Change of phase transformation and bond strength of Y-TZP with various hydrofluoric acid etching

Is zirconia surface etching a viable alternative to airborne particle abrasion? A systematic review and meta-analysis of in vitro studies

OBJECTIVES

This systematic review aimed to determine the effectiveness of various etching surface treatments on zirconia bond strength with the following research question: "Can zirconia etching serve as a viable alternative to airborne particle abrasion (APA) for achieving reliable bonding?".

DATA

In vitro studies comparing APA, performed with either conventional or silica-coated aluminum oxide (Al2O3) particles, with various etching protocols in terms of bonding performance were included. The risk of bias of the included studies was assessed using the QUIN's tool for in vitro studies. Meta-analyses were performed using RevMan; random-effects models were applied, and heterogeneity was tested using the I2 index. The significance level was set at p < 0.05.

SOURCES

A comprehensive literature search was conducted across electronic databases, including Clarivate Analytics' Web of Science, Cochrane Library, EMBASE, PubMed, Scopus and ProQuest.

STUDY SELECTION

Fifty-four relevant articles were included in this systematic review. According to the QUIN's tool, 7 studies were rated as "high risk of bias", 46 studies were rated as "medium risk", and 1 study was rated as "low risk". Nineteen studies were used for meta-analyses. Mostly, APA demonstrated significantly higher bond strength compared to various etching protocols (p < 0.05). However, no statistical difference was found between APA and high concentrations (40-48 %) of hydrofluoric acid (HF) in terms of immediate- and medium-term bond strength to resin composite (p > 0.05). On enamel, an experimental hot etching solution performed significantly better than APA in short-term follow-up (p < 0.05). A novel multi-acid solution exhibited significantly higher immediate shear bond strength to resin cement than APA (p < 0.05). Variable heterogeneity, ranging from low to high, was observed.

CONCLUSIONS

APA remains the surface treatment with the strongest evidence in the literature and it is usually more efficacious than zirconia etching. However, highly concentrated HF and an experimental hot etching solution have demonstrated similar or significantly higher bond strength values over time compared to APA, depending on the adhesive substrate. A recently introduced multi-acid solution (Zircos-E) needs to be further explored, especially in regards to long-term bond durability.

CLINICAL SIGNIFICANCE

This systematic review provides a comprehensive analysis of the existing in vitro evidence on the potential of zirconia etching and the bond durability of resin-based materials after artificial aging. Selecting appropriate surface treatment protocols is crucial for achieving optimal clinical outcomes.

Exploring Zirconia Adhesion: Pre and Postsintering Physical Surface Treatment, Chemical Treatment, and Cement Interactions

Background: Adhesion to zirconia remains a significant dental challenge. This study is aimed at assessing the bond strength of zirconia based on surface treatment with pre or postsintering sandblasting associated with different chemical treatments and resin cements. Methods: Zirconia blocks were divided into 12 experimental groups based on the surface treatment (presintering sandblasting or postsintering sandblasting/tribochemical abrasion treatment), chemical treatment (none, Single Bond Universal, or Signum Zirconia Bond), and choice of cement (Panavia F or RelyX™ U200). The bond strength was measured by shear tests using a universal testing machine. The fracture analysis was performed using stereomicroscopy. Data were analyzed using three-way ANOVA and Tukey's test (α = 5%). Results: Triple and double factor's interactions were not significant (p > 0.05). Regarding the surface treatment factor, the bond strength following postsintering sandblasting treatment associated with tribochemical abrasion (9.15 ± 3.62 MPa) was significantly higher than presintering sandblasting treatment (5.24 ± 3.53 MPa). Concerning the chemical treatment factor, bond strengths were ranked as follows: Signum Zirconia Bond > Single Bond Universal > no treatment. The bond strength of the resin cements did not differ among them. Most fractures (67%) were classified as adhesive, and 32% were categorized as mixed fractures. Conclusion: Surface treatment via postsintering sandblasting combined with tribochemical abrasion demonstrated superior efficacy than in presintering sandblasting. Additionally, chemical treatment with zirconia primer increased the bond strength of zirconia irrespective of the surface physical treatment.

