Load-bearing capacity of all-ceramic posterior four-unit fixed partial dentures with different zirconia frameworks

Fracture Resistance of Chairside CAD/CAM Lithium Disilicate-reinforced Ceramic Occlusal Veneers With and Without Margin and Full Coverage Crowns

OBJECTIVE

The aim of this investigation was to compare the fracture resistance of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) lithium disilicate-reinforced ceramic occlusal veneers with and without margin and traditional full coverage premolar crowns.

METHODS AND MATERIALS

A total of 60 chairside CAD/CAM lithium disilicate-reinforced ceramic (Amber Mill, Hass Bio) restorations were designed and fabricated with a chairside CAD/CAM system (CEREC Dentsply Sirona). The restorations were divided into three groups (n=20): 1) occlusal veneer with 1.0-mm uniform occlusal thickness and with chamfer margin; 2) occlusal veneer with 1.0-mm uniform occlusal thickness and without margin; and 3) full coverage crown with uniform occlusal thickness and gingival margin. Occlusal veneers and crowns were cemented with dual cured resin luting cement (Multilink, Ivoclar Vivadent) to printed resin dies, load cycled (5 million load cycles at 1 Hz with 275 N force), and then loaded until fracture. Load at break (LB) and peak load (PL) until fracture were recorded. Scanning electron microscope images of the tested restorations on the abutments were obtained.

RESULTS

Fracture strengths were different depending on the design of the restoration. There was no significant difference in fracture strength between the two types of occlusal veneer (LB: 1132.45 N; PL: 1143.30 N for veneers with margin; LB: 1149.25 N; PL: 1219.05 N for veneers without margin). Full coverage crowns showed the lowest fracture resistance (LB: 936.26 N, PL: 976.42 N), which was significantly lower than both designs of occlusal veneer.

CONCLUSIONS

The fracture resistance of the CAD/CAM lithium disilicate-reinforced ceramic restorations was influenced by the design. Occlusal veneers with and without margin displayed higher fracture resistance than traditional crowns.

Effect of dynamic loading on fracture resistance of gradient zirconia fixed partial denture frameworks

STATEMENT OF PROBLEM

The new strength-gradient zirconia composed of 3-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) and 5-mol% yttria-stabilized tetragonal zirconia polycrystal (5Y-TZP) has been claimed to have superior mechanical properties. However, data on the fracture resistance of 3-unit gradient 5Y-TZP and 3Y-TZP fixed partial denture frameworks are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of dynamic loading on the fracture resistance of gradient zirconia fixed partial denture frameworks.

MATERIAL AND METHODS

Two standardized stainless-steel master dies were designed to simulate a mandibular left second premolar and second molar prepared to receive zirconia frameworks. The frameworks were designed with a 0.6-mm uniform wall thickness. The mesiodistal width of the connectors was 3 ±0.02 mm, and the occlusogingival height was 3 ±0.02 mm. Forty zirconia frameworks were fabricated and divided into 2 groups according to the tested materials (n=20): 3Y-TZP and gradient 5Y-TZP and 3Y-TZP. The frameworks were cemented onto their corresponding dies with a conventional glass ionomer cement. Half of the cemented frameworks in each group underwent 600 000 cycles of dynamic loading in a mastication simulator (n=10). The other half was fractured without dynamic loading (n=10). Fracture resistance measurements (N) for each framework were recorded by using a universal testing machine at a crosshead speed of 1 mm/min. A fractured framework from each group was examined by using a scanning electron microscope (SEM) at ×100 magnification. The data obtained were statistically analyzed by using 2-way ANOVA, the pairwise Tukey honestly significant difference (HSD), and simple main effect tests to detect the difference between group mean values (α=.05).

RESULTS

The mean ±standard deviation of fracture load value before dynamic loading was 1919 ±193 N for the 3Y-TZP group and 908 ±99 N for the gradient 5Y-TZP and 3Y-TZP group. In addition, the mean fracture load value after dynamic loading was 1418 ±163 N for the 3Y-TZP group and 716 ±85 N for the gradient 5Y-TZP and 3Y-TZP group. The interaction between the effects of the zirconia material and dynamic loading on the fracture resistance was statistically significant (P=.002). The 3Y-TZP group had a statistically significant, higher fracture load mean value the gradient 5Y-TZP and 3Y-TZP group before and after dynamic loading (P<.001).

CONCLUSIONS

The fracture resistance of 3Y-TZP frameworks was significantly higher than that of gradient 5Y-TZP and 3Y-TZP frameworks before and after dynamic loading. Dynamic loading significantly reduced the fracture resistance of 3Y-TZP and gradient 5Y-TZP and 3Y-TZP frameworks.

The Structural Integrity and Fracture Behaviour of Teeth Restored with PEEK and Lithium-Disilicate Glass Ceramic Crowns

Polyetheretherketone (PEEK) is a unique polymer material which has recently been introduced to dentistry. This study aimed to assess the structural integrity of PEEK as a posterior tooth crown and compared it with ceramic-based material. A total of 31 monolithic CAD-CAM PEEK (JuvoraTM, Strumann, Andover, MA, USA) crowns and 31 lithium disilicate (IPS e.max®CAD, Voclar Vivadent AG, Liechtenstein) crowns were created and cemented on dentin-like teeth (AlphaDie®MF, Schütz Dental GmbH, Rosbach, Germany) in a precise procedure mimicking the physical and mechanical properties of natural teeth and periodontal ligaments. A static compressive strength test using a universal testing machine and a dynamic fatigue test using a chewing simulator machine were used until crown failure to assess the fracture behaviour by mode of fracture (fractographic analysis) and 3D digital subtraction analysis. The results showed that PEEK has a greater fracture resistance than IPS e.max®CAD by 2060 N to 703 N. Additionally, in fatigue limit, IPS e.max®CAD showed a constant failure under 2.0 Kg (=320 N) before 5000 chewing cycles while PEEK survived at a significantly higher load > 11 Kg (930 N). Furthermore, PEEK showed a continued survival at >1,250,000 cycles while the mean fatigue life of IPS e.max®CAD was around 133,470 cycles. PEEK illustrated a significantly less catastrophic failure mode with some plastic deformation at the fractographic stereomicroscope and in the 3D digital subtraction analysis. Using PEEK for crowns looks very promising, however, further clinical studies are required to assure this study’s results.

