Is dentin analogue material a viable substitute for human dentin in fatigue behavior studies?

This study aimed to compare the fatigue performance of a lithium disilicate ceramic cemented on different substrates (human dentin and glass fiber-reinforced epoxy resin - GFRER), treated with different types of conditioning (CTR - without surface conditioning; HF5 - 5% hydrofluoric acid; HF10 - 10% hydrofluoric acid; H3PO4 - phosphoric acid 37%; SAND - sandblasting with aluminum oxide). The occlusal surface of human molars (DENT group) (n = 15) was ground for dentin exposure and the root portion was cut, then the dentin slice (2.0 mm thick) was conditioned with 37% phosphoric acid and a dual-curing dental adhesive was applied. The GFRER in a round-rod format was cut into discs (Ø = 10 mm, 2.0 mm thick). Lithium disilicate glass ceramic blocks (IPS e.max CAD, Ivoclar, Schaan, Liechtenstein) were shaped into a cylinder format and cut, resulting in 90 discs (Ø = 10 mm, 1.5 mm thick). The substrate materials of each group were etched according to the groups and the ceramic was etched with 5% hydrofluoric acid for 30 s. A silane coupling agent was applied over the cementation surface in ceramic and GFRER surfaces and a dual cement was used for cementation (ceramic/GFRER or dentin). The disc/disc sets were submitted to thermocycling (25,000 cycles + storage for 6 months), and then tested in step-wise accelerated cyclic fatigue test. The failure pattern and topography were analyzed and the roughness and contact angle were measured before and after surface treatment. The DENT group presented the lowest load to failure values and number of cycles to failure in fatigue (637.33 N; 118.333), showing no statistical similarity with any of the other tested groups (p < 0.05). The topographic analysis showed that all proposed surface treatments modified the substrate surface when compared to the CTR group. All of the fractographical inspections demonstrated failure by radial crack. Considering the roughness analysis, the post-etched DENT group showed similar roughness to all groups of GFRER materials with their surface treated, except for SAND, which showed greater roughness and statistically different from the other groups. The DENT group (49.5) showed statistically different post-conditioning contact angle values from the HF10 group (96.5) and similar to the other groups. The glass fiber-reinforced epoxy resin was not able to simulate the results presented by the human dentin substrate when cemented to lithium disilicate regarding fatigue failure load and number of cycles for failure, regardless of the surface treatment. Lithium disilicate cemented on dentin analogue overestimates the load values for fatigue failure.

CAD/CAM machining Vs pre-sintering in-lab fabrication techniques of Y-TZP ceramic specimens: Effects on their mechanical fatigue behavior.

This study evaluated the effects of different pre-sintering fabrication processing techniques of Y-TZP ceramic (CAD/CAM Vs. in-lab), considering surface characteristics and mechanical performance outcomes. Pre-sintered discs of Y-TZP ceramic (IPS e.max ZirCAD, Ivoclar Vivadent) were produced using different pre-sintering fabrication processing techniques: Machined- milling with a CAD/CAM system; Polished- fabrication using a cutting device followed by polishing (600 and 1200 SiC papers); Xfine- fabrication using a cutting machine followed by grinding with extra-fine diamond bur (grit size 30 µm); Fine- fabrication using a cutting machine followed by grinding with fine diamond bur (grit size 46 µm); SiC- fabrication using a cutting machine followed by grinding with 220 SiC paper. Afterwards, the discs were sintered and submitted to roughness (n=35), surface topography (n=2), phase transformation (n=2), biaxial flexural strength (n=20), and biaxial flexural fatigue strength (fatigue limit) (n=15) analyses. No monoclinic-phase content was observed in all processing techniques. It can be observed that obtaining a surface with similar characteristics to CAD/CAM milling is essential for the observation of similar mechanical performance. On this sense, grinding with fine diamond bur before sintering (Fine group) was the best mimic protocol in comparison to the CAD/CAM milling.

Surface micro-morphology, phase transformation, and mechanical reliability of ground and aged monolithic zirconia ceramic.

This study aimed to determine the effects of grinding and low temperature aging on the biaxial flexural strength, structural reliability (Weibull analysis), surface topography, roughness analysis, and phase transformation (t→m) of an yttrium-stabilized tetragonal zirconia polycrystalline ceramic. Ceramic discs (15.0×1.2±0.2mm, VITA In-Ceram YZ) were prepared and randomly assigned into six groups according to 2 factors (n=30): 'grinding' (Ctrl - without treatment, as-sintered; Xfine - grinding with extra fine diamond bur - 30µm; Coarse - grinding by coarse diamond bur - 151µm), and 'aging' (without or with aging: CtrlLTD; XfineLTD; CoarseLTD). Grinding was performed in an oscillatory motion with a contra-angle handpiece under constant water-cooling. Low temperature degradation (LTD) was simulated in an autoclave at 134°C, under 2bar pressure, for 20h. The roughness (Ra and Rz parameters) significantly increased after grinding in accordance with bur grit-size (Coarse>Xfine>Ctrl), and aging promoted distinct effects (Ctrl=CtrlLTD; Xfine>XfineLTD; Coarse=CoarseLTD). Grinding increased the m-phase, and aging led to an increase in the m-phase in all groups. However, different susceptibilities to LTD were observed. Weibull analysis showed a significant increase in the characteristic strength after grinding (Coarse=Xfine>Ctrl), while aging did not lead to any deleterious impact. Neither grinding nor aging resulted in any deleterious impact on material reliability (no statistical decrease in the Weibull moduli). Thus, neither grinding nor aging led to a deleterious effect on the mechanical properties of the evaluated Y-TZP ceramic although a high m-phase content and roughness were observed.

