Impact of high-speed sintering and choice of preshaded monochrome or multilayered blanks on fatigue behavior of 4 mol% yttria-stabilized tetragonal zirconia polycrystal.

STATEMENT OF PROBLEM: High-speed sintering allows the rapid fabrication of esthetic restorations with adequate flexural strength. However, data on the fatigue behavior of high-speed sintered 4 mol% yttria-stabilized tetragonal zirconia polycrystal (4Y-TZP) are lacking. PURPOSE: The purpose of this in vitro study was to examine the effect of high-speed sintering and the preshading of blanks (monochrome versus multilayer) on the fatigue behavior of 4Y-TZP ceramics. MATERIAL AND METHODS: Four-point flexural strength specimens (N=405) were fabricated from high-speed sintered multilayer 4Y-TZP (Zolid DRS) processed at 1580 °C for about 20 minutes and conventionally sintered at 1450 °C for about 10 hours, multilayer 4Y-TZP (Zolid Gen-x), and monochrome 4Y-TZP (Ceramill Zolid HT+PS), the control group. The specimens were loaded under 5 different dynamic test conditions for fatigue testing (P1-P5). Three were step-stress protocols (P1: 50 N for 5000 cycles; P2: 10 N for 1000 cycles, P3: 5% for 5000 cycles), 1 was tested with a constant force of 720 N (P4), and 1 was tested for different constant load levels (P5). For analysis of P1-P3, the Kaplan-Meier test and Mantel Cox test were performed (α=.05). P4 was analyzed with the Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests, and P5 by creating a load-cycle diagram. A fracture analysis was performed. RESULTS: ZMLC showed better fatigue behavior than ZMLH (P≤.006) and ZMOC (P≤.002) in all 3 step-stress protocols (P1-P3). ZMLH showed results comparable with those for ZMOC (P≥.285). In P4 and P5, all materials showed comparable values (P=.163 for P4). CONCLUSIONS: The multilayer technique showed a positive effect on the fatigue behavior of 4Y-TZP. In contrast, high-speed sintering negatively influenced the fatigue behavior of multilayer 4Y-TZP. The high-speed sintered material showed no deterioration compared with the conventional sintered monochrome material.

Impact of the material and sintering protocol, layer thickness, and thermomechanical aging on the two-body wear and fracture load of 4Y-TZP crowns.

OBJECTIVES: The aim of this study is to investigate the influence of the material and corresponding sintering protocol, layer thickness, and aging on the two-body wear (2BW) and fracture load (FL) of 4Y-TZP crowns. MATERIALS AND METHODS: Multi-layer 4Y-TZP crowns in three thicknesses (0.5 mm/1.0 mm/1.5 mm) were sintered by high-speed (Zolid RS) or conventional (Zolid Gen-X) sintering. 2BW of ceramic and enamel antagonist after aging (1,200,000 mechanical-, 6000 thermal-cycles) was determined by 3D-scanning before and after aging and subsequent matching to determine volume and height loss (6 subgroups, n = 16/subgroup). FL was examined initially and after aging (12 subgroups, n = 16/subgroup). Fractographic analyses were performed using light-microscope imaging. Global univariate analysis of variance, one-way ANOVA, linear regression, Spearman's correlation, Kolgomorov-Smirnov, Mann-Whitney U, and t test were computed (alpha = 0.05). Weibull moduli were determined. Fracture types were analyzed using Ciba Geigy table. RESULTS: Material/sintering protocol did not influence 2BW (crowns: p = 0.908, antagonists: p = 0.059). High-speed sintered Zolid RS presented similar (p = 0.325-0.633) or reduced (p < 0.001-0.047) FL as Zolid Gen-X. Both 4Y-TZPs showed an increased FL with an increasing thickness (0.5(797.3-1429 N) < 1.0(2087-2634 N) < 1.5(2683-3715 N)mm; p < 0.001). For most groups, aging negatively impacted FL (p < 0.001-0.002). Five 0.5 mm specimens fractured, four showed cracks during and after aging. CONCLUSIONS: High-speed sintered crowns with a minimum thickness of 1.0 mm showed sufficient mechanical properties to withstand masticatory forces, even after a simulated aging period of 5 years. CLINICAL RELEVANCE: Despite the manufacturer indicating a thickness of 0.5 mm to be suitable for single crowns, a minimum thickness of 1.0 mm should be used to ensure long-term satisfactory results.

Impact of varying step-stress protocols on the fatigue behavior of 3Y-TZP, 4Y-TZP and 5Y-TZP ceramic.

