Bonding Effectiveness of Veneering Ceramic to Zirconia after Different Grit-Blasting Treatments.

Objective: To determine the effect of grit-blasting before and after sintering on the surface roughness of zirconia and the micro-tensile bond strength of a pressable veneering ceramic to zirconia. Methods: Pre-sintered zirconia blocks (IPS e.max ZirCAD, Ivoclar) were divided into four test groups of three specimens each and a control group ('CTR'; no surface treatment). Pre-S-30, Pre-S-50, and Pre-S-110 were grit-blasted with 30-µm SiO2-coated Al2O3, 50-µm Al2O3 and 110-µm Al2O3 particles, respectively, before sintering. Post-S-30 was grit-blasted with 30-µm SiO2-coated Al2O3 after sintering. For each treatment, the surface roughness was measured (Ra, Perthometer M4P, Mahr Perthen). After sintering the zirconia blocks, a liner was applied and a pressable ceramic (IPS e.max ZirPress, Ivoclar) was heat-pressed. Sixteen microbars were obtained from each block and submitted to micro-tensile bond-strength (µTBS) testing. Data were analyzed with one-way ANOVA. Any correlation between Ra and µTBS was evaluated (Sperman test). Results: Grit-blasting before sintering with 110-µm Al2O3 (RaPre-S-110 = 3.4 ± 0.4 µm), 50-µm Al2O3 (RaPre-S-50 = 2.3 ± 0.5 µm), and 30-µm SiO2-coated Al2O3 (RaPre-S-30 = 1.2 ± 0.2 µm) resulted in significantly higher roughness than grit-blasting after sintering with 30-µm SiO2-coated Al2O3 (RaPost-S-30 = 0.5 ± 0.1 µm). The highest µTBS was measured when the sintered zirconia was grit-blasted with 30-µm SiO2-coated Al2O3 (µTBSPost-S-30 = 28.5 ± 12.6 MPa), which was significantly different from that of specimens that were grit-blasted before sintering (µTBSPre-S-30 = 21.8 ± 10.4; µTBSPre-S-50 = 24.1 ± 12.6; µTBSPre-S-110 = 26.4 ± 14.1) or were not grit-blasted (µTBSCTR = 20.2 ± 11.2). Conclusions: Grit-blasting zirconia before sintering enhanced the surface roughness proportionally to the particle size of the sand used. Grit-blasting with 30-µm SiO2-coated Al2O3 after sintering improved bonding of the veneering ceramic to zirconia. Clinical Significance: As grit-blasting with 30-µm SiO2-coated Al2O3 after sintering improved bonding of the veneering ceramic to zirconia, it may reduce veneering ceramic fractures/chipping.

Mechanical Properties of High- and Low-Fusing Zirconia Veneering Ceramics Fired on Different Trays and Substrates.

This study aimed to evaluate the effect of ceramic type, firing tray, and firing substrate on the density, shrinkage, biaxial flexural strength, Martens' hardness, and elastic indentation modulus of zirconia veneering ceramics. Disk-shaped specimens were fabricated from a high-fusing (HFZ) and a low-fusing (STR) zirconia veneering ceramic. These specimens were then divided into 10 groups according to firing trays (round, small honeycomb-shaped, cordierite [RSC]; round, large honeycomb-shaped, aluminum oxide [RLA]; rectangular, plane, silicon nitride [RCPS]; round, plane, silicon nitride [RPS]; and rectangular, plane, calcium silicate [RCPC]) and firing substrates (firing cotton and platinum foil) used (n = 12). The density, shrinkage, biaxial flexural strength, Martens' hardness, and indentation modulus were measured, and analyzed with generalized linear model analysis (α = 0.05). The interaction between the ceramic type and firing substrate affected density (p < 0.001), and the other outcomes were affected by the interaction among all main factors (p ≤ 0.045). Higher density was observed with HFZ or platinum foil (p ≤ 0.007). RSC and RLA led to a higher density than RCPS within HFZ and led to the lowest density within STR (p ≤ 0.046). STR had a higher shrinkage (p < 0.001). RSC mostly led to a lower shrinkage of HFZ (p ≤ 0.045). The effect of ceramic type and firing substrates on the biaxial flexural strength, Martens' hardness, and indentation modulus was minimal while there was no clear trend on the effect of firing tray on these properties. Ceramic type, firing tray, and firing substrate affected the mechanical properties of the tested zirconia veneering ceramics. Firing the tested zirconia veneering ceramics over a round and small honeycomb-shaped cordierite firing tray with firing cotton mostly led to improved mechanical properties.

