned, and 40 three-unit fixed partial dentures (FPDs) and 40 disk specimens were designed and prepared from monolithic zirconia blanks. The specimens were divided into traditional or speed sintering groups (20 FPDs and 20 disks each); half of each group (10 FPDs and 10 disks) was polished with a handpiece at 10 000 rpm, and the other half was glazed. Half of the specimens were thermocycled with 3500 cycles in 5 °C and 55 °C water baths, and the remaining half were not thermocycled. Translucency was measured with a spectrophotometer. Surface free energy was calculated in mNm with a contact angle device; surface roughness was measured in nm with an atomic force microscope. Translucency data were analyzed by the Kruskal-Wallis and Mann-Whitney tests, while surface free energy and surface roughness data were analyzed by 3-way ANOVA (α=.05).

RESULTS

The highest transmittance was in the speed sintered, polished, nonthermocycled group, and the lowest transmittance was in the speed sintered, polished, thermocycled group (P=.029). The transmittance of the traditionally sintered, polished, nonthermocycled group was significantly higher than that in all the speed sintered, glazed groups; the traditionally sintered, glazed groups; and the traditionally sintered, polished, thermocycled group (P=.029). The transmittance of the traditionally sintered, polished, thermocycled group was significantly higher than that of all traditionally sintered, glazed groups (P=.029). The mean surface free energy in the traditionally sintered groups was higher than that in the speed sintered groups (P=.002); also, it was higher in the glazed groups than in the polished groups (P<.001). The aging process decreased surface free energy (P=.023). The mean surface roughness in the speed sintered groups was significantly lower than that in the traditionally sintered groups (P=.004). No significant difference in surface roughness was found between the polished and glazed groups and between the 2 variables of the aging process (P>.05).

CONCLUSIONS

Speed sintering and polishing may decrease the surface free energy and increase the translucency of the monolithic zirconia restoration. Also, speed sintering creates a smoother surface. Aging had a more significant effect on decreasing the surface free energy of the specimens and could make the least translucent restorations.

Clinical outcomes of tooth-supported monolithic zirconia vs. porcelain-veneered zirconia fixed dental prosthesis, with an additional focus on the cement type: a systematic review and meta-analysis

PURPOSE

To compare the failure rates and the prevalence of technical complications between full-coverage tooth-supported monolithic zirconia (MZ) and porcelain-veneered zirconia (PVZ) fixed dental prosthesis, based on a systematic literature review.

METHODS

An electronic search was performed in three databases, supplemented by hand searching. Several statistical methods were used.

RESULTS

Seventy-four publications reported 6370 restorations (4264 PVZ; 2106 MZ; 8200 abutment teeth; 3549 patients), followed up until 152 months. A total of 216 prostheses failed, and survival was statistically significant different between groups. PVZ had higher occurrence of complications than MZ; the difference was especially greater for either minor or major chipping. The difference in prevalence of either minor or major chipping was statistically significant for PVZ prostheses between cementation with glass ionomer and adhesive resin cement (higher), adhesive resin and resin-modified glass ionomer cement (RMGIC, higher), and between RMGIC (higher) and glass ionomer cement. For MZ the difference was significant only for minor chipping between RMGIC (higher) and adhesive resin cement. Abutment teeth to PVZ prostheses more often lost vitality. Decementation was not observed with RMGIC. Air abrasion did not seem to clinically decrease the decementation risk. The 5-year difference in the occurrence of minor or major chipping between MZ and PVZ prostheses was statistically significant, but nor for catastrophic fracture.

CONCLUSION

Tooth-supported PVZ prostheses present higher failure and complication rates than MZ prosthesis. The difference in complications is striking when it comes to chipping.

CLINICAL RELEVANCE

Awareness of the outcome differences between different types of zirconia prostheses is important for clinical practice.

Comparison of the clinical outcomes of resin-modified glass ionomer and self-adhesive resin cementations for full-coverage zirconia restorations

OBJECTIVES

Both resin-modified glass ionomer cement (RMGIC) and self-adhesive resin cement (SAC) may be suitable for cementation of full-coverage zirconia restorations. This retrospective study aimed to investigate the clinical outcomes of zirconia-based restorations cemented with RMGIC and compare them with those cemented with SAC.

METHODS

Cases of full-coverage zirconia-based restorations cemented with either RMGIC or SAC between March 2016 and February 2019 were evaluated in this study. The clinical outcomes of the restorations were analyzed according to the type of cement used. In addition, cumulative success and survival rates were evaluated according to the cement and abutment types. Non-inferiority, Kaplan-Meier, and Cox hazard tests were conducted (α=.05).

RESULTS

A total of 288 full-coverage zirconia-based restorations (natural teeth, 157; implant restorations, 131) were analyzed. Loss of retention occurred in only one case; a single-unit implant crown cemented with RMGIC, which decemented 4.25 years post-restoration. RMGIC was non-inferior to SAC in terms of loss of retention (<5%). For single-unit natural tooth restorations, the four-year success rates in the RMGIC and SAC groups were 100% and 95.65%, respectively (p=.122). For single-unit implant restorations, the four-year success rates in the RMGIC and SAC groups were 95.66% and 100%, respectively (p=.365). The hazard ratios of all the predictor variables, including cement type, were not significant (p>.05).

CONCLUSIONS

Cementation of full-coverage zirconia restorations of both natural teeth and implants using RMGIC and SAC yields satisfactory clinical outcomes. Furthermore, RMGIC is non-inferior to SAC in terms of cementation success.

CLINICAL SIGNIFICANCE

Cementation with RMGIC or SAC for full-coverage zirconia restorations has favorable clinical outcomes in both natural teeth and implants. Both RMGIC and SAC have advantages in the cementation of full-coverage zirconia restorations to abutments with favorable geometries.

Up to 10 years clinical performance of zirconia ceramic and metal-ceramic fixed partial dentures: A retrospective study

STATEMENT OF PROBLEM

Completely veneered zirconia ceramic (ZC) fixed partial dentures (FPDs) have been reported to have a higher incidence of ceramic chipping than the standard metal-ceramic FPDs. However, data from comparative long-term studies are sparse.

PURPOSE

The purpose of this retrospective study was to compare the long-term survival, chipping-free survival, and success of ceramic-veneered high noble metal alloy (HN), base metal alloy (cobalt-chromium alloy) (CC), and ZC FPDs and to isolate risk factors for the incidence of failure, veneer chipping, and overall complications.

