Fracture Strength of Zirconia and Alumina Ceramic Crowns Supported by Implants

Gallium-doped zirconia coatings modulate microbiological outcomes in dental implant surfaces

Despite the significant recent advances in manufacturing materials supporting advanced dental therapies, peri-implantitis still represents a severe complication in dental implantology. Herein, a sol-gel process is proposed to easily deposit antibacterial zirconia coatings onto bulk zirconia, material, which is becoming very popular for the manufacturing of abutments. The coatings' physicochemical properties were analyzed through x-ray diffraction and scanning electron microscopy-energy-dispersive x-ray spectroscopy investigations, while their stability and wettability were assessed by microscratch testing and static contact angle measurements. Uniform gallium-doped tetragonal zirconia coatings were obtained, featuring optimal mechanical stability and a hydrophilic behavior. The biological investigations pointed out that gallium-doped zirconia coatings: (i) displayed full cytocompatibility toward human gingival fibroblasts; (ii) exhibited significant antimicrobial activity against the Aggregatibacter actinomycetemcomitans pathogen; (iii) were able to preserve the commensal Streptococcus salivarius. Furthermore, the proteomic analyses revealed that the presence of Ga did not impair the normal oral microbiota. Still, interestingly, it decreased by 17% the presence of Fusobacterium nucleatum, a gram-negative, strictly anaerobic bacteria that is naturally present in the gastrointestinal tract. Therefore, this work can provide a valuable starting point for the development of coatings aimed at easily improving zirconia dental implants' performance.

Comparative assessment of flexural strength of monolithic zirconia with different thicknesses and two sintering techniques

OBJECTIVES

This study aimed to compare the flexural strength of monolithic zirconia with different thicknesses and two sintering techniques.

MATERIALS AND METHODS

This in vitro, experimental study was conducted on 28 monolithic zirconia discs with 10 mm diameter and 0.5 (n = 14) and 1.2 mm (n = 14) thickness. Each group was divided into two subgroups (n = 7) for fast (60 min) and conventional (120 min) sintering at 1450°C. After sintering, the specimens were thermocycled and their flexural strength was measured by piston-on-3-balls technique in a universal testing machine (0.5 mm/min, 1.2 mm pin diameter). Data were analyzed by the Weibull test, one-way analysis of variance, and Tukey's test (α = .05).

RESULTS

The flexural strength of specimens with 1.2 mm thickness was significantly higher than that of specimens with 0.5 mm thickness (p < .05). The flexural strength of 1.2 mm/120-min group was slightly, but not significantly, higher than that of 1.2 mm/60-min group (p > .05). The flexural strength of 0.5 mm/120-min group was slightly, but not significantly, higher than that of 0.5 mm/60-min group (p > .05).

CONCLUSION

The increase in thickness of monolithic zirconia increases its flexural strength; however, increasing the sintering time appears to have no significant effect on the flexural strength of monolithic zirconia.

Load, unload and repeat: Understanding the mechanical characteristics of zirconia in dentistry

OBJECTIVES

Zirconia-based dental restorations and implants are gaining attention due to their bioactivity, corrosion resistance and mechanical stability. Further, surface modification of zirconia implants has been performed at the macro-, micro- and nanoscale to augment bioactivity. While zirconia's physical and chemical characteristics have been documented, its relation to mechanical performance still needs to be explored. This extensive review aims to address this knowledge gap.

METHODS

This review critically compares and contrasts the findings from articles published in the domain of 'mechanical stability of zirconia\ in dentistry' based on a literature survey (Web of Science, Medline/PubMed and Scopus databases) and a review of the relevant publications in international peer-reviewed journals. Reviewing the published data, the mechanical properties of zirconia, such as fracture resistance, stress/tension, flexural strength, fatigue, and wear are detailed and discussed to understand the biomechanical compatibility of zirconia with the mechanical performance of modified zirconia in dentistry also explored.

RESULTS

A comprehensive insight into dental zirconia's critical fundamental mechanical characteristics and performance is presented. Further, research challenges and future directions in this domain are recommended.

SIGNIFICANCE

This review extends existing knowledge of zirconia's biomechanical performance and it they can be modulated to design the next generation of zirconia dental restorations and implants to withstand long-term constant loading.

