Novel Translucent and Strong Submicron Alumina Ceramics for Dental Restorations

Conventional sintering of nano-crystalline Yttria-Stabilized Zirconia enables high-strength, highly translucent and opalescent dental ceramics

Development of restorative materials capable of mimicking optical and mechanical performance of natural teeth is a quest in aesthetic density. Yttria-Stabilized Zirconia (YSZ) ceramics represent one of the most popular choices for dental restorations, owing to their biocompatibility, white colour, and the possibility to use CAD-CAM technologies. In particular, YSZ doped with 3 mol. % yttria (3YSZ) is popular because it presents high strength. Nonetheless, the limited light transmission of commercially available high strength 3YSZ does not meet the requirements of highly aesthetic cases. On the other side, YSZ presenting a larger portion of yttria are more translucent but exhibit modest strength. Here, we report on fabrication of dense zirconia nanostructures in bulk form via conventional pressure-less sintering at temperatures down to 1100-1200 °C, achieving highly translucent and strong 3YSZ with significant opalescent behaviour. Both Hall-Petch and inverse Hall-Petch relationship were observed in 3YSZ samples with average grain size in the range of 250 nm and 55 nm, demonstrating the importance of grain size control to enhance both optical and mechanical properties of zirconia ceramics, simultaneously. Maximum biaxial strength of 1980 ± 260 MPa, in-line light transmission of 38% in the visible spectrum and opalescence approaching that of enamel were obtained at optimum grain size of 80 ± 5 nm. The notable optical properties are linked to the miniaturization of the residual pores and refinement of grain size towards the nanoscale while the superior mechanical strength is justified by the activation of different energy dissipation processes at nano and macroscale.

Emerging trends and clinical recommendations for zirconia ceramic crowns: a concise review

Introduction A little over ten years ago, zirconia crowns made their debut in the field of dentistry. Despite early problems with the chipping of veneering porcelain, clinical studies have demonstrated excellent performance. It is essential for a ceramic crown to have good aesthetic qualities, in addition to having good mechanical characteristics. The exceptional mechanical qualities of zirconia crowns and the simplicity with which they may be machined, employing computer-aided design and computer-aided manufacturing schemes, are primarily responsible for the widespread use of these materials in clinical settings. New ceramic-based materials, including monolithic zirconia, zirconia-containing lithium disilicate ceramics, and graded glass/zirconia/glass, have recently been launched in the field of dentistry. These newly discovered zirconia crown materials stem from varied technological approaches, each likely to lead to additional clinical advancements. At this point, it seems imperative to offer a concentrated report on the newer developments, along with essential clinical recommendations for best clinical outcomes with zirconia crowns.Types of studies This review article is a consolidation of several case studies, cohort studies and systematic reviews, as well as experimental and observational randomised control trials and other peer-reviewed articles.Results On reviewing, a concise list of clinical recommendations is generated, demonstrating that monolithic zirconia offers some clinical advantages over veneered zirconia crowns.Conclusion This review article discloses various clinical revelations and in-office recommendations for favourable usage of zirconia ceramic crowns that can lead to better patient outcomes and long-term clinical success rates.

Effect of multiple firings on optical and mechanical properties of Virgilite-containing lithium disilicate glass-ceramic of varying thickness

OBJECTIVES

To investigate the effect of multiple firings on color, translucency, and biaxial flexure strength of Virgilite-containing (Li0.5Al0.5Si2.5O6) lithium disilicate glass ceramics of varying thickness.

MATERIALS AND METHODS

Sixty discs were prepared from Virgilite-containing lithium disilicate blocks. Discs were divided according to thickness (n = 30) into T0.5 (0.5 mm) and T1.0 (1.0 mm). Each thickness was divided according to the number of firing cycles (n = 10); F1 (Control group): 1 firing cycle; F3: 3 firing cycles, and F5: 5 firing cycles. The discs were tested for color change (ΔE00) and translucency (TP00) using a spectrophotometer. Then, all samples were subjected to biaxial flexure strength testing using a universal testing machine. Data were collected and statistically analyzed (α = 0.5). For chemical analysis, six additional T0.5 discs (2 for each firing cycle) were prepared; for each firing cycle one disc was subjected to X-ray diffraction analysis (XRD) and another disc was subjected to Energy dispersive X-ray spectroscopy (EDX) and Scanning electron microscope (SEM).

