Color Stability of CAD/CAM Ceramics Prepared with Different Surface Finishing Procedures

Effect of Successive At-home Bleaching Sessions on the Surface Properties, Biaxial Flexural Strength, and Reliability of CAD-CAM Monolithic Materials

Although at-home bleaching can recover the optical properties of stained CAD-CAM monolithic materials, little is known about its impact on their surface and mechanical properties, especially when successive sessions are performed. This study evaluated the effect of successive at-home bleaching sessions on the microhardness, roughness, topography, biaxial flexural strength (BFS), and reliability of CAD-CAM monolithic materials. Disks from Lava Ultimate (LU), Vita Enamic (VE), and IPS Empress CAD (EMP) were fabricated and submitted to up to three bleaching sessions. At-home bleaching was performed with 10% carbamide peroxide, and each session consisted of one application for 10 hours/day for 14 days. The analyses of the aforementioned parameters were assessed before and after the first, second, and third bleaching sessions, except for BFS, which was evaluated at baseline and after the third session. The Weibull modulus was calculated from the BFS data. The microhardness of the three materials as well as the roughness of LU were not affected by the sessions, whereas the roughness of VE and EMP increased from the second session. All materials displayed topographic changes, which became more pronounced with the increase in the number of sessions. Although bleaching decreased the BFS of the materials, it did not adversely affect their reliability. Successive at-home bleaching sessions with the protocol used in the present study cannot be considered a safe procedure for the materials evaluated.

Effect of polishing and bleaching on color, whiteness, and translucency of CAD/CAM monolithic materials

OBJECTIVE

To evaluate the effect of polishing and bleaching on the recovery of lightness, color, whiteness, and relative translucency parameter (RTP) in CAD/CAM materials and changes in these properties when another staining in coffee was conducted after the treatments.

MATERIALS AND METHODS

Disks of Lava Ultimate (LU), Vita Enamic (VE), IPS Empress CAD (EMP), IPS e.max CAD (EMAX), and Vita Suprinity (VS) were (1) not treated (control), (2) polished with Proxyt or (3) Ceramisté, (4) bleached with Opalescence PF or (5) Whiteness HP Blue, and (6) air polished with Clinpro Prophy Powder. CIE L*a*b* color coordinates were registered at baseline (R0), after staining with coffee for 30 min daily for 36.5 days and treatment (R1), and after another staining (R2). Differences (R1-R0 and R2-R0) in lightness (ΔL00), color (ΔE00), RTP (ΔRTP00), and whiteness (ΔWID) were evaluated by mixed repeated measures ANOVA and 95% confidence intervals (α = 0.05) and interpreted in function of their respective 50:50% PT and AT thresholds. Topography was evaluated by scanning electron microscopy (SEM).

RESULTS

In LU, Opalescence PF and Proxyt decreasedΔ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ ,Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {\mathrm{R}}_0\right)} $$ , andΔWI D R 1 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_1\hbox{--} {R}_0\right)} $$ and showed lowerΔ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ ,Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , andΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ . In VE, all treatments decreasedΔ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ ,Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , andΔWI D R 1 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_1\hbox{--} {R}_0\right)} $$ , whereasΔ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ ,Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ , andΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ were lower in Opalescence PF than in the control group. In both moments, ΔE00 and ΔWID in EMP (also ΔL00) and EMAX were higher in Opalescence PF than in the control group, from which the other treatments did not differ in R1-R0. In EMP,Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ in Whiteness HP Blue (alsoΔ L 00 R 2 - R 0 $$ {\Delta L}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ ) and Proxyt were also higher in comparison to the control group and in VS, Ceramisté decreasedΔ L 00 R 1 - R 0 $$ {\Delta L}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ ,Δ E 00 R 1 - R 0 $$ {\Delta E}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , andΔ R T P 00 R 1 - R 0 $$ \varDelta RT{P}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ , whereas Opalescence PF increasedΔRTP 00 R 1 - R 0 $$ {\Delta \mathrm{RTP}}_{00\left({R}_1\hbox{--} {R}_0\right)} $$ .Δ E 00 R 2 - R 0 $$ {\Delta E}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ of Ceramisté andΔWI D R 2 - R 0 $$ {\Delta \mathrm{WI}}_{\mathrm{D}\left({R}_2\hbox{--} {R}_0\right)} $$ andΔ R T P 00 R 2 - R 0 $$ \varDelta RT{P}_{00\left({R}_2\hbox{--} {R}_0\right)} $$ of Proxyt were lower than those of the control group.

CONCLUSIONS

The most suitable treatment to recover the lightness, color, whiteness, and RTP without changing these properties after another coffee exposure is material-dependent.

CLINICAL SIGNIFICANCE

Although the effectiveness of the treatment was material-dependent, Proxyt was the only treatment that promoted clinically acceptable changes for both LU and VE, while for purely ceramic materials, this condition was observed with Ceramisté and Clinpro Prophy Powder.

Assessment of color stability and translucency of various CAD/CAM ceramics of different compositions and Thicknesses: An in vitro study

Background

Translucency and optical characteristics significantly affect the aesthetics of ceramic restorations. The introduction of new virgilite crystals to novel ceramic advanced lithium disilicate through a matrix firing process enhances the material's strength and aesthetic quality according to the manufacturer.

Materials and Methods

Four types of CAD/CAM ceramics; lithium disilicate (LD), leucite reinforced (LR), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS) exposed to different staining solutions (tea, cola, coffee, and distilled water). Each ceramic type had 120 specimens, divided into subgroups based on thickness (0.5 mm, 1 mm, and 1.5 mm). Color changes (ΔE00) and translucency parameters (TP00) were measured after thermocycling, and spectrophotometry was employed to evaluate ΔE00 and TP00 after 1, 7, and 30 days of exposure to the staining solutions.

Results

ZLS exhibited the lowest color stability, while lithium LD and ALD displayed the highest. Thickness significantly affected color stability, with 0.5 mm thickness showing the least change. The duration of exposure also impacted color changes, with 30 days causing the most significant shift. LD demonstrated the highest translucency. Coffee and tea induced more pronounced reductions in translucency and color stability compared to the control group.

