Lava Plus Research Articles

Effects of multiple firings on the translucency, crystalline phase, and mechanical strength of highly translucent zirconia.

This study aimed to clarify the effects of multiple firings on the translucency, crystal structure, and mechanical strength of highly translucent zirconia. Four types of highly translucent zirconia (LAVA Esthetic, LAVA Plus, KATANA Zirconia STML, and KATANA Zirconia HTML) were fired three times at three different temperatures, and the translucency, crystal structure, and flexural strength were evaluated before and after firing. The translucency was statistically compared using repeated-measures analysis of variance; the zirconia phase composition was assessed using X-ray diffraction followed by Rietveld analysis; and the biaxial flexural strength was assessed using Weibull analysis. The translucency of LAVA Esthetic and KATANA Zirconia HTML decreased significantly after firing, and the crystal composition of LAVA Plus and KATANA Zirconia HTML changed after multiple firings, whereas multiple firings did not affect the biaxial flexural strength of any samples. Thus, multiple firings may affect the optical properties of highly translucent zirconia.

Effect of sintering time on microstructure and optical properties of yttria-partially stabilized monolithic zirconia

ObjectivesTo evaluate the impact of speed sintering on the microstructure and optical properties of 3 and 5 mol% yttria-partially stabilized monolithic zirconias. Methods120 plate-shaped zirconia specimens (10x10x 0.4 mm) were prepared from three commercial 5 mol% yttria-partially stabilized zirconia blocks (5Y-PSZs); Katana UTML (Kuraray Noritake), Cercon xtML (Dentsply Sirona), and Zolid FX white (Amann Girrbach), and two commercial 3 mol% yttria-partially stabilized zirconia blocks (3Y-PSZs); Lava Plus (3 M ESPE) and InCoris (Sirona, GmbH). Specimens were either conventional sintered (CS) using a 7-hour program or speed sintered (SS) using a quick 90-minute program. The microstructure was inspected with a scanning electron microscope (SEM), and phase fractions were detected using x-ray diffraction analysis (XRD). Translucency (TP00), and contrast ratio (CR) were obtained using a spectrophotometer (VITA Easyshade V). Color difference (ΔE00) between both sintering processes was calculated with the CIEDE2000 formula. ΔE00 up to 1.8 was set as the acceptability threshold. Data were analyzed using two-way ANOVA, Krusakll-Wallis, and Mann-Whitney U tests. (n = 12, α = .05). ResultsGrain size was significantly decreased after SS for all tested materials (P < .0001). The average grain sizes of 5Y-PSZs were significantly larger than those of 3Y-PSZs. The atomic structure, microstructure, and transparency of CS and SS were all affected by the amount of yttria, the size of the crystals, and tetragonality. SS significantly reduced TP00 (F = 7135.95, P < 0.0001) and increased CR (F = 453.21, P < 0.0001). The CS Katana presented the highest TP00 and lowest CR value. ΔE00 between the CS and SS groups were clinically acceptable except for Lava, which had values above the set threshold (1.89). SignificanceSS altered the grain size and internal structure of the tested materials, which was reflected in translucency.

Three-Dimensional Peri-Implant Tissue Changes in Immediately vs. Early Placed Tapered Implants Restored with Two Different Ceramic Materials-1 Year Results.

A prospective multi-center randomized controlled clinical trial was performed to digitally analyze tissue volume changes in immediately and early placed implants with simultaneous bone augmentation restored with two different all-ceramic materials. A total of 60 patients received 60 bone-level tapered implants (BLT, Straumann AG) immediately (n = 30) or early placed, 8-10 weeks after tooth extraction, (n = 30). Implants were restored with all-ceramic single crowns fabricated out of zirconia (Lava Plus, 3M), or lithium disilicate (E.max CAD, Ivoclar Vivadent AG) bonded to titanium base abutments (Variobase for Cerec, Straumann AG). Impressions were taken at baseline (BL), 6 and 12 months, and STL data were used to define an area of interest (AOI) to analyze peri-implant volume changes and midfacial recessions. For immediate placement, a mean volume loss of -5.56 mm3 (±5.83 mm3) was found at 6 months, and of -6.62 mm3 (±6.56 mm3) at 12 months. For early placement, a mean volume loss of -1.99 mm3 (±5.82 mm3) at 6 months, and of -3.7 mm3 (±5.62 mm3) at 12 months was found. The differences in volume loss at 12 months between the two implant placement protocols were significant (p = 0.005). In both groups, mean midfacial recessions of 0.48 mm (±0.52) occurred. A more pronounced peri-implant volume loss can be expected 12 months after immediate implant placement compared with early placement.

