Feldspathic and Lithium Disilicate Onlays with a 2-Year Follow-Up: Split-Mouth Randomized Clinical Trial.

The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance.

Feldspathic and Lithium Disilicate Onlays with a 2-Year Follow-Up: Split-Mouth Randomized Clinical Trial

Abstract The present study was a prospective, controlled, randomized, clinical short-term trial aiming to evaluate the clinical performance of adhesively luted, lithium disilicate and feldspathic glass-ceramics onlays over a period up to 2 years. A total of 11 patients (7 female, 4 male; age range: 18-60 years, mean age: 39 years) were selected for this study. Each patient received a maximum of two restorations per group in a split-mouth-design. LD: Eleven onlays, performed with lithium disilicate-based ceramic (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and FP: Eleven onlays, performed with feldspathic ceramic (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Recalls were performed at 2 weeks (baseline = R1), 1 year (R2) and 2 years (R3) after the cementation by three calibrated blinded independent investigators using mirrors, magnifying eyeglasses, probes and bitewing radiographs. The postoperative sensitivity, secondary caries, marginal integrity, marginal discoloration, color match, surface roughness, tooth integrity, and restoration integrity were evaluated. The Friedman test was used to determine if there was a statistically significant difference in time-to-time comparison of the parameters in the ceramics restorations. A total of 95.4% of the restorations were clinically acceptable at the 2-year recall, without a difference for any evaluation parameter for both ceramic materials. Based on the 2-year data, the CAD-CAM onlays manufactured with feldspathic and lithium-disilicate based ceramics showed similar clinical performance.

Resumo O presente estudo é um estudo clínico prospectivo, controlado, randomizado e de longo curto prazo, com o objetivo de avaliar o desempenho clínico de restauraç ões adesivas cerâmica vítrea reforçada com dissilicato de lítio e cerâmica feldspática por um período de até 2 anos. Um total de 11 pacientes (7 mulheres, 4 homens; faixa etária: 18-60 anos, idade média: 39 anos) foram inseridas para este estudo. Cada paciente recebeu duas restaurações por grupo em um delineamento de boca dividida. LD: Onze onlays, realizados com cerâmica à base de dissilicato de lítio (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein); e FP: Onze onlays, realizados com cerâmica feldspática (Vita Mark II, Vita Zanhfabrik, Bad Säckingen). Os retornos foram realizados em 2 semanas (linha de base = R1), 1 ano (R2) e 2 anos (R3) após a cimentação, por três investigadores independentes, cegos e calibrados, usando espelhos, óculos de aumento, sondas e radiografias interproximais. Foram avaliadas a sensibilidade pós-operatória, cárie secundária, integridade marginal, descoloração marginal, correspondência de cores, rugosidade da superfície, integridade dentária e integridade da restauração. O teste de Friedman (95%) foi utilizado para determinar se havia uma diferença estatisticamente significante na comparação periódica dos parâmetros nas restaurações cerâmicas. Um total de 95,4% das restaurações estava clinicamente aceitável no retorno de 2 anos, sem diferença para qualquer parâmetro de avaliação para ambos os materiais cerâmicos. Com base nos dados de 2 anos, as restaurações CAD-CAM fabricados com cerâmica feldspática e à base de dissilicato de lítio apresentaram desempenho clínico semelhante.

Effect of resin cement space on the fatigue behavior of bonded CAD/CAM leucite ceramic crowns.

This study evaluated the influence of occlusal resin cement space on the fatigue performance of bonded-leucite crowns to a dentin-analogue material. Leucite anatomical crowns were adhesively cemented to dentin-like preparations having distinct occlusal cement space (50, 100 and 300 µm) (n = 18), and subjected to step-stress fatigue testing (150 N - 350 N; step-size: 25 N; 20,000 cycles/step; 20 Hz). Fatigue data (load and number of cycles for failure) were analyzed using Kaplan-Meier and Mantel-Cox (log-rank) tests (p <0.05). Fractographic analysis and occlusal internal space measurements were also performed. There was no significant difference for the distinct occlusal cement layer (50 µm: 289 N, 136,111 cycles; 100 µm: 285 N, 132,778 cycles; 300 µm: 246 N, 101,667 cycles). Occlusal internal space analysis showed a mean thickness of 120.4 (50 µm), 174.9 (100 µm) and 337.2 (300 µm). All failures were radial cracks originating at the ceramic-cement interface. Distinct occlusal cement spaces had no effect on the fatigue behavior of anatomical leucite crowns.