In vitro evaluation of the influence of titanium nitride coating on the retention force between components of two-part abutments

Background

Two-part abutments are typically made up of a base composed of titanium and a ceramic build-up. The long-term outcomes are affected by the mechanical durability. The purpose of the present investigation was to evaluate and compare the retention force of two-part abutment systems with titanium or titanium nitride bases—as fixed with zirconia components and with various surface treatments.

Methods

A total of 60 two-part abutments were investigated—with a titanium base (n = 30) or titanium nitride coated bases (n = 30) and bonded with zirconia ceramic build-ups. The bonding surfaces were treated with aluminium oxide blasting, with an average particle size of 110 µm. The titanium bases were then pretreated with Alloy Primer or Clearfil Ceramic Primer. The ceramic build-ups were only treated with Clearfil Ceramic Primer. For twenty test specimens, no chemical pretreatment was performed. Test specimens were classified into six groups in accordance with the pretreatment (A–F; n = 10). A resin-based luting agent was employed to attach the two parts. Specimens were then subjected to artificial thermal aging (10⁴ cycles with 5 °C/55 °C). The retention force between the two parts was then investigated with a pull-off test. The findings were analyzed by ANOVA statistics. Fracture patterns were examined by electron microscopy.

Results

In the absence of primer, titanium nitride coated bases gave significantly greater retention forces than other samples (p < 0.05). Chemical preconditioning with silane coupling agents did not effect on the retention force of coated bases.

Conclusions

The results of the current study suggested that modifying metal surfaces by coating the base with titanium nitride not only has esthetic and biological advantages, but also enhances the mechanical properties of the adhesive bond of two-part abutments.

Effect of connector size and design on the fracture resistance of monolithic zirconia fixed dental prosthesis

Background. Designing a high strength all-ceramic fixed partial denture with favorable esthetics can be challenging for clinicians; this study aimed to evaluate the effect of connector size and design on the fracture resistance of monolithic zirconia fixed dental prostheses.

Methods. Two groups of twenty 3-unit monolithic zirconia (Sirona inCoris TZI, Sirona Dental Systems GmbH) bridges, extending from the mandibular first premolar to the first molar with different connector sizes (9 mm² and 12 mm²), were divided into two subgroups with different connector designs (round and sharp). The specimens were subjected to the three-point bending test to obtain the fracture-bearing load. The results were reported using descriptive statistics (mean ± standard deviation). Mann-Whitney U test was used to compare the fracture load in two types of designs for each connector size and two connector size types for each connector design. The significance level was considered at P<0.05.

Results. The minimum failure load was related to the group with a 9-mm² connector size and a sharp embrasure design (1054.4±133.89 N), and the highest mean value belonged to the group with 12-mm² connector size and rounded embrasure design (1599.8±167.09 N). Mann-Whitney U test indicated a significant difference between the mean failure load of the rounded and sharp embrasure designs in the 9-mm² connector size (P =0.007). However, the difference was insignificant in the 12-mm² connector size (P =0.075).

Conclusion. Sharp embrasure design is not recommended for high-stress areas with restricted occlusogingival height. A 9-mm2 connector size for 3-unit monolithic zirconia fixed dental prosthesis (FDP), which is recommended by the manufacturer, should be used more cautiously

Computational Biomechanical Analysis of Engaging and Nonengaging Abutments for Implant Screw-Retained Fixed Dental Prostheses

PURPOSE

To evaluate the stress distribution, using 3-dimensional finite element analysis (FEA), on different implant components of a mandibular screw-retained fixed dental prosthesis (FDP) situation when using different combinations of engaging and nonengaging abutments.

MATERIAL AND METHODS

A model of artificial bone was digitally designed. Dental implants were positioned in the lower right posterior area of teeth #'s 28 (premolar - pm) and 30 (molar - m). Restorative implant components were digitally designed and placed into the implant model. Four different implant abutment situations were simulated through FEA: (1) Both engaging abutments (mE-pmE), (2) both nonengaging (mNE-pmNE), (3) molar nonengaging and premolar engaging (mNE-pmE), and (4) molar engaging and premolar nonengaging (mE-pmNE). Thirty-five (35) Ncm preload to the abutment screws and 160 N static load at 45° angle to the occlusal plane were applied in each group.

RESULTS

The equivalent Von Mises stress was measured on each component. Stress distribution changed among the different configurations and ranged from 516.0 to 1304.6 MPa in the implants, and from 554.6 to 994.5 MPa with the abutments. Higher stress was found for the mNE-pmNE designs (1078.6-1106.9 MPa). Engaging and nonengaging abutments had different stress distributions on the screw (698.8-902.5 MPa). Peak stress areas were located on the upper part of the screws for the nonengaging configuration, and on the lower areas for the engaging abutments. The sum of the stress on both implants decreased in the following order: mNE-pmNE > mE-pmNE > mNE-pmE > mE-pmE.

CONCLUSION

Under conditions of this study, abutment design produced different stress patterns to the implant components. The lowest and most balanced stress distribution was found for the mE-pmE configuration followed by the mNE-pmE configuration.

The effect of crown fabrication process on the fatigue life of the tooth-crown structure

OBJECTIVE

To compare the fatigue strength of lithium disilicate ceramic crowns when cemented as a compound structure, as a function of the manufacturing process and the type of ceramic variation.

METHOD

A typodont maxillary first premolar was prepared for an all-ceramic crown in accordance with the manufacturer's guidelines for monolithic ceramic crowns (IPS e. max®; Ivoclar-Vivadent, Liechtenstein). 60 dies were duplicated in a polymer with a Young's Modulus closely matched to dentine (Alpha die, Schütz GmbH). Three different crown fabrication techniques were used (n = 20): (i) Manually applied wax spacer and pressed-crown; (ii) digitally scanned preparation, CAD-printed wax-pattern (D76PLUS, Solidscape Inc.) and pressed-crown; (iii) digitally scanned preparation and machined-crown (CEREC-inLab® v3.6 Sirona GmbH). Resin-based cement (Variolink-II®, Ivoclar-Vivadent, Liechtenstein) was employed with a standardised mechanised cementation technique to apply a controlled axial cementation pressure [Universal testing machine (Lloyd LRX®, Lloyd Materials Testing Inc)]. The samples were subjected to fatigue life testing with a cyclic impact load of 453 N for 1.25 × 10⁶cycles at 37C⁰ and 1 Hz frequency until the point of fracture.