Influence of Different Surface Conditioning Methods on Adhesion of Resin Cement to Zirconia

Statement of the problem: The challenge of enhancing the bond between zirconia and resin remains, and the efforts continue to determine a simple method for achieving a durable bond. Objective: This study aimed to evaluate the effect of different surface conditioning strategies on the bond strength between zirconia and resin ce-ment. Materials &amp; Methods: Forty zirconia specimens (Lava Plus) were fabricated and divided into four groups: control (no surface treatment), pri-mer application (Z-Prime Plus), experimental acid (H2O:HF:H2O2) applica-tion, and the combination of the acid and primer application (n=10). A dual-cure resin cement (RelyX Ultimate) was applied over the zirconia specimens. Shear bond strength tests were conducted using a universal testing machine with a cross-head speed of 1 mm/min. The results were analyzed using one-way ANOVA followed by Tukey's post hoc test within the 95% confidence interval. Results: The results of the one-way ANOVA showed that acid appli-cation alone (22.99 ± 2.49 MPa) and acid and primer application (25.24 ± 3.19 MPa) had significantly higher bond strength than the primer (18.87 ± 3.13 MPa) and control (14.91 ± 3.72 MPa) groups (P&lt;0.05). However, there was no significant difference between the acid group and acid and primer combination group (P=0.396). The control group had the lowest bond strength in all test groups (P&lt;0.05). Conclusions: Experimental acid treatment alone or in combination with primer application could be effective in improving the bond strength.

Evaluation of the Translucency Properties for CAD/CAM Full Ceramic Crowns Fabricated From Glass Ceramics (E.max) or High Translucency Zirconia (Lava Plus): A Clinical Study.

Introduction Nowadays, cosmetic demands are the first reason to visit dental clinic. However, most ceramic prostheses need an excessive removal of the dental structure, whether for full crowns or veneer preparation. With the innovation in ceramic materials, high translucent zirconia that demands minimal preparation with high aesthetic results was used for computer-aided design/computer-aided manufacturing (CAD/CAM) Full ceramic crown fabrication. The objective of this study was to compare the translucency properties of CAD/CAM full ceramic crowns fabricated from glass ceramics (E.max) and high translucency zirconia (Lava plus, 3M EPSE). Material and methods The sample consisted of 60 full ceramic crowns divided into two groups; the first group consisted of 30 IPS E.max CAD/CAM full ceramic crowns, while the second one consisted of 30 high translucent zirconia CAD/CAM full ceramic crowns. Translucency for both groups was evaluated directly after cementation by observing the blue light passing through the prostheses. Pearson Chi-Square test was used to study the difference in translucency between the two study groups. Results IPS E.max CAD showed a higher translucency compared to lava plus high translucency zirconia; in addition, this difference was statistically significant (p=0.028). Conclusion Within the limitation of this study, we found that the translucency of dental ceramic was affected by the ceramic material. As IPS E.max CAD was significantly higher in terms of translucency compared to High Translucent Zirconia.

Effects of Particle Abrasion Media and Pressure on Flexural Strength and Bond Strength of Zirconia.

To compare the effects of particle abrasion medium and pressure on shear bond strength and biaxial flexural strength of three generations of zirconia (Lava Frame, Lava Plus, and Lava Esthetic) with the goal of optimizing the bond to zirconia. 280 discs (14 mm diameter; 1 mm thickness) of each zirconia were milled and sintered. Specimens of each material were randomly distributed into 14 groups (n=20); half were tested for shear bond strength and half were tested for biaxial flexural strength. The specimens were particle abraded on one surface by 2 different media (50 μm alumina particles or 50 μm glass beads) for 10 seconds at three different pressures (15, 30, and 45 psi or 0.1, 0.2, 0.3 MPa). Untreated specimens served as positive control. A tube (1.50 mm diameter) filled with dual cured resin cement (Panavia SA) was placed onto the surface and light cured. Specimens were stored in water (37°C for 24 hours) and shear bond strength was measured in a universal testing machine (Instron). Biaxial flexural strength of each specimen was measured according to ISO 6872. Shear bond strength and biaxial flexural strength were compared individually with a 2-way analysis of variance (ANOVA) for factors surface treatment and zirconia composition. Significant differences were seen between surface treatments (p<0.01), zirconia composition (p<0.01) and their interaction (p<0.01) for both bond strength and flexural strength. With alumina particle abrasion, higher pressure produced higher bonds for Lava Frame and Lava Plus zirconia while the bond of Lava Esthetic declined with increased pressure. Higher pressure (>0.2 MPa or 30 psi) with alumina decreased biaxial flexural strength with Lava Esthetic zirconia. Particle abrasion with alumina produced a significantly better combination of bond strength while maintaining biaxial strength of three zirconia materials than particle abrasion with glass beads. The bond strength also depended upon the pressure of particle abrasion and the generation of zirconia used.

