A study on the in-vitro wear of the natural tooth structure by opposing zirconia or dental porcelain

Optimized 3D printed zirconia-reinforced leucite with antibacterial coating for dental applications

OBJECTIVES

This study aims to produce by robocasting leucite/zirconia pieces with suitable mechanical and tribological performance, convenient aesthetics, and antibacterial properties to be used in dental crown replacement.

METHODS

Leucite pastes reinforced with 12.5%, 25%, and 37.5% wt. ZrO2 nanoparticles were prepared and used to print samples that after sintering were characterized in terms of density, shrinkage, morphology, porosity, mechanical and tribological properties and translucency. A coating of silver diamine fluoride (SDF) and potassium iodide (KI) was applied over the most promising material. The material's antibacterial activity and cytotoxicity were assessed.

RESULTS

It was found that the increase of ZrO2 reinforcement up to 25% enhanced both microhardness and fracture toughness of the sintered composite. However, for a superior content of ZrO2, the increase of the porosity negatively affected the mechanical behaviour of the composite. Moreover, the composite with 25% ZrO2 exhibited neglectable wear in chewing simulator tests and induced the lowest wear on the antagonist dental cusps. Although this composite exhibited lower translucency than human teeth, it was three times higher than the ZrO2 glazed material. Coating this composite material with SDF+KI conferred antibacterial properties without inducing cytotoxicity.

SIGNIFICANCE

Robocasting of leucite reinforced with 25% ZrO2 led to best results. The obtained material revealed superior optical properties and tribomechanical behaviour compared to glazed ZrO2 (that is a common option in dental practice). Moreover, the application of SDF+KI coating impaired S. aureus proliferation, which anticipates its potential benefit for preventing pathogenic bacterial complications associated with prosthetic crown placement.

Antagonist enamel tooth wear produced by different dental ceramic systems: A systematic review and network meta-analysis of controlled clinical trials

OBJECTIVES

The aim of this study was to evaluate the amount of enamel tooth wear induced by different antagonistic ceramic crown materials in the posterior area within a follow-up period up to 24 months in function. A network meta-analysis was performed to assess the effect of the materials on the mean vertical loss (MVL) of the antagonist enamel tooth surface.

DATA

Main search terms used in combination: ceramic, dental materials, metal ceramic, tooth wear and dental enamel.

SOURCES

An electronic search was conducted in PubMed/Medline, Embase, and Cochrane CENTRAL plus hand-searching.

STUDY SELECTION

Eligibility criteria included clinical studies reporting on MVL on antagonist's tooth up to 24 months following the permanent crown placement. From a total of 5697 articles, 7 studies reporting on 261 crowns for 177 subjects with 3 ceramic materials (Lithium disilicate, metal-ceramic, monolithic zirconia) were included. Among all, metal-ceramic and zirconia caused significantly higher enamel tooth wear on antagonist teeth, representing 82.5 µm [54.4; 110.6]) and 40.1 µm [22.2; 58.0]) more MVL than natural teeth group. In contrast, lithium disilicate showed only 5.0 µm [-48.2; 58.1]) more MVL than occurs on opposing natural teeth.

CONCLUSIONS

This systematic review demonstrated that prosthodontic ceramic materials produced significantly more antagonist enamel tooth wear than opposing natural enamel tooth wear, and ceramic material type was correlated to the degree of enamel tooth wear. Additional well-conducted, randomized controlled trials with homogeneous specimens are required due to inadequate sample size and number of the clinical studies included in the analyses.

CLINICAL SIGNIFICANCE

The amount of wear caused by different restorative materials has a high influence on the antagonistic natural teeth and should therefore be evaluated intensively by the dentist.

3D quantitative analysis and SEM qualitative analysis of natural antagonist enamel opposing CAD-CAM monolithic zirconia or lithium disilicate tooth-supported crowns versus enamel opposing natural enamel

PURPOSE

This study aimed to evaluate the maximum vertical wear, volume wear, and surface characteristic of antagonist enamel, opposing monolithic zirconia or lithium disilicate crowns.

MATERIALS AND METHODS

The study comprised 24 participants (n = 12), who were randomly allocated to receive either a 5 mol% Y-TZP or a lithium disilicate crown in positions which would oppose the natural first molar tooth. The contralateral first molar along with its antagonist was considered as the enamel opposing natural enamel control. Data collection was performed using an intraoral scanner and polyvinylsiloxane impression. The means of the maximum vertical loss and the volume loss at the occlusal contact areas of the crowns and the various natural antagonists were measured by 3D comparison software. A scanning electron microscope was subsequently used to assess the wear characteristics.

Results

The one-year results from 22 participants (n = 11) indicated no significant differences when comparing the zirconia crown's antagonist enamel (40.28 ± 9.11 µm, 0.04 ± 0.02 mm3) and the natural enamel wear (38.91 ± 7.09 µm, 0.04 ± 0.02 mm3) (P > .05). Also, there is no significant differences between lithium disilicate crown's antagonist enamel (47.81 ± 9.41 µm, 0.04 ± 0.02 mm3) and the natural enamel wear (39.11 ± 7.90 µm, 0.04 ± 0.02 mm3) (P > .05).

Conclusion

While some studies suggested that monolithic zirconia caused less wear on opposing enamel than lithium disilicate, this study found similar wear levels to enamel for both materials compared to natural teeth.

Effect of zirconia surface conditioning before glazing on the wear of opposing enamel: an in vitro study

OBJECTIVES

This in vitro study aimed to evaluate the wear of natural teeth opposing 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) with different surface conditions.

MATERIALS AND METHODS

Sixty 3Y-TZP specimens were randomly assigned to six groups (n = 10), differing in surface condition. In three groups, the samples underwent glazing-with the glaze applied to roughened (i.e., 106-µm-grit diamond-finished), as-sintered, and polished zirconia. The three remaining groups consisted of unglazed specimens: solely polished samples and diamond-finished samples (106-µm-grit and 46-µm-grit) without further conditioning. Two-body wear was evaluated at extracted, non-carious molars (n = 60), which served as antagonists in chewing simulation (10,000 masticatory cycles, 49N load). As a control, natural teeth with intact enamel surfaces were tested against natural molars (n = 10). All samples were 3D-scanned before and after the chewing simulation (7 Series, Straumann). Volume loss was calculated (Inspect Software, GOM), and statistically analyzed (SPSS Statistics 24, IBM).

RESULTS

Volume loss of the natural antagonists decreased in the following order: 106-µm-grit diamond-finished zirconia (4.6 ± 2.5 mm3), glazed 106-µm-grit diamond-finished zirconia (3.8 ± 1.1 mm3), glazed as-sintered zirconia (3.5 ± 0.9 mm3), 46-µm-grit diamond-finished zirconia (1.7 ± 0.6 mm3), control (1.6 ± 0.7 mm3), glazed polished zirconia (1.4 ± 0.5 mm3), and solely polishing (0.4 ± 0.2 mm3). Even when polishing the surfaces before glazing, volume loss was not mitigated to the same extent as after polishing alone.

CONCLUSIONS

The zirconia surface condition beneath the glazing influences antagonist wear. Although polishing before glazing resulted in acceptable levels of antagonist wear, this approach did not yield as favorable results as polishing alone.

CLINICAL RELEVANCE

For operators favoring glazing, pre-polishing the zirconia surface could be advantageous to reduce wear.

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.

Evaluation of the marginal integrity of various pit and fissure sealants

PURPOSE

To evaluate the marginal integrity of various pit and fissure sealants subjected to different application methods.

