A Critical Review of Dental Lithia-Based Glass-Ceramics.

The purpose of this article is to review current understanding of lithia-based glass-ceramics and to identify future research needs for this class of dental materials in relation to novel compositions and fabrication methods. With rapid advances in material development and digital technology, time efficiency of dental workflow and fit accuracy of ceramic restorations are ever improving. Lithia-based glass-ceramics are at the forefront of this advance-new variants with more efficient fabrication routes are continually being introduced into the marketplace. Base glass composition, crystallization heat treatment, nucleant and coloration additives, and property gradation are some pertinent variables. The trend in fabrication is to move from CAD/CAM grinding of partially crystallized glass-ceramics to fully crystallized materials, thereby circumventing the need for postmachining firing altogether. In these endeavors, a better understanding of mechanical properties and evolving shaping technologies, such as ductile grinding, is paramount. Additive manufacturing and 3-dimensional printing methodologies offer a promising alternative to current CAD/CAM subtractive manufacturing routes. Challenges to the implementation of new technologies in efficient development and production of high-quality dental glass-ceramic prostheses are addressed.

Exploring Ductility in Dental Ceramics.

Two damage regimes-"brittle" and "ductile"-have been identified in the literature on ceramic grinding, machining, grit blasting, and wear. In the brittle regime, the damage mechanism is essentially crack formation, while in the ductile region, it is quasiplasticity. Onset of the brittle mode poses the greater threat to strength, so it becomes important to understand the mechanics of ductile-brittle thresholds in these materials. Controlled microcontact tests with a sharp indenter are employed to establish such thresholds for a suite of contemporary computer-aided design/computer-aided manufacturing dental ceramics. Plots of flexural strength S versus indentation load P show a steep decline beyond the threshold, consistent with well-established contact mechanics relations. Threshold dimensions occur on a scale of order 1 µm and contact load of order 1 N, values pertinent to practical grit finishing protocols. The ductile side of ceramic shaping is accessed by reducing grit sizes, applied loads, and depths of cut below critical levels. It is advocated that critical conditions for ductile shaping may be most readily quantified on analogous S(P) plots, but with appropriate machining variable (grit size, depths of cut, infeed rate) replacing load P. Working in the ductile region offers the promise of compelling time and cost economies in prosthesis fabrication and preparation.

Novel Zirconia Materials in Dentistry.

Zirconias, the strongest of the dental ceramics, are increasingly being fabricated in monolithic form for a range of clinical applications. Y-TZP (yttria-stabilized tetragonal zirconia polycrystal) is the most widely used variant. However, current Y-TZP ceramics on the market lack the aesthetics of competitive glass-ceramics and are therefore somewhat restricted in the anterior region. This article reviews the progressive development of currently available and next-generation zirconias, representing a concerted drive toward greater translucency while preserving adequate strength and toughness. Limitations of efforts directed toward this end are examined, such as reducing the content of light-scattering alumina sintering aid or incorporating a component of optically isotropic cubic phase into the tetragonal structure. The latest fabrication routes based on refined starting powders and dopants, with innovative sintering protocols and associated surface treatments, are described. The need to understand the several, often complex, mechanisms of long-term failure in relation to routine laboratory test data is presented as a vital step in bridging the gaps among material scientist, dental manufacturer, and clinical provider.

Chipping resistance of graded zirconia ceramics for dental crowns.

A serious drawback of veneering porcelains is a pronounced susceptibility to chipping. Glass-infiltrated dense zirconia structures can now be produced with esthetic quality, making them an attractive alternative. In this study, we examined the hypothesis that such infiltrated structures are much more chip-resistant than conventional porcelains, and at least as chip-resistant as non-infiltrated zirconia. A sharp indenter was used to produce chips in flat and anatomically correct glass-infiltrated zirconia crown materials, and critical loads were measured as a function of distance from the specimen edge (flat) or side wall (crown). Control data were obtained on zirconia specimens without infiltration and on crowns veneered with porcelains. The results confirmed that the resistance to chipping in graded zirconia is more than 4 times higher than that of porcelain-veneered zirconia and is at least as high as that of non-veneered zirconia.

Joining dental ceramic layers with glass.

