Influence of nanostructured alumina coating on the clinical performance of zirconia cantilevered resin-bonded fixed dental prostheses: Up to 3-year results of a prospective, randomized, controlled clinical trial.

STATEMENT OF PROBLEM: The debonding of zirconia cantilevered resin-bonded fixed dental prostheses remains a technical complication because zirconia's chemical inertness impedes adequate surface preparation for bonding. Limited clinical evidence on the performance of various pretreatment methods for the bonding surface of zirconia resin-bonded fixed dental prostheses is available. PURPOSE: The present prospective, randomized, controlled clinical trial aimed at evaluating the performance of zirconia resin-bonded fixed dental prostheses prepared with nanostructured alumina coating. MATERIAL AND METHODS: The study adopted a prospective, randomized, controlled, double-blind (patients, operator) design to compare the performance of nanostructured alumina coating with that of conventional airborne-particle abrasion. Twenty-seven healthy patients needing a replacement of a missing maxillary or mandibular central or lateral incisor were screened and rated to be eligible, and 31 zirconia cantilevered resin-bonded fixed dental prostheses were randomly allocated into 1 of 2 groups. The first group (n=15), where the restoration bonding surface was airborne-particle abraded with 50-µm alumina, served as a control group. In the second group (n=16), the restorations were pretreated with nanostructured alumina coating. Treatment and data collection were standardized. The primary outcome evaluated was the survival of the RBFDPs as defined by the restoration not debonding. The Kaplan-Meier analysis of cumulative survival was performed, and nonparametric tests were used to determine patient-specific differences between both study groups (age, sex, restored arch, tooth replaced, bonding surface area) (α=.05). Retainer wing surfaces of debonded resin-bonded fixed dental prostheses were inspected under a scanning electron microscope. RESULTS: Within a mean ±standard deviation observation period of 22.4 ±7.7 months (minimum, 8.3; maximum, 37.9 months), 3 debondings occurred, and the survival rate was 90.3%. The survival rate was 93.8% for the nanostructured alumina coating and 86.7% for the control group, with no statistically significant differences (log-rank, P=.54). No patient-specific differences were found between study groups (P>.05). As per the scanning electron micrographs, the majority of the nanostructured alumina-coated surfaces had large areas of nanostructured alumina residue, whereas the airborne-particle abraded surfaces exhibited predominantly adhesive failure with less cement residue. CONCLUSIONS: Over a mean observation period of 2 years, both zirconia pretreatments showed promising and comparable clinical results; therefore, nanostructured alumina coating could be regarded as a viable alternative pretreatment method to airborne-particle abrasion.

The combined effect of alumina and silica co-doping on the ageing resistance of 3Y-TZP bioceramics.

The combined effect of alumina and silica co-doping on the ageing resistance of 3Y-TZP bioceramics was investigated. In order to differentiate between the distinct contributions of two dopants to the overall resistance to low-temperature degradation (LTD), specimens were prepared by infiltration of silica sol into pre-sintered 3Y-TZP pellets, produced from commercially available powders, which were alumina-free or contained 0.05 and 0.25 wt.%. After sintering, specimens were exposed to accelerated ageing in distilled water at 134°C for 6-48 h. X-ray diffraction was applied to quantify the tetragonal-to-monoclinic (t-m) phase transformation associated with the LTD, while a focused ion beam-scanning electron microscopy technique was employed to study the microstructural features in the transformed layer. The results showed that the minor alumina and/or silica additions did not drastically change the densities, grain sizes or mechanical properties of 3Y-TZP, but they did significantly reduce LTD. The addition of either alumina or silica has the potential to influence both the nucleation and the propagation of moisture-induced transformation, but in different ways and to different extents. The co-doped ceramics exhibited predominantly transgranular fracture, reflecting strong grain boundaries (limiting microcracking of the transformed layer), for alumina doping, and rounded grains with a glassy phase at multiple grain junctions (reducing internal stresses) for silica-doped material. These two additives evidently have different dominant mechanisms associated with the deceleration of LTD of 3Y-TZP, but their combination increases resistance to ageing, importantly, without reducing the fracture toughness of this popular biomaterial.

Influence of contamination on resin bond strength to nano-structured alumina-coated zirconia ceramic.

The purpose of this study was to evaluate the influence of contamination and subsequent cleaning on the bond strength and durability of an adhesive resin to nano-structured alumina-coated zirconia ceramic. Zirconia ceramic disks were coated with nano-structured alumina, utilizing the hydrolysis of aluminum nitride powder. After immersion in saliva or the use of a silicone disclosing agent, specimens were cleaned with phosphoric acid etching or with tap water rinsing only. Uncontaminated specimens served as controls. Plexiglas tubes filled with composite resin were bonded with a phosphate monomer [10-methacryloxydecyl-dihydrogenphosphate (MDP)]-containing resin (Panavia 21). Subgroups of eight specimens each were stored in distilled water at 37 degrees C, either for 3 d without thermal cycling (TC) or for 150 d with 37,500 thermal cycles from 5 to 55 degrees C. The tensile bond strength (TBS) was determined using a universal testing machine at a crosshead speed of 2 mm min(-1). The topography of the debonded surface was scrutinized for fractographic features, utilizing both optical and scanning electron microscopy. The TBS to uncontaminated nano-structured alumina-coated zirconia ceramic was durable, while contamination significantly reduced the TBS. Phosphoric acid cleaning was effective in removal of saliva contamination from the coated bonding surface but was not effective in removal of the silicone disclosing agent. Nano-structured alumina coating improves resin bonding to zirconia ceramic and eliminates the need for air-abrasion before bonding.

The effect of nano-structured alumina coating on resin-bond strength to zirconia ceramics.

OBJECTIVES: The aim of this study was to functionalize the surface of yttria partially stabilized tetragonal zirconia ceramics (Y-TZP) with a nano-structured alumina coating to improve resin bonding. MATERIALS AND METHODS: A total of 120 densely sintered disc-shaped specimens (15.5+/-0.03 mm in diameter and 2.6+/-0.03 mm thick) were produced from biomedical-grade TZ-3YB-E zirconia powder (Tosoh, Tokyo, Japan), randomly divided into three groups of 40 and subjected to the following surface treatments: AS - as-sintered; APA - airborne-particle abraded; POL - polished. Half of the discs in each group received an alumina coating that was fabricated by exploiting the hydrolysis of aluminium nitride (AlN) powder (groups AS-C, APA-C, POL-C). The coating was characterized using scanning electron microscopy (SEM), atomic force microscopy (AFM), and transmission electron microscopy (TEM). The shear-bond strength of the self-etching composite resin (RelyX Unicem, 3M ESPE, USA) was then studied for the coated and uncoated surfaces of the as-sintered, polished and airborne-particle abraded specimens before and after thermocycling (TC). RESULTS: The SEM/TEM analyses revealed that the application of an alumina coating to Y-TZP ceramics created a highly retentive surface for resin penetration. The coating showed good surface coverage and a uniform thickness of 240 nm. The resin-bond strength to the groups AS-C, APA-C, POL-C was significantly higher than to the groups AS, APA and POL, both before and after TC (p< or =0.05). During TC all the specimens in the POL and AS groups debonded spontaneously. In contrast, the TC did not affect the bond strength of the AS-C, POL-C and APA-C groups. SIGNIFICANCE: A non-invasive method has been developed that significantly improves resin-bond strength to Y-TZP ceramics. After surface functionalization the bond survives thermocycling without reduction in strength. The method is relatively simple and has the potential to become an effective conditioning method for zirconia ceramics.