Surface roughness and optical characteristics evaluations after chairside adjustment of different zirconia types.

STATEMENT OF PROBLEM: Limited evidence is available for the effect of chairside adjustment using rotary cutting instruments on the surface roughness and optical properties of different zirconia types. PURPOSE: To evaluate the effect of simulated adjustments on surface roughness and optical properties of different zirconia types. MATERIALS AND METHODS: Three Partially Stabilized Zirconia (PSZ) types based on mole percent yttria (Y) concentration from the same manufacturer (Katana; Kuraray) were used: 3Y-PSZ, 4Y-PSZ, and 5Y-PSZ. Thirty disk-shaped specimens (Ø14 × 1.2 mm) from different zirconia types (N = 90) were prepared. Specimens were either left without adjustment (NA), adjusted with Dialite ZR finishing and polishing system (Brasseler) (APol), or adjusted with course diamond instruments only (ADia). The specimens were distributed into 9 groups (n = 10): Group 3Y-PSZ/NA, Group 3Y-PSZ/APol, Group 3Y-PSZ/ADia, Group 4Y-PSZ/NA, Group 4Y-PSZ/APol, Group 4Y-PSZ/ADia, Group 5Y-PSZ/NA, Group 5Y-PSZ/APol, and Group 5Y-PSZ/ADia. The surface roughness of specimen was analyzed using an Atomic Force Microscope (AFM) (Bruker's Dimension Icon, Bruker) and Root Means Square (RMS) were recorded (nm). Surface Gloss (SG), Translucency Parameter (TP), and Contrast Ratio (CR) values of all groups were recorded using an integrating sphere spectrophotometer. Statistical analysis was performed using analysis of variance (ANOVA) and Tukey's multiple comparison tests for pairwise comparisons at p < 0.05 and 95% confidence interval. RESULTS: APol had no effect on the surface roughness (p = 0.88) while ADia had a significant negative effect (p < 0.05) despite the type of zirconia. Out of the three testes optical properties, only SG was negatively affected by ADia for all types of zirconia (p < 0.05). The two adjustment types did not affect the TP of all the tested zirconia (p = 0.91). The CR was not affected by the tested adjustments for all zirconia types (p = 0.726). CONCLUSION: Proper zirconia adjustment following a sequence of burs and polishers can maintain acceptable roughness and optical properties. Adjustment of zirconia with rough diamond can lead to deleterious effects and should be avoided. CLINICAL SIGNIFICANCE: Chairside adjustment of zirconia could lead to rougher surface and unpredictable changes of surface gloss. Therefore, zirconia adjustment should be minimized to the greatest extent possible and a proper protocol should be followed if had to be done.

Er:YAG laser debonding of zirconia and lithium disilicate restorations.

STATEMENT OF PROBLEM: Yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) restorations of different formulations are being used increasingly in monolithic form for a range of clinical applications. Using rotary instruments to remove such restorations for any purpose is challenging, but they can be removed conservatively with erbium lasers. However, studies on how a laser penetrates different zirconias to break the cement bond between the tooth surface and the zirconia are lacking. PURPOSE: The purpose of this in vitro study was to evaluate and compare the time required for an erbium-doped yttrium-aluminum-garnet (Er:YAG) laser to remove different types of zirconia and lithium disilicate crowns. MATERIAL AND METHODS: Forty extracted premolar teeth were prepared, scanned, designed, and milled to fabricate 40 computer-aided design and computer-aided manufacturing (CAD-CAM) crowns, which were assigned to 4 groups (n=10): 3 mol% Y-TZP, 4 mol% Y-TZP, 5 mol% Y-TZP, and lithium disilicate as a control. All crowns were bonded to the teeth with a self-adhesive resin cement (Panavia SA Cement Universal). Each specimen was irradiated with an Er:YAG laser with the following parameters: 300 mJ, 15 Hz, 5.0 W, and a 50-microsecond pulse duration (supershort pulse mode). The irradiation time required for crowns to be retrieved successfully was recorded for each specimen. Data were statistically analyzed using analysis of variance and the Tukey honestly significant difference post hoc test (α=.05). The intaglio surfaces of the restorations were analyzed using scanning electron microscopy (SEM). RESULTS: The mean ±standard deviation times in minutes needed for crown debonding were 12.46 ±4.17 for the 3 mol% Y-TZP group, 10.30 ±3.33 for the 4 mol% Y-TZP group, 4.03 ±1.62 for the 5 mol% Y-TZP group, and 2.08 ±0.92 for the lithium disilicate group. A statistically significant difference (P<.05) in the debonding time was found for all investigated groups, expect between the 3 mol% and 4 mol% Y-TZP groups and between the 5 mol% Y-TZP and lithium disilicate groups. SEM analysis of the ceramic surfaces showed no visual damage associated with Er:YAG laser irradiation. CONCLUSIONS: Zirconia crown retrieval time with the Er:YAG laser was influenced by the yttria content of the zirconia, with decreasing retrieval time with increasing yttria content. Er:YAG laser debonding of zirconia crowns is a noninvasive, efficient, and rapid approach to the removal of crowns and could be applied in clinical practice.