OBJECTIVE: Test the hypothesis that glass-bonding of free-form veneer and core ceramic layers can produce robust interfaces, chemically durable and esthetic in appearance and, above all, resistant to delamination. METHODS: Layers of independently produced porcelains (NobelRondo™ Press porcelain, Nobel BioCare AB and Sagkura Interaction porcelain, Elephant Dental) and matching alumina or zirconia core ceramics (Procera alumina, Nobel BioCare AB, BioZyram yttria stabilized tetragonal zirconia polycrystal, Cyrtina Dental) were joined with designed glasses, tailored to match thermal expansion coefficients of the components and free of toxic elements. Scanning electron microprobe analysis was used to characterize the chemistry of the joined interfaces, specifically to confirm interdiffusion of ions. Vickers indentations were used to drive controlled corner cracks into the glass interlayers to evaluate the toughness of the interfaces. RESULTS: The glass-bonded interfaces were found to have robust integrity relative to interfaces fused without glass, or those fused with a resin-based adhesive. SIGNIFICANCE: The structural integrity of the interfaces between porcelain veneers and alumina or zirconia cores is a critical factor in the longevity of all-ceramic dental crowns and fixed dental prostheses.

Mechanics of longitudinal cracks in tooth enamel.

A study is made of longitudinal "channel" cracking in tooth enamel from axial compressive loading. The cracks simulate those generated in the molar and premolar teeth of humans and animals by natural tooth function. Contact loading tests are made on extracted human molars with hard and soft indenting plates to determine the evolution of such cracks with increasing load. Fracture is largely stable, with initial slow growth followed by acceleration as the cracks approach completion around an enamel side wall. A simple power law relation expresses the critical load for full fracture in terms of characteristic tooth dimensions-base radius and enamel thickness-as well as enamel toughness. Extended three-dimensional finite element modeling with provision for growth of embedded cracks is used to validate this relation. The cracks leave "fingerprints" that offer valuable clues to dietary habits, and provide a basis for a priori prediction of bite forces for different animals from measured tooth dimensions.

Graded structures for all-ceramic restorations.

One failure mode of all-ceramic restorations is radial cracking at the cementation surface, from occlusally induced flexure of the stiffer ceramic layer(s) on the softer dentin underlayer. We hypothesize that such failure may be substantially mitigated by an appropriate grading of elastic modulus through the ceramic thickness. In this study, we fabricated graded structures by infiltrating glass into zirconia plates, with resulting diminished modulus in the outer surfaces. The plates were then bonded to a polymeric base and subjected to flexure by contact loading until fracture. Comparison of infiltrated specimens with non-infiltrated controls showed a significant increase in the fracture loads, by a factor of nearly 2. Finite element analysis revealed the cause of increase in the load-bearing capacity to be diminished tensile stresses within the lower-modulus graded zone, corresponding to an increase in material strength. The results confirmed that suitably graded structures can be highly beneficial in the design of next-generation all-ceramic restorations.

Fracture modes in human teeth.

The structural integrity of teeth under stress is vital to functional longevity. We tested the hypothesis that this integrity is limited by fracture of the enamel. Experiments were conducted on molar teeth, with a metal rod loaded onto individual cusps. Fracture during testing was tracked with a video camera. Two longitudinal modes of cracking were observed: median cracking from the contact zone, and margin cracking along side walls. Median cracks initiated from plastic damage at the contact site, at first growing slowly and then accelerating to the tooth margin. Margin cracks appeared to originate from the cemento-enamel junction, and traversed the tooth wall adjacent to the loaded cusp from the gingival to the occlusal surface. All cracks remained confined within the enamel shell up to about 550 N. At higher loads, additional crack modes--such as enamel chipping and delamination--began to manifest themselves, leading to more comprehensive failure of the tooth structure.

Veneer vs. core failure in adhesively bonded all-ceramic crown layers.

Joining a brittle veneer to a strong ceramic core with an adhesive offers potential benefits over current fabrication methods for all-ceramic crowns. We tested the hypothesis that such joining can withstand subsurface radial cracking in the veneer, from enhanced flexure in occlusal loading, as well as in the core. Critical conditions to initiate fractures were investigated in model crown-like layer structures consisting of glass veneers epoxy-joined onto alumina or zirconia cores, all bonded to a dentin-like polymer base. The results showed a competition between critical loads for radial crack initiation in the veneers and cores. Core radial cracking was relatively independent of adhesive thickness. Zirconia cores were much less susceptible to fracture than alumina, attributable to a relatively high strength and low modulus. Veneer cracking did depend on adhesive thickness. However, no significant differences in critical loads for veneer cracking were observed for specimens containing alumina or zirconia cores.