Effect of final temperature and heating rate on the mechanical and optical properties of a zirconia veneering ceramic.

PURPOSE: To evaluate the effect of firing temperature and heating rate on the volumetric shrinkage, translucency, flexural strength, hardness, and fracture toughness of a zirconia veneering ceramic. MATERIAL AND METHODS: Zirconia veneering ceramic specimens (N = 45) with varying final temperatures (730 °C, 750 °C, and 770 °C) and heating rates (70 °C/min, 55 °C/min, and 40 °C/min) were fabricated (n = 5). Each specimen's shrinkage, translucency, flexural strength, hardness, and fracture toughness were determined. Two-way analysis of variance, Scheffé test, and Pearson's correlation analysis were used to evaluate data (α = 0.05). RESULTS: The shrinkage (44.9 ± 3.1-47.5 ± 1.6 vol%) and flexural strength (74.1 ± 17.4-107.0 ± 27.1 MPa) were not affected by tested parameters (P ≥ 0.288). The interaction between the main factors affected the translucency, hardness, and fracture toughness of the specimens (P ≤ 0.007). Specimens with 770 °C final temperature and 70 °C/min heating rate had the lowest (21.8 ± 3.2 %) translucency (P ≤ 0.039). The hardness ranged between 4.98 ± 0.51 GPa (730 °C; 70 °C/min) and 5.60 ± 0.37 GPa (770 °C; 70 °C/min). Fracture toughness ranged between 0.54 ± 0.04 MPa√m and 0.67 ± 0.08 MPa√m with the highest values for specimens fired at 730 °C with 70 °C/min (P ≤ 0.001). There was a positive correlation between translucency and hardness (r = 0.335, P = 0.012), and a negative correlation between fracture toughness and all parameters other than shrinkage (translucency: r = -0.693/P < 0.001, flexural strength: r = -0.258/P = 0.046, hardness: r = -0.457/P < 0.001). CONCLUSIONS: Heating rate and final temperature should be considered while fabricating veneered zirconia restorations with tested ceramic as they affected the translucency, hardness, and fracture toughness.

Evaluation of the effects of thermal changes on the bond strength between zirconia framework and veneering ceramic during the firing process.

Purpose: The aim of this in-vitro study was to evaluate the effect of thermal changes to shear bond strength during the firing process of veneering porcelain on a zirconia framework. Materials and methods: Single yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) framework ceramic (Kavo Dental GmbH) and three different types of veneering ceramics (IPS e.max Ceram, Vita VM9, and GC Initial Zr-FS) were used. One-hundred-twenty standard disc-shaped samples were prepared from zirconia blocks by using a CAD/CAM system (Kavo Everest). Four different cooling processes (maximum, 25°C/min, 50°C/min and 75°C/min) were applied to the veneering ceramics and the shear bond strength (SBS) test was performed. Ceramic surfaces were investigated by using scanning electron microscopeic (SEM). The possible occurrence of a t-m transformation of zirconia was evaluated by X-Ray Diffraction (XRD). Two-way analysis of variance, Bonferroni correction and paired comparisons were used for statistical analysis. Results: The main effects of veneering ceramics on shear bond strength were found to be significant (p=0.042). The mean shear bond strength values differ according to the cooling process (p<0.001). The monoclinic phase ratio increased in groups with fast cooling process. Conclusion: The thermal changes during the firing process of veneering porcelain on a zirconia framework influenced the shear bond strength of the all-ceramic bilayered system. A slow cooling process provided higher strength for bilayer ceramic samples.

The Effects of Abutment Materials on Peri-Implant Soft Tissue Integration: A Study in Minipigs.