The performance of sol-gel silica coated Y-TZP for veneered and monolithic dental restorations.

OBJECTIVES: The purpose of the study was to characterize the microstructure, constituents, and mechanical properties of mono and bilayered zirconia specimens infiltrated with silica by the sol gel method. METHODS: 180 zirconia discs (14-mm diameter) were divided in 3 groups (n = 60) according to thickness (1.2, 0.5 mm) and further divided in two groups (n = 30) according to treatment (infiltrated or not). Disk thickness was 1.2 mm for the control samples. Veneering feldspathic porcelain had two thicknesses (0.5 mm and 1 mm) at the tops of the zirconia discs. All groups were subjected to the biaxial flexural test in an aqueous medium. Weibull analysis was performed for determination of the Weibull modulus (m) and characteristic strength (σ0). The specimens were characterized by SEM and EDS and XRD. Hardness and elastic modulus were measured by nano-indentation and pulse-echo methods, respectively. Fracture toughness was determined by the nano-indentation technique. A scratch test was used for evaluation of the adhesion between the zirconia and porcelain. RESULTS: There was less variability (higher Weibull modulus) in the infiltrated monolithic specimens; biaxial flexural strength was not statistically higher in the veneered infiltrated specimens and was decreased for the 1-mm veneered infiltrated group. The diffractograms showed formation of ZrSiO4 crystal phase. Hardness also increased in the infiltrated monolithic zirconia, whereas fracture toughness decreased. Adhesion between zirconia and porcelain was superior in the non-infiltrated monolithic specimens. CONCLUSIONS: Infiltration increased the structural homogeneity and hardness of the monolithic zirconia, but it reduced fracture toughness, and the adhesion to porcelain. CLINICAL SIGNIFICANCE: Within the limitations of the present study, it is possible to recommend the infiltration of silica gel in zirconia only for monolithic restorations.

Bioinspired silica-infiltrated zirconia bilayers: Strength and interfacial bonding.

Conventionally veneered zirconia restorations are susceptible to chipping and spalling of the veneering material. The novel translucent zirconias were developed to overcome such issues, although layered zirconia restorations can be re-designed to improve mechanical performance. Thus, the aim of this study was to analyze the strength and structural reliability of zirconia bilayers using conventional (porcelain ceramic under tensile stress) and bioinspired (zirconia under tensile stress) configurations. Sol-gel silica infiltration served as a smooth transition between the zirconia and veneering porcelain. Failure mode and interfacial adhesive mechanism were analyzed using scratch test and interfacial indentation. Bilayered specimens were produced for biaxial flexural testing with Y-TZP and pressed ceramic, which were further divided into four groups (n = 30): Conventional (C), Infiltrated conventional (IC), Bioinspired (B) and Infiltrated bioinspired (IB). The results of biaxial flexural strength tests were analyzed by Weibull analysis (95% CI) for determination of the Weibull modulus (m). The infiltration layer was characterized by XRD and SEM, FEG-SEM and EDS. The bioinspired infiltrated group was the most reliable (m = 9.59), although the fine damage of veneered conventional (conventional) zirconia demonstrated its superior resistance to scratching and debonding. Therefore, the filling of superficial defects by zirconia silicate demonstrated the need for mechanical retention for better porcelain adhesion.

The effect of extended glaze firing on the flexural fatigue strength of hard-machined ceramics.

STATEMENT OF PROBLEM: It is unclear whether an extended glaze firing could improve the long-term mechanical performance of densely sintered CAD-CAM ceramics. PURPOSE: The purpose of this in vitro study was to analyze the effect of an extended glaze firing on the flexural fatigue strength (FFS) of densely sintered milled (hard-machined) leucite-based (LEU) and lithium disilicate-based (DIS) ceramics. MATERIAL AND METHODS: Disks were machined from ceramic blocks and divided into 6 groups (n=20) according to the material, LEU or DIS, and to the applied glaze firing: manufacturer-recommended glaze (G group), extended glaze (EG group), and control/no firing (C group). The surface roughness of the disks was measured before and after firing by using a contact profilometer, and data were compared by paired sample tests. Specimens were submitted to fatigue by using the staircase test design in water (piston-on-3 balls; 500 000 cycles, 20 Hz, and sinusoidal loading). Mean (±SD) FFS values were then calculated and analyzed by using 1-way analysis of variance and post hoc Tukey test (α=.05). RESULTS: Surface roughness did not change after the firing (P>.05). The highest FFS value in both ceramics was obtained after EG firing (LEU-EG=80.52 ±6.3 MPa; DIS-EG=147.25 ±10.5 MPa), which was statistically superior to G firing (LEU-G=73 ±6.8 MPa, P=.003; DIS-G=134.34 ±15.6 MPa; P=.023) and C group (LEU-C=61.94 ±6.3 MPa; P<.001; DIS-C=134.13 ±17.3 MPa; P=.023). CONCLUSIONS: EG firing optimized the biaxial flexural fatigue strength of hard-machined leucite and lithium disilicate ceramics compared with conventional glaze firing.