METHODS

A total of 253 non-carious human third molars extracted and randomly divided into two groups according to the preparation method employed: invasive or non-invasive. Eight fissure sealant materials were tested: nano-filled flowable composite (Filtek Ultimate Flow), nanohybrid flowable composite (GrandioSo Flow), micro-hybrid flowable composite (Majesty Flow), resin-based unfilled fissure sealant (ClinPro Sealant), resin-based filled fissure sealant (Fissurit FX), resin-based highly filled fissure sealant (GrandioSeal), giomer-based fissure sealant (BeautiSealant), and glass ionomer-based fissure sealant (Fuji Triage). Samples were subjected to two-year cyclic thermo-mechanical and brushing simulations. Two observers quantitatively evaluated the restoration margins and classified them as either "permanent restoration edge", or if a gap larger than 250 μm was evident, "gapping at the restoration edge". The extent of the gap was recorded as a percentage relative to the total length of the restoration edge.

RESULTS

The baseline marginal adaptation had no significant effect on the marginal adaptation (P > 0.05). However, the preparation method and type of fissure sealant material had a significant impact on the marginal adaptation (P < 0.05).

CONCLUSION

On the basis of quantitative analysis, the highest marginal integrity was observed for flowable composites, whereas the lowest was observed for glass ionomer-based fissure sealant.

In Vitro Evaluation of marginal adaptation of polyether ether ketone and zirconia copings

Background

Polyether ether ketone (PEEK) has emerged as a new thermoplastic material with potential applications as a restorative material. Aim: This study aimed to evaluate the marginal adaptation of PEEK copings compared to zirconia copings using field emission scanning electron microscopy.

Materials and Methods

A freshly extracted maxillary central incisor was prepared for a full-coverage restoration following standard principles of tooth preparation. The tooth was sent to a laboratory for fabrication of samples using computer-aided design and manufacturing (CAD/CAM). Twenty samples of polyether ether ketone (PEEK) copings (group A) and 20 of zirconia copings were fabricated (group B). The copings were scanned under a field emission scanning electron microscope and measurements were taken at four distinct points. The marginal adaptation over the buccal, lingual, mesial, and distal margins for both groups was evaluated. One-way analysis of variance (ANOVA) and independent t test were applied.

Results

Our findings indicate that PEEK showed better marginal adaptation than zirconia at all measurement points. The mean marginal gap value of the PEEK group was 33.99 ± 8.81 μm and of the zirconia group was 56.21 ± 15.07 μm. On comparing marginal adaptation among the mesial, distal, buccal, and lingual aspects, PEEK showed better adaptation on all four margins, with the best adaptation on the buccal margin that had the lowest mean gap value of 29.27 ± 6.07 μm. The zirconia group adapted best at the distal margin, with a lowest mean gap value of 53.58 ± 15.25 μm (P ≤ 0.05).

Conclusion

PEEK copings had better marginal adaptation and fit compared to zirconia copings. It may have applications as a restorative material in fixed prostheses.

The mechanical properties, tribological behaviors and color stability of a feldspar nanoceramics strengthening extrinsic stain for high-translucent zirconia

The present work is aimed to explore the mechanical properties, tribological behaviors and color stability of nanoceramics and microceramics strengthened extrinsic stain coatings (NS and MS) upon high-translucent zirconia (TZ). The Na-rich feldspar ceramics component, microstructure and particle size of NS and MS were verified. The mechanical properties including elastic modulus and hardness of NS were enhanced compared to MS. Reciprocating wear tests under a ball-on-plate configuration manifested that the reduced coefficient of friction, wear depth and wear volume loss of NS was evaluated after 1 × 10 ⁴ cycles and the wear scar morphology of NS characterized by microcracks while MS featured more delamination and wear debris. Post toothbrushing simulation revealed that the color stability of extrinsic stain coatings was elevated with the addition of feldspar nanoceramics. The feldspar nanoceramics strengthening extrinsic stain exhibited enhanced elastic modulus, hardness, wear resistance and color stability, especially for TZ.

Effect of surface treatments on wear and surface properties of different CAD-CAM materials and their enamel antagonists

STATEMENT OF PROBLEM

Which surface treatment provides optimal surface roughness, microhardness, and wear behavior for computer-aided design and computer-aided manufacturing (CAD-CAM) materials and their enamel antagonists is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of surface treatment on the surface roughness, microhardness, and 2-body wear of different CAD-CAM materials and their enamel antagonists.

MATERIAL AND METHODS

Monolithic zirconia, polymer-infiltrated ceramic network, lithium disilicate, leucite-reinforced ceramic, zirconia-reinforced lithium silicate, and feldspathic ceramic specimens were sliced into 2-mm-thick rectangular plates and divided into polished or glazed subgroups (n=6). After surface roughness and microhardness measurements, the specimens were loaded at 49 N for 250 000 cycles and simultaneously thermocycled (5 °C and 55 °C). All specimens were scanned before and after the wear test by using a scanner. The volumetric loss and wear depth of the materials and the volumetric and height loss of the enamel were calculated, and scanning electron microscope images of the specimens were made. Multiple 2-way ANOVAs and Tukey honestly significant difference tests were used to assess the effect of material and surface treatment on surface roughness, microhardness, and wear behavior of materials and enamel (α=.05).

RESULTS

Material and surface treatment interactions affected the surface roughness (P<.001), microhardness (P<.001), volumetric loss of materials (P=.044), and height loss of enamel (P<.001).

CONCLUSIONS

Polishing resulted in higher surface roughness and microhardness than glazing. Volumetric loss depended on the material, which affected the height loss of the antagonists. Glazing and polishing had similar effects on the volumetric loss of materials and antagonists. No correlation was found between the wear of materials and the antagonists, nor between the surface roughness of materials and the volumetric loss of materials or antagonists.

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).

The Effect of Simulated Chewing on the Surface Roughness of Direct and Indirect Resin-Composites Opposed by Zirconia: An In Vitro Study

Purpose

To assess the surface roughness of two different light-cured resin-composites when opposed by monolithic zirconia after simulated mastication.

Materials and Methods

Materials included a direct restorative nanohybrid (n = 10) and an indirect microhybrid (n = 10) resin-composite (Tetric EvoCeram and Sinfony, respectively). The antagonist material was 3 mol% yttria-stabilized tetragonal zirconia polycrystalline ceramic. Each material was subjected to in vitro chewing against zirconia using a chewing simulator for 250,000 cycles. A 3D profilometer was used to assess the surface roughness parameters of each resin-composite before and after the simulated chewing. Independent t-test and paired sample t-test were performed to compare roughness values for both materials and to compare baseline and after chewing simulation values (p = 0.05).

Results

Sinfony showed significantly greater roughness values compared to Tetric EvoCeram (p ≤ 0.025) before and after simulated chewing, except for Sa and Sv parameters after simulated chewing where the difference between the two materials was insignificant (p = 0.06 and 0.89, respectively). Surface roughness increased for both materials after simulated chewing compared to baseline values, but the difference was insignificant (p ≥ 0.065). However, Sa (p = 0.04) and Sv (p = 0.012) for Tetric EvoCeram were significantly higher after compared to before chewing simulation.

Conclusion

Tetric EvoCeram had a smoother surface than Sinfony before and after simulated chewing. Surface roughness for both materials was higher after simulated chewing compared to baseline values which represent surface damage that was significant for Tetric EvoCeram while Sinfony showed better resistance.

Wear of various restorative materials against 5Y-ZP zirconia

STATEMENT OF PROBLEM

The ceramic 5-mol% yttria-stabilized zirconia (5Y-ZP) has been developed for dental use in the esthetic zone with greater translucency than 3-mol% yttria-stabilized zirconia (3Y-ZP). However, studies on the wear behavior of 5Y-ZP zirconia against clinically relevant antagonist materials are lacking.

PURPOSE

The purpose of this in vitro study was to investigate the wear behavior of 5Y-ZP zirconia against the antagonists 5Y-ZP zirconia, lithium disilicate, palladium alloy, and human enamel.

MATERIALS AND METHODS

Flat specimens (n=8) were fabricated from 5Y-ZP zirconia, lithium disilicate, palladium alloy, and human central incisor enamel. A custom wear-simulating device with a sliding pin-on-plate configuration was used for a total of 120 000 wear cycles at 1.6-Hz frequency under a 49-N vertical load while submerged in distilled water at room temperature. The wear volume and maximum wear depth of flat specimens were evaluated with a 3D profilometer. Scanning electron microscopy was used to analyze the characteristics of the worn surfaces.