MATERIAL AND METHODS

Data from 289 study participants (58.7% women; mean age, 57.97 ±11.51 years) provided with a total of 400 FPDs comprising 197 (49.3%) HN FPDs, 121 (30.3%) CC FPDs, and 82 (20.5%) ZC FPDs fabricated from presintered 3 mol% yttria-stabilized zirconia (mean time of service, 6.85 ±3.25 years) were evaluated. Of these, 278 (69.5%) FPDs were provided by dentists and 122 (30.5%) by dental students. Five- and 10-year survival, chipping-free survival, and success rates were calculated using the Kaplan-Meier method and compared with the log-rank test. Risk factors were assessed using Cox regression analysis. The study was exploratory, so all P values were considered exploratory and descriptive.

RESULTS

The 5- and 10-year survival rates were 94.7% and 77.8% for HN, 93.7% and 81.2% for CC, and 92.9% and 53.3% for ZC FPDs, respectively, indicating no clear difference in survival among the framework materials. The 5- and 10-year chipping-free rates were 94.1% and 82.8% for HN, 96.1% and 78.9% for CC, and 82.6% and 62.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The 5- and 10-year success rates were 83.7% and 55.3% for HN, 86.5% and 51.4% for CC, and 68.9% and 30.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The Cox regression model indicated framework material as an influencing risk factor for success, and this influence persisted when chipping was investigated. Compared with zirconia, the use of a metal alloy reduced the risk of chipping or the occurrence of complications by up to one-third.

CONCLUSIONS

All FPDs showed high 5-year survival rates and acceptable 10-year survival rates with no strong differences among the materials. Higher success and chipping-free rates were observed for both HN and CC restorations compared with ZC restorations. Metal frameworks had a lower risk for complications or veneer chipping than zirconia frameworks.

Do tooth-supported zirconia restorations present more technical failures related to fracture or loss of retention? Systematic review and meta-analysis

OBJECTIVES

This systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs), categorizing them as fracture/chipping or loss of retention/decementation.

MATERIALS AND METHODS

Electronic and manual searches were performed for randomized clinical trials, prospective clinical trials, and prospective cohort studies that reported the technical failure rates of zirconia restorations. The Cochrane Collaboration risk-of-bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies.

RESULTS

Fifty-two studies were included and most of them had unclear risk of bias. Considering all reported fractures/chipping, for veneered crowns with 1 to 3 years of follow-up, the relative risk (RR) of fracture in relation to loss or retention was 3.95 (95% CI 1.18-13.23; p = 0.03). For 4 to 6 years of follow-up, the RR was 5.44 (95% CI 1.41-20.92; p = 0.01). For veneered FPDs with 1 to 3 years of follow-up, the RR was 5.98 (95% CI 2.31-15.01; p = 0.0002). For 4 to 6 years of follow-up, the RR was 3.70 (95% CI 1.63-8.41; p = 0.002). For 7 years or more of follow-up, the RR was 3.45 (95% CI 1.84-6.46; p = 0.0001). When only framework fractures were considered, there were no significant differences for the RR in all follow-up periods (p > 0.05).

CONCLUSIONS

Higher RR for fracture/chipping in relation to decementation for veneered zirconia crowns and FPDs at all follow-up times. For framework fractures, no difference was observed between the risk of failure of the restoration due to fracture or decementation.

CLINICAL RELEVANCE

Zirconia crowns and FPDs showed relatively high success and survival rates. However, considering the technical failures, there is approximately four times higher chance of fracture/chipping than loss of retention for both single and multi-unit tooth-supported veneered zirconia restorations.

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.

Randomized clinical trial comparing monolithic and veneered zirconia three-unit posterior fixed partial dentures in a complete digital flow: three-year follow-up

Objectives

To evaluate and to compare the clinical performance and survival rate of posterior monolithic and veneered zirconia fixed partial dentures (FPDs).

Material and methods

Sixty 3-unit posterior FPDs were included in the study. The patients were randomly distributed into two groups (n = 30 each) to receive either a monolithic (Zenostar T, Wieland Dental) or veneered zirconia (IPS e.max ZirCAD, Ivoclar Vivadent) FPD. Each patient received only 1 FPD. Tooth preparations were scanned (Trios 3, 3Shape), designed (Dental System 2016, 3 Shape), milled (Zenotec CAM 3.2, Wieland Dental), and cemented with a resin cement. Technical and biological outcomes and periodontal parameters were assessed. Data analysis was made using the Friedman and the Wilcoxon signed-rank tests with the Bonferroni correction and the Mann–Whitney U test.

Results

The survival rate at 3 years was 100% for veneered and 90% for monolithic zirconia restorations. Three monolithic zirconia FPDs were lost because of biologic complications. The main complication in the veneered zirconia FPDs was the fracture of the veneering ceramic in 4 of the veneered zirconia FPDs. No fracture of the frameworks was observed in any of the groups. All restorations were assessed as satisfactory after 3 years. No differences in periodontal parameters were observed between the groups.

Conclusions

The results of this study suggest that monolithic zirconia and complete digital flow could be a viable alternative to veneered zirconia in the posterior regions.

Clinical relevance

The monolithic zirconia restorations with a digital workflow can be a viable alternative in posterior fixed partial dentures, with good periodontal outcomes.

Clinical trial registration number

ClinicalTrials.gov (Identifier NCT 04,879,498).

Clinical Performance of CAD/CAM All-Ceramic Tooth-Supported Fixed Dental Prostheses: A Systematic Review and Meta-Analysis

Although CAD/CAM ceramics present a promising alternative to metal-ceramic fixed dental prostheses, little is known about their mid- and long-term clinical performance. This systematic review aims to estimate the survival and success rates and describes the underlying complication characteristics for CAD/CAM tooth-supported zirconia- and lithium disilicate-based fixed dental prostheses (FDPs). We systematically searched MEDLINE and Web of Science to find relevant prospective studies with a follow-up of at least one year. We estimated pooled 1-, 5-, and 10-year survival and success rates by combining the collected data in a Poisson regression model. Descriptive statistics were conducted to evaluate the distribution of failures and complications in the included studies. Risk of bias for the included studies was assessed with an adapted checklist for single-arm trials. Pooled estimated 1-, 5-, and 10-year survival rates ranged from 93.80% to 94.66%, 89.67% to 91.1%, and 79.33% to 82.20%, respectively. The corresponding success rates excluding failures, but including any other types of intervention were 94.53% to 96.77%, 90.89% to 94.62%, and 81.78% to 89.25%. Secondary caries was the most frequent cause of failure, followed by chipping of the veneering. The most common cause of complication excluding failures but requiring intervention was chipping of the veneering. Risk of bias was generally acceptable for the included studies, with seven studies associated with low risk of bias, eight studies with a moderate risk of bias, and three studies with serious risk of bias. The current meta-analysis on CAD/CAM-supported FDPs revealed satisfying survival and success rates for up to 10 years of exposure. More prospective studies focusing on long-term performance are needed to strengthen the evidence currently available in the literature.