RESULT

There was a significant difference in the resistance to fatigue loading between the three groups. Weibull probability analysis and the α and β Weibull parameters indicate that the teeth restored with a 'Manually-applied wax spacer and pressed-crown' are best able to resist cyclic fatigue loading. They also have the most uniform interface geometry.

CONCLUSION

Teeth restored with IPS e. max® crowns constructed by manually applied wax spacer and pressing, have a more uniform interface and a greater structural integrity than wax CAD-printed patterns or CAD-CAM crowns.

Influence of Radius of Curvature at Gingival Embrasure in Connector Area on Stress Distribution of Three-Unit Posterior Full-Contour Monolithic Zirconia Fixed Partial Denture on Various Amounts of Load Application: A Finite Element Study

Objectives

To test the hypothesis that radius of curvature at gingival embrasure in connector area significantly affects the fracture resistance of full-contour monolithic zirconia three-unit posterior Fixed partial denture (FPD) on various amounts of load application.

Materials and Methods

In this study, two types of three-dimensional finite element models of a three-unit posterior full-contour monolithic zirconia FPD with two gingival embrasure radii (r_GE I, 0.45 mm and r_GE II, 0.25 mm) were constructed. The components modeled through finite element modeling were subjected to 400, 600, and 800 N vertical loads at the central fossa of the pontic, and further analysis was carried out.

Results

All the results were displayed by post-processor finite element analysis software (ANSYS). The study revealed that with increase in the amount of load application as well as decrease in the gingival embrasure radii, stress concentration values were increasing gradually for both the full-contour monolithic zirconia FPD.

Conclusion

The fracture resistance of the zirconia posterior FPD was significantly affected by the gingival embrasure radii and the mode of load application. When there is a clinical situation of heavier occlusal forces, the fracture resistance can be increased by designing greater gingival embrasure radii in the connector region.

Fracture resistance of monolithic and veneered all-ceramic four-unit posterior fixed dental prostheses after artificial aging

This study compared the fracture resistance of monolithic and veneered all-ceramic four-unit posterior fixed dental prostheses (FDPs) generated by computer-aided design/computer-aided manufacturing (CAD/CAM) after aging in a mastication simulator. Four-unit FDPs were designed from six different all-ceramic systems: 1) monolithic lithium disilicate (M-E), 2) monolithic zirconia (M-TZI), 3) veneered zirconia by conventional layering (V-L), 4) veneered zirconia by lithium disilicate pressing (V-P), 5) veneered zirconia by lithium disilicate fusing (CAD-F-E), and 6) veneered zirconia by feldspathic ceramic cementing (CAD-C-CB). The specimens were divided into control and aging groups (n = 10 per group). The aging process included both thermocycling and mechanical loading and was followed by fracture resistance testing. All specimens in the M-E, M-TZI, and V-L groups survived; however, all specimens in the V-P group were fractured during artificial aging. The highest fracture resistance values were observed in the M-TZI group. According to the fracture resistance test, connector fractures were the most frequent type of failure. M-TZI and M-E FDPs revealed no failures during aging and showed higher fracture resistance than the veneered groups. Among the veneered zirconia framework groups, V-L FDPs showed the highest success rate during aging, while the fracture resistance was similar among all the veneered zirconia groups.

Is Anterior Guidance a Key Factor on Planning Implant Treatment for Free-End Missing in the Posterior Mandible?

To perform safe implant treatment, the anatomical structure and bone quality at implant placement sites are evaluated based on a patient's computerized tomography (CT) data, but there is no definite method to determine placement sites and the appropriate number of implants. The objective of this study was to investigate the influence of the number and arrangement of implants on the stress distribution in 3-unit posterior fixed partial dentures for the posterior mandible by mechanical analysis using the finite element method. Three-dimensional finite element analysis models were constructed from the CT data of a patient with missing mandibular teeth (Nos. 35, 36, 37). Implant placement was simulated under various conditions. Superstructures were connected and fixed with a titanium frame. As the loading conditions, 400 N vertical and lateral loads (45° on the lingual side and 45° on the buccal side) were applied to the upper areas of Nos. 35, 36, and 37, and the stress distribution and frame displacement were evaluated. When a vertical force was applied, no difference of the von Mises stress was noted among the 5 experimental conditions. When lateral force was applied from the lingual and buccal sides at 45°, the stress was higher than that induced by vertical force under all conditions, and it was especially high under mesial and distal cantilever conditions. When displacement of the titanium frame was measured, the displacement caused by lateral force was greater than that due to vertical force. In addition, comparison between long and short distal cantilever bridges revealed that displacement of the titanium frame tended to be smaller when the short cantilever was used. These findings suggested that the stress on peri-implant tissues and displacement of the titanium frame vary depending on the configuration and number of implants, with greater stress and more marked displacement of the titanium frame being induced by lateral force when the number of implants is reduced and a cantilever bridge is selected.

Influence of nonthermal argon plasma on the shear bond strength between zirconia and different adhesives and luting composites after artificial aging

PURPOSE

Plasma activation of hydrophobic zirconia surfaces might be suitable to improve the bond strength of luting materials. The aim of this study was to analyze the influence of nonthermal argon-plasma on the shear bond strength (SBS) between zirconia and different combinations of 10-MDP adhesive systems and luting composites after artificial aging.

MATERIALS AND METHODS

Two hundred forty Y-TZP specimens were ground automatically with 165 µm grit and water cooling. Half of the specimens received surface activation with nonthermal argon-plasma. The specimens were evenly distributed into three groups according to the adhesive systems ([Futurabond U, Futurabond M, Futurabond M + DCA], VOCO GmbH, Germany, Cuxhaven) and into further two subgroups according to the luting materials ([Bifix SE, Bifix QM], VOCO GmbH). Each specimen underwent artificial aging by thermocycling and water storage. SBS was measured in a universal testing machine. Statistical analysis was performed using ANOVA and Scheffè procedure with the level of significance set to 0.05.