Recent advances in the application and biological mechanism of silicon nitride osteogenic properties: a review

Silicon nitride, an emerging bioceramic material, is highly sought after in the biomedical industry due to its osteogenesis-promoting properties, which are a result of its unique surface chemistry and excellent mechanical properties. Currently, it is used in clinics as an orthopedic implant material. The osteogenesis-promoting properties of silicon nitride are manifested in its contribution to the formation of a local osteogenic microenvironment, wherein silicon nitride and its hydrolysis products influence osteogenesis by modulating the biological behaviors of the constituents of the osteogenic microenvironment. In particular, silicon nitride regulates redox signaling, cellular autophagy, glycolysis, and bone mineralization in cells involved in bone formation via several mechanisms. Moreover, it may also promote osteogenesis by influencing immune regulation and angiogenesis. In addition, the wettability, surface morphology, and charge of silicon nitride play crucial roles in regulating its osteogenesis-promoting properties. However, as a bioceramic material, the molding process of silicon nitride needs to be optimized, and its osteogenic mechanism must be further investigated. Herein, we summarize the impact of the molding process of silicon nitride on its osteogenic properties and clinical applications. In addition, the mechanisms of silicon nitride in promoting osteogenesis are discussed, followed by a summary of the current gaps in silicon nitride mechanism research. This review, therefore, aims to provide novel ideas for the future development and applications of silicon nitride.

Shear Bond Strength of Colored and Sandblasted Zirconia to Ceramic Veneers Fabricated by the Pressing and Layering Techniques: An In Vitro Study

Introduction

Porcelain-veneered zirconia (PVZ) restorations are increasingly used due to their optimal esthetics and high strength. However, chipping of porcelain limits the application of PVZ restorations. The aim of this study was to assess the shear bond strength (SBS) of colored and sandblasted zirconia to ceramic veneers fabricated by the pressing and layering techniques.

Materials and Methods

Sixty cubic zirconia specimens (10 × 10 × 2 mm) were assigned to three groups according to their surface treatment: (I) control, (II) sandblasting with 50 μm alumina particles (S), and (III) coloring (C). Each group was subsequently divided into two subgroups according to the porcelain-veneering technique: (I) layering (L) and (II) pressing (P). The specimens underwent 10,000 thermal cycles between 5 and 55°C, and their biaxial SBS was measured in an electromechanical universal test machine (0.5 mm/min with 2.5 kN load cell). The failure mode was also assessed under a stereomicroscope. Three samples were randomly selected from each subgroup (n = 18) for examination of zirconia-phase transformation by X-ray diffraction (XRD). Two-way and one-way ANOVA followed by the post hoc Tukey test were used to analyze statistical differences among the groups and subgroups (α = 0.05).

Results

The sandblasted zirconia with press porcelain (SP) subgroup showed the highest (24.40 ± 8.16 MPa) and the colored zirconia with press porcelain (CP) subgroup showed the lowest (13.76 ±3.62 MPa) SBS. All failures were cohesive. Rate of phase transformation in layered porcelain was significantly lower than that in pressed porcelain (P < 0.01).

Conclusion

The sandblasted group showed the highest and the colored group showed the lowest SBS; the layered group showed higher SBS than the pressed group.

Mechanical Properties of Translucent Zirconia: An In Vitro Study

Background: The introduction of translucent zirconia has improved mimetics: nevertheless, a reduction in the mechanical performance was registered. The study aim was to investigate the mechanical characteristics of a high-translucent zirconia used for monolithic restorations before and after the aging process compared to a low-translucent zirconia. Methods: A total of 23 specimens were used in the present study. Group A (n = 10) was made of a high-translucent Y-TZP; group B (n = 7) was made of a low-translucent Y-TZP and finally group C (n = 6) was an aged high-translucent Y-TZP. Flexural strength, fracture toughness, brittleness, microcrack’s propagation and grain size were analyzed. Results: The Vickers hardness was: 1483 ± 187 MPa (group C); 1102 ± 392 MPa (group A); 1284 ± 32 MPa (group B). The flexural strength was: 440 (±96.2) MPa (group C); 427 (±59.5) MPa (group A); 805 (±198.4) MPa (group B). The fracture toughness was: 5.1 (±0.7) MPa.m1/2 (group C); 4.9 (±0.9) MPa.m1/2 (group A); 8.9 (±1.1) MPa.m1/2 (group B). The brittleness was: 295 (±42.8) (group C), 230.9 (±46.4) (group A) and 144.9 (±20.3) (group B). The grain size was: 2.75 (±1.2) µm2 (group A); 0.16 (±0.05) µm2 (group B); 3.04 (±1.1) µm2 (group C). Conclusions: The significant reduction in the mechanical properties of high-translucent zirconia, compared to the traditional one, suggests their use in the anterior/lateral area (up to premolars).