Conclusions

Material structure, thickness, staining solution, and exposure duration significantly influenced the color stability and translucency of CAD/CAM ceramics, with LD and ALD demonstrating superior color stability and LD exhibiting the highest translucency.

Determination of the Color Change of Various Esthetic Monolithic Monochromatic Computer-Aided Design/Computer-Aided Manufacturing Materials

Dental technology has developed materials for prosthetics that are very similar to natural teeth and offer a good balance between durability and esthetics; however, some of these materials are not very color-stable under the influence of external factors. Therefore, the aim of this study is to determine and compare the color change (∆E00) of different esthetic monolithic monochromatic CAD/CAM materials after they have been thermocycled and treated with staining solutions. The color parameters were determined using a spectrophotometer on a white and black background. Five CAD/CAM materials were used for this study-CAD/CAM nanoceramic (GC Cerasmart270), CAD/CAM lithium disilicate ceramic (IPS e.max CAD), CAD/CAM polymer (Telio CAD), CAD/CAM composite (Tetric CAD) and CAD/CAM polymer-infiltrated ceramic (Vita Enamic). The test specimens produced were divided into groups and were thermocycled in distilled water. They were then stored for four weeks at 37 °C in either distilled water as a control liquid, black tea, instant coffee or red wine. The aim is also to evaluate the color changes as a function of the exposure time of the staining solutions. The results obtained were analyzed statistically. All CAD/CAM materials tend to discolor to varying degrees. Among the factors contributing to discoloration, red wine proved to be the most significant influencing factor. The conclusion from the results is that the color change is influenced by the type of material, the staining solution, the sample thickness, the color background and the aging time.

Color stability of precolored and extrinsically colored monolithic multilayered polychromatic zirconia: Effects of surface finishing and aging

PURPOSE

To explore the impact of zirconia types, coloring methods, and surface finishing on the color stability of monolithic multilayered polychromatic zirconia after artificial aging, including thermocycling and simulated toothbrushing.

MATERIALS AND METHODS

Eighty square-shaped zirconia samples were divided into 2 types (M3Y-TZP and M6Y-PSZ), further categorized based on coloring methods (precolored and extrinsically colored) and surface finishing techniques (mechanical polishing or glazing). The color stability was assessed using the CIEDE2000 formula. Artificial aging was simulated via thermocycling and toothbrushing. All samples were analyzed with a spectrophotometer to determine the post-aging color changes (ΔE00). The ΔE00 were interpreted and classified using the 50:50% perceptibility threshold (PT) and the 50:50% acceptability threshold (AT). Comparisons between groups for ΔE00 differences were performed using three-way ANOVA, with pairwise comparisons facilitated by Fisher's protected least significant difference test, α = 0.05.

RESULTS

The study results indicated significant impacts of zirconia type, coloring method, and surface finishing on color stability. The M6Y groups experienced significantly greater color changes (6.61 ± 1.63) compared to the M3Y groups (3.40 ± 2.24), p < 0.0001. For both types of zirconia, extrinsically colored samples exhibited significantly higher ΔE00 when mechanically polished (p = 0.004). However, surface finishing had no significant effect on ΔE00 in precolored samples of either zirconia material (p = 1.000). The evaluation and categorization of ΔE00 variations indicated that nearly all color changes in the M6Y groups, regardless of being precolored, extrinsically colored, polished, or glazed, were deemed extremely unacceptable (Grade 1). In contrast, the M3Y groups showed more acceptable results, with the majority of color changes classified as moderately unacceptable (Grade 3).

CONCLUSIONS

The color stability of multilayered polychromatic zirconia is influenced by the type of material, extrinsic coloring, and the chosen surface treatment post-artificial aging. The translucent 6Y-PSZ exhibited lower color stability, especially with only mechanical polishing. For the fabrication of M3Y-TZP and 6Y-PSZ monolithic multilayered polychromatic zirconia restorations, extrinsic coloring should be paired with glazing to maintain color stability. Conversely, in the absence of extrinsic coloring, both glazing and mechanical polishing are effective in preserving color stability.

Investigating the impact of post-curing cycles on surface hardness and color stability in 3D printed resin crowns

This study evaluated the effect of different post-curing cycles on the Vickers hardness, color change, and translucency value of 3D printed methacrylic acid ester-based temporary and permanent crown resins. A total of 300 samples were printed in disk shape (ø:8 mm, thickness: 2 mm) using VarseoSmile Crown Plus (VSC) and VarseoSmile Temp (VST) materials from a 3D printer. These disks were divided into five subgroups (n = 30 each) based on flash-curing cycles (0, 750, 1500, 2250, and 3000). Surface hardness tests and color tests were conducted on both the green state and flash-cured groups. The data were analyzed using univariate analysis of variance (ANOVA). The hardness of 3D printed temporary and permanent crown resin increased with post-curing time. Compared to the post-curing cycle recommended by the manufacturer, no clinically significant color change (ΔE00 ≥ 2.25) was observed in any of the polymerized groups. It was determined that permanent crown material had a more translucent structure than temporary crown material. The interaction between material and post-curing had significant effects on surface hardness, color (ΔE00), and translucency of 3D printed methacrylic acid ester-based resins.

Color stability of CAD-CAM hybrid ceramic materials following immersion in artificial saliva and wine

PURPOSE

To examine the color stability of 3D-printed and milled, interim, and definitive, restorative materials after immersion in artificial saliva and wine for 1, 3, and 6 months.

MATERIAL AND METHODS

The study used a 2 × 5 factorial design with 10 subgroups, including 2 immersion liquids (artificial saliva and wine) and 5 manufacturing technology and restorative material combinations (n = 10). Color measurements were taken using a contact-type digital spectrophotometer (CM-2600d Spectrophotometer; Konica Minolta Healthcare Americas Inc) before immersion and at 1 month (T1), 3 months (T3), and 6 months (T6) after immersion. The CIE2000 system was used to calculate quantitative measurements of color differences in ΔE00, and comparisons were made to the acceptability threshold (AT) and perceptibility threshold (PT). Repeated measures of ANOVA (α = 0.05) were used to compare differences in color changes between manufacturing technology/restorative material-immersion liquid combinations at T1, T3, and T6.

