Influence of microstructure on optical properties of CAD-CAM lithium disilicate glass-ceramics.

OBJECTIVES: To evaluate the influence of microstructure and chemical composition on the optical properties of CAD-CAM lithium disilicate glass-ceramics. METHODS: Samples (n = 5; 1.0 mm thickness) of shades A1, A2, and A3 were fabricated from CAD-CAM ceramic blocks (Ivoclar Vivadent): IPS e.max® CAD LT (emLT) and HT (emHT). Samples were polished to 1.0 ± 0.01 mm in thickness. The optical properties (R- reflectance; T- transmittance; µs'- reduced scattering and µa- absorption coefficients) from the post-crystallized samples were determined using the inverse adding-doubling (IAD) method based on integrating-sphere measurements. Additionally, scanning electron microscopy (SEM) and X-ray diffraction (XRD) techniques were used to evaluate the microstructural properties. Energy-dispersive X-ray (EDX) was employed to analyze the chemical composition. The chemical and structural characterization were performed before and after crystallization of the ceramic samples. RESULTS: emLT showed higher values of µs'and lower values of µa and T than emHT for each shade in all wavelengths (p < 0.003). Considering T for emHT, there were no statistical differences for shades A1 and A2 at 488 nm and 514.5 nm (p > 0.003) and shades A1 and A3 at 457.9 nm (p > 0.003). emLT showed particle length ranging from 0.74 to 2.78 µm (mean = 1.57 µm and RF-relative frequency = 28 %) and particle width ranging from 0.21 to 0.74 µm (mean = 0.30 µm and RF = 31 %). emHT showed particle length ranging from 0.83 to 3.08 µm (mean = 1.86 µm and RF = 21 %) and particle width ranging from 0.24 to 1.12 µm (mean = 0.56 µm and RF = 28 %). In comparison with emHT, emLT showed greater vol% for C, K, and Zr and lower vol% for O and Al. SIGNIFICANCE: The optical properties of CAD-CAM lithium disilicate glass-ceramics are influenced by the chemical composition and, consequently, by the material microstructure.

Introducing a novel approach to dental color reproduction using AI technology.

OBJECTIVE: This article aims to describe a systematic method for tooth color reproduction with ceramics restorations employing artificial intelligence (AI) software named Matisse. It provides a comprehensive analysis of the entire process, beginning with shade-taking and extending to ceramic application in a complex clinical case in the anterior region-specifically, a single central restoration supported by an implant. CLINICAL CONSIDERATIONS: The clinical case presented highlights the potential of Matisse software for generating ceramic (inSync-Jensen Dental, USA) and staining (Miyo-Jensen Dental, USA) recipes over a zirconia abutment (Katana-Noritake Dental, Japan). This approach achieves an optimal single central restoration utilizing CAD-CAM and layering techniques. CONCLUSIONS: The systematic method employing the Matisse software achieved accurate color reproduction for a single central restoration supported by an implant. This result was achieved by the dental ceramist within the first attempt and without seeing the patient in the entire process. CLINICAL SIGNIFICANCE: The Matisse AI-assisted protocol offers a systematic and scientifically grounded method for color reproduction in dentistry for indirect restorations.

Assessment of color stability and translucency of various CAD/CAM ceramics of different compositions and Thicknesses: An in vitro study.

Background: Translucency and optical characteristics significantly affect the aesthetics of ceramic restorations. The introduction of new virgilite crystals to novel ceramic advanced lithium disilicate through a matrix firing process enhances the material's strength and aesthetic quality according to the manufacturer. Materials and Methods: Four types of CAD/CAM ceramics; lithium disilicate (LD), leucite reinforced (LR), advanced lithium disilicate (ALD), and zirconia-reinforced lithium silicate (ZLS) exposed to different staining solutions (tea, cola, coffee, and distilled water). Each ceramic type had 120 specimens, divided into subgroups based on thickness (0.5 mm, 1 mm, and 1.5 mm). Color changes (ΔE00) and translucency parameters (TP00) were measured after thermocycling, and spectrophotometry was employed to evaluate ΔE00 and TP00 after 1, 7, and 30 days of exposure to the staining solutions. Results: ZLS exhibited the lowest color stability, while lithium LD and ALD displayed the highest. Thickness significantly affected color stability, with 0.5 mm thickness showing the least change. The duration of exposure also impacted color changes, with 30 days causing the most significant shift. LD demonstrated the highest translucency. Coffee and tea induced more pronounced reductions in translucency and color stability compared to the control group. Conclusions: Material structure, thickness, staining solution, and exposure duration significantly influenced the color stability and translucency of CAD/CAM ceramics, with LD and ALD demonstrating superior color stability and LD exhibiting the highest translucency.

