Zirconia Ceramic Restorations Research Articles

Comparative Effect of No Finish Line, Heavy Chamfer, and Shoulder Marginal Designs on the Fracture Resistance of Zirconia (Cercon) Ceramic Restoration: An In Vitro Study.

Background Because all-ceramic crowns are more aesthetic and biocompatible than metal-ceramic crowns, they have grown in popularity among patients and dentists. Poor finish line layout can result in restoration margin fracturing, hence, finish line arrangement is critical to maintaining the restoration's marginal integrity. The goal of this in-vitro study is to evaluate zirconia's resistance to fracture (Cercon) ceramic restorations with three marginal designs (no finish line, heavy chamfer, and shoulder). This study is important in contributing to the ongoing debate about the optimal finish line design for zirconia restorations. Methodology Three different finish lines, namely, biologically oriented preparation technique (BOPT) with a marginal width of less than 0.3 mm, heavy chamfer with a marginal width of up to 0.3 mm, and shoulder with a marginal width greater than 0.3 mm, were made on 10 extracted maxillary first premolar tooth to make 30 epoxy resin dies on which zirconia (Cercon) coping was done using CAD/CAM technology, and marginal discrepancies were measured using a three-dimensional scanner. All the copings were affixed to their respective dies using GIC luting cement, and fracture resistance was measured using a digital universal testing machine. Results The Kruskal-Wallis test revealed that the mean fracture resistance was more in the heavy chamfer finish line, followed by the no finish line (BOPT) and the shoulder finish line. No statistically significant difference was seen between the no finish line and the heavy chamfer finish line. There was a significant difference between the heavy chamfer and shoulder finish lines (p = 0.004). Conclusions To increase the biomechanical performance of posterior single zirconia restorations, heavy chamfer margins are indicated.

Mechanical Properties of Five Esthetic Ceramic Materials Used for Monolithic Restorations: A Comparative In Vitro Study

Monolithic zirconia and hybrid ceramic restorations have been widely used in the last decade for both anterior and posterior dental restorations. However, their use lacks sufficient scientific evidence in most cases, as the expeditious manufacturing of these versatile ceramic materials exceeds the limits of in vitro and/or in vivo validation. This study aimed to evaluate and compare the mechanical properties (flexural strength, fracture toughness, Vickers hardness, and brittleness index) of three CAD-CAM monolithic multilayer zirconia ceramics (GNX—Ceramill Zolid® Gen-X, ZCP—IPS e.max® ZirCAD, and UPC—Upcera® Esthetic Explore Prime) and one CAD-CAM monolithic multilayer polymer-infiltrated hybrid ceramic (ENM—Vita® Enamic) with a CAD-CAM monolithic lithium disilicate ceramic as a control (EMX —IPS e.max® CAD). A total of 160 discs (GNX = 32, ZCP = 32, UPC = 32, ENM = 32, and EMX = 32) were cut, polished, and fully sintered (except for the ENM). Half of the samples for each group were subjected to hydrothermal aging. Descriptive analysis and ANOVA tests were used to compare the groups. The zirconia groups showed significantly higher mechanical properties than the EMX group for both the non-aged and aged samples (p < 0.05). The ENM group showed the lowest brittleness index, while EMX showed the highest. The mechanical properties of monolithic multilayer zirconia ceramics were generally better than those of monolithic multilayer polymer-infiltrated hybrid ceramic and lithium disilicate ceramic. All groups showed, to some extent, a change in their mechanical properties after aging, with the ENM being the most affected.

Implant angulation and fracture resistance of one-piece screw-retained hybrid monolithic zirconia ceramic restorations.