RESULTS

Surface activation with nonthermal plasma did not improve the bond strength between zirconia and the tested combinations of adhesive systems and luting materials. The plasma-activation trended to reveal higher bond strength if the self-etch luting material (Bifix SE) was used, irrespective of the adhesive system.

CONCLUSION

Plasma-activation seems to be suitable to improve bond strength between zirconia and self-etch resin materials. However, further research is necessary to identify the influence of varying plasma-parameters.

Displacement of teeth without and with bonded fixed orthodontic retainers: 3D analysis using triangular target frames and optoelectronic motion tracking device

PURPOSE

The objective of this study was to evaluate the anterior tooth movement without and with bonded fixed orthodontic retainers under incremental loading conditions.

MATERIALS AND METHODS

Six extracted mandibular anterior human teeth were embedded in acrylic resin in True Form I Arch type and 3D reconstruction of Digital Volume Tomography (DVT) images (0.4 mm³ voxels) were obtained. The anatomy of each tooth was segmented and digitally reconstructed using 3D visualization software for medical images (AMIRA, FEI SVG). The digital models of the teeth were repositioned to form an arch with constant curvature using a CAD software (Rhinoceros) and a base holder was designed fitting the shape of the roots. The clearance between the roots and their slot in the holder was kept constant at 0.3 mm to replicate the periodontal ligament thickness. The holder and the teeth were then manufactured by 3D printing (Objet Eden 260VS, Stratasys) using a resin material for dental applications (E = 2-3 GPa). The 3D-printed teeth models were then positioned in the holder and the root compartments were filled with silicone. The procedure was repeated to obtain three identical arch models. Each model was tested for tooth mobility by applying force increasing from 5 to 30 N with 5 N increments applied perpendicular on the lingual tooth surface on the incisal one third (crosshead speed: 0.1 mm/s). The teeth on each model were first tested without retainer (control) and subsequently with the bonded retainers (braided bonded retainer wire; Multi-strand 1 × 3 high performance wire, 0.022″ × 0.016″). Tooth displacement was measured in terms of complicance (F/Δ movement) (N/mm) using custom-built optoelectronic motion tracking device (OPTIS) (accuracy: 5 µm; sampling rate: 200 Hz). The position of the object was detected through three LEDs positioned in a fixed triangular shape on a metal support (Triangular Target Frame). The measurements were repeated for three times for each tooth. Data were analyzed using mixed model with nesting (alpha = 0.05).

RESULTS

The use of retainer showed a significant effect on tooth mobility (0.008 ± 0.004) compared to non-bonded teeth (control) (0.014 ± 0.009) (p < 0.0001). The amount of displacement on the tooth basis was also significantly different (p = 0.0381) being the most for tooth no. 42 (without: 0.024 ± 0.01; with: 0.012 ± 0.002) (p = 0.0018). No significant difference was observed between repeated measurements (p = 0.097) and the incremental magnitude of loading (5-30 N: 0.07 ± 0.01-0.09 ± 0.02) (p > 0.05).

CONCLUSION

Mandibular anterior teeth showed less tooth mobility when bonded with stainless steel wire as opposed to non-bonded teeth but the tooth mobility varied depending on the tooth type. Intermittent increase in loading from 5 to 30 N did not increase tooth displacement.

Load-bearing capacity of novel resin-based fixed dental prosthesis materials

To evaluate the influence of different materials on the load-bearing-capacity of inlay-retained fixed-dental-prosthesis (FDP). Ten types of FDPs were evaluated (n=7/group): Group PEEK: CAD-CAM polyetheretherketone (PEEK-TechnoMed), Group RC, made of discontinuous-fiber-composite (EverX Posterior); Group FRC1, made of discontinuous-fiber-composite (EverX Posterior) with two-bundles of continuous-unidirectional fiber-reinforced-composite (FRC) (Everstick C&B); Group FRC2, made of discontinuous-fiber-composite (EverX Posterior) with two-bundles of continuous-unidirectional-FRC (Everstick C&B) covered by two-pieces of short-unidirectional-FRC (Everstick C&B) placed perpendicular to the main-framework; Group FB, CAD-CAM fiber-block (Fibra-Composite Bio-C); Group PMMA, CAD-CAM polymethyl methacrylate block (Temp basic); Group RP, resin-paste; Group FRP1, made of resin-paste (G-Fix) with two-bundles of continuous-unidirectional-FRC (Everstick C&B); Group FRP2, made of resin-paste (G-Fix) two-bundles of continuous-unidirectional-FRC covered by two-pieces of short unidirectional-FRC placed perpendicular to the main-framework and Group exp-FRC, experimental CAD-CAM FRC. The bridges were statically-loaded until fracture. Fracture modes were visually examined. ANOVA revealed that significant differences were observed between FDP-materials (p<0.05). In addition, fiber addition to the framework significantly affected load-bearing-capacity (p<0.05).

Effect of thickness and surface modifications on flexural strength of monolithic zirconia

STATEMENT OF PROBLEM

A recommended minimum thickness for monolithic zirconia restorations has not been reported. Assessing a proper thickness that has the necessary load-bearing capacity but also conserves dental hard tissues is essential.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of thickness and surface modifications on monolithic zirconia after simulated masticatory stresses.

MATERIAL AND METHODS

Monolithic zirconia disks (10 mm in diameter) were fabricated with 1.3 mm and 0.8 mm thicknesses. For each thickness, 21 disks were fabricated. The specimens of each group were further divided into 3 subgroups (n=7) according to the surface treatments applied: untreated (control), airborne-particle abrasion with 50-μm Al₂O₃ particles at a pressure of 400 kPa at 10 mm, and grinding with a diamond rotary instrument followed by polishing. The biaxial flexure strength was determined by using a piston-on-3-balls technique in a universal testing machine. Flexural loading was applied with a 1.4-mm diameter steel cylinder, centered on the disk, at a crosshead speed of 0.5 mm/min until fracture occurred. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed. The data were statistically analyzed with 2-way ANOVA, Tamhane T2, 1-way ANOVA, and Student t tests (α=.05).

RESULTS

The 1.3-mm specimens had significantly higher flexural strength than the 0.8-mm specimens (P<.05). Airborne-particle abrasion significantly increased the flexural strength (P<.05). Grinding and polishing did not affect the flexural strength of the specimens (P>.05).

