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.

Comparison of subcritical growth parameters of a Y-TZP obtained via cyclic or dynamic fatigue tests.

OBJECTIVE: The objective of this study was to 1) compare the stress corrosion coefficient (n) of a Y-TZP obtained by two fatigue tests: cyclic and dynamic and 2) evaluate the effect of frequency in the characteristic lifetime and the existence of interaction between the cyclic fatigue and slow crack growth. METHODS: A total of 145 Y-TZP specimens were produced in accordance with the manufacturer's instructions. These specimens, measuring 4.0 × 3.0 × 25.0 mm, were used for dynamic (n = 70) and cyclic fatigue tests (n = 75). The specimens were obtained from CAD/CAM blocks, sectioned, and sintered in a furnace at 1530 °C with a heating rate of 25 °C/min. They were tested in their "as-sintered" form without any additional surface treatment. The fatigue tests were conducted using a four-point bending to obtain the slow crack growth parameters (n). The cyclic fatigue test was also conducted in two frequencies (2 and 10 Hz), using stress levels between 350 and 600 MPa. Data from these tests were analyzed using ASTM C 1368-00 formulas and Weibull statistics. Scanning electron microscope (SEM) was used for fracture surface analysis to identify the origin of the fracture. Critical defect size was measured and used, along with flexural strength values, to estimate fracture toughness. Dynamic fatigue test data were used to obtain subcritical crack growth (SCG) parameters and perform Weibull statistical analysis. The cyclic fatigue data were used in the General Log-linear Model equation using the ALTA PRO software. Data were analyzed using one-way ANOVA followed by Tukey post-hoc tests and Student's t-test at a significance level of p ≤ 0.05. RESULTS: In the dynamic fatigue test, the values obtained for σfo and n were 667 and 54, respectively. This parameter indicates how the strength of the material diminishes over time due to internal cracks. The Weibull parameters obtained from the same test results were m = 7.9, σ0 = 968, 9 and σ5% = 767, which indicates the reliability of the material. The Weibull parameters obtained by cyclic fatigue were statistically similar for the two frequencies used, the m* was 0.17 (2 Hz) and 0.21 (10 Hz); characteristic lifetimes (η) were 1.93 × 106 and 40,768, respectively. The n values obtained by cyclic fatigue were 48 and 40 at frequencies of 2 and 10 Hz, respectively. There was no effect of the frequency, the stress level or the interaction of the two in the Y-TZP lifetime, when analysed by General Log Linear Model. SIGNIFICANCE: the n values obtained by cyclic and dynamic fatigue tests showed no statistically significant difference and the effect of frequency in the characteristic lifetime and the existence of interaction between the cyclic fatigue and subcritical growth were not observed in the tested specimens.

Harmonizing color measurements in dentistry using translucent tooth-colored materials.

BACKGROUND: Since color measurements are relative, the discrepancy among different instruments is alarmingly high. This multicenter study evaluated the effectiveness of instrument calibration and inter-instrument harmonization of different spectrophotometers with the same optical geometry using tooth-colored, translucent dental materials. METHODS: The coordinating center (CC) spectrophotometer was calibrated using the NPL Ceram Series II set. Two sets of 10 specimens, labeled 1 to 10 and I to X (10 mm in diameter and 1 mm thick), were tested at CC and three research sites (RS1, RS2, and RS3) using the same d/8° optical geometry spectrophotometers. Calibration factors were calculated for each material and site to obtain the average calibration factors for sets 1-10, set I-X, and the combination of both. The differences among the non-corrected and corrected reflection values were calculated using CIEDE2000 (DeltaE00) and CIELAB (DeltaEab) color difference formulas and were submitted to ANOVA and Tukey test (α = 0.05). RESULTS: A significant decrease of color differences between non-corrected as compared to corrected measurements was recorded for all CC-RS and RS-RS comparisons. The reduction of DeltaE00 values between non-corrected and corrected for CC-RS1, CC-RS2, and CC-RS3 were 83.1%, 77.2%, and 73.6%, respectively. The corresponding DeltaE00 values for RS1-RS2, RS1-RS3, and RS2-RS3 comparisons, indirectly compared in the experiment, were 84.2%, 82.8%, and 68.5%, respectively. There was a significant reduction of DeltaE00 and DeltaEab color difference for all combined RS pairs and each of three RS pairs, corrected with one of two specimen sets calibration factors separately. CONCLUSIONS: Calibration and harmonization of color measurements in dentistry using tooth-colored, translucent restorative materials significantly decreased measurement discrepancies between the coordinating center and research sites and among pairs of research sites.