Extended glaze firings for porcelain-veneered zirconia: Effects on the mechanical and optical behavior

OBJECTIVE

This study evaluated the effect of dwell time (conventional or extended) and cooling protocol (fast or slow) of self-glaze firings on the mechanical (flexural strength and crack propagation) and optical (color and translucency) properties of a porcelain-veneered zirconia system.

METHODS

Bilayer disc-shaped samples were prepared (Vita VM9 + In-Ceram YZ) and divided according to the final thermal treatment: glaze firing followed by slow cooling (furnace opening at 200 °C) (G-S) or fast cooling (furnace opening at 600 °C) (G-F, manufacturer-recommended protocol), extended glaze firing (15 min of dwell time) followed by slow cooling (EG-S) or fast cooling (EG-F), or no thermal treatment (CTRL). Porcelain roughness (Ra and Rz) was measured before and after glaze firings. Color (ΔE₀₀) and translucency (TP₀₀) alteration were also evaluated. Flexural strength was measured with the piston-on-three-ball test and crack propagation analysis was performed after Vickers indentations. Complementary analyzes of crystalline phase and scanning electron microscopy were carried out.

RESULTS

Significant effect of dwell time was observed, with extended glaze leading to higher flexural strength and shorter crack lengths. Cracks of EG groups were observed to end in clusters of crystals. Color and translucency changed below perceptibility thresholds. All treatments led to a smoother surface and EG groups reached the lowest Rz values. An extra SiO₂ peak was revealed in control and EG groups. No effect of cooling protocol was found.

SIGNIFICANCE

Extended glaze firing was able to improve the resistance to crack initiation and propagation of porcelain-veneered zirconia without clinically perceptible changes in optical properties.

High bonding strength between zirconia and composite resin based on combined surface treatment for dental restorations

Zirconia is the preferred material for dental restorations; however, dental restorations are usually affected by zirconia fractures due to chipping and delamination of the veneer ceramic. One effective solution for repairing chemically inert zirconia frameworks is to strongly chemically bond them with the composite resin via surface modification. Thus, the bonding strength between the zirconia and composite resin determines the performance of dental restoration. Herein, we investigate the shear bond strength between zirconia ceramic and two ceramic repair systems before and after thermal cycling based on different surface pretreatments, including air-abrasion and a novel silane coupling agent. When treated with combined sandblasting, novel silane and 10-methacryloyloxydecyl hydrogen phosphate act as a bonding agent for the zirconia surface, and the maximum shear bond strength achieves 27.5 MPa, as measured by a universal testing machine through the average of 16 separate measurements. The results show that the combined treatment resists the interface damage caused by expansion and contraction during thermal cycling. The long-term bond durability is due to the micro-mechanical bond force formed by resin and ceramic, and the chemical bonds of Zr-O-Si at the interface. Results indicate that selective pretreating the surface results in high bond strength between the zirconia and the composite resin, which is meaningful to optimize dental restoration.

Effect of artificial aging on high translucent dental zirconia: simulation of early failure

Higher yttria content enhances the translucency and appearance of dental zirconia materials. Alterations in material composition also affect mechanical properties. The aim of this study was to compare the fracture load after artificial short-term aging of monolithic, full-contour zirconia crowns with different amounts of yttria-stabilization. Sixty crowns (thirty super high translucent crowns (5Y-Z) and thirty high translucent crowns (3Y-Z)) were produced to fit a model of a premolar with a shallow chamfer preparation. The crowns were cemented with self-adhesive resin cement on composite abutments. For each zirconia type, three groups of crowns (n = 10) were allocated to: (i) cyclic loading (200 N, 1 Hz, 30,000 cycles), (ii) hydrothermal aging (3 × 20 min, 134°C 3.2 bar), or (iii) no treatment (control). Surviving crowns from the aging process were quasistatically loaded until fracture. The 3Y-Z crowns had statistically significantly higher fracture values (3,449 N) than the 5Y-Z crowns (1,938 N). The aging procedures did not affect load at fracture. Fractographic analysis showed that fractures started either at the crown margin or at the occlusal intaglio area. Higher yttria content leads to a reduction in material strength and damage tolerance, and this should be reflected in recommendations for clinical use.

Influence of zirconia surface treatments of a bilayer restorative assembly on the fatigue performance

PURPOSE

This study evaluated the influence of different surface treatments of zirconia used to enhance bonding with veneering porcelain, and thermocycling on the resistance to porcelain cracking and delamination during fatigue test.

METHODS

Bilayer ceramic discs were made from zirconia blocks (IPS e.max Zircad MO, Ivoclar Vivadent - 0.7 mm thickness) and randomized into 8 groups (n= 15) according to two factors: 'zirconia surface treatment' (Control; Grinding - diamond bur; Air-abrasion - aluminum oxide particles; and Liner - application of a ceramic liner [IPS e.max Zirliner, Ivoclar Vivadent]); and 'thermocycling' (presence - 12,000 thermal cycles; 5-55ºC; or absence). The discs were veneered with porcelain (IPS e.max Ceram, Ivoclar Vivadent - 0.7 mm; totaling 1.4 mm thickness) according to ISO 6872:2015 for biaxial flexure strength testing. Fatigue tests (step-stress approach; 20 to 100 MPa; step of 10 MPa; 10,000 cycles per step; 10 Hz frequency) were run, followed by the data analysis (Kaplan-Meier and Mantel-Cox post-hoc tests). Analysis of roughness, topography, crystallographic phase arranges and fractography were also executed.

RESULTS

The surface treatment and thermocycling did not influence the porcelain crack nor delamination resistance. When only comparing the surface treatments for crack resistance outcome, the liner application depicted the worst fatigue performance in comparison to grinding and air-abrasion, while all groups were similar for delamination.

CONCLUSIONS

Neither the surface treatment of the zirconia nor the thermocycling influences the porcelain crack resistance or the resistance to delamination of the bilayer porcelain-veneered zirconia specimens.

Long-term chipping and failure rates of implant-supported and combined tooth-implant-supported metal-ceramic and ceramic fixed dental prostheses: A cohort study

STATEMENT OF PROBLEM

Combined tooth-implant-supported fixed dental prostheses have been associated with an increased risk of long-term failure. Furthermore, high chipping rates have been reported for ceramic fixed dental prostheses. However, clinical data are sparse.

PURPOSE

The purpose of this observational cohort study was to evaluate the chipping and failure rates of metal-ceramic and ceramic implant-supported and combined tooth-implant-supported fixed dental prostheses.