This study aimed to investigate the fracture resistance of one-piece screw-retained hybrid monolithic zirconia ceramic restorations in different implant angulations. Three implant fixtures were embedded in acrylic resin blocks with 0°, 15°, and 25° angulations. For each group of implant angulations, 11 screw-retained one-piece monolithic zirconia restorations were made and bonded to the titanium inserts with a dual-cure self-adhesive resin. The complexes were screwed to the implant fixtures with titanium screws. The samples were thermocycled, subjected to compressive load, and fracture modes were recorded. One-way ANOVA and post hoc Tukey's test were used for statistical analyses (α = 0.05). One-way ANOVA showed the fracture resistance to be significanltly different among the study groups (P = 0.036). The 15° group was significantly more resistant than 0° (P = 0.031). However, the 25° group was not significantly different from the 15° (P = 0.203) and 0° groups (P = 0.624). Fractures occurred only on the restorations, not at the screw levels. Tilting the implant up to 15° improves the fracture resistance of one-piece screw-retained hybrid monolithic zirconia restorations; however, increasing the tilt to 25° would not yield restorations with significantly better fracture strength than the straight implants. Accordingly, when angulated implants are indicated in the esthetic zones, one-piece screw-retained hybrid monolithic zirconia ceramic restorations can be used with acceptable fracture strength.

Patient with dental metal allergy treated with zirconia ceramic restorations

Patient with dental metal allergy treated with zirconia ceramic restorations

Up to 10 years clinical performance of zirconia ceramic and metal-ceramic fixed partial dentures: A retrospective study

Statement of problemCompletely veneered zirconia ceramic (ZC) fixed partial dentures (FPDs) have been reported to have a higher incidence of ceramic chipping than the standard metal-ceramic FPDs. However, data from comparative long-term studies are sparse. PurposeThe purpose of this retrospective study was to compare the long-term survival, chipping-free survival, and success of ceramic-veneered high noble metal alloy (HN), base metal alloy (cobalt-chromium alloy) (CC), and ZC FPDs and to isolate risk factors for the incidence of failure, veneer chipping, and overall complications. Material and methodsData from 289 study participants (58.7% women; mean age, 57.97 ±11.51 years) provided with a total of 400 FPDs comprising 197 (49.3%) HN FPDs, 121 (30.3%) CC FPDs, and 82 (20.5%) ZC FPDs fabricated from presintered 3 mol% yttria-stabilized zirconia (mean time of service, 6.85 ±3.25 years) were evaluated. Of these, 278 (69.5%) FPDs were provided by dentists and 122 (30.5%) by dental students. Five- and 10-year survival, chipping-free survival, and success rates were calculated using the Kaplan–Meier method and compared with the log-rank test. Risk factors were assessed using Cox regression analysis. The study was exploratory, so all P values were considered exploratory and descriptive. ResultsThe 5- and 10-year survival rates were 94.7% and 77.8% for HN, 93.7% and 81.2% for CC, and 92.9% and 53.3% for ZC FPDs, respectively, indicating no clear difference in survival among the framework materials. The 5- and 10-year chipping-free rates were 94.1% and 82.8% for HN, 96.1% and 78.9% for CC, and 82.6% and 62.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The 5- and 10-year success rates were 83.7% and 55.3% for HN, 86.5% and 51.4% for CC, and 68.9% and 30.2% for ZC FPDs, respectively, indicating a difference between HN and ZC, and CC and ZC restorations. The Cox regression model indicated framework material as an influencing risk factor for success, and this influence persisted when chipping was investigated. Compared with zirconia, the use of a metal alloy reduced the risk of chipping or the occurrence of complications by up to one-third. ConclusionsAll FPDs showed high 5-year survival rates and acceptable 10-year survival rates with no strong differences among the materials. Higher success and chipping-free rates were observed for both HN and CC restorations compared with ZC restorations. Metal frameworks had a lower risk for complications or veneer chipping than zirconia frameworks.