Zirconia toughened fluorosilicate glass-ceramics for dental prosthetic restorations.

Background: Dental glass-ceramics have limited strength and are unsuitable for high-stress-bearing areas. Zirconia stands out as a popular choice for reinforcing dental glass-ceramics due to its biocompatibility and high fracture toughness. Objectives: The objective of the study is to investigate the effect of an increase in zirconia (25, 30, 35 and 50 wt%) on microstructure, chemical solubility, hardness, fracture toughness, and brittleness index of fluorosilicate glass systems for dental restorative applications. Material and methods: The fluorosilicate glass frit was obtained through the melt-quench technique. The glass frit was ball-milled with 25, 30, 35 and 50 wt % of 3 mol% yttria-stabilized zirconia (G-25Z, G-30Z, G-35Z, and G-50Z). The composites were sintered to 1000 °C for 48h at a heating rate of 5 °C/min. The glass frit was subject to differential scanning calorimetry. Phase analysis and microstructural characterization were carried out. The crystallite size of zirconia and glass-ceramics, micro-hardness, indentation fracture toughness, brittleness index, and chemical solubility were evaluated. Results: Phase analysis reveals tetragonal and monoclinic zirconia with minor peaks of forsterite, fluorphlogopite, norbergite, and spinel. Their microstructures reveal the characteristic house-of-cards arrangement of fluorophlogopite crystals with dispersed zirconia. The results of hardness and fracture toughness show a statistically significant improvement with an increase in zirconia content. The crystallite size of zirconia and fluorophlogopite crystals with aspect ratio, brittleness index, and chemical solubility declined as the zirconia content increased. Conclusions: Increase in zirconia content from 25 wt % to 50 wt % in heat-treated fluorosilicate glass systems reveals non-reactive zirconia with a stable glass matrix and limits the growth of fluorphlogopite crystals with a house-of-cards microstructure. This results in a range of properties suitable for dental restorations of enhanced hardness, and improved fracture toughness. Despite these improvements, the material maintains its machinability with reduced chemical solubility.

Effect of glazing and thermocycling on the fracture toughness and hardness of a New fully crystallized aluminosilicate CAD/CAM ceramic material.

BACKGROUND: The mechanical properties of fully crystallized lithium aluminosilicate ceramics may be influenced by intraoral temperature variations and postmilling surface treatment. The purpose of this study is to explore the interplay among glazing, thermocycling, and the mechanical characteristics (namely, fracture toughness and hardness) of fully crystallized lithium aluminosilicate ceramics. METHODS: Bending bars (n = 40) cut from LisiCAD blocks (GC, Japan) were randomly assigned to glazed or unglazed groups (n = 20) and subjected to the single edge v-notch beam method to create notches. A glazing firing cycle was applied to the glazed group, while the unglazed group was not subjected to glazing. Half of the specimens (n = 10) from both groups underwent thermocycling before fracture toughness testing. The fracture toughness (KIC) was evaluated at 23 ± 1 °C using a universal testing machine configured for three-point bending, and the crack length was measured via light microscopy. Seven specimens per group were selected for the hardness test. Hardness was assessed using a Vickers microhardness tester with a 1 kg load for 20 s, and each specimen underwent five indentations following ISO 14705:2016. The Shapiro-Wilk and Kolmogorov-Smirnov tests were used to evaluate the normality of the data and a two-way ANOVA was utilized for statistical analysis. The significance level was set at (α = 0.05). RESULTS: Regardless of the thermocycling conditions, the glazed specimens exhibited significantly greater fracture toughness than did their unglazed counterparts (P < 0.001). Thermocycling had no significant impact on the fracture toughness of either the glazed or unglazed specimens. Furthermore, statistical analysis revealed no significant effects on hardness with thermocycling in either group, and glazing alone did not substantially affect hardness. CONCLUSIONS: The impact of glazing on the fracture toughness of LiSiCAD restorations is noteworthy, but it has no significant influence on their hardness. Furthermore, within the parameters of this study, thermocycling was found to exert negligible effects on both fracture toughness and hardness.