Fractographic analysis of 35 clinically fractured bi-layered and monolithic zirconia crowns

OBJECTIVES

The aim of this retrieval study was to analyze the fracture features and identify the fracture origin of zirconia-based single crowns that failed during clinical use.

METHODS

Thirty-five fractured single crowns were retrieved from dental practices (bi-layered, n=15; monolithic, n=20). These were analyzed according to fractographic procedures by optical and scanning electron microscopy to identify fracture patterns and fracture origins. The fracture origins were closely examined. The crown margin thickness and axial wall height were measured.

RESULTS

Three types of failure modes were observed: total fractures, marginal semilunar fractures, and incisal chippings. Most of the crowns (23) had fracture origins at the crown margin and seven of them had defects in the fracture origin area. The exact fracture origin was not possible to identify due to missing parts in four crowns. The crown wall thickness was 20% thinner and wall height 30% shorter in the fracture origin area compared to the opposite side.

CONCLUSIONS

The findings in this study show that fractography can reveal fracture origins and fracture modes of both monolithic and bi-layered dental zirconia. The findings indicate that the crown margin on the shortest axial wall is the most common fracture origin site.

CLINICAL SIGNIFICANCE

Crown design factors such as material thickness at the margin, axial wall height and preparation type affects the risk of fracture. It is important to ensure that the crown margins are even and flawless.

Hybrid abutment during prosthetic planning and oral rehabilitation

BACKGROUND

The present study aims to describe through a literature review, the characteristics and properties of hybrid abutments, as well as their proper use as a new rehabilitation strategy.

METHODS

A bibliographic search was conducted in the main health databases Pubmed (www.pubmed.gov) and Google Scholar (www.scholar.google.com.br), in which studies published from 2001 to 2020 were collected. Laboratory studies, case reports, systematic and literature reviews were included. Therefore, articles that do not adress the characteristics and properties of hybrid abutments were excluded. In addition, studies that did not report the use of hybrid abutments as a new rehabilitation strategy.

RESULTS

According to the inclusion and exclusion criteria, 80 research articles were selected and 20 were excluded, while 25 in vitro, 17 in vivo and 9 in silico studies were reviewed.

CONCLUSIONS

The literature demonstrates that hybrid abutments are an excellent alternative in cases of implant-supported rehabilitation, presenting high esthetic results, associated with good soft tissue response, periimplant marginal bone stability and adequate stress distribution during the masticatory loads dissipation.

Effects of sintering time and hydrothermal aging on the mechanical properties of monolithic zirconia ceramic systems

STATEMENT OF PROBLEM

The flexural strength of zirconia restorations is partially dependent on the sintering process. Changes in sintering protocols as well as hydrothermal aging may affect the flexural strength of zirconia materials.

PURPOSE

The purpose of this in vitro study was to investigate how changes in sintering parameters and hydrothermal aging affect the biaxial flexural strength of monolithic zirconia.

MATERIAL AND METHODS

Specimens were produced from 2 translucent monolithic zirconia ceramics (Zircon X ST, Upcera YZ HT). After coloring, specimens of both ceramics were distributed into groups and subjected to 1 of 6 different sintering protocols. Half were subjected to biaxial flexural strength tests directly after sintering, and the remaining specimens were subjected to hydrothermal aging and then to biaxial flexural strength testing. Biaxial flexural strength data were analyzed by using a statistical software program. Normality of distribution was determined by the Shapiro-Wilk test. Biaxial flexural strength data were compared among groups by using 1-way ANOVA and Tukey post hoc tests, and intragroup data were compared by using paired specimens t tests (α=.05).

RESULTS

The highest overall biaxial flexural strength value was obtained in UW-II. The highest biaxial flexural strength for Zircon X was obtained in ZX-VI and ZX-HTA-VI, whereas the highest biaxial flexural strength for Upcera was obtained in UW-II before hydrothermal aging and in UW-HTA-V after aging (P<.05).

CONCLUSIONS

The biaxial flexural strength of Zircon X increased with longer sintering times. Upcera specimens were more fracture-resistant than Zircon X both before and after hydrothermal aging. Based on these findings, longer sintering times are recommended to increase the strength of monolithic zirconia.