RESULTS

Repeated firing significantly reduced the translucency of F3 and F5 compared to F1 in T0.5 (p < 0.001), while for T1.0 only F5 showed a significant decrease in TP00 (p < 0.001). For ΔE00, a significant increase was recorded with repeated firings (p < 0.05) while a significant decrease resulted in the biaxial flexure strength regardless of thickness.

CONCLUSIONS

Repeated firings had a negative effect on both the optical and mechanical properties of the Virgilite-containing lithium disilicate glass ceramics.

CLINICAL RELEVANCE

Repeated firings should be avoided with Virgilite-containing lithium disilicate ceramics to decrease fracture liability and preserve restoration esthetics.

Recent advances in dental zirconia: 15 years of material and processing evolution

OBJECTIVES

The objective was to discuss the research on zirconia published in the past 15 years to help the dental materials community understand the key properties of the types of zirconia and their clinical applications.

METHODS

A literature search was performed in May/2023 using Web of Science Core Collection with the term "dental zirconia". The search returned 5102 articles, which were categorized into 31 groups according to the research topic.

RESULTS

The current approach to improving the translucency of zirconia is to decrease the alumina content while increasing the yttria content. The resulting materials (4Y-, 5Y-, and above 5 mol% PSZs) may contain more than 50% of cubic phase, with a decrease in mechanical properties. The market trend for zirconia is the production of CAD/CAM disks containing more fracture resistant 3Y-TZP at the bottom layers and more translucent 5Y-PSZ at the top. Although flaws located between layers in multilayered blocks might represent a problem, newer generations of zirconia layered blocks appear to have solved this problem with novel powder compaction technology. Significant advancements in zirconia processing technologies have been made, but there is still plenty of room for improvement, especially in the fields of high-speed sintering and additive manufacturing.

SIGNIFICANCE

The wide range of zirconia materials currently available in the market may cause confusion in materials selection. It is therefore imperative for dental clinicians and laboratory technicians to get the needed knowledge on zirconia material science, to follow manufacturers' instructions, and to optimize the design of the prosthetic restoration with a good understanding where to reinforce the structure with a tough and strong zirconia.

Optical properties of dental zirconia, bovine dentin, and enamel-dentin structures

OBJECTIVE

To evaluate the optical properties and the relative translucency parameter of Ceramill ZI White (3Y-TZP) and Ceramill Zolid FX White (5Y-PSZ) zirconia ceramic systems and compare them with those of the bovine dentin and enamel/dentin structures.

MATERIALS AND METHODS

3Y-TZP and 5Y-PSZ zirconia ceramic systems were evaluated. A 0.5-mm-thick 3Y-TZP (3Y-NC.5), 0.5-mm-thick (5Y-NC.5), and 1.4-mm-thick (5Y-C.14) were used. A 0.5-mm-thick dentin specimens and 1.4-mm-thick enamel/dentin specimens (n = 5) were obtained from anterior bovine maxillary teeth. Scattering, absorption, transmittance, and albedo coefficient were calculated using Kubelka-Munk's model. Data were statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (p < 0.001), and goodness-of-fit coefficient (GFC). Relative translucency parameter differences were evaluated using translucency thresholds.

RESULTS

Reflectance, scattering, absorption, and transmittance properties were wavelength dependent. Good matches (GFC ≥ 0.999) in spectral reflectance were observed between 0.5-mm-thick dentin and 1.4-mm-thick enamel/dentin, and 3Y-NC.5 and 5Y-NC.5. Scattering was the main optical extinction process during light interaction with zirconia and dental structures, as indicated by albedo coefficient. Translucency differences were acceptable only for 3Y-NC.5 and the dentin structure, and 5Y-C.14 and the enamel/dentin structure.

CONCLUSIONS

Optical properties of 3Y-TZP and 5Y-PSZ dental zirconia differed from each other and from bovine dental structures. Nevertheless, 3Y-TZP showed similar relative translucency parameter to bovine dentin.

CLINICAL SIGNIFICANCE

To achieve the best esthetic results in restorative dentistry, it is crucial for clinicians to know about the optical properties of 3Y-TZP and 5Y-PSZ and to be able to compare these properties with those of dental structures.