How do different intraoral scanners and milling machines affect the fit and fatigue behavior of lithium disilicate and resin composite endocrowns?

The aim of this in vitro study was to evaluate the effect of the combinations of two different intraoral scanners (IOS), two milling machines, and two restorative materials on the marginal/internal fit and fatigue behavior of endocrowns produced by CAD-CAM. Eight groups (n= 10) were considered through the combination of TRIOS 3 (TR) or Primescan (PS) IOS; 4-axes (CR; CEREC MC XL) or 5-axes (PM; PrograMill PM7) milling machines; and lithium disilicate (LD; IPS e.max CAD) or resin composite (RC; Tetric CAD) restorative materials. Specific surface treatments were applied to each material, and the bonding to its corresponding Endocrown-shaped fiberglass-reinforced epoxy resin preparations was performed (Variolink Esthetic DC). Computed microtomography (µCT) was performed to assess the marginal/internal fit, as well as a mechanical fatigue test (20 Hz, initial load = 100 N/5000 cycles; step-size = 50 N/10,000 cycles until a threshold of 1500 N, then, the step-size was increased if needed to 100 N/10,000 cycles until failure or a threshold of 2800 N) to evaluate the restorations long-term behavior. Complementary analysis of the fracture features and surface topography in scanning electron microscopy was performed. Three-way ANOVA and Kaplan-Meier test (α = 0.05) were performed for marginal/internal fit, and fatigue behavior data, respectively. PS scanner, CR milling machine, and RC endocrowns resulted in a better marginal fit compared to their counterparts. Still, the PM machine resulted in a better pulpal space fit compared to the CR milling machine. Regardless of the scanner and milling machine, RC endocrowns exhibited superior fatigue behavior than LD ones. LD endocrowns presented margin chipping regardless of the milling machine used. Despite minor differences in terms of fit, the 'IOS' and 'milling machine' factors did not impair the fatigue behavior of endocrowns. Resin-composite restorations resulted in a higher survival rate compared to glass-ceramic ones, independently of the digital devices used in the workflow.

Methodological approaches in graded dental ceramics.

BACKGROUND: Functionally graded materials (FGM) with indistinct boundaries potentially eliminate the damaging stresses occurring at the interfaces. FGM applications in dental ceramics have enhanced their fatigue resistance and interfacial toughness. OBJECTIVES: This scoping review aims to map graded designs in dental ceramics, distinguish their methodological approaches with their material characteristics and properties, and understand the factors affecting the outcomes of each of the graded approaches. METHODS: A systematic electronic search was performed with the databases MEDLINE (PubMed), Scopus, Cochrane Library, EBSCO, and Google Scholar along with a manual search. RESULTS: About 2675 articles were initially found from all the searches with no date restriction till July 2023. After rejecting duplicates and based on exclusion criteria, about 52 articles were included. SIGNIFICANCE: Methodological approaches in grading such as glass-infiltration and silica-infiltration have been investigated on pre-sintered zirconia. The type of infiltration and the method of infiltrate application significantly influenced the phase transformation of zirconia, its microstructure, surface hardness, fracture toughness, flexural strength, wear, and fatigue strength of graded dental zirconia. Interlayers were accommodated between metal-ceramic and veneer-core all-ceramic layers. Fractions of zirconia-porcelain and alumina-porcelain showed high bending strength and better stress distribution. The results of finite element analysis studies predicted that using 10-layered graded layers reduced the stresses at the crown-cement-dentin interface.

A Clinician's Perspective on the Accuracy of the Shade Determination of Dental Ceramics-A Systematic Review.