RESULTS

After wear simulation, the 5Y-ZP zirconia and palladium-silver alloy specimens exhibited the least amount of material loss, both in terms of maximum wear depth and wear volume (0.079 ±0.042 μm, 0.001 ±0.001 mm³ and 0.637 ±0.307 μm, 0.001 ±0.000 mm³, respectively). This was followed by human enamel (6.034 ±1.086 μm, 0.009 ±0.001 mm³) and by lithium disilicate, which showed excessive material loss (38.342 ±2.569 μm, 0.213 ±0.024 mm³). Scanning electron microscopy revealed variations in wear mechanisms among the materials.

CONCLUSIONS

The 5Y-ZP zirconia and palladium-silver alloy exhibited the lowest wear, followed by human enamel and lithium disilicate. Slight grain dislodgement was displayed on worn 5Y-ZP surfaces, while more apparent grain dislodgement and wear grooves were found on lithium disilicate. Plastic deformation of worn palladium-silver alloy accumulated at the end of wear track. Cracks were detected in the human enamel specimens.

Review on synthesis, properties and multifarious therapeutic applications of nanostructured zirconia in dentistry

Amongst dental ceramics, nano zirconia (ZrNp) has shown exceptional developments in the field of dentistry in recent years. Zirconia is an oxide that possess superior optical, mechanical, and biological properties. As a novel nanoparticle, it has been widely used in various fields of dentistry due to its improved mechanical properties, biocompatibility, and stable structure. Provision of metal free solutions is one of the prime requirements in dental materials. Many metal alloys used extensively possess unaesthetic colors and display chemical interactions in the oral cavity encouraging use of zirconia for dental use. Use of ZrNp based ceramics has increased due to its resistance to corrosion, superior color matching that enhances esthetics and improved strength compared to conventional biomaterials. This review discusses the recent scientific literature on the synthesis, properties and types, applications, and toxicity of ZrNp in the field of dentistry.

Enamel wear against monolithic zirconia restorations: A meta-analysis and systematic review of in vitro studies

OBJECTIVE

An assessment was performed to identify and evaluate dental enamel wear caused by monolithic zirconia restoration. Literature searches were conducted in PubMed, Science Direct, Cochrane Evidence, and the Cochrane Library up to May 2020.

MATERIAL AND METHODS

Studies were selected for systematic review according to the inclusion (articles conducted on the wear of enamel samples opposing monolithic zirconia) and exclusion (case reports, non-English articles, and monolithic zirconia samples facing other materials rather than human enamel) criteria. Of those, articles on polished and glazed monolithic zirconia subjected to a 50 N vertical load with a range of 240,000-250,000 cycles, equivalent to 1 year of in vivo mastication, were included in the meta-analysis.

RESULTS

In total, 3968 articles were pooled. Twenty-five articles met the inclusion criteria for the systematic review. Three studies were included in the meta-analysis. The results showed that the enamel wear against monolithic zirconia was within the statistically accepted level. Moreover, the polished monolithic zirconia surface caused less enamel wear than the glazed surface.

CONCLUSION

This review indicates that monolithic zirconia restorations cause acceptable antagonist enamel wear. Moreover, the meta-analysis results agreed that the final restoration's surface texture plays an essential role in the wear process.

CLINICAL SIGNIFICANCE

Monolithic zirconia restorations have been widely used in dental practice because they eliminate the chipping problems resulting from using veneered restorations. With recent technology development, monolithic zirconia has obtained more esthetic features and a more natural look. However, due to the high strength and surface roughness of monolithic zirconia, wear on the antagonist's teeth was detected. The results showed that this wear amount was statistically acceptable and lower than other ceramics such as feldspathic porcelain and enamel. Furthermore, surface treatment methods must be applied to minimize tooth wear, as polished or glazed surfaces interfere with enamel loss.

Wear Behavior of Different Generations of Zirconia: Present Literature

Objective. The wear behavior of the novel zirconia generation is less well understood and may be affected by compositional modifications compared to the conventional zirconia. Materials and Methods. Combinations of keywords such as “zirconia,” “high translucent,” and “wear” were searched in PubMed and Google Scholar databases up to May 2021. The total of 23 relevant articles was selected according to inclusion criteria. Results. Reports show comparable wear resistance of translucent zirconia to the conventional zirconia despite an increased cubic phase content and lower mean flexural strength. A meticulously polished surface creates the lowest surface roughness, producing favorable zirconia wear resistance and antagonist wear compared to a glazed surface. In comparison to other ceramic materials, zirconia produces the least wear on an enamel antagonist and almost undetectable wear when opposed by zirconia. Wear when paired against resin materials yields a favorable outcome, whereas wear behavior against a metal antagonist varies with the surface hardness of the metal. Conclusions. All zirconia generations are considered wear-friendly to all types of antagonists. Nonetheless, comparative studies on antagonist wear opposing zirconia of different compositions are still limited and further investigation is required.

Full-Arch, Implant-Fixed Complete Dentures in Monolithic Zirconia and Titanium: A Digital Workflow to Maximize Cost Effectiveness

Different techniques can be used to design and manufacture a full-arch, implant-supported prosthesis, and different materials can be chosen for its production, each with its advantages and limitations. One of the possibilities provided by digital tools is their ability to maintain low costs to give more patients the chance to choose this commonly expensive treatment. The present work aims to present a protocol for the realization of full-arch, implant-fixed complete dentures (IFCDs) in monolithic zirconia and titanium. When the analogic master model is obtained, it is scanned to perform the digital wax-up, and the two parts of the prosthesis—a bar in titanium and an aesthetic component in monolithic zirconia—are milled. The dental team must then verify the precision of the milled components on the master model, so that they can be cemented together and delivered to the patient. This technique offers different advantages, in terms of cost sustainability, minimal wear risk for the prosthesis and its antagonists, and ease of re-intervening in the case of complications. The main limitations of the technique may lie in the aesthetic needs of the patient, because of the relatively poor aesthetic performance of monolithic zirconia and the absence of a pink orthopedic component.

Ex Vivo Assessment of Natural Teeth Wear against Zirconia and Novel Glass-Fiber-Reinforced Composite Crowns in Primary Teeth by a Three-Dimensional Assessment Method

Objectives. The main purpose of the study was to assess the material wear, antagonistic natural primary teeth wear, and microhardness of zirconia (ZR), a recently launched novel glass-fiber-reinforced composite crown (GFRC). The research question was, are these aesthetic crowns resulting in antagonistic natural primary tooth wear and the crown material itself? Methods. Forty-five primary canines were divided into three groups (15 per group) and mounted against Zr (Group A), GFRC (Group B), and natural teeth as control (Group C) in the wear test machine. All samples were assessed for surface wear with pre- and post-3-dimensional scanning. In addition, microhardness was assessed for all three groups. Results. The mean microhardness value for the Zr disc was 1157 ± 7 HV; for the GFRC disc, it was 29.35 ± 2 HV; while with natural teeth, it was 105 ± 4 HV. There was a statistically significant difference in teeth wear in the prescan and postscan in the natural tooth ( $p<0.05$ ) group, highly significant difference ( $p<0.001$ ) in the ZR group, and no significant difference in the GFRC group. Conclusion. There is more significant wear loss of glass-fiber-reinforced composite discs as compared to zirconia. In addition, the wear of the antagonistic tooth with zirconia and natural teeth is more remarkable than with GFRC. There is a vast difference of microhardness between natural teeth and zirconia (almost 10 times higher) which suggests further scope of study. Clinical Relevance. Pediatric dentistry deals with the transition of dentition from primary to permanent through mixed dentition. Selection of restorative material needs to be done cautiously when we are dealing with primary teeth and young permanent teeth as antagonistic teeth. Wear of the crown material itself and opposing natural teeth are essential factors that should be considered in selecting crowns in clinical practice. The present study results can be extrapolated to clinical practice, and the practitioner can consider various factors in selecting full-coverage crowns for primary teeth. The vast difference in aesthetic crowns and natural teeth microhardness indicates a further need for research. Additionally, there is no literature published for the recently launched GFRCs.