PURPOSE: To evaluate, in a minipig model, the soft tissue integration of four different transmucosal materials, as well as the peri-implant bone remodeling. MATERIALS AND METHODS: A total of 40 implants were placed in five minipigs in a single stage surgery, and two of each of the following abutment materials were used in each animal: (1) titanium (Ti; control), (2) polymethylmethacrylate (PMMA), (3) zirconia (Zi), and (4) veneering ceramic (VC). After a healing period of 3 months, the samples were collected and subjected to nondecalcified histology. The soft tissue dimensions (sulcus, junctional epithelium, and connective tissue attachment) were assessed on each abutment and the distance from the implant margin to first bone-to-implant contact (BIC) was measured. RESULTS: The mean biological width-characterized by the sum of junctional epithelium and connective tissue measurements-was 3.8 (0.6) mm and no statistically significant difference was found between the four groups (p = 0.41). However, a long junctional epithelium (3.3-3.8 mm) and a very short connective tissue attachment (0.1-0.2 mm) were observed with all abutments. The measured peri-implant bone remodeling was similar in all four groups (p = 0.88). CONCLUSIONS: Within its limitations, this study showed that all tested materials allowed soft tissue integration, consisting of a long junctional epithelium, extending close to the bone level, and a rather short portion of connective tissue.

Surface characterization of different surface treatments associations with plasma and bonding analysis of Y-TZP and the veneering ceramic.

OBJECTIVES: To characterize the surface of zirconia (Y-TZP) submitted to different surface treatments (with and without plasma associations) and to evaluate the shear bond strength (SBS) between veneering ceramic (VC) and Y-TZP after different aging methods. METHODS: 301 Y-TZP specimens were fabricated and distributed into 7 groups: C (control): no treatment; Al: airborne abrasion with 27 µm Al2O3 particle; L: liner; P: plasma; Al + L: airborne + liner; Al + P: airborne + plasma; P + L: plasma + liner. The Y-TZP surface was characterized by SEM, EDS, AFM, surface profilometry, surface-free energy (SFE), and XRD. SBS between Y-TZP and VC was verified after three aging protocols: initial, after hydrothermal aging (autoclave for 5 h), or thermal fatigue (30,000 baths - 5-55 °C). One- (profilometry, SFE) and two-way ANOVA (SBS), and Tukey's HSD test were used. RESULTS: For the plasma groups, a full globular surface coverage was observed (SEM, AFM). Si was found for Al, L, Al + L, and P + L. Roughness was lower for C, P, and Al + P. For SFE, the highest values were found when the liner was applied (>74.59 nm/Nm). The highest monoclinic content was observed for Al + L (6.96%) and Al + P (5.86%). For the initial period, Al and P + L presented the lowest SBS values (<5.85 MPa; P > 0.331). The highest SBS values were found for L, P, and P + L (hydrothermal aging) and for P, L, Al + L, and Al + P (thermal fatigue). SIGNIFICANCE: Changes in Y-TZP topography and the SBS with the VC were found, according to treatments performed. Plasma treatment improved SBS and did not cause phase transformation.

Effect of laser irradiation on bond strength between zirconia and resin cement or veneer ceramic: A systematic review and meta-analysis.

Aim: This systematic review with meta-analysis aimed to evaluate the effect of the laser treatment on bond strength between Y-TZP and the resin cement or with the veneering ceramic, and the effect on the alteration of the Y-TZP surface roughness. Settings and Design: Systematic review and meta analysis following PROSPERO guidelines. Materials and Methods: A comprehensive review was performed up to September 2020 on four databases (PubMed/MEDLINE, Embase, Scopus, and Cochrane Library), using the combination of keywords: "laser AND zirconia AND surface treatment AND bond strength". Statistical Analysis Used: The meta-analysis was based on the Mantel-Haenszel and inverse variance methods. The continuous outcome was evaluated by mean difference and the corresponding 95% confidence intervals. Results: A total of 37 studies were identified for the inclusion of data, with only in vitro studies. The types of laser reported in the studies were: Er:YAG, Nd:YAG, Er,Cr:YSGG, CO2, Femtosecond, and Yb lasers. A random-effect model found statistically significant differences between lasers and control groups of Y-TZP (P < 0.00001; MD: 3.08; 95% CI: 2.58 to 3.58). Only the bond strength with the Er:YAG laser did not present statistical difference (P = 0.51; MD: 0.22; 95% CI: -0.44-0.88). In another analysis, a random-effect model found a statistically significant difference between the laser and control groups on surface roughness (P < 0.00001; MD: 0.96; 95% CI: 0.86 to 1.06). Conclusions: Laser irradiation is capable to improve the Y-TZP surface roughness and the bond strength of zirconia with resin cement and veneering ceramics. However, there is a lack of laser protocol for the zirconia surface, a fact that makes a simple and direct comparison difficult.