BACKGROUND: No systematic review or meta-analysis has been identified that provides a clinician's perspective on the shade selection process for ceramic restorations. The aim of the present systematic review is to find and systematize the available knowledge by referring to the methods to assess the color of dental ceramics. METHODS: The final search was performed on 10 December 2023 in six search engines. The keywords used in the search strategy were as follows: ("color matching" OR "shade matching" OR "color measurement" AND "porcelain" OR "dental ceramics") AND "dentistry" AND "accuracy". RESULTS: The search strategy identified 139 potential articles. After the screening process, sixteen articles were included in the review. CONCLUSIONS: In conclusion, the most common method, the visual method, has lower accuracy and repeatability. Devices like spectrophotometers and colorimeters provide precise, repeatable, and objective measurements, but fail to be widely applied in everyday clinical practice. Clinicians should not rely solely on their senses for shade determination, but should turn to quantitative methods. Colorimetric devices connected to mobile applications are an interesting and useful tool. Software and apps based on artificial intelligence are emerging as promising tools, but they require further research.

The Surface Roughness of Contemporary Indirect CAD/CAM Restorative Materials That Are Glazed and Chair-Side-Finished/Polished.

The surface roughness (Ra) of indirect computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated dental restorations is crucial for their long-term durability. This study intended to evaluate the Ra of five different types of contemporary indirect CAD/CAM restorative materials with varying compositions that were glazed and finished/polished. A total of 75 specimens, disc-shaped (10 mm × 2 mm), were obtained from five materials (n = 15) (Tetric CAD, IPS e.max CAD, IPS e.max ZirCAD, CELTRA Duo, and Vita Enamic) and fabricated by CAD/CAM. One of the two surfaces for each specimen was subjected to glazing, while the other surface was subjected to finishing/polishing. The Ra of the two surfaces in micrometers (µm) was evaluated using a Profilometer, while the surface topography was examined using a scanning electron microscope. Using SPSS, the Kruskal-Wallis, post hoc Conover, and Mann-Whitney tests were used to statistically evaluate the data. A comparison of the Ra for the finished/polished surfaces of the five test materials showed significant differences (p < 0.0001). Among the finished/polished surfaces, the mean rank values of Vita Enamic were significantly higher than the other four test materials (p < 0.0001). A comparison of the Ra of glazed surfaces among the five study materials revealed significant differences (p < 0.0001). The Ra for the IPS e.max ZirCAD material was significantly higher than the rest of the four materials (p < 0.001). A comparison of the Ra for two types of surface conditioning within each of the five test materials showed a significant difference (p < 0.05). Only for IPS e.max ZirCAD was the Ra of the glazed surface significantly higher than the finished/polished surface (p < 0.0001). Significant variations in the surface roughness (Ra) were exhibited between the finished/polished and glazed surfaces of the five test materials. Hybrid ceramics showed the highest Ra values for the finished/polished surfaces, and zirconia exhibited the highest Ra values among the glazed surfaces among the tested materials. The Ra values of either finished/polished or glazed surfaces of the test materials were within the clinically acceptable range (0.2-0.5 µm), except for the glazed surface of the zirconia ceramics (0.84 µm).

Additive manufacturing of dental ceramics in prosthodontics: The status quo and the future.

PURPOSE: This review aims to summarize the available technologies, material categories, and prosthodontic applications of additive manufacturing (AM) dental ceramics, evaluate the achievable accuracy and mechanical properties in comparison with current mainstream computer-aided design/computer-aided manufacturing (CAD/CAM) subtractive manufacturing (SM) methods, and discuss future prospects and directions. STUDY SELECTION: This paper is based on the latest reviews, state-of-the-art research, and existing ISO standards on AM technologies and prosthodontic applications of dental ceramics. PubMed, Web of Science, and ScienceDirect were amongst the sources searched for narrative reviews. RESULTS: Relatively few AM technologies are available and their applications are limited to crowns and fixed partial dentures. Although the accuracy and strength of AM dental ceramics are comparable to those of SM, they have the limitations of relatively inferior curved surface accuracy and low strength reliability. Furthermore, functionally graded additive manufacturing (FGAM), a potential direction for AM, enables the realization of biomimetic structures, such as natural teeth; however, specific studies are currently lacking. CONCLUSIONS: AM dental ceramics are not sufficiently developed for large-scale clinical applications. However, with additional research, it may be possible for AM to replace SM as the mainstream manufacturing technology for ceramic restorations.

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.

Conventional-, bulk-fill- or flowable-resin composites as prosthetic core build-up: Influence on the load-bearing capacity under fatigue of bonded leucite-reinforced glass-ceramic.