Strength and phase transformation of different zirconia types after chairside adjustment.

STATEMENT OF PROBLEM: Limited evidence is available for the effect of chairside adjustment using diamond instruments on different types of zirconia. PURPOSE: The purpose of this in vitro study was to evaluate the effect of simulated adjustments on the biaxial flexural strength and phase transformation of 3 different zirconia types. MATERIAL AND METHODS: Three zirconia types from the same manufacturer (Katana; Kuraray) were used: High Translucency (3Y-PSZ), Super Translucent Multi Layered (4Y-PSZ), and Ultra Translucent Multi Layered (5Y-PSZ). Thirty disk-shaped specimens (Ø14×1.2 mm) were fabricated according to the International Organization for Standardization (ISO) Standard 6872 from different zirconia types (N=90). Specimens were either left without adjustment (NA), adjusted with Dialite ZR finishing and polishing system (Brasseler) (APol), or adjusted with course diamond instruments only (ADia). The specimens were distributed into 9 groups (n=10): group 3Y-PSZ/NA, group 3Y-PSZ/APol, group 3Y-PSZ/ADia, group 4Y-PSZ/NA, group 4Y-PSZ/APol, group 4Y-PSZ/ADia, group 5Y-PSZ/NA, group 5Y-PSZ/APol, and group 5Y-PSZ/ADia. The biaxial flexural strength of each specimen was measured by using a universal testing machine (Model 4411; Instron) and according to ISO 6872. X-ray diffraction analysis was conducted to quantify the monoclinic phase transformation. Scanning electron microscopy images were obtained to evaluate the fracture pattern. Statistical analysis was performed by using analysis of variance (ANOVA) and Tukey multiple comparison tests for pairwise comparisons (α=.05). RESULTS: The mean biaxial flexural strengths ranked from the highest to the lowest were for 3Y-PSZ, 4Y-PSZ, and 5Y-PSZ under any test condition (P=.007). Chairside adjustment with a diamond instrument significantly decreased the flexural strength of all zirconia types (P<.05). No statistically significant difference was found between the effect of APol and ADia on the strength of zirconia 3Y-PSZ (P=.603), 4Y-PSZ (P=.993), and 5Y-PSZ (P=.660). Phase transformation did not occur in the 5Y-PSZ groups. ADia groups had significantly higher phase transformation values regardless of zirconia type (P<.05). CONCLUSIONS: The biaxial flexural strength of zirconia decreased significantly after chairside adjustment with diamond instruments regardless of the yttria percentage. Adjustment with the Dialite ZR finishing and polishing system caused less tetragonal to monoclinic phase transformation than adjustment with a course-grit diamond instrument.

Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions.

PURPOSE: To evaluate resin cement bond strength after removal of salivary contamination from a zirconia surface using different cleaning solutions and air-borne particle abrasion. MATERIALS AND METHODS: One-hundred and twenty zirconia specimens (KATANA STML, Noritake) were prepared and divided into 12 groups (n = 10). Groups were subjected to a notched-edge shear bond strength test (ISO 29022) to analyze the bonding efficiency of a resin cement (Panavia V5, Kuraray Noritake Dental Inc.) before and after contamination with saliva. Group 1 (control) was prepared and cemented without salivary contamination. Group 2 was coated with ceramic primer (Clearfil Ceramic Primer Plus, Kuraray Noritake Dental Inc.) then subjected to salivary contamination then tested. Group 3 was contaminated, cleaned by air-borne particle abrasion, ceramic primer and resin cement applied, and tested. Groups 4 to 12 were contaminated, and then different cleaning solutions (water, 4.5% hydrofluoric acid, 35% phosphoric acid, Ivoclean, KATANA cleaner, Zirclean, sodium hypochlorite 4%, and 7.5%) were used to decontaminate the zirconia surface, followed by ceramic primer, resin cement application, and tested. One-way ANOVA and Tukey post-hoc analysis was used to analyze the data. RESULTS: One-way ANOVA showed statistical differences among cleaning procedures (p < 0.001, F = 13.48). Air-borne particle abrasion was the only group which provided a bond strength (21 ± 2.8 MPa) that was not statistically different than the control group in which no contamination occurred (25.3 ± 3.3 MPa) (p = 0.247). The use of hydrofluoric acid and zirconia cleaning solutions resulted in bond strengths values which were not statistically different from each other (17.5-19.1 MPa). CONCLUSION: Air-borne particle, zirconia cleaning solutions and hydrofluoric acid are feasible to decontaminate the zirconia surface from saliva prior to bonding the restoration.