Development of Y-TZP/MWCNT-SiO2 nanocomposite for dental protheses.

Y-TZP/MWCNT-SiO2 nanocomposite was synthesized by co-precipitation and hydrothermal treatment methods. After the characterization of the MWCNT-SiO2 powder, specimens were obtained from the synthesized material Y-TZP/MWCNT-SiO2 by uniaxial pressing for a second characterization and later comparison of its optical and mechanical properties with the conventional Y-TZP. The MWCNT-SiO2 was presented in bundles of carbon nanotubes coated by silica (mean length: 5.10 ± 1.34 µm /D90: 6.9 µm). The composite manufactured was opaque (contrast ratio: 0.9929 ± 0.0012) and had a white color with a slightly difference from the conventional Y-TZP (ΔE00: 4.4 ± 2.2) color. The mechanical properties of Y-TZP/MWCNT-SiO2: vickers hardness (10.14 ± 1.27 GPa; p = 0.25) and fracture toughness (4.98 ± 0.30 MPa m1/2; p = 0.39), showed no significant difference from the conventional Y-TZP (hardness: 8.87 ± 0.89; fracture toughness: 4.98 ± 0.30 MPa m1/2). However, for flexural strength (p = 0.003), a lower value was obtained for Y-TZP/MWCNT-SiO2 (299.4 ± 30.5 MPa) when compared to the control Y-TZP (623.7 ± 108.8 MPa). The manufactured Y-TZP/MWCNT-SiO2 composite presented satisfactory optical properties, however the co-precipitation and hydrothermal treatment methods need to be optimized to avoid the formation of porosities and strong agglomerates, both from Y-TZP particles and MWCNT-SiO2 bundles, which lead to a significant decrease in the material flexural strength.

Special care in dental curriculum: A transversal axis for integrating oral health with systemic health.

AIMS: Distance between dentistry and medicine is a traditional and historical obstacle that affects multiple levels of the health system, especially the health policies to improve health service quality. Changes in dental education, especially involving the adoption of integrative health models in professional development, are considered essential for reducing this gap. We aimed to show a dental curriculum focused on special care as a tool for medicine-dentistry integration. METHODS: In this study, we present a new proposal for an undergraduate dental curriculum in which topics related to special care are addressed transversally and are the core for interdisciplinary integration of oral health with systemic health. We also describe how themes related to dental home care and hospital dentistry were included in this course as basic professional competencies. RESULTS AND CONCLUSION: This initiative is aligned with the global trend to adopt educational systems that contribute to the reduction of health care inequalities and improve health service quality.

Effect of intracanal diode laser irradiation on fracture resistance of roots restored with CAD/CAM posts