Evaluation of the Effect of Electronic Cigarette Devices/Vape on the Color of Dental Ceramics: An In Vitro Investigation

The use of vaping or electronic cigarette devices (ECDs) has recently increased as an alternative to conventional tobacco smoking products. By recording the CIELAB coordinates (L*a*b*) and computing the total color difference (ΔE) values using a spectrophotometer, the effect of ECDs on contemporary aesthetic dental ceramics was investigated in this in-vitro study. A total of seventy-five (N = 75) specimens from five different (n = 15) dental ceramic materials (Pressable ceramics (PEmax); Pressed and layered ceramics (LEmax); Layered zirconia (LZr); Monolithic zirconia (MZr) and Porcelain fused to metal (PFM)) were prepared and exposed to aerosols produced by the ECDs. The color assessment was performed using a spectrophotometer at six time intervals (0 = baseline; 250-puff exposures; 500-puff exposures; 750-puff exposures; 1000-puff exposures; 1250-puff exposures; and 1500-puff exposures). By recording L*a*b* and computing total color difference (ΔE) values, the data were processed. A one-way ANOVA and Tukey procedure for pairwise comparisons were used to assess color differences between tested ceramics (p < 0.05). All test materials demonstrated significant color differences (ΔE) after exposure to vaping (p < 0.05). The LZr group displayed noticeably high ΔE values at all the distinct puff exposure intervals, with the highest ΔE value of (13.67) after 1500 puffs. The lowest (ΔE) values were observed in the PFM group after 250 and 500 puffs (0.85 and 0.97, respectively). With the exception of the group PEmax (p = 0.999), all groups produced readings of "ΔE" that indicated significant differences (p < 0.05) at various degrees of puff exposures. ECDs can noticeably alter the color of the dental ceramics affecting the esthetics of the patients. All the materials tested demonstrated significant color changes (ΔE > 3.33) above the clinically acceptable threshold, except for the PFM and PEmax group (ΔE < 3.33) which showed color stability after exposure to the ECDs.

Advances in Barrier Membranes for Guided Bone Regeneration Techniques

Guided bone regeneration (GBR) is a widely used technique for alveolar bone augmentation. Among all the principal elements, barrier membrane is recognized as the key to the success of GBR. Ideal barrier membrane should have satisfactory biological and mechanical properties. According to their composition, barrier membranes can be divided into polymer membranes and non-polymer membranes. Polymer barrier membranes have become a research hotspot not only because they can control the physical and chemical characteristics of the membranes by regulating the synthesis conditions but also because their prices are relatively low. Still now the bone augment effect of barrier membrane used in clinical practice is more dependent on the body’s own growth potential and the osteogenic effect is difficult to predict. Therefore, scholars have carried out many researches to explore new barrier membranes in order to improve the success rate of bone enhancement. The aim of this study is to collect and compare recent studies on optimizing barrier membranes. The characteristics and research progress of different types of barrier membranes were also discussed in detail.

Composition, processing, and properties of biphasic zirconia bioceramics: relationship to competing strength and optical properties

A study is made of relationships between composition, processing, structure and properties of biphasic zirconia bioceramics. The focus is on zirconia compositions with different yttria dopant contents used in modern dental restorations, namely 3 - 5 mol% yttria stabilized zirconia (3YSZ, 4YSZ, and 5YSZ). Crystallographies and densities are surveyed, sintering conditions examined, and microstructures characterized. Strength and optical tests are conducted on each YSZ, and dependencies on sintering temperature, cubic content and grain size analyzed. Strength correlates with the amount of tetragonal zirconia (t-ZrO2) crystals with large lattice distortions (tetragonality). YSZ translucency correlates with content of cubic zirconia (c-ZrO2) and t-ZrO2 with low levels of tetragonality. Consistent with literature reporting, the materials rank in decreasing order 3YSZ, 4YSZ to 5YSZ for strength but increasing order for translucency. However, for a given composition, the data suggest that the strengths of densely sintered 3YSZ and 4YSZ actually increase with translucency, although that of 5YSZ remains undiminished. These trends are in apparent contradiction to prevailing experience, and offer potential future processing routes to optimization of clinical materials.

Modulation of Lithium Disilicate Translucency through Heat Treatment

The aim of this study was to present a control method for modulating the translucency of lithium disilicate ceramics through thermal refinement. Identical lithium disilicate blocks were thermally refined using four different heat treatment schedules, and the microstructure, translucency, and flexural strength of the ceramics were investigated in detail by SEM, spectroscopy, and a piston-on-three-ball test. The results showed that ceramics treated under higher heat had larger grains, with an average size between 240 and 1080 nm. In addition, a higher transmittance of all wavelengths was observed in ceramics treated under lower heat, and the transmittance in the 550 nm wavelength ranged from 27 to 34%. The results suggest that the translucency of ceramics can be modified through thermal refinement under two conditions: (1) the particle size of the ceramic is small enough to achieve minimal grain-boundary light scattering, and (2) the percentage of particles allowing visible light transmission is altered by the heat treatment.

