Effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia fixed partial dentures: An in vitro study.

STATEMENT OF PROBLEM: Strength-gradient zirconia combining 3 zirconia formulations with different flexural strengths has been reported to have outstanding mechanical properties. However, data concerning the effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia fixed partial dentures (FPDs) are sparse. PURPOSE: The purpose of this in vitro study was to test the effect of different sintering protocols on the fracture strength of 3-unit monolithic gradient zirconia FPDs. MATERIAL AND METHODS: Two custom-made stainless-steel master dies were designed to replicate a mandibular right second premolar and second molar prepared to receive a 3-unit monolithic zirconia FPD. Thirty monolithic zirconia FPDs were milled from gradient zirconia blanks and allocated to 3 groups (n=10) according to the sintering protocols: high-speed sintering, speed sintering, and conventional sintering. The FPDs were cemented onto the corresponding dies with traditional glass ionomer cement. All FPDs were cyclic loaded (600 000 cycles/49 N/1.7 Hz) in a mastication simulator. Fracture load measurements for each FPD were determined by using a universal testing machine. Scanning electron microscopy (SEM) at ×80 magnification was used to examine a fractured FPD from each group. A representative specimen from each group was examined with SEM at ×30 000 magnification to determine the grain size. One-way ANOVA, pair-wise Tukey honestly significant difference (HSD), and Pearson correlation tests were used for statistical analysis of the data (α=.05). RESULTS: The high-speed sintered FPDs recorded the highest statistically significant fracture load mean ±standard deviation value (2526 ±300 N), followed by the speed sintered FPDs (2136 ±127 N), while the lowest statistically significant fracture load mean value was recorded with the conventionally sintered FPDs (1361 ±181 N) (P<.001). In addition, the mean ±standard deviation grain size values were 488 ±272 nm for the high-speed sintered specimen, 578 ±409 nm for the speed sintered specimen, and 832 ±551 nm for the conventionally sintered specimen (P<.001). A significant negative correlation was found between fracture strength and grain size among the 3 groups. CONCLUSIONS: The fracture strength of 3-unit monolithic gradient zirconia FPDs sintered by using a high-speed protocol was significantly higher than that of speed and conventionally sintered FPDs (P<.001). The high-speed sintering protocol reduced the mean grain size of gradient zirconia FPDs compared with that of both speed and conventional sintering protocols.

Micro-CT analysis of marginal and internal fit of milled and pressed polyetheretherketone single crowns.

STATEMENT OF PROBLEM: Polyetheretherketone (PEEK) has been increasingly used as a framework material in prosthetic dentistry. However, data on the marginal and internal fit of PEEK restorations fabricated by using either the computer-aided design and computer-aided manufacturing (CAD-CAM) or heat-pressing technique are sparse. PURPOSE: The aim of this in vitro study was to assess the marginal and internal fit of milled and pressed PEEK single crowns by using microcomputed tomography (µCT). MATERIAL AND METHODS: A custom-made, single stainless-steel die was designed to replicate a maxillary first premolar prepared for a ceramic crown. PEEK copings (N=30) were fabricated and allocated to 3 groups (n=10) according to the fabrication technique: milled from a prefabricated PEEK blank, heat pressed from PEEK pellets, and heat pressed from PEEK granules. All copings were veneered with a composite resin material. The marginal fit was recorded at 4 predetermined points and the internal fit at 8 predetermined points on each crown by using µCT. Two-way ANOVA, pair-wise Tukey honestly significant difference (HSD), and simple main effect tests were used for statistical analysis of the data (α=.05). RESULTS: Concerning marginal fit, the milled crowns demonstrated the best marginal fit overall (44 ±3 µm), followed by those pressed from pellets (92 ±3 µm), and finally by those pressed from granules (137 ±7 µm) (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the marginal fit was not statistically significant (P=.142). The milled crowns demonstrated the lowest mean gap values overall, followed by those pressed from pellets and those pressed from granules (P<.001). The interaction between the effects of the fabrication technique and the measurement point on the internal fit was statistically significant (P<.001). Except for the distal occlusal gap and mesial occlusal gap, all tested groups showed a statistically significant difference (P<.001). In addition, statistically significant differences were observed among all measurement points in different fabrication techniques (P<.001). CONCLUSIONS: The marginal and internal fit of milled PEEK crowns was significantly better than pressed crowns. However, both CAD-CAM and heat-pressing techniques produced PEEK crowns with a clinically acceptable marginal and internal fit. The mean marginal gap of the PEEK crowns pressed from granules was above the range of clinically acceptable value.