Effect of Zirconia Core Thickness and Veneer Firing Cycle on the Biaxial Flexural Strength of Veneering Ceramic.

PURPOSE: To evaluate the influence of various Y-TZP thicknesses and veneer firing cycles on the strength of two ceramic veneers. MATERIALS AND METHODS: 180 Y-TZP cores of 0.5, 1.0, and 5.0 mm thickness were prepared followed by sintering in a high temperature furnace; 180 presintered veneering ceramic discs (Vita VM9 porcelain and e.max Ceram) were also prepared using a mold. The discs were placed on zirconia plates (zirconia cores) of different thickness (0.5, 1.0, and 5.0 mm) and exposed to different firing cycles (Vita VM9 porcelain-910, 930, and 950°C; e.max Ceram-750, 770, and 790°C). Ball-on-three-balls flexural strength test was performed (universal testing machine) at a crosshead speed of 0.5 mm/min. Scanning electron microscopy of fractured specimens was performed. Means and standard deviations of flexural strength were analyzed using Tukey-Kramer HSD test for multiple comparisons. RESULTS: Specimens within material groups showed no significant difference (p > 0.05) for flexural strength with respect to Y-TZP core thickness (0.5, 1.0, and 5.0 mm) (VM9 [117.30 ± 14.328, 117.75 ± 13.66, 113.75 ± 20.10], e.max Ceram [94.79 ± 17.5, 100.02 ± 14.7, 95.23 ± 15.4]). Flexural strength within material groups with respect to different firing cycles ([VM9-910, 930, 950°C], e.max Ceram [750, 770, 790°C]), for VM9 (111.49 ± 15.7, 120.86 ± 13.2, 116.46 ± 18.4), and e.max Ceram (94.64 ± 15.2, 101.6 ± 16.69, 93.8 ± 15.20) showed no significant difference (p > 0.05). CONCLUSIONS: Different zirconia thicknesses (0.5, 1.0, and 5.0 mm) and veneer firing cycles for Vita VM9 and e.max ceramics failed to show any significant influence on their biaxial flexural strengths.

Debonding/crack initiation and flexural strengths of bilayered zirconia core and veneering ceramic composites.

The aim of this study was to evaluate the effects of the kinds of veneering ceramics and veneering methods on the debonding/crack initiation and 3-point flexural strengths in bilayered zirconia core and veneering ceramic composites. Zirconia block was used as core material, and Cerabien ZR and Lava Ceram for the layering technique and IPS e.max ZirPress and Amber LiSi-POZ for the heat pressing technique were used as veneering materials. Both debonding/crack initiation and 3-point flexural strengths of bilayered zirconia core and veneering ceramic composites as well as the bi-axial flexural strengths of veneering materials, were higher when using heat pressing technique than layering technique. It was identified that not only bonding strength between zirconia core and veneering materials but also the intrinsic strength of veneering ceramic should be high to prevent chipping of veneering material.

Effect of cooling protocol on mechanical properties and microstructure of dental veneering ceramics.

OBJECTIVES: Understand how cooling protocols control the microstructure and mechanical properties of veneering porcelains. METHODS: Two porcelain powders were selected, one used to veneer metallic frameworks (VM13) and one for zirconia frameworks (VM9). After the last firing cycle, the monolithic specimens were subjected to two cooling protocols: slow and fast. Flexural strength (FS) was evaluated by three-point beam bending and fracture toughness (KIC) was evaluated by the single-edge V-notch beam (SEVNB) method. Scanning electron microscopy (SEM) was performed to determine the leucite crystal volume fraction (%), particle size, and matrix microcrack density. The results were compared by analysis of variances (ANOVA) and Tukey's multiple comparison test. RESULTS: The mechanical properties were significantly (p<0.05) higher for the VM13 porcelain (FS=111.0MPa, KIC=1.01MPa.√m) compared to VM9 (FS=79.6MPa, KIC =0.87MPa.√m) regardless of cooling protocol due to ∼250% higher volume fraction of leucite crystals. The slow cooled VM13 and fast cooled VM9 resulted in the highest and lowest mechanical properties, respectively, while the VM9 slow cooled properties were similar to the VM13 fast cooled. The SEM revealed that the slow cooling significantly increased the volume fraction of leucite crystals by 33-41 %. Across both porcelains, a significant linear correlation between both mechanical properties (strength and toughness) and leucite crystal content was found. Slow cooling was also associated with increased crystal growth resulting in more matrix microcracking. SIGNIFICANCE: Controlled crystallization using slow cooling can be applied as a means of strengthening dental porcelains. However, the benefits of slow cooling may be partially offset by increasing the microcrack density in the glass matrix. To achieve the maximum benefit of slow cooling, it is recommending to develop heat treatments to produce porcelain with fine-grained and homogenously dispersed leucite crystals to achieve minimal glass matrix microcracking.