Aim: To evaluate the fracture resistance of roots restored with CAD/CAM-fabricated posts, receiving or not intracanal laser treatment, compared with glass fiber posts under mechanical cycling. Methods: Twenty-seven endodontically treated, single-rooted teeth were divided into 3 groups: group 1 (control), prefabricated glass fiber posts relined with resin composite; group 2, CAD/CAM-fabricated intraradicular posts using Resin Nano Ceramic (RNC) blocks; and group 3, CAD/CAM-fabricated intraradicular posts using RNC blocks in canals irradiated with a 940-nm diode laser (100 mJ, 300-um optic fiber, coronal-apical and apical-coronal helical movements, speed of 2 mm/second, 4 times each canal). After cementation of the coping, cyclic loading was applied at an angle of 135° to the long axis of the root, with a pulse load of 130 N, frequency of 2.2 Hz, and 150,000 pulses on the crown at a point located 2 mm below the incisal edge on the lingual aspect of the specimen. Every 50,000 cycles, the specimens were evaluated for root fracture occurring below or above the simulated bone crest. Results were analyzed by one-way ANOVA followed by Tukey's test (p<0.05). Results: Group 1 was the least resistant, while groups 2 and 3 were the most resistant. Group 1 differed significantly from groups 2 and 3 (p<0.01), but there was no difference between groups 2 and 3 (p<0.01). Conclusion: Treatment of the intracanal surface with diode laser had no influence on fracture resistance of roots restored with CAD/CAM-fabricated posts, but a longer cycling time is required to evaluate the real benefits of diode laser irradiation

Advances in Ceramics for Dental Applications.

The purpose of this study is to present current dental ceramic materials and processing methods. The clinical indication was emphasized on basis of the material's microstructure and composition. Studies of ceramic characterization were also discussed, as they impact the clinical indication and serve as a parameter for the development of new materials. The novel strategies were mostly found aiming to mimic the natural dental structures, provide mechanical reliability, and develop predictable restorations in terms of adaptation and design.

Do tooth-supported zirconia restorations present more technical failures related to fracture or loss of retention? Systematic review and meta-analysis.

OBJECTIVES: This systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs), categorizing them as fracture/chipping or loss of retention/decementation. MATERIALS AND METHODS: Electronic and manual searches were performed for randomized clinical trials, prospective clinical trials, and prospective cohort studies that reported the technical failure rates of zirconia restorations. The Cochrane Collaboration risk-of-bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies. RESULTS: Fifty-two studies were included and most of them had unclear risk of bias. Considering all reported fractures/chipping, for veneered crowns with 1 to 3 years of follow-up, the relative risk (RR) of fracture in relation to loss or retention was 3.95 (95% CI 1.18-13.23; p = 0.03). For 4 to 6 years of follow-up, the RR was 5.44 (95% CI 1.41-20.92; p = 0.01). For veneered FPDs with 1 to 3 years of follow-up, the RR was 5.98 (95% CI 2.31-15.01; p = 0.0002). For 4 to 6 years of follow-up, the RR was 3.70 (95% CI 1.63-8.41; p = 0.002). For 7 years or more of follow-up, the RR was 3.45 (95% CI 1.84-6.46; p = 0.0001). When only framework fractures were considered, there were no significant differences for the RR in all follow-up periods (p > 0.05). CONCLUSIONS: Higher RR for fracture/chipping in relation to decementation for veneered zirconia crowns and FPDs at all follow-up times. For framework fractures, no difference was observed between the risk of failure of the restoration due to fracture or decementation. CLINICAL RELEVANCE: Zirconia crowns and FPDs showed relatively high success and survival rates. However, considering the technical failures, there is approximately four times higher chance of fracture/chipping than loss of retention for both single and multi-unit tooth-supported veneered zirconia restorations.

Effects of polyvinyl chloride film and oxygen-blocking gel on irradiance and depth of cure.

