Interdisciplinary Delphi study by PROSEC North America: Recommendations on single indirect restorations made from ceramic and nonmetallic biomaterials for posterior teeth.

OBJECTIVE: This article puts forward consensus recommendations from PROSEC North America regarding single indirect restorations made from ceramic and nonmetallic biomaterials in posterior teeth. OVERVIEW: The consensus process involved a multidisciplinary panel and three consensus workshops. A systematic literature review was conducted across five databases to gather evidence. The recommendations, informed by findings from systematic reviews and formulated based on a two-phase e-Delphi survey, emphasize a comprehensive treatment strategy that includes noninvasive measures alongside restorative interventions for managing dental caries and tooth wear. The recommendations advocate for selecting between direct and indirect restorations on a case-by-case basis, favoring inlays and onlays over crowns to align with minimally invasive dentistry principles. The recommendations highlight the critical role of selecting restorative biomaterials based on clinical performance, esthetic properties, and adherence to manufacturer guidelines. They emphasize the importance of precision in restorative procedures, including tooth preparation, impression taking, contamination control, and luting. Regular follow-up and maintenance tailored to individual patient needs are crucial for the longevity of ceramic and nonmetallic restorations. CONCLUSIONS: These PROSEC recommendations provide a framework for dental practitioners to deliver high-quality restorative care, advocating for personalized treatment planning and minimally invasive approaches to optimize oral health outcomes. CLINICAL SIGNIFICANCE: The PROSEC North America recommendations highlight the importance of minimally invasive techniques in posterior tooth restorations using ceramic and non-metallic biomaterials. These principles prioritize tooth structure conservation and personalized treatment planning, essential for enhancing clinical outcomes and long-term oral health.

ADM guidance-Ceramics: all-ceramic multilayer interfaces in dentistry.

This guidance document describes the specific issues involved in dental multilayer ceramic systems. The material interactions with regard to specific thermal and mechanical properties are reviewed and the characteristics of dental tooth-shaped processing parameters (sintering, geometry, thickness ratio, etc.) are discussed. Several techniques for the measurement of bond quality and residual stresses are presented with a detailed discussion of advantages and disadvantages. In essence no single technique is able to describe adequately the all-ceramic interface. Invasive or semi-invasive methods have been shown to distort the information regarding the residual stress state while non-invasive methods are limited due to resolution, field of focus or working depth. This guidance document has endeavored to provide a scientific basis for future research aimed at characterizing the ceramic interface of dental restorations. Along with the methodological discussion it is seeking to provide an introduction and guidance to relatively inexperienced researchers.

ADM guidance-Ceramics: Fracture toughness testing and method selection.

OBJECTIVES: The objective is within the scope of the Academy of Dental Materials Guidance Project, which is to provide dental materials researchers with a critical analysis of fracture toughness (FT) tests such that the assessment of the FT of dental ceramics is conducted in a reliable, repeatable and reproducible way. METHODS: Fracture mechanics theory and FT methodologies were critically reviewed to introduce basic fracture principles and determine the main advantages and disadvantages of existing FT methods from the standpoint of the dental researcher. RESULTS: The recommended methods for FT determination of dental ceramics were the Single Edge "V" Notch Beam (SEVNB), Single Edge Precracked Beam (SEPB), Chevron Notch Beam (CNB), and Surface Crack in Flexure (SCF). SEVNB's main advantage is the ease of producing the notch via a cutting disk, SEPB allows for production of an atomically sharp crack generated by a specific precracking device, CNB is technically difficult, but based on solid fracture mechanics solutions, and SCF involves fracture from a clinically sized precrack. The IF test should be avoided due to heavy criticism that has arisen in the engineering field regarding the empirical nature of the calculations used for FT determination. SIGNIFICANCE: Dental researchers interested in FT measurement of dental ceramics should start with a broad review of fracture mechanics theory to understand the underlying principles involved in fast fracture of ceramics. The choice of FT methodology should be based on the pros and cons of each test, as described in this literature review.

ADM guidance-Ceramics: guidance to the use of fractography in failure analysis of brittle materials.