Acoustic emission and finite element study on the influence of cusp angles on zirconia dental crowns

OBJECTIVE

The effect of cusp angle on the load-carrying capacity and failure behaviour of BionZ Diamond zirconia crowns is carried out using experimental and numerical investigations.

METHODS

The experimental program using monolithic crowns were divided into three groups (n = 14) for three cusp angles, 60, 80 and 120 degrees and were tested to failure under the static load. A 2-channel acoustic emission (AE) system was used to monitor the failure process while the piezo sensors were attached to the rigid stainless-steel jig for recoding the AE events. Load-displacement and AE response were simultaneously monitored until failure of specimens. Parametric AE analysis was conducted for the factors such as amplitude, energy released, signal duration and cumulative counts, for each AE signal. Fast Fourier transform (FFT) was conducted to assess the frequency at failure. Linear finite element analysis (FEA) was carried out using commercial software Ansys Workbench 19.1 to present the stress distribution and failure modes. Post-failure surface morphology study was carried out using scanning electron microscopy (SEM) and statistical analysis was performed using Weibull analysis.

RESULTS

All the samples in three different groups have failed at the mid-line, splitting the zirconia crowns into two equal pieces. The load to failure was directly proportional to the cusp angle in crowns; 120° group had the highest load-carrying capacity of 2.93 ± 0.26 kN while 60 and 80° groups had a failure load of 2.46 ± 0.53 and 2.52 ± 0.16 kN, respectively. Parametric AE analysis revealed that the failure was instantaneous and 60-degree samples had higher AE signature. FE analysis showed the crack initiation at the occlusal surface of the crown which is in agreement with the SEM images. A close agreement of results for the load and stress distribution from FEA complemented with the experimental study.

SIGNIFICANCE

Optimisation of cusp-angle could help clinicians to accurately design the monolithic zirconia crown focussing on maximum load-carrying capacity, increasing the restoration life.

Preparation of a Novel Transplant Material, Zirconium Oxide (ZrO₂) Nanotubes, and Characterizations Research

Background

Zirconia is one of the most widely used ceramic materials for transplanting and treating caries. This study aimed to synthesize zirconium oxide (ZrO₂) nanotubes and evaluated their characteristics.

Material/Methods

Zr film was prepared using an ion plating method. Nanoarray film was constructed with anodizing. Photocatalytic properties of nnanotubes were assessed by evaluating decolorization of methyl orange. Elemental analysis and structural morphology for coatings were evaluated using x-ray analysis and scanning electron microscopy (SEM). Dimensions for layers were measured with SEM imaging. X-ray diffraction (XRD) was measured using Empyrean x-ray diffractometry.

Results

There were irregular cavities on the surface of ZrO₂ nanotubes undergoing anodizing of 30V. Anodizing voltage of 45 V (with regular nano-pore arrays and smooth nanotube walls) and anodic oxidation duration of 60 min (ZrO₂ nanotubes clearly formed atop ZrO₂-coated substrate surface) were the optimal condition for ZrO₂ nanotube formation. TEM illustrated tube length of ZrO₂ nanotubes was approximately 2.01 μm. Nanotube diameter was 51.06 nm, and wall thickness was 13 to 14 nm. Annealed nanotubes showed an obvious crystal diffraction pattern. TEM diffraction ring showed nanotube array without obvious transistor structure before annealing, but with good crystallinity post-annealing. Increased annealing temperatures result in enhanced intensity for the monoclinic phase (400–800°C). After annealing at 600°C, the decolorization effect of ZrO₂ nanotubes on methyl orange was better than that post-annealing at 400 and 800°C. ZrO₂ nanotubes demonstrated higher microshear bond strength.

Conclusions

Zirconium nanotubes were successfully synthesized and demonstrated good structural characteristics, which can be applied to transplanting and treating caries.

Effects of 10-MDP Based Primer on Shear Bond Strength between Zirconia and New Experimental Resin Cement