OBJECTIVE: To test the impact of three varying step-stress protocols on the fatigue behavior of two 3Y-TZP, one 4Y-TZP and one 5Y-TZP zirconia materials. METHODS: Eight specimens per zirconia material (N = 32) were selected for static testing to determine the start load for dynamic tests (30% of the mean value of static fracture load). 45 specimens per material (N = 180) were used for dynamic load tests using three step-stress protocols: 1. 50 N/5000 cycles; 2. 5% of static load/5000 cycles, and 3. 10 N/1000 cycles. Following materials were tested: 3Y-TZP(<0.25 Al2O3) (O: opaque) 3Y-TZP(<0.05 Al2O3) (T: translucent), 4Y-TZP(<0.01 Al2O3) (ET: extra translucent) and 5Y-TZP(<0.01 Al2O3) (HT: high translucent). The specimens (4 ± 0.02 × 3 ± 0.02 × 45 mm) were placed centrally on the support rolls and the load was applied perpendicularly over the 4 mm specimen side (∼4-point flexural strength according to the DIN 6872:2019). Data was analyzed with Kolmogorov-Smirnov-test, t-test, one-way ANOVA with post-hoc Scheffé-test, Chi-square-test, Kaplan-Meier with Log-Rank-test and two-parametric Weibull analysis (p < 0.05). RESULTS: The step-stress protocols showed no impact on the fracture load or Weibull modulus within one zirconia material. However, the zirconia materials T, ET and HT showed differences in cycle number to fracture between the step-stress protocols (T: 3 > 2 > 1; ET: 2 > 3 > 1; HT: 2, 3 > 1) with lowest cycle number to fracture for protocol 1. Within one step-stress protocol, the cycle number to fracture varied according to the zirconia material as follows: 1: T, O ≥ O, ET > HT; 2: ET > O, T, HT; 3: O, T, ET > HT. Cracking started at the tensile side of the specimens at all times. All specimens showed typical compression curls (single or double). Fragmentation patterns were similar for all materials with a lot of crack branching and fragmentation due to secondary cracks indicating high energy fractures. SIGNIFICANCE: Dynamic fatigue tests seem to provide important information on the long-term stability of zirconia materials. Zirconia materials with higher opacity seem to be more robust towards varying step-stress protocols than translucent zirconia materials. Regarding expenditure of time, a step-stress protocol with a load increase of 50 N every 5000 cycles seems favorable to gain information on the long-term stability of zirconia materials.

Fatigue resistance of monolithic strength-gradient zirconia materials.

PURPOSE: Evaluation of the effect of three different dynamic fatigue protocols on the fracture resistance of two monolithic strength-gradient zirconia materials. MATERIALS AND METHODS: A total of 240 specimens (3 × 4 × 45 mm) was milled from two different layers (incisal and middle) of two types of strength-gradient zirconia blanks (IPS e. max ZirCAD MT Multi A2 vs. IPS e. max ZirCAD Prime A2), resulting in 60 specimens per material and layer group (IPS e. max ZirCAD MT Multi A2: incisal (MI), middle (MM); IPS e. max ZirCAD Prime A2: incisal (PI), middle (PM)). Each group was divided into one static (n = 15) and three dynamic fatigue protocols (N = 45, n = 15): i. 50 N increase every 5000 cycles ii. Increase by 5% of static fracture load every 5000 cycles iii. 10 N increase every 1000 cycles until facture. All specimens were loaded until facture in CeraTest 2 k. Kaplan-Meier, Log-Rank and Chi-squared-test as well as Weibull statistics were performed. A fractographic analysis was performed. The specimens were classified according to the number of crack origins and evaluated using the Ciba-Geigy table. RESULTS: With regard to the fracture load, in the static loading MI and PI showed a higher fracture load and in dynamic fatigue protocol 2 PI showed a lower fracture load. The number of cycles until fracture only differed within three groups: MM and MI survived a higher number of cycles in dynamic fatigue protocol 2; PI survived a higher number of cycles in dynamic fatigue protocol 2 than in protocol 1. Within dynamic fatigue protocols, PM resisted the highest number of cycles in protocol 1 and 3 and MI in protocol 2. Comparing groups, Weibull modulus differed only within the static loading, with PI showing lower values than MM and MI. Within the material groups, MI showed higher values in static loading than in dynamic fatigue protocol 1 and 2, and PI showed higher values in the dynamic fatigue protocol 3 than in static loading. With regard to fracture patterns, no differences were found between the groups. CONCLUSIONS: Dynamic fatigue protocols provide clinically relevant information on the long-term stability and reliability of monolithic strength-gradient zirconia materials. However, no definitive instructions for dynamic testing can be provided from this investigation.