RESULTS

To compare the effect of immersion liquid and time on the manufacturing technology/restorative material groups, the ΔE00 values were compared to the PT of 0.8 and the AT of 1.8. Wine caused significant color changes in ΔE00 values beyond the PT and AT values in all groups at all time intervals, except for the AT value of milled definitive crowns (hybrid nano-ceramic material). Wine immersion caused significant ΔE00 for all manufacturing technology/restorative material groups at all time intervals (1 month, 3 months, and 6 months) when compared to artificial saliva immersion (all p < 0.001).

CONCLUSION

Upon exposure to artificial saliva, 80%-100% of samples from all groups remained within the acceptable and perceptible color change thresholds. The wine had significant chromogenic effects on all tested restorative materials, however, the milled definitive crowns (hybrid nano-ceramic material) showed the greatest color stability. For patients with heavy wine consumption, 3D-printed definitive crowns (hybrid ceramic-filled material) may show discoloration exceeding acceptable and perceptible color change limits.

The Influence of Thickness on Light Transmission for Pre- and Fully Crystallized Chairside CAD/CAM Lithium Disilicate Ceramics

AIM

This in vitro study aimed to compare the light-transmission properties of two chairside CAD/CAM lithium disilicate (LD) ceramics (a novel fully crystallized and a traditional pre-crystallized) across varying thicknesses.

MATERIALS AND METHODS

One hundred flat specimens were obtained from precrystallized (e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein) and fully crystallized (LiSi GC Block; GC, Tokyo, Japan) LD at five different thicknesses (0.5, 0.75, 1.0, 1.50 and 2.0 mm). All specimens were polished with a polishing system for lithium disilicate restorations following recommendations from the manufacturer. Light transmission was evaluated with a radiometer. The statistical analysis between e.max CAD and LiSi GC Block was performed using a Mann-Whitney test for each thickness at a significance level of 0.05 (p < 0.05), followed by a Kruskal-Wallis test to compare the light transmission between the thicknesses of e.max CAD and LiSi GC Block.

RESULTS

Light transmittance was significantly affected by ceramic thickness. The 0.5 mm thick specimens exhibited the highest transmittance values compared to all other groups, while a light transmittance of 0.00 was observed in the 2.0 mm thick specimens for both e.max CAD and LiSi GC Block. In the comparison between e.max CAD and LiSi GC Block according to thickness, there was a statistically significant difference exclusively between groups with a thickness of 1.50 mm (p = 0.002).

CONCLUSIONS

Light transmission for pre- and fully crystallized CAD/CAM lithium disilicate ceramics only showed a statistical difference at the thickness of 1.50 mm (p = 0.002). E.max CAD demonstrated acceptable light transmission up to a thickness of 1.5 mm.

CLINICAL SIGNIFICANCE

A thickness of 2 mm for chairside CAD/CAM lithium disilicate ceramics, whether pre-crystallized or fully crystallized, necessitates the use of dual-cure resin luting cement due to reduced light transmission.

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

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

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of sintering on the translucency of CAD-CAM lithium disilicate restorations: A comparative in vitro study

PURPOSE

The available independent data on the translucency of novel pre and fully sintered chairside computer-aided design and computer-aided manufacturing (CAD-CAM) lithium disilicate are limited. This comparative in vitro study evaluated the translucency degree of pre and fully sintered chairside CAD-CAM lithium disilicate crowns after optional, required, and additional firing processes.

MATERIALS AND METHODS

One hundred and five maxillary left central incisor crowns manufactured by three different CAD-CAM lithium disilicate brands shade A1 were assigned into seven groups as follows (n = 15): (1) Straumann n!ce without sintering; (2) Straumann n!ce with one additional sintering process; (3) Straumann n!ce with two additional sintering processes; (4) Amber Mill with one sintering process; (5) Amber Mill with two sintering processes; (6) IPS e.max CAD with one sintering process; and (7) IPS e.max CAD with two sintering processes. The translucency of all crowns was evaluated with a color imaging spectrophotometer. All statistical analyses were performed using statistical software. A standard level of significance was set at α < 0.05.

RESULTS

All the milled crowns presented different degrees of translucency, and additional sintering processes altered it. IPS e.max CAD with two (4.33 ± 0.26) and one (4.01 ± 0.15) sintering processes displayed the highest translucency, whereas Straumann n!ce with no sintering process provided the lowest value (2.82 ± 0.16).

CONCLUSIONS

The translucency of chairside lithium disilicate single-unit full-coverage restorations manufactured with subtractive technology was significantly influenced by the brand and the number of sintering processes. The traditional presintered IPS e.max CAD and the fully crystallized glass-ceramic Straumann n!ce considerably increased the translucency after one additional firing process, whereas Amber Mill decreased its translucency.

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

STATEMENT OF PROBLEM

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

PURPOSE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluation of one versus two glaze firings on the color stability and mechanical properties of an extrinsically characterized monolithic CAD-CAM lithium disilicate glass ceramic

PURPOSE

To evaluate the effects of 1 versus 2 glaze firings on the color and mechanical properties of an extrinsically characterized lithium disilicate ceramic after thermal cycling, brushing, or both.

MATERIALS AND METHODS

Eighty specimens were divided into 2 groups: 1 glaze firing (GL1) and 2 glaze firings (GL2). Each group was subdivided into 4 groups (n = 10), according to the experimental conditions: thermal-cycling, brushing, thermal-cycling + brushing, and immersion in distilled water (control). Color variation, surface roughness, and Vickers microhardness were analyzed before each designated experiment and after the simulated periods of 2.5, 5, and 10 years. Three-way mixed ANOVA was used for all outcomes, followed by 1-way ANOVA, repeated measures 1-way ANOVA, Bonferroni post hoc test, and t-test to check for statistical differences (α = 0.05).

RESULTS

Thermal cycling generated greater color changes in the GL1 group at 2.5 and 5 years (p < 0.001; p = 0.013). Brushing generated color changes in GL1 at 5 years (p = 0.003) and in GL2 at 10 years (p = 0.017). Regarding surface roughness, the GL1 group suffered alterations in thermal cycling + brushing at 5 years. In the control group, the GL1 group exhibited higher roughness values than GL2 (p < 0.05). Most of the groups experienced an increase in microhardness at 2.5 years (p < 0.05). In the GL1 group, thermal-cycling increased the microhardness at 5 years (p = 0.006); at 5 and 10 years, the GL1 group had a higher microhardness than the GL2 in thermal-cycling + brushing (p < 0.05).