Zirconia Cantilever Fixed Dental Prostheses Supported by One or Two Implants: An In Vitro Study on Mechanical Stability and Technical Outcomes

To evaluate the mechanical stability of highly translucent zirconia (Zr) cantilevered fixed dental prostheses (cFDPs) and to investigate the influence of the number of implants (one versus two) supporting cFDPs with different restorative materials on their mechanical stability and load-bearing capacity. Thirty-two specimens consisting of implant-supported prostheses embedded in resin blocks were fabricated. Sixteen specimens received one implant (bone-level implant, 4.1-mm diameter, 13-mm length; Straumann) to support two-unit cement-retained cFDPs with one extension unit and the other 16 received two implants (bone-level implant, 4.1-mm diameter, 13-mm length; Straumann) positioned corresponding to the missing maxillary central incisors to support three-unit cement-retained cFDPs with one extension unit. Two different prosthetic materials, chromium-cobalt (Cr-Co; Wirobond C+, Bego) and highly translucent Zr (Lava Plus, 3M ESPE) were selected to fabricate the two- and three-unit cFDPs. Standardized twoand three-unit Cr-Co frameworks (CC-I, n = 8; CC-II, n = 8) and highly translucent Zr frameworks (Zr-I, n = 8; Zr-II, n = 8) with a 6-mm cantilever extension were fabricated using CAD/CAM (EOS M 290). Following thermomechanical fatigue loading, the specimens were tested for fracture resistance under static loading. The influence of restoration material and number of supporting implants on fracture resistance were tested using two-way analysis of variance (ANOVA). The level of statistical significance was set below 5% (α < .05). All specimens survived aging. The mean (± standard deviation) fracture resistance values were 416.25 (± 42.71) N for Zr-I, 548.75 (± 75.41) N for Zr-II, 601.0 (± 41.51) N for CC-I, and 664.5 (± 37.59) N for CC-II. CC and Zr group specimens showed significantly different fracture resistance results (P < .001). The number of implants significantly influenced the fracture resistance of Zr groups (P = .001), whereas the influence was not significant for CC groups (P = .089). Within the limitations of this in vitro study, highly translucent zirconia cFDP frameworks demonstrated the potential to withstand reported physiologic occlusal forces applied in the anterior region. The increase in the number of implants supporting zirconia cFDPs significantly contributed to achieving higher fracture resistance values.

Mechanical properties–translucency–microstructure relationships in commercial monolayer and multilayer monolithic zirconia ceramics

ObjectivesTo evaluate the phase composition, microstructure, optical properties and mechanical properties of eight commercially available multilayer and monolayer monolithic dental zirconias. MethodsFive commercial 3Y-TZP (GC ST, GC HT [GC, Tokyo Japan]; Katana ML, Katana HT [Kuraray Noritake] and Lava Plus [3M Oral Care]) and three Y-PSZ (Katana STML, Katana UTML [Kuraray Noritake]; GC UHT [GC, Tokyo Japan]) zirconia ceramic grades were cut in plate-shaped specimens, sintered according to the manufacturer’s instructions and mirror polished. The zirconia chemical composition was determined using X-ray fluorescence (XRF), phase composition was characterized using X-ray diffraction (XRD), while the grain size was measured using scanning electron microscopy (SEM). The translucency Parameter (TP) and Contrast Ratio (CR) were measured with a spectrophotometer (n = 10/group). The indentation fracture toughness (n = 10), Vickers hardness (n = 10) and biaxial strength (n = 20) of the sintered ceramics were assessed. The stress distribution during biaxial testing was assessed by Finite element analysis (FEA). Statistical analysis involved one-way ANOVA and post-hoc Tukey’s HSD test and Pearson correlation test (α = 0.05). ResultsFEA showed that the stress distribution in plate shape specimens was the same as for disks, rationalizing the use of plates for biaxial strength testing. As expected, higher quantities of Y2O3 were related to a higher cubic ZrO2 phase content and lower tetragonality t-ZrO2, which improved translucency but diminished flexural strength and toughness. While there was no significant correlation between grain size and other material properties, addition of pigments to the zirconia grade statistically negatively affected hardness. ConclusionEven though an improvement in strength and translucency could be recorded for the last Y-TZP generation, future research still needs to strive for combined improvement of optical properties and mechanical reliability of zirconia ceramics.