Distribuição de tensões e probabilidade de falha de coroas totais em zircônia tradicional, graduada e bioinspirada / Stress distribution and failure probability of all ceramic crowns in traditional, graded and bioinspired zirconia

O objetivo foi avaliar a probabilidade de falha de coroas de zircônia-porcelana com e sem infiltração de sílica (gradação) da zircônia, em disposição tradicional, graduada e bioinspirada, através da análise de Weibull e de elementos finitos pelo critério de Tensão Máxima Principal. Foram utilizados cem preparos anatômicos de primeiro molar superior (26) confeccionados em resina epóxi- Nema G10, que foram divididos em quatro grupos: Tradicional: infraestrutura em zircônia (Zircônia ConvencionalIncoris ZI, Sirona, Brasil) e cobertura de porcelana (Cerâmica Feldspática-Cerec Blocs); Graduada: infraestrutura em zircônia infiltrada por sílica e cobertura de porcelana; Bioinspirada: infraestrutura em porcelana e cobertura com zircônia (Zircônia translúcida-Incoris TZI, Sirona, Brasil); e Bioinspirada Graduada: infraestrutura em porcelana e cobertura com zircônia infiltrada por sílica. A porção mais externa de todas as coroas foi revestida com uma camada glaze. A carga para fadiga deslizante foi de 100 N. Então os espécimes foram ciclados mecanicamente em um simulador de ciclos mastigatórios no qual uma ponta aplicadora fez 2.106 ciclos a uma frequência de 4 Hz. A cada 500.000 ciclos as coroas foram avaliadas quanto à presença de falhas (trincas, lascamentos ou descolamento entre porcelana e zircônia, fraturas catastróficas), em estereomicroscópio. Os tipos de falhas predominantes para as coroas Tradicional e Graduada foram delaminação e trincas, respectivamente. Os parâmetros de Weibull (beta e eta), com intervalo de confiança bilateral de 95% foram respectivamente: Tradicional - 1,29 e 0,23 E+07 ciclos; Graduada - 1,95 e 0,23 E+07 ciclos; Bioinspirada - 1,00 e 1,67 E+07 ciclos e Bioinspirada graduada - 1,00 1,67 E+07 ciclos. As coroas Tradicionais e Graduadas apresentaram maior susceptibilidade à falha por fadiga e as Bioinspiradas e Bioinspiradas graduadas não demonstraram susceptibilidade à fadiga. Ainda, através da Análise de elementos finitos, pôde-se verificar que as coroas bioinspiradas e bioinspiradas graduadas apresentaram a melhor distribuição de tensões tanto sobre a coroa quanto para a estrutura dentária. As diferentes configurações de restauração apresentaram diferentes probabilidades de falha após o ensaio de fadiga deslizante, sendo que as coroas Bioinspirada e Bioinspirada Graduada apresentam a menor probabilidade de falha e melhor distribuição de tensões, podendo ser consideradas restaurações mais duradouras em longo prazo(AU)