CONCLUSION

Ceramics with 1 glaze firing showed greater color, roughness, and microhardness changes compared to those submitted to 2 firings.

Evaluation of Glazing and Polishing Systems for Novel Chairside CAD/CAM Lithium Disilicate and Virgilite Crowns

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of glazing, two zirconia, and two lithium disilicate polishing systems on surface roughness of a CAD/CAM lithium disilicate and virgilite ceramic with atomic force microscopy (AFM) and visual assessment performed by dental students and faculty.

METHODS AND MATERIALS

Sixty maxillary right central incisor crowns made of a novel chairside CAD/CAM lithium disilicate and virgilite (CEREC Tessera) were milled for glazing and polishing. The crowns were divided into six groups: no polishing/glazing provided (NoP/G); glazed (GZ); glazed and polished with Brasseler Dialite LD Lithium Disilicate (DiLD); glazed and polished with Meisinger Luster Lithium Disilicate (LuLD); glazed and polished with Brasseler Dialite ZR Zirconia (DiZR); and glazed and polished with Meisinger Luster Zirconia (LuZR). Surfaces were scanned with AFM to measure roughness (Ra) and root mean square roughness (Rq) and generate micrographs. Crowns were visually assessed by 10 dental students and 10 dental school faculty members to determine clinical acceptableness.

RESULTS

Glazing and all polishing kits significantly reduced Ra and Rq compared to no polishing/glazing. No significant Ra differences were found between glazing and all polishing kits (p>0.05). DiZR significantly reduced Rq compared to other groups (p<0.05). Visual assessment showed that GZ, LuLD, and DiZR were the most clinically acceptable crowns.

CONCLUSION

Polishing and glazing considerably improve the surface smoothness of maxillary central incisor crowns fabricated out of a chairside CAD/CAM lithium disilicate and virgilite ceramic. Altogether, zirconia polishing systems provided smoother and more clinically acceptable surfaces than the lithium disilicate kits.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

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

Influence of coloring techniques on the surface characteristics and color stability of a monolithic zirconia ceramic

STATEMENT OF PROBLEM

The color of monolithic zirconia restorations is obtained by presintering or postsintering coloring techniques. However, studies on the differences in surface characteristics and their influence on color stability are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of shading and staining techniques for a zirconia ceramic on the surface characteristics and colorimetric parameters (color difference, translucency, and whiteness index) after exposure to coffee or red wine and then polishing.

MATERIAL AND METHODS

Ceramic disks (N=30; Ø10×1mm) were allocated into 3 groups: preshaded-shaded by the manufacturer (IPS e.max ZirCAD MT, shade A2); manually shaded-unshaded zirconia (IPS e.max ZirCAD MT, bleaching shade-BL) colored by the brushing technique, before sintering; stained-unshaded zirconia (IPS e.max ZirCAD MT BL) colored by the staining technique, after sintering. Spectrophotometric color assessments ensured the same initial perceived color (Vita Classical A2) for specimens included in the study (∆E00<1.77 acceptability threshold). Surface characteristics were assessed by scanning electron microscopy and atomic force microscopy. The specimens were immersed in coffee (n=5) or red wine (n=5) for 12 and 24 days and subsequently polished. The data were statistically and descriptively analyzed for color differences (∆E00), translucency parameters (TP00), and whiteness indexes for dentistry (WID), considering acceptability and perceptibility thresholds.

RESULTS

The shaded groups found an irregular ceramic surface with uniformly sized zirconia crystals. The stained group found a glass-covered smoother surface. Significant alterations in color parameters (∆E00, TP00, WID) were observed with immersion in pigmenting beverages (P<.001) both after 12 days, and after 24 days. The shaded specimens had greater color alterations after immersion but benefited from the polishing procedure, which reduced color differences below an acceptable threshold in comparison with the baseline. Stained specimens had lower color alterations after immersion, but the polishing protocol was detrimental as it whitened the ceramic by subsurface exposure.

CONCLUSIONS

The coloring technique influences the surface characteristics of zirconia ceramic and also the color parameters after exposure to colored beverages and polishing.

Clinical evaluation of cemented and adhesively resin-bonded monolithic and partially layered zirconia and lithium disilicate crowns

Purpose

Zirconia and lithium disilicate crowns are very popular dental restorations. The cement type and layering technique used can profoundly affect the clinical performance of these crowns.This retrospective study is designed to investigate the success rate of cemented and adhesively bonded monolithic and partially layered zirconia and lithium disilicate crowns placed in faculty practice settings.

Materials and Methods

Patients who had received zirconia or lithium disilicate crowns at the faculty practice were invited for clinical examination. The examiner used the modified United States Public Health Service (MUSPHS) evaluation criteria to evaluate the crowns. The crowns were either glass ionomer cemented zirconia (GIC-Zr), resin-bonded zirconia (Adh-Zr), or resin-bonded lithium disilicate (Adh-LD). The crowns were also divided into monolithic and layered groups. Inferential analysis was used to examine the differences through bivariate analysis using t-testing and one-way ANOVA.

Results

Thirty-five patients, with a combined total of 218 single crowns, agreed to participate in the study. No statistically significant differences in the quality outcome variables considered were found between the groups, except for marginal adaptation, where Adh-Zr achieved significantly higher scores compared to GIC-Zr and Adh-LD. Layered zirconia and lithium disilicate crowns have significantly higher quality outcomes in terms of anatomic form, marginal adaptation, and color match compared to monolithic zirconia and lithium disilicate crowns.

Conclusions

Conventionally cemented zirconia and adhesively bonded zirconia and lithium disilicate crowns are reliable treatment options with high short-term success rates. Clinical studies with longer follow-up times are needed to investigate their long-term success rates.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

The Effect of Finishing and Polishing with Proprietary Vs Interchanged Polishing Kits on the Surface Roughness of Different Ceramic Materials

PURPOSE

To evaluate the surface roughness of glazed and polished monolithic ceramic materials and to use this as a baseline for comparison after adjustment and polishing with both the recommended kit for the specific materials as well as interchanged polishing kits.

