Zirconia Implants Produced by Additive Manufacturing - A Scoping Review.

INTRODUCTION: Additive manufacturing is a tool with potential use in medicine and dentistry. The manufacture of metals and composites is already advanced, however, concerns about titanium hypersensitivity, tissue staining, and corrosion caused by gradual material degradation encourage research into more biocompatible alternatives. OBJECTIVE: This systematic scoping review aimed to gather studies that evaluated zirconia implants produced by additive manufacturing to describe the current stage of the printing technique and the final product. METHODS: Searches in Embase, PubMed, SCOPUS, Web of Science, and Google Scholar databases were enriched with manual searches between February and March 2021 and updated in June 2022 using keywords: zirconium implants, zirconium oxide, additive manufacturing, rapid prototyping, 3D printing, selective laser melting, and electron beam melting. The criteria included studies that evaluated or described zirconia implants obtained by 3D printing, with a direct relationship to dentistry or orthopedics. RESULTS: The database search resulted in 671 articles. Eight articles were selected for full reading and remained in this systematic review. CONCLUSION: The printing technique for zirconia implants is promising. However, further studies are required before implants produced by the printing technique can be tested clinically. The literature with results regarding the impression product is still limited.

Fatigue strength of 5Y-FSZ: glazing and polishing effects.

OBJECTIVE: The aim of this study was to evaluate the effect of four different finishing procedures on the fatigue strength of a fully stabilized zirconia (5Y-FSZ) material. MATERIALS AND METHODS: Disc-shaped specimens of a 5Y-FSZ (Katana UTML, Kuraray Noritake) were made (ISO 6872-2015), grinded with 600- and 1200-grit silicon carbide paper, sintered as recommended, and randomly assigned into four groups according to the finishing technique: C (control, as-sintered), P (polished with polishing rubbers), G (glaze application - powder/liquid technique), and PG (polished with polishing rubbers + glaze application - powder/liquid). Then fatigue strength (staircase method), X-ray diffraction (XRD), and scanning electron microscopy (SEM) analyses were performed. RESULTS: The C group presented the lowest fatigue strength, while the PG group presented the highest. The P and G groups presented intermediate behavior, presenting similar statistical results. XRD showed similar crystalline phase patterns for all groups. SEM images revealed some changes in the zirconia surface, with the P group presenting some scratches on the surface, while the scratches in the PG group were filled with the glaze material. CONCLUSION: None of the techniques analyzed in this study impaired the fatigue strength of fully stabilized zirconia. Importantly, the polishing rubbers combined with glaze application (PG group) improved its fatigue strength. CLINICAL RELEVANCE: The polishing rubbers followed by glaze application improve the fatigue strength in ultra-translucent zirconia.

Current prospect of dental zirconia recycling: A scoping review.

PURPOSE: This scoping review aimed to identify and discuss the recyclability of dental zirconia residuals along with the factors influencing the properties of dental recycled zirconia. STUDY SELECTION: In vitro studies written in both English and Chinese that evaluated the recyclability of dental zirconia residue were selected. A literature search was conducted in Medline, PubMed, Web of Science, and Cochrane Library databases with no restrictions on the publication year. RESULTS: Sixteen studies were included in this review. Residual dental zirconia can be recycled. Cold isostatic pressing improved the density of recycled zirconia compared with uniaxial pressing. Recycled zirconia powder with fine particles enhanced the performance of recycled zirconia compared with coarse particles. A presintering temperature of 950 to 1100°C was suitable for preparing recycled zirconia presintered bodies. Recycled zirconia may require a higher sintering temperature (≥1500°C) compared with commercially available zirconia. Additionally, recycled zirconia powder can enhance the properties of polymethylmethacrylate as a reinforcing filler and can be combined with alumina powder to obtain an alumina/zirconia composite material. CONCLUSIONS: Despite a limited body of literature, the recycling and reutilization of dental zirconia residuals are feasible and reliable, and can reduce economic and environmental losses. Nevertheless, several factors influence the recycling effect, including the particle size, molding techniques, and sintering parameters. In addition, recycled zirconia powder can act as a reinforcing filler, potentially enhancing the mechanical properties of other materials. To realize commercially viable recycled zirconia materials, further studies are essential to comprehensively explore and understand their recycling performance.

Effect of airborne particle abrasion and regeneration firing on the strength of 3D-printed 3Y and 5Y zirconia ceramics.