Effect of airborne-particle abrasion with a novel spherical abrasive on the zirconia surface

Statement of problemA novel zirconia-alumina composite (ZAC) particle has yet to be studied for airborne-particle abrasion in a bonding protocol for the zirconia surface. PurposeThe purpose of this in vitro study was to evaluate the shear bond force of resin cement to yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) when using spherical ZAC particles to conduct airborne-particle abrasion and modify the topography of Y-TZP. Material and methodsSpherical 30- to 70-μm ZAC particles were fabricated by using a hybrid gel technique. A total of 160 Ø6.6×4.0-mm zirconia disks were fabricated from 4 commercially available zirconia blanks, e.max ZirCAD zirconia (EM), NexxZr T zirconia (NE), Lava Plus High Translucency zirconia (LP), and Imagine High Translucency Zirconia (IM), by using computer-aided manufacturing technology. As-sintered specimens without further surface treatment were used as controls (ZR0). Surface treatment groups included sharp-edged alumina airborne-particle abrasion (ABC), 50 μm, 0.2 MPa; airborne-particle abrasion with ZAC particle at 0.2 MPa (2ZA); and airborne-particle abrasion with spherical ZAC particle at 0.4 MPa (4ZA). All surface treatment groups were airborne-particle abraded at the specified pressures for 10 seconds at a standardized distance of 10 mm. The surface roughness (Ra) and area roughness (Sa) of specimens from each group were measured. Following the application of an adhesive (Scotchbond Universal), Ø6.6×4.0-mm resin cement (RelyX Ultimate) buttons were fabricated for shear bond testing by using a universal testing machine at a 5-mm/min crosshead speed (n=10). The data were analyzed by using a 2-way ANOVA, Tukey HSD test, and regression analysis (α=0.05). Scanning electron microscopy (SEM) was performed to observe changes of the zirconia surface and the failure modes of each group before and after shear bond testing. ResultsThe mean ±standard deviation shear bond force values ranged from 272.6 ±41.4 N to 686.7 ±152.8 N. Statistically significant higher force values than those of the controls (P<.05) were obtained by using airborne-particle abrasion. No significant differences were found among any of the airborne-particle abrasion treatment groups (P>.05). The mean of Ra values ranged from 0.27 μm to 0.74 μm, and the mean of Sa values, from 0.48 μm to 1.48 μm. SEM observation revealed that the zirconia surface was made jagged by abrasion with sharp-edged alumina particles. The spherical ZAC particles create microcraters on the zirconia surface. Fractographic observation disclosed that failures were adhesive-cohesive failure modes with residual resin cement attached on the zirconia surface. ConclusionsThe surface treatment of zirconia with sharp-edged alumina or the spherical ZAC abrasives improved the bonding force between the zirconia and resin cement. No statistically significant differences in shear bond force values were found between airborne-particle abrasion surface treatment groups.

Evaluation of marginal adaptation of (CAD/CAM) Lava plus high translucent zirconia and (CAD/CAM) IPS-Emax Full Crowns

The purpose of this research to compare the internal and marginal fit of two full crown’s materials made by (Cad/Cam) machine “lava plus high translucent zirconia and Ips-Emax using replica technique. The research sample consisted of 60 premolars prepared to have a full crown and it was divided into two equal groups (n1=n2=30), in the first group the full crowns were fabricated by Lava Plus high translucent zirconia whereas in the second group the full crowns were fabricated by IPS-Emax. Marginal adaptation of the crowns was measured by (cement replica technique) before applying the cementation steps of crowns, gingivo-incisal sections and mesio-distal sections were made and measured the marginal adaptation in 3 points in the cervical area and 3 points in the contact area using the BX41 OLYMPUS optical microscope magnifying ×10. Normal distribution of data was confirmed by using Kolmogorov-Smirnov test, then data analysis was done using Independent samples t-test at significance level of (α=0.05). The average marginal gap of the Lava Plus and IPS-Emax full crowns were 105.72 and 152.57 micron respectively, therefor there is a statistically significant difference at 95% confidence level (p&lt;0.05), the average marginal gap value of the second group was higher than the first group by (46.85 micron). Among the limitations of this study we conclude that the marginal gap value of the full crowns varies according to the material which they were fabricated by it, Thus, LAVA Pluas high translucent zirconia Full crowns have more adaptation than Ips-Emax Full crowns as it represents less marginal gap values, although all values were within clinically acceptable limits.