CONCLUSIONS

The mean flexural strength of 0.8-mm and 1.3-mm thick monolithic zirconia was greater than reported masticatory forces. Airborne-particle abrasion increased the flexural strength of monolithic zirconia. Grinding did not affect flexural strength if subsequently polished.

Clinical performance of screw-retained and cemented implant-supported zirconia single crowns: 36-month results

OBJECTIVES

The objective of this clinical study was to evaluate the clinical performance of implant-supported zirconia crowns with a sintered veneering cap. Furthermore, the influence of the type of retention (screw-retained vs cemented single crowns) was analysed.

MATERIALS AND METHODS

Fifty-eight patients were accommodated with 114 implants, inserted in the molar and premolar regions. Zirconia-based crowns with a sintered veneering cap were either screw-retained (n = 53) or cemented (n = 61) on the implant. Recalls were performed every 6 months. The state of soft tissue was documented by the modified plaque and gingiva index (mPI) and sulcus bleeding index (mSBI). The restorations were evaluated for technical failures like veneering porcelain fractures, surface qualities and marginal fitting.

RESULTS

Neither implant loss nor crown fractures occurred. After a mean clinical service time of 36.9 months, fractures of the veneering porcelain were registered in 1.8 % of the cases. The Kaplan-Meier survival probability regarding eventless restorations was 98.2 %. Chipping of the veneering porcelain was registered in two cemented crowns without statistical influence of the type of retention. The indices showed healthy soft periimplant tissues in both groups.

CONCLUSIONS

Implant-supported zirconia crowns with a sintered veneering cap demonstrated good clinical performance. The type of retention had no influence on technical complications.

Monoclinic phase transformation and mechanical durability of zirconia ceramic after fatigue and autoclave aging

OBJECTIVES

This study evaluated the influence of two aging procedures on the biaxial flexural strength of yttria-stabilized tetragonal zirconia ceramics.

MATERIAL AND METHODS

Disc-shaped zirconia specimens and (ZE: E.max ZirCAD, Ivoclar; ZT: Zirkon Translucent, Zirkonzahn) (N = 80) (∅:12 mm; thickness:1.2 mm, ISO 6872) were prepared and randomly divided into four groups (n = 10 per group) according to the aging procedures: C: Control, no aging; M: mechanical cycling (2 × 10⁶ cycles/3.8 Hz/200 N); AUT: Aging in autoclave at 134°C, 2 bar for 24 h; AUT + M: Autoclave aging followed by mechanical cycling. After aging, the transformed monoclinic zirconia (%) were evaluated using X-ray diffraction and surface roughness was measured using atomic force microscopy. The average grain size was measured by scanning electron microscopy and the specimens were submitted to biaxial flexural strength testing (1 mm/min, 1000 kgf in water). Data (MPa) were statistically analyzed using 2-way analysis of variance and Tukey's test (α = 0.05).

RESULTS

Aging procedures significantly affected (p = 0.000) the flexural strength data but the effect of zirconia type was not significant (p = 0.657). AUT_ZT (936.4 ± 120.9^b ) and AUT + M_ZE (867.2 ± 49.3^b ) groups presented significantly higher values (p < 0.05) of flexural strength than those of the control groups (C_ZT : 716.5 ± 185.7^a ; C_ZE : 779.9 ± 114^a ) (Tukey's test). The monoclinic phase percentage (%) was higher for AUT_ZE (71), AUT_ZT (66), AUT + M_ZE (71), and AUT + M_ZM (66) compared to the C groups (ZE:0; ZT:0). Surface roughness (µm) was higher for AUT_ZE (0.09), AUT_ZT (0.08), AUT + M_ZE (0.09 µm), and AUT + M_ZT (0.09 µm) than those of other groups.

CONCLUSIONS

Regardless of the zirconia type, autoclave aging alone or with mechanical aging increased the flexure strength but also induced higher transformation from tetragonal to monoclinic phase in both zirconia materials tested. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1972-1977, 2017.

Fracture resistance of three-unit zirconia fixed partial denture with modified framework

Obtaining ideal prosthetic framework design is at times hindered by anatomical limitations in the posterior region that might increase the risk for zirconia restoration fracture. Modification such as increasing the bulk thickness especially in the connector region could result in strengthening the zirconia framework. Three-unit zirconia fixed partial dentures replacing mandibular molars were fabricated using the following two techniques: CAD/CAM technology and manual copy milling. Modified framework with unveneered full thickness connectors were designed and fabricated with the aforementioned methods. Conventional frameworks (0.5 mm thick with rounded 3 mm connectors) served as control (N = 20). After cementation on epoxy dies, the frameworks were loaded to fracture in a universal testing machine. Fractured surfaces were prepared for examination using scanning electron microscopy. Statistical analysis revealed significant differences in fracture resistance between conventional and modified framework design for both fabrication techniques tested. SEM examination indicated that critical crack originated at the tensile surface of the connectors for conventional frameworks. The critical crack for modified frameworks occurred on the axial wall of the abutments. The modification of the zirconia framework design presented significant improvement of the fracture resistance compared to the conventional design.

Basic Finite Element Analysis of Para-periodontal Ligament in All-ceramic Zirconia Fixed Partial Denture

The purpose of the present study was to investigate the validity of incorporating a para-periodontal ligament in the test mold used in a basic fracture test of a zirconia all-ceramic fixed partial denture (FPD). A simplified three-dimensional finite element analysis model was designed based on the three-unit FPD fracture test. Two types of model, one with and one without a para-periodontal ligament between the abutment and base mold, were fabricated. Microfocus CT of the missing first molar area in a dry human mandible was performed. A three-dimensional model was then fabricated based on the data obtained. A load of 600 N was applied to the center of the pontic and stress distribution observed. The model with the para-periodontal ligament showed stress dispersion to the dental root with rotation of the abutment mold. Stress distribution in the finite element analysis model with a para-periodontal ligament showed greater similarity with that in the mandibular model than with that in the other two models without a para-periodontal ligament.

Influence of Cyclic Fatigue in Water on Screw Torque Loss of Long-Span One-Piece Implant-Supported Zirconia Frameworks

PURPOSE

It is still unclear whether four, six, or more implants should be used when restoring fully edentulous maxillae. This research evaluated the in vitro screw torque loss of zirconia frameworks supported by six implants and cantilevered zirconia frameworks supported by four implants.