The effect of grinding on the mechanical behavior of Y-TZP ceramics: A systematic review and meta-analyses.

The aim of this study was to systematically review the literature to assess the effect of grinding on the mechanical properties, structural stability and superficial characteristics of Y-TZP ceramics. The MEDLINE via PubMed and Web of Science (ISI - Web of Knowledge) electronic databases were searched with included peer-reviewed publications in English language and with no publication year limit. From 342 potentially eligible studies, 73 were selected for full-text analysis, 30 were included in the systematic review with 20 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Statistical analyses were performed using RevMan 5.1, with random effects model, at a significance level of 0.05. A descriptive analysis considering phase transformation, Y-TZP grain size, Vickers hardness, residual stress and aging of all included studies were executed. Four outcomes were considered in the meta-analyses (factor: grinding x as-sintered) in global and subgroups analyses (grinding tool, grit-size and cooling) for flexural strength and roughness (Ra) data. A significant difference (p<0.05) was observed in the global analysis for strength, favoring as-sintered; subgroup analyses revealed that different parameters lead to different effects on strength. In the global analysis for roughness, a significant difference (p<0.05) was observed between conditions, favoring grinding; subgroup analyses revealed that different parameters also lead to different effects on roughness. High heterogeneity was found in some comparisons. Generally grinding promotes decrease in strength and increase in roughness of Y-TZP ceramics. However, the use of a grinding tool that allows greater accuracy of the movement (i.e. contra angle hand-pieces coupled to slowspeed turbines), small grit size (<50µm) and the use of plenty coolant seem to be the main factors to decrease the defect introduction and allow the occurrence of the toughening transformation mechanism, decreasing the risk of deleterious impact on Y-TZP mechanical properties.

Mechanical behavior of a Y-TZP ceramic for monolithic restorations: effect of grinding and low-temperature aging.

This study aimed to investigate the effects of grinding with diamond burs and low-temperature aging on the mechanical behavior (biaxial flexural strength and structural reliability), surface topography, and phase transformation of a Y-TZP ceramic for monolithic dental restorations. Disc-shaped specimens (Zirlux FC, Ivoclar Vivadent) were manufactured according to ISO 6872 (2008) and divided in accordance with two factors: "grinding - 3 levels" and "LTD - 2 levels". Grinding was performed using a contra-angle handpiece under constant water-cooling with different grit-sizes (extra-fine and coarse diamond burs). LTD was simulated in an autoclave at 134°C, under a pressure of 2 bar, over a period of 20h. Surface topography analysis showed an increase in roughness based on surface treatment grit-size (Coarse>Xfine>Ctrl), LTD did not influence roughness values. Both grinding and LTD promoted an increase in the amount of m-phase, although different susceptibilities to degradation were observed. According to existing literature the increase of m-phase content is a direct indicative of Y-TZP degradation. Weibull analysis showed an increase in characteristic strength after grinding (Coarse=Xfine>Ctrl), while for LTD, distinct effects were observed (Ctrl

Comparison of different low-temperature aging protocols: its effects on the mechanical behavior of Y-TZP ceramics.

This study evaluated the effect of different protocols of low-temperature degradation simulation on the mechanical behavior (structural reliability and flexural strength), the surface topography (roughness), and phase transformation of a Y-TZP ceramic. Disc-shaped specimens (1.2mm×12mm, Lava Frame, 3M ESPE, Seefeld, Germany) were manufactured according to ISO:6872-2008 and divided (n=30) according to the aging protocol executed: "Ctrl" - as-sintered - without any treatment; "Dist Water" - stored at distilled water at 37°C for 365 days; "MC" mechanical cycling into two steps: First - 200N, 2.2Hz for 2.000.000 cycles, Second - 450N, 10Hz for 1.000.000 cycles; "Aut" - steam autoclave at 134°C, 2bar (200kPa) for 20h; "Aut+MC"- Aut and MC methods. Roughness analysis (µm) showed, for Ra parameter, higher statistically significant values for Ctrl 0.68 (0.27), while for Rz parameter, the highest values were observed for Ctrl 4.43(1.53) and Aut 2.24 (0.62). Surface topography analysis showed that none aging method promoted surface alterations when compared to control group. Phase transformation analysis showed that all aging methods promoted an increase in m-phase content (Ctrl: 0.94%, Dist Water: 20.73%, MC: 9.47%, Aut: 53.33% and Aut+MC: 61.91%). Weibull Analysis showed higher statistical characteristic strength values for Aut (1033.36MPa) and Dist Water (1053.76MPa). No aging method promoted deleterious impact either on the biaxial flexural strengths or on the structural reliabilities (Weibull moduli). Also, none of the aging methods promoted reduction of Y-TZP mechanical properties; thus the development of new methodologies and the association between mechanical stimuli and hydrothermal degradation should be considered to better understand the mechanism of low-temperature degradation.