Optical properties of monolithic zirconia crowns: In vitro and In vivo evaluation

Background/Aim: The aim of this study was to compare the monolithic and layered zirconia crowns by their optical property of translucency, using in vitro and in vivo evaluation methods. Material and Methods: One upper incisor and one canine were prepared to receive 6 monolithic Lava Plus HT and 6 layered Lava crowns using the CAD/CAM technology. The translucency in the vitro evaluation, was determined using a digital photoradiometer to measure the light reflected by the crowns in two different conditions, natural and metal plated abutment tooth. A provisional complete prosthesis of an edentulous patient, with the abutment teeth mounted in their anatomical position, was used for the in vivo evaluation. The crowns were randomly placed and evaluated by two independent operators in the oral cavity conditions. Results: In vitro results showed that monolithic crowns were not significantly less translucent than layered ones in both incisor (p=0.098) and canine (p=0.340): contrast ratio 0.978 vs. 0.956 and 0.941 vs. 0.929, respectively (Student -t test; a=0.05). In vivo evaluation results showed that the difference in the luminance was not statistically significant between Lava Plus HT and layered Lava crowns according to Mann Whitney Test, p=0.089 (a=0.01). Conclusions: The difference in translucency between monolithic and layered zirconia crowns was not statistically significant both in vitro and in vivo evaluation. Monolithic zirconia had a good masking ability of the abutment tooth.

Do high translucency zirconia shades contribute to the degree of conversion of dual-cure resin cements?

The opacity of the zirconia ceramic restoration may influence the degree of conversion (%DC) of dual-cured resin cements. The aim of this study was to evaluate the degree of conversion of resin luting agents photocured under different high translucency zirconia shades. The opacity of each ceramic shade was evaluated. The opacity percentage of Lava Frame and three Lava Plus High Translucency Zirconia ceramic shades (W1, A2, and B4) was determined. A spectrophotometer MiniScan was used to measure the opacity percentage of each specimen (0.7 mm thick) and then the opacity was calculated. Specimens from three different resin cements (Panavia F2.0, RelyX Unicem 2 Automix Self-Adhesive, and PermaFlo DC) were prepared with 100-µm thickness. The specimens were photocured according to the manufacturers' instructions under a ceramic block (0.7 mm thick). Specimens photocured without the ceramic block were used as control. Fifteen groups (n = 3) were evaluated. Micro-ATR/FTIR (micro-attenuated total reflectance/Fourier-transformed infrared spectroscopy) spectrometry was used to evaluate the extent of polymerization of all specimens after 24 hours. The %DC was determined using experimentally polymerized versus maximally polymerized composite. The opacity percentages (mean ± SD) of W1, Lava Frame, A2, and B4 ceramics were 72.41% ± 0.04%, 74.24% ± 0.09%, 77.63% ± 0.11%, and 78.17% ± 0.12%, respectively. There was a statistically significant difference in %DC among the different cements investigated (P = .003) and a statistical difference in %DC was also found among the different ceramic shades studied (P = .030). For the Lava Frame and A2 ceramic blocks, the resin cements tested presented the lowest %DC except for the RelyX Unicem resin cement. The %DC of RelyX Unicem 2 cement under low zirconia opacities (W1 and Lava Frame) was greater compared to high zirconia opacities (A2 and B4). For the Panavia F2.0 cement, no effect on the %DC under different high translucency shades was observed. The highest %DC of PermaFlo cement was exhibited when the ceramic shade W1 was used. Dual-cured resin cements exhibited different degrees of conversion depending on the opacity of the zirconia restoration. However, different brands demonstrated higher or lower dependency of the light transmittance on their degree of conversion.

Evaluation of Resin Bonding to Tetragonal and Gradient-Shaded Cubic Zirconia Ceramics After Air-Abrasion.

Self-assembled nano-layering resulting from combined ionic and hydrogen-bonding interactions of phosphate functional monomers with zirconia have been proposed. The purpose of this study was to investigate the bond strengths of two phosphate monomer-containing adhesive resin cements (Panavia F 2.0 and RelyX U200) to a conventional tetragonal zirconia (Lava Plus, LP) and a new cubic zirconia (Lava Esthetic, LE), with three different shade zones, after air-abrasion. The structures of the zirconia surfaces were examined with scanning electron microscopy (SEM) and X-ray diffractometry (XRD). Vickers hardness and fracture toughness of the surfaces were also evaluated using a hardness tester. After air-abrasion (with 50 µm Al₂O₃ at a pressure of 0.25 MPa), the surface roughness was measured using confocal laser scanning microscopy (CLSM) and the resin cements were bonded (diameter: 2.38 mm) to the surfaces. All bonded specimens were stored in water at 37 °C for 24 h before performing the shear bond strength (SBS) test (n = 15). In the SEM images, the LP group showed a finer grain size than the LE groups. The XRD patterns confirmed that LP and LE had tetragonal and cubic phases, respectively. Although there were no significant differences in Vickers hardness among the four groups (p = 0.117), the three LE groups revealed inferior fracture toughness to the LP group (p < 0.001). However, neither the surface roughness of the air-abraded zirconia surfaces nor SBS values of each resin cement bonded to them were significantly different (p > 0.05). In conclusion, no significant difference in SBS value was detected between the tetragonal and cubic zirconia within each resin cement used, probably due to the similar surface roughness of the air-abraded zirconia ceramics.