OBJECTIVES: This study aimed to assess the effect of airborne particle abrasion (APA) and regeneration firing (RF) on the subsurface damage and strength distribution of 3D-printed 3Y-TZP and 5Y-PSZ zirconia parts for dental applications. METHODS: Disc-shaped specimens were prepared using vat photopolymerization (VPP) technology from 3Y and 5Y zirconia ceramics, followed by thermal debinding and sintering. APA treatment with 50 µm Al2O3 particles and RF at 1000 °C for 15 min were applied. Microstructural analysis was conducted using FIB-SEM, and XRD analysis determined crystalline phase content. Biaxial flexural strength was measured using the ball on three balls method and analyzed with Weibull statistics. ANOVA and Tukey HSD test were employed to compare strength differences between groups. RESULTS: APA treatment increased the flexural strength of the 3Y specimens but decreased it for the 5Y specimens. RF treatment reversed the effect, restoring the strength to as-sintered levels for both materials. APA-treated 3Y specimens exhibited characteristic strength values above 1400 MPa, attributed to phase-transformation toughening. As sintered 5Y specimens showed strength values above 600 MPa. APA treatment increased the Weibull modulus of the 5Y specimens, indicating a narrower defect size distribution. SIGNIFICANCE: The study demonstrates that the impact of APA and RF treatments on the mechanical properties and reliability of VPP-fabricated 3Y-TZP and 5Y-PSZ ceramics is comparable to conventionally prepared zirconia. VPP technology for 3D printing provides a viable approach for future manufacturing of dental restorations with potential clinical applications.

Electrochemical behavior and surface stability of dental zirconia ceramics in acidic environments.

Dental zirconia ceramics, widely employed in dentistry for their biocompatibility and mechanical properties, face challenges in long-term viability within the oral cavity. This study focuses on analyzing the electrochemical behavior of a commercial dental zirconia ceramic type in acidic environments. Through extensive electrochemical investigations, including Electrochemical Impedance Spectroscopy (EIS) and cyclic polarization resistance (Cpol), corrosion resistance was assessed. Despite indications of material dissolution, our results demonstrate significant corrosion resistance, as reflected in low corrosion current density (Icorr) values. Notably, the study reveals the development of a protective oxide layer at the ceramic-electrolyte interface, contributing to material stability. XRD analysis confirms the presence of stable crystallographic phases (t-ZrO2) even after exposure to acidic media. Surface characterizations utilizing scanning electron microscopy-energy-dispersive X-ray spectroscopy (SEM-EDX) affirm minimal surface damage and maintained elemental composition. These findings illuminate the intricate electrochemical behavior of dental zirconia ceramics in challenging environments, underscoring their potential for durable dental restorations. This interdisciplinary research bridges dentistry and materials science, providing valuable insights for optimizing material properties and advancing dental materials and restorative techniques.

Recent advances in dental zirconia: 15 years of material and processing evolution.

OBJECTIVES: The objective was to discuss the research on zirconia published in the past 15 years to help the dental materials community understand the key properties of the types of zirconia and their clinical applications. METHODS: A literature search was performed in May/2023 using Web of Science Core Collection with the term "dental zirconia". The search returned 5102 articles, which were categorized into 31 groups according to the research topic. RESULTS: The current approach to improving the translucency of zirconia is to decrease the alumina content while increasing the yttria content. The resulting materials (4Y-, 5Y-, and above 5 mol% PSZs) may contain more than 50% of cubic phase, with a decrease in mechanical properties. The market trend for zirconia is the production of CAD/CAM disks containing more fracture resistant 3Y-TZP at the bottom layers and more translucent 5Y-PSZ at the top. Although flaws located between layers in multilayered blocks might represent a problem, newer generations of zirconia layered blocks appear to have solved this problem with novel powder compaction technology. Significant advancements in zirconia processing technologies have been made, but there is still plenty of room for improvement, especially in the fields of high-speed sintering and additive manufacturing. SIGNIFICANCE: The wide range of zirconia materials currently available in the market may cause confusion in materials selection. It is therefore imperative for dental clinicians and laboratory technicians to get the needed knowledge on zirconia material science, to follow manufacturers' instructions, and to optimize the design of the prosthetic restoration with a good understanding where to reinforce the structure with a tough and strong zirconia.

Effect of exposure energy dose on lateral resolution and flexural strength of three-dimensionally printed dental zirconia.