This study aimed to evaluate the fatigue performance of simplified ceramic restorations (leucite-reinforced glass ceramic) adhesively cemented onto substrates of different resin composites. Three options from the same commercial line were selected (Tetric N-Line, Ivoclar), classified as Conventional (CRC), Bulk-fill (BRC) and Flowable (FRC), which were used to make discs using a cylindrical metallic device (n = 19; Ø = 10 mm, thickness = 2.0 mm). A total of 57 discs (Ø = 10 mm, thickness = 1.0 mm) were made from CAD/CAM prefabricated blocks of a leucite reinforced glass-ceramic (Empress CAD, Ivoclar) to simulate a monolithic restoration, then were randomly distributed to be bonded on 19 discs of each three different resin composite substrates (CRC; BRC; or FRC) with a dual resin cement (Multilink N; Ivoclar). The samples were subjected to a compression test with a hemispherical stainless-steel piston (Ø = 40 mm) at a monotonic regimen (n = 4; 1 mm/min loading rate and 500 kgf loading cell until fracture). The cyclic fatigue test was performed underwater at a frequency of 20 Hz (n = 15). The first step was applied using 200N for 5000 cycles, followed by increments of 50N at each step of 10,000 until failure. The outcome considered for both tests was the occurrence of radial crack. Specific statistical tests (α = 0.05) were performed for monotonic (One-way ANOVA; Tukey's test) and fatigue data (Kaplan-Meier test; Log-rank test). Fractography of fractured samples were also performed. The FRC group had the lowest failure load in both test regimes (p < 0.05; monotonic: 726.64N; fatigue: 716.67N). There were no differences between the CRC and BRC groups (p > 0.05; monotonic: 989.30 and 990.11N; fatigue: 810.00 and 833.33N, respectively). The same result was obtained considering cycles for fatigue failure (FRC < CRC=BRC). Leucite glass-ceramic bonded to substrates made of flowable resin composite behaves worse mechanically than bonding to conventional or bulk-fill resin composite substrates.

Impact of try-in paste removal on the fatigue behavior of bonded lithium disilicate ceramics.

This in vitro study assessed the effectiveness of three cleaning protocols (air-water spray, 37% phosphoric acid, or Ivoclean) on lithium disilicate restorations' fatigue behavior after try-in paste application, compared to a clean condition. Lithium disilicate discs (IPS e.max CAD, Ivoclar) with Ø-= 12 mm and 1 mm thickness were prepared from prefabricated CAD-CAM blocks, polished, subjected to CAD-CAM milling topography simulation and crystallization. After, etching with 5% hydrofluoric acid and the application of try-in paste (Variolink try-in paste shade white; load of 2.5 N for 5 min) was performed. Discs that received try-in paste were divided into three groups according to the removal protocol: SPRAY - air-water spray for 30 s; HPO - active application of 37% phosphoric acid for 60 s; IVOC - application of Ivoclean for 20 s. Control group (CTRL group) did not receive the try-in paste application. Half of the specimens (n= 15) were tested in the baseline condition (24 h up to 7 days), and the others underwent 25,000 thermal cycles (5 - 55 °C) + 210 days of distilled water storage (37 °C). Additional specimens (n= 3) underwent monotonic testing (1 mm/min). Fatigue testing involved a cyclic fatigue approach (20 Hz, initial load = 100 N - 5000 cycles, step size = 50 N - 10,000 cycles) until a visible crack appeared. Fractographic and topographic analyses were performed. Fatigue data were statistically analyzed with two-way ANOVA, Kaplan-Meier log-rank (Mantel-Cox), and independent t-test (α= 0.05). In the baseline condition, the IVOC group resulted in a superior fatigue behavior compared to the CTRL and SPRAY groups, but similar to the HPO group. The HPO and SPRAY presented a similar fatigue behavior to the CTRL group. It was noticed a decrease in fatigue behavior after aging, which resulted in all the cleaning protocols leading to similar fatigue behavior compared to the CTRL group. On the SPRAY group surface, try-in pastes remnants were noticed. In summary, despite a detrimental impact at baseline conditions, all tested cleaning protocols seem proper to remove the try-in paste from the ceramic's surface in the long-term evaluation.

Fatigue behavior of multilayer ceramic structures in traditional and reverse layering designs.

