Digital versus conventional veneering of zirconia and cobalt chromium crowns: Fracture load before and after thermomechanical aging.

STATEMENT OF PROBLEM: To complement the digital workflow for manufacturing fixed dental prostheses, both high-strength frameworks and esthetic veneers should be designed and fabricated digitally. However, how the fracture load of digitally veneered restorations compares with conventionally fabricated restorations is unclear. PURPOSE: The purpose of this in vitro study was to examine the fracture load of digitally and conventionally veneered zirconia and cobalt chromium crowns initially and after thermomechanical aging. MATERIAL AND METHODS: Milled zirconia and cobalt chromium copings for a maxillary canine were fabricated (N=96). Digital veneers were milled and connected to the copings with a sintered ceramic slurry. The conventional veneers were fabricated by using a master mold, and the crowns were bonded to the cobalt chromium abutments. Half the specimens were subjected to 6000 thermal (5 °C to 55 °C, 60 seconds) and 1 200 000 mechanical (50 N, 1.5 Hz, 0.7 mm lateral movement) cycles opposed by steatite antagonists, and the fracture load was determined. Fracture types were categorized, and scanning electron microscopy performed. The data were analyzed with a 3-way global univariate analysis of variance, t test, the Pearson chi-squared test, and the Weibull modulus (α=.05). RESULTS: Unlike the framework material (P=.316) and artificial aging (P=.064), the veneering protocol affected the fracture load (P=.007). Digital veneers (range: 2242 to 2929 N) led to lower values than conventional veneers (range: 2825 to 3166 N), which was significant for aged cobalt chromium copings (P=.024; 2242 versus 3107 N). Conventionally veneered crowns showed lower Weibull moduli after thermomechanical aging (range: 3.2 to 3.5) than initially (range: 7.8 to 11.4). The copings of all the zirconia specimens fractured, while chipping occurred with the cobalt chromium specimens. CONCLUSIONS: The high fracture load values of the veneered crowns, even after simulated 5-year aging, indicated sufficient mechanical properties (nearly 4-fold the average occlusal force of 600 N) for the successful clinical application of digitally veneered zirconia and cobalt chromium copings.

Effect of final temperature and heating rate on the mechanical and optical properties of a zirconia veneering ceramic.

PURPOSE: To evaluate the effect of firing temperature and heating rate on the volumetric shrinkage, translucency, flexural strength, hardness, and fracture toughness of a zirconia veneering ceramic. MATERIAL AND METHODS: Zirconia veneering ceramic specimens (N = 45) with varying final temperatures (730 °C, 750 °C, and 770 °C) and heating rates (70 °C/min, 55 °C/min, and 40 °C/min) were fabricated (n = 5). Each specimen's shrinkage, translucency, flexural strength, hardness, and fracture toughness were determined. Two-way analysis of variance, Scheffé test, and Pearson's correlation analysis were used to evaluate data (α = 0.05). RESULTS: The shrinkage (44.9 ± 3.1-47.5 ± 1.6 vol%) and flexural strength (74.1 ± 17.4-107.0 ± 27.1 MPa) were not affected by tested parameters (P ≥ 0.288). The interaction between the main factors affected the translucency, hardness, and fracture toughness of the specimens (P ≤ 0.007). Specimens with 770 °C final temperature and 70 °C/min heating rate had the lowest (21.8 ± 3.2 %) translucency (P ≤ 0.039). The hardness ranged between 4.98 ± 0.51 GPa (730 °C; 70 °C/min) and 5.60 ± 0.37 GPa (770 °C; 70 °C/min). Fracture toughness ranged between 0.54 ± 0.04 MPa√m and 0.67 ± 0.08 MPa√m with the highest values for specimens fired at 730 °C with 70 °C/min (P ≤ 0.001). There was a positive correlation between translucency and hardness (r = 0.335, P = 0.012), and a negative correlation between fracture toughness and all parameters other than shrinkage (translucency: r = -0.693/P < 0.001, flexural strength: r = -0.258/P = 0.046, hardness: r = -0.457/P < 0.001). CONCLUSIONS: Heating rate and final temperature should be considered while fabricating veneered zirconia restorations with tested ceramic as they affected the translucency, hardness, and fracture toughness.

Mechanical Properties of High- and Low-Fusing Zirconia Veneering Ceramics Fired on Different Trays and Substrates.