A thick frame decreases the fracture toughness of veneering ceramics used for zirconia-based all-ceramic restorations.

PURPOSE: To investigate the influence of firing condition and thickness of a yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) frame on the fracture toughness of veneering ceramics. METHODS: Layering and pressable ceramics without frames or on 0.8- and 1.2-mm-thick Y-TZP frames were fired with 5 schedules (normal and 4 customized conditions). The fracture toughness of the ceramics was measured at 0.5-2.5mm from the frame by the indentation fracture method. Crystal structures at the measurement points were evaluated by X-ray diffraction (XRD) and scanning electron microscopy (SEM). RESULTS: Under customized firing conditions, the fracture toughness of the layering ceramic significantly decreased, particularly near the frame. Use of a 1.2-mm-thick frame significantly decreased the fracture toughness of both layering and pressable ceramics compared to ceramics without the frame. The decreased fracture toughness only occurred close (0.5 and 1.0mm) to the frame. XRD analysis showed identical diffraction patterns between points near and far from the frame, suggesting that the decreased fracture toughness was not due to crystal defects or impurities. SEM revealed many microcracks and large crystals in layering ceramic near the 1.2-mm-thick frame, possibly resulting from the thermal properties of the zirconia frame, such as large heat capacity and low thermal conductivity. CONCLUSIONS: Modification of the firing conditions from the manufacturer's instructions and inclusion of a thick Y-TZP frame decreased the fracture toughness of veneering ceramics at the interface, suggesting that a thick frame would pose a potent fracture risk in veneering ceramics used for zirconia-based all-ceramic restorations.

The Use of the FEM to Identify the Optimal Groove Dimensions Ensuring the Least Stressed Connection between a Zirconia Coping and Veneering Ceramic.

Background: To examine the influence of coping notches with varying groove widths and depths on the quality of the connection with ceramic. Methods: Ten rectangular sintered zirconia (3Y-TZP) samples were etched with a neodymium-yag laser Nd:YAG. Then, a profilometer was used to test the depths and spacing of the grooves. A notch profile was used to design the shapes and spacing of the grooves based on a finite element method (FEM) simulating zirconia. The following situations were simulated: an increase in groove width from 100% to 180% and depth from 40% and 80%; and a 40% depth and width. Results: An increase of 10% in the baseline width caused an insignificant reduction of the strain in the connection. A further increase in this dimension led to a 50% increase in strain with a 40% increase in width. An increase in the groove depth by 40% reduced the strain level by 13%, while an increase in the groove depth by 80% reduced the strain level by 22%. Simultaneous deepening and widening of the groove by 40% had no significant impact on the strain level. Conclusion: Maintaining the width of the groove bottom while increasing the depth offers fewer advantages than deepening and narrowing the groove bottom.

Fracture load of metal-ceramic, monolithic, and bi-layered zirconia-based posterior fixed dental prostheses after thermo-mechanical cycling.