Joining veneers to ceramic cores and dentition with adhesive interlayers.

Adhesive joining of veneers to cores offers potential simplicity and economy in the fabrication of all-ceramic crowns. We tested the hypothesis that resin-based adhesives can be used for such fabrication without compromising mechanical integrity of the crown structure. A simple test procedure for quantifying this hypothesis was proposed. A model glass veneer layer 1 mm thick (representative of porcelain), adhesively bonded onto a glass-like core substrate (ceramic or dental enamel), was loaded at its top surface with a hard sphere (occlusal force) until a radial crack initiated at the veneer undersurface. The critical loads for fracture, visually observable in the transparent glass, afforded a measure of the predisposition for the adhesive to cause veneer failure in an occlusal overload. Two adhesives were tested, one a commercial epoxy resin and the other a relatively stiff in-house-developed composite. The results confirmed that stiffer adhesives provide higher resistance to failure.

Materials design of ceramic-based layer structures for crowns.

Radial cracking has been identified as the primary mode of failure in all-ceramic crowns. This study investigates the hypothesis that critical loads for radial cracking in crown-like layers vary explicitly as the square of ceramic layer thickness. Experimental data from tests with spherical indenters on model flat laminates of selected dental ceramics bonded to clear polycarbonate bases (simulating crown/dentin structures) are presented. Damage initiation events are video-recorded in situ during applied loading, and critical loads are measured. The results demonstrate an increase in the resistance to radial cracking for zirconia relative to alumina and for alumina relative to porcelain. The study provides simple a priori predictions of failure in prospective ceramic/substrate bilayers and ranks ceramic materials for best clinical performance.

Use of contact testing in the characterization and design of all-ceramic crownlike layer structures: a review.

Ceramic-based crowns, particularly molar crowns, can fail prematurely from accumulation of fracture and other damage in continual occlusal contact. Damage modes depend on ceramic types (especially microstructures), flaw states, loading conditions, and geometric factors. These damage modes can be simulated and characterized in the laboratory with the use of Hertzian contact testing on monolayer, bilayer, and trilayer structures to represent important aspects of crown response in oral function. This article reviews the current dental materials knowledge base of clinically relevant contact-induced damage in ceramic-based layer structures in the context of all-ceramic crown lifetimes. It is proposed that simple contact testing protocols that make use of sphere indenters on model flat, ceramic-based layer structures-ceramic/polymer bilayers (simulating monolithic ceramic crowns on dentin) and ceramic/ceramic/polymer trilayers (simulating veneer/core all-ceramic crowns on dentin)-can provide useful relations for predicting critical occlusal loads to induce lifetime-threatening fracture. It is demonstrated that radial cracking from the lower core layer surface is the dominant failure mode for ceramic layer thicknesses much below 1 mm. Such an approach may be used to establish a scientific, materials-based foundation for designing next-generation crown layer structures.

Lifetime-limiting strength degradation from contact fatigue in dental ceramics.

The hypothesis under examination in this paper is that the lifetimes of dental restorations are limited by the accumulation of contact damage during oral function; and, moreover, that strengths of dental ceramics are significantly lower after multi-cycle loading than after single-cycle loading. Accordingly, indentation damage and associated strength degradation from multi-cycle contacts with spherical indenters in water are evaluated in four dental ceramics: "aesthetic" ceramics-porcelain and micaceous glass-ceramic (MGC), and "structural" ceramics-glass-infiltrated alumina and yttria-stabilized tetragonal zirconia polycrystal (Y-TZP). At large numbers of contact cycles, all materials show an abrupt transition in damage mode, consisting of strongly enhanced damage inside the contact area and attendant initiation of radial cracks outside. This transition in damage mode is not observed in comparative static loading tests, attesting to a strong mechanical component in the fatigue mechanism. Radial cracks, once formed, lead to rapid degradation in strength properties, signaling the end of the useful lifetime of the material. Strength degradation from multi-cycle contacts is examined in the test materials, after indentation at loads from 200 to 3000 N up to 10(6) cycles. Degradation occurs in the porcelain and MGC after approximately 10(4) cycles at loads as low as 200 N; comparable degradation in the alumina and Y-TZP requires loads higher than 500 N, well above the clinically significant range.