This study aimed to evaluate the effect of ceramic type, firing tray, and firing substrate on the density, shrinkage, biaxial flexural strength, Martens' hardness, and elastic indentation modulus of zirconia veneering ceramics. Disk-shaped specimens were fabricated from a high-fusing (HFZ) and a low-fusing (STR) zirconia veneering ceramic. These specimens were then divided into 10 groups according to firing trays (round, small honeycomb-shaped, cordierite [RSC]; round, large honeycomb-shaped, aluminum oxide [RLA]; rectangular, plane, silicon nitride [RCPS]; round, plane, silicon nitride [RPS]; and rectangular, plane, calcium silicate [RCPC]) and firing substrates (firing cotton and platinum foil) used (n = 12). The density, shrinkage, biaxial flexural strength, Martens' hardness, and indentation modulus were measured, and analyzed with generalized linear model analysis (α = 0.05). The interaction between the ceramic type and firing substrate affected density (p < 0.001), and the other outcomes were affected by the interaction among all main factors (p ≤ 0.045). Higher density was observed with HFZ or platinum foil (p ≤ 0.007). RSC and RLA led to a higher density than RCPS within HFZ and led to the lowest density within STR (p ≤ 0.046). STR had a higher shrinkage (p < 0.001). RSC mostly led to a lower shrinkage of HFZ (p ≤ 0.045). The effect of ceramic type and firing substrates on the biaxial flexural strength, Martens' hardness, and indentation modulus was minimal while there was no clear trend on the effect of firing tray on these properties. Ceramic type, firing tray, and firing substrate affected the mechanical properties of the tested zirconia veneering ceramics. Firing the tested zirconia veneering ceramics over a round and small honeycomb-shaped cordierite firing tray with firing cotton mostly led to improved mechanical properties.

Mechanical and physical properties of splint materials for oral appliances produced by additive, subtractive and conventional manufacturing.

OBJECTIVES: To investigate the flexural strength (FS), elastic modulus (E), Martens hardness (HM), water sorption (wsp), water solubility (wsl) and degree of conversion (DC) of 3D-printed, milled and injection molded splint materials. METHODS: Specimens (N = 1140) were fabricated from five 3D-printed (GR-22 flex, GR-10 guide, ProArt Print Splint clear, V-Print Splint, V-Print Splint comfort), five milled (BioniCut, EldyPlus, ProArt CAD Splint clear, Temp Premium Flexible, Thermeo) and two injection molded (PalaXPress clear, Pro Base Cold) materials. FS, E, HM, wsp, wsl and DC were tested initially (24 h, 37 °C, H2O), after water storage (90 d, 37 °C, H2O) as well as after thermal cycling (5000 thermal cycles, 5/55 °C). Data were analyzed with Kolmogorov-Smirnov, Kruskal- Wallis, Mann-Whitney U test and Spearman's correlation (p < 0.05). RESULTS: Initially, the mean flexural strength values ranged from 1.9 to 90.7 MPa for printed, 3.8 to 107 MPa for milled and 99.7 to 102 MPa for injection molded materials. The initial mean elastic modulus values were 0.0 to 2.4 GPa for printed, 0.1 to 2.7 GPa for milled and 2.8 GPa for injection molded materials. The initial mean Martens hardness values were 14.5 to 126 N/mm2 for printed, 50.2 to 171 N/mm2 for milled and 143 to 151 N/mm2 for injection molded materials. Initially, the mean water sorption values ranged from 23.1 to 41.2 µg/mm3 for printed, 4.5 to 23.5 µg/mm3 for milled and from 22.5 to 23.3 µg/ mm3 for injection molded materials. The initial mean water solubility values ranged from 2.2 to 7.1 µg/mm3 for printed, 0.0 to 0.5 µg/mm3 for milled and 0.1 to 0.3 µg/mm3 for injection molded materials. After water storage and thermal cycling most of the values decreased and some increased. The mean DC values ranged initially from 72.3 to 94.5 %, after water storage from 74.2 to 96.8 % and after thermal cycling from 75.6 to 95.4 % for the printed materials. SIGNIFICANCE: The mechanical and physical properties of printed, milled and injection molded materials for occlusal devices vary and are influenced by aging processes. For clinical applications, materials need to be chosen according to the specific indications.

Three-Dimensional Printed Resin: Impact of Different Cleaning Protocols on Degree of Conversion and Tensile Bond Strength to a Composite Resin Using Various Adhesive Systems.