MATERIALS AND METHODS

Computer aided design/computer-assisted machining was used to fabricate 10 one-piece frameworks. Standardized pressable porcelain crowns were fabricated and luted to the frameworks. Specimens were divided into two groups (n = 5): AO4, cantilevered 12-unit full-arch fixed dental prosthesis supported by four implants; AO6, 14-unit supported by six implants. An opposing mandibular dental arch was fabricated with bis-acrylic composite resin. Specimens were submitted to 200 N underwater cyclic load at 2-Hz frequency for 1 × 10⁶ cycles in a controlled 37°C temperature. A digital torque gauge assessed the initial and postload screw removal torque. Linear mixed-effects model was used for statistical analysis (α = 0.05).

RESULTS

Significant screw torque loss was found for AO6 after cyclic loading (before: 36.20%/after: 52.82%; p < 0.05). Group AO6 (36.20%) presented lower preload loss before the cyclic loadings compared with AO4 (60.10%) (p < 0.05).

CONCLUSIONS

Cyclic loading and lower implant-to-replaced-units ratio do not seem to compromise screw stability compared with higher implant-to-replaced-units ratio; however, a steep drop in preload was found before cyclic loading for both groups.

Flexural strengths of implant-supported zirconia based bridges in posterior regions

PURPOSE

Impact forces in implant supported FDP (fixed dental prosthesis) are higher than that of tooth supported FDPs and the compositions used in frameworks also has a paramount role for biomechanical reasons. The aim of this study was to evaluate the flexural strength of two different zirconia frameworks.

MATERIALS AND METHODS

Two implant abutments with 3.8 mm and 4.5 mm platform were used as premolar and molar. They were mounted vertically in an acrylic resin block. A model with steel retainers and removable abutments was fabricated by milling machine; and 10 FDP frameworks were fabricated for each Biodenta and Cercon systems. All samples were thermo-cycled for 2000 times in 5-55℃ temperature and embedded in 37℃ artificial saliva for one week. The flexural test was done by a rod with 2 mm ending diameter which was applied to the multi-electromechanical machine. The force was inserted until observing fracture. The collected data were analyzed with SPSS software ver.15, using Weibull modulus and independent t-test with the level of significance at α=.05.

RESULTS

The mean load bearing capacity values were higher in Biodenta but with no significant differences (P>.05). The Biodenta frameworks showed higher load bearing capacity (F₀=1700) than Cercon frameworks (F₀=1520) but the reliability (m) was higher in Cercon (m=7.5).

CONCLUSION

There was no significant difference between flexural strengths of both zirconia based framework systems; and both Biodenta and Cercon systems are capable to withstand biting force (even parafunctions) in posterior implant-supported bridges with no significant differences.

3D Finite element analysis of functionally graded multilayered dental ceramic cores

This study aimed at investigating and establishing stress distributions in graded multilayered zirconia/alumina ceramic cores and at veneer-core-cement-dentin interfaces, using finite element analysis (FEA), to facilitate the structural design of ceramic cores through computer modeling. An intact maxillary premolar was digitized using CT scanning. An imaging software, Mimics, was used to reconstruct 3D models based on computed tomography (CT) data saved in DICOM format. Eight different 3D models were created for FEA, where each 3D model was meshed and its bottom boundaries constrained. A static load was applied in the oblique direction. The materials were assumed to be isotropic and homogeneous. Highest von Mises stress values were found in areas directly below the load application point, and stress gradually decreased in occlusal loading direction from the external surface toward the dentin. Stress levels occurring at veneer-ceramic core-cement-dentin interfaces were shown to be lower in multilayered ceramic cores than in single-layer models.

Finite element analysis of the influence of geometry and design of zirconia crowns on stress distribution

PURPOSE

To evaluate the influence of the geometry and design of prosthetic crown preparations on stress distribution in compression tests, using finite element analysis (FEA).

MATERIALS AND METHODS

Six combinations of 3D drawings of all-ceramic crowns (yttria-stabilized zirconia framework and porcelain veneer) were evaluated: F, flat preparation and simplified crown; FC, flat preparation and crown with contact point; FCM, flat preparation and modified crown; A, anatomical preparation and simplified anatomical crown framework; AC, anatomical preparation and crown with contact point; and ACM, anatomical preparation and modified crown. Bonded contact types at all interfaces with the mesh were assigned, and the material properties used were according to the literature. A 200 N vertical load was applied at the center of each model. The maximum principal stresses were quantitatively and qualitatively analyzed.

RESULTS

The highest values of tensile stress were observed at the interface between the ceramics in the region under the load application for the simplified models (F and A). Reductions in stress values were observed for the model with the anatomical preparation and modified infrastructure (ACM). The stress distribution in the flat models was similar to that of their respective anatomical models.

CONCLUSIONS

The modified design of the zirconia coping reduces the stress concentration at the interface with the veneer ceramic, and the simplified preparation can exert a stress distribution similar to that of the anatomical preparation at and near the load point, when load is applied to the center of the crown.

Full-arch prostheses from translucent zirconia: accuracy of fit

OBJECTIVES

The aim of this study was to evaluate the marginal and internal fit of single crowns, compared to 14-unit frameworks made of translucent yttria-stabilized zirconia. We hypothesized that there is an influence of the type of restoration on the marginal and internal fit.

METHODS

Eight teeth (FDI locations 17, 15, 13, 11, 21, 23, 25 and 27) of a typodont maxillary model were provided with a chamfer preparation to accommodate a 14-unit prosthesis or four single crowns (SCs). Ten 14-unit fixed dental prostheses (FDPs) and 40 single crowns were fabricated using a computer aided design (CAD)/computer aided manufacturing (CAM) system with pre-sintered translucent yttria-stabilized zirconia blanks. The restorations were cemented onto twenty master dies, which were sectioned into four pieces each. Then, the marginal and internal fits were examined using a binocular microscope. In order to detect the differences between the two types of restorations a non-parameteric test (Mann-Whitney-U) was carried out; to detect differences between the abutment teeth and the abutment surfaces non-parametric tests (Kruskal-Wallis) and pairwise post hoc analyses (Mann-Whitney-U) were performed after testing data for normal distribution (method according to Shapiro-Wilk). Level of significance was set at 5%.