Effect of Different Shading Techniques on the Color of Zirconia Ceramic Restoration (An In vivo Study)

BACKGROUND: The color of all ceramic restorations has a significant effect on the final appearance of the restoration. AIM: This study aimed to evaluate the effect of different shading techniques on the color stability of monolithic zirconia crowns cemented on the upper anterior teeth. METHODS: In this study, there were nine patients. Each patient has undergone a reduction for the upper six anterior teeth. Fifty-four zirconia jacket crowns were constructed using CAD/CAM technique. According to the shading technique, the crowns were categorized into two groups (pre-shaded and liquid shaded), where the upper right reduced teeth received pre-shaded zirconia crowns while the upper left reduced teeth received liquid-shaded zirconia crowns according to the selected shade. The color was assessed using easy shade after cementation and 1 year follow-up period. Data were collected, tabulated, and statistically analyzed. RESULTS: Color change (ΔE) of the cemented pre-shaded zirconia crowns on the upper right central incisors, lateral incisors, and canines was 2.37, 2.84, and 1.92, respectively, while color change (ΔE) of the cemented liquid-shaded zirconia crowns on the upper left central incisors, lateral incisors, and canines was 2.52, 2.88, and 2.77, respectively. Color change of both pre-shaded and liquid-shaded zirconia crowns after 1 year follow-up was within the clinically acceptable range 1>E>3.7, and there was no significant difference between them. CONCLUSIONS: The aging and technique of shading had no significant effect on the color of zirconia ceramic.

Impact of Surface Treatments on the Roughness Surface and Fracture Pattern of Zirconia Ceramic Restorations

Purpose: The aim of this study was to assess the surface roughness, and fracture pattern of zirconia ceramic restorations after the application of different surface treatments.
 Material and method: We conducted a systematic literature search on the electronic databases PubMed and Science direct using 12 key words via Boolean equations. We identified articles that met the eligibility criteria by checking the title and abstract. A full-text review was used to select articles based on the CASP grid. (The Critical Skills Appraisal Programme)
 Results: 13 articles were selected after reading the full text. We noted a predominance of mixed failure in our study.
 Conclusion: Sandblasting before sintering is a recommended method to increase surface roughness and improve the bond strength of the cosmetic ceramic. The mixed fracture mode is the most frequent mode in our study. Further clinical studies with standardization of protocols should be conducted.

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.

An in vitro comparison of the marginal and internal adaptation of ultrathin occlusal veneers made of 3D-printed zirconia, milled zirconia, and heat-pressed lithium disilicate

Statement of problemWhether additively produced zirconia could overcome problems with conventional computer-aided design and computer-aided manufacture (CAD-CAM) such as milling inaccuracies and provide accurate occlusal veneers is unclear. PurposeThe purpose of this in vitro study was to compare the marginal and internal fit of 3D-printed zirconia occlusal veneers with CAD-CAM–fabricated zirconia or heat-pressed lithium disilicate ceramic (LS2) restorations on molars. Material and methodsThe occlusal enamel in 60 extracted human molars was removed, with the preparation extending into dentin. Occlusal veneers at a thickness of 0.5 mm were designed and manufactured according to their group allocation: 3DP, 3D-printed zirconia; CAM, milled zirconia; and HPR, heat-pressed LS2. The prepared teeth and restorations were scanned and superimposed, and the marginal and internal adaptation were measured 2- and 3-dimensionally; the production accuracy (trueness) was also measured. The comparisons of the group medians were performed with nonparametric methods and a pairwise group comparison (α=.05). ResultsThree-dimensionally printed zirconia revealed median outcomes of 95 μm (margin), 252 μm (cusp), 305 μm (fossa), and 184 μm (3D internal adaptation). CAM showed median values of 65 μm (margin), 128 μm (cusp), 203 μm (fossa), and 120 μm (3D internal adaptation). The respective values for the group HPR were 118 μm (margin), 251 μm (cusp), 409 μm (fossa), and 180 μm (3D internal adaptation). Significant differences (P<.001) between CAM and 3DP (cusp, fossa, 3D internal adaptation) and between CAM and HPR (all regions) were found, with the former group showing higher accuracies. The trueness showed median discrepancies of 26 μm (3DP), 13 μm (CAM), and 29 μm (HPR) with significant differences (P<.001) for the comparisons 3DP-CAM and CAM-HPR. ConclusionsThree-dimensionally printed zirconia occlusal veneers produced by means of lithography-based ceramic manufacturing exhibit a marginal adaptation (95 μm) and a production accuracy (26 μm) similar to those of conventional methods.