This study aimed to analyze the effects of polyvinyl chloride (PVC) film and oxygen-blocking gel (OBG) on the irradiance from an LED source and the depth of cure of a composite resin. Irradiance was measured with a curing radiometer, and curing depth was evaluated according to the methods described by the International Organization for Standardization (ISO 4049). Twelve experimental conditions were investigated in a 3 × 4 factorial design (n = 5 specimens per condition): no PVC film at the tip of the device, fitted PVC film, or misfit PVC film; and no OBG or a 1-, 2-, or 3-mm-thick layer of OBG. The data were analyzed using analysis of variance and Tukey tests (P < 0.05), and a linear regression test was performed between the variables (P < 0.05). The analyses showed that the variables under study influenced the irradiance (P < 0.05) but not the curing depth (P > 0.05). The 3 groups that did not have the PVC film and either did not have the OBG or had the OBG in a thickness of 1 or 2 mm were not significantly different from each other (P > 0.05) but presented the highest irradiance values among all the groups (P < 0.05). The use of the misfit PVC film with a 3-mm layer of OBG led to the lowest irradiance values (P < 0.05). The variables did not influence each other (P > 0.05). The results of this study indicated that the presence of PVC film, especially misfit film, reduced the irradiance. In addition, the greater the thickness of the OBG, the lower the irradiance. None of the PVC film barrier conditions or OBG thicknesses had an effect on the depth of cure.

Effect of processing methods on the chipping resistance of veneered zirconia.

OBJECTIVES: To evaluate the edge chipping resistance (ReA) and the fracture toughness (KC) of 3Y-TZP bilayers produced with the following materials/processing combinations: fluorapatite glass-ceramic applied on zirconia using the traditional layering and hot-pressing (press-on) techniques; feldspathic porcelain using rapid layer technology (RLT); and lithium disilicate glass-ceramic using CAD-on method. The influence of the cooling rate (slow and fast) was analyzed for layering and hot-pressing. METHODS: Bilayer bars (25x4x2 mm) were made following manufacturers' instructions. The edge chipping test was performed in an universal testing machine, using a coupled Vickers indenter. ReA was calculated dividing the critical load at fracture by the edge distance. Fracture toughness was calculated by a regression fit with a fixed slope of 1.5 correlating the critical chipping load regarding edge distance and also with indentation fracture (IF) method. Data were statistically analyzed using ANOVA and Tukey's test (α = 5%). RESULTS: ReA and KC was significantly higher for the CAD-on bilayers. RLT showed intermediate ReA means, and layering and hot-pressing techniques showed the lowest ReA values. For both processing methods there was no effect of the cooling protocol on the ReA and fracture toughness. CONCLUSIONS: There is a significant effect of the material/processing association on the edge chipping resistance and fracture toughness of the bilayers. There was no effect of the cooling protocol on the edge chipping resistance and fracture toughness for the specimens processed by both the layering and hot-pressing techniques.

Influence of different combinations of CAD-CAM crown and customized abutment materials on the force absorption capacity in implant supported restorations - In vitro study.

OBJECTIVES: To evaluate the force absorption capacity of implant supported restorations utilizing different CAD-CAM materials for the fabrication of crowns and customized abutments. METHODS: 80 titanium inserts were scanned to design customized abutments and crowns. The specimens were divided into four groups (n = 20/material): (Z): zirconia, (P): PEEK, (V): VITA Enamic, and (E): IPS e.max. Each group was subdivided into two subgroups according to customized abutment material: (Z) zirconia, and (P) for PEEK. For the assessment of force absorption, all specimens were loaded in a universal testing machine, applied loads curves were collected from the machine's software, and resulting loads curves were collected from forcemeter below the assembly. The slopes of all curves were analyzed using Two-way multivariate analysis of variance with pairwise comparisons using Tukey Post Hoc test (p < 0.05). RESULTS: The curve progression of the applied and resulting forces varied among the investigated materials for each specimen. For zirconia abutments, ZZ showed the highest slope values of the applied and resulting force curves, followed by EZ, VZ, and PZ demonstrating statistically significant differences (P < .001). As for PEEK abutments, ZP and EP showed the least slope values, followed by PP then VP demonstrating statistically significant differences (P < .001). For Zirconia and e.max crowns, using PEEK abutments significantly increased slope loss. As for PEEK and Vita Enamic crowns changing abutment material did not significantly affect slope loss. SIGNIFICANCE: Combining rigid crown materials with less rigid abutments might enhance their force absorption capacity. However, with less rigid crown materials a stiff substructure might be mandatory to preserve their force absorption behavior.

