Fracture Load and Fracture Patterns of Monolithic Three-Unit Anterior Fixed Dental Prostheses after In Vitro Artificial Aging-A Comparison between Color-Gradient and Strength-Gradient Multilayer Zirconia Materials with Varying Yttria Content

The influence of core-build up materials on biaxial flexural strength of strength-gradient zirconia and lithium disilicate ceramics: an in-vitro study

The aim of this study was to investigate the effect of using different core build-up materials on biaxial flexural strength (BFS) of multilayered strength-gradient zirconia ceramic in comparison to lithium disilicate ceramic. Thirty zirconia discs were fabricated from IPS e.max ZirCAD Prime (Zir), 30 discs from IPS e.max CAD (LS2), 30 composite discs were prepared from Tetric N-Ceram (TNC) and 30 from MultiCore Flow (MCF). The ceramic discs were adhesively cemented to composite discs forming 4 groups (n = 15) (Zir-MCF, Zir-TNC, LS2-MCF and LS2-TNC). BFS was determined using a piston-on-3-ball test. The data were statistically analyzed with independent t-tests for significant differences (p = 0.05). In zirconia groups, significantly higher stress values were recorded in the composite and the ceramic for Zir-TNC, compared to Zir-MCF (p < 0.001), while for LS2 groups, no significant differences were found between the 2 composites (p = 0.157) but stresses in LS2 were significantly higher for LS2-TNC than LS2-MCF (p < 0.001). Comparing the values between the ceramic groups, stresses were significantly higher for zirconia than LS2 (p < 0.001). It was concluded that the tested composite materials significantly differ in their strength, which also influenced the strength of the overlying ceramics, and that strength-gradient zirconia had higher strength than LS2. Monolithic strength-gradient zirconia restorations supported by composite core build-up materials with superior mechanical properties can be durable restorative options for high stress-bearing areas.

Comparison of Optical Properties and Fracture Loads of Multilayer Monolithic Zirconia Crowns with Different Yttria Levels

Multilayer monolithic zirconia, which incorporates polychromatic layers that mimic natural tooth gradients, offers enhanced aesthetics and functionality while reducing debonding risks and improving fabrication efficiency. However, uncertainties remain regarding the fracture characteristics of multilayer monolithic zirconia crowns under occlusal loading, whether composed of uniform or combined yttria levels. The current study investigated how variations in yttria levels and thicknesses affected the optical properties and fracture loads of multilayer monolithic zirconia. Samples of multilayer monolithic zirconia in the Vita A1 shade were used, while employing 3Y (SZ) and 4Y + 5Y (AZ) yttria levels. The optical properties, including the color difference (ΔEWS) and translucency parameters (TP00), were measured using a digital colorimeter. The fracture loads were analyzed using a universal testing machine, and fractured surfaces were examined under a stereomicroscope. Statistical analyses assessed the impacts of the yttria levels and sample thicknesses on the optical properties. The ΔEWS values of SZ ranged 3.6 to 4.0, while for AZ, ΔEWS at 0.5 mm was 3.9 and <2.6 for other thicknesses. The TP00 values decreased with an increased thickness, with AZ generally exhibiting greater translucency than SZ. In the fracture load investigations, SZ (>1600 N) generally exceeded AZ (>1260 N), with fracture loads notably increasing with thickness, particularly for premolars (SZ > 3270 N, AZ > 2257 N). SZ predominantly exhibited partial and complete fractures, whereas AZ showed fewer non-fracture categorizations. Complete fractures began with dense, irregular cracks that extended outward to reveal smooth surfaces, while premolars subjected to higher loads exhibited concentric ripple-like structures. Partial fractures revealed radial textures indicative of areas of stress concentration. In summary, higher yttria levels were correlated with increased translucency, while variations in the fracture loads primarily stemmed from differences in the tooth position or thickness. Overall, multilayer monolithic zirconia incorporating combined yttria levels of 4Y + 5Y (AZ) offered high translucency, precise color matching, and substantial fracture resistance, rendering it highly suitable for aesthetic and functional dental applications.

Impact of the sintering parameters on the grain size, crystal phases, translucency, biaxial flexural strength, and fracture load of zirconia materials

OBJECTIVES

To investigate the influence of the zirconia and sintering parameters on the optical and mechanical properties.

METHODS

Three zirconia materials (3/4Y-TZP, 4Y-TZP, 3Y-TZP) were high-speed (HSS), speed (SS) or conventionally (CS) sintered. Disc-shaped specimens nested in 4 vertical layers of the blank were examined for grain size (GS), crystal phases (c/t'/t/m-phase), translucency (T), and biaxial flexural strength. Fracture load (FL) of three-unit fixed dental prostheses was determined initially and after thermomechanical aging. Fracture types were classified, and data statistically analyzed.