MATERIAL AND METHODS

Four hundred thirty-four fixed dental prostheses placed in 324 patients (mean age: 60.8 years) were selected from a prospective clinical long-term study comprising 213 implant-supported fixed dental prostheses, 66 implant-supported cantilever fixed dental prostheses, and 155 tooth-implant-supported fixed dental prostheses. Metal-ceramic fixed dental prostheses (n=260) were fabricated with a high noble metal alloy (n=225) or Co-Cr base metal alloy (n=35) frameworks. Ceramic fixed dental prostheses (n=174) were all zirconia based and had monolithic (n=68), completely veneered (n=43), or partially veneered frameworks (n=63). Kaplan-Meier curves were used to estimate the survival probability and the chipping-free survival rate of the fixed dental prostheses.

RESULTS

During the observation period of 0.5 to 12.6 years (mean: 4.26 years), 17 fixed dental prostheses failed because of implant failure (n=6), tooth loss (n=5), major chipping (n=5), or abutment screw loosening (n=1). Survival probability was 96% after 5 years and 91% after 10 years. Cox regression analysis showed that age, sex, fixed dental prosthesis location, type of fixed dental prosthesis support, and fixed dental prosthesis material had no significant effect on fixed dental prosthesis failure. Chipping (n=61) was significantly affected by the framework material and type of veneer (P=.001). After 5 years, the greatest incidence of chipping (39%) was observed for zirconia fixed dental prostheses with a complete veneer compared with an 18% incidence of chipping for metal-ceramic fixed dental prostheses with a high noble metal framework. A lower incidence of chipping was observed for zirconia fixed dental prostheses with a partial veneer or monolithic design.

CONCLUSIONS

Implant-implant-supported and combined tooth-implant-supported fixed dental prostheses have promising long-term survival rates. Chipping seems to occur less frequently in monolithic or partially veneered fixed dental prostheses than in fixed dental prostheses with complete veneers.

Acid Effects on the Physical Properties of Different CAD/CAM Ceramic Materials: An in Vitro Analysis

PURPOSE

To evaluate the flexural strength, elastic modulus, microhardness, and surface roughness of monolithic zirconia, lithium disilicate ceramics, and feldspathic ceramics after being exposed to different acidic solutions.

MATERIALS AND METHODS

Rectangular specimens (n = 180) were prepared from three different ceramic materials: lithium disilicate, monolithic zirconia, and feldspathic porcelain. Initial Surface roughness of ninety specimens (n = 30/material) was evaluated using an optical noncontact profilometer. Thirty specimens of each material were immersed in one of the following solutions (n = 10/group): citric acid; acidic beverage; and artificial saliva, which served as the control. Post immersion surface roughness, flexural strength, and elastic modulus were determined using an optical noncontact profilometer and three-point bending test. Another thirty specimens of each material were immersed in the aqueous solutions (n = 10/group) following the same protocol and subjected to microhardness test using a Vickers diamond microhardness tester. A scanning electron microscope (SEM) was used to examine the surface characteristics changes. ANOVA and Post-hoc Tukey's Kramer tests were used for data analysis (α = 0.05).

RESULTS

Immersion in different solutions did not affect the flexural strength and elastic modulus of lithium disilicate or zirconia. Microhardness and surface roughness were significantly affected in all groups (p < 0.05). For feldspathic porcelain groups, the flexural strength and elastic modulus were significantly decreased in the citric acid group (p = 0.045 and p = 0.019). Also, there were significant differences among all feldspathic porcelain groups (p = 0.001) in terms of microhardness and surface roughness values.

CONCLUSIONS

The tested acidic agents significantly affected the flexural strength, elastic modulus, surface roughness, and microhardness of feldspathic porcelain. However, the flexural strength and elastic modulus of evaluated lithium disilicate and zirconia did not change significantly.

Impact of artificial aging by thermocycling on edge chipping resistance and Martens hardness of different dental CAD-CAM restorative materials

STATEMENT OF PROBLEM

The selection of an appropriate restorative material based on fracture behavior is important for the marginal integrity of a dental restoration. For computer-aided design and computer-aided manufacturing (CAD-CAM) restorative materials, information regarding their edge chipping resistance is scarce.

PURPOSE

The purpose of this in vitro study was to determine the edge chipping resistance (ECR) and Martens hardness (HM) of 6 different dental CAD-CAM restorative materials before and after thermocycling.

MATERIAL AND METHODS

Four composite resin materials including Brilliant Crios; Cerasmart, an experimental material; Lava Ultimate, a polymer-infiltrated ceramic-network (PICN) material (VITA Enamic), and a glass-ceramic control (IPS Empress CAD) were tested. The specimens were tested before and after thermocycling (30 000 times, 5 °C/55 °C). The ECR was measured for each material (n=25) and related to the point of loading and to the maximum chipping depth. HM was determined for each material (n=25). The Kruskal-Wallis and Mann-Whitney U tests were used to compare materials (α=.05). The impact of thermocycling was analyzed by using the Wilcoxon test (α=.05). The correlations between all parameters were calculated by using the Spearman-Rho test (α=.05). For fractographic analysis of chip patterns, chipped surfaces were analyzed by laser scanning microscopy.

RESULTS

For ECR and HM, the materials showed different values. ECR_md and ECR_pl showed a positive correlation, but both showed a negative correlation to HM. The materials showed a different chip size (P<.001). Chip patterns revealed brittle material behavior in all cases.

CONCLUSIONS

All tested CAD-CAM materials behaved as brittle materials, but HM and ECR differed among the materials. The control glass-ceramic material showed the highest values for HM, followed by the PICN material. ECR values revealed the opposite order of materials, with the highest for composite resins. Artificial aging by thermocycling affected all dental CAD-CAM restorative materials. Especially for composite resin materials, ECR changed after aging.

Do thermal treatments affect the mechanical behavior of porcelain-veneered zirconia? A systematic review and meta-analysis

OBJECTIVES

A systematic review of in vitro studies was conducted to assess the effect of thermal treatments on flexural strength or critical load to failure of porcelain-veneered zirconia (PVZ).

SOURCES

Literature searches were performed up to June 2018 in PubMed/MEDLINE, Scopus and Web of Science databases, with no publication year or language limits.

DATA

From 393 relevant studies, 21 were selected for full-text analysis, from which 7 failed to meet the inclusion criteria. The 14 remaining papers were included in the systematic review: 8 for meta-analysis and 6 restricted to descriptive analyses. Hand searching of reference lists resulted in no additional papers.