Edge chipping resistance of veneering composite resins.

OBJECTIVES: To investigate the edge chipping resistance (ECR) of six veneering composite resins after different treatment protocols. MATERIALS AND METHODS: Rectangular bar specimens were manufactured from Ceramage Incisal (CER; Shofu), dialog Vario Occlusal (DIA; Schütz Dental), Gradia Plus Heavy Body Enamel (GRA; GC Europe), in:joy incisal (INJ; Dentsply Sirona Deutschland), SR Nexco Paste Incisal (SRN; Ivoclar Vivadent), and Signum composite enamel (SIG; Kulzer). ECR was determined after five treatment protocols: (1) no treatment, (2) after storage in distilled water at 37 °C for 7 days, (3) storage in distilled water with an additional 10 000 thermal cycles (5 °C/55 °C), and hydrothermal treatment at 134 °C at a water vapor pressure of 0.2 MPa for a duration of (4) 3.5 min or (5) 23.5 min. Force was applied with the universal testing machine ZHU 0.2 (Zwick Roell) mounted with a Vickers diamond indenter until the chip fractured off the specimen and ECR values were computed by dividing the applied maximum force by the distance to the center of the applied force. Fracture analysis was performed employing light microscope imaging. Univariate and one-way ANOVA, Scheffé and Tukey-B post hoc, and partial eta squared (ƞp2) were computed (p < 0.05). RESULTS: DIA presented consistently high ECR values, while CER showed low results. For some groups, seven days' storage in water and hydrothermal treatment for 3.5 min led to higher ECR results than observed in the initial state, while an additional 10 000 thermal cycles and hydrothermal treatment for 23.5 min resulted in lower ECR values. CONCLUSIONS: The examined veneering composite resins differed in regard to their mechanical properties, with DIA possessing the highest resistance to chipping. While post-processing can initially increase a material's edge chipping resistance, intensified treatment protocols reduced the mechanical properties of veneering composite resins.

Impact of artificial aging by thermocycling on edge chipping resistance and Martens hardness of different dental CAD-CAM restorative materials.

STATEMENT OF PROBLEM: The selection of an appropriate restorative material based on fracture behavior is important for the marginal integrity of a dental restoration. For computer-aided design and computer-aided manufacturing (CAD-CAM) restorative materials, information regarding their edge chipping resistance is scarce. PURPOSE: The purpose of this in vitro study was to determine the edge chipping resistance (ECR) and Martens hardness (HM) of 6 different dental CAD-CAM restorative materials before and after thermocycling. MATERIAL AND METHODS: Four composite resin materials including Brilliant Crios; Cerasmart, an experimental material; Lava Ultimate, a polymer-infiltrated ceramic-network (PICN) material (VITA Enamic), and a glass-ceramic control (IPS Empress CAD) were tested. The specimens were tested before and after thermocycling (30 000 times, 5 °C/55 °C). The ECR was measured for each material (n=25) and related to the point of loading and to the maximum chipping depth. HM was determined for each material (n=25). The Kruskal-Wallis and Mann-Whitney U tests were used to compare materials (α=.05). The impact of thermocycling was analyzed by using the Wilcoxon test (α=.05). The correlations between all parameters were calculated by using the Spearman-Rho test (α=.05). For fractographic analysis of chip patterns, chipped surfaces were analyzed by laser scanning microscopy. RESULTS: For ECR and HM, the materials showed different values. ECRmd and ECRpl showed a positive correlation, but both showed a negative correlation to HM. The materials showed a different chip size (P<.001). Chip patterns revealed brittle material behavior in all cases. CONCLUSIONS: All tested CAD-CAM materials behaved as brittle materials, but HM and ECR differed among the materials. The control glass-ceramic material showed the highest values for HM, followed by the PICN material. ECR values revealed the opposite order of materials, with the highest for composite resins. Artificial aging by thermocycling affected all dental CAD-CAM restorative materials. Especially for composite resin materials, ECR changed after aging.

Fracture resistance and 2-body wear of 3-dimensional-printed occlusal devices.