Effect of dynamic loading on fracture resistance of gradient zirconia fixed partial denture frameworks.

STATEMENT OF PROBLEM: The new strength-gradient zirconia composed of 3-mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) and 5-mol% yttria-stabilized tetragonal zirconia polycrystal (5Y-TZP) has been claimed to have superior mechanical properties. However, data on the fracture resistance of 3-unit gradient 5Y-TZP and 3Y-TZP fixed partial denture frameworks are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effect of dynamic loading on the fracture resistance of gradient zirconia fixed partial denture frameworks. MATERIAL AND METHODS: Two standardized stainless-steel master dies were designed to simulate a mandibular left second premolar and second molar prepared to receive zirconia frameworks. The frameworks were designed with a 0.6-mm uniform wall thickness. The mesiodistal width of the connectors was 3 ±0.02 mm, and the occlusogingival height was 3 ±0.02 mm. Forty zirconia frameworks were fabricated and divided into 2 groups according to the tested materials (n=20): 3Y-TZP and gradient 5Y-TZP and 3Y-TZP. The frameworks were cemented onto their corresponding dies with a conventional glass ionomer cement. Half of the cemented frameworks in each group underwent 600 000 cycles of dynamic loading in a mastication simulator (n=10). The other half was fractured without dynamic loading (n=10). Fracture resistance measurements (N) for each framework were recorded by using a universal testing machine at a crosshead speed of 1 mm/min. A fractured framework from each group was examined by using a scanning electron microscope (SEM) at ×100 magnification. The data obtained were statistically analyzed by using 2-way ANOVA, the pairwise Tukey honestly significant difference (HSD), and simple main effect tests to detect the difference between group mean values (α=.05). RESULTS: The mean ±standard deviation of fracture load value before dynamic loading was 1919 ±193 N for the 3Y-TZP group and 908 ±99 N for the gradient 5Y-TZP and 3Y-TZP group. In addition, the mean fracture load value after dynamic loading was 1418 ±163 N for the 3Y-TZP group and 716 ±85 N for the gradient 5Y-TZP and 3Y-TZP group. The interaction between the effects of the zirconia material and dynamic loading on the fracture resistance was statistically significant (P=.002). The 3Y-TZP group had a statistically significant, higher fracture load mean value the gradient 5Y-TZP and 3Y-TZP group before and after dynamic loading (P<.001). CONCLUSIONS: The fracture resistance of 3Y-TZP frameworks was significantly higher than that of gradient 5Y-TZP and 3Y-TZP frameworks before and after dynamic loading. Dynamic loading significantly reduced the fracture resistance of 3Y-TZP and gradient 5Y-TZP and 3Y-TZP frameworks.

Effect of different surface treatments on the bond strength of milled polyetheretherketone posts.

STATEMENT OF PROBLEM: Polyetheretherketone (PEEK) can be used as a framework material for removable and fixed dental prostheses. However, information about the use of PEEK as a post-and-core restoration is scarce. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different surface treatments on the push-out bond strength of milled polyetheretherketone posts to resin cement. MATERIAL AND METHODS: Sixty intact human maxillary central incisors were selected and endodontically treated, and standardized post spaces were prepared. Sixty PEEK posts were milled from a prefabricated PEEK blank by using a computer-aided design and computer-aided manufacturing (CAD-CAM) system and divided into 3 groups (n=15) according to the surface treatment: acid etching by using 98% sulfuric acid (AE); airborne-particle abrasion by using 50-µm Al2O3 (AA); nonthermal plasma treatment (NTP); in addition, PEEK posts (n=15) received no treatment (NT) and served as a control. All posts were bonded by using a self-adhesive resin cement. Three sections (coronal, middle, and apical) were obtained for each specimen. Push-out bond strength measurements (MPa) for each section were recorded by using a universal testing machine at a crosshead speed of 0.5 mm/min until failure occurred. The post-cement interfaces and failure modes were evaluated by using scanning electron microscopy. The data obtained were statistically analyzed by using 1-way ANOVA and the pair-wise Tukey (HSD) test to study the difference between group mean values (α=.05). RESULTS: The overall mean ±standard deviation of the push-out bond strength was 11 ±2 MPa for AE group, 6 ±1 MPa for AA group, 5 ±1 MPa for NTP group, and 3 ±1 MPa for NT group. A statistically significant difference was found among all groups subjected to different surface treatments as indicated by the ANOVA test (P<.001). The pair-wise Tukey honestly significant difference (HSD) test showed a significant difference among the AE group and all groups (P<.001); however, no significant difference was observed between the AA and NTP groups (P>.05). Moreover, a significant difference was observed among all root sections (P<.001). CONCLUSIONS: Surface treatment of PEEK posts with 98% sulfuric acid for 60 seconds showed significantly higher bond strength values than those in other groups. The bond strength of PEEK posts to resin cement was significantly higher in the coronal section than that in other sections.