OBJECTIVES: To provide background information and guidance as to how to use fractography accurately, a powerful tool for failure analysis of dental ceramic structures. METHODS: An extended palette of qualitative and quantitative fractography is provided, both for in vivo and in vitro fracture surface analyses. As visual support, this guidance document will provide micrographs of typical critical ceramic processing flaws, differentiating between pre- versus post sintering cracks, grinding damage related failures and occlusal contact wear origins and of failures due to surface degradation. RESULTS: The documentation emphasizes good labeling of crack features, precise indication of the direction of crack propagation (dcp), identification of the fracture origin, the use of fractographic photomontage of critical flaws or flaw labeling on strength data graphics. A compilation of recommendations for specific applications of fractography in Dentistry is also provided. SIGNIFICANCE: This guidance document will contribute to a more accurate use of fractography and help researchers to better identify, describe and understand the causes of failure, for both clinical and laboratory-scale situations. If adequately performed at a large scale, fractography will assist in optimizing the methods of processing and designing of restorative materials and components. Clinical failures may be better understood and consequently reduced by sending out the correct message regarding the fracture origin in clinical trials.

Thermal gradients and residual stresses in veneered Y-TZP frameworks.

OBJECTIVES: The occurrence of "chipping" of all-ceramic restorations with Y-TZP frameworks has resulted in various designs and cooling procedures recommended for reducing such behavior. In this paper the temperature gradients during fast and slow cooling for conventional and anatomical designs are compared as well as an optical procedure to directly compare the influence of cooling rate on residual stress. METHODS: This investigation quantifies the temperature gradients between the inner and outer surfaces of crowns measured with thermocouples during two different cooling methods with uniform and anatomical frameworks. In the first method the crown was removed from the furnace after commencement of cooling whereas for the second method the crown was cooled to the glass transition temperature (600°C) before removal. Direct observation of the residual stresses was made with an optical polarimeter and thin slices of veneered copings. RESULTS: This study observed that slow cooling decreases the temperature differences but still differences of up to 88°C were observed. For the fast cooled crown, temperature differences of more than 100°C for the uniform and 140°C for the anatomical framework at temperatures above the glass transition temperature were recorded. Optical polarimeter observations indicated much lower stresses within the porcelain layer upon cooling by removing the crown below the glass transition temperature. CONCLUSION: Slow cooling during the final veneering of dental restorations with zirconia frameworks reduces the temperature gradients and residual stresses within the porcelain layer, which represent one possible cause for chipping. An anatomical designed framework did not show the same reduction extent.

XRD2 micro-diffraction analysis of the interface between Y-TZP and veneering porcelain: role of application methods.

OBJECTIVES: The metastability of the tetragonal crystal structure of yttria partial stabilized zirconia polycrystalline (Y-TZP) ceramics is a basis of concern for dental restorations. Reactions between the porcelain and the Y-TZP framework may result in a reduction of the stability of the zirconia and interface bonding caused by a transformation from tetragonal to monoclinic crystalline structure during veneering. METHODS: XRD(2) micro-diffraction measurements were carried out on tapered veneered cross-sections of the interface area to generate locally resolved information of the phase content in this region. To get a high intensity X-ray beam for short measurement times a focussing polycapillary with a spot size of app. 50 microm was used to evaluate the porcelain zirconia interface. RESULTS: Under almost all conditions the phase composition of zirconia grains at the interface revealed both the monoclinic and tetragonal structure. These observations indicate that destabilization of the tetragonal phase of zirconia occurs at the interface during veneering with porcelain. SIGNIFICANCE: These results and their relevance to the long-term stability of the interface adhesion between zirconia and veneering porcelain as well as the tetragonal to monoclinic crystal transformations at the interface are discussed.

SEM observations of porcelain Y-TZP interface.

OBJECTIVES: The metastability of the tetragonal phase of yttria tetragonal zirconia polycrystalline (Y-TZP) ceramics is a cause for concern in dental crown and bridge applications. One specific problematic area is the nature of the interface between the veneering porcelain and the Y-TZP framework and whether the associated preparation procedures and reactions result in a reduction of the stability of the zirconia. METHODS: To investigate this aspect, high-resolution SEM observations were made of polished and etched (HF content gel) cross-sections of the interface area. Dry and moist veneering porcelain powders were built up on the zirconia base. RESULTS: In some instances the zirconia grains at the interface appear to show multiplicity of subgrain faceting whereas in other instances they do not. The latter indicate destabilisation of the tetragonal phase occurs and in addition that the porcelain veneering material wets and some dissolution of the Y-TZP occurs. SIGNIFICANCE: These results and their relevance to the long-term stability of the interface adhesion to the veneering porcelain as well as possible tetragonal to monoclinic crystal transformations at the interface are discussed.