The present investigation tested the effect of cleaning methods and adhesives on the tensile bond strength (TBS) of a resin-based composite luted to a temporary 3D printed resin. Substrates (n= 360) were printed using a Rapidshape D20II and cleaned with a butyldiglycol-based solution, isopropanol, or by centrifugation. Specimens were air-abraded with Al2O3 (mean particle size 50 µm) at 0.1 MPa followed by pretreatment (n = 30/subgroup) with: (1) Clearfil Ceramic Primer (CCP); (2) Clearfil Universal Bond (CUB); (3) Scotchbond Universal Plus (SUP) or 4. Visio.link (VL) and luted to PanaviaV5. TBS (n = 15/subgroup) was measured initially (24 h at 37 °C water) or after thermal cycling (10,000×, 5/55 °C). The degree of conversion (DC) for each cleaning method was determined prior and after air-abrasion. Univariate ANOVA followed by post-hoc Scheffé test was computed (p < 0.05). Using Ciba-Geigy tables and chi-square, failure types were analyzed. The DC values were >85% after all cleaning methods, with centrifugation showing the lowest. CCP pretreatment exhibited the lowest TBS values, with predominantly adhesive failures. The combination of CCP and centrifugation increased the TBS values (p < 0.001) compared to the chemical cleaning. CUB, SUP, and VL, regardless of cleaning, can increase the bond strength between the 3D printed resin and the conventional luting resin.

Loading capacity of zirconia implant supported hybrid ceramic crowns.

OBJECTIVE: Recently a polymer infiltrated hybrid ceramic was developed, which is characterized by a low elastic modulus and therefore may be considered as potential material for implant supported single crowns. The purpose of the study was to evaluate the loading capacity of hybrid ceramic single crowns on one-piece zirconia implants with respect to the cement type. METHODS: Fracture load tests were performed on standardized molar crowns milled from hybrid ceramic or feldspar ceramic, cemented to zirconia implants with either machined or etched intaglio surface using four different resin composite cements. Flexure strength, elastic modulus, indirect tensile strength and compressive strength of the cements were measured. Statistical analysis was performed using two-way ANOVA (p=0.05). RESULTS: The hybrid ceramic exhibited statistically significant higher fracture load values than the feldspar ceramic. Fracture load values and compressive strength values of the respective cements were correlated. Highest fracture load values were achieved with an adhesive cement (1253±148N). Etching of the intaglio surface did not improve the fracture load. SIGNIFICANCE: Loading capacity of hybrid ceramic single crowns on one-piece zirconia implants is superior to that of feldspar ceramic. To achieve maximal loading capacity for permanent cementation of full-ceramic restorations on zirconia implants, self-adhesive or adhesive cements with a high compressive strength should be used.

Damage tolerance of indirect restorative materials (including PICN) after simulated bur adjustments.

OBJECTIVE: To analyze the damage tolerance of indirect restorative materials after grinding with diamond burs to simulate adjustments by clinicians and technicians. METHODS: Seven commercially available restorative materials (Mark II, ENAMIC, In-Ceram Alumina, VM 9, In-Ceram YZ, IPS e.max CAD) and an experimental one (PICN) were analyzed. Forty bending bars per material were fabricated according to manufacturer's instructions and lapped with 15 µm diamond suspension. The initial flexural strength was determined in three-point-bending on 10 specimens. Additionally the elastic modulus and Poisson's ratio were determined by the resonant frequency method. The remaining bending bars were divided into six groups (n=5) and subjected to standardized grinding with three different diamond grit burs (coarse, 151 µm; medium, 107 µm and extra fine 25 µm) and two grinding directions (transversal and longitudinal). The ground specimens were subsequently loaded to fracture and analyzed by SEM. RESULTS: Except for the YTZP bending bars, the initial materials strength of all tested materials decreased significantly with all diamond burs upon adjustments in both transversal and longitudinal grinding directions. The resistance of the ground materials to strength reduction follow the order from highest to least damage tolerant material: PICN>ENAMIC>Mark II>VM 9>In-Ceram Alumina>IPS e.max CAD. The loss in strength of all examined materials after longitudinal grinding is generally less compared to transversal grinding. The lowest loss in strength occurred for VM 9 (7.79%) and ENAMIC (9.18%) upon longitudinal grinding direction with extra fine and medium diamond grit bur, respectively. SIGNIFICANCE: The damage tolerance of restorative materials upon adjustments depends on specific mechanical properties and the adjustment procedure. The outcomes of the simulated grinding protocols of this study can be adopted clinically in terms of the selection of appropriate materials, burs and adjustment parameters.