Physical properties and wear behavior of CAD/CAM resin composite blocks containing S-PRG filler for restoring primary molar teeth

OBJECTIVES

This study aimed to develop computer-aided design/computer-aided manufacturing (CAD/CAM) resin composite blocks (RCBs) containing surface pre-reacted glass-ionomer (S-PRG) filler for primary molar teeth and evaluate their physical properties and wear resistance.

METHODS

Experimental CAD/CAM RCBs containing S-PRG filler for primary molar teeth (EB), a commercial CAD/CAM RCB (HC), two resin composites for primary teeth (BKP and BKZ) and one for permanent teeth (BⅡ) were used. Hardness tests, three-point bending tests, fracture toughness tests, and water absorption tests were conducted. Wear tests were conducted for these materials and stainless steel crowns (SSCs).

RESULTS

The Vickers hardness of EB was lower than that of HC (p < 0.05), and there was no significant difference among BKZ, BKP, and BⅡ (p > 0.05). After 1 week of water immersion, EB and HC showed greater flexural strength than the other materials (p < 0.05). EB showed greater fracture toughness than the other materials (p < 0.05). The water absorption of EB was lower than that of HC, BKZ, and BKP (p < 0.05), and greater than that of BⅡ (p < 0.05). Antagonist wear was significantly smaller in EB than in HC and BⅡ (p < 0.05), and significantly greater than in BKZ (p < 0.05). Antagonist wear could not be measured in SSC because of excessive wear that was out of range of the surface roughness tester.

SIGNIFICANCE

The CAD/CAM RCBs containing S-PRG filler for primary molar teeth developed in this study demonstrated adequate physical properties and wear performance, suggesting that they are suitable for restoration of primary molar teeth and could function in place of SSCs.

Friction and wear behavior of chairside CAD-CAM materials against different types of antagonists: An in vitro study

STATEMENT OF PROBLEM

Studies on the friction and wear behavior of recently introduced chairside computer-aided design and computer-aided manufacture (CAD-CAM) restorative materials are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the wear behavior of chairside CAD-CAM materials against different types of antagonists (human tooth enamel, composite resin, and feldspathic porcelain).

MATERIAL AND METHODS

Specimens (14×14×2 mm) of different CAD-CAM materials (Brilliant Crios, Lava Ultimate, Vita Enamic, Vita Suprinity) were obtained by using a low-speed precision cutter (n=10). Wear tests were performed with a 20-N load, 2.5-mm/s sliding speed, 1-mm sliding distance, and 1500 cycles via a tribometer according to ASTM-G133. The coefficient of friction (CoF) of the material pairs was measured and recorded by using a special software program. Surface roughness (Ra), maximum wear depth, and mean maximum wear depth were measured with a profilometer, and values were analyzed by using 2-way ANOVA and the Bonferroni correction. Vickers hardness of CAD-CAM specimens was determined with a microhardness tester. Microhardness values were analyzed by using 1-way ANOVA and Tukey post hoc tests. Worn surfaces were observed by scanning electron microscopy and a 3D noncontact profilometer to determine the wear pattern and primary wear mechanisms.

RESULTS

Significant differences were found in the interactions between CAD-CAM materials and different types of antagonists (P<.001) for maximum wear depth, mean maximum wear depth, CoF, and Ra values.

CONCLUSIONS

Vita Suprinity exhibited superior wear resistance and Ra against all antagonists compared with other CAD-CAM materials. However, Vita Suprinity increased the destructive effects on antagonists. The safety of CAD-CAM materials is best determined when the wear behavior of materials and their effect on the antagonist are evaluated together.

Wear evaluation of CAD-CAM dental ceramic materials by chewing simulation

PURPOSE

To evaluate the wear of computer-aided design/computer-aided manufacturing (CAD-CAM) dental ceramic materials opposed by enamel as a function of increased chewing forces.

MATERIALS AND METHODS

The enamel cusps of healthy human third molar teeth (n = 40) opposed by materials from CAD-CAM dental ceramic groups (n = 10), including Vita Enamic® (ENA), a polymer-infiltrated ceramic network (PICN); GC Cerasmart® (CERA), a resin nanoceramic; Celtra® Duo (DUO), a zirconia-reinforced lithium silicate (ZLS) ceramic; and IPS e.max ZirCAD (ZIR), a polycrystalline zirconia, were exposed to chewing simulation (1,200,000 cycles; 120 N load; 1 Hz frequency; 0.7 mm lateral and 2 mm vertical motion). The wear of both enamel cusps and materials was quantified using a 3D laser scanner, and the wear mechanisms were evaluated by scanning electron microscopy (SEM). The results were analysed using Welch ANOVA and Kruskal Wallis test (α = .05).

RESULTS

ZIR showed lower volume loss (0.02 ± 0.01 mm³) than ENA, CERA and DUO (P = .001, P = .018 and P = .005, respectively). The wear of cusp/DUO [0.59 mm³ (0.50-1.63 mm³)] was higher than cusp/CERA[0.17 mm³ (0.04-0.41 mm³)] (P = .007). ZIR showed completely different wear mechanism in SEM.

CONCLUSION

Composite structured materials such as PICN and ZLS ceramic exhibit more abrasive effect on opposing enamel due to their loss against wear, compared to uniform structured zirconia. The resin nanoceramic causes the lowest enamel wear thanks to its flexible nano-ceramic microstructure. While zirconia appears to be an enamel-friendly material in wear volume loss, it can cause microstructural defects of enamel.

Wear behavior of current computer-aided design and computer-aided manufacturing composites and reinforced high performance polymers: An in vitro study

OBJECTIVE

To analyze the wear rate of computer-aided design and computer-aided manufacturing (CAD/CAM) composites, polyetheretherketones and glass ceramics.

MATERIAL AND METHODS

Our study groups were prepared from two different resin-based composites (Brillant Crios, Cerasmart), a glass ceramic (IPS Emax CAD) and reinforced polyetheretherketone (BioHPP) material (n = 10). Premolar teeth were used as antagonists. The specimens, which were subjected to two body wear tests (240,000 cycles, 1.2 Hz, 50N) in the chewing simulator, were scanned with a 3D laser scanner both before and after the wear test. Volume loss and wear depth were determined by means of the obtained images software program. The wear pattern was examined by scanning electron microscopy. Kruskal Wallis test served for analyzing.

RESULTS

The least volume loss and wear depth were seen in the polyetheretherketone material (0.06 ± 0.04 mm³ , 0.02 ± 0.01 mm), while the maximum volume loss was seen in the groups containing resin-based composite. (p = 0.05). The volume loss value in glass ceramics is between CAD/CAM composites and polyetheretherketone.

CONCLUSION

The behavior of polyetheretherketone against enamel was different from glass ceramics and composite materials in terms of the amount of wear.

CLINICAL SIGNIFICANCE

Polyetheretheketone can be considered as an alternative to other chairside materials in terms of wear resistance.

Classification and Properties of Dental Zirconia as Implant Fixtures and Superstructures

Various types of zirconia are widely used for the fabrication of dental implant superstructures and fixtures. Zirconia-alumina composites, such as ATZ and NanoZR, are adequate for implant fixtures because they have excellent mechanical strength in spite of insufficient esthetic properties. On the other hand, yttria-stabilized zirconia has been used for implant superstructures because of sufficient esthetic properties. They are classified to 12 types with yttria content, monochromatic/polychromatic, uniform/hybrid composition, and monolayer/multilayer. Zirconia with a higher yttria content has higher translucency and lower mechanical strength. Fracture strength of superstructures strongly depends on the strength on the occlusal contact region. It suggests that adequate zirconia should be selected as the superstructure crown, depending on whether strength or esthetics is prioritized. Low temperature degradation of zirconia decreases with yttria content, but even 3Y zirconia has a sufficient durability in oral condition. Although zirconia is the hardest dental materials, zirconia restorative rarely subjects the antagonist teeth to occlusal wear when it is mirror polished. Furthermore, zirconia has less bacterial adhesion and better soft tissue adhesion when it is mirror polished. This indicates that zirconia has advantageous for implant superstructures. As implant fixtures, zirconia is required for surface modification to obtain osseointegration to bone. Various surface treatments, such as roughening, surface activation, and coating, has been developed and improved. It is concluded that an adequately selected zirconia is a suitable material as implant superstructures and fixtures because of mechanically, esthetically, and biologically excellent properties.