Damage modes in dental layer structures.

Natural teeth (enamel/dentin) and most restorations are essentially layered structures. This study examines the hypothesis that coating thickness and coating/substrate mismatch are key factors in the determination of contact-induced damage in clinically relevant bilayer composites. Accordingly, we study crack patterns in two model "coating/substrate" bilayer systems conceived to simulate crown and tooth structures, at opposite extremes of elastic/plastic mismatch: porcelain on glass-infiltrated alumina ("soft/hard"); and glass-ceramic on resin composite ("hard/soft"). Hertzian contacts are used to investigate the evolution of fracture damage in the coating layers, as functions of contact load and coating thickness. The crack patterns differ radically in the two bilayer systems: In the porcelain coatings, cone cracks initiate at the coating top surface; in the glass-ceramic coatings, cone cracks again initiate at the top surface, but additional, upward-extending transverse cracks initiate at the internal coating/substrate interface, with the latter dominant. The substrate is thereby shown to have a profound influence on the damage evolution to ultimate failure in the bilayer systems. However, the cracks are highly stabilized in both systems, with wide ranges between the loads to initiate first cracking and to cause final failure, implying damage-tolerant structures. Finite element modeling is used to evaluate the tensile stresses responsible for the different crack types. The clinical relevance of these observations is considered.

Contact damage resistance and strength degradation of glass-infiltrated alumina and spinel ceramics.

All-ceramic crowns are coming into widespread use because of their superior esthetics and chemical inertness. This study examines the hypothesis that glass-infiltrated alumina and spinel core ceramics are resistant to damage accumulation and strength degradation under representative oral contact conditions. Accordingly, Hertzian indentation testing with hard spheres is used to evaluate damage accumulation in alumina and spinel ceramics with different pre-form grain morphologies and porosities. Indentation stress-strain curves measured on fully infiltrated materials reveal a marked insensitivity to the starting pre-form state. The glass phase is shown to play a vital role in providing mechanical rigidity and strength to the ceramic structures. All the infiltrated ceramics show subsurface cone fracture and quasi-plastic deformation above critical loads P(C) (cracking) and P(Y) (yield), depending on sphere radius, with P(Y) < P(C). Strength degradation from accumulation of damage in Hertzian contacts above these critical loads is conspicuously small, suggesting that the infiltrated materials should be highly damage-tolerant to the "blunt" contacts encountered during mastication. Failure in the strength tests originates from either cone cracks ("brittle mode") or yield zones ("quasi-plastic mode"), with the brittle mode more dominant in the spinels and the quasi-plastic mode more dominant in the aluminas. Multi-cycle contacts at lower loads, but still above loads typical of oral function, are found to be innocuous up to 10(5) cycles in air and water, although contacts at 10(6) cycles in water do cause significant strength degradation. By contrast, contacts with Vickers indenters produce substantial strength losses at low loads, suggesting that the mechanical integrity of these materials may be compromised by inadvertent "sharp" contacts.

Mechanical characterization of dental ceramics by hertzian contacts.