STUDY SELECTION

In vitro studies using PVZ specimens testing the influence of thermal treatments on the fracture resistance to monotonic or cyclic loading. Papers evaluating cooling rate were divided into those applying fast cooling from above the porcelain glass transition temperature (T_g), or from below it. Meta-analyses were performed separately for flexural strength and critical load to failure, using random effects at a 5% significance level.

CONCLUSIONS

Delaying furnace opening at a temperature below the porcelain T_g is advised for PVZ restorations, in order to improve their fracture resistance. Additional information is required to confirm the apparent beneficial effect of self-glaze and repeated veneer firings on the mechanical properties of these restorations. Finally, in order to obtain conclusive and relevant evidence regarding thermal treatments and the fracture resistance of PVZs, future studies should concentrate on anatomically-correct crown specimens.

The effect of zirconia surface architecturing technique on the zirconia/veneer interfacial bond strength

PURPOSE

The purpose of this study was to evaluate the effect of the zirconia surface architecturing technique (ZSAT) on the bond strength between veneering porcelain and zirconia ceramic.

MATERIALS AND METHODS

20 sintered zirconia ceramic specimens were used to determine the optimal surface treatment time, and were randomly divided into 4 groups based on treatment times of 0, 1, 2, and 3 hours. After etching with a special solution, the surface was observed under scanning electron microscope, and then the porcelain was veneered for scratch testing. Sixty 3 mol% yttria-stabilized tetragonal zirconia polycrystal ceramic blocks were used for tensile strength testing; 30 of these blocks were surface treated and the rest were not. Statistical analysis was performed using ANOVA, the Tukey post-hoc test, and independent t-test, and the level of significance was set at α=.05.

RESULTS

The surface treatment of the zirconia using ZSAT increased the surface roughness, and tensile strength test results showed that the ZSAT group significantly increased the bond strength between zirconia and veneering porcelain compared to the untreated group (36 MPa vs. 30 MPa). Optimal etching time was determined to be 2 hours based on the scratch test results.

CONCLUSION

ZSAT increases the surface roughness of zirconia, and this might contribute to the increased interfacial bond strength between zirconia and veneering porcelain.

Mechanical and Surface Properties of Monolithic Zirconia

Purpose:

This study compared monolithic zirconia with conventional ones based on mean roughness (Ra), Vickers hardness (VHN), topography, transmittance, grain size, flexural strength (FS), Weibull modulus, and fractographic behavior.

Methods and Materials:

One monolithic (Prettau Zircon [PR group]) and two conventional (ICE Zirkon Transluzent [IZ group] and BloomZir [BL group]) zirconias were used. Specimens were tested using a profilometer, a microhardness tester, a scanning electron microscope, a spectrophotometer, and a Universal Testing Machine (EMIC DL 2000). Ra, VHN, grain size, and transmittance were analyzed using the Kruskal-Wallis test associated with Dunn test (α=0.05). FS was analyzed using one-way analysis of variance with the Tukey honestly significant difference test (α=0.05).

Results:

Means and standard deviations of roughness, after sintering (Ra, in μm) and VHN, were, respectively, 0.11 ± 0.01, 1452.16 ± 79.49, for the PR group; 0.12 ± 0.02, 1466.72 ± 91.76, for the IZ group; and 0.21 ± 0.08, 1516.06 ± 104.02, for the BL group. BL was statistically rougher (p&lt;0.01) than PR and IZ. Hardness was statistically similar (p=0.30) for all groups. Means and standard deviations of FS (in MPa) were 846.65 ± 81.97 for the PR group, 808.88 ± 117.99 for the IZ group, and 771.81 ± 114.43 for the BL group, with no statistical difference (p&gt;0.05). Weibull moduli were 12.47 for the PR group, 7.24 for the IZ group, and 6.31 for the BL group, with no statistical differences. The PR and BL groups had higher transmittance values and grain sizes than the IZ group (p&lt;0.05). Although the BL group had some fractures that originated in the center of the tensile surface, fractographic analyses showed the same fracture pattern.

Conclusions:

All tested zirconia showed similar VHN, and the monolithic zirconia had similar roughness compared to one of the conventional zirconias. In addition, the monolithic zirconia showed similar flexural strength and Weibull modulus compared to the others even though its mean grain size was larger. The total transmittance of monolithic zirconia was higher than only one of the conventional zirconias tested.

The effect of various polishing systems on surface roughness and phase transformation of monolithic zirconia

PURPOSE

The purpose of this study was to evaluate and compare three polishing systems on the surface roughness and phase transformation of monolithic zirconia.

MATERIALS AND METHODS

100 disk shaped specimens (10 mm diameter, 3 mm thickness) were fabricated from monolithic zirconia blocks. 20 specimens were left as a control group and remaining specimens were grinded by diamond bur to simulate the occlusal adjustments. Grinded specimens were randomly divided into 4 groups: group G (no polishing), group M (Meisinger, zirconia polishing kit), group E (EVE Diacera, zirconia polishing kit), and group P (EVE Diapol, porcelain polishing kit). Surface roughness was measured with profilometer and surface topography was observed with SEM. XRD analysis was performed to investigate the phase transformation. Statistical analysis was performed with one-way ANOVA and Tukey's post hoc tests at a significance level of P=.05.

RESULTS

All polishing groups showed a smoother surface than group G. Among 3 polishing systems, group M and group E exhibited a smoother surface than the group P. However, no significant differences were observed between group M and group E (P>.05). Grinding and polishing did not cause phase transformations in zirconia specimens.

CONCLUSION

Zirconia polishing systems created a smoother surface on zirconia than the porcelain polishing system. Phase transformation did not occur during the polishing procedure.

Effect of different semimonolithic designs on fracture resistance and fracture mode of translucent and high-translucent zirconia crowns

Purpose

The aim of this study was to describe different designs of semimonolithic crowns made of translucent and high-translucent zirconia materials and to evaluate the effect on fracture resistance and fracture mode.

Methods

One hundred crowns with different designs were produced and divided into five groups (n=20): monolithic (M), partially veneered monolithic (semimonolithic) with 0.3 mm buccal veneer (SM0.3), semimonolithic with 0.5 mm buccal veneer (SM0.5), semimonolithic with 0.5 mm buccal veneer supported by wave design (SMW), and semimonolithic with 0.5 mm buccal veneer supported by occlusal cap design (SMC). Each group was divided into two subgroups (n=10) according to the materials used, translucent and high-translucent zirconia. All crowns underwent artificial aging before loading until fracture. Fracture mode analysis was performed. Fracture loads and fracture modes were analyzed using two-way ANOVA and Fisher's exact probability tests (P≤0.05).