Correlation between microhardness and wear resistance of dental alloys against monolithic zirconia

PURPOSE

The aim of this study is to compare the hardness according to the conditions of metal alloys. Moreover, the correlation between the cast crown hardness before and after wear testing and the degree of wear for each dental alloy was assessed.

MATERIALS AND METHODS

Cast crowns of three metal alloys (Co-Cr, gold, and Ni-Cr alloys) opposing smooth-surface monolithic zirconia were used. The Vickers microhardness of the ingot (which did not undergo wear testing) and the cast crown before and after wear testing were measured for each alloy. Two-way ANOVA and Scheffé tests were used to compare the measured hardness values. Moreover, the Pearson correlation coefficient was used to evaluate the relationship between the surface hardness and the wear of the cast crown (α=.05).

RESULTS

There was no significant difference in the hardness before and after wear testing for the gold alloy (P>.05); however, the hardness of the worn surface of the cast crown increased compared to that of the cast crown before the wear tests of Ni-Cr and Co-Cr alloys (P<.05). Furthermore, there was no correlation between the wear and hardness of the cast crown before and after wear testing for all three metal alloys (P>.05).

CONCLUSION

There was a significant difference in hardness between dental alloys under the same conditions. No correlation existed between the surface hardness of the cast crown before and after wear testing and the wear of the cast crown.

Irradiation therapy and chewing simulation: effect on zirconia and human enamel

PURPOSE

Ionizing radiation therapy (RT) is the main option for head and neck cancer treatment, but it is associated with multiple side effects. This study aimed to evaluate the effect of RT associated with chewing simulation on the surface of human enamel and Yttria-partially stabilized zirconia (Y-TZP).

METHODS

Maxillary premolar cusps and Y-TZP slabs were divided in 7 experimental groups: CO: no RT (control); EZ groups had irradiation applied to both, enamel and zirconia samples (simulating restoration prior to RT); E groups had irradiation applied to enamel only (simulating restoration after RT). RT doses were either 30, 50 or 70 Gray (Gy). Enamel cusps were abraded against zirconia slabs in a chewing simulator (CS - one million cycles/ 80 N/ 60 mm/min, 2 mm horizontal path, artificial saliva, 37˚ C). Zirconia hardness was evaluated before CS; zirconia roughness and enamel volume (wear) were evaluated before and after CS. Hardness and wear data were analyzed by one-way Analysis of Variance and Tukey post hoc test. Roughness was analyzed by Repeated Measures test and Bonferroni test (p=0.05).

RESULTS

There was no significant effect of enamel or zirconia irradiation on enamel cusp wear (p=0.226), regardless of the irradiation dose used - up to 70 Gy. Irradiation also did not affect Y-TZP surface roughness (p=0.127) and hardness (p=0.964).

CONCLUSIONS

RT does not promote significant changes to the surface characteristics of zirconia. Irradiated enamel abraded against zirconia does not show higher wear volume when compared to non-irradiated enamel.

Tribological performance of the pair human teeth vs 3D printed zirconia: An in vitro chewing simulation study

This study aims to evaluate the tribological performance of the pair human teeth/robocasted zirconia, with a special focus on the enamel wear mechanisms. Zirconia pieces produced by robocasting (RC) and unidirectional compression (UC) were compared in terms of crystalline structure, density, porosity, hardness and toughness. Chewing simulation tests were performed against human dental cusps. The cusps wear was quantified and the wear mechanisms identified. Although most of the properties of UC and RC samples are similar, differences were observed for surface roughness and porosity. Although the samples did not suffer wear, the antagonist cusps worn in a similar way. In conclusion, robocasting seems a promising technique to produce customized zirconia dental pieces, namely in what concerns the overall tribological behaviour.

Effect of ionizing radiation and chewing simulation on human enamel and zirconia

PURPOSE

To evaluate the effect of ionizing irradiation on human enamel and zirconia after chewing simulation.

METHODS

Twenty enamel and twenty translucent Yttria-stabilized zirconia (Y-PSZ) specimens were divided in 4 groups: Co (control) - no irradiation on enamel cusps/opposing zirconia slabs; E70 - irradiated (70 Gray) enamel cusps/opposing irradiated enamel slabs; Z70 - irradiated zirconia cusps/opposing irradiated zirconia slabs; EZ70 - irradiated enamel cusps/opposing irradiated zirconia slabs. Cusps were abraded against slabs in a chewing simulator (CS - one million cycles, 80 N, artificial saliva, 37˚C). Wear and roughness of zirconia and enamel were analyzed using a stylus profilometer. The abraded enamel was analyzed by Electron probe micro-analyzer (EPMA) and zirconia was characterized by nanoindentation and X-ray diffraction. One-way analysis of variance (ANOVA) and Tukey test were used for analysis of wear, Repeated Measures and Bonferroni test for roughness, and hardness and modulus values were compared using Wilcoxan Mann Whitney rank sum test (overall 5% significance).

RESULTS

Significantly higher volume loss was presented by cusps in the E70 group (p<0.001). Wear was similar between Co and EZ70 groups. There was no significant effect of irradiation on roughness of enamel or zirconia slabs (p=0.072). Irradiated Y-PSZ slabs had significantly higher hardness and modulus than non-irradiated ones and a 7% increase in m phase content was detected after irradiation.

CONCLUSIONS

The opposing surface characteristics played a more significant role on enamel wear than did ionizing radiation. However, radiation affects Y-PSZ crystalline composition, hardness and modulus of elasticity.

Influence of different surface treatments on two-body wear and fracture load of monolithic CAD/CAM ceramics

OBJECTIVES

To investigate two-body wear (2BW) and fracture load (FL) of monolithic ceramics after different surface pretreatments.

MATERIALS AND METHODS

Zirconia (MOZ), lithium-disilicate (LIT), and leucite-reinforced (LEU) specimens (n = 60/group) were manufactured with CAD/CAM-technology and underwent (n = 15/subgroup): 1) grinding + polishing (GrPo), 2) grinding + glazing (GrGz), 3) grinding (Gr), or 4) glazing (Gz). Scanning electron microscope (n = 3/subgroup) and 3D measurements of the ceramic crowns and antagonists (N = 180) were performed to determine 2BW before and after 120,000/1,200,000 masticatory cycles. FL was examined for all specimens (N = 180). Data were analyzed using Kolmogorov-Smirnov, one-way ANOVA, Scheffé post hoc, Kruskal-Wallis, Mann-Whitney-U, and Wilcoxon (p < 0.05).

RESULTS

MOZ presented the highest FL independent on pretreatment (6960-9250 N), while LEU (1405-2320 N) showed the lowest (p < 0.001). Ceramic and antagonist wear increased between 120,000 and 1,200,000 masticatory cycles (p < 0.001). For pretreatments GrPo, GrGz, and Gz, MOZ showed the lowest wear of the ceramic, while causing the highest antagonist wear (p < 0.001). GrPo resulted in the lowest wear for MOZ (p < 0.001), with Gr leading to the highest antagonist wear (p = 0.008). LIT specimens presented the highest wear of the ceramic and antagonist after Gz (p < 0.001), while GrPo resulted in the lowest antagonist wear (p < 0.001). GrGz led to the highest antagonist wear for LEU (p < 0.001).