PURPOSE: This study evaluated the fatigue failure load (FFL) and the number of cycles for fatigue failure (CFF) of traditional (porcelain layer up) and reversed (zirconia layer up) designs of porcelain-veneered zirconia samples prepared with heat-pressing or file-splitting techniques. MATERIALS AND METHODS: Zirconia discs were prepared and veneered with heat-pressed or machined feldspathic ceramic. The bilayer discs were bonded onto a dentin-analog according to the bilayer technique and sample design: traditional heat-pressing (T-HP), reversed heat-pressing (R-HP), traditional file-splitting with fusion ceramic (T-FC), reversed file-splitting with fusion ceramic R-FC), traditional file-splitting with resin cement (T-RC), and reversed file-splitting with resin cement (R-RC). The fatigue tests were performed using the stepwise approach at 20 Hz, 10,000 cycles/step, step-size of 200 N starting at 600 N, and proceeding until failure detection or up to 2600 N if enduring. The failure modes (from radial and/or cone cracks) were analyzed in a stereomicroscope. RESULTS: The reversed design decreased the FFL and CFF of bilayers prepared with heat-pressing and file-splitting with fusion ceramic. The T-HP and T-FC reached the highest results, which were statistically similar between them. The bilayers prepared by the file-splitting with resin cement (T-RC and R-RC) were similar to the R-FC and R-HP groups regarding FFL and CFF. Almost all reverse layering samples failed by radial cracks. CONCLUSIONS: The reverse layering design did not improve the fatigue behavior of porcelain veneered zirconia samples. The three bilayer techniques behaved similarly when used in the reversed design.

Borosilicate glass as a surface finishing alternative for improving the mechanical properties of third-generation zirconia.

OBJECTIVE: This study evaluated the effect of an experimental borosilicate glass on the mechanical and optical behavior of 5Y-PSZ zirconia and comparing it to commercial glaze and as-sintered. METHODS: Disc-shaped specimens of a 5Y-PSZ (Zpex Smile) were prepared and sintered (1550 °C, 2 h). The zirconia discs were randomly divided according to the surface treatment: as-sintered (C), commercial glaze (G), and experimental borosilicate glass (SL). Glaze and experimental glass powders were mixed with building liquids and applied to zirconia with a brush. G specimens were fired at 950 °C and SL at 1200 °C. An extended dwell time of 20 min was applied to both groups. Biaxial flexural strength, roughness (Ra and Rz), translucency (TP00), color alteration (ΔE00), Vickers hardness, fracture toughness, residual stresses, and x-ray diffraction analyses were conducted. Statistical analyses were performed with Weibull statistics, Kruskal-Wallis, or ANOVA tests (α = 5%). RESULTS: SL yielded the highest flexural strength (799.35 MPa), followed by G (662.34 MPa), and C (485.38 MPa). The fracture origin of SL specimens was in the bulk zirconia, while G and C showed fractures starting at the surface. As-sintered reached the highest fracture toughness and hardness. Glaze and borosilicate glass provided surface compressive stresses. Borosilicate glass application led to phase transformation (t→m). SL and G showed the lowest roughness. TP00 and ΔE00 were similar among groups. SIGNIFICANCE: Borosilicate glass improved strength without harming the optical properties of third-generation zirconia. Toughness and roughness provided by the experimental glass were similar to those from commercial glaze.

Marginal gap of zirconia and lithium disilicate frameworks produced by the CAD-CAM technique through a comparator microscope ­ in vitro analysis / Fenda marginal de estruturas de zircônia e dissilicato de lítio produzidas pela técnica CAD-CAM através de um microscópio comparador ­ análise in vitro

Objective: The aim of this study was to evaluate the marginal gap of frameworks produced using the CAD-CAM system, from zirconia and lithium disilicate blocks, adapted to a tooth preparation and a gypsum die. Material and Methods: For this study, a human first molar tooth was used as a master model with a full crown preparation. It was molded 20 times to obtain the gypsum die and randomly divided into 2 groups (n=10) for the fabrication of zirconia and lithium disilicate frameworks. The frameworks were made using pre-sintered zirconia blocks and lithium disilicate blocks, both CAD-CAM systems. The marginal gap was measured in µm at four points (buccal, palatal, mesial, and distal) using a comparator microscope with 30x magnification, with the framework seated on the master model (tooth), and on the gypsum die. Marginal gap data (µm) were evaluated using two-way analysis of variance and Tukey's test with a significance level of 5%. Results: The results showed that there was no statistically significant interaction between the factors studied (p=0.223) or isolated factors (ceramic factor p=0.886 and die factor p=0.786). Conclusion: Both ceramics produced using the CAD-CAM technique did not exhibit statistical differences in marginal adaptation on the two types of substrates, both on tooth preparation and on the gypsum die (AU)