Fatigue limit of polycrystalline zirconium oxide ceramics: Effect of grinding and low-temperature aging.

The following study aimed to evaluate the effect of grinding and low-temperature aging on the fatigue limit of Y-TZP ceramics for frameworks and monolithic restorations. Disc specimens from each ceramic material, Lava Frame (3M ESPE) and Zirlux FC (Ivoclar Vivadent) were manufactured according to ISO:6872-2008 and assigned in accordance with two factors: (1) "surface treatment"-without treatment (as-sintered, Ctrl), grinding with coarse diamond bur (181µm; Grinding); and (2) "low-temperature aging (LTD)" - presence and absence. Grinding was performed using a contra-angle handpiece under constant water-cooling. LTD was simulated in an autoclave at 134°C under 2-bar pressure for 20h. Mean flexural fatigue limits (20,000 cycles) were determined under sinusoidal loading using stair case approach. For Lava ceramic, it was observed a statistical increase after grinding procedure and different behavior after LTD stimuli (Ctrl

Low-temperature degradation of Y-TZP ceramics: A systematic review and meta-analysis.

The aim of this study was to systematically review the literature to assess if low-temperature degradation (LTD) simulation in autoclave promotes deleterious impact on the mechanical properties and superficial characteristics of Y-TZP ceramics compared to the non-aged protocol. The MEDLINE via PubMed electronic database was searched with included peer-reviewed publications in English language and with no publication year limit. From 413 potentially eligible studies, 49 were selected for full-text analysis, 19 were included in the systematic review with 12 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Statistical analysis was performed using RevMan 5.1, with random effects model, at a significance level of p<0.05. Descriptive analysis of monoclinic phase content data showed that aging in autoclave promotes an increase in m-phase content (ranging from 0% up to 13.4% before and 2.13% up to 81.4% after aging) with intensity associated to the material susceptibility and to the aging parameters (time, pressure and temperature). Risk of bias analysis showed that only 1 study presented high risk, while the majority showed medium risk. Five meta-analyzes (factor: aging×control) were performed considering global and subgroups analyzes (pressure, time, temperature and m-phase % content) for flexural strength data. In the global analysis a significant difference (p<0.05) was observed between conditions, favoring non-aging group. Subgroup analysis revealed statistical difference (p<0.05) favoring non-aging, for aging time >20h. However, for shorter aging times (≤20h), there was no difference between groups. Pressure subgroup analysis presented a statistical difference (p<0.05) only when a pressure ≥2bar was employed, favoring non-aging group. Temperature subgroup analysis showed a statistical difference (p<0.05) only when temperature=134°C was used, favoring the non-aging group. M-phase % content analysis presented statistical difference (p<0.05) when more than 50% of m-phase content was observed, favoring non-aging group. High heterogeneity was found in some comparisons. Aging in autoclave promoted low-temperature degradation, impacting deleteriously on mechanical properties of Y-TZP ceramics. However, the effect of LTD depends on some methodological parameters indicating that aging time higher than 20h; pressure ≥2bar and temperature of 134°C are ideal parameters to promote LTD effects, and that those effect are only observed when more than 50% m-phase content is observed.

Effect of grinding with diamond-disc and -bur on the mechanical behavior of a Y-TZP ceramic.

This study compared the effects of grinding on the surface micromorphology, phase transformation (t→m), biaxial flexural strength and structural reliability (Weibull analysis) of a Y-TZP (Lava) ceramic using diamond-discs and -burs. 170 discs (15×1.2mm) were produced and divided into 5 groups: without treatment (Ctrl, as-sintered), and ground with 4 different systems: extra-fine (25µm, Xfine) and coarse diamond-bur (181µm, Coarse), 600-grit (25µm, D600) and 120-grit diamond-disc (160µm, D120). Grinding with burs was performed using a contra-angle handpiece (T2-Revo R170, Sirona), while for discs (Allied) a Polishing Machine (Ecomet, Buehler) was employed, both under water-cooling. Micromorphological analysis showed distinct patterns generated by grinding with discs and burs, independent of grit size. There was no statistical difference for characteristic strength values (MPa) between smaller grit sizes (D600 - 1050.08 and Xfine - 1171.33), although they presented higher values compared to Ctrl (917.58). For bigger grit sizes, a significant difference was observed (Coarse - 1136.32>D120 - 727.47). Weibull Modules were statistically similar between the tested groups. Within the limits of this study, from a micromorphological point-of-view, the treatments performed did not generate similar effects, so from a methodological point-of-view, diamond-discs should not be employed to simulate clinical abrasion performed with diamond-burs on Y-TZP ceramics.