CONCLUSIONS

With FL exceeding maximum masticatory forces, the three tested ceramics can be recommended for restorations, even in posterior regions. While glazing resulted in higher wear and impaired FL, polishing improved mechanical properties while largely preserving the antagonist.

CLINICAL RELEVANCE

While surface pretreatment after grinding is vital to ensure a ceramic's optimal mechanical properties, glazing and polishing varies with regard to material properties, costs, and time.

A State-of-the-Art Review on the Wear of the Occlusal Surfaces of Natural Teeth and Prosthetic Crowns

This review focuses on the wear mechanisms of natural and restorative dental materials, presenting a comprehensive description and analysis of the works published in the last two decades on the wear at the interface of occlusal surfaces. Different groups of tribological pairs were considered: tooth-tooth, tooth-restorative material (tooth-ceramic, tooth-resin-based-materials, and tooth-metal), and restorative-restorative materials. The lack of standardization of the wear tests impairs the direct comparison of the obtained results. However, it was possible to infer about the main wear mechanisms observed on the different classes of dental materials. Concerning ceramics, their toughness and surface finishing determines the wear of antagonist tooth. Abrasion revealed to be the main wear mechanisms at occlusal interface. In the case of resin-based composites, the cohesion of the organic matrix and the nature, shape, and amount of filler particles greatly influences the dental wear. The protruding and detachment of the filler particles are the main causes of abrasion of antagonist enamel. Metallic materials induce lower wear on antagonist enamel than the other classes of materials, because of their low hardness and high ductility. Most of the studies revealed plastic deformation and adhesive wear as the main wear mechanisms. Overall, more research in this area is needed for a better understanding of the mechanisms involved at the occlusal surfaces wear. This would be essential for the development of more suitable restoration materials.

Simulated clinical adjustment and intra-oral polishing of two translucent, monolithic zirconia dental ceramics: An in vitro investigation of surface roughness

OBJECTIVE

To assess the surface roughness and residual flaws in two translucent zirconia substrates following simulated clinical adjustment and intra-oral finishing/polishing.

MATERIALS AND METHODS

Specimens were prepared from two translucent (5Y-ZP/8Y-ZP) and one conventional (3Y-TZP) zirconia substrates (n = 84 p/g). Arithmetic mean roughness parameter (R_a) was determined for all experimental groups at four stages (n = 21 p/g): (1) as-sintered, (2) surface grinding using a zirconia cutting diamond bur, (3) polishing using 1-step, 2-step or 4-step intra-oral polishing kits, and (4) laboratory polishing/glazing. Scanning electron microscopy (SEM) was used to evaluate residual surface flaws. Data were statistically analysed using a two-way ANOVA test, multiple and pairwise comparisons were performed using a Bonferroni post hoc test.

RESULTS

R_a was significantly higher for as-sintered and ground 5Y-ZP/8Y-ZP compared to 3Y-TZP (p ≤ 0.001). Material type and polishing protocol had statistically significant effect on R_a (p < 0.001). The 4-step polishing resulted in the lowest R_a in 3Y-TZP/5Y-ZP (p ≤ 0.001). No significant differences were observed between different polishing protocols in 8Y-ZP (p≥0.655). Glazing significantly reduced R_a in all materials compared to other polishing protocols (p ≤ 0.001) except for the 4-step protocol in 3Y-TZP (p = 0.195). SEM revealed pronounced surface flaws in ground 5Y-ZP/8Y-ZP. Grinding of 3Y-TZP induced ductile material removal and thereby, minimal cohesive material loss. The 4-step polishing protocol resulted in the fewest and shallowest surface flaws in all groups. Glazing of 3Y-TZP resulted in the most homogenous surface contrary to 5Y-ZP/8Y-ZP.

CONCLUSIONS

The finest surface finish was achieved using the 4-step polishing protocol in all studied materials. This protocol might be inadequate however for polishing of ground 5Y-ZP/8Y-ZP as a result of the pronounced surface damage induced by the grinding process. The glazing of 5Y-ZP/8Y-ZP might not be as predictable as for 3Y-TZP.

CLINICAL SIGNIFICANCE

The higher susceptibility to surface damage, as a result of increasing dopant concentration, may render polishing of ground, translucent zirconia more complicated compared to the conventional 3Y-TZP counterparts.

Two-body wear test of enamel against laboratory polished and clinically adjusted zirconia

AIM

A two-body wear test experiment was performed on human enamel, in simulated chewing motion, against non-veneered zirconia ceramic. Aim-1 was to ascertain the effect of zirconia roughness on enamel wear. Aim-2 was to ascertain the relative enamel wear between enamel-zirconia wear pair and enamel-enamel control pair.

MATERIALS

Six molar and premolar human enamel cusps per group were used for a dental wear test against laboratory polished (LP) zirconia and laboratory polished and clinically adjusted (LP + CA) zirconia. Enamel antagonists were tested against incisor teeth as a control group to demonstrate laboratory enamel wear.

METHODOLOGY

Two-body wear tests were conducted in a dual-axis biomimetic dental wear simulator. 49N loading force was used for 120,000 cycles with 1 mm lateral movement of the test specimen at 1.6Hz frequency, under constant ambient temperature water flow. Surface roughness before testing was determined using 3D profilometry. Loss of enamel height and volume i.e. vertical wear and volumetric wear respectively, were measured by superimposition of before and after testing scans by 3D laser scanning. Scanning electron microscopy was used for surface morphology assessment. One-way ANOVA and Post Hoc Multiple Comparisons with Bonferroni corrections were used at the 5% significance level to determine whether surface finish affected volumetric and vertical enamel loss. The relationship between volumetric and vertical loss of enamel was assessed using Pearson's correlation test.

RESULTS

No significant difference was found between LP and LP + CA zirconia in vertical and volumetric enamel wear results. Control enamel had significantly higher vertical and volumetric enamel wear than LP and LP + CA zirconia. Pearson correlation revealed a strong relationship between vertical wear and volumetric wear of enamel.

CONCLUSION

Within the constraints of the test method in this experiment, zirconia irrespective of surface preparation, was found to cause less vertical and volumetric enamel wear compared to control enamel. No statistically significant difference was seen between LP zirconia and LP + CA zirconia.

Marginal gap and fracture resistance of CAD/CAM ceramill COMP and cerasmart endocrowns for restoring endodontically treated molars bonded with two adhesive protocols: an in vitro study

Endocrowns represent a conservative and esthetic restorative alternative to full coverage crowns. They can be constructed using various CAD/CAM materials that can provide a modulus of elasticity similar to that of teeth. The ability to use of such materials in composite blocks that can be easily repaired is also an advantage, provided appropriate bonding performance is ensured. This study, therefore, evaluated the marginal gap and fracture resistance of two CAD/CAM endocrown materials using two bonding protocols. Thirty-two mandibular molars were evaluated in two groups based on the material type: a Cerasmart group (GC America Inc; n = 16) acting as the control and a Ceramill COMP group (Amann Girrbach, Germany; n = 16). These groups were then classified according to the bonding protocol used: a total-etch bonding protocol (n = 8) and a self-etch bonding protocol (n = 8) implemented using RelyX ultimate adhesive resin cement (3M ESPE). The samples were then subjected to aging by simulating a 1-year thermo-mechanical process. The marginal gap results were statistically insignificant across the material and bonding protocol groups before thermo-mechanical aging. Thermo-mechanical aging significantly reduced the marginal gap distance for Ceramill COMP endocrowns cemented using the total-etch protocol (p = 0.002). No statistically significant difference was recorded for the fracture resistance in either the material or bonding protocol groups (p ≥ 0.05). Both materials and bonding protocols can, therefore, be used in the posterior region providing conservative treatment, adequate marginal gap and fracture resistance.

Suitability of 3D printed pieces of nanocrystalline zirconia for dental applications

OBJECTIVES

The main goal of this work is to evaluate the suitability of nanostructured zirconia pieces obtained by robocasting additive manufacturing (AM), for dental applications.