Results

SM0.3 design showed highest fracture loads with no significant difference compared to M and SMW designs (P>0.05). SM0.5 design showed lower fracture loads compared to SMW and SWC designs. Crowns made of translucent zirconia showed higher fracture loads compared to those made of high-translucent zirconia. M, SM0.3, and all but one of the SMC crowns showed complete fractures with significant differences in fracture mode compared to SMW and SM0.5 crowns with cohesive veneer fractures (P≤0.05).

Conclusion

Translucent and high-translucent zirconia crowns might be used in combination with 0.3 mm microcoating porcelain layer with semimonolithic design to enhance the esthetic properties of restorations without significantly decreasing fracture resistance of the crowns. If 0.5 mm porcelain layer is needed for a semimonolithic crown, wave design or cap design might be used to increase fracture resistance. In both cases, fracture resistance gained is likely to be clinically sufficient as the registered fracture loads were high in relation to expected loads under clinical use.

Survival rate of modern all-ceramic FPDs during an observation period from 2011 to 2016

PURPOSE

In literature, many studies compare survival rates of different types of FPDs. Most of them compared restorations, which originated from one university, but from different clinicians. Data about restoration survival rates by only one experienced dentist are very rare. The aim of this study was to evaluate the survival rate of allceramic FPDs without the blurring effects of different clinicians.

MATERIALS AND METHODS

153 veneeredzirconia FPDs were observed for follow-up. 22 patients received 131 single crowns and 22 bridges. Because of the different bridge lengths, one unit was defined as a restored or replaced tooth. In total, 201 units were included. Only the restorations performed by the same clinician and produced in the same dental laboratory from 2011 to 2016 were included. Considered factors were defined as “type of unit”, “type of abutment”, “intraoral region”, and “vitality”. Modified UHPHS criteria were used for evaluation. Statistical analysis was performed using cox-regression.

RESULTS

189 units (94.0%) showed no kind of failure. 5 chippings (2.4%) could be corrected by intraoral polishing. 4 units (1.9%) exhibited spontaneous decementation. These polishable and recementable restorations are still in clinical use. Chippings or decementations, which lead to total failure, did not occur. One unit was completely fractured (0.5 %). Biological failures (caries, periodontitis or periimplantitis) did not occur. The statistical analysis of the factors did not reveal any significant differences.

CONCLUSION

Modern all-ceramic FPDs seem to be an appropriate therapy not only for single restorations but for complex occlusal rehabilitations.

Load-bearing capacity of various CAD/CAM monolithic molar crowns under recommended occlusal thickness and reduced occlusal thickness conditions

PURPOSE

The goal of this study was to evaluate the fracture resistances of various monolithic crowns fabricated by computer-aided design and computer-aided manufacturing (CAD/CAM) with different thickness.

MATERIALS AND METHODS

Test dies were fabricated as mandibular molar forms with occlusal reductions using CAD/CAM. With different occlusal thickness (1.0 or 1.5 mm), a polymer-infiltrated ceramic network (Enamic, EN), and zirconia-reinforced lithium silicate (Suprinity, SU and Celtra-Duo, CD) were used to fabricate molar crowns. Lithium disilicate (e.max CAD, EM) crowns (occlusal: 1.5 mm) were fabricated as control. Seventy crowns (n=10 per group) were bonded to abutments and stored in water for 24 hours. A universal testing machine was used to apply load to crown until fracture. The fractured specimens were examined with a scanning electron microscopy.

RESULTS

The type of ceramics and the occlusal thickness showed a significant interaction. With a recommended thickness (1.5 mm), the SU revealed the mean load similar to the EM, higher compared with those of the EN and CD. The fracture loads in a reduced thickness (1.0 mm) were similar among the SU, CD, and EN. The mean fracture load of the SU and CD enhanced significantly when the occlusal thickness increased, whereas that of the EN did not.

CONCLUSION

The fracture loads of monolithic crowns were differently influenced by the changes in occlusal thickness, depending on the type of ceramics. Within the limitations of this study, all the tested crowns withstood the physiological masticatory loads both at the recommended and reduced occlusal thickness.

A systematic review and meta-analysis of 3-unit fixed dental prostheses: Are the results of 2 abutment implants comparable to the results of 2 abutment teeth?

The purpose of the systematic review and meta-analysis was to compare the performance of 3-unit bridges on teeth with 3-unit bridges on implants, evaluating survival of the bridges, survival of the teeth or implants, condition of the hard and soft tissues surrounding the supports, complications and patient-reported outcome measures (PROM) after a mean observation period of at least 1 year. A literature search was conducted using a combination of the search terms: fixed partial denture and fixed dental prostheses (FDPs). An electronic search for data published until January 2017 was undertaken using the MEDLINE, EMBASE and Cochrane Library databases. Eligibility criteria included clinical human studies, either randomised or not, interventional or observational, which evaluated the results of 3-unit FDPs on either 2 implants or 2 abutment teeth. The search identified 1686 unique references. After applying eligibility criteria, 66 articles were included in the analysis. A total of 1973 3-unit FDPs were supported by teeth, and 765 were implant-supported. No significant differences were found either in the survival of the supporting abutments (P = .52; 99% vs 98.7% survival per year) or in the survival of the prostheses (P = .34; 96.4% vs 97.4% survival per year). Both treatments show an almost equally low complication rate, but there is a low level of reporting of hard and soft tissue conditions and PROM. It is concluded that implant-supported 3-unit FDPs seem to be a reliable treatment with survival rates not significantly different from the results of teeth-supported 3-unit FDPs.

Dental Ceramics for Restoration and Metal Veneering

A survey of the development of dental ceramics is presented to provide a better understanding of the rationale behind the development and clinical indications of each class of ceramic material. Knowledge of the composition, microstructure, and properties of a material is critical for selecting the right material for specific applications. The key to successful ceramic restorations rests on material selection, manufacturing technique, and restoration design, including the balancing of several factors such as residual stresses, tooth contact conditions, tooth size and shape, elastic modulus of the adhesives and tooth structure, and surface state.

Multidisciplinary full-mouth rehabilitation with soft tissue regeneration in the esthetic zone

OBJECTIVE

Oral rehabilitation often requires a multidisciplinary approach including restorative dentistry, prosthodontics, and periodontology to fulfill high esthetic and functional demands, frequently combined with changes in the vertical dimension. The presence of gingival recessions can be associated with numerous factors, such as brushing or preparation trauma and persistent inflammation of the gingiva due to inadequate marginal fit of restorations. Because gingival recessions can cause major esthetic and functional problems, obtaining stability of the gingival tissue around prosthetic restorations is of essential concern. Modifications of the occlusal vertical dimension require sufficient experience of the whole dental team. Especially in patients with functional problems and craniomandibular dysfunction, a newly defined occlusal position should be adequately tested and possibly adjusted.