OBJECTIVES: This study aims to evaluate the fracture load of differently fabricated 3-unit posterior fixed dental prostheses (FDPs) with an intermediate pontic. METHODS: Fifty sets of two stainless-steel abutments were randomly assigned to five groups (n = 10 each) depending on the material and technique used for manufacturing the FDPs: (1) Metal-ceramic (MC, control); (2) Lava Zirconia (LZ, bi-layered); (3) Lava Plus (LM, monolithic); (4) VITA In-Ceram YZ (YZ, bi-layered); and (5) IPS e-max ZirCAD (ZZ, bi-layered). After being luted to the dies, all FDPs were submitted to thermo-mechanical cycling (120,000 masticatory cycles, 50 N; plus 774 thermal cycles of 5 °C/55 °C, dwell time: 30 s). Samples were then subjected to a three-point bending test until fracture in a universal testing machine (cross-head speed: 1 mm/min). Fracture load of the veneering ceramic (VF) and total fracture load (TF) were recorded. Microstructure and failure patterns were assessed. Data was analysed using one-way ANOVA and Tukey HSD post-hoc tests (α = 0.05). RESULTS: MC restorations recorded higher VF and TF values than did zirconia FDPs (p = 0.0001), which showed no between-group differences. Within the bi-layered groups, TF was significantly higher than VF. LM pieces registered lower average grain size than did LZ specimens (p = 0.001). Overall, the connector was the weakest part. CONCLUSIONS: All of the groups tested could withstand clinical chewing forces in terms of average fracture load. Zirconia-based samples performed similarly to each other, but showed lower mean fracture load values than did metal-ceramic ones. CLINICAL SIGNIFICANCE: Monolithic zirconia may be recommendable for solving the chipping problem.

Effect of finish line design on stress distribution in bilayer and monolithic zirconia crowns: a three-dimensional finite element analysis study.

This study evaluated the influence of different finish line designs and abutment materials on the stress distribution of bilayer and monolithic zirconia crowns using three-dimensional finite element analysis (FEA). Three-dimensional models of two types of zirconia premolars - a yttria-stabilized zirconia framework with veneering ceramic and a monolithic zirconia ceramic - were used in the analysis. Cylindrical models with the finish line design of the crown abutments were prepared with three types of margin curvature radius (CR): CR = 0 (CR0; shoulder margin), CR = 0.5 (CR0.5; rounded shoulder margin), and CR = 1.0 (CR1.0; deep chamfer margin). Two abutment materials (dentin and brass) were analyzed. In the FEA model, 1 N was loaded perpendicular to the occlusal surface at the center of the crown, and linear static analysis was performed. For all crowns, stress was localized to the occlusal loading area as well as to the axial walls of the proximal region. The lowest maximum principal stress values were observed when the dentin abutment with CR0.5 was used under a monolithic zirconia crown. These results suggest that the rounded shoulder margin and deep chamfer margin, in combination with a monolithic zirconia crown, potentially have optimal geometry to minimize occlusal stress.

Clinical evaluation of zirconia-based all-ceramic single crowns: an up to 12-year retrospective cohort study.

OBJECTIVES: This study aims to investigate the incidence of clinical complications with tooth-supported zirconia-based all-ceramic single crowns and identify pertinent risk parameters. MATERIALS AND METHODS: A retrospective cohort study (May 2004 to April 2016) utilizing clinical records of patients receiving yttrium-oxide-partially stabilized zirconia (Y-TZP)-based all-ceramic crowns placed at Tohoku University Hospital was performed. The length of time of treatment success (complication event-free) and restoration survival (including minor complication events and remaining clinically functional) were estimated using Kaplan-Meier analysis. Multilevel survival analysis was used to identify risk factors. RESULTS: One hundred thirty-seven crowns were evaluated (mean follow-up time, 7.0 years). A total of 21 crowns experienced at least one complication with fracture of veneering ceramic being the most common (16 crowns). Estimated success and survival rates at 5 years (96.9 and 98.5%, respectively) decreased at 10 years to 62.1 and 67.2%, respectively. The risk of complications was significantly higher for molar crowns compared to anterior crowns (p < 0.01). A significant association of complications with metal antagonist restorations was shown by univariate analysis (p < 0.01). CONCLUSIONS: Given the study limitations, Y-TZP single crowns placed on anterior teeth demonstrated encouraging clinical results over a period of up to 10 years. However, there is a substantial risk of complications with posterior teeth within 10 years of restoration placement. CLINICAL RELEVANCE: Treatment with zirconia-based all-ceramic crowns for molar teeth with metal antagonist occlusion should be undertaken with caution.

[Effect of different surface processes on the bond strength between zirconia framework and veneering ceramic].