The effect of the design of a mandibular implant-supported zirconia prosthesis on stress distribution

Statement of problemProsthetic complications have been frequently reported in implant-supported complete-arch prosthesis. Prosthetic restorations designed with an all-on-four treatment concept and fabricated from zirconia ceramic may be used to overcome these problems. PurposeThe purpose of this biomechanical study was to evaluate the effects of cantilever length and inclination of implant on the stress distribution in bone tissue, implant, and a monolithic zirconia ceramic-lithium disilicate glass-ceramic superstructure for all-on-four prosthesis. Material and methodsAll-on-four mandibular prosthesis fabricated from a zirconia and lithium disilicate glass-ceramic (LDGC) superstructure was designed with cantilever lengths of either 5 mm or 9 mm and posterior implants with a distal tilt of either 15 or 30 degrees. Stresses were evaluated with a simulated application of a static load of 600 N. ResultsIncreasing implant inclination from 15 to 30 degrees led to a decrease in maximum principal stress (MaxPS) values of approximately 4 to 7 MPa in cortical bone around all implants except the right anterior implant in the designs with short cantilevers and an increase in MaxPS values (approximately 3 to 19 MPa) in the same places in the designs with the long cantilevers. Increasing cantilever length from 5 to 9 mm resulted in an increase in minimum principal stress (MinPS) values of approximately 3 to 13 MPa in the cortical bone surrounding all posterior implants. In the designs with the long cantilever, MaxPS values increased approximately 3 to 4 MPa in spongy bone adjacent to the right posterior implant. An increase in cantilever length also led to higher vMS values at the first and second implant grooves in the right posterior implant in the design with the 15-degree implant tilt. An increase in implant inclination in the design with the short cantilever resulted in lower vMS values at the apex and all grooves of the left posterior implant, whereas in the design with the long cantilever, an increase in implant inclination resulted in lower stress values in the first and second grooves of the same implant. An increase in implant inclination led to in an increase in vMS values in the core structure. ConclusionsIn zirconia ceramic restorations by using an all-on-four design with an LDGC superstructure, short cantilevers may be preferable because they result in a more favorable distribution of stress than long cantilevers. An increase in implant angulation from 15 to 30 degrees decreased MaxPS values in cortical bone.

Effect of finishing/polishing techniques and low temperature degradation on the surface topography, phase transformation and flexural strength of ultra-translucent ZrO2 ceramic

ObjectiveTo investigate the effect of different surface finishing and polishing regimes and low temperature degradation on flexural strength, phase transformation and surface topography of ultra-translucent ZrO2 ceramic. Methods300 (n=15/group) of conventional zirconia (Z: Ice Zirkon Transluzent) and ultra-translucent zirconia (UT: Prettau Anterior) bar-specimens were made and divided according to the "Finishing/Polishing" - (C — Control, B — diamond rubber polishers, P — adjusting with burs, PB — adjusting with burs+diamond polishers, PG — adjusting with burs+glaze), "Low temperature Degradation (LTD)" (with or without a treatment at 127°C, 1.7bar/24h). Then, a 3-point mini flexural test was performed in a universal testing machine (1mm/min, 500kgf load cell). SEM, EDS, XDR, AFM, optical profilometry and Weibull analysis were performed. Data were analyzed by 3-way ANOVA and Tukey’s post-test (5%). ResultsGroups ZPBD (1670±253MPa), ZBD (1664±217MPa), and ZB (1655±3678MPa) showed significantly higher flexural strength than the UTPG group (372±56MPa). The Weibull modulus was significantly higher for the ZPD group compared to the UB, UCD, UPD and UPBD, while UTB, UTCD and UTPD had the lowest value. Monoclinic phases were observed only in the conventional zirconia groups and were more evident after LTD. Diamond rubber polishers presented less roughness for both zirconias. SignificanceThe use of diamond rubber polishers is the most suitable finishing/polishing method for zirconia ceramic restorations and that final glazing reduces the fracture resistance of these materials.