Hertzian indentation testing is proposed as a protocol for evaluating the role of microstructure in the mechanical response of dental ceramics. A major advantage of Hertzian indentation over more traditional fracture-testing methodologies is that it emulates the loading conditions experienced by dental restorations: Clinical variables (masticatory force and cuspal curvature) identify closely with Hertzian variables (contact load and sphere radius). In this paper, Hertzian responses on four generic dental ceramics systems-micaceous glass-ceramics, glass-infiltrated alumina, feldspathic porcelain, and transformable zirconiaare presented as case studies. Ceramographic sectioning by means of a "bonded-interface" technique provides new information on the contact damage modes. Two distinct modes are observed: "brittle" mode, classic macroscopic fracture outside the contact (ring, or cone cracks), driven by tensile stresses; and "quasi-plastic" mode, a relatively new kind of deformation below the contact (diffuse microdamage), driven by shear stresses. A progressive transition from the first to the second mode with increasing microstructural heterogeneity is observed. The degree of quasi-plasticity is readily apparent as deviations from ideal linear elastic responses on indentation stress-strain curves. Plots of threshold loads for the initiation of both fracture and deformation modes as a function of indenter radius constitute "damage maps" for the evaluation of prospective restoration damage under typical masticatory conditions. The degree of damage in both modes evolves progressively with load above the thresholds. Strength tests on indented specimens quantify sustainable stress levels on restoration materials after damage. The most brittle responses are observed in the fine glass-ceramics and porcelain; conversely, the most quasi-plastic responses are observed in the coarse glass-ceramics and zirconia; the medium glass-ceramics and alumina exhibit intermediate responses. Implications of the results in relation to future materials characterization, selection, and design are considered in the clinical context.

Role of microstructure on contact damage and strength degradation of micaceous glass-ceramics.

OBJECTIVES: This study examines the hypothesis that microstructure plays a critical role in the accumulation of strength-degrading damage in dental ceramics. A series of micaceous glass-ceramics crystallized from a common glass composition, using heat treatments to increase the diameter and aspect ratio of mica platelets, is used as a model ceramic system. METHODS: Damage modes are investigated by Hertzian contact testing. Four-point bend tests on indented specimens quantify the influence of single-cycle and multi-cycle damage on strength. RESULTS: Two competing damage modes are observed: fracture, by tensile-induced cone cracking at the macroscopic level; and quasi-plastic deformation, by shear-induced yield at the microscopic level. The quasi-plastic mode becomes more dominant as the microstructures become coarser and more elongate. Bend tests show severe strength losses in the finer grain structures where cone cracking dominates, but relatively small losses in the coarser grain structures where quasi-plasticity dominates. Whereas natural strengths decline with increasing crystallization temperature, the strengths after indentation damage attain a maximum at intermediate crystallization temperatures. Multiple-cycle contact loading reduces strengths even further, and at relatively low indentation loads, indicating susceptibility to fatigue. Finite element modelling is carried out to evaluate the stress components that drive the damage modes. SIGNIFICANCE: Microstructure is confirmed to be a controlling factor in determining the nature and degree of strength-impairing damage accumulation in dental ceramics. The Hertzian test provides a means of characterizing such damage in the context of clinical function.

Making ceramics "ductile".

Distributed irreversible deformation in otherwise brittle ceramics (specifically, in silicon carbide and micaceous glass-ceramic) has been observed in Hertzian contacts. The deformation takes the form of an expanding microcrack damage zone below the contact circle, in place of the usual single propagating macrocrack (the Hertzian "cone fracture") outside. An important manifestation of this deformation is an effective "ductility" in the indentation stress-strain response. Control of the associated brittle-ductile transition is readily effected by appropriate design of weak interfaces, large and elongate grains, and high internal stresses in the ceramic microstructure.

Indentation Fractography: A Measure of Brittleness.

Indentation constitutes one of the most powerful test techniques for the systematic investigation of deformation and fracture responses in brittle materials. Indentations can be used to evaluate critical mechanical parameters (toughness, hardness, elastic modulus) with great simplicity and high accuracy.

Controlled Indentation Flaws for the Construction of Toughness and Fatigue Master Maps.

A simple and economical procedure for accurate determinations of toughness and lifetime parameters of ceramics is described. Indentation flaws are introduced into strength test pieces, which are then taken to failure under specified stressing and environmental conditions. By controlling the size of the critical flaw, via the contact load, material characteristics can be represented universally on "master maps" without the need for statistical considerations. This paper surveys both the theoretical background and the experimental methodology associated with the scheme. The theory is developed for "point" flaws for dynamic and static fatigue, incorporating load explicitly into the analysis. A vital element of the fracture mechanics is the role played by residual contact stresses in driving the cracks to failure. Experimental data on a range of Vickers-indented glasses and ceramics are included to illustrate the power of the method as a means of graphic materials evaluation. It is demonstrated that basic fracture mechanics parameters can be measured directly from the slopes, intercepts and plateaus on the master maps, and that these parameters are consistent, within experimental error, with macroscopic crack growth laws.