Effect of silica coating and laser treatment on the flexural strength, surface characteristics, and bond strength of a dental zirconia.

This study investigated the effect of irradiation with an erbium-doped yttrium aluminium garnet (Er:YAG) laser and coating with silica on the surface characteristics, bond strength, and flexural strength of dental zirconia. Three hundred and forty-three standard zirconia specimens were created, and 49 were assigned to each of seven surface treatment groups: (i) no treatment; Er:YAG laser (80 mJ/2 Hz) with pulse widths of 50 µs (ii), 100 µs (iii), 300 µs (iv), or 600 µs (v); or tribochemical silica coating at the partially sintered stage (vi) or after sintering was complete (vii). All specimens were sintered after the surface treatments, except for the group in which specimens were sintered before treatment. The study outcomes were roughness, surface loss, microshear bond strength (µSBS), and biaxial flexural strength (BFS). Mean roughness and surface loss values were significantly higher in specimens from irradiated groups than in those from silica-coated groups. Regarding µSBS, after aging, specimens from all experimental groups presented very low and similar µSBS values, irrespective of the surface treatment. Silica coating after sintering yielded the highest BFS (1149.5 ± 167.6 MPa), while coating partially sintered specimens with silica resulted a BFS (826.9 ± 60.9 MPa) similar to that of the untreated control group (794.9 ± 101.7 MPa). Laser treatments, irrespective of pulse width used, significantly decreased the BFS. In the group treated with laser at 300 µs pulse width, specimens exhibited the lowest BFS value (514.1 ± 71.5 MPa). Adhesion to zirconia was not stable after aging, regardless of the surface treatment implemented.

Influence of Er:YAG laser surface treatment on flexural and bond strengths to glass-infiltrated zirconia-reinforced ceramic.

To evaluate the effect of Er:YAG laser conditioning of a glass-infiltrated alumina-based zirconia-reinforced ceramic on its flexural strength and on bonding to a resin cement. Sixteen blocks (5 × 5 × 4 mm) and 50 discs (Ø 12 mm, 1 mm thickness) of In-Ceram Zirconia (ICZ) obtained from CAD-CAM blocks were infiltrated with glass. For the microtensile bond strength (µTBS) test, all blocks were treated with aluminum oxide (AOX) and divided into 4 groups (n = 4): G1 (AOX), no combined surface treatment; G2 (ROC), tribochemical silica-coating; G3 (EY200), Er:YAG laser 200 mJ/15 Hz; and G4 (EY250), Er:YAG laser 250 mJ/10 Hz. The ceramic blocks were silanated and cemented with a resin cement (Panavia F2.0/Kuraray) to composite resin blocks and subjected to the µTBS test. For the flexural strength evaluation, the discs were divided into 5 groups (n = 10) as described above, in addition to a control group (G5 - CTRL, mirror-polished without further treatment). Each surface treatment was submitted to qualitative evaluation under SEM. One-way ANOVA (α = 5%) revealed the highest bond strength value for EY200 with no significant difference from ROC. The groups AOX and EY250 showed similar µTBS values that were statistically lower than those of EY200. For flexural strength, ROC was the only group with significantly lower values when compared with the CTRL. The use of Er:YAG laser at 200 mJ/15 Hz can be considered an innovative and effective alternative for surface conditioning of ICZ since it did not reduce the flexural strength of the ceramic and improved the resin cement bond to this substrate.

Effect of titania addition and sintering temperature on the microstructure, optical, mechanical and biological properties of the Y-TZP/TiO2 composite.