CLINICAL CONSIDERATIONS

This case report presents a complete prosthetic rehabilitation combined with a periodontal surgical approach for a patient with gingival recessions and functional/esthetic related problems. The vertical dimension was carefully defined through long-term polymethyl methacrylate provisionals as a communication tool between all parts involved. All-ceramic crowns were inserted after periodontal healing as definitive rehabilitation.

CONCLUSIONS

Complex rehabilitation in patients with high esthetic demands including soft tissue corrections requires a multidisciplinary team approach that consists of periodontal surgeon, dentist and dental technician.

Influence of Surface Properties on Adhesion Forces and Attachment of Streptococcus mutans to Zirconia In Vitro

Zirconia is becoming a prevalent material in dentistry. However, any foreign bodies inserted may provide new niches for the bacteria in oral cavity. The object of this study was to explore the effect of surface properties including surface roughness and hydrophobicity on the adhesion and biofilm formation of Streptococcus mutans (S. mutans) to zirconia. Atomic force microscopy was employed to determine the zirconia surface morphology and the adhesion forces between the S. mutans and zirconia. The results showed that the surface roughness was nanoscale and significantly different among tested groups (P < 0.05): Coarse (23.94 ± 2.52 nm) > Medium (17.00 ± 3.81 nm) > Fine (11.89 ± 1.68 nm). The contact angles of the Coarse group were the highest, followed by the Medium and the Fine groups. Increasing the surface roughness and hydrophobicity resulted in an increase of adhesion forces and early attachment (2 h and 4 h) of S. mutans on the zirconia but no influence on the further development of biofilm (6 h~24 h). Our findings suggest that the surface roughness in nanoscale and hydrophobicity of zirconia had influence on the S. mutans initial adhesion force and early attachment instead of whole stages of biofilm formation.

Prospective cohort clinical study assessing the 5-year survival and success of anterior maxillary zirconia-based crowns with customized zirconia copings

STATEMENT OF PROBLEM

Studies evaluating anterior zirconia-based crowns are limited.

PURPOSE

The purpose of this prospective cohort clinical study was to assess the efficacy of zirconia-based anterior maxillary crowns with 0.3-mm customized copings at the cervical third and anatomical design elsewhere for up to 5 years of service.

MATERIAL AND METHODS

Eighteen participants who required an anterior maxillary crown (n=20) and who had signed a consent form approved by the University of Washington Health Sciences Center Human Subjects Division were enrolled. All preparations were standardized and prepared with an occlusal reduction of 1.5 to 2 mm and an axial reduction of 1 to 1.5 mm with 10 degrees of convergence angle. All finish lines were located on the sound tooth structure. Zirconia copings (Lava; 3M ESPE) were custom designed and milled to a 0.3-mm thickness at the cervical third and with selective thickness elsewhere to support the veneering porcelain. All restorations were luted with self-etching self-adhesive composite resin cement. Recall appointments were at 2 weeks, 6 months, and 12 months, and annually thereafter for 5 years. Modified Ryge criteria were used to assess the clinical fracture measurements, esthetics, marginal discoloration, marginal adaptation, radiographic proximal recurrent caries, and periapical pathoses. Descriptive statistics and 95% confidence intervals were used to describe the number and rate of complications and self-reported satisfaction with the crowns.

RESULTS

Twenty crowns with a mean follow-up of 58.7 months were evaluated. All crowns were rated as Alfa for fracture measurements (smooth surface, no fracture/chipping). Twelve crowns were rated esthetically as Romeo (no mismatch in color and shade) and 8 as Sierra (mismatch in color and shade within normal range). Twelve crowns were rated as Alfa (no visible evidence of crevice) and 8 as Bravo (visible evidence of crevice, no penetration of explorer) for marginal integrity. Nineteen were rated as Alfa (no discoloration) and 1 as Bravo (superficial discoloration) for marginal discoloration. No proximal caries or periapical pathoses were detected in 5 years. Participants were highly satisfied with their crowns after 5 years (mean ±SD: 9.8 ±0.4 on 0 to 10 scale).

CONCLUSIONS

Zirconia-based anterior maxillary crowns with customized copings with 0.3-mm thickness at the cervical third and zirconia margins performed well after 5 years of service.

Influence of aging on flexural strength of translucent zirconia for monolithic restorations

STATEMENT OF PROBLEM

Concern has been raised with regard to the low-temperature degradation (LTD) of translucent yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) for monolithic zirconia restorations.

PURPOSE

The purpose of this in vitro study was to assess the LTD behavior of 4 commercially available translucent Y-TZP materials by accelerated aging specimens in steam at 134°C, 0.2 MPa.

MATERIAL AND METHODS

Thin bars (22×3×0.2 mm) of Y-TZP, including Katana ML (Kuraray Noritake Dental Inc), Katana HT13 (Kuraray Noritake Dental Inc), Prettau (Zirkonzahn), and BruxZir (Glidewell Laboratories) (n=30 for each group), were machined from sintered blocks. Control specimens were assessed in the nonaged condition. Artificially ageing (n=5 per group at 5, 50, 100, 150, and 200 hours) was conducted in steam at 134°C at 0.2 MPa. The specimens were characterized, tested in 4-point flexure, and the fracture surfaces were analyzed. The monoclinic-to-tetragonal (m/t) peak intensity ratio measured by x-ray diffraction was used to calculate the monoclinic phase fraction and monitor LTD. Linear regression with heteroscedasticity-consistent robust standard errors was used to test for the effect of LTD (aging time) on (σ_f) and m/t. The Spearman rank correlation coefficient was used to assess the relationship between σ_f and monoclinic phase fraction (α=.05).

RESULTS

Artificial aging resulted in LTD as shown by an increase in the monoclinic phase fraction for all specimens. After aging for 200 hours, the mean ±SD monoclinic phase fraction increased from 2.90 ±0.34% to 76.1 ±0.64% for Prettau, 2.69 ±0.18% to 76.0 ±0.26% for BruxZir, 4.6 ±0.19% to 35.8 ±0.80% for Katana HT13, and 3.57 ±0.35% to 33.2 ±1.1% for Katana ML (all P<.001). Flexural strength changed from a mean ±SD of 1612 ±197 MPa to all fractured during aging for Prettau (P<.001); 1248 ±73.5 MPa to all fractured during aging for BruxZir (P<.001); 1052 ±84.2 to 1099 ±70 MPa ±130 for Katana HT13 (P=.45); and from 875 ±130 to 909 ±70 MPa (P=.82) for Katana ML. The mean flexural strength values of Prettau and BruxZir decreased with an increase in the monoclinic phase with Spearman rank correlation coefficients of -0.80 (P=.001) for Prettau and -0.63 (P=.022) for BruxZir. No significant changes in flexural strength were measured for Katana ML or Katana HT13 (P>.05).