Surface property changes observed in zirconia during etching with high-concentration hydrofluoric acid over various immersion times

This study investigated the degree of phase transformation, surface roughness, and bond strength of zirconia immersed for various times in a 40% hydrofluoric acid (HF) solution. Non-etched sintered zirconia specimens were used as the control, while experimental groups were etched with a 40% HF solution for 5, 10, 20, 40, 80, 160 and 320 min. In each of the control and experimental groups, five specimens for X-ray diffraction analysis, four for surface morphology and surface roughness analysis, and ten for bonding strength measurement were used. As a result, the surface roughness of zirconia increased as the application time increased during the 40% HF etching, but the bond strength between zirconia and resin cement did not increase proportionally. The phase transformation from tetragonal to monoclinic also gradually increased with application time.

Zirconia bond strength durability following artificial aging: A systematic review and meta-analysis of in vitro studies

The present study systematically reviewed the literature regarding the bond strength durability of zirconia ceramics to resin-based luting cements after application of different bonding protocols and aging conditions. Electronic searches in PubMed, Scopus, and Web of Science databases were performed for relevant literature published between January 1st 2015 and November 15th 2022. Ninety-three (93) English language in-vitro studies were included. The percentage of the mean bond strength change was recorded prior to and after artificial aging, and the weighted mean values and 95% confidence intervals were calculated. Bonding protocols were classified based on the combination of MDP/non-MDP containing cement/primer and surface pretreatment, as well as the level of artificial aging performed. Alumina sandblasting (SA) was identified as the most frequently used surface pre-treatment while an insufficient number of studies was identified for each category of alternative surface treatments. The combination of MDP cement with tribochemical silica coating (TSC) or SA yielded more durable results after aging, while the application of SA and TSC improved bond durability when a non-MDP cement and a non-MDP primer were used. TSC may lead to increased bond durability compared to SA, whereas MDP cements may act similarly when combined with SA or TSC.

Effect of surface topography and wettability on shear bond strength of Y-TZP ceramic

Zirconia ceramics have been widely used as dental restorations due to their esthetic appearance and high flexural strength. The bonding of zirconia with resin cement should rely on both mechanical and chemical bonds. This study was performed to investigate the effect of zirconia surface topography and its wettability after surface pretreatments on the microshear bond strength (μSBS) of a resin cement. Zirconia slabs were prepared and randomly divided into 5 groups based on the surface treatment as follows: no treatment (control), air abrasion (AB), etching with hydrofluoric acid (F), the mixture of hydrofluoric acid and nitric acid (FN), or the mixture of hydrochloric acid and nitric acid (CN) for 10 min. The specimens were subjected to investigation of surface roughness characteristics [average roughness (Ra), peak-to-valley average distance (Rpv), skewness (Rsk), and kurtosis (Rku)] using atomic force microscopy (AFM) and measurements of surface contact angle (θc) and μSBS of a resin cement. In addition, the area % of the nanoscale surface irregularity (nSI%) was calculated from the AFM images. The effects of nSI%, Ra and θc on the μSBS were analyzed by multiple linear regression analysis (p < 0.05). Multiple regression analysis revealed that the nSI% was the most predominant factor for the μSBS (p < 0.001). A surface with larger nSI%, higher Ra and relatively lower θc was essential for establishing a reliable resin-zirconia bond.