OBJECTIVE: The aims of this study were: 1) to evaluate the effect of sintering temperature on microstructure, density and flexural strength of a 3Y-TZP/TiO2 composite containing 12.5 wt% of TiO2 compared to 3Y-TZP specimens (control); 2) to compare 3Y-TZP with the experimental 3Y-TZP/TiO2 composite, both sintered at 1400 °C, with respect to the following parameters: optical properties, characteristic strength, Weibull modulus, fatigue behavior, induction of osteoblasts proliferation and differentiation (mineralization nodules formation). METHODS: The 3Y-TZP and 3Y-TZP/TiO2 powders were uniaxially pressed and sintered at 1200 °C, 1300 °C, 1400 °C or 1500 °C for one hour in a furnace. The microstructural analysis consisted of X-ray diffraction and scanning electron microscopy. The density was measured by the Archimedes' principle and the flexural strength was obtained by the biaxial flexure test. The optical properties were measured using a spectrophotometer operating in the visible light wavelength range. The step-stress accelerated life testing was performed by the pneumatic mechanical cycler and the biological behavior achieved by using osteoblast-like cells (Osteo-1 cell line). RESULTS: Tetragonal zirconia was identified in all groups and cubic zirconia was identified only at 3Y-TZP group. The addition of TiO2 decreased the values of density and flexural strength of the composite 3Y-TZP/TiO2 in relation to 3Y-TZP regardless of the sintering temperature. The color difference between the two materials was not significant regarding L*a*b* parameters. The composite showed higher probability of failure, and induced higher proliferation and differentiation than control. SIGNIFICANCE: The composite developed have good aesthetic and biologics properties. However, its microstructure and mechanical properties need to be improved for future dental implant applications.

Effect of erosive and abrasive challenges on the glaze layer applied to ceramic materials.

PURPOSE: This study aims to evaluate the effect of erosive, abrasive, and erosive/abrasive challenges on the glaze layer of ceramic materials. METHODS: Ninety-five samples of monolithic zirconia (MZ) (LuxaCam Zircon HT-Plus) and lithium disilicate (LD) (IPS e.max CAD) were divided according to the response variables: Surface roughness and surface loss (n = 10), evaluated with optical profilometry; surface topography, with scanning electron microscopy SEM (n = 3); and biofilm deposition, with microbiological assay (n = 5). The evaluations were performed in three different time evaluations: (a) Sintered, (b) Glaze, and (c) Challenge (Erosion, Abrasion, and Erosion/Abrasion). Erosion consisted in immersing specimens in HCl solution, abrasion was performed with brushing machine, and erosion/abrasion consisted of a combination of the two previous protocols. Data were analyzed with parametric tests (P < 0.05). RESULTS: MZ glaze layer presented significantly higher surface roughness (P = 0.00), surface loss (P = 0.03), and biofilm deposition (P = 0.00) than LD. Abrasion and erosion/abrasion showed similar outcomes, generating significantly higher surface roughness (P = 0.00), surface loss (P = 0.00), and biofilm deposition (P = 0.01) than erosion. CONCLUSIONS: Glaze layer properties were altered by the challenges, with abrasion and erosion/abrasion generating higher surface roughness, surface loss, and biofilm deposition than erosion. A significant correlation was found between the surface roughness and biofilm deposition. CLINICAL SIGNIFICANCE: The glaze layer is susceptible to challenges, especially to abrasion and erosion/abrasion, which generated greater surface roughness and surface loss than erosion. The greater surface roughness lead to a greater biofilm deposition on the glaze layer.

Evaluation of the Surface Roughness and Accelerated Aging of CAD/CAM Materials.