Fracture rate of 188695 lithium disilicate and zirconia ceramic restorations after up to 7.5 years of clinical service: A dental laboratory survey

Statement of problemThe use of ceramic materials has increased significantly because of high esthetic demands, low costs, and ease of fabrication. Long-term, clinically based evidence is scarce, and laboratory studies have limited relevance in determining clinical durability. PurposeThe purpose of this dental laboratory survey was to evaluate the fracture rate of layered and monolithic lithium disilicate and zirconia single crowns and fixed partial dentures after up to 7.5 years of clinical service. Material and methodsTwo commercial dental laboratories with a database system that was able to track the number of remakes because of fracture only were identified. Lithium disilicate restorations (monolithic and layered) were categorized according to restoration type (single crown, fixed partial denture, veneer, and onlay). Zirconia restorations (monolithic and layered) were categorized according to type (single crown, fixed partial denture) and then into anterior or posterior restoration. Restoration remakes due to poor fit, shade, or marginal integrity were excluded from the evaluation. Data were analyzed, and statistical significance was evaluated with chi-square tests (α=.05). ResultsA total of 188 695 (51 751 lithium disilicate and 136 944 zirconia) restorations were included in the analysis, with an overall fracture rate of 1.35%. Lithium disilicate monolithic single crowns had a fracture rate of 0.96%, which was significantly lower than that of layered single crowns at 1.26% (P<.05). When the different types of lithium disilicate restorations were compared, fixed partial denture (monolithic and layered) fracture rates were significantly higher than those of single crowns (P<.001). Monolithic zirconia single crowns (0.54%) fractured at a lower rate than layered zirconia single crowns (2.83%) and monolithic fixed partial dentures (1.83%) (P<.001), while layered single crowns (2.83%) had a higher fracture rate than that of layered fixed partial dentures (1.93%) (P<.001). Monolithic anterior and posterior zirconia restorations fractured at a lower rate than layered anterior and posterior zirconia restorations (P<.05). Posterior monolithic zirconia restorations fractured at a lower rate than anterior restorations, while posterior layered zirconia restorations fractured at a higher rate than anterior zirconia restorations (P<.05). ConclusionsWithin the 7.5-year period, restorations fabricated with lithium disilicate and zirconia restorations had relatively low fracture rates. Monolithic restorations fractured at a lower rate than layered restorations.