Additively Manufactured Zirconia for Dental Applications.

We aimed to assess the crystallography, microstructure and flexural strength of zirconia-based ceramics made by stereolithography (SLA). Two additively manufactured 3 mol% yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP: LithaCon 3Y 230, Lithoz; 3D Mix zirconia, 3DCeram Sinto) and one alumina-toughened zirconia (ATZ: 3D Mix ATZ, 3DCeram Sinto) were compared to subtractively manufactured 3Y-TZP (control: LAVA Plus, 3M Oral Care). Crystallographic analysis was conducted by X-ray diffraction. Top surfaces and cross-sections of the subsurface microstructure were characterized using scanning electron microscopy (SEM). Biaxial flexural strength was statistically compared using Weibull analysis. The additively and subtractively manufactured zirconia grades revealed a similar phase composition. The residual porosity of the SLA 3Y-TZPs and ATZ was comparable to that of subtractively manufactured 3Y-TZP. Weibull analysis revealed that the additively manufactured LithaCon 3Y 230 (Lithoz) had a significantly lower biaxial flexural strength than 3D Mix ATZ (3D Ceram Sinto). The biaxial flexural strength of the subtractively manufactured LAVA Plus (3M Oral Care) was in between those of the additively manufactured 3Y-TZPs, with the additively manufactured ATZ significantly outperforming the subtractively manufactured 3Y-TZP. Additively manufactured 3Y-TZP showed comparable crystallography, microstructure and flexural strength as the subtractively manufactured zirconia, thus potentially being a good option for dental implants.

Edge chipping of translucent zirconia

Statement of problemMore translucent dental zirconias have been developed by incorporating the cubic phase and reducing the tetragonal phase content that undergoes transformation toughening, leading to reduced mechanical properties. Whether the clinically relevant mechanical property of the edge chipping toughness of the material is also reduced is unclear. PurposeThe purpose of this in vitro study was to evaluate the edge chipping toughness and translucency of translucent zirconia, 3mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP), and lithium disilicate. Material and methodsTwo translucent zirconia products, Katana and Lava Esthetic; one 3Y-TZP, Lava Plus; and one lithium disilicate, IPS e.max Press were prepared and tested for phase composition via X-ray diffraction (XRD) (n=3), translucency via a spectrophotometer (n=20), and edge chipping via a universal testing machine with a custom-machined specimen holder and diamond indenter (n=20). The 3Y-TZP and lithium disilicate served as the optimal control materials for edge chipping and translucency, respectively. Translucency was compared with 1-way ANOVA and edge toughness with ANCOVA (α=.05). ResultsThe XRD showed the 3Y-TZP to be almost completely tetragonal phase compared with the 2 translucent zirconia products that were predominantly cubic. Katana UTML and IPS e.max Press had a statistically similar (P>.05) translucency that was significantly (P<.05) greater than that of Lava Esthetic and Lava Plus. The edge toughness of Katana UTML was 304 N/mm, IPS e.max Press was 354 N/mm, Lava Esthetic was 394 N/mm, and Lava Plus was 717 N/mm, with significance rankings of Katana UTM<IPS e.max Press=Lava Esthetic<Lava Plus. ConclusionsSome translucent zirconias had translucency similar to that of lithium disilicate; however, as translucency increased with increased cubic content, edge toughness decreased.

Prospective study of monolithic zirconia crowns: clinical behavior and survival rate at a 5-year follow-up.

Purpose To evaluate the clinical behavior and survival of full coverage monolithic zirconia crowns on posterior teeth over a 5-year follow-up.Methods Fifty patients were recruited and underwent restoration with a Lava Plus monolithic zirconia crown (Lava™ Frame Zirconia, 3M Espe, Germany) on premolars or molars. Patients were monitored over a 5-year follow-up (2014-19), recording any biological and/or mechanical complications; these data were used to estimate the crowns' success rate. Periodontal clinical parameters were recorded (pocket probing depth (PPD), plaque index (PLI), bleeding on probing (BOP), and gingival recession (GR)). Wear to the zirconia crowns and antagonist teeth were also evaluated with Geomagic software (3D Systems, U.S.A.). Patients' satisfaction with treatment was evaluated in a questionnaire.Results For the 50 monolithic zirconia crowns analyzed, the survival rate was 98% after 5 years. Only 6% of the crowns presented some type of complication (two debonding and one root fracture). No fracture or fissures were detected. GR and BOP were the only clinical parameters found to be significantly greater around teeth restored with crowns. The monolithic zirconia crowns suffered less wear than the enamel of antagonist teeth. Patient's general satisfaction with treatment was high.Conclusions Monolithic zirconia crowns on posterior teeth are a highly predictable treatment option, with a high survival rate. The single treatment failure was due to a biological complication arising from root fracture. This treatment may be recommended as a treatment that conserves dental structure, and requires minimal dental preparation.