PURPOSE: To compare the influence of surface roughness and accelerated aging on the mechanical properties of polymer-based and ceramic CAD/CAM materials. MATERIALS AND METHODS: Three polymers (Lava Ultimate [LVU], VITA ENAMIC [ENA], and Shofu Block HC [SFB]) and one ceramic (IPS Empress CAD [EMP]) were selected for this study. The specimens were treated with the aim of measuring surface roughness (Ra [mm]) and its influence on the mechanical properties. The treatments were: polishing (POL); etching with 9.6% hydrofluoric acid for 90 seconds (ETC); airborne-particle abrasion with 50-µm aluminum oxide at 2-bar pressure (SBT); and airborne-particle abrasion with 50-µm aluminum oxide at 2-bar pressure plus etching with 9.6% hydrofluoric acid (SAC) for 90 seconds. Before and after the accelerated aging (AA) protocol (30,000 cycles, 5°C and 55°C), the specimens were subjected to the 3-point bending test. The data were analyzed with two-way and three-way ANOVA and post hoc Tukey test (P < .05). RESULTS: The surface roughness ranged from 0.24 µm to 1.96 µm, with statistically significant differences (P < .05). The highest surface roughness, in descending order, was exhibited by: LVU > SFB > EMP > ENA. The AA demonstrated an influence on the flexural strength of LVU, ENA, and SFB. The surface treatment did not affect the flexural moduli of the materials tested. The LVU and SFB showed decreased moduli of resilience after the AA; however, modulus of resilience was not influenced by surface treatment. CONCLUSION: The polymer-based materials were affected by AA. In addition, surface treatment could jeopardize their mechanical properties in certain conditions.

Aging resistant ZTA composite for dental applications: Microstructural, optical and mechanical characterization.

OBJECTIVE: To synthesize a zirconia toughened alumina (ZTA) composite with 70% alumina reinforced by 30% zirconia for dental applications and to characterize its microstructure and optical properties for comparison with the isolated counterpart materials and a first-generation 3Y-TZP. METHODS: Disc-shaped specimens were divided in four groups (n = 70/material): (1) 3YSB-E (first generation 3Y-TZP), (2) Zpex (second generation 3Y-TZP), (3) alumina, and (4) ZTA-Zpex 70/30. After synthesis, ceramic powders were pressed, and green-body samples sintered following a predetermined protocol. Specimens were polished to obtain a mirror surface finish. Apparent density was measured by Archimedes principle. X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to characterize the crystalline content and microstructure. Reflectance tests were performed to determine the contrast-ratio (CR) and translucency-parameter (TP). Mechanical properties were assessed by biaxial flexural strength (BFS) test. All analyses were conducted before and after artificial aging (20 h, 134 °C, 2.2 bar). Optical parameters were evaluated through repeated-measures analysis of variance and Tukey tests (p < 0.05). BFS data were analyzed using Weibull statistics (95% CI). RESULTS: High density values (95-99%) were found for all ceramic materials and SEM images exhibited a dense microstructure. While XRD patterns revealed the preservation of crystalline content in the ZTA composite, an increase in the monoclinic peak was observed for pure zirconias after aging. Significantly higher CR and lower TP values were observed for the ZTA composite, followed by alumina, 3YSB-E, and Zpex. The highest characteristic stress was recorded for 3YSB-E, followed by intermediate values between ZTA and Zpex, and the lowest for alumina. Aging affected the optical and mechanical properties of both zirconias, while remained stable for ZTA composite and alumina. SIGNIFICANCE: The synthesis of experimental 70-30% ZTA composite was successful and its relevance for dental applications relies on its higher masking ability, aging resistance, and strength similar to zirconia.

Structural, chemical and optical characterizations of an experimental SiO2-Y-TZP ceramic produced by the uniaxial/isostatic pressing technique.

This study aimed to produce a new SiO2+Y-TZP ceramic via uniaxial/isostatic compression that was structurally and chemically characterized relating to its translucency and flexural strength. SiO2 and Y-TZP were mixed using a ball mill, pressed and sintered at 1150 °C. The optical and mechanical properties of the specimens were compared to lithium disilicate (LD) and zirconia-reinforced lithium silicate (ZLS) (Kruskal-Wallis, α = 0.05). The Fourier Transform Infrared Spectroscopy bands suggested an interaction between Si, O and Zr. Contrast ratio and translucency parameter of the experimental ceramic were higher and lower, (p = 0.000001) respectively, than those of the LD and ZLS. The experimental ceramic presented similar flexural strength to ZLS, but lower than LD (p < 0.0001). It can be concluded that this processing method is efficient to obtain a SiO2+Y-TZP ceramic and 1150 °C crystallizes SiO2 without inducing t-m transformation. The SiO2+Y-TZP ceramic presented lower translucency and higher masking ability than the commercially available glass-ceramics, but similar flexural strength to one glass-ceramics.