MATERIAL AND METHODS

Flat ceramic specimens (n = 150) were fabricated from IPS ZirCAD Prime, IPS E.max, and Vitabloc Mark II. The specimens were adjusted and polished using either the proprietary polishing kit for the material or interchanged kits. The surface roughness was objectively assessed using Atomic Force Microscopy (AFM) and profilometer. Subjective assessment of surface finish was performed using a scanning electron microscope (SEM). Gravimetric weight loss of each sample was measured before and after polishing using a digital microscale. The mean surface roughness and standard deviation was calculated for each ceramic- polisher pair. A factorial ANOVA was used to compare the mean surface roughness values in nanometers between multiple groups (α = 0.05). The subjective results from the SEM were reported as descriptive statistics RESULTS: The zirconia polishing system produced surfaces with the lowest surface roughness regardless of the ceramic material. The polisher-ceramic combination was found to have a statistically significant effect on both Ra and RMS values when the AFM was used (p = 0.039 and 0.010, respectively).

CONCLUSION

The zirconia polishing system resulted in the lowest surface roughness values regardless of ceramic materials tested. The zirconia polishing system also did not result in significant gravimetric weight loss regardless of the ceramic material used.

Indirect restorative systems-A narrative review

OBJECTIVE

The background and clinical understanding of the properties of currently available indirect restorative systems and fabrication methods is, along with manufacturer and evidence-based literature, an important starting point to guide the clinical selection of materials for tooth and/or implant supported reconstructions. Therefore, this review explores most indirect restorative systems available in the market, especially all-ceramic, along with aspects of manufacturing process, clinical survival rates, and esthetic outcomes.

OVERVIEW

Progressive incorporation of new technologies in the dental field and advancements in materials science have enabled the development/improvement of indirect restorative systems and treatment concepts in oral rehabilitation, resulting in reliable and predictable workflows and successful esthetic and functional outcomes. Indirect restorative systems have evolved from metal ceramics and polymers to glass ceramics, polycrystalline ceramics, and resin-matrix ceramics, aiming to improve not only biological and mechanical properties, but especially the optical properties and esthetic quality of the reconstructions, in attempt to mimic natural teeth.

CONCLUSIONS

Based on several clinical research, materials, and patient-related parameters, a decision tree for the selection of indirect restorative materials was suggested to guide clinicians in the rehabilitation process.

CLINICAL SIGNIFICANCE

The pace of materials development is faster than that of clinical research aimed to support their use. Since no single material provides an ideal solution to every case, professionals must continuously seek information from well designed, long-term clinical trials in order to incorporate or not new materials and technological advancements.

Effectiveness and safety of bleaching agents on lithium disilicate glass ceramics

Background

Aesthetic expectations have increased the use of aesthetic materials in dentistry. Lithium disilicates are frequently used materials for these expectations. Bleaching is another method used to provide aesthetics. Bleaching processes on restorative materials are not fully known. This study investigated the effect of at-home and in-office bleaching methods on the color change, surface roughness, and topography of lithium disilicate glass-ceramic materials produced with two different techniques and subjected to different polishing procedures.

Methods

A total of 144 disc-shaped pressed and computer-aided design (CAD) lithium disilicate glass-ceramic specimens were randomly divided into four groups. Glazing and three different chair-side polishing procedures were performed. The specimens in each group were randomly divided into two groups and subjected to at-home and in-office bleaching processes (n=9). The home bleaching process was repeated with 16% carbamide peroxide agent for six hours for seven days, while the in-office bleaching process was applied with 40% hydrogen peroxide agent for two sessions of 20 minutes. After the bleaching processes, the final color and surface roughness experiments of the specimens were carried out, and the results were recorded. ANOVA and Tukey multiple comparison tests were used FOR the statistical analysis of the data (α=0.05).

Results

The material*polish*bleaching, polish*bleaching, material*bleaching, and material*polishing interactions were not statistically significant regarding color and roughness changes of both specimens (P>0.05).

Conclusion

Both bleaching processes can be safely applied to lithium disilicate glass-ceramic materials.

In vitro study on how antioxidant solutions affect enamel surface characteristics and bonding interface of ceramic laminate veneers luting after dental bleaching

PURPOSE

This in vitro study aimed to determine the effect of antioxidant solutions used after dental bleaching on the shear bond strength and adhesive interface sealing of ceramic laminate veneer luting. Additionally, effects on the enamel surface characteristics of hydrogen peroxide neutralization, surface energy, total free interaction energy, morphology, and chemical composition of enamel were assessed.

MATERIAL AND METHODS

Total 127 bovine incisors were divided into experimental groups, according to the surface treatment (unbleached and bleached enamel), antioxidant types (control; 10% ascorbic acid and 10% α-tocopherol), and periods of luting of ceramic laminates (24 h and after 14 days). Shear bond strength was assessed using microtensile test before and after thermal cycling (5760 cycles, 5-55 °C) (n = 6). The sealing of the adhesive interface was assessed using a confocal laser scanning microscope (n = 3). Hydrogen peroxide neutralization analysis was performed using a spectrophotometer (n = 5). The surface energy and total free interaction energy (n = 10) were measured using an automatic goniometer, while enamel morphology and chemical composition were assessed by scanning eletron microscopy (n = 3). Shear bond strength and enamel surface properties data were subjected to ANOVA followed by Tukey's test (α = 0.05). Adhesive interface micrographs were evaluated by the inter-examiner Kappa test and subjected to Kruskal-Wallis and Dunn's tests (α = 0.05).

RESULTS

In general, thermal aging decreased the shear bond strength values of the luting agents to enamel (P < .05). The α-tocopherol solution was able to reverse the oxidizing effect from dental bleaching, increasing the shear bond strength values and preserving the integrity of the adhesive interface sealing (P < .05). Moreover, the α-tocopherol antioxidant agent promoted higher hydrogen peroxide neutralization after dental bleaching (P < .05). Dental bleaching influenced the enamel surface, decreasing the surface energy and total free interaction energy values (P < .05).

CONCLUSION

α-tocopherol was able to reverse the oxidizing effects of dental bleaching, improving the enamel surface properties, as well as the adhesion and interface sealing of ceramic laminate veneer restorations.