Y-TZP Physicochemical Properties Conditioned with ZrO2 and SiO2 Nanofilms and Bond Strength to Dual Resin Cement

Commercial Yttria-tetragonal zirconia polycrystalline (Y-TZP) was subjected to surface treatments, and the bond strength of dual resin cement to Y-TZP and failure modes were evaluated. Disks (12 mm × 2 mm), cylinders (7 mm × 3.3 mm), and bars (25 mm × 5 mm × 2 mm) were milled from Y-TZP CAD-CAM blocks, divided into seven groups, and subjected to different surface treatments; silicatization was used as control. On the basis of the literature, this study evaluated modifications with films containing SiO2 nanoparticles and silane; SiO2+ZrO2—SiO2 (50%) and ZrO2 (50%) nanoparticles, SiO2+ZrO2/Silane-SiO2 (50%) and ZrO2 (50%) nanoparticles, and silane. Specimens were analyzed by wettability (n = 3), surface free energy (n = 3), X-ray diffraction (n = 1), Fourier transform infrared spectroscopy (FTIR) (n = 1), roughness (n = 5), shear bond test (n = 10), and dynamic modulus (n = 3). Specimens treated with hydrofluoric acid—HF 40% presented significantly higher contact angle and lowest surface free energy (p < 0.05). The SiO2/Silane presented crystalline SiO2 on the surface. The surface roughness was significantly higher for groups treated with nanofilms (p < 0.05). Shear bond strength was significantly higher for silicatization, HF 40%/silicatization, SiO2/Silane, and SiO2+ZrO2/Silane groups. The proposed treatments with nanofilms had potentially good results without prejudice to the physicochemical characteristics of zirconia. Generally, groups that underwent silica surface deposition and silanization had better bond strength (p < 0.005).

Enhanced osteogenic activity of titania-modified zirconia implant by ultraviolet irradiation

Zirconia is a superior implant material owing to its high mechanical strength, durable corrosion resistance, superior aesthetic effect and excellent biocompatibility. However, the bioactivity of zirconia surfaces remains a great challenge for implant osseointegration. A titania (TiO₂) coating was innovatively synthesized on the surface of zirconia by infiltration in a suspension of zirconium oxychloride and titania for dense sintering. Subsequently, the coating was subjected to ultraviolet (UV) light to enhance the biological inertness of zirconia. Scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and contact angle analysis were conducted to confirm the surface characteristics. Afterwards, in vitro assessments of cell adhesion, proliferation and osteogenic differentiation of MC3T3-E1 cells were performed. Zirconia samples were implanted into rat femurs to assess biocompatibility and host tissue response in vivo. Micro-CT evaluation and histological testing were conducted. After UV irradiation, the content of hydroxyl groups and hydrophilicity of TiO₂-modified zirconia were significantly increased. The results of in vitro experiments showed that TiO₂-modified zirconia subjected to UV light could promote cell proliferation and spreading, enhance ALP activity and the degree of mineralization, and upregulate osteogenesis-related genes. Furthermore, in vivo assessments confirmed that UV-irradiated TiO₂-modified zirconia implants maximized the promotion of osseointegration. TiO₂-modified zirconia after UV treatment will have broad clinical application prospects in improving the osseointegration of zirconia implants.

Adhesive Cementation of Zirconia Based Ceramics-Surface Modification Methods Literature Review

Introduction: The conditioning procedures for glass-based ceramic restorations before adhesive cementation are generally recognized. In the case of polycrystalline ceramics, which include zirconium oxide, there is still no standardized protocol. The aim of this work was to present conditioning methods of the cementation surface of zirconium oxide fixed dentures. The new generation high translucency zirconia has been also considered. Material and method: The following keywords for the PUBMED and EMBASE databases were used: zirconium oxide, zirconium oxide with increased translucency, bond strength, bending strength, surface treatment. The inclusion criteria were original papers in English published between 2015–2021. Results: Out of 1537 publications, 53 articles were selected for the study, covering methods of conditioning zirconium ceramics, including new materials with increased translucency. These procedures were divided into 5 main groups. Summary: Due to the widespread use of zirconia ceramics and the introduction of new zirconia-based materials, the use of a predictable and standardized cementation protocol is one of the most important factors contributing to the long-term clinical success of prosthetic restorations. Therefore, the research showed differences in the properties of the covered materials after conditioning. It suggests the need to create separate conditioning protocols for highly translucent and traditional zirconia.