PURPOSE: This study aims to evaluate the effects of exposure energy on the lateral resolution and mechanical strength of dental zirconia manufactured using digital light processing (DLP). MATERIALS AND METHODS: A zirconia suspension and a custom top-down DLP printer were used for in-office manufacturing. The viscosity of the suspension and uniformity of the exposed light intensity were controlled. Based on the exposure energy dose delivered to each layer, the specimens were classified into three groups: low-energy (LE), medium-energy (ME), and high-energy (HE). For each energy group, a simplified molar cube was used to measure the widths of the outline (Xo and Yo) and isthmus (Xi and Yi), and a bar-shaped specimen of the sintered body was tested. A Kruskal-Wallis test for the lateral resolution and one-way analysis of variance for the mechanical strength were performed (α = .05). RESULTS: The zirconia green bodies of the ME group showed better lateral resolution than those of the LE and HE groups (both P < .001). Regarding the flexural strength of the sintered bodies, the ME group had the highest mean value, whereas the LE group had the lowest mean value (both P < .05). The ME group exhibited fewer agglomerates than the LE group, with no distinctive interlayer pores or surface defects. CONCLUSION: Based on these findings, the lateral resolution of the green body and flexural strength of the sintered body of dental zirconia could be affected by the exposure energy dose during DLP. The exposure energy should be optimized when fabricating DLP-based dental zirconia.

Esthetic Solutions With Layered Zirconia Prostheses: A Case Report.

To meet the challenges of rehabilitating anterior teeth and achieving natural-looking restorations, it is essential to address issues such as improper shape, size, irregular gingival contour, and unaesthetic shades. The increasing demand for aesthetically pleasing and metal-free solutions has popularized materials like dental zirconia, offering optimal aesthetics and desirable mechanical properties. Within this context, a case report highlights clinical experiences with layered zirconia fixed dental prostheses designed specifically for anterior teeth. The report focuses on the prosthetic rehabilitation of both endodontically treated and vital abutments, exploring the influence of zirconia composition, design, layering technique, shade selection, occlusion, and the unique clinical challenges associated with each condition. The selection of zirconia composition, framework design, and shade in layered zirconia prostheses is intricately tied to the characteristics of the abutments. This interconnectedness underscores the importance of a thoughtful and customized approach to address the specific requirements of each clinical scenario.

Glazing as a bonding system for zirconia dental ceramics.

Studies have reported challenges of debonding of dental zirconia crowns to from luting cement and prepared teeth. The aim of the study was to explore the application of dental glazing systems for enhancing the bonding of zirconia dental ceramics to luting resin cement. Commercial glaze powder and liquid (Vita Akzent) and experimental mica-based glaze powders were used for the study. X-ray diffraction analysis of the glaze powders (XRD) and Fourier Transform InfraRed Spectroscopy (FTIR) was done on the glaze liquid. Sandblasted sintered dental zirconia (Katana, Noritake) were the control samples. Glazed zirconia samples were coated with commercial glaze and experimental glaze powders which were further etched with 5% hydrofluoric acid. Shear bond strengths of sandblasted and glazed zirconia samples to resin composites were evaluated. XRD of commercial and experimental glaze powders revealed a broad peak confirming the amorphous nature of glass and FTIR analysis of the glaze liquid revealed symmetrical stretching (CH2-CH3) of the alcohol group indicating a mixture of iso-butane and ethanol. Glazed and etched zirconia showed significantly higher shear bond strength to resin cement compared to sand-blasted zirconia. The study confirms the glassy nature of dental glaze powders and the presence of ethanol-based mixtures in the commercial glaze liquid. Glazing systems have the potential to be explored for enhancing the bonding of non-etchable zirconia ceramics to resin cement and tooth substrates.

Surface and bulk properties of zirconia as a function of composition and aging.

Yttria-stabilized zirconia (Y-SZ) materials with different levels of translucency have been used for indirect dental restorations. Y-SZ composition and microstructure are modified to improve translucency, and it is not clear how these materials respond to aging. This study evaluated the effect of hydrothermal aging (HA) performed in an autoclave on the properties of four dental Y-SZ materials with different compositions. Sintered bar-shaped specimens (14 x 4 x 2 mm) were prepared from four different zirconia-based materials (n = 40): low translucency 3 mol % Y-SZ (3Y-LT; Ceramill ZI, Amann Girrbach); high translucency 4 mol % Y-SZ (4Y-HT; Ceramill Zolid); and two high translucency 5 mol % Y-SZ (5Y-HT - Lava Esthetic, 3M; 5Y-SHT - Ceramill Zolid FX). Fully sintered specimens were exposed to HA for different times (control - 0 h, 5 h, 10 h, or 15 h at 134 °C, 2 bar pressure) and characterized for surface roughness, flexural strength (three-point bending), hardness and elastic modulus (nanoindentation), surface wettability (sessile drop technique) and crystalline content (x-ray diffraction, XRD). Data was analyzed by two-way ANOVA and Tukey HSD (p < 0.05). Zirconia composition significantly affected roughness (p = 0.016). Zirconia*aging interaction affected flexural strength (p = 0.012), surface wettability (p < 0.001), and hardness (p = 0.002). Zirconia composition (p = 0.011) and aging (p = 0.001) affected elastic modulus, while the interaction effect was not significant (p = 0.94). HA affects zirconia-based materials in different degrees. For 3Y-LT and 4Y-HT, surface and bulk properties were affected by aging to a similar extent. However, surface and bulk properties may change during clinical use as a result of prolonged degradation of Y-SZ.