The objective was to evaluate the failure probability of zirconia-porcelain crowns with and without silica infiltration (graded material) of the zirconia, using traditional, graded and bio-inspired design, through Weibull and finite element analysis by maximum principal stress. One hundred anatomical preparations of first upper molar were made of epoxy resin Nema G10 and divided into four groups: Traditionalzirconia (Conventional zirconia -Incoris ZI, Sirona, Brazil) and porcelain cover (Feldsphatic ceramic-Cerec Blocks); Graded- infrastructure in zirconia silica infiltrated and porcelain cover; Bioinspired- porcelain infrastructure and zirconia cover (Trasnlucent zirconia-Incoris TZI, Sirona, Brazil); and Graded Bioinspired- porcelain infrastructure and zirconia infiltrated by silica cover. The outermost portion of all crowns was coated with a glaze layer. The load for sliding fatigue was 100 N. Then the specimens were mechanically cycled in a masticatory cycle simulator for 2 x 106 cycles at 4 Hz of frequency. Every 500k cycles the crowns were evaluated in stereomicroscope for failures presence (cracks, chipping or detachment between porcelain and zirconia, or catastrophic fractures). The predominant failure types for the Traditional and Graded crowns were delamination and cracking, respectively. The Weibull parameters (beta and eta) with 95% bilateral confidence interval were respectively: Traditional - 1.29 and 0.23 E + 07 cycles; Graded - 1.95 and 0.23 E + 07 cycles; Bioinspired - 1,00 and 1,67 E + 07 cycles and Graded Bioinspired - 1,00 1,67 E + 07 cycles. The Traditional and Graded crowns presented greater susceptibility to failure due to fatigue and the Bioinspired and Graded Bioinspired crowns showed no susceptibility to fatigue. Also, through the finite elements analysis, it was verified that the Bioinspired and Graded Bioinspired crowns presented the best stress distribution on both crown and dental structure. The different restoration configurations presented different failure probabilities after the sliding fatigue test. Bioinspired and Graded Bioinspired crowns had the lowest failure probability and better stress distribution, which may be considered lasting restorations in the long term(AU)

Effect of grinding and heat treatment on the mechanical behavior of zirconia ceramic.

The present study investigated the effect of grinding on roughness, flexural strength, and reliability of a zirconia ceramic before and after heat treatment. Seven groups were tested (n = 15): a control group (labeled CG, untreated), and six groups of samples ground with diamond discs, simulating diamond burs, with grits of 200 µm (G80); 160 µm (G120), and 25 µm (G600), either untreated or heat-treated at 1200°C for 2 h (labeled A). Yttria tetragonal zirconia polycrystal discs were manufactured, ground, and submitted to roughness and crystalline phase analyses before the biaxial flexural strength test. There was no correlation between roughness (Ra and Rz) and flexural strength. The reliability of the materials was not affected by grinding or heat treatment, but the characteristic strength was higher after abrasion with diamond discs, irrespective of grit size. The X-ray diffraction data showed that grinding leads to a higher monoclinic (m) phase content, whereas heat treatment produces reverse transformation, leading to a fraction of m-phase in ground samples similar to that observed in the control group. However, after heat treatment, only the G80A samples presented strength similar to that of the control group, while the other groups showed higher strength values. When zirconia pieces must be adjusted for clinical use, a smoother surface can be obtained by employing finer-grit diamond burs. Moreover, when the amount of monoclinic phase is related to the degradation of zirconia, the laboratory heat treatment of ground pieces is indicated for the reverse transformation of zirconia crystals.

Effect of grinding and heat treatment on the mechanical behavior of zirconia ceramic

Abstract The present study investigated the effect of grinding on roughness, flexural strength, and reliability of a zirconia ceramic before and after heat treatment. Seven groups were tested (n = 15): a control group (labeled CG, untreated), and six groups of samples ground with diamond discs, simulating diamond burs, with grits of 200 µm (G80); 160 µm (G120), and 25 µm (G600), either untreated or heat-treated at 1200°C for 2 h (labeled A). Yttria tetragonal zirconia polycrystal discs were manufactured, ground, and submitted to roughness and crystalline phase analyses before the biaxial flexural strength test. There was no correlation between roughness (Ra and Rz) and flexural strength. The reliability of the materials was not affected by grinding or heat treatment, but the characteristic strength was higher after abrasion with diamond discs, irrespective of grit size. The X-ray diffraction data showed that grinding leads to a higher monoclinic (m) phase content, whereas heat treatment produces reverse transformation, leading to a fraction of m-phase in ground samples similar to that observed in the control group. However, after heat treatment, only the G80A samples presented strength similar to that of the control group, while the other groups showed higher strength values. When zirconia pieces must be adjusted for clinical use, a smoother surface can be obtained by employing finer-grit diamond burs. Moreover, when the amount of monoclinic phase is related to the degradation of zirconia, the laboratory heat treatment of ground pieces is indicated for the reverse transformation of zirconia crystals.

Failure Probability of Three Designs of Zirconia Crowns.