STATEMENT OF PROBLEM: Polymeric material for 3-dimensional printing can be used to fabricate occlusal devices. However, information about fracture resistance and wear is scarce. PURPOSE: The purpose of this in vitro study was to investigate the fracture resistance and 2-body wear of 3-dimensional-printed (3DP) (FotoDent splint; Dreve Dentamid GmbH), milled polymethylmethacrylate (CAM) (Temp Basic; Transpa 95H16, Zirkonzahn GmbH), and conventionally fabricated polymethylmethacrylate (CAST) (Castdon; Dreve Dentamid GmbH) occlusal devices. MATERIAL AND METHODS: A total of 96 occlusal devices were prepared according to the 3 different manufacturing techniques 3DP, CAM, and CAST (n=32). For each manufacturing technique, specimens were further divided into initial fracture resistance tests (n=16) and artificial aging in the mastication simulator (50 N, 37°C) with 2-body wear followed by fracture resistance tests (n=16). The fracture resistance was determined using a universal testing machine (1 mm/min). The wear was measured after 20 000 and 120 000 mastication cycles with the replica technique, mapped with a laser scanner, and quantified in R software. Data were analyzed using a 2-way ANOVA followed by a 1-way ANOVA with Scheffé or Games-Howell post hoc tests, repeated measures ANOVA with corrected Greenhouse-Geisser P values, and the Levene, Mann-Whitney, and paired t tests (α=.05). RESULTS: CAM presented higher initial fracture resistance than 3DP or CAST (P<.001). After mastication simulation, CAM followed by 3DP showed higher fracture resistance than CAST (P<.001). Mastication simulation decreased the fracture resistance for CAM and CAST (P<.001) but not for 3DP (P=.78). Three-dimensional-printed occlusal devices showed the highest material volume loss, followed by CAM and the lowest in CAST (P<.001). CONCLUSIONS: Three-dimensional-printed occlusal devices showed lower wear resistance and lower fracture resistance than those milled or conventionally fabricated. Therefore, only short-term application in the mouth is recommended. Further developments of occlusal device material for 3-dimensional printing are necessary.

Reliability of wear measurements of CAD-CAM restorative materials after artificial aging in a mastication simulator.

OBJECTIVES: The purpose of this in vitro study was to assess the 2-body wear behavior of computer-aided design and computer-aided manufacturing (CAD-CAM) restorative materials and additionally to validate an automatic approach to wear quantification as provided by newly developed software. MATERIALS AND METHODS: Two composite resins (Experimental Composite, Shofu Block HC), 1 polymethyl methacrylate- (PMMA)-based material (Telio CAD), and 1 dual-network material (VITA Enamic) were tested (n = 12). The materials were stored in distilled water at 37 °C for 14 days, then aged in a mastication simulator (cycles: 400 000, 50 N, 1.2 Hz, 5/55 °C) for 2-body wear testing with human molars as antagonists. Software was developed as a freely available function in R for automatic wear quantification and was applied to 2 (vertical and horizontal) images obtained by an optical laser scanner (SDM). Wear measurements were validated with a reference confocal laser scanning microscope (LSM) system. The Kruskal-Wallis with Tukey-Kramer post hoc test (α = 0.05), coefficient of variation, Bland-Altman method, and intraclass correlation were applied. RESULTS: Shofu Block HC showed the greatest wear, and no differences were found among other materials. The automatic wear measurements agreed well with the reference LSM system. The reliability of the SDM scans was 98.5%. CONCLUSIONS: The wear resistance caused by two-body wear differed among the restorative materials tested, with the mean wear resistance of the 2 composite resin materials differing significantly. Wear quantification with R software based on SDM scans showed satisfactory agreement with the reference LSM system.

The effect of artificial aging on Martens hardness and indentation modulus of different dental CAD/CAM restorative materials.

OBJECTIVES: To determine the Martens hardness parameters for five different classes of CAD/CAM restorative materials after storage in water and thermo-cycling. MATERIALS AND METHODS: Lithium disilicate ceramic IPS e.max CAD (EX), silicate ceramic IPS Empress CAD (EC), a polymer infiltrated interpenetrating network material (hybrid material) VITA Enamic (VE), two compact filled composites Lava Ultimate (LU), experimental material (EM), two low filled resin composites Katana Avencia (KA), Ambarino High-Class (AH) and ultra-low/unfilled acrylic polymers CAD-Temp (CT), Telio CAD (TC), breCAM.HIPC (BC) were tested. Specimens were stored in water at 37 °C for 30, 60, 90, 120 days and afterwards thermo-cycled (30,000×, 5 °C/55 °C). Martens hardness (HM) and indentation modulus (EIT) were longitudinally investigated after each storage time. For structural analysis, each material was analyzed by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). RESULTS: The groups of unfilled polymers/ultra-low filled composite (CT, TC, BC) followed by low (KA, AH) and compact filled resin composites (LU, EM) showed the lowest HM and EIT values (p < 0.001). The highest values presented ceramics (EX, EC) followed by hybrid material (VE) (p < 0.001). High influence on the Martens hardness parameters was exerted by the aging duration (HM: ηP2 = 0.108, p < 0.001; EIT: ηP2 = 0.074, p < 0.001). Structural analyses of resin composites revealed big differences in shape, size and distribution of filler particles. CONCLUSIONS: The tested CAD/CAM materials showed differences in Martens hardness and indentation modulus pursuant to the material class. Ceramics showed highest values, followed by the hybrid material. For resin composites the Martens hardness and indentation modulus increased with the filler content. Artificial aging affected CAD/CAM materials differently. Some materials tested are prone to aging, the Martens hardness and indentation modulus decreased after thermo-cycling.