Effect of different fabrication techniques on the marginal precision of polyetheretherketone single-crown copings.

STATEMENT OF PROBLEM: Demand is increasing for polyetheretherketone (PEEK) as a fixed dental prosthesis core material. However, information is lacking about how the precision of these restorations is affected by the fabrication procedures. PURPOSE: The purpose of this in vitro study was to evaluate the influence of different fabrication techniques on the marginal precision of PEEK single-crown copings. MATERIAL AND METHODS: A stainless-steel master die was designed to simulate a prepared mandibular second molar to receive ceramic crowns. Thirty PEEK copings were fabricated and divided into 3 groups (n=10) according to the fabrication technique: milled from a prefabricated PEEK blank by using a computer-aided design and computer-aided manufacturing (CAD-CAM) system (PC); pressed from prefabricated PEEK pellets (PP); and pressed from PEEK granules (PG); in addition, 3-mol yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) copings (n=10) were produced by using the same CAD-CAM system and served as a control. Marginal precision measurements (in µm) were recorded at 4 reference points on each coping by using a digital microscope. The data obtained were statistically analyzed by using 1-way ANOVA and the pair-wise Tukey (HSD) test to study the difference between group mean values (α=.05). RESULTS: The overall mean ±standard deviation marginal gap at the marginal opening for the copings was 78 ±10 µm for PEEK granules copings, 72 ±9 µm for PEEK pellet copings, 45 ±6 µm for PEEK CAD-CAM copings, and 43 ±1 µm for the 3Y-TZP CAD-CAM control. A statistically significant difference was found between the milled and pressed copings as indicated by the ANOVA test (P<.001). The pair-wise Tukey honestly significant difference (HSD) test showed a nonsignificant difference (P>.05) between milled 3Y-TZP and milled PEEK copings; moreover, no significant difference was observed between the PEEK copings pressed from pellets or granules (P>.05). CONCLUSIONS: The marginal precision of PEEK CAD-CAM-fabricated copings showed significantly lower mean marginal gap values than PEEK pressed copings. The marginal gap mean values recorded were all within a clinically acceptable range (120 µm).

Effect of decontamination methods on shear bond strength of resin cement to translucent monolithic zirconia / Efeito de métodos de descontaminação na resistência ao cisalhamento entre cimento resinoso e zircônia monolítica translúcida

Objective: The aim of this study was to evaluate the effect of decontamination methods on shear bond strength of resin cement to translucent monolithic zirconia. Material and Methods: Eighty 4-mol yttria-stabilized tetragonal zirconia polycrystal specimens were fabricated. All specimens were subjected to saliva contamination and divided into four groups (n = 20) according to the decontamination methods: 70% isopropanol (AL); zirclean (ZC); 5.25% sodium hypochlorite (NaOCL); and no cleaning (NC). All specimens were bonded by using self-adhesive resin cement. Half of the specimens in each group (n = 10) were subjected to aging. All specimens were subjected to shear bond strength test in a universal testing machine. Failure modes were evaluated by using a scanning electron microscope (SEM). The data obtained were statistically analyzed by using one-way ANOVA followed by the HSD Tukey test (p < 0.05). Results: ANOVA test revealed a significant difference among the different decontamination methods (p < 0.05). No significant differences were found among NaOCL, ZC, and AL groups as revealed by the HSD Tukey test (p > 0.05). The effect of aging was significantly different in all groups (p < 0.05); whereas, no significant difference was found in group ZC (p > 0.05). The (SEM) analysis showed mixed failures in all groups, except in group NC where only adhesive failure was observed. Conclusion: Saliva contamination during clinical evaluation significantly decreases the shear bond strength between self-adhesive resin cement and translucent monolithic zirconia. The cleaning methods have an impact on improving the bond strength between resin cement and translucent monolithic zirconia (AU)