Monitoring fatigue damage in different CAD/CAM materials: A new approach with optical coherence tomography.

To investigate fatigue damage over time, monolithic posterior computer-aided-designed/computer-aided-manufactured (CAD/CAM) crowns were artificially aged in a mouth-motion-simulator, and damage was monitored with optical coherence tomography (OCT). Forty-eight crowns were milled of six different CAD/CAM-materials (n=8), including 3Y-TZP (Lava Plus,'3Y'), 4Y-PSZ (Pritidentamultidisc,'4Y'), 5Y-PSZ (Prettauanterior,'5Y'), zirconia-reinforced lithium silicate (CeltraDuo,'ZLS'), hybrid ceramic (Vita Enamic,'VE'),and resin composite (BrilliantCrios,'COM'), and were adhesively luted on CAD/CAM-milled human molars. Specimens were artificially aged in a mouth-motion-simulator (50-500N, 2Hz, 37°C) for a period of 1 million cycles. Before loading and every 250,000 cycles, the specimens were investigated with spectral domain (SD)-OCT (RS-3000). The maximum vertical and horizontal damage were measured with imaging-processing-software (ImageJ). After testing, the specimens were sliced and analysed via light microscope (Zeiss) to compare the new OCT method with the established light microscope method. Data were subjected to ANCOVA and 2x4-ANOVA. No failure occurred during mouth-motion-simulation. However, all specimens (except for 3Y and 4Y) showed fatigue damage. There was a significant difference in the maximum damage between the CAD/CAM-materials (p<.05). ZLS exhibited the highest damage, followed by VE, COM and 5Y. While damage associated with 5Y was initially noticed after 750,000 cycles, all other materials already showed crack formation after 250,000 cycles. Furthermore, a linear increase in damage over time was noticed in all materials. Due to the shallow light penetration of OCT, damage in the outer area could only be visualized with light microscope. OCT is feasible for monitoring fatigue damage over time within different CAD/CAM-materials, particularly for subsurface damages.

Effects of Tribochemical Silica Coating and Alumina-Particle Air Abrasion on 3Y-TZP and 5Y-TZP: Evaluation of Surface Hardness, Roughness, Bonding, and Phase Transformation.

To determine and compare the effects of tribochemical silica coating and alumina-particle air abrasion on 3 mol% and 5 mol% yttria-stabilized tetragonal zirconia polycrystals (Y-TZP). Two different 3Y-TZP samples (Lava Plus, 3M Oral Care; Ceramill Zolid, Amann Girrbach) and one 5Y-TZP sample (Katana Zirconia UTML, Kuraray Noritake) were prepared and treated with alumina-particle air abrasion and a 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP)-containing self-adhesive composite cement or with tribochemical silica coating followed by silanization (n = 30). Resin columns were cemented onto the treated ceramic surfaces to form specimens. After 24-h water storage or aging with 10,000 thermocycles plus 60-day water storage, shear bond strength (SBS) testing was conducted. Surface roughness, surface Vickers hardness, and crystallographic phase analyses were also performed. The SBS of tribochemically silica-coated 5Y-TZP before and after aging were 13.8 ± 1.4 and 13.2 ± 1.5 MPa, resp., for Lava Plus (3Y-TZP) 14.4 ± 1.4 and 13.9 ± 1.6 MPa, respectively, and for Ceramill Zolid (3Y-TZP) 14.8 ± 1.1 and 13.9 ± 1.5 MPa, respectively. There was no statistical difference between tribochemical silica coating and alumina air abrasion treatments (p = 0.21) on the bonding performance (SBS) of the 3Y-TZPs and 5Y-TZP (p = 0.25) before and after aging (p = 0.50). After alumina air abrasion, 5Y-TZP showed higher surface roughness (Ra = 1.7 ± 0.1) than did the 3Y-TZPs (Ra = 1.2 ± 0.1 for Lava Plus; Ra = 1.2 ± 0.1 for Ceramill Zolid), while the Vickers hardness was similar among the three materials (p = 0.70). Monoclinic zirconia was not detected in 5Y-TZP irrespective of treatment, with the zirconia being mainly cubic phase. However, the 3Y-TZPs were mainly tetragonal phase with some monoclinic zirconia; the latter increased after being alumina-particle air abraded. The bond strength to 5Y-TZP is similar to those of the 3Y-TZPs under the same bonding strategies. Durable bonding can be achieved both by alumina air abrasion combined with a 10-MDP-containing self-adhesive composite cement and by tribochemical silica coating followed by silanization for both the 3Y-TZPs and 5Y-TZP.