Impact of Smokeless Tobacco on the Color Stability of Zirconia, Zirconia-Reinforced Lithium Silicate and Feldspathic CAD/CAM Restorative Materials: An In-Vitro Study

WHO estimates that the global number of tobacco users exceeds 1.3 billion people. Few studies have examined the effect of locally made smokeless tobacco (ST) products on the color changes of material used in dental prosthetics. Bearing the recent advances in CAD/CAM ceramic restorations material in mind, this study aimed to assess ST influence on mean color change (∆E*) values among selected CAD/CAM ceramic types: multilayer zirconia (Ceramill Zolid PS), zirconia-reinforced lithium silicate ceramic (Vita Suprinity), and feldspathic (Vita TriLuxe) restorative materials. The color changes of the ceramics were compared to VITA classical and VITA 3D-MASTER shade guides. Sixty CAD/CAM ceramic specimens (20 samples each) were fabricated from Ceramill Zolid PS, Vita TriLuxe Forte, and VITA Suprinity. Specimens were prepared and divided into two groups according to the ST type and immersed for two weeks. Basic VITA classical and VITA 3D-MASTER colors were recorded at a baseline of one week and two weeks. The highest ∆E* values were recorded in the black ST for Vita Suprinity (4.77) in the first week, followed by Vita TriLuxe (4.07) in the second week. For white ST, Vita TriLuxe (4.87), and Vita Suprinity (4.42) showed extensive color change after two weeks and one week, respectively. The color change was least in zirconia for black and white ST after one week. CAD/CAM ceramic materials showed no significant difference after 1 and 2 weeks for the tested ST types. The effects of ST on CAD/CAM ceramic material (∆E* values) were high but did not reach clinically unacceptable values. Zirconia showed the least amount of color change among all the tested materials.

Color stability of fully- and pre-crystalized chair-side CAD-CAM lithium disilicate restorations after required and additional sintering processes

PURPOSE

The aim of this study was to investigate shade changes in fully- and pre-crystalized CAD-CAM lithium disilicate crowns after the required and additional firing processes.

MATERIALS AND METHODS

One hundred and five crowns of shade A1 with high translucency were milled out of CAD-CAM lithium disilicate blocks and categorized as follows (n = 15): (1) restorations fabricated from Straumann n!ce with no additional sintering process; (2) restorations fabricated from Straumann n!ce with one additional sintering process; (3) restorations fabricated from Straumann n!ce with two additional sintering processes; (4) restorations fabricated from Amber Mill with one sintering process; (5) restorations fabricated from Amber Mill with two sintering processes; (6) restorations fabricated from IPS e.max CAD with one sintering process; (7) restorations fabricated from IPS e.max CAD with two sintering processes. All restorations were evaluated with a color imaging spectrophotometer.

RESULTS

All restorations presented some color alteration from the original shade both after a single and after two firing processes.

CONCLUSION

The required and additional sintering processes for restorations fabricated with chairside CAD-CAM lithium disilicate blocks cause an alteration of the original shade selected. Shade A1 high translucency restorations tend to change to a more yellowish B1 shade after a sintering process.

Effect of staining on the mechanical, surface and biological properties of lithium disilicate

•

Staining and glazing procedures affects the microbial adherence and surface roughness.

•

Stained and glazed surfaces result in higher wear than polished ceramic surfaces.

•

The stain and glaze layer on the ceramic surface promotes lower strength value.

Purpose

To simulate biodegradation and wear of stained and glazed CAD lithium disilicate ceramic, and evaluate their effects on the microbial adherence and mechanical and surface properties of lithium disilicate ceramic

Materials and methods

160 lithium disilicate ceramic discs were fabricated and divided in eight groups according to manual stain and glaze application with a fine paint brush (without stain and glaze; with stain and glaze) and aging procedures (no aging; wear at 30 N load, 1.7 Hz, 3 × 10⁵ cycles; biodegradation by exposure to microcosm biofilm; biodegradation + wear; biodegradation + wear). Profilometry was performed to determine the surface roughness and the wear consequences. Biaxial flexural strength test was performed, and a Streptococcus mutans adherence test was conducted to evaluate the number of colony forming units.

Results

Unaged samples with and without stain and glaze presented the lowest values of surface roughness (p < 0.001), but after aging (wear, biodegradation, or both), the samples in the stain and glaze groups were rougher than those in the no stain and glaze groups (p < 0.001). The stain and glaze groups showed the highest volume of wear after aging (p = 0.04), and had the lowest flexural strength values (p < 0.01), irrespective of the aging method. The aging method did not affect the flexural strength (p = 0.06). The number of colonies forming units was higher for biodegradation + no stain and glaze, biodegradation + wear + no stain and glaze, no aging + stain and glaze, biodegradation + stain and glaze, and biodegradation + wear + stain and glaze. The lowest values were observed for no aging + no stain and glaze.

Conclusion

The staining and glazing of lithium disilicate increased the surface wear and bacterial adherence, and decreased biaxial flexural strength of the material. When exposed to S. mutans, surface roughness increased, and biodegradation favored bacterial adherence.

Stainability of different ceramic materials against mouth rinses and effect of polishing after staining

STATEMENT OF PROBLEM

Mouth rinses are known to stain tooth surfaces. However, their staining effect on different ceramics after prolonged use and the effect of polishing after staining are still unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the stainability of different ceramic materials against different mouth rinses and the effect of polishing on staining.

MATERIAL AND METHODS

Forty disk-shaped specimens were prepared from each material (total of 160 specimens): lithium disilicate (IPS e.max CAD), zirconia-reinforced lithium disilicate (VITA SUPRINITY PC), leucite-reinforced feldspar (GC Initial LRF), and resin matrix ceramic (CERASMART). Baseline color measurements (T0) were recorded with a clinical spectrophotometer (VITA Easyshade V). The specimens were immersed in chlorhexidine gluconate (CHX) 0.2% mouth rinse (Klorhex), (KLO) chlorhexidine gluconate 0.1% mouth rinse (Eludril) (ELU), a daily mouth rinse (LISTERINE Cool Mint) (LIS), artificial saliva (CON) continuously for 7 days (T1), 14 days (T2), and 28 days (T3). Discoloration values (ΔE) between the immersion time points (T0,T1,T2,T3) were calculated by using the following formula: ΔE= ([ΔL∗]² + [Δa∗]² + [Δb∗]²)^1/2. After the immersion process, specimens were polished and ΔE values remeasured. The Kruskal-Wallis and Mann-Whitney U tests were performed (α=.05) and were adjusted by postanalysis Bonferroni testing.