METHODS

The density, crystalline structure, morphology/porosity, surface roughness, hardness, toughness, wettability and biocompatibility of the produced samples were compared with those of samples obtained by conventional subtractive manufacturing (SM) of a similar commercial zirconia material. Chewing simulation studies were carried out against dental human cusps in artificial saliva. The wear of the material was quantified and the wear mechanisms investigated, as well as the influence of glaze coating.

RESULTS

AM samples, that revealed to be biocompatible, are slightly less dense and more porous than SM samples, showing lower hardness, toughness and wettability than SM samples. After chewing tests, no wear was found both on AM and SM samples. However, the dental wear was significantly lower when AM samples were used as counterbody. Concerning the glazed samples, both coated surfaces and dental cusps suffered wear, being the cusps' wear higher than that found for unglazed samples. More, cusps tested against AM coated samples suffered less wear comparatively to those opposed to SM coated samples.

SIGNIFICANCE

Overall, the results presented in this paper show that AM processed nanostructured zirconia can be used in dental restorations, with important advantages from the point of view of processing and tribological performance. Moreover, the option for glaze finishing should be carefully considered both in SM and AM processed specimens.

Analysis of enamel and material wear by digital microscope: an in-vitro study

The objective of the study was to analyze the surface area (SA) of the wear caused by simulated chewing on human enamel and opposing restorative material, namely: composite resin (CR), porcelain fused to metal (PFM), lithium disilicate (LD), or monolithic zirconia (MZr). Forty-eight premolars were selected as enamel specimens and divided randomly into 4 groups (n = 48; n =12) used as antagonists in chewing simulation (250,000 loading cycles) against one of the four selected test materials. Enamel and material specimens were scanned and evaluated under digital microscope, and wear SA (mm2) were recorded. Descriptive statistics, paired t-test, one-way ANOVA, and post-hoc Tukey-HSD tests were used for statistics (p < 0.05). The smallest and largest SA were exhibited by enamel against LD (0.80 mm2) and PFM (1.74 mm2), respectively. PFM (3.48 mm2) showed the largest SA and CR (2.28 mm2) showed the smallest SA. Paired t-test for SA values showed significant difference (p < 0.05) in all wear comparisons between materials and enamel antagonists. The wear of materials were greater than that of their respective enamel antagonists (p < 0.05). One-way ANOVA of the logarithmic means of wear SA revealed significant differences (P<0.05). Post-hoc Tukey test revealed significance for PFM (p < 0.05) with other materials. Wear of all test materials was greater compared to the wear of enamel antagonists. PFM and LD caused the largest and the smallest enamel wear, respectively. CR, LD, and MZr are more resistant than PFM to wear after simulated chewing against enamel.

Compressive Strength of New Glass Ionomer Cement Technology based Restorative Materials after Thermocycling and Cyclic Loading

OBJECTIVE

The objective of the study was to compare compressive strengths of two glass ionomer-based materials, with and without a light-cured, nano-filled coating, after cyclic loading and thermocycling.

MATERIALS AND METHODS

To determine compressive strength of new restorative materials over a longer period of time, materials were analysed under simulated conditions where cyclic loading replicated masticatory loading and thermocycling simulated thermal oscillations in the oral cavity. Four groups of samples (n=7)-(1) Equia Fil (GC, Tokyo, Japan) uncoated; (2) Equia Fil coated with Equia Coat (GC, Tokyo, Japan); (3) Equia Forte Fil (GC, Tokyo, Japan) uncoated; and (4) Equia Forte Fil coated with Equia Forte coat (GC, Tokyo, Japan)-were subjected to cyclic loading (240,000 cycles) using a chewing simulator (MOD, Esetron Smart Robotechnologies, Ankara, Turkey).

RESULTS

Compressive strength measurements were performed according to ISO 9917-1:2007, using the universal mechanical testing machine (Instron, Lloyd, UK). Scanning electron microscope (SEM) analysis was performed after thermocycling. There were no statistically significant differences between Equia Fil and Equia Forte Fil irrespective of the coating (p<0.05), but a trend of increasing compressive strength in the coated samples was observed.

CONCLUSIONS

Coating increases the compressive strength of Equia Fil and Equia Forte Fil, but not significantly.

Evaluating the Wear of Resin Teeth by Different Opposing Restorative Materials

The aim of this study was to evaluate the wear properties of resin teeth with different opposing dental restorative materials. One type of resin tooth (Trubyte Biotone) was tested against six types of restorative materials including type III gold alloy (GO), monolithic zirconia (MZ), lithium disilicate glass ceramic (LD), nickel-chromium alloy (NC), feldspathic ceramic (FC), and steatite (ST). Two-body wear tests were performed under a vertical load of 5 kgf and thermo-cycling at 5/55 °C with a total of 120,000 cycles. The wear amount was quantified by measuring the volume loss of the resin teeth and the vertical substance loss of the opposing materials using three-dimensional images. The FC group showed a significantly greater amount of wear of the resin teeth, followed by the ST, NC, LD, MZ, and GO groups. The GO group showed significantly less wear of resin teeth than the other groups. There were no statistically significant differences in the wear of opposing restorative materials between groups. Within the limits of this study, it is recommended that zirconia, rather than feldspathic ceramic, should be used for restorations in the esthetic zone, and gold alloy should be used for areas with little or no esthetic demand.

Evolution of Indirect Restorations for Fixed Prosthodontics: Planning, Preparation and Cementation

The provision of indirect restorations utilising contemporary materials for single or multiple abutment units in primary health care is an essential requirement for all general dental practitioners to ensure predictable patient outcomes. This paper highlights the important considerations for comprehensive planning and adept treatment execution and delivery that can enhance the patient's dental experience and outcome. A selection of clinical cases highlighting established and novel restorative materials utilising conventional and adhesive clinical techniques is presented and discussed.

Surface, Microstructural, and Mechanical Characterization of Prefabricated Pediatric Zirconia Crowns

The purpose of this study was to characterize the surface roughness, the microstructure, and mechanical properties of four prefabricated zirconia pediatric crowns. Ten prefabricated crowns from four different manufacturers (Cheng Crowns Zirconia), (EZCrowns), (NuSmile ZR), and (Zirconia Pediatric Crowns) were included in this study. The surface roughness parameters (Sa, Sq, Sz, Sc, and Sv) of all samples were studied by optical profilometry and then the microstructure was studied by Raman spectroscopy. Then, all samples were embedded in epoxy resin and after metallographic polishing, the Martens hardness (HM), indentation modulus (E_IT), elastic index (η_IT), Vickers hardness (HV), and fracture toughness (K_IC) were identified by the Instrumented Indentation Testing (IIT). All data were statistically analyzed by a one-way ANOVA and a Tukey multiple comparison test at α = 0.05. Only the tetragonal phase of zirconia for all materials tested was identified after Raman analysis. However, statistically significant differences were found among the surface roughness parameters, HV and K_IC, while no differences were allocated for HΜ, E_IT, and η_ΙΤ. Although the materials tested shared a similar microstructure, significant differences in surface roughness parameters HV and K_IC were identified and, thus, differences in their clinical performance were anticipated.

The Wear Performance of Glazed and Polished Full Contour Zirconia

Abstract This study evaluated the influence of zirconia surface finishes on the wear of an enamel analogue. 40 zirconia discs were divided into four groups: control (without finish); glazed; polished; polished and glazed. All samples were subjected to wear against steatite antagonists. The specimens underwent roughness, topographic, scanning electron microscopy (SEM) and wettability analyses. Quantitative wear measurements were performed on both steatites and discs. To measure wear of steatites the weight before and after the test and the diameter after the test were used. Profilometer measurements were performed to determine the wear on discs. Roughness, volumetric wear and mass loss were analyzed using the Kruskal-Wallis and Dunn tests (5%), while contact angle values were analyzed with One-way ANOVA and Tukey tests (5%). The polished group had the lowest roughness means, being statistically different from the other groups (p-value=0.0001). The glazed group presented the lowest steatite volumetric wear (p-value=0.0001), but not statistically different from the polished and glazed group, whereas these groups presented the highest zirconia volumetric wear, with statistically different (p-value=0.0002) compared to the others. SEM showed irregularities on the control groups surface, grooves on the polished group, and a homogeneous surface for the glazed group with a few pores. All groups presented contact angles lower than 90 degrees, characterizing hydrophilic surfaces. It can be concluded that just glazed zirconia caused less wear on the antagonist when compared to no finish and polished zirconia.