CONCLUSIONS

The LTD of Y-TZP resulted in a significant decrease in flexural strength of Prettau and BruxZir, whereas Katana ML and Katana HT13 exhibited less LTD and no significant decrease in flexural strength.

Shear bond strength of indirect composite material to monolithic zirconia

PURPOSE

This study aimed to evaluate the effect of surface treatments on bond strength of indirect composite material (Tescera Indirect Composite System) to monolithic zirconia (inCoris TZI).

MATERIALS AND METHODS

Partially stabilized monolithic zirconia blocks were cut into with 2.0 mm thickness. Sintered zirconia specimens were divided into different surface treatment groups: no treatment (control), sandblasting, glaze layer & hydrofluoric acid application, and sandblasting + glaze layer & hydrofluoric acid application. The indirect composite material was applied to the surface of the monolithic zirconia specimens. Shear bond strength value of each specimen was evaluated after thermocycling. The fractured surface of each specimen was examined with a stereomicroscope and a scanning electron microscope to assess the failure types. The data were analyzed using one-way analysis of variance (ANOVA) and Tukey LSD tests (α=.05).

RESULTS

Bond strength was significantly lower in untreated specimens than in sandblasted specimens (P<.05). No difference between the glaze layer and hydrofluoric acid application treated groups were observed. However, bond strength for these groups were significantly higher as compared with the other two groups (P<.05).

CONCLUSION

Combined use of glaze layer & hydrofluoric acid application and silanization are reliable for strong and durable bonding between indirect composite material and monolithic zirconia.

A Contemporary Framework and Suprastructure Ceramic Design for Posterior Implant Fixed Partial Denture

Bone and soft tissue deformities in long-standing partial edentulism are commonly treated with implant therapy. The various ceramic restorative systems available and digital technology allow for customization of design and material selection. A substructure design that mimics tooth preparation in a custom zirconia framework with a lithium disilicate suprastructure is presented as an effort to address the functional and esthetic challenges posed by long-standing posterior partial edentulism. The aim is to present several contemporary elements of design to address the functional, esthetic, and maintenance needs.

Influence of Veneering Fabrication Techniques and Gas-Phase Fluorination on Bond Strength between Zirconia and Veneering Ceramics

PURPOSE

Porcelain chipping has been one of the main problems of porcelain-fused-to-zirconia restorations. This study evaluates the bond strengths of layered, pressed, and adhesively bonded porcelain to yttria-stabilized zirconia substrates that have undergone traditional preparation or gas-phase fluorination.

MATERIALS AND METHODS

A three-point bending test was used to evaluate the bond strength of the porcelain and zirconia interface. Sixty-six specimens were prepared (n = 11) following ISO 9693 and loaded until failure using an Instron testing machine. One-half of the zirconia substrates received gas phase fluorination treatment before veneering application. Three porcelain veneering methods were evaluated: layered, pressed, and adhesively bonded porcelain. Bond strength results were interpreted using a two-way ANOVA and a Bonferroni multiple comparisons test. Statistical significance was set at α = 0.05.

RESULTS

ANOVA revealed a statistically significant effect of the veneering fabrication methods. No main effect was observed regarding the surface treatment to the zirconia. There was a significant effect related to the veneering method used to apply porcelain to zirconia. For untreated zirconia, layered porcelain had a significantly higher flexural strength compared to pressed or bonded, while pressed and bonded porcelains were not significantly different from one another. For zirconia specimens receiving fluorination treatment, both layered and pressed porcelains had significantly higher bond strengths than adhesively bonded porcelain. In addition, fluorinated pressed porcelain was not statistically different from the control layered or fluorinated layered porcelain.

CONCLUSION

The choice of veneering fabrication technique was critical when evaluating the zirconia to porcelain interfacial bond strength. Bonded porcelain to zirconia had a lower flexural strength than layered or pressed porcelain, regardless of zirconia surface treatment. In addition, fluorination had an effect on the bond strength of pressed porcelain.

New Knowledge about Zirconium-Ceramic as a Structural Material in Fixed Prosthodontics

Dental ceramics represents a major structural material in fixed prosthodontics. Increasing demands for esthetics led to development of new ceramic materials in order to eliminate the use of metal framework and for all ceramic restorations with mechanical properties to withstand high occlusal forces. Out of all the present ceramic materials, zirconium-ceramic has the best mechanical properties, and is the only material that can be used for longer span fixed dental restorations. Despite its excellent mechanical properties, to achieve great esthetics, due to absence of translucency, zirconium-dioxide cannot be used as a single material and needs veneering with more esthetic ceramic. When introduced in dental medicine, it was considered an almost ideal material for fixed prosthodontics, but clinical use and in vivo and in vitro studies showed many problems which still persist despite the improvements.
This review aims to reveal new developments in zirconium-ceramics and technical procedures which could increase clinical performance and longevity of these restorations.

Effect of various intermediate ceramic layers on the interfacial stability of zirconia core and veneering ceramics

OBJECTIVES

The purposes of this study were to evaluate the effects of intermediate ceramics on the adhesion between the zirconia core and veneer ceramics.

MATERIALS AND METHODS

The polished surfaces of fully sintered Y-TZP blocks received three different treatments: (1) connector (C), (2) liner (L) or (3) wash layer (W). All the treated zirconia blocks were veneered with either (a) fluorapatite glass-ceramic (E) or (b) feldspathic porcelain (V) and divided into four groups (CE, CV, LE and WV). For the control group, the testing surfaces of metal blocks were veneered with feldspathic porcelain (VM). A half of the samples in each group (n = 21) were exposed to thermocycling, while the other half of the specimens were stored at room temperature under dry conditions. All specimens were subjected to the shear test and the failed surfaces were microscopically examined. The elemental distribution at the zirconia core/veneer interface was analyzed.

RESULTS

The specimens in Groups CE and CV exhibited significantly greater mean bond strength values than those in Groups LE and WV, respectively (p < 0.05). However, the mean bond strengths significantly decreased in the connector groups (CE and CV) after thermal cycling (p < 0.05). The elemental analysis suggested diffusion of ceramic substances into the zirconia surface.

CONCLUSIONS

A glass-ceramic based connector is significantly more favorable to core/veneer adhesion than the other intermediate ceramics evaluated in the study. However, thermal cycling affected the bond strength at the core/veneer interface differently according to the intermediate ceramics.