Macro- and microtopographical examination and quantification of CAD-CAM composite resin 2- and 3-body wear.

STATEMENT OF PROBLEM: The selection of an appropriate restorative material based on wear behavior is important for the long-term success of a dental restoration. For computer-aided design and computer-aided manufacturing (CAD-CAM) composite resins, information about their wear resistance and wear mechanism is scarce. PURPOSE: The purpose of this in vitro study was to compare the 2- and 3-body wear of CAD-CAM composite resins with that of lithium disilicate ceramic and to develop analysis software. MATERIAL AND METHODS: Flat specimens were prepared from the following CAD-CAM composite resins: Cerasmart (CS), SHOFU Block HC (SH), Katana Avencia (KA), Brilliant Crios (BC), an experimental composite resin (EXP), and lithium disilicate ceramic IPS e.max CAD (REF). The specimens underwent 2-body wear (50 N, 5/55°C, 400 000 cycles) opposed by human enamel antagonists. Specimen wheels were prepared with each material on each wheel for 3-body wear with a millet slurry (15 N, 15% slip, 200 000 cycles). All specimens were digitized by using a dedicated laser scanner. Analysis software was developed to calculate macrotopographical examination of volume loss. The microtopography of the surfaces was examined by using scanning electron microscopy. For data analysis, the Kruskal-Wallis test with the Tukey-Kramer post hoc test and the 1-sample Wilcoxon test were used (α=.05). RESULTS: After 2-body wear simulation, SH and KA presented higher volume loss than the other CAD-CAM materials. For 3-body wear, REF had lower volume loss than CS, SH, or BC. In addition, BC led to higher volume loss than EXP. The patterns of 2- and 3-body wear were different. CONCLUSIONS: The ceramic showed good global wear resistance. The volume loss of the CAD-CAM composite resins differed and depended on the material. The 2- and 3-body wear test methods tended to differ with regard to volume loss. Examination of the worn surfaces revealed different mechanisms acting in 2- and 3-body wear test.

Glass Fiber Post/Composite Core Systems Bonded to Human Dentin: Analysis of Tensile Load vs Calculated Tensile Strength of Various Systems Using Pull-out Tests.

PURPOSE: Pull-out testing was used to determine the tensile load (TL) and tensile strength (TS) of five different fiber post systems bonded to human intracanal dentin. MATERIALS AND METHODS: 120 caries-free premolars, canines, and maxillary central incisors were divided into 5 different groups for 5 fiber post systems (n = 24): 1. RelyX Fiber Post 3D (RX3D); 2. RelyX Fiber Post (RX); 3. Luxa- Post (LP); 4. FibreKleer 4X Tapered Post (FK); 5. ParaPost Taper Lux (PP). The teeth were prepared and posts inserted. Core buildups were performed with the corresponding product's resin composite. All specimens were stored in water for 24 h at 37°C. TL and TS were tested on half of the specimens (n = 12/group). The remaining samples were thermocycled (10,000 x 5°C/55°C) before testing. TL was directly measured and TS was calculated using the bonding surface. Failure modes were identified using a stereomicroscope. Data were analyzed using twoway ANOVA with the post-hoc Scheffé test, as well as the chi-squared test (p < 0.05). RESULTS: FK and LP resulted in the lowest mean TL but were not significantly different from those of RX and RX3D. The highest mean TL and TS were observed for PP. Nevertheless, PP fell within the same statistical subset as RX3D and RX. Thermocycling showed no impact on the results. RX3D predominantly showed debonding of the post plus core buildup from the tooth; all other systems mainly demonstrated detachment of the core from the posts. CONCLUSION: PP, RX, and RX3D together with an adhesive core buildup yielded the highest bond strength to human dentin. Parameters TL and TS showed the same tendencies and statistical evidence.