RESULTS

4Y-TZP showed a higher amount of c + t'-phase and lower amount of t-phase, and higher optical and lower mechanical properties than 3Y-TZP. In all materials, T declined from Layer 1 to 4. 3/4Y-TZP showed the highest FL, followed by 3Y-TZP, while 4Y-TZP showed the lowest. In 4Y-TZP, the sintering parameters exercised a direct impact on GS and T, while mechanical properties were largely unaffected. The sintering parameters showed a varying influence on 3Y-TZP. Thermomechanical aging resulted in comparable or higher FL.

CONCLUSION

3/4Y-TZP presenting the highest FL underscores the principle of using strength-gradient multi-layer blanks to profit from high optical properties in the incisal area, while ensuring high mechanical properties in the lower areas subject to tensile forces. With all groups exceeding maximum bite forces, the examined three-unit FDPs showed promising long-term mechanical properties.

Effect of low-temperature degradation on the fatigue performance of dental strength-gradient multilayered zirconia restorations

OBJECTIVES

Fatigue and low-temperature degradation (LTD) are the main factors contributing to zirconia restoration failure. This study evaluated the effect of LTD on the fatigue performance of the novel "strength & shade-gradient" multilayered zirconia restorations.

METHODS

Discs (15 mm × 1.2 mm) of each yttria content layer from a newly developed strength-gradient multilayered zirconia were fabricated and under accelerated aging in an autoclave at 134℃ for 0 h, 32 h, and 64 h. Then, the phase transformation, microstructure, and mechanical properties after LTD were assessed. In addition, the crown samples, including the multi-Zir, 3Y-Zir, and 5Y-Zir were fabricated, and their monotonic and fatigue load before and after LTD, percentage of fatigue degradation (Sd) and the fracture morphology were investigated. Statistical analyses were performed using paired samples t-test (α' = α/3 = 0.017), one-way ANOVA and Weibull analysis.

RESULTS

After LTD, the phase transformation, surface roughness, depth of transformed zone, and residual stress were increased and inversely associated with the yttria content. The indentation elastic modulus and hardness after LTD decreased; however, there was no significant difference between the different yttria content layers. The monotonic and fatigue load of multi-Zir restorations decreased, but their Weibull modulus increased, and Sd decreased, similar to 3Y-Zir. The crack origin was associated with the cervical region.

CONCLUSION

These results show that although LTD reduces the absolute fatigue strength of strength-gradient multilayered zirconia restorations, it also reduces the effect of cyclic fatigue itself on the strength of zirconia (relative to monotonic strength), which might be due to the increase of residual stress.

CLINICAL SIGNIFICANCE

The novel "strength & shade-gradient" multilayered zirconia restorations show a promising performance during in vitro LTD and fatigue test and their reliability to some extent is comparable to 3Y-Zir. Yet, further in vivo longitudinal studies are warranted to confirm their precise performance.

Effect of connector configuration on the fracture load in conventional and translucent zirconia three-unit fixed dental prostheses

PURPOSE

The purpose of this study was to determine the effect of the connector configuration on the fracture load in conventional and translucent zirconia of three-unit fixed dental prostheses (FDPs).

MATERIALS AND METHODS

Six different three-unit FDPs were prepared (n = 6) from three types of zirconia (3Y-TZP (Katana ML®), 4Y-TZP (Katana STML®), and 5Y-TZP (Katana UTML®)) in combination with two connector configurations (4 × 2.25, 3 × 3 mm). The Co-Cr master models were scanned, and the FDPs were designed and fabricated using CAD-CAM. The FDPs were cemented on the metal model and then loaded with a UTM at a crosshead speed of 1 mm/min until failure. Two-way ANOVA and Tukey's test were used for statistical analysis (α = .05).

RESULTS

Fracture loads of 3Y-TZP (2740.6 ± 469.2 and 2718.7 ± 339.0 N for size 4 × 2.25 mm and 3 × 3 mm, respectively) were significantly higher than those of 4Y-TZP (1868.3 ± 281.6 and 1663.6 ± 372.7 N, respectively) and 5Y-TZP (1588.0 ± 255.0 and 1559.1 ± 110.0 N, respectively) (P < .05). No significant difference was found between fracture loads of 4Y-TZP and 5Y-TZP (P > .05). The connector configuration within 9 mm2 was found to have no effect on the fracture loads on all three types of zirconia (P > .05).

CONCLUSION

Fracture loads of three-unit FDPs were affected by the type of zirconia. The fracture loads of conventional zirconia were higher than those of translucent zirconia. However, it was not affected by the connector configuration when the connector had a cross-sectional area of 9 mm2.