Monolithic Zirconia Partial Coverage Restorations: An In Vitro Mastication Simulation Study.

PURPOSE: To evaluate the survival rate (fatigue resistance), bonding efficiency and marginal integrity of monolithic zirconia partial and full coverage single restorations adhesively bonded to the tooth structure using air-particle abrasion, a primer with 10-methacryloyloxydecyl dihydrogen phosphate and a composite-resin cement (APC) protocol. MATERIALS AND METHODS: Extracted human premolars (N = 32) were randomly divided into four groups of eight specimens each. Premolars were prepared for the following restorations: full crown (group 1, control), mesial-occlusal-distal-facial onlay (MODF, group 2) preserving 2 mm facio-lingual functional cusp width, mesial-occlusal-distal-lingual onlay (MODL, group 3) preserving 2 mm facio-lingual nonfunctional cusp width, mesial-occlusal-distal-buccal-lingual onlay (MODBL, group 4), overlay preparation. All restorations were milled from monolithic 3 mol% yttria (3Y) zirconia blocks (ZirCad, A1 LT, Ivoclar Vivadent) with CAD/CAM software presets at minimum occlusal and axial thicknesses of 1 mm. The intaglio surface of the restorations was air-particle abraded (50 µm Al2 O3 , 2-Bar pressure, 15 s, 10 mm distance) and primed. An adhesive cement system was used to bond the restorations. Each group was subjected to thermomechanical loading for 1.2 million cycles (force = 70 N, 1.4 Hz) with simultaneous thermocycling (5-55°C, 30 s dwell time) using a mastication simulator. All specimens were examined under scanning electron microscope (SEM) analysis (30, 100, and 150×) to evaluate cracks and marginal defects. Fracture of restoration and/or fracture within tooth structure, and debonding were considered modes of failure. RESULTS: One specimen from group 2 debonded at 632,000 cycles. None of the specimens failed due to fracture. SEM analysis at 30× indicated marginal integrity issue of the remaining seven intact specimens of group 2 in the area of antagonist contact. No specimens from group 1, 3, and 4 demonstrated marginal integrity issue at 30×. None of the specimens demonstrated any microcrack at 100× and150×. CONCLUSIONS: Due to its fatigue resistance, 3Y-zirconia is a viable option for partial and full coverage single restorations. Following a strict bonding protocol, zirconia demonstrated durable adhesion to the tooth structure. Occlusal contact on restoration margins should be avoided.

Fracture Load of Different Zirconia Types: A Mastication Simulation Study.

PURPOSE: To assess the effect of yttria mol% concentration and material thickness on the biaxial fracture load (N) of zirconia with and without mastication simulation. MATERIALS AND METHODS: Disk-shaped specimens (N = 120) of 3 mol% yttria-partially stabilized zirconia, 3Y-PSZ (Katana High Translucent, Kuraray Noritake), 4 mol% yttria-partially stabilized zirconia, 4Y-PSZ (Katana Super Translucent Multi Layered) and 5 mol% Yttria-partially stabilized zirconia, 5Y-PSZ (Katana Ultra Translucent Multi Layered) were prepared to thicknesses of 0.7 and 1.2 mm. For each thickness, the biaxial fracture load (N) was measured with and without mastication simulation with 1.2 million cycles at a 110-N load and simultaneous thermal cycling at 5°C to 55°C. The data were analyzed by three-way Analysis of Variance (α = 0.05) and Tukey-Kramer adjusted multiple comparison test. RESULTS: Yttria mol% concentration and material thickness had a statistically significant effect on the mean biaxial fracture load (F = 388.16, p < 0.001 and F = 714.33, p < 0.001 respectively). The mean biaxial fracture load ranged from the highest to the lowest; 3Y-PSZ, 4Y-PSZ, and 5Y-PSZ (p = 0.012). The mean biaxial fracture load of the 1.2 mm thickness groups was significantly higher than 0.7 mm thickness at any given condition (p = 0.002). Not all specimens survived the mastication simulation protocol. Fifty percent of the 0.7-mm-thick 4Y-PSZ specimens, 70% of the 0.7-mm-thick 5Y-PSZ specimens and 20% of 1.2-mm-thick 5Y-PSZ specimens fractured during mastication simulation. Mastication simulation had no statistically significant effect on the biaxial fracture load (F = 1.24, p = 0.239) of the survived specimens. CONCLUSIONS: Lowering yttria mol% concentration and increasing material thickness significantly increases the fracture load of zirconia. At 0.7 mm thickness, only 3Y-PSZ survived masticatory simulation. A minimum material thickness of 1.2 mm is required for 4Y-PSZ or 5Y-PSZ.