Hertzian contact response and damage tolerance of dental ceramics.

OBJECTIVES: To determine the contact response and damage tolerance or strength degradation of a range of dental CAD/CAM ceramic materials including novel polymer-infiltrated-ceramic-network (PICN) materials by means of spherical indentations at various loads and indenter radii. METHODS: The seven tested materials included Mark II, PICN test materials 1 and 2, In-Ceram Alumina, VM 9, In-Ceram YZ (Vita Zahnfabrik, Bad Saeckingen, Germany) and IPS e.max CAD, (Ivoclar Vivadent, Schaan, Liechtenstein). To evaluate the damage tolerance and role of indenter size, indentations with tungsten carbide spheres (0.5mm and 1.25mm radius) were placed on bending bars with varying loads (1.96-1000N). The indented bending bars were subsequently loaded to fracture in three-point bending. The contact induced damage was analyzed by light microscopy (LM) and SEM. The spherical contact response was measured on polished surfaces. RESULTS: The initial strengths for the individual materials were found to reduce above specific indentation loads, which were a function of the indenter radius. Employing a 0.5mm radius sphere resulted in the following strength degrading loads and ordering of materials: VM9 (98N)

Mechanical properties of polymer-infiltrated-ceramic-network materials.

OBJECTIVES: To determine and identify correlations between flexural strength, strain at failure, elastic modulus and hardness versus ceramic network densities of a range of novel polymer-infiltrated-ceramic-network (PICN) materials. METHODS: Four ceramic network densities ranging from 59% to 72% of theoretical density, resin infiltrated PICN as well as pure polymer and dense ceramic cross-sections were subjected to Vickers Indentations (HV 5) for hardness evaluation. The flexural strength and elastic modulus were measured using three-point-bending. The fracture response of PICNs was determined for cracks induced by Vickers-indentation. Optical and scanning electron microscopy (SEM) was employed to observe the indented areas. RESULTS: Depending on the density of the porous ceramic the flexural strength of PICNs ranged from 131 to 160MPa, the hardness values ranged between 1.05 and 2.10GPa and the elastic modulus between 16.4 and 28.1GPa. SEM observations of the indentation induced cracks indicate that the polymer network causes greater crack deflection than the dense ceramic material. The results were compared with simple analytical expressions for property variation of two phase composite materials. SIGNIFICANCE: This study points out the correlation between ceramic network density, elastic modulus and hardness of PICNs. These materials are considered to more closely imitate natural tooth properties compared with existing dental restorative materials.

In-vitro strength degradation of dental ceramics and novel PICN material by sharp indentation.

OBJECTIVES: To determine the flexural strength and subsequent strength degradation of a range of dental CAD/CAM ceramic materials and novel PICN (Polymer-Infiltrated-Ceramic-Network) materials by means of pre-damaging with Vickers indentations at various loads. METHODS: The materials tested included (Mark II, PICN test material 1 and 2, In-Ceram Alumina, VM 9, In-Ceram YZ; Vita Zahnfabrik, Bad Saeckingen, Germany) and (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein). Bending bars were cut and lapped with 15 µm diamond suspension. Initial flexural strength (n=10) was determined in three-point-bending. To evaluate the damage tolerance, Vickers indentations were placed on the bending bars (n=35) with varying loads (1.96-98.07 N). The indented bending bars were subsequently loaded to fracture in three-point-bending. In addition, the fracture toughness was determined by the indentation strength (IS) and the SEVNB technique (n=5). RESULTS: With increasing indentation loads the fracture strength of all materials tested decreased. The material with the highest fracture resistance to indentation induced damage, was the PICN test material 1 with an indentation load-flexural strength curve slope of 0.21. In-Ceram YZ exhibited the highest damage susceptibility with a slope of 0.4. The fracture toughness varied with the measurement technique and material in the range of 0.82 (VM 9) to 4.94 (In-Ceram YZ) MPa√m for the SEVNB method and 0.96 (VM 9) to 4.97 (In-Ceram YZ) MPa√m for the IS method respectively. SIGNIFICANCE: This study aims to indicate the likely clinical behavior by evaluating the damage tolerance and R-curve behavior of dental ceramics by in-vitro strength degradation and fracture toughness measurements.