Objetivo: O objetivo deste estudo foi avaliar o efeito dos métodos de descontaminação na resistência ao cisalhamento entre cimento resinoso e zircônia monolítica translúcida. Material e métodos: Foram fabricados oitenta espécimes policristalinos de zircônia tetragonal estabilizada com ítria a 4 mol. Todas as amostras foram submetidas à contaminação salivar e divididas em quatro grupos (n = 20) de acordo com os métodos de descontaminação: isopropanol a 70% (AL); zircleano (ZC); Hipoclorito de sódio a 5,25% (NaOCL); e sem limpeza (NC). Todas as amostras foram cimentadas utilizando um cimento resinoso autoadesivo. Metade das amostras de cada grupo(n = 10) foram submetidas ao envelhecimento. Todas as amostras foram submetidas ao teste de resistência ao cisalhamento em uma máquina de teste universal. Os módulos de falha foram avaliados usando um microscópio eletrônico de varredura (MEV). Os dados obtidos foram analisados estatisticamente utilizando ANOVA de uma via, seguida pelo teste de HSD Tukey (p < 0,05). Resultados: O teste ANOVA revelou diferença significativa entre os diferentes métodos de descontaminação (p < 0,05). Não foram encontradas diferenças significativas entre os grupos NaOCl, ZC e AL, conforme revelado pelo teste HSD Tukey (p> 0,05). O efeito do envelhecimento foi significativamente diferente em todos os grupos (p < 0,05); enquanto nenhuma diferença significativa foi encontrada no grupo ZC (p > 0,05). A análise (SEM) mostrou falhas mistas em todos os grupos, exceto no grupo NC, onde apenas foi observada falha adesiva. Conclusão: A contaminação por saliva durante a avaliação clínica diminui significativamente a resistência ao cisalhamento entre o cimento resinoso autoadesivo e a zircônia monolítica translúcida. Os métodos de limpeza têm um impacto na melhoria da resistência da união entre o cimento resinoso e a zircônia monolítica translúcida. (AU)

Flexural strength of small connector designs of zirconia-based partial fixed dental prostheses.

STATEMENT OF PROBLEM: Partial fixed dental prostheses with a small connector size are required for optimal esthetics and limited interarch space; however, final strength is endangered. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different connector designs on the flexural strength of simulated 3-unit partial fixed dental prostheses made of yttria-stabilized tetragonal zirconia polycrystalline using computer-aided design and computer-aided manufacturing technology. MATERIAL AND METHODS: To simulate a 3-unit partial fixed dental prosthesis, 20 rectangular bar-shaped specimens were fabricated with dimensions of 4 ± 0.05 mm (H) × 4 ± 0.05 mm (W) × 30 0.5 mm (L). Each bar specimen had 2 constricted parts on both sides, representing the connector and defining a central pontic of 10 ± 0.10 mm in length. The specimens were divided into 4 groups according to the connector diameter and design, as follows: SR: 2 mm (H) × 3 mm (W) round 0.6 mm radius of curvature; SS: 2 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature; CR: 3 mm (H) × 3 mm (W) round 0.6 mm radius of curvature; and CS: 3 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature. An additional 5 specimens were fabricated with no constriction and served as the control group. The specimens were subjected to a 3-point flexural strength test in a universal testing machine with a crosshead speed of 0.5 mm/min until failure. Scanning electron microscopic and photomicrograph images were used to examine the fracture surfaces. Two-way ANOVA and the Tukey-Kramer post hoc test were used to analyze the data (α = .05). RESULTS: The mean flexural strength for SR 2 mm (H) × 3 mm (W) round 0.6 mm radius of curvature (583.6 ± 49.7 MPa) was significantly higher than that of SS, which was 2 mm (H)× 3 mm (W) sharp 0.1 mm radius of curvature (502.8 ± 23.3 MPa). Similarly, the mean flexural strength for CR was 3 mm (H) × 3 mm (W) round 0.6 mm radius of curvature (682.9 ± 36.8), which was significantly higher than that of CC, 3 mm (H) × 3 mm (W) sharp 0.1 mm radius of curvature (486.7 ± 35.6 MPa). CONCLUSIONS: The flexural strength of the yttria-stabilized tetragonal zirconia polycrystalline-based ceramics was affected by the connector dimension and design. The 2-round connector design was more able to withstand occlusal forces than the sharp design. The 3-connector design with a minimum cross section of 2 × 3 mm is recommended for anterior fixed dental prostheses, provided it has a round curvature.