Effect of repeated firings and staining on the mechanical behavior and composition of lithium disilicate.

OBJECTIVE: To evaluate the composition, flexural strength and fatigue behaviour of lithium disilicate ceramic (LD) after repeated firings and different staining techniques. METHODS: LD discs were fabricated and divided according to number of firing cycles and staining technique: CO - control, discs were crystallized (850°C/10min); SC - single-step characterization - crystallization and staining (applied with a thin brush) were performed in a single step with one firing cycle (850°C/10min); and DC - double-step characterization - crystallization firing cycle was performed first (850°C/10min), followed by staining firing cycle (770°C/90s). Specimens were fired two, four or six times (one crystallization firing cycle and one, three or five staining firing cycles), resulting into 9 groups (n=30): COII, COIV, COVI, SCII, SCIV, SCVI, DCII, DCIV and DCVI. The composition of the specimens was investigated (EDS, XRD, Raman spectroscopy), and the biaxial flexural strength (n=10) and staircase tests (n=20, 5×104 cycles, 5Hz) were performed. Data were subjected to one-way ANOVA and Tukey's test (α=0.05). RESULTS: EDS and XRD revealed amorphous content for stained groups. Biaxial flexural strength was not affected by repeated firings in any group, but stained groups presented lower flexural strength than control groups (p=0.001). The fatigue limit results decreased in all groups compared to flexural strength. SC groups showed similar (SCII and SCIV) or even higher fatigue limits (SCVI) than the control groups, and DC showed the lowest fatigue limit values. SEM and Raman suggested that the interfaces between staining and the LD showed only an overlap for the DC groups, whereas for the SC it was suggested an interaction between the stain and the LD. SIGNIFICANCE: Repeated firings did not result in decreased lithium disilicate flexural strength.Staining affected flexural strength and also resulted in increased amorphous content in the characterized specimens. Single-step staining resulted in the highest fatigue limit.

Comparison of endocrowns made of lithium disilicate glass-ceramic or polymer-infiltrated ceramic networks and direct composite resin restorations: fatigue performance and stress distribution.

This study compared the fatigue performance and the stress distribution of endodontically treated molars restored with endocrowns obtained with lithium disilicate glass-ceramic or a polymer-infiltrated ceramic network, both processed by CAD-CAM, and direct composite restorations. Forty-eight human mandibular molars were randomly assigned into 03 groups (n = 16) and restored with endocrowns (LD - lithium disilicate glass-ceramic or PICN - polymer-infiltrated ceramic network) or with direct composite restorations. Fatigue testing followed a step-stress approach (initial maximum load of 200 N and 5000 cycles, incremental step load of 200N and 10,000 cycles/step, being the specimens loaded until failure or to a maximum of 135,000 cycles at 2800 N). The fatigue failure load and number of cycles until failure were recorded and statistically analyzed. Fractographic and finite element (FEA) analyzes were conducted as well. There were no differences in fatigue failure load, number of cycles until fracture and mean survival probabilities among groups. However, indirect endocrowns had higher mechanical structural reliability, and LD restorations lasted more time before start to failing. FEA showed that the stress concentration in tooth tissues was higher for the resin composite, followed by PICN and LD in a decreasing order. Almost all fractures were restricted to the restorative material (without tooth involvement), and origins were identified at occlusal surface. The type of restoration did not influence the fatigue failure load, number of cycles until fracture and mean survival probabilities of the restorative strategies. Despite that, the mechanical structural reliability of endocrowns, especially those made of lithium disilicate, was higher and lasted more time before start to failing.