OBJECTIVE: To compare the effect of different surface processes on bond strength and microscopic structure using a scanning electron microscope (SEM) and an energy distribution spectrum (EDS) at the bonding interface between zirconia framework and veneering ceramic. METHODS: WIELAND zirconia core material was cut into 33 rectangular specimens and fired on into rectangular specimens (10 mm×5 mm×5 mm). The specimens were randomly divided into three groups (n=
11). The sandblasting group was sandblasted before firing. The sandblasting and liner coverage group was sandblasted before firing and then sintered with liner coverage after firing. The control group was not processed. All the veneering ceramics (5 mm×
5 mm×5 mm) were fired on into the zirconia substructure by slip-casting technique. One bilayered specimen in each group was prepared for SEM and EDS to examine the bonding conditions. The other specimens were measured for shear force using an electronic universal dynamometer. The data obtained were analyzed by using the statistical software SPSS 17.0. RESULTS: The values of the shear bond strength test were (13.80±1.54) MPa for the control group, (18.06±0.59) MPa for the sandblasting group, and (21.04±1.23) MPa for the sandblasting and liner coverage group. Significant differences existed among the three groups (P<0.01). CONCLUSIONS: Abrasion before firing significantly increases the shear bond strength of zirconia to veneering porcelain. The use of porcelain combined with liner increases the shear bond strength.

Effect of different surface processes on the bond strength between zirconia framework and veneering ceramic / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare the effect of different surface processes on bond strength and microscopic structure using a scanning electron microscope (SEM) and an energy distribution spectrum (EDS) at the bonding interface between zirconia framework and veneering ceramic.</p><p><b>METHODS</b>WIELAND zirconia core material was cut into 33 rectangular specimens and fired on into rectangular specimens (10 mm×5 mm×5 mm). The specimens were randomly divided into three groups (n=
11). The sandblasting group was sandblasted before firing. The sandblasting and liner coverage group was sandblasted before firing and then sintered with liner coverage after firing. The control group was not processed. All the veneering ceramics (5 mm×
5 mm×5 mm) were fired on into the zirconia substructure by slip-casting technique. One bilayered specimen in each group was prepared for SEM and EDS to examine the bonding conditions. The other specimens were measured for shear force using an electronic universal dynamometer. The data obtained were analyzed by using the statistical software SPSS 17.0.</p><p><b>RESULTS</b>The values of the shear bond strength test were (13.80±1.54) MPa for the control group, (18.06±0.59) MPa for the sandblasting group, and (21.04±1.23) MPa for the sandblasting and liner coverage group. Significant differences existed among the three groups (P<0.01).</p><p><b>CONCLUSIONS</b>Abrasion before firing significantly increases the shear bond strength of zirconia to veneering porcelain. The use of porcelain combined with liner increases the shear bond strength.</p>

Influence of core design, production technique, and material selection on fracture behavior of yttria-stabilized tetragonal zirconia polycrystal fixed dental prostheses produced using different multilayer techniques: split-file, over-pressing, and manually built-up veneers.

AIM: To investigate and compare the fracture strength and fracture mode in eleven groups of currently, the most commonly used multilayer three-unit all-ceramic yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) fixed dental prostheses (FDPs) with respect to the choice of core material, veneering material area, manufacturing technique, design of connectors, and radii of curvature of FDP cores. MATERIALS AND METHODS: A total of 110 three-unit Y-TZP FDP cores with one intermediate pontic were made. The FDP cores in groups 1-7 were made with a split-file design, veneered with manually built-up porcelain, computer-aided design-on veneers, and over-pressed veneers. Groups 8-11 consisted of FDPs with a state-of-the-art design, veneered with manually built-up porcelain. All the FDP cores were subjected to simulated aging and finally loaded to fracture. RESULTS: There was a significant difference (P<0.05) between the core designs, but not between the different types of Y-TZP materials. The split-file designs with VITABLOCS(®) (1,806±165 N) and e.max(®) ZirPress (1,854±115 N) and the state-of-the-art design with VITA VM(®) 9 (1,849±150 N) demonstrated the highest mean fracture values. CONCLUSION: The shape of a split-file designed all-ceramic reconstruction calls for a different dimension protocol, compared to traditionally shaped ones, as the split-file design leads to sharp approximal indentations acting as fractural impressions, thus decreasing the overall strength. The design of a framework is a crucial factor for the load bearing capacity of an all-ceramic FDP. The state-of-the-art design is preferable since the split-file designed cores call for a cross-sectional connector area at least 42% larger, to have the same load bearing capacity as the state-of-the-art designed cores. All veneering materials and techniques tested in the study, split-file, over-press, built-up porcelains, and glass-ceramics are, with a great safety margin, sufficient for clinical use both anteriorly and posteriorly. Analysis of the fracture pattern shows differences between the milled veneers and over-pressed or built-up veneers, where the milled ones show numerically more veneer cracks and the other groups only show complete connector fractures.