Monolithic Zirconia: An Update to Current Knowledge. Optical Properties, Wear, and Clinical Performance

The purpose of this paper was to update the knowledge concerning the wear, translucency, as well as clinical performance of monolithic zirconia ceramics, aiming at highlighting their advantages and weaknesses through data presented in recent literature. New ultra-translucent and multicolor monolithic zirconia ceramics present considerably improved aesthetics and translucency, which, according to the literature reviewed, is similar to those of the more translucent lithium disilicate ceramics. A profound advantage is their high strength at thin geometries preserving their mechanical integrity. Based on the reviewed articles, monolithic zirconia ceramics cause minimal wear of antagonists, especially if appropriately polished, although no evidence still exists regarding the ultra-translucent compositions. Concerning the survival of monolithic zirconia restorations, the present review demonstrates the findings of the existing short-term studies, which reveal promising results after evaluating their performance for up to 5 or 7 years. Although a significant increase in translucency has been achieved, new translucent monolithic zirconia ceramics have to be further evaluated both in vitro and in vivo for their long-term potential to preserve their outstanding properties. Due to limited studies evaluating the wear properties of ultra-translucent material, no sound conclusions can be made, whereas well-designed clinical studies are urgently needed to enlighten issues of prognosis and long-term survival.

Simulated occlusal adjustments and their effects on zirconia and antagonist artificial enamel

PURPOSE

The aim of this study was to evaluate the effect of occlusal adjustments on the surface roughness of yttria-tetragonal zirconia polycrystal (Y-TZP) and wear of opposing artificial enamel.

MATERIALS AND METHODS

Twenty-five Y-TZP slabs from each brand (Lava, 3M and Bruxzir, Glidewell Laboratories) with different surface conditions (Control polished - CPZ; Polished/ground - GRZ; Polished/ground/repolished - RPZ; Glazed - GZ; Porcelain-veneered - PVZ; n=5) were abraded (500,000 cycles, 80 N) against artificial enamel (6 mm diameter steatite). Y-TZP roughness (in µm) before and after chewing simulation (CS) and antagonist steatite volume loss (in mm³) were evaluated using a contact surface profilometer. Y-TZP roughness was analyzed by three-way analysis of variance (ANOVA) and teatite wear by two-way ANOVA and Tukey Honest Difference (HSD) (P=.05).

RESULTS

There was no effect of Y-TZP brand on surface roughness (P=.216) and steatite loss (P=.064). A significant interaction effect (P<.001) between surface condition and CS on Y-TZP roughness was observed. GZ specimens showed higher roughness after CS (before CS − 3.7 ± 1.8 µm; after CS − 13.54 ± 3.11 µm), with partial removal of the glaze layer. Indenters abraded against CPZ (0.09 ± 0.03 mm³) were worn more than those abraded against PVZ (0.02 ± 0.01 mm³) and GZ (0.02 ± 0.01 mm³). Higher wear caused by direct abrasion against zirconia was confirmed by SEM.

CONCLUSION

Polishing with an intraoral polishing system did not reduce the roughness of zirconia. Wear of the opposing artificial enamel was affected by the material on the surface rather than the finishing technique applied, indicating that polished zirconia is more deleterious to artificial enamel than are glazed and porcelain-veneered restorations.

Tribology and Dentistry: A Commentary

Since 1966 the term “tribology” has integrated different topics like friction, lubrication and wear. After a few years, interest in this type of phenomena rapidly spread out around the world of biology and medicine, determining a new research area defined as biotribology. This commentary is conceived within this framework with the aim of underlining the close link between tribology and dentistry regarding both physiological and restorative issues. The contact between teeth requires investigation into their tribological behavior focusing on the enamel wear process against natural teeth and/or artificial teeth, allowing us to obtain useful information on the tribological behavior of restorative materials. Thus, tested materials may be natural teeth, restorative materials (metal alloys, ceramics, composites) or both. This work aims to make a contribution to underlining the need for greater standardization of tribological experimental procedures as well as to obtaining more homogeneous and indicative results on the tested tribo systems.

Wear Characteristics of Dental Ceramic CAD/CAM Materials Opposing Various Dental Composite Resins

The aim of this study was to evaluate the wear properties of opposed dental ceramic restorative CAD/CAM materials and several posterior direct restorative composite resins. Three kinds of dental ceramics CAD/CAM materials (monolithic zirconia, lithium disilicate, leucite) and four dental composite resins—that is, MI Gracefil, Gradia Direct P, Estelite Σ Quick, and Filtek Supreme Ultra—were used in this study. For each of the 12 groups (three ceramics × four composite resins), five each of a canine-shaped ceramic specimen and a cuboidal shape opposing composite resin were prepared. All of the specimens were tested in a thermomechanical loading machine (50 N, 100,000 cycles, 5/55 °C). Wear losses of ceramic specimens and composite resin specimens were evaluated using a three-dimensional profiling system and an electronic scale, respectively. Statistical analyses were performed using the Kruskal–Wallis test and Mann–Whitney U test with Bonferroni’s correction. Zirconia showed significantly less volumetric loss than lithium disilicate or leucite regardless of composite resin type (p > 0.05/3 = 0.017), and that Estelite Σ Quick showed significantly more weight loss than Filtek Supreme Ultra, MI Gracefil, or Gradia Direct P regardless of ceramic type (p > 0.05/6 = 0.083). Zirconia showed less volumetric loss than lithium disilicate or leucite. Some composite resins opposing ceramics showed considerable weight loss.

Zirconia Use in Dentistry - Manufacturing and Properties

Several types of metal-free ceramics have been developed to meet the patients demand for natural looking appearance restorations. Owing to their biocompatibility and good mechanical properties zirconia has been successfully used in recent years as a dental biomaterial. Due to its high opacity zirconia cores are generally covered with ceramic veneers that provide a more natural appearance but have frequent incidence of chipping. As an alternative to veneered zirconia full-contour zirconia restorations become more widely used nowadays. The paper reviews the current knowledge and scientific data of the zirconia use in dentistry in order to compare the zirconia based dental restorations with the metal-ceramic ones and also the two types of dental restoration based on zirconia, veneered or monolithic zirconia.

Experimental Comparison on Dental BioTribological Pairs Zirconia/Zirconia and Zirconia/Natural Tooth by Using a Reciprocating Tribometer

The application of tribology in dentistry is growing rapidly, intense research has been conducted to develop an understanding of dental tribology for better selection of artificial materials and dental implant design. Dental biotribology, has been one of the most important branches in biotribology in recent years. The aim of this research is to investigate the tribological performances in the tooth-to-tooth contact and material-to-natural tooth contact (zirconia vs. zirconia and natural tooth vs. zirconia). The presented research was carried out by testing the above mentioned tribological pairs with the use of a reciprocating tribometer under lubricated conditions (artificial saliva). The normal force used in the tests was 20 N the time for each test was of 60 min. The stroke length was 2 mm, according to the range of displacement used in scientific literature. The wear mass loss evaluation was evaluated by using a gravimetric method. In order to characterize the wear mechanisms, present in the worn surfaces after each of tribo-tests, a topographic analysis was carried with a 3D non-contact optical profiler. The results show that the minimum value of the COF is obtained in the case of Zirconia vs. Zirconia tribo-couple. The results on the wear mass loss show a very low wear rate when coupling in tribological condition natural tooth with a ceramic restoration (a mean value of 0.5 mg was found). This rate is even lower when the contact is between two artificial zirconia teeth.