Room-temperature atomic layer deposition of SiO2 on microcracked ZrO2 layers.

Yttria-stabilized zirconia (Y-SZ) has become a reliable material option to restore severely compromised teeth. Y-SZ materials are prone to low-temperature degradation (LTD), which generates a tetragonal-to-monoclinic (t-m) transformed, porous layer. We suggest that room-temperature atomic layer deposition (RT-ALD) could be used for the infiltration and deposition of nanoscale SiO2 film over this layer, creating a protective hybrid surface against further degradation by LTD. This study investigated the potential of developing a Y-SZ transformed layer under controlled conditions for the infiltration of silica using RT-ALD, aiming to develop a hybrid zirconia-silica interface, and to investigate the effect of silica deposition/infiltration via RT-ALD on the surface roughness and wettability of zirconia-based materials. Sintered specimens (14 mm × 4 mm x 2 mm) were prepared from four different Y-SZ materials (n = 40): low translucency 3 mol % Y-SZ (3Y-LT; Ceramill ZI, Amann Girrbach); high translucency 4 mol % Y-SZ (4Y-HT; Ceramill Zolid); and two high translucency 5 mol % Y-SZ (5Y-HT - Lava Esthetic, 3M; 5Y-SHT - Ceramill Zolid, FX white). Specimens were exposed to hydrothermal treatment (HTT) to develop similar depths of crystalline changes. RT-ALD was used to deposit a thin film of silica (SiO2). Surface roughness and wettability analyses were performed to investigate the effect of treatment (HTT and RT-ALD) and material on Y-SZ surface properties, and data was analyzed by two-way ANOVA and Tukey HSD (p < 0.05). RT-ALD and HTT-RT-ALD treated specimens of 3Y-LT and 5Y-HT materials were exposed to further hydrothermal aging (HA) and the surface was characterized by time-of-flight secondary ion mass spectrometry (ToF-SIMS). There was a significant interaction effect of material and treatment (HTT and RT-ALD) on roughness (p = 0.02), and surface wettability (p < 0.001). Silica deposition via RT-ALD resulted in a significant increase in surface roughness of all materials tested, while surface wettability was either improved or not changed based on the material type and HTT exposure. Nanofilms of SiO2 were successfully deposited on Y-SZ materials and infiltrated 3Y-LT zirconia.

Influence of firing temperature and duration on the hardness of dental zirconia for optimum selection of sintering conditions.

OBJECTIVE: In order to optimize the properties of dental zirconia, the sintering process involves firing zirconia to elevated temperatures for an extended time that can take several hours. The aim of this study is to investigate the effect of firing temperature and firing duration on the hardness of dental zirconia to indicate the optimum sintering conditions. METHODS: Thirty-six zirconia specimens in shape of bars were randomly assigned to nine groups. The zirconia specimen groups were sintered using a sintering furnace with different firing temperatures (900°C, 1200°C, and 1800°C) and firing durations (6, 9, and 12 h). A total of 108 hardness measurements were conducted for all specimens (12 hardness readings per group). For each of the specimen groups, micro Vickers hardness test was performed using a load of 1 Kgf (9.807 N) and the Vickers hardness number was computed. Statistical analysis using Kruskal-Wallis test was conducted to examine the significant differences on Vickers hardness number HV among the specimen groups according to the firing parameters with 0.005 p-value used as an indicator. RESULTS: Results suggest that there is an association between the increase in the hardness number and the increase in firing duration at a given firing temperature. The results also indicate that there is an association between the increase in the hardness number and increase in firing temperature at a given firing duration. CONCLUSIONS: The greatest rate of hardness increase with time is associated with groups of firing temperature 1200°C. The highest rate of hardness increase with temperature happened during the first 6 h of sintering process. On the other hand, there is no significant increase in the hardness number when increasing the firing temperature beyond 1200°C.

Rhombohedral Phase Formation in Yttria-Stabilized Zirconia Induced by Dental Technical Tools and Its Impact on Dental Applications.

In the study the influence of different dental technical tools on the surface temperature and phase composition of fixed dental prostheses (FDPs) made of yttria-partially stabilized zirconia polycrystals (3Y-/4Y-/5Y-PSZ) was investigated. FDPs were fabricated by using computer-aided manufacturing (CAM). The FDPs were treated with a contra-angle handpiece equipped with different burs and polishers. The resulting surface temperatures were measured with a thermographic camera, and the resulting phase transformations were investigated by X-ray diffraction and quantified by Rietveld refinement. Processing with burs resulted in no phase transformation, but a preferred orientation shift. Using coarse polisher induced a phase transformation to the rhombohedral phase, while fine polishers produced no relevant phase transformations and no preferred orientation shift. Compared to the monoclinic phase (ca. 9% theoretical volume increase), which is associated with low-temperature degradation (LTD), the rhombohedral phase is much more voluminous (ca. 15% theoretical volume increase) and distorted and, therefore, has a greater degradation potential.

Optimization of self-colored dental zirconia block parameters for an effective machining performance using response surface methodology based artificial bee colony.

OBJECTIVES: Self-colored dental zirconia blocks eliminate the drawbacks of the coloring process of traditional blocks and ensure disposal time and cost in dental prosthesis laboratories. Like traditional dental zirconia frameworks, self-colored dental zirconia frameworks are produced by grinding pre-sintered zirconia blocks via manual or CAD/CAM operating devices. The process parameters such as powder type, pre-sintering temperature and doping amount of coloring powder affect the machining performance of blocks through microhardness, bulk density and shrinkage values (diameter and thickness) during fabrication. In this study, we propose the response surface methodology (RSM) based artificial bee colony (ABC) algorithm to adjust the suitable combination of process parameters on the machining performance for self-colored dental zirconia blocks. METHODS: The optimum machining performance of the self-colored dental zirconia blocks is investigated using a multi-objective model named as RSM integrated ABC algorithm. Sensitivity analysis is utilized to identify the effects of objectives on the responses considering the different importance weights of each objective. RESULTS: After obtaining the optimized parameters of pre-sintering temperature= 1066.546 â„ƒ, doping amount of coloring powder= 10.638 (wt%) and powder type=TZP-1 by multi-objective ABC algorithm, the machining performance-related properties are found out Hυ1= 44.918 MPa, bulk density= 3.098 g/cm3, and shrinkage (%) (diameter)= 0.197, shrinkage (thickness)= 0.254. SIGNIFICANCE: Process parameters that directly affect the machining performance of the self-colored dental zirconia blocks were investigated with a multi-objective method for the first time in the literature. The results provide a base for further research on optimizing the self-colored dental zirconia block parameters for an effective machining performance.

Classification and Properties of Dental Zirconia as Implant Fixtures and Superstructures.

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

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

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

Low-temperature degradation increases the cyclic fatigue resistance of 3Y-TZP in bending.

OBJECTIVE: Due to past failures of orthopedic 3Y-TZP femoral implants linked to accelerated tetragonal-to-monoclinic phase transformation (t → m), the susceptibility to 'low-temperature degradation' or 'ageing' of 3Y-TZP has been advertised as detrimental to its long-term structural stability. However, no systematic mechanistic experiments on the fatigue resistance of aged 3Y-TZP under cyclic loading can support such statement. In this study, we aim to clarify this issue. METHODS: Here we evaluate the subcritical crack growth behavior of 3Y-TZP under cyclic loading after 0-50 h of accelerated ageing in an autoclave at 134 °C. The same 3Y-TZP sintered at two different temperatures (1450 °C or 1650 °C) allows for the comparison of materials containing grains with different susceptibilities to transformation. The volume fraction of surface transformed grains was measured using Raman spectroscopy, and the depth of the transformed surface layer from trenches milled with a Focus-Ion Beam. The fracture toughness before and after ageing was determined using the Chevron-notch Beam method. The quasi-static flexural strength was measured in dry conditions and the cyclic lifetime in water at 10 Hz and R-ratio = 0.3 in 4-point-bending at different applied stresses. The fatigue parameter n was derived from 3 different methods, namely SN curves, crack velocity plots and Weibull distributions. RESULTS: The progression of transformation showed linear kinetics with higher rates for the 3Y-TZP sintered at 1650 °C. Accelerated transformation induced severe crack formation within the transformed layer with parallel orientation to the surface plane, which supposedly behaved as the critical crack size population governing fracture. The stress intensity factor within the transformed layer was increased due to compressive stresses. Consequently, the fatigue parameter n increased consistently from 5 to 50 h of ageing, regardless of the derivation method, suggesting an increased resistance against crack growth during cyclic loading in bending. SIGNIFICANCE: Our results do not support the long suggested negative clinical implications of LTD regarding mechanical performance, to the contrary, LTD seems to increase the resistance against subcritical crack growth in a humid environment in bending.

Effect of grain size of dental zirconia on shear bond strength of composite resin cement.

The effect of grain size of dental zirconia on the shear bond strength of composite resin cement was newly studied. Disc-shaped dental zirconia with small (sample S) and large (sample L) grains were made by sintering of pre-sintered dental zirconia at 1450°C for 0.5 h and 40 h, respectively. After the sintering, the average grain size of sample S was 1.37 ± 0.15 µm, while that of sample L was 3.74 ± 0.50 µm. The sintered discs were successively polished with different grades of diamond and alumina slurries. The interfacial free energies were 63.5 ± 4.2 dyne/cm for sample S and 52.1 ± 5.5 dyne/cm for sample L. Stainless steel cylinders, previously sandblasted with 50 µm alumina powder, were bonded to the zirconia discs using composite resin cement. Next, samples were kept in an oven for 7 d at 36.5°C. The shear bond strength of sample S was 23.0 ± 4.5 MPa while that of sample L was 17.5 ± 4.6 MPa. After the fracture, the areal % values of composite resin cement remaining on the zirconia surfaces were 89.7 ± 5.9% for sample S and 61.6 ± 5.5% for sample L. The results suggest that grain size reduction has a potential to enhance the degree of bonding between a composite resin cement and a dental zirconia due to the increase of interfacial free energy.

Primer-Treated Ceramic Bracket Increases Shear Bond Strength on Dental Zirconia Surface.

The purpose of this study is to evaluate the shear bond strength (SBS) of a primer-treated ceramic bracket on dental zirconia and to compare it with conventional ceramic bracket bonding on surface-treated zirconia. Sintered and finished dental zirconia was sandblasted. Samples were divided according to the treated surfaces: no treatment (X), ceramic primer on zirconia (Z), ceramic primer on bracket base (B), and ceramic primer on both zirconia and bracket base (ZB). The ceramic bracket was bonded on zirconia and SBS was measured before (T0) and after 10,000 cycles of thermocycling (Tf). The failed surfaces were examined under field emission scanning electron microscope (FE-SEM), and adhesive remnant index (ARI) was evaluated. SBS was significantly higher in ZB and significantly lower in X in both T0 and Tf. There was no significant difference between Z and B. In X and B, adhesive failure occurred while ZB showed mixed failures. There was no apparent change in the zirconia surface except for the existence of some adhesive and resin remnants. The application of ceramic primer on the bracket base increased the bonding strength to the level of conventional bonding with fewer adhesive remnants. The highest bonding strength was obtained when the primer-treated bracket was bonded on the primer-treated zirconia.

Effect of Simplified Bonding on Shear Bond Strength between Ceramic Brackets and Dental Zirconia.

The aim of this study was to evaluate the long term stability of shear bond strength (SBS) when 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) containing universal adhesive was used in the ceramic bracket bonding on dental zirconia. Twenty human maxillary incisors were collected. The ceramic bracket was bonded on the buccal enamel surface after the acid-etching and orthodontic primer application (Group CON). Sixty zirconia specimens were sintered, sandblasted and divided into three experimental groups; group CP-ceramic primer followed by an orthodontic primer; group U-universal adhesive; group CU-ceramic primer followed by a universal adhesive. For each specimen, the bracket was bonded onto the treated surface with composite resin (Transbond XT, 3M ESPE). The SBS tested before (CON0, CP0, U0, CU0) and after the artificial aging (CON1, CP1, U1, CU1). The data were statistically analyzed with the Kruskal-Wallis test at a significance level of 0.05. The mean SBS of CON0, CP0, U0 and CU0 were within the clinically acceptable range without significant differences. After the aging process, SBS decreased in all groups. Among the aged groups, CP1 showed the highest SBS. Based on the results, when bonding ceramic brackets to a dental zirconia surface, we can conclude that ceramic primer used with an orthodontic primer, rather than using a universal adhesive, is recommended.