Has zirconia made a material difference in implant prosthodontics? A review

ObjectiveThe main goal of this review is to provide an in-depth description of published work on the application of zirconia for dental implansts and restorations on titanium implants, with an emphasis on clinical studies from the past dozen years with at least 1-year follow-up. MethodsOnline databases (Pubmed, Science Direct, Web of Science) were consulted on this topic. Published work from 2007 to 2019 was collected, analyzed and pertinent articles were selected for inclusion on this review. ResultsNo clear superiority has been documented in biocompatibility, osteoconductivity, physical properties or allergenicity with zirconia implants compared to titanium, notwithstanding an esthetic benefit. While short-term studies have been promising, larger multicentered, longitudinal and randomized clinical trials with success data are required to validate zirconia as a viable alternative to the titanium implant and its design. Zirconia abutments with a titanium base have revealed a high survival rate and show no difference to metal. Bi-layered zirconia ceramic restorations are a valid treatment alternative to metal ceramic implant restorations for single crowns with similar biological complications and enhanced esthetics. Monolithic zirconia restorations hold promise to address the chipping incidence of the bi-layered ceramic restoration, but longer-term studies are necessary, and work needs to be done to improve their esthetics. The gingival feldspathic porcelain veneered monolithic zirconia complete arch prosthesis versus a resin metal prosthesis, in medium-term studies, offers a high survival rate and low mechanical complication rate, reduced laboratory costs, superior durability and wear characteristics, enhanced fit due to digital fabrication, availability of a digital file for duplication in the future, acrylic try-for adjustment and approval, and reduced plaque and biofilm accumulation. SignificanceZirconia is a versatile material for implant prosthodontic application. Longer-term multi-centered studies are needed to assess success criteria and patient-related outcomes measurements. Monolithic zirconia offers enhanced mechanical properties for implant restorations, but development is needed to optimize esthetics.

The effect of firing protocols on the resin-bond strength to alumina-coated zirconia ceramics

ABSTRACT Bonding surface pretreatment of zirconia ceramic dental restorations with a nanostructured alumina coating (NAC) provides a substantially stronger and durable bond than clinically established air-particle abrasion. However, the synthesis of NAC should completely comply with everyday dental laboratory practices. In the present study, the effect of various dental laboratory firing procedures, such as glaze, veneer and regeneration firings of zirconia, on the temperature-dependent phase evolution of NAC was studied (XRD) and related to the resin-cement shear-bond strength of as-sintered, high-pressure (4 bar) and low-pressure (1 bar) air-particle-abraded zirconia surfaces with or without a combination of MDP primer. Half of each sample groups (n = 20) were subjected to 12000× thermocycles in water. The results were statistically analysed using t-test and one-way ANOVA. When fired at 900 and 1050°C and topotactically transformed to γ- or a mixture of δ- and θ-aluminas, NAC provided highest and clinically acceptable bond-strengths (>20Mpa) not affected by thermocycling.

CAD/CAM system influence marginal fit of different ceramic types?

This study aimed to evaluate the marginal fit of zirconia and lithium disilicate ceramic restorations processed by computer-aided design (CAD)/computer-aided manufacturing (CAM) system. Ten models were prepared from a metal die, on which scanning was carried out to obtain the virtual model for the processing of zirconia and lithium disilicate ceramics using the CAD/CAM technique. Gypsum models were fabricated and used for scanning the restorations. The infrastructures were designed using software, and CAD/CAM was used to fabricate the restorations (n = 10). The analysis of the marginal discrepancy was measured at 12 points of the margin using the original metallic die. For each crown, an arithmetic average of the discrepancy values was obtained. The marginal fit of the copings of lithium disilicate was 133.10 ± 26.87 μm and zirconia was 127.34 ± 47.97 μm. There was no statistically significant difference (P = 0.7709) between the materials. The marginal fit is similar between lithium disilicate and zirconia ceramics milled in the CAD/CAM system used.

Influence of cleaning methods on bond strength to saliva contaminated zirconia.