RESULTS

KLO caused the highest ΔE values in all groups. IPS e.max CAD had the lowest ΔE values, and CERASMART showed the highest ΔE values against all of the solutions (P<.05). However, polishing caused a decrease in the ΔE values in all groups.

CONCLUSIONS

Prolonged use of mouth rinses may cause color change in different ceramic materials. Polishing affected the color change and resulted in a decrease in ΔE values. Mouth rinses containing CHX should be recommended with caution for daily use.

The effect of bleaching on the optical and physical properties of externally stained monolithic zirconia

Objective

This study aimed to investigate the effects of bleaching on the color, translucency, surface roughness, and surface hardness of monolithic zirconia with external stainin .

Methods

In this experimental study, 32 specimens of monolithic zirconia (1 × 1 mm; shade A2) were divided into two groups based on random permuted blocks. Overglaze and staining procedures were performed with a yellow stain or a value stain (GC Stain). Baseline color, translucency, roughness, and surface hardness were measured. The specimens were then randomly bleached with hydrogen peroxide (HP) 40% (20 min, twice with a 1‐week interval in between) as office bleaching or carbamide peroxide (CP) 20% (4 h per day for 14 days) as home bleaching. Finally, the color, translucency, surface roughness, and surface hardness were measured again.

Results

Bleaching with CP and HP caused a perceptible change in the color of the specimens (ΔE > 2), although this change was within the clinically acceptable range (ΔE < 3.3). HP significantly reduced the surface hardness of the specimens (p = 0.043). Changes in surface roughness of the specimens were neither statistically nor clinically significant (p = 0.19 and p = 0.25 for office and home bleaching, respectively).

Conclusion

The effects of home and office bleaching on the surface characteristics of monolithic zirconia were almost the same. It is not necessary to exchange or even to polish the surfaces of zirconia restorations after exposure to bleaching agents. Further studies are recommended to confirm the color stability of externally stained monolithic zirconia.

Optical behaviors, surface treatment, adhesion, and clinical indications of zirconia-reinforced lithium silicate (ZLS): A narrative review

OBJECTIVES

The present narrative review was focused on the optical properties, surface treatment, adhesion, and clinical indications of zirconia-reinforced lithium silicate ceramics (ZLS) for Computer-aided design / Computer-aided manufacturing (CAD/CAM) technologies.

DATA/SOURCES

A literature search was performed by 3 calibrated independent researchers on PubMed, Scopus, Embase, Google Scholar, Dynamed, and Open Grey. The criteria for inclusion were: 1) papers addressing at least one of the following variables about ZLS: optical properties, surface treatment, adhesion, and clinical indications; 2) in vitro, in silico, or in vivo studies; 3) case reports; 4) systematic reviews. The exclusion criteria were: 1) animal studies; 2) non-dental studies; 3) studies only focusing on ZLS used in the heat-pressed process.

STUDY SELECTION

98 records among in vitro studies and case reports were included.

CONCLUSIONS

Despite the promising microstructure characteristics of ZLS, increased translucency compared to lithium disilicate ceramics (LS₂) was not proven, but acceptable color changes and stability were reported. Mechanical polishing was the most effective method to reduce surface roughness. Moreover, machinability and handling of ZLS resulted harder than LS₂. Conventional acid etching procedures seemed effective in conditioning ZLS surface, but no protocol has been established yet. Besides, silane-coupling and dual-curing resin cements were recommended.

CLINICAL SIGNIFICANCE

ZLSs can be used for anterior and posterior fixed single-unit CAD/CAM restorations onto both natural teeth and implants, but do not seem to represent a viable treatment option for endocrowns onto posterior teeth or fixed dental prostheses.

Review on Polymer, Ceramic and Composite Materials for CAD/CAM Indirect Restorations in Dentistry-Application, Mechanical Characteristics and Comparison

The aim of this review article is to present various material groups, including ceramics, composites and hybrid materials, currently utilized in the field of CAD/CAM. The described technology is amongst the most important in modern prosthetics. Materials that are applicable in this technique are constantly tested, evaluated and improved. Nowadays, research on dental materials is carried out in order to meet the increasing demand on highly aesthetic and functional indirect restorations. Recent studies present the long-term clinical success of restorations made with the help of both ceramic and composite materials in the CAD/CAM method. However, new materials are developed and introduced that do not have long-term in vivo observations. We can outline a monolithic polymer-infiltrated ceramic network and zirconia teeth support that show promising results to date but require further assessment. The materials will be compared with regard to their mechanical and clinical properties, purpose, advantages and limitations.

Toothbrushing Wear Resistance of Stained CAD/CAM Ceramics

Aim: To investigate the effect of toothbrushing on different stained Computerd Aided Design/Computer Aided Manufacturing CAD/CAM ceramics. Materials and Methods: Fifty specimens (high translucency zirconia, YZHT; zirconia-reinforced lithium silicate, ZLS; feldspathic, FDL; hybrid ceramic, HC; all from Vita Zahnfabrik) were divided into five groups according to their staining technique. ZLS allowed the composition of two groups: ZLS1 with crystallization and staining together; ZLS2, with the stain firing after the crystallization. YZHT received a stain firing after the sintering process, and FDL received stain firing directly. The HC was stained with acrylic staining, and was light-cured on its surface. The specimens were brushed in total for 150,000 cycles at 2.45 N with 180 strokes/min. Surface measurements to obtain Rz were performed after 50,000, 100,000 and 150,000 cycles, with five evaluation lines (5 mm) per specimen orthogonal to the brushing direction, covering brushed and unbrushed areas. The wear was analyzed using two-way ANOVA and Tukey tests (α = 5%). Scanning electron microscopy (SEM) was performed to access the surface profile. The wear was affected by material (p < 0.001) and time (p = 0.139). Superior wear (µm) was observed for HC (6.6 ± 4.4; 6.8 ± 4.0; 9.2 ± 3.5) compared to ZLS2 (1.0 ± 0.3; 1.2 ± 2.2; 1.3 ± 0.3), YZHT (1.0 ± 0.1; 1.2 ± 0.3; 1.2 ± 0.3), ZLS1 (0.9 ± 0.1; 1.1 ± 0.5; 1.2 ± 0.3) and FDL (0.9 ± 0.1; 0.9 ± 0.1; 1.0 ± 0.2) after 5, 10 and 15 years of simulation, respectively. SEM showed different wear patters for HC with the removal of the glaze layer. HC showed a higher staining wear rate compared to the glass-based and polycrystalline ceramics after 15 years. The extrinsic characterization of feldspathic ceramic showed its superior longevity compared to the evaluated high-translucency zirconia, zirconia-reinforced lithium silicate, and hybrid ceramic.