Targeted Delivery of Paclitaxel in Liver Cancer Using Hyaluronic Acid Functionalized Mesoporous Hollow Alumina Nanoparticles

Hyaluronic acid functionalized mesoporous hollow alumina nanoparticles (HMHA) were used as a tumor-targeted delivery carrier for liver cancer therapy. Paclitaxel (PAC) incorporated in the carrier by the adsorption method was analyzed by X-ray diffraction and differential scanning calorimetry. PAC was found to be in an amorphous state. The hyaluronic acid coated on the surface of mesoporous hollow alumina nanoparticles (MHA) regulated the drug release rate and the loaded samples obtained a sustained drug release. In vitro experiments demonstrated that paclitaxel-hyaluronic acid functionalized mesoporous hollow alumina nanoparticles (PAC-HMHA) had a high cellular uptake, which increased the drug level in tumor tissues and was beneficial to promote apoptosis. An in vivo tumor inhibition rate study demonstrated that PAC-HMHA (64.633 ± 4.389%) had a better antitumor effect than that of paclitaxel-mesoporous alumina nanoparticles (PAC-MHA, 56.019 ± 6.207%) and pure PAC (25.593 ± 4.115%). Therefore it can be concluded that PAC-HMHA are a prospective tumor-targeted delivery medium and can be useful for future cancer therapy.

Recent Advances in Color and Whiteness Evaluations in Dentistry

Background:

The final goal of color measurement or shade specification in dentistry is the reproduction by prosthetic materials of all important appearance characteristics of natural oral structures. The application of color science in dentistry is an objective way to measure and evaluate such structures and dental materials in clinical practice and dental research.

Methods:

Literature on color science was reviewed to present new metrics to evaluate color differences of dental materials and dental structures. Visual acceptability and perceptibility values of color differences are reviewed and new whiteness indexes to describe whiteness in dentistry are presented.

Results:

In the last decade, the CIELAB 50:50% perceptibility and acceptability thresholds were set to 1.2 and 2.7, respectively, and the CIEDE2000 50:50% perceptibility and acceptability thresholds were set to 0.8 and 1.8. The CIEDE2000 color-difference formula became increasingly popular in dentistry. Developments in color science have led to the description of tooth whiteness and changes in tooth whiteness based on whiteness indexes, with the most relevant being the WID whiteness index, which is a customized index based in CIELAB color space.

Conclusion:

The application of color science in dentistry has allowed the precise description of tooth color and whiteness. The revised and new CIEDE2000 color-difference formula is expected to fully replace the outdated CIELAB formula in almost all dental applications. Recent psychophysical studies have reported values of visual thresholds and new whiteness indexes, which can serve as quality control tools to guide the selection of esthetic dental materials, evaluate clinical performance, and interpret visual and instrumental findings in clinical dentistry, dental research, and subsequent standardization.

Optical properties of translucent zirconia: A review of the literature

Translucent monolithic zirconia is the newest option of zirconia-based ceramics, which aimed to substitute the opaque classic yttria-stabilized tetragonal zirconia polycrystal (Y-TZPs) in more demanding esthetic cases.

The aim of this review was to assess the available literature regarding the optical, chemical and mechanical properties of translucent zirconia ceramics.

This systematic review was developed according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. An electronic literature search was undertaken through Medline (National Library of Medicine) via PubMed to identify relevant articles, published in the interval 2010-2018. The search was limited to the English language publications, in vitro studies of color and microstructure of translucent zirconia material.

Yttria-stabilized tetragonal zirconia polycrystals (Y-TZPs) has excellent mechanical properties, but its intense white color and high opacity represent an esthetic limit. Cubic zirconia represents a new generation of dental ceramics with molecular structure and physical properties different from the conventional zirconia. Dental manufacturers created new formulations of this restorative material, introducing new cubic varieties of zirconia with improved optical properties. Translucent monolithic zirconia provides a new restorative option that combines strength with improved esthetics, due to its increased translucency. Translucent zirconia is indicated for anterior and posterior restorations but should be used carefully for discolored teeth, because the background color can affect the final esthetic appearance of the restoration.