RESULTS

The mean (SD) marginal opening gap dimensions were 18 μm (14) for the single crowns and 29 μm (27) for the 14-unit FDPs (p<0.001). Abutment 21 of the FDPs showed statistical differences concerning the location of the teeth in both marginal and internal fit (p<0.001). The measured gaps (types I-IV) revealed statistical differences between all types, when comparing SCs to the FDPs (p<0.001).

SIGNIFICANCE

Single crowns showed significantly better accuracy of fit, compared to the 14-unit FDPs. However, both restorations showed clinically acceptable marginal and internal fit.

A CAD/CAM designed, semi-fixed, high strength, all-ceramic prosthesis for maxillary rehabilitation--a case report

The clinical and laboratory steps involved in rehabilitating the maxillary arch following the loss of several teeth due to periodontal disease are outlined in this case report. This article illustrates the use of a laboratory based CAD/CAM system (Sirona In-Lab) and a copy milling technique in the fabrication of a fixed-movable bridge, high strength, all-ceramic, cross-arch bridge.

CLINICAL RELEVANCE

Adopting a semi-fixed approach in cross-arch rehabilitation has conventionally involved the use of porcelain fused to metal (PFM) components but the demands placed by patients and clinicians have led to the development of novel techniques in order to achieve highly aesthetic and functional results.

Evaluation of the adaptation of zirconia-based fixed partial dentures using micro-CT technology

The objective of the study was to measure the marginal and internal fit of zirconia-based all-ceramic three-unit fixed partial dentures (FPDs) (Y-TZP - LAVA, 3M-ESPE), using a novel methodology based on micro-computed tomography (micro-CT) technology. Stainless steel models of prepared abutments were fabricated to design FPDs. Ten frameworks were produced with 9 mm2 connector cross-sections using a LAVATM CAD-CAM system. All FPDs were veneered with a compatible porcelain. Each FPD was seated on the original model and scanned using micro-CT. Files were processed using NRecon and CTAn software. Adobe Photoshop and Image J software were used to analyze the cross-sectional images. Five measuring points were selected, as follows: MG - marginal gap; CA - chamfer area; AW - axial wall; AOT - axio-occlusal transition area; OA - occlusal area. Results were statistically analyzed by Kruskall-Wallis and Tukey's post hoc test (α= 0.05). There were significant differences for the gap width between the measurement points evaluated. MG showed the smallest median gap width (42 µm). OA had the highest median gap dimension (125 µm), followed by the AOT point (105 µm). CA and AW gap width values were statistically similar, 66 and 65 µm respectively. Thus, it was possible to conclude that different levels of adaptation were observed within the FPD, at the different measuring points. In addition, the micro-CT technology seems to be a reliable tool to evaluate the fit of dental restorations.

Effect of particle size on the flexural strength and phase transformation of an airborne-particle abraded yttria-stabilized tetragonal zirconia polycrystal ceramic

STATEMENT OF PROBLEM

Because airborne-particle abrasion is an efficient method of improving the bond at the zirconia-cement interface, understanding its effect on the strength of yttria-stabilized tetragonal zirconia polycrystal is important.

PURPOSE

The purpose of this study was to evaluate the effect of the particle size used for airborne-particle abrasion on the flexural strength and phase transformation of a commercially available yttria-stabilized tetragonal zirconia polycrystal ceramic.

MATERIAL AND METHODS

For both flexural strength (20.0 × 4.0 × 1.2 mm) (n=14) and phase transformation (14.0-mm diameter × 1.3-mm thickness) (n=4), the zirconia specimens were made from Lava, and their surfaces were treated in the following ways: as-sintered (control); with 50-μm aluminum oxide (Al2O3) particles; with 120-μm Al2O3 particles; with 250-μm Al2O3 particles; with 30-μm silica-modified Al2O3 particles (Cojet Sand); with 120-μm Al2O3 particles, followed by 110-μm silica-modified Al2O3 particles (Rocatec Plus); and with Rocatec Plus. The phase transformation (%) was assessed by x-ray diffraction analysis. The 3-point flexural strength test was conducted in artificial saliva at 37°C in a mechanical testing machine. The data were analyzed by 1-way ANOVA and the Tukey honestly significant difference post hoc test (α=.05).

RESULTS

Except for the Cojet Sand group, which exhibited statistically similar flexural strength to that of the as-sintered group and for the group abraded with 250-μm Al2O3 particles, which presented the lowest strength, airborne-particle abrasion with the other particle sizes provided the highest values, with no significant difference among them. The as-sintered specimens presented no monoclinic phase. The groups abraded with smaller particles (30 μm and 50 μm) and those treated with the larger ones (110 μm and/or 120 μm particles and 250 μm) exhibited percentages of monoclinic phase that varied from 4% to 5% and from 8.7% to 10%.

CONCLUSIONS

Except for abrasion with Cojet Sand, depending on the particle size, zirconia exhibited an increase or a decrease in its flexural strength. Airborne-particle abrasion promoted phase transformation (tetragonal to monoclinic), and the percentage of monoclinic phase varied according to the particle size.

Load-bearing capacity of soldered and subsequently veneered 4-unit zirconia FDPs

OBJECTIVES

This study evaluated and compared the impact of soldering on fracture resistance of veneered 4-unit fixed dental prostheses (FDPs).

MATERIALS AND METHODS

Forty-eight 4-unit zirconia frameworks were milled and randomly divided in four groups (n=12). Untreated frameworks served as control, one group underwent thermal treatment, one group was sectioned and soldered in the connector between both pontics and one group was sectioned and soldered centrally in the mesial pontic. All frameworks were veneered with glass-ceramic material in powder build-up technique. The fracture load was determined on two different failure types, namely on chipping of the veneering ceramic and on total fracture of the FDP. Data were analysed using descriptive statistics, one-way ANOVA together with the Scheffé post-hoc test and Weibull statistics (p<0.05).

RESULTS

The mean range of fracture load of chipped FDPs was determined between 655 N and 789 N; no differences between the tested groups were found (p=0.587). The mean fracture load until total fracture ranged in all tested groups from 768 N to 1261 N. Sound FDPs and soldered FDPs in the connector area presented lower mean total fracture load compared to soldered FDPs in the pontic (p<0.001).