Effect of surface finishing treatments on the color stability of CAD/CAM materials

PURPOSE

The aim of this study was to evaluate the effect of different surface finishing processes on the color stabilities of lithium disilicate glass-ceramics, zirconia-reinforced lithium silicate ceramics, and resin nanoceramics after artificial ageing.

MATERIALS AND METHODS

216 samples were prepared from 3 different CAD/CAM materials (LAVA Ultimate, IPS e.max CAD, VITA Suprinity) with A1 HT color at a size of 14 × 12 mm and a thickness of 0.5 ± 0.05 mm. Color measurements of the samples were performed with a spectrophotometer using color parameters and CIE Lab color system on a gray backing between baseline color and after 5000 cycles of artificial ageing in 4 stages (i.e. the first measurement before the treatment, the second measurement after polishing, the third measurement after cement application, and the fourth measurement after artificial ageing). The results were evaluated using the Variance analysis and Fisher's LSD test.

RESULTS

Resin nanoceramics (LU) exhibited higher color change values than zirconia-reinforced lithium silicate (VS) and lithium disilicate (EC) ceramics after artificial ageing. Manual polishing and glazing resulted in similar color change for LU and VS (P>.05). In the EC group, glazing provided statistically different results as compared to the manual polishing and control groups (P<.05). Among the ceramic groups, color change values of the subgroup, which was treated by glazing, of the zirconia-reinforced lithium silicate (VS) and lithium disilicate (EC) samples were below the clinically acceptable level (ΔE < 3.5).

CONCLUSION

The lowest color change for all stages was observed in Vita Suprinity.

Color matching of full ceramic versus metal-ceramic crowns - a spectrophotometric study

Background and aims

To verify the color match of metal-ceramic and full ceramic crowns, using instrumental methods.

Methods

A number of 153 teeth (anterior and posterior teeth), in 62 patients, were restored with metal ceramic (MC, n=119), pressed-ceramic (PC, n=28), and zirconia-ceramic (ZC, n=6) full coverage crowns. The shade of a reference natural tooth was recorded instrumentally with a dental spectrophotometer (Vitaeasyshade Advance 4.0) in “single tooth measurement”, which provided the base color in Vita Classic (VC) and Vita 3D Master shades (3D).

For verifying the outcome of the restoration “verify restoration” mode was used, and ΔE values were recorded for both VC and 3D Master shade guides. Moreover, matching symbols were also recorded (***=good, **=fair, *=poor). Descriptive statistics was performed and data were analyzed (One-sample z-Test, α=0.05) for comparison with visual thresholds in dentistry (Perceptibility Threshold – PT=1.2 and Acceptability Threshold – AT=2.7).

Results

The data did not follow a normal distribution (Kolmogorov-Smirnov test, p<0.05). Recorded color difference was significantly higher than PT and AT, for all types of restorations, regardless of the coding system (p<0.05). For MC crowns in 2.52% (4.20% for 3D) of the cases the color difference was smaller than PT, in 19.32% (the same for 3D) of cases was between PT and AT, and in 78.15% (76.47% for 3D) of cases was higher than the AT. For PC crowns in 3.57% (0% for 3D) of the cases the color difference was smaller than PT, in 25% (32.14% for 3D) of cases was between PT and AT, and in 71.42% (67.85% for 3D) of cases was higher than the AT. In the case of ZC crowns none of the restorations had color difference smaller than PT, but in 16.66% of cases was between PT and AT, and in 83.33% of cases was higher than the AT, for both VC and 3D.

Conclusion

Within the limitations of the study, a better color match was achieved in the case of pressed ceramic crowns, made of lithium disilicate. In most of the situations the color difference between the restoration and the reference tooth exceeded the perceptibility thresholds, but the matching was recorded as “fair” by the spectrophotometer.

An in vitro evaluation of the effect of polishing on the stainability of different CAD/CAM ceramic materials

Purpose

To determine the effect of coffee on the stainability of CAD/CAM ceramics after different surface treatment protocols.

Methods

Ninety specimens (2 mm × 10 mm) of CAD/CAM ceramic materials (Vitablocs Mark II, VITA Enamic, and VITA Suprinity) were prepared. The specimens were subdivided (n = 10) into three groups: G1: Glazed (control group), G2: Subjected to finishing and polishing, and G3: Re-glazed after finishing and polishing. The surface treatment was performed using a diamond polishing system for porcelain (Diapol) followed by applying a diamond polishing paste (Diapolisher). The specimens were immersed in distilled water for 24 h, and the baseline color measurement after finishing and polishing was recorded. Each group was then immersed in a staining solution (coffee) for one week, and the second color measurement was recorded.

Results

The color of the CAD/CAM ceramic materials in the finishing and polishing groups changed significantly after staining (P < 0.05). Statistically significant differences were noticed after staining in the polished groups of Vita Enamic and Vita Suprinity compared with the glazed group (control). However, the color change between the re-glazed and control groups was insignificant for all the materials (P > 0.05). Although the color change values of the three CAD/CAM materials increased, these changes were within the clinically acceptable value (ΔE < 3.3).

Conclusion

Staining of the tested CAD/CAM ceramic materials increased the color change values within the clinically acceptable range in all the groups, with the highest values found after finishing and polishing. Re-glazing is recommended after surface adjustment for all the tested materials to increase their resistance to staining.