Objetivo: O objetivo deste estudo foi avaliar o espaço marginal de estruturas produzidas usando o sistema CAD-CAM, a partir de blocos de zircônia e dissilicato de lítio, adaptadas a um preparo sobre dente e a um troquel de gesso. Material e Métodos: Para este estudo, um dente molar humano foi utilizado como modelo mestre com preparo para coroa total. Este foi moldado 20 vezes para obter o troquel de gesso e dividido aleatoriamente em 2 grupos (n=10) para a fabricação de estruturas de zircônia e dissilicato de lítio. As estruturas foram feitas usando blocos de zircônia pré-sinterizados e blocos de dissilicato de lítio, ambos sistemas para CAD-CAM. O espaço marginal foi medido em µm, em quatro pontos (bucal, palatal, mesial e distal), utilizando um microscópio comparador com ×30 de ampliação e com a estrutura assentada no modelo mestre (dente) e no troquel de gesso. Os dados de espaço marginal (µm) foram avaliados usando análise de variância bidirecional e teste de Tukey com um nível de significância de 5%. Resultados: Os resultados mostraram que não houve interação estatisticamente significativa entre os fatores estudados (p=0,223) ou isoladamente (fator cerâmica p=0,886 e fator troquel p=0,786). Conclusão: Ambas as cerâmicas produzidas usando a técnica CAD-CAM não apresentaram diferenças estatísticas em relação à adaptação marginal nos dois tipos de substratos, tanto na preparação dentária quanto no troquel de gesso(AU)

Evaluation of one versus two glaze firings on the color stability and mechanical properties of an extrinsically characterized monolithic CAD-CAM lithium disilicate glass ceramic.

PURPOSE: To evaluate the effects of 1 versus 2 glaze firings on the color and mechanical properties of an extrinsically characterized lithium disilicate ceramic after thermal cycling, brushing, or both. MATERIALS AND METHODS: Eighty specimens were divided into 2 groups: 1 glaze firing (GL1) and 2 glaze firings (GL2). Each group was subdivided into 4 groups (n = 10), according to the experimental conditions: thermal-cycling, brushing, thermal-cycling + brushing, and immersion in distilled water (control). Color variation, surface roughness, and Vickers microhardness were analyzed before each designated experiment and after the simulated periods of 2.5, 5, and 10 years. Three-way mixed ANOVA was used for all outcomes, followed by 1-way ANOVA, repeated measures 1-way ANOVA, Bonferroni post hoc test, and t-test to check for statistical differences (α = 0.05). RESULTS: Thermal cycling generated greater color changes in the GL1 group at 2.5 and 5 years (p < 0.001; p = 0.013). Brushing generated color changes in GL1 at 5 years (p = 0.003) and in GL2 at 10 years (p = 0.017). Regarding surface roughness, the GL1 group suffered alterations in thermal cycling + brushing at 5 years. In the control group, the GL1 group exhibited higher roughness values than GL2 (p < 0.05). Most of the groups experienced an increase in microhardness at 2.5 years (p < 0.05). In the GL1 group, thermal-cycling increased the microhardness at 5 years (p = 0.006); at 5 and 10 years, the GL1 group had a higher microhardness than the GL2 in thermal-cycling + brushing (p < 0.05). CONCLUSION: Ceramics with 1 glaze firing showed greater color, roughness, and microhardness changes compared to those submitted to 2 firings.

A study on the discoloration of different dental porcelain systems.