A practice-based clinical evaluation of the survival and success of metal-ceramic and zirconia molar crowns: 5-year results.

This practice-based study evaluates the survival and success of conventionally luted metal-ceramic and zirconia molar crowns fabricated by using a prolonged cooling period for the veneering porcelain. Fifty-three patients were treated from 07/2008 to 07/2009 with either metal-ceramic crowns (MCC) or zirconia crowns (ZC). Forty-five patients (26 female) with 91 restorations (obser-vational period: 64.0 ± 4.8 months) participated in a clinical follow-up examination and were included in the study. Estimated cumulative survival (ECSv), success (ECSc) and veneering ceramic success (ECVCSc) were calculated (Kaplan-Meier) and analysed by the crown fabrication technique and the position of the restoration (Cox regression model) (P < 0.05). Five complete failures (MCC: 2, ZC: 3) were recorded (5-year ECSv: MCC: 97.6%, (95% confidence interval (95%-CI): [93%; 100%]/ZC: 94.0%, (95%-CI): [87%; 100%]). Of the MCCs (n = 41), 85.0%, [95%-CI: (77%; 96%)] remained event-free, whereas the ECSc for the ZCs (n = 50) was 74.3% (95%-CI): [61%; 87%]. No significant differences in ECSv (P = 0.51), ECSc (P = 0.43) and ECVCSc (P = 0.36) were detected between the two fabrication techniques. Restorations placed on terminal abutments (n = 44) demonstrated a significantly lower ECVCSc (P = 0.035), (5-year VCF-rate: 14.8%) than crowns placed on tooth-neighboured abutments (n = 47), (5-year VCF-rate: 4.3%). In the present study, zirconia molar crowns demonstrated a 5-year ECSv, ECSc and ECVCSc comparable to MCCs. Irrespective of the fabrication technique, crowns on terminal abutments bear a significantly increased risk for VCFs. Clinical investigations with an increased number of restorations are needed.

Biaxial flexural strength of bilayered zirconia using various veneering ceramics.

PURPOSE: The aim of this study was to evaluate the biaxial flexural strength (BFS) of one zirconia-based ceramic used with various veneering ceramics. MATERIALS AND METHODS: Zirconia core material (Katana) and five veneering ceramics (Cerabien ZR; CZR, Lava Ceram; LV, Cercon Ceram Kiss; CC, IPS e.max Ceram; EM and VITA VM9; VT) were selected. Using the powder/liquid layering technique, bilayered disk specimens (diameter: 12.50 mm, thickness: 1.50 mm) were prepared to follow ISO standard 6872:2008 into five groups according to veneering ceramics as follows; Katana zirconia veneering with CZR (K/CZR), Katana zirconia veneering with LV (K/LV), Katana zirconia veneering with CC (K/CC), Katana zirconia veneering with EM (K/EM) and Katana zirconia veneering with VT (K/VT). After 20,000 thermocycling, load tests were conducted using a universal testing machine (Instron). The BFS were calculated and analyzed with one-way ANOVA and Tukey HSD (α=0.05). The Weibull analysis was performed for reliability of strength. The mode of fracture and fractured surface were observed by SEM. RESULTS: It showed that K/CC had significantly the highest BFS, followed by K/LV. BFS of K/CZR, K/EM and K/VT were not significantly different from each other, but were significantly lower than the other two groups. Weibull distribution reported the same trend of reliability as the BFS results. CONCLUSION: From the result of this study, the BFS of the bilayered zirconia/veneer composite did not only depend on the Young's modulus value of the materials. Further studies regarding interfacial strength and sintering factors are necessary to achieve the optimal strength.