To evaluate the influence of saliva contamination and cleaning procedures on shear bond strength (SBS) of a self-adhesive resin cement (SAC) to zirconia surfaces. A total of 160 sandblasted zirconia blocks were randomly divided into eight groups as follows: No saliva contamination, no cleansing (NC-NC); contamination with saliva, no cleansing (SC-NC); no saliva contamination, cleansing with a zirconia primer (ZP; Z-Bond, Danville Materials, Inc., S. Ramon, California) (NC-ZP); contamination with saliva, cleansing with ZP (SC-ZP); no saliva contamination, cleansing with hydrofluoric acid (HF; Ultradent Porcelain Etch; Ultradent Products, South Jordan, Utah) followed by cleansing with ZP (NC-HF-ZP); contamination with saliva, cleansing with HF followed by cleansing with ZP (SC-HF-ZP); cleansing with ZP, contamination with saliva, cleansing with ZP (ZP-SC-ZP); application of ZP, contamination with saliva, cleansing with HF followed by cleansing with ZP (ZP-SC-HF-ZP). Cylindrical resin composite blocks were luted to the zirconia surfaces with SAC (Clearfil SA Cement Automix, Kuraray, Inc., Tokyo, Japan). Specimens were subjected to shear forces at a cross-head speed of 0.5 mm/min. Data were analyzed with Analysis of Variance and Tukey tests (α = 0.05). The bond strength values to zirconia were significantly influenced by saliva contamination (P < .05). The SC-NC group showed the lowest bond strength values (5.6 ± 1.4 MPa; P < .05). All cleansing or pretreatment agents improved the bond strengths when compared to noncleansing groups, NC-NC and SC-NC. In situations where saliva contamination is deemed unavoidable, application of ZP after try-in of the zirconia restoration could be beneficial for the accurate cementation. During try-in sessions of fixed dental prostheses, zirconia ceramic restoration may come into contact with saliva and surfaces should be cleansed to obtain an optimal surface for adhesion. Application of zirconia primer to the sandblasted zirconia surface is recommended whether the surface is contaminated with saliva or not.

Application of zirconia surface coating to improve fracture resistance and stress distribution of zirconia ceramic restorations

Zirconia ceramic restoration (ZCR) has a higher fracture incidence rate than metal ceramic restoration. Different surface treatments were used to improve fracture performance of ZCR such as grit blasting (GB) by aluminium oxide powder. This type of surface treatment generate residual stresses on veneering ceramic causing crack initiation and ending with a fracture. In order to overcome the stress generated by GB, zirconia surface coating is used as a surface treatment to improve fracture resistance and to accommodate stresses along the ZCR layers. Fifty zirconia ceramic crowns were fabricated and divided according to the type of surface treatment into three groups; the first group is (ZG), involving 20 cores were coated with a mixture of partially-sintered zirconia powder (PZP) and glaze ceramic powder; the second group is (ZL), including of 20 cores were coated with PZP and liner ceramic paste. The third group is grit blasting (GB), preparing of 10 fully sintered cores at 1350 °C which then abraded by 50 µm aluminium oxide powder. The groups ZG and ZL were further subdivided into ZG26, ZG47, ZL26 and ZL47 based on two PZP sizes (47 and 26 µm). Each treated core was veneered with the veneering ceramic layer. Fracture resistance (FR) was measured by the universal testing machine. Finite element analysis (FEA) was used to simulate the stress distributions on the coated and non-coated zirconia crown models. The ZG47 group had higher FR (647.92 ± 97.33 N) and a significant difference (P < 0.00) compared to GB and other coated groups. The FEA exhibited lower and evenly distributed stresses of the zirconia glaze model than the zirconia liner and the non-coated models. The ZG47 coating considered as an alternative method to GB treatment which increases the FR which significantly improved the clinical performance of the ZCR.

Influence of cleaning methods on resin bonding to saliva-contaminated zirconia.