Assessing Flexural Strength Degradation of New Cubic Containing Zirconia Materials

Newer zirconia materials may have greater strength degradation under cyclic fatigue with increased yttria and cubic content. The purpose of this study was to evaluate the flexural strength (FS) degradation of newer zirconia materials compared to more traditional tetragonal zirconia materials. The following materials were tested: two 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) materials (Lava Plus, 3M ESPE; Katana ML, Kuraray), one 4 mol% partially stabilized zirconia (4Y-PSZ) material (Katana STML, Kuraray), two 5 mol% partially stabilized zirconia (5Y-PSZ) materials (Katana STML, Kuraray; Lava Esthetic, 3M ESPE), and one lithium disilicate material (IPS e.max CAD LT, Ivoclar Vivadent). Thirty beams were milled for each ceramic material with final dimensions of 4.0 × 1.3 × 18.0 mm after sintering or crystallization. Each specimen was placed on a 3-point bend test device on a universal testing machine (Instron, Norwood, MA). Flexural strength was determined on 10 beam specimens per group with a central load applied until fracture. Flexural fatigue strength was then measured on the remaining 20 beam specimens per group using the staircase method for 6,000 cycles at 2 Hz. Data were analyzed with one-way ANOVAs/Tukey post hoc tests (α = 0.05). A significant difference was found between groups (p < 0.001) per property. The 3Y-TZP zirconia materials had the greatest flexural and flexural fatigue strength. The cubic containing zirconia materials performed more moderately. The lithium disilicate material had the lowest strength values. The percent degradation in flexural fatigue strength of the 3Y-TZP zirconia materials was less than the 5Y-PSZ, Katana UTML, and the 4Y-PSZ, Katana STML, cubic containing materials, but similar to the 5Y-PSZ cubic containing material, Lava Esthetic. The amount of strength degradation was material dependent, with the 4Y-PSZ or 5Y-PSZ cubic containing zirconia materials demonstrating greater or similar strength degradation compared to the primarily tetragonal 3Y-TZP zirconia materials. The differences in FS degradation between cubic containing materials and traditional zirconia materials could significantly impact the long-term success of these newer materials. Clinicians should be aware that these cubic containing materials may perform differently long-term than the very strong traditional 3Y-TZP materials and to follow manufacturer instructions on required material thickness and indications for use to prevent premature failure of the restoration.

Color and translucency stability of novel restorative CAD/CAM materials.

The wide range of restorative materials available for use in the computer-aided design/ computer-aided manufacturing (CAD/CAM) technology requires a better understanding of their esthetic properties. The aim of the study was to assess the stability of the color and translucency of different CAD/ CAM restorative materials before and after being subjected to different staining solutions. A total of 160 disc-shaped specimens were prepared from glass ceramic (IPS-e.max®-CAD and Celtra Duo®), high-translucency zirconia (LavaTM Plus), resin nanoceramic (LavaTM Ultimate), and hybrid ceramic (VITA ENAMIC®) CAD/CAM blocks (5 groups, n = 32). The specimen color and translucency parameter (TP) were assessed using a spectrophotometer at baseline and after subjecting the specimens to different staining solutions (coffee, cola, ginger, and water). Changes in color (ΔE) and TP (ΔTP) were calculated. The data was analyzed using the analysis of variance (ANOVA) and Tukey's post hoc test (p < 0.05). The correlation between ΔE and ΔTP was investigated using Pearson's correlation coefficient. Staining significantly affected the baseline color of all specimens. Ginger had the most significant effect on Lava Plus (ΔE = 4.01 ±1.2), cola on Celtra Duo (ΔE = 2.29 ±0.25) and coffee on Lava Ultimate (ΔE = 2.59 ±0.17). Generally, IPS-e.max-CAD showed the smallest ΔE. No significant differences in ΔTP were found between different staining solutions. Increased ΔE correlated with decreased translucency for all the tested materials and staining solutions. Staining had a marked effect on the color and translucency of the tested CAD/CAM materials. The color change was staining solutionand material-dependent, with IPS-e.max-CAD showing the greatest color stability.