To date, numerous materials in the dental field are marketed to ensure stable adhesive cementation of zirconia ceramics (Y-TZP). The aims of this study were to assess the shear bond strength of the new experimental cement Surgi Dual Flo' Zr to Y-TZP compared to Panavia V5 cement, and to evaluate the effect of 10-MDP (10-methacryloyloxydecyl dihydrogen phosphate) containing primer on their bond strength. Twenty composite cylinders and Y-TZP disks were adhesively luted and divided into four groups based on cement type used and application or not of 10-MDP. The groups (n = 5 each) were S 10MDP (Surgi Dual Flo' Zr with 10-MDP); S no 10MDP (Surgi Dual Flo' Zr without 10-MDP); P 10MDP (Panavia V5 with 10-MDP); P no 10MDP (Panavia V5 without 10-MDP). Maximum load resistance (ML) and shear bond strength (SBS) were tested and mode of failure qualitative documented via scanning electron microscopy. The data were analyzed with one-way ANOVA, Holm-Sidak method, and Bayesian analysis. ML and SBS were significantly higher in S 10MDP than in S no 10MDP; and in P 10MDP than in P no 10MDP (p < 0.05). No significant differences were found between S 10MDP and P 10MDP; S no 10MDP and P no 10MDP (p > 0.05). Cohesive, adhesive, and mixed failure occurred among the groups. Bond strength between the experimental resin-based cement and Y-TZP was adequate for clinical application when 10-MDP was added. 10-MDP containing primer was effective improving the bond strength to Y-TZP more than the different type of resinous cement.

Nanostructured Zirconia-Based Ceramics and Composites in Dentistry: A State-of-the-Art Review

The objective of this paper is to review the current knowledge on the development of nanostructured zirconia-based ceramics and composites suitable for application in dentistry. Isi Web of Science, Science Direct, Scientific.net databases, and Google were searched electronically for the period of 1980 to the present, matching the keywords “nano” with the keywords: “Zirconia, ZrO₂, Y-TZP, and dental, dentistry”. A total of 74 papers were found, with the majority coming from Asia, indicating a more active scientific interest on the topic in this geographic area, followed by Europe, South America, and North America. The research shows, even though the scientific activity on nanostructured ceramics was intense in the last fifteen years, the development of fully dense zirconia-based nanoceramics is yet at an initial stage, most of all from the point of view of the clinical applications. It has been demonstrated that nanostructured ceramics can show improved properties because of the reduction of the grain size to the nanoscale. This is also true for zirconia-based nanoceramics, where some improvements in mechanical, optical, as well as resistance in low-temperature degradation have been observed. Potential applications of this class of material in the dental field are discussed, summarizing the results of the latest scientific research.

Effect of different sintering process on flexural strength of translucency monolithic zirconia

Background

Sintering process is responsible for the strength of zirconia restoration. This study evaluated the effect of different sintering temperatures and sintered-holding times on flexural strength of translucency monolithic zirconia.

Material and Methods

One hundred and thirty five zirconia bar specimens (width-length-thickness = 10×20×1.5 mm) were prepared from yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramic and randomly divided into nine groups to be sintered at different temperatures [decreasing- (SD, 1350°C), regular- (SR, 1450°C), and increasing- (SI, 1550°C) sintering temperature] and different sintered-holding times [shortening- (HS, 60 min), regular- (HR, 120 min), and prolonged- (HP, 180 min) sintered-holding time]. Flexural strength was determined using three-point bending test in a universal testing machine at 1 mm/min crosshead speed. An analysis of variance (ANOVA) and Tukey’s multiple comparisons were used to determine for statistically significant difference of flexural strength (α=0.05). Weibull analysis was applied for survival probability, Weibull modulus (m), and characteristics strength (σo) of the flexural strength. The crystal sizes were microscopically examined using scanning electron microscope (SEM). The phase composition of zirconia was determined using X-ray diffraction (XRD).

Results

The mean±sd (MPa), m, and σo of flexural strength were 1080.25±217.19, 5.54, and 1167.53 for SDHS, 1243.41±233.17, 5.19, and 1352.30 for SDHR, 1298.92±235.68, 6.24, and 1394.79 for SDHP, 1303.34±171.87, 8.40, and 1377.90 for SRHS, 1331.73±278.84, 5.31, and 1444.50 for SRHR, 1348.13±283.35, 5.32, and 1460.68 for SRHP, 1458.45±289.19, 4.51, and 1604.41 for SIHS 1581.34±190.56, 8.20, and 1675.21 for SIHR and, 1604.10±139.52, 12.57, and 1667.90 for SIHP. The flexural strength was significantly affected by altering sintering temperatures and holding times (p<0.05). Enlarging grain size and increasing t→m phase shifting related with raising temperatures and times.

Conclusions

Increasing sintering temperature and prolonged sintered-holding time lead to enhancing flexural strength of translucency monolithic zirconia, and are suggested for sintering process to achieve durable restoration.

Key words:Flexural strength, monolithic zirconia, sintering temperature, sintered-holding time.