The aim of this study was to investigate the influence of different cleaning methods on the shear bond strengths of 2 resin cements to saliva-contaminated zirconia. After saliva contamination, alumina-blasted zirconia specimens were cleaned with 1 of 5 methods of water-rinsing (SA), K-etchant GEL phosphoric acid (PA), Ivoclean (IC), AD Gel (ADG), or additional alumina-blasting (AB). Alumina-blasted zirconia without saliva contamination was used as control group (Cont). Composite cylinders were bonded to the zirconia with 1 of 2 dual-cured resin cements. The bond strengths were measured by shear testing after 24 hours (TC0) and after thermal cycling at 4°C-60°C (TC10000) and specimen surfaces were evaluated using X-ray photoelectron spectroscopy (XPS). Data were statistically analyzed using 3-way analysis of variance and Tukey test (α = 0.05). There were no significant differences in the bond strengths of 2 resin cements between the Cont ADG, and AB groups before and after TCs (P > .05). SA, PA, and IC groups did not exhibit durable resin bonding to zirconia. XPS showed that carbon and nitrogen increased in the SA group in comparison to the Cont group. The concentration of carbon in other 4 groups returned to the concentration range of the Cont group; however, nitrogen was not detected in the only AB group. Saliva contamination significantly reduced the bond strength of 2 resin cements to zirconia. Additional AB or cleaning with ADG resulted in effective cleaning of saliva contamination and preserved resin cement bond strength to zirconia. Saliva contamination occurs during clinical procedures for adjustment of zirconia ceramic restorations in the oral environment. AD Gel application is effective for removing saliva contaminants on the alumina-blasted zirconia surface beforehand by the dental laboratory instead of additional AB since AD Gel application and AB had a similar effect on the removal of organic components of saliva.

Effect of endodontic access cavity preparation on monolithic and ceramic veneered zirconia restorations.

Due to the high chipping rates observed in veneered zirconia ceramic restorations, the use of monolithic zirconia restorations has been recommended. This study tried to compare veneered and monolithic zirconia fixed dental prostheses (FDPs) with respect to the amount of damage induced by endodontic access preparation. Monolithic and ceramic veneered (n = 10) three-unit restorations (retainers: first premolar and first molar; pontic: second premolar) were subject to endodontic access cavity preparation in both retainers using a diamond rotary instrument under continuous water cooling. The number of chipping fractures and microfractures detected using the fluorescent penetrant method were recorded. Statistical analysis was based on Wilcoxon rank sum tests with Bonferroni correction (level of significance α = .05). Only one microfracture could be identified in the group of monolithic FDPs while a maximum of seven microfractures and three chipping fractures per retainer crown were recorded in the group of veneered restorations. At the premolar site, the veneered restorations showed significantly more microfractures (P = .0055) and chipping fractures (P = .0008). At the molar site, no significant difference with respect to microfractures could be detected (P = .0767), while significantly more chipping fractures occurred in the veneered samples (P = .0293). Monolithic zirconia restorations seem to be less susceptible to damage when endodontic access cavities have to be prepared as compared to veneered zirconia reconstructions. However, no conclusions can be drawn on the long-term performance of a specific restoration based on this study.

Effect of Different Contact Materials on Approximal Caries Detection by Laser Fluorescence and Light-Emitting Diode Devices.

The aim of this in vitro study was to investigate the influence of the adjacent tooth surface on pen type laser fluorescence (LFpen) and light-emitting diode (LED) device readings in detecting approximal caries lesions in permanent teeth. Early detection of noncavitated dental caries is important, because disease progression can be easily halted at this stage with certain applications, such as fluoride therapy, antibacterial therapy, dietary changes, or low-intensity laser irradiation. A total of 87 permanent molars with 156 approximal surfaces were assessed with LED- and LF-based devices in contact with sound tooth surfaces (the control group) as well as approximal amalgam, composite, zirconia, and full ceramic restorations. All teeth were assessed once by one trained examiner. After the LF and LED assessments, the teeth were histologically evaluated using stereomicroscopy as the gold standard. The sensitivity, specificity, accuracy, and area under the receiver operating characteristics (ROC) curve were calculated according to the appropriate thresholds (T1, sound surface or enamel caries; T2, dentin caries). For the LFpen device, higher sensitivity and accuracy was found when the adjacent surface was sound at the T1 threshold and no significant differences were found among accuracy at the T2 threshold. For the LED-based device, no significant differences were found among sensitivities at the T1 threshold. At the T2 threshold, specificity was higher when the adjacent tooth had a zirconia restoration. It was found that both devices could be used effectively for evaluating approximal surfaces with adjacent restored teeth, regardless of the different kinds of restorative materials.