This study used a two-parameter Weibull analysis for evaluation of the lifespan of fully or partially porcelain-/glaze-veneered zirconia crowns after fatigue test. A sample of 60 first molars were selected and prepared for full-coverage crowns with three different designs (n = 20): traditional (crowns with zirconia framework covered with feldspathic porcelain), modified (crowns partially covered with veneering porcelain), and monolithic (full-contour zirconia crowns). All specimens were treated with a glaze layer. Specimens were subjected to mechanical cycling (100 N, 3 Hz) with a piston with a hemispherical tip (Ø = 6 mm) until the specimens failed or up to 2 × 106 cycles. Every 500,000 cycles, the fatigue tests were interrupted and stereomicroscopy (10×) was used to inspect the specimens for damage. The authors performed Weibull analysis of interval data to calculate the number of failures in each interval. The types and numbers of failures according to the groups were: cracking (13 traditional, 6 modified) and chipping (4 traditional) of the feldspathic porcelain, followed by delamination (1 traditional) at the veneer/core interface and debonding (2 monolithic) at the cementation interface. Weibull parameters (ß, scale; η, shape), with a two-sided confidence interval of 95%, were: traditional-1.25 and 0.9 × 106 cycles; modified-0.58 and 11.7 × 106 cycles; and monolithic-1.05 and 16.5 × 106 cycles. Traditional crowns showed greater susceptibility to fatigue, the modified group presented higher propensity to early failures, and the monolithic group showed no susceptibility to fatigue. The modified and monolithic groups presented the highest number of crowns with no failures after the fatigue test. The three crown designs presented significantly different behaviors under fatigue. The modified and monolithic groups presented less probability of failure after 2 × 106 cycles.

Probabilidade de falha de coroas com infraestrutura em zircônia com diferentes geometrias / Failure probability of crowns with zirconia infrastructure with different geometries

Este estudo avaliou a probabilidade de falha de coroas de zircônia recobertas total ou parcialmente com cerâmica de cobertura e glaze, para determinação da sua confiabilidade por meio da análise de Weibull. Sessenta molares foram selecionados e preparados para coroa total, e divididos em três grupos (n = 20): Tradicional - infraestrutura em zircônia e cobertura total em porcelana; Modificada - infraestrutura em zircônia com cobertura parcial de cerâmica de cobertura (Vestibular) e; Monolítica - totalmente em zircônia. Em todos os espécimes, foi aplicada uma fina camada de vidro (glaze). Os espécimes foram submetidos à ciclagem mecânica (100 N, 3 Hz), com um pistão (Ø = 6 mm), até a falha dos espécimes ou até completar 2 x 106 ciclos. A cada 500.000 ciclos, os espécimes foram inspecionados quanto à presença de falhas, em estereomicroscópio (10×). Os tipos de falhas predominantes foram as trincas e o lascamento na cerâmica de cobertura, e também falhas por delaminação e descolamento da coroa. Os parâmetros de Weibull (beta e eta), com intervalo de confiança bilateral de 95% foram respectivamente: Tradicional - 1,25 e 0,09 E + 07 ciclos; Modificada - 0,58 e 1,16 E + 07 ciclos e Monolítica - 1,05 e 1,64 E + 07 ciclos. As coroas Tradicionais apresentaram maior susceptibilidade à falha por fadiga, as Modificadas apresentaram maior propensão a falhas precoces e as Monolíticas não demonstraram susceptibilidade à fadiga. As coroas Modificada e Monolítica apresentaram então maior número de coroas que não apresentam falhas após o teste de fadiga

This study evaluated the failure probability of fully or partially porcelain / glaze veneered crowns, determining their failure probability with Weibull analysis. Sixty molars were selected and prepared for first molar full crown and divided into three groups (n = 20): Traditional -crowns with zirconia infrastructure covered with feldspathic porcelain; Modified - crown partially covered with veenering porcelain and Monolithic - Full countour zirconia crown. All specimens were treated with glaze layer. Specimens were submitted to mechanical cycling (100 N, 3 Hz) using a piston (Ø = 6 mm) until the specimens failure or up to 2 x 106 cycles. Every 500,000 cycles the specimens were inspected for the presence of flaws in stereomicroscope (10×). The predominant type of failure was cracking and chipping of the feldsphatic porcelain, followed by delamination and debonding . Weibull parameters (beta and eta), with two-sided confidence interval of 95 % , were respectively: Traditional - 1,25 and 0,09 E + 07 cycles ; Modified- 0,58 and 1,16 E + 07 cycles; Monolithic - 1,05 and 1,64 E + 07cycles. Traditional crowns showed greater susceptibility to fatigue, the Modified group presented higher propensity to early failures, and Monolithic showed no susceptibility to fatigue. Modified and Monolithic presented then highest number of crowns presenting no failures after the fatigue test. The three crown designs presented quite different behaviors under fatigue. The two modified groups presented less probability to failure after 2 x 106 cyles