CONCLUSIONS

Soldered zirconia frameworks showed similar in-vitro performance compared to sound frameworks.

Low-temperature degradation of different zirconia ceramics for dental applications

The aim of this investigation was to determine the influence of simulated ageing on the tetragonal-to-monoclinic phase transformation and on the flexural strength of a 3Y-TZP ceramic, compared to alumina toughened zirconia (ATZ) and ceria-stabilized zirconia (12Ce-TZP). Standardized disc specimens of each material were hydrothermally aged in steam at 134°C and 3bar for 0, 16, 32, 64 or 128h. The phase transformation was determined by X-ray diffraction (XRD) and atomic force microscopy. Scanning electron microscopy was performed to estimate the depth of the transformation zone. The flexural strength was investigated in a biaxial flexural test. XRD revealed a significant increase in the monoclinic phase content for 3Y-TZP and ATZ due to ageing, although this increase was less pronounced for ATZ. In contrast, the monoclinic phase content of 12Ce-TZP was not influenced. For 3Y-TZP and ATZ, a transformation zone was found of which the depth linearly correlated with ageing time, while for 12Ce-TZP no transformation zone could be observed. Changes in flexural strength after ageing were heterogeneous: while 3Y-TZP showed a significant decrease in strength - from 1740 to 1169 MPa - with ATZ there was a considerable increase - from 1093 to 1378 MPa. The flexural strength of 12Ce-TZP remained unaffected at the low level of about 500 MPa. These results indicate that both alumina and ceria, as stabilizing oxides, reduce the susceptibility of zirconia to hydrothermal degradation; the alternative use of these oxides may enhance the clinical long-term stability of dental zirconia restorations.

A 3-year follow-up study of all-ceramic single and multiple crowns performed in a private practice: a prospective case series

OBJECTIVES

Zirconia-based prostheses are commonly used for aesthetic crown and fixed restorations, although follow-up data are limited, especially for implant-supported crowns. The aim of this study was to evaluate the three-year clinical results of the installation of 463 zirconia core crowns by a general dental private practice.

METHODS

This study followed 142 patients (69 men and 73 women; aged 28-82 years) who had received 248 single crowns (202 tooth-supported, 36 implant-supported) and 225 multiple units of up to six elements (81 tooth-supported, 144 implant-supported). Clinical events, including fracture and loss of retention, secondary caries, and marginal integrity, were recorded. The overall failure rate was computed for the fractured and lost prostheses. Aesthetic, functional, and biological properties were rated, and patient satisfaction was investigated.

RESULTS

During the three-year follow-up period, four patients were lost from the study (18 crowns, 4% of the total crowns). Three of the zirconia prostheses suffered fractures in more than three units (11 crowns; one- vs. three-year follow-up, p<0.05, Wilcoxon signed-rank test), and the cumulative prosthesis survival rate was 98.2%. Twelve units lost retention and were re-cemented, and no secondary caries of the abutment teeth were reported. The aesthetic, functional, and biological properties were generally well-rated, and there were no differences between tooth- and implant-supported crowns. The lowest scores were given regarding the anatomical form of the crowns, as some minor chipping was reported. Relatively low scores were also given for the periodontal response and the adjacent mucosa. Overall, patient satisfaction was high.

CONCLUSIONS

At the three-year follow-up, the zirconia-core crowns appeared to be an effective clinical solution as they had favorable aesthetic and functional properties. Only the marginal fit of the prostheses should be improved upon.

Influence of the veneering process on the marginal fit of zirconia fixed dental prostheses

Distortions in the marginal region during manufacture are detrimental to the long-term success of fixed dental prostheses (FDPs). The aim of the present in vitro study was to evaluate changes in marginal fit because of the veneering process of four-unit FDPs made from different zirconia materials. Two groups of FDPs with 10 specimens each were machined from white body zirconia blanks (VITA In-Ceram YZ Cubes, KaVo Everest ZS-Blanks) by means of computer-aided design/computer-aided manufacturing systems and subsequently sintered to their final density. The marginal and internal gaps of the frameworks were determined using a replica technique. Afterwards, frameworks were veneered with the recommended ceramics (VITA VM9, GC Initial Zr), and fitting accuracy was evaluated again. Statistical analyses were performed by Student's t-test with the level of significance chosen at 0.05. With one framework/veneering system (Everest ZS-Blanks/Initial Zr), both marginal gap (P = 0.019) and internal gap (P = 0.001) at the premolar retainer were significantly affected by the veneering process. The resulting distortions were directed towards the lumina of the retainers and the mean values of the measured gaps decreased by about 23.8 mum (marginal gap) and 27.3 mum (internal gap). For the other system (In-Ceram YZ Cubes/VM9), no distortions because of the veneering were found. The veneering of zirconia restorations may lead to significant changes in the marginal fit, while the combination of core and veneering material used influences the resulting distortions.

Influence of surface treatments on surface roughness, phase transformation, and biaxial flexural strength of Y-TZP ceramics

The aim of this study was to evaluate the influence of surface grinding and sandblasting on surface roughness, phase chances, and biaxial flexural strength of yttria-stabilized tetragonal zirconia (Y-TZP) materials. Thirty disk specimens of Cercon (C), DentaCAD (DC), Zirkonzahn (ZZ) were fabricated. The specimens were divided into three groups according to surface treatment (control, ground, and sandblasted). Surface roughness was measured, and X-ray diffraction analysis was performed. Finally, biaxial flexural strength was determined. The data was analyzed by two-way ANOVA. Weibull statistics was used to analyze the variability of strength. The effects of surface treatments on surface roughness values were different for each material. X-ray diffraction analysis revealed that control groups of C and ZZ were composed of tetragonal zirconia. Relative amount of monoclinic zirconia (SD) was 7.366 (0.716)% in the DC control group. In all materials, transformation occurred after treatments. Grinding decreased and sandblasting increased the strength of control groups in all materials. Ground C and DC specimens had higher Weibull modulus than control groups while lower m was found for ground ZZ. Sandblasting, resulted in lower m compared with grinding for all materials although increased strength. The roughness and crystalline phase of Y-TZP materials were influenced by surface treatments. Biaxial flexural strength of materials decreased after grinding and increased after sandblasting. The low m of sandblasted groups may indicate further weakening of the materials, resulting in unexpected failures.