Purpose: This study aimed to investigate the discoloration of four types of dental porcelain systems (feldspathic, monolithic zirconia, lithium disilicate, and leucite glassceramic) with various surface treatments (glazed and mechanically polished) after undergoing chewing simulation against a natural tooth antagonist. Materials and methods: Disc-shaped porcelain groups (9x3mm) were produced for the following categories: feldspathic glazed (FG), feldspathic mechanically polished (FM), zirconia glazed (ZG), zirconia mechanically polished (ZM), lithium disilicate glazed (ExG), lithium disilicate mechanically polished (ExM), leucite glass-ceramic glazed (EG), and leucite glass-ceramic (EM). In vitro chewing simulation was conducted on all porcelain groups, and a spectrophotometer was used to compare the color changes between their initial states. Results: The ΔE values (discoloration) of all porcelain samples were statistically different (p <0.05), and the ΔE values of the glazed samples were higher than those of the mechanically polished samples. Conclusion: All the glazed samples are more likely to show more color change than the mechanically polished sample groups.

Effect of simulated gastric acid on aesthetical restorative CAD-CAM materials' microhardness and flexural strength.

Background: Gastric acid, which is among erosive substances, gradually rises to the mouth in individuals with reflux and bulimia nervosa disorders, and this causes various effects on dental restorations. Aim: The objective of this study is in vitro investigation of gastric acid's effect on flexural strength and hardness on aesthetic restorative computer-aided design and computer-aided manufacturing (CAD-CAM) materials. Materials and Methods: For this study, four materials have been used, namely Enamic (Vita), Superfect Zir (Aidite) Zirconia, IPS e.max CAD (Ivoclar Vivadent), and Mark II (Vita). From these four different materials, 24 samples with 14 × 4 × 1 dimensions in rectangular prism form are used, which makes a total of 96 samples. One group was separated as the control group, while the rest was allowed to wait at 37°C, 5 ml gastric acid for 96 hours. Hardness value and flexural strengths were measured as pre-exposure and post-exposure to gastric acid. Results: There is a statistically significant difference between the groups in terms of the amount of decrease in the mean hardness after exposure to gastric acid compared to pre-exposure values (p: 0,000; P < 0,05). There was no statistically significant difference between the groups in terms of the amount of decrease in the post-exposure average flexural strength compared to the pre-exposure value (p: 0.063; P > 0.05). There is a statistically significant difference between the groups in terms of the average flexural strength after exposure to the acid. Conclusions: According to the data obtained, it was concluded that exposure to gastric acid affects the hardness and flexural strength properties of dental restorative ceramic materials.

Influences of luting cement shade on the color of various translucent monolithic zirconia and lithium disilicate ceramics for veneer restorations.

PURPOSE: The purpose of this study was to assess the effect of resin cement shade on the color of different novel ultratranslucent monolithic zirconia and lithium disilicate veneer materials. MATERIALS AND METHODS: For a total of 40 specimens, flat cylindrical discs with a 9-mm diameter and 0.5-mm thickness were created using CAD/CAM technology. The specimens were divided into five groups according to their material (n = 8) (e.max, Prettau, Aidite, Shofu and Dima) using A1 shade. Resin discs with the same diameter and shade as the specimens served as tooth-colored substructures. Three shades (neutral, light and warm) of resin cement try-in pastes (Variolink Esthetic LC) were used as the luting cement material. The color of each material group was measured before and after cementation using the three cement shades, and the CIE L*a*b* coordinates were obtained with a spectrophotometer. Values for the translucency parameter (TP) and color change delta E (E) before (baseline) and after cementation of each specimen were determined. To compare differences among the material groups within each shade of cement and among various shades of cement within each material, the data were analyzed using one-way ANOVA and post hoc testing. RESULTS: Color coordinates L*, a* and b* significantly changed after the application of try-in pastes relative to baseline values, with a noticeable decrease in lightness (L*) (P < .05). A significant color change (ΔE) was observed in all tested materials after cementation, with ΔE values exceeding 3.3 (P < .05). Although TP changed after cementation for most materials tested, these changes were not statistically significant (P > .05). Shofu and Dima ceramics showed the lowest TP values, while Aidite and Prettau showed the highest TP values. For e.max, translucency decreased after cementation with neutral and warm shades, and it significantly increased after cementation with a light shade. CONCLUSION: The shade of cement significantly altered the final color of the ceramic veneer material to a level above the threshold at which the clinical perception of color change occurred (> 3.3). The TP was not influenced by the cement shade. The translucency levels of the novel ultratranslucent multilayer monolithic zirconia ceramics Aidite and Prettau were higher than that of the lithium disilicate e.max material.