Physical Properties, Film Thickness, and Bond Strengths of Resin-Modified Glass Ionomer Cements According to Their Delivery Method.

PURPOSE: To determine the effect of changing the dispensing or mixing method of resin-modified glass ionomer (RMGI) cements on their water sorption, solubility, film thickness, and shear bond strength. MATERIALS AND METHODS: Disc-shaped specimens of RMGI cements (RelyX: Luting [handmix], Luting Plus [clicker-handmix], Luting Plus [automix], GC: Fuji PLUS [capsule-automix], FujiCEM 2 [automix], [n = 10]) were prepared according to ISO standard 4049 for water sorption and solubility tests. Furthermore, the percentage of mass change, percentage of solubility, and percentage of water absorbed was also determined. Film thickness was measured according to ISO standard 9917-2; the mean of 5 measurements for each cement was calculated. Shear bond strength for each cement was determined according to ISO standard 29022 before and after thermocycling at 20,000 cycles, temperatures 5 to 55°C with a 15-second dwell time (n = 10/subgroup). Two- and one-way ANOVA were used to analyze data for statistical significance (p < 0.05). RESULTS: Water sorptions of the RMGI cements were in close range (214-250 µg/mm3 ) with no statistical differences between counterparts (p > 0.05). RelyX Luting Plus (clicker-handmix) displayed lower solubility than its handmix and automix counterparts (p < 0.05). Film thickness of RelyX cements was significantly different (p < 0.05). RelyX Luting Plus (automix) had the lowest film thickness (19 µm) compared to its handmix (48 µm) and clicker-handmix (117 µm) counterparts (p < 0.05). GC Fuji PLUS (capsule-automix, 22 µm) was significantly lower than the automix version (GC FujiCEM 2, 127 µm) (p < 0.05). Shear bond strength of RelyX Luting Plus (automix) was significantly lower than its handmix and clicker-handmix versions (p < 0.05). GC Fuji PLUS (capsule-automix) was significantly higher than GC FujiCEM 2 (automix) (p < 0.05). The binary interaction of the two independent variables (dispensing/mixing method and thermocycling) was significant for the shear bond strengths of the GC cements only (p < 0.05). CONCLUSIONS: Change in the dispensing/mixing method of RMGI cement from the same brand may have an effect on its physical properties, in addition to its film thickness and shear bond strength. Newer, easier, and faster cement delivery systems are not necessarily better. Clinical outcomes of these differences are yet to be confirmed.

Mechanical properties of resin-based cements with different dispensing and mixing methods.

STATEMENT OF PROBLEM: Resin-based cements are frequently used in clinical practice. To reduce time and technique sensitivity, manufacturers have introduced the same brand of cement with different dispensing methods. The effect of this change on properties of the cement is unknown. PURPOSE: The purpose of this in vitro study was to evaluate the mechanical properties of resin-based cements with different dispensing systems. MATERIAL AND METHODS: Specimens of resin-based cements (n=14) PANAVIA SA Cement Plus Handmix, PANAVIA SA Cement Plus Automix, RelyX Unicem Handmix, RelyX Unicem 2 Automix, G-CEM Capsule Automix, G-CEM LinkAce Automix, Variolink II Handmix, and Variolink Esthetic Automix were prepared for each mechanical test. They were examined after thermocycling (n=7/subgroup) for 20000 cycles as to fracture toughness (FT) (ISO standard 6872; single-edge V-notched beam method), compressive strength (CS) (ISO 9917-1), and diametral tensile strength (DTS). The specimens were mounted and loaded at a crosshead rate of 1 mm/min (0.5 mm/min for FT) with a universal testing machine until failure occurred. The 2-and 1-way ANOVA followed by the Tukey HSD post hoc test were used to analyze data for statistical significance (α=05). RESULTS: Thermocycling had a significant effect in reducing the FT property of all resin-based cements except RelyX Unicem 2 and G-CEM LinkAce (P<.05). Variolink II and G-CEM LinkAce showed better FT properties than their automixed counterparts (P<.05). The overall CS of all automixed resin-based cements was better than that of their hand-mixed counterpart, except for Variolink II. PANAVIA SA Automixed and G-CEM LinkAce had higher DTS than their hand-mixed counterparts (P<.05). CONCLUSIONS: Changing the dispensing method alters the mechanical properties of resin-